{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:31:03Z","timestamp":1790400663093,"version":"4.1.0"},"reference-count":31,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2020,2,6]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>We used an in-house molecular assay for the detection of<jats:italic>Klebsiella granulomatis<\/jats:italic>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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<jats:italic>Klebsiella<\/jats:italic>screening assay targeting the<jats:italic>phoE<\/jats:italic>(phosphate porin) gene was used in combination with restriction digest analysis and sequencing to confirm the presence of<jats:italic>K. granulomatis<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The<jats:italic>Klebsiella<\/jats:italic>screening assay tested positive in 19\/974 (2.0%) genital ulcer specimens. Restriction digest analysis and nucleotide sequencing of the<jats:italic>phoE<\/jats:italic>gene confirmed that none of these specimens was positive for<jats:italic>K. granulomatis<\/jats:italic>DNA. Similarly, Donovan bodies were not identified in the Giemsa stained ulcer smears of these specimens.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This is the first study to assess<jats:italic>K. granulomatis<\/jats:italic>as a cause of genital ulceration in South Africa over a 12-year surveillance period using molecular methods. The results demonstrate that<jats:italic>K. granulomatis<\/jats:italic>is no longer a prevalent cause of GUD in our population.<\/jats:p><\/jats:sec>","DOI":"10.1136\/sextrans-2019-054316","type":"journal-article","created":{"date-parts":[[2020,2,19]],"date-time":"2020-02-19T22:17:06Z","timestamp":1582150626000},"page":"596-600","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["The changing epidemiology of genital ulcer disease in South Africa: has donovanosis been eliminated?"],"prefix":"10.1136","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9800-491X","authenticated-orcid":false,"given":"Etienne E","family":"Muller","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranmini","family":"Kularatne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,2,19]]},"reference":[{"key":"2024092304051008000_96.8.596.1","doi-asserted-by":"publisher","DOI":"10.1099\/00207713-49-4-1695"},{"key":"2024092304051008000_96.8.596.2","doi-asserted-by":"publisher","DOI":"10.1099\/00222615-48-8-707"},{"key":"2024092304051008000_96.8.596.3","doi-asserted-by":"publisher","DOI":"10.1136\/sti.78.6.452"},{"key":"2024092304051008000_96.8.596.4","doi-asserted-by":"publisher","DOI":"10.1086\/514495"},{"key":"2024092304051008000_96.8.596.5","first-page":"327","article-title":"Genital ulcer disease in men in Durban, South Africa","volume":"67","author":"O'Farrell","year":"1991","journal-title":"Genitourin Med"},{"key":"2024092304051008000_96.8.596.6","first-page":"322","article-title":"Genital ulcer disease in women in Durban, South Africa","volume":"67","author":"O'Farrell","year":"1991","journal-title":"Genitourin Med"},{"key":"2024092304051008000_96.8.596.7","doi-asserted-by":"publisher","DOI":"10.1258\/0956462011923435"},{"key":"2024092304051008000_96.8.596.8","doi-asserted-by":"publisher","DOI":"10.1159\/000249722"},{"key":"2024092304051008000_96.8.596.9","doi-asserted-by":"publisher","DOI":"10.1086\/517768"},{"key":"2024092304051008000_96.8.596.10","doi-asserted-by":"publisher","DOI":"10.1086\/503424"},{"key":"2024092304051008000_96.8.596.11","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/23.6.1328"},{"key":"2024092304051008000_96.8.596.12","first-page":"13","article-title":"Granuloma inguinale in the eastern Transvaal","volume":"67","author":"Wistrand","year":"1985","journal-title":"S Afr Med J"},{"key":"2024092304051008000_96.8.596.13","first-page":"366","article-title":"Trends in reported cases of donovanosis in Durban, South Africa","volume":"68","author":"O'Farrell","year":"1992","journal-title":"Genitourin Med"},{"key":"2024092304051008000_96.8.596.14","first-page":"200","article-title":"A rapid stain for the diagnosis of granuloma inguinale","volume":"66","author":"O'Farrell","year":"1990","journal-title":"Genitourin Med"},{"key":"2024092304051008000_96.8.596.15","article-title":"Sexually transmitted diseases in South Africa: epidemic donovanosis in Durban?","volume":"73","author":"O'Farrell","year":"1997","journal-title":"Genitourin Med"},{"key":"2024092304051008000_96.8.596.16","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1590\/abd1806-4841.20187948","article-title":"Donovanosis in a child victim of sexual abuse: response to doxycycline treatment","volume":"93","author":"Magalh\u00e3es","year":"2018","journal-title":"An Bras Dermatol"},{"key":"2024092304051008000_96.8.596.17","doi-asserted-by":"crossref","unstructured":"Ornelas J , Kiuru M , Konia T , et al . Granuloma inguinale in a 51-year-old man. Dermatol Online J 2016;22.","DOI":"10.5070\/D3224030657"},{"key":"2024092304051008000_96.8.596.18","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.annder.2016.03.011","article-title":"[A case of donovanosis acquired in France]","volume":"143","author":"Okhremchuk","year":"2016","journal-title":"Ann Dermatol Venereol"},{"key":"2024092304051008000_96.8.596.19","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(15)60992-8","article-title":"Donovanosis causing lymphadenitis, mastoiditis, and meningitis in a child","volume":"385","author":"Ahmed","year":"2015","journal-title":"Lancet"},{"key":"2024092304051008000_96.8.596.20","doi-asserted-by":"crossref","first-page":"56","DOI":"10.4103\/0253-7184.132433","article-title":"Granuloma inguinale mimicking as squamous cell carcinoma of penis","volume":"35","author":"Pilani","year":"2014","journal-title":"Indian J Sex Transm Dis AIDS"},{"key":"2024092304051008000_96.8.596.21","doi-asserted-by":"crossref","first-page":"e81","DOI":"10.1016\/j.jpag.2011.10.002","article-title":"Hypertrophic donavanosis in a young pregnant woman","volume":"25","author":"Liverani","year":"2012","journal-title":"J Pediatr Adolesc Gynecol"},{"key":"2024092304051008000_96.8.596.22","doi-asserted-by":"crossref","DOI":"10.1093\/clinids\/22.2.391","article-title":"Culture of Calymmatobacterium granulomatis","volume":"22","author":"Kharsany","year":"1996","journal-title":"Clin Infect Dis"},{"key":"2024092304051008000_96.8.596.23","doi-asserted-by":"publisher","DOI":"10.1099\/00222615-46-7-579"},{"key":"2024092304051008000_96.8.596.24","doi-asserted-by":"crossref","first-page":"2915","DOI":"10.1128\/jcm.35.11.2915-2917.1997","article-title":"Culture of the causative organism of donovanosis (Calymmatobacterium granulomatis) in HEp-2 cells","volume":"35","author":"Carter","year":"1997","journal-title":"J Clin Microbiol"},{"key":"2024092304051008000_96.8.596.25","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0194125","article-title":"Trends in the relative prevalence of genital ulcer disease pathogens and association with HIV infection in Johannesburg, South Africa, 2007-2015","volume":"13","author":"Kularatne","year":"2018","journal-title":"PLoS One"},{"key":"2024092304051008000_96.8.596.26","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr6404a1"},{"key":"2024092304051008000_96.8.596.27","doi-asserted-by":"publisher","DOI":"10.1177\/0956462416633626"},{"key":"2024092304051008000_96.8.596.28","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1177\/0956462418770319","article-title":"2018 UK national guideline for the management of donovanosis","volume":"29","author":"O'Farrell","year":"2018","journal-title":"Int J STD AIDS"},{"key":"2024092304051008000_96.8.596.29","unstructured":"National Department of Health, Republic of South Africa . Protocols for the management of a person with a Sexually Transmitted Disease - According to the essential drugs list 1997. Available: http:\/\/www.kznhealth.gov.za\/STDprotocols.pdf [Accessed 26 Sep 2019]."},{"key":"2024092304051008000_96.8.596.30","unstructured":"National Department of Health, Republic of South Africa . First line comprehensive management and control of sexually transmitted infections (STIs). Protocol for the management of a person with a Sexually Transmitted Infection - According to the Essential Drug List, 2008. Available: http:\/\/www.nicd.ac.za\/assets\/files\/STI%20Book%202008%20Edited(1).pdf [Accessed 26 Sep 2019]."},{"key":"2024092304051008000_96.8.596.31","unstructured":"National Department of Health, Republic of South Africa . Sexually transmitted infections. management guidelines 2018. adapted from: standard treatment guidelines and essential medicine list PHC, 2018. Available: http:\/\/www.nicd.ac.za\/wp-content\/uploads\/2019\/03\/2018-STI-syndromic-management-guidelines.pdf [Accessed 26 Sep 2019]."}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2019-054316","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T11:05:36Z","timestamp":1727089536000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2019-054316"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,19]]},"references-count":31,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2020,11,18]]},"published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1136\/sextrans-2019-054316"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2019-054316","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,19]]}}}