Donovanosis: Is there really a “flesh-eating” STI on the loose?

Depending on your TikTok algorithm, you may have recently encountered an alarming bit of news involving a rare sexually transmitted infection, the phrase “flesh-eating,” and a description of some “red beefy sores.”

The video in question was created by Karan Raj, a doctor in the United Kingdom with about 4.4 million TikTok followers. In the video, Raj describes a “terrifying” and “flesh-eating” sexually transmitted infection called donovanosis that, he claims, is “spreading in the UK.” That video has racked up about 1.5 million views and spawned a cycle of news coverage from local to national outlets.

The evidence that donovanosis is “spreading in the UK,” as Rajs claims, is thin at best. Raj did not respond to Inverse’s request for comment but his Sunday TikTok seems to be in response to this tabloid article.

Its explosion in popularity — not every TikTok gets its own Washington Post article — speaks to the growing medical side of TikTok, a space where, on one side of the coin, actual doctors share advice and, on the other, where misinformation spreads. In this case, the news is overblown: while donovanosis is an actual STI, it is no more dangerous now than it was last year.

What is donovanosis? — Donovanosis is a real, but rare, sexually transmitted infection caused by the bacteria Klebsiella granulomatis.

It begins with relatively painless growths that usually appear about 50 days post-exposure (usually around the genitals). If untreated, they eventually break down into red ulcers that can engulf the genitals.

There’s actually no “flesh-eating” happening, though the ulcers can bleed if touched.

Donovanosis is primarily found in certain subtropical places like Papua New Guinea, and certain areas of South Africa, Australia, India, and Brazil. Elsewhere, it’s very rare. There are about 100 cases each year in the United States, per the U.S. National Library of Medicine. That’s an extremely low count compared to other STIs in the US – for example, there were about 1.8 million cases of chlamydia in the US in 2019.

Why are people talking about a ‘flesh-eating’ STI? — The TikTok appears to be based on a news report published Thursday by Birmingham Live, a tabloid based in England. The piece quotes Shree Datta, a consultant obstetrician and gynecologist, who noted donovanosis is becoming “more common on these shores.”

The Birmingham Live article doesn’t actually cite any data, but Public Health England does track donovanosis cases. There are typically about 20 to 30 cases per year. Cases hit a low peak at 30 in 2019 and dove back down to 18 in 2020, likely thanks to the pandemic.

Technically cases have been going up. There were:

1. Nineteen cases in 2016
2. Twenty-six in 2017
3. Twenty-one in 2018
4. Thirty in 2019

But John Kaldor, a Scientia Professor at the Kirby Institute in Australia tells Inverse these numbers don’t mean much without more context.

“The Public Health England data cited in these articles do not look much like an upward trend,” he says.

Rather, Kaldor says it’s more important to know whether these cases are a result of local transmission, or if they’re in travelers who may have picked up the disease elsewhere. In short, this information is far from enough to suggest that this condition is “spreading” in the UK.

What happens if you get donovanosis? — The good news is that donovanosis does respond extremely well to antibiotics, and ulcers can start healing within days. Usually, an azithromycin regimen is given for more than three weeks, or until all ulcers heal is enough to treat the condition.

Even when cases do spread widely, donovanosis outbreaks can be brought back under control.

In the late nineties, for instance, 115 cases were detected in an Aboriginal population in Australia. Before then, treatment usually consisted of multiple doses of antibiotics per day for extended periods, but two studies surfaced showing that a large weekly dose of azithromycin or a smaller daily dose for 4 to 6 weeks helped heal the ulcers. A swab-based test was also developed, which helped enable rapid testing for the condition.

With a combination of less involved treatment and faster testing, cases plummeted to about five by 2004. In 2018, a follow-up report issued by the Australian government found there were only two reported cases between 2011 and 2016. The disease was considered “close to elimination” because it was so rarely seen.

Perhaps because of the gruesome nature of the condition, donovanosis does tend to generate headlines every now and then. In 2018, The Liverpool Echo published a story documenting one case of donovanosis in the UK and caused a brief spike in Google searches around the topic.

But in most places, donovanosis isn’t something you’re likely to encounter – and if you do, it’s a treatable condition, no matter how gruesome the Google search results might be.