You have a sore in your genital area that is reddish, doesn't hurt, and is getting bigger over time. Tests for common sexually transmitted infections (STIs) are negative, but the lesion is still there. This strange and concerning situation calls for a doctor who has the time to be a real medical detective. Donovanosis, an exceedingly rare bacterial infection in the United States, is frequently associated with travel to particular regions of the globe. Direct Primary Care (DPC), which focuses on in-depth, investigative medicine, is the best place to find out what this rare condition is and how to treat it over the long term.
Donovanosis is a long-lasting and worsening bacterial STI that causes sores on the genitals. The bacterium Klebsiella granulomatis is what causes it.
Very Rare in the U.S.:
It is important to know that this disease is not very common in the US. Most of the time, it is found in areas where it is common, such as parts of India, South Africa, South America, and the Caribbean. Most of the time, cases in the U.S. are directly linked to traveling to or having sex with someone from one of these areas.
The Signs That Tell You:
The classic way that donovanosis shows up is very different from other STIs:
Ulcers that are "beefy red," painless, and grow slowly. When you touch the lesions, they bleed very easily and look like they are made of flesh and granules.
Donovanosis does not usually cause painful, swollen lymph nodes in the groin like many other STIs do.
The Dangers of Not Treating Donovanosis:
If the right antibiotics aren't used, the ulcers will keep getting bigger and destroy the tissue around the genitals. This can cause serious permanent scars, chronic genital swelling (elephantiasis), and a higher chance of getting skin cancer in the long-lasting ulcers.
Direct Primary Care (DPC) is a membership-based system that lets patients talk to their doctor whenever they want. The DPC model is a game-changer for donovanosis, a rare and complicated STI. This is why DPC is the best option for this condition:
Making the Uncommon Diagnosis: The Strength of a Detailed History:
It's time to be a detective. DPC's long, relaxed appointments give your doctor time to ask you about your sexual and travel history in detail. This is the most important piece of information that would make a U.S. doctor even think about this rare diagnosis.
A High Level of Suspicion: Your DPC doctor has time to think outside the box and look for a more unusual diagnosis once the usual causes of genital ulcers have been ruled out.
Getting the Definitive Test ready: Then they can set up a timely referral to a dermatologist or infectious disease specialist for the tissue biopsy or smear that will look for the "Donovan bodies" that confirm the diagnosis.
Managing long-term therapy based on guidelines:
The DPC model is the best way to keep track of the treatment plan for donovanosis.
The Right Plan for Treatment: The CDC says that the best treatment is a long course of antibiotics like azithromycin that should be taken for at least three weeks and kept going until all of the lesions have healed completely.
Close, Ongoing Follow-Up: DPC's continuity and easy access (like through secure photo messaging) make it possible for the close follow-up that is needed to check on your healing and make sure you finish the long course of medication you need to get better.
Full sexual health and partner management:
Your DPC doctor gives you a safe and private place to get all of your sexual health care.
Complete STI Testing: They will test you for all other STIs, such as HIV and syphilis, which is very important.
Partner Notification: They can have the important, helpful, and non-judgmental talk about how important it is to tell and treat all recent sexual partners to stop the infection from spreading.
Case 1: David, 38, comes back from a trip to South America and later gets a red ulcer on his genitals that doesn't hurt and slowly gets bigger. At an urgent care clinic, tests for syphilis and herpes come back negative. He goes to see his DPC doctor, who spends 45 minutes going over his sexual and travel history in detail. The doctor suspects a rare tropical STI and quickly refers the patient to an infectious disease specialist, who confirms donovanosis with a tissue smear. The DPC doctor then takes care of David's 4-week course of azithromycin by checking in on him once a week with a secure photo to see how he is healing.
Case 2: A patient has been diagnosed with donovanosis. During the long DPC follow-up visits to manage her antibiotic therapy, the doctor not only checks on how her body is healing but also gives her ongoing counseling and support to help her deal with the emotional pain and body image issues that come with having genital lesions.
Q: I have a sore on my genitals. Is it possible that it's donovanosis? A: It's very unlikely in the US unless you've traveled to or had sexual contact with someone from an area where the disease is common, like parts of the Caribbean, India, or Southern Africa. Herpes and syphilis are two other common causes of genital ulcers in the U.S. Your doctor always needs to do a full checkup.
Q: Why does it take so long to treat donovanosis with antibiotics? A: The Klebsiella granulomatis bacteria live inside your body's cells (they are intracellular), so it takes a long time for antibiotics to completely get rid of the infection and let the big, ulcerative lesions heal. It is very important to keep getting treatment until the sores are completely healed.
Q: Is "granuloma inguinale" the same as a granuloma from a piercing? A: No, not at all. "Granuloma inguinale" is just an old name for the disease donovanosis, which is an infectious disease. It has nothing to do with the harmless inflammatory granulomas that can form around skin piercings or other foreign objects.
DPC has a clear advantage for this uncommon but serious STI because it
Being great at the "medical detective work" needed to make a rare diagnosis: The DPC model gives you the time to go over your travel and sexual history in detail, which is necessary to even think about this diagnosis in the U.S.
Giving the best setting for long-term therapy: DPC's ease of use and ability to stay open make it easy to manage a multi-week course of antibiotics and keep a close eye on the clinical cure.
Providing full, private sexual health care: A reliable DPC relationship makes it easier to notify partners and screen for all other STIs.
If you have a health problem that doesn't fit a common diagnosis, you need a doctor who can think outside the box and take the time to do so. You need a medical detective for an unusual infection that comes from another country, like donovanosis. Direct Primary Care is the investigative partner that helps you find the right diagnosis and gives you ongoing support until you are completely healed.
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