In the 1990s donovanosis (or granuloma inguinale) had disappeared from most parts of the developed world. However, any practitioner working in the Northern Territory, far north Queensland, or the northern part of Western Australia would have been aware of the spectrum of morbidity associated with the condition in the Aboriginal and Torres Strait Islander population--ranging from mild genital ulceration to severe, disfiguring disease and disseminated, life threatening infection.

Of the 432 genital ulcer cases seen in 1985, 36 had donovanosis, thus forming an incidence of 8.33%. In contrast, 42 (6.38%) cases of donovanosis were diagnosed among a total of 658 cases of genital ulcers in 1983. The majority of patients in both epidemics were young unmarried men who contracted the disease through extramarital sexual intercourse. Perianal lesions were seen primarily in those who had a history of sodomy. The disease chiefly affected illiterate persons of low socioeconomic strata. The incubation period varied from 1 to 90 days. Twenty (62.50%) patients in the 1985 epidemic had an incubation period of less than 7 days, in contrast to only 9 (34.61%) in the 1983 epidemic. The epidemics occurred from autumn to the start of winter. Duration of the disease varied from 1 day to 6 years. The clinical features and sites of afflication were usual; however, pseudobubo and pseudoelephantiasis were conspicuous in a significant minority.

In the 1990s donovanosis (or granuloma inguinale) had disappeared from most parts of the developed world. However, any practitioner working in the Northern Territory, far north Queensland, or the northern part of Western Australia would have been aware of the spectrum of morbidity associated with the condition in the Aboriginal and Torres Strait Islander population--ranging from mild genital ulceration to severe, disfiguring disease and disseminated, life threatening infection.

Genital ulcer disease (GUD) is well recognised in the developing world as a co-factor for heterosexual HIV transmission. Men with GUD are an important high frequency HIV transmitter core group in the general population but few interventions have targeted such individuals so far. Donovanosis is an uncommon GUD with low infectivity characterised by large ulcers that bleed readily and has been identified as a risk factor for HIV in men in Durban, South Africa. Donovanosis is also endemic in Papua New Guinea, India, Brazil and amongst the Aboriginal community in Australia. This curious geographical distribution is unique to any of the sexually transmitted diseases (STD) and might lend itself to control measures not tried previously. In the 1950-60s a global eradication programme was successfully introduced against yaws but this strategy has not been implemented against any of the STD. Donovanosis is a symptomatic disease usually diagnosed on clinical grounds and could be targeted for eradication. Any programme would need to be community-based and require co-operation with both hospital doctors, private general practitioners, nurses, primary health care workers, pharmacists and traditional healers. Donovanosis is usually treated by readily available antibiotics but treatment failure may occur in advanced HIV disease. Drug compliance is often a problem but may be improved by counselling. Early implementation of an eradication programme targeting men with donovanosis could have a significant impact in limiting the spread of HIV in donovanosis-endemic countries and would pre-empt the possibility of both the emergence of drug resistance and treatment failure in individuals with immune impairment.