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Original research
The changing epidemiology of genital ulcer disease in South Africa: has donovanosis been eliminated?
  1. Etienne E Muller1,
  2. Ranmini Kularatne1,2
  1. 1 STI Section, Centre for HIV & STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
  2. 2 Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  1. Correspondence to Dr Etienne E Muller, STI Section, Centre for HIV & STIs, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; etiennem{at}


Objectives We used an in-house molecular assay for the detection of Klebsiella granulomatis in ulcer specimens collected over a 12-year surveillance period in order to determine whether a diagnosis of donovanosis could be ascribed to genital ulcer disease (GUD) of unknown aetiology in our setting.

Methods Between 2007 and 2018, a total of 974 genital ulcer specimens with no previously identified sexually transmitted (STI) pathogens were selected from STI aetiological surveys conducted in all nine provinces of South Africa. Giemsa-stained ulcer smears from the same participants had previously been routinely analysed for the presence of typical Donovan bodies within large mononuclear cells. A Klebsiella screening assay targeting the phoE (phosphate porin) gene was used in combination with restriction digest analysis and sequencing to confirm the presence of K. granulomatis.

Results The Klebsiella screening assay tested positive in 19/974 (2.0%) genital ulcer specimens. Restriction digest analysis and nucleotide sequencing of the phoE gene confirmed that none of these specimens was positive for K. granulomatis DNA. Similarly, Donovan bodies were not identified in the Giemsa stained ulcer smears of these specimens.

Conclusions This is the first study to assess K. granulomatis as a cause of genital ulceration in South Africa over a 12-year surveillance period using molecular methods. The results demonstrate that K. granulomatis is no longer a prevalent cause of GUD in our population.

  • donovanosis
  • granuloma inguinale
  • genital ulcers
  • Africa

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  • Handling editor Jonathan Ross

  • Contributors EEM and RK worked on the conceptualisation of the study and study design. EEM was responsible for molecular testing, data analysis, interpretation of data and manuscript preparation. RK critically reviewed the manuscript.

  • Funding The study was internally funded by the National Institute for Communicable Diseases.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for the study was granted by the Human Research Ethics Committee (Medical) of the University of the Witwatersrand, Johannesburg, South Africa (clearance number M131129).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.