**2.1** *Klebsiella granulomatis*

This is an intracellular gram-negative bacterium responsible for the granuloma inguinale (donovanosis). Clinically, the disease is characterized as painless, slowly progressive ulcerative lesions on the genitals or perineum without regional lymphadenopathy; subcutaneous granulomas (pseudo buboes) also might occur. A study in Nigeria observed a prevalence of Klebsiella species of 12.3% among women with suspected genital tract infections in a tertiary hospital [20]**.**

For the laboratory testing for Klebsiella, serologic testing is unhelpful. On gram staining, the organism appears as short, plump, and gram-negative bacilli. They are usually surrounded by a capsule and appear as clear space. The organism can be cultured in the laboratory from a specimen from urethral discharge, cervical discharge, vaginal discharge, etc. in infected patients. Klebsiella is micro-aerophilic and can grow in the presence or absence of oxygen. They have no special cultural requirements. Most species can use citrate and glucose as the sole carbon source and so they grow well in most ordinary culture media. But even so, most patients in the resourcelimited settings are treated using the syndromic case management approach due to a lack of personnel and facilities and patronage of unskilled caregivers.

The Center for Disease Control (CDC) United States of America recommends oral Azithromycin, 1 g once weekly or 500 mg once a day for up to 3 weeks and until all lesions of Granuloma Inguinale (Donovanosis) have completely healed. Other recommended regimen includes (a) oral Doxycycline 100 mg twice daily for up to 3 weeks and until all lesions of Granuloma Inguinale (Donovanosis) have completely healed. (b) oral Erythromycin 500 mg orally four times/day for up to 3 weeks and until all lesions of Granuloma Inguinale (Donovanosis) have completely healed. (c) oral Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) twice daily for up to 3 weeks and until all lesions of Granuloma Inguinale (Donovanosis) have completely healed [1].
