Antimicrobial therapy is the mainstay of treatment for donovanosis. Azithromycin 1 g PO once per week for at least 3 weeks and until all lesions have completely healed is the preferred regimen. Alternative regimens include doxycycline, ciprofloxacin, erythromycin, and trimethoprim-sulfamethoxazole. Pregnant women should be treated with erythromycin. Sexual partners should also be evaluated and treated.

• A limited number of studies on donovanosis treatment have been published.
• Treatment halts progression of lesions, although prolonged therapy is usually required to permit granulation and reepithelialization of the ulcers.
• Healing typically proceeds inward from the ulcer margins.
• Relapse can occur 6–18 months after apparently effective therapy.
• Several antimicrobial regimens have been effective, but a limited number of controlled trials have been published.^[1]

• Preferred regimen: Azithromycin 1 g PO once per week for at least 3 weeks and until all lesions have completely healed^[2]
• Alternative regimen (1): Doxycycline 100 mg PO bid for at least 3 weeks and until all lesions have completely healed
• Alternative regimen (2): Ciprofloxacin 750 mg PO bid for at least 3 weeks and until all lesions have completely healed
• Alternative regimen (3): Erythromycin base 500 mg PO qid for at least 3 weeks and until all lesions have completely healed
• Alternative regimen (4): Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet PO bid for at least 3 weeks and until all lesions have completely healed

• Note: The addition of an Aminoglycoside (e.g., Gentamicin 1 mg/kg IV q8h) to these regimens can be considered if improvement is not evident within the first few days of therapy.

• Pregnancy: Doxycycline, ciprofloxacin and sulfonamides are contraindicated among pregnant women. Pregnant and lactating women should be treated with the erythromycin or azithromycin regimen, and consideration should be given to the addition of a parenteral aminoglycoside (e.g., gentamicin).
• HIV coinfection: Individuals with both donovanosis and HIV infection should receive the same regimens as those who are HIV-negative; however, the addition of a parenteral aminoglycoside (e.g., gentamicin) can also be considered.^[2]

Patients should be followed clinically until signs and symptoms resolve.^[2]

Persons who have had sexual contact with a patient who has granuloma inguinale within the 60 days before onset of the patient’s symptoms should be examined and offered therapy.

• Note: the value of empiric therapy in the absence of clinical signs and symptoms has not been established.^[2]

Surgery may be necessary to correct elephantiasis, strictures, or fistulae.

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