A 29-year-old cisgender woman from Brazil presents to clinic with a complaint of several months of a slowly progressive perianal ulcer. She came to the United States approximately 3 weeks prior to starting a graduate school program. The ulcer is painless, and there is no associated lymphadenopathy. Physical examination is notable for a 4 by 5 cm perianal area of red, friable granulation tissue. Empiric treatments for genital herpes syphilis were given with no improvement, and test results for syphilis, herpes simplex virus, and HIV are all negative. She returns 1 week later, and during the examination, a wooden tongue depressor is gently applied to the ulcer and this causes bleeding. A diagnosis of granuloma inguinale is suspected based on the appearance of the lesion and the clinical course.