Fournier’s gangrene is a rare, life-threatening bacterial infection of your scrotum, penis or perineum (the area between your genitals and rectum). It’s an infection that worsens quickly and requires emergency care. Go to the emergency department if your genitals or perineum are red, tender or swollen, and you have either a fever of at least 100.4 degrees Fahrenheit or you feel unwell in general.
Fournier is the name of the French physician who first identified this disease. Gangrene is where your tissues die because of a lack of blood flow or a bacterial infection. Fournier’s gangrene is a type of necrotizing fasciitis (flesh-eating disease). Necrotizing fasciitis destroys your soft tissues, including your:
Arteries (blood vessels).
Muscles.
Nerves.
Fournier’s gangrene affects the soft tissues of your scrotum, penis and perineum. In severe cases, the bacterial infection stretches to the thighs, stomach and chest, destroying those areas' muscles, nerves and arteries.
Fournier’s gangrene is life-threatening. Some studies concluded that 3% of people who get this type of necrotizing fasciitis will likely die. Other studies determined that the number is as high as 50%. But Fournier's gangrene is very rare. There are steps you can take to prevent it, and there are treatments available.
What causes Fournier’s gangrene?
Bacteria (anaerobic bacteria or aerobic bacteria) sometimes cause Fournier's gangrene. The most common aerobic organisms include:
E. coli (Escherichia coli).
Klebsiella.
Proteus.
Staphylococcus.
Streptococcus.
The most common anaerobic organisms include:
Bacteroides.
Clostridium.
Peptostreptococcus.
Bacteria can enter the genital and rectal areas of your body in several ways. A few examples include an:
Children sometimes get a bacterial infection from circumcision.
What are the early symptoms of Fournier’s gangrene?
The first symptoms of Fournier’s gangrene you might notice include:
Red genitals or perineum.
Tender genitals or perineum.
Swollen genitals or perineum.
Additionally, if you have diabetes and notice your glucose is elevated despite taking your insulin as instructed, please contact your healthcare provider. This may be an early sign that something isn’t right.
Take the early symptoms of Fournier’s gangrene seriously. This infection moves forward very quickly, and you can get worse very suddenly. Don’t ignore the early signs.
What are the symptoms of Fournier’s gangrene?
The symptoms that go along with or follow the redness, tenderness and swelling of the genitals or perineum include:
Crepitus (a popping or crackling sound when you rub the sore area).
Itching.
Some symptoms are in your urinary tract. Examples include:
Urinary extravasation is where your urine fills cavities in your body other than your bladder.
Urethral obstruction is a blockage somewhere in your urinary tract.
The following conditions are associated with the late stages of Fournier’s gangrene:
Blood clots, which happen when inflammation blocks the blood supply to the tissues and those tissues start to die.
Death of your tissues releases bacteria and necrotic tissue byproducts into the bloodstream. These byproducts cause septic shock, where your body can't maintain blood pressure and your organs start shutting down.
Inflammation of your blood vessel linings caused by the infection spreading to the deeper tissues.
Multiple organ failure.
What does Fournier’s gangrene feel like?
Sudden pain in the genitals and perineum is usually the first symptom of Fournier’s gangrene. People describe the pain as tender, moderate or severe. The type of pain (dull, sharp, etc.) is unclear.
What does Fournier’s gangrene look like?
If you have Fournier's gangrene, the skin of your perineum, penis or scrotum will change color. Your skin might look reddish-purple, then turn to blue-gray and, finally, black when the tissues are dead.
Is Fournier’s gangrene contagious?
Fournier’s gangrene is not a contagious disease. You won’t get this infection from anyone else, and they won’t get it from you.
Go to the emergency department if you’re experiencing the symptoms of Fournier’s gangrene.
How is Fournier’s gangrene treated?
Surgery is the number one treatment for Fournier’s gangrene. Sometimes it's necessary to skip the diagnosis process and go straight to debridement (the removal of damaged tissues from your body). There might be three or more operations. Ideally, your healthcare provider can remove enough tissue to keep the bacterial infection from spreading. Rarely, the entire penis and scrotum get surgically removed.
After the surgery, your healthcare provider will likely prescribe broad-spectrum antibiotics. If you also have sepsis, you’ll receive additional medications to decrease your risk of blood clots.
Next, you’ll have reconstructive surgery. Reconstructive surgery helps your perineum, scrotum or penis look like it did before the Fournier’s gangrene.
Finally, you might go through hyperbaric oxygen therapy. That is where you inhale pure oxygen in a pressurized room. The procedure helps in several ways, including:
Promoting wound healing.
Reducing blood vessel damage.
Stopping bacteria from growing.
Are there any at-home treatments for Fournier’s gangrene?
Go to the emergency department if you have Fournier’s gangrene symptoms. It’s vital to get antibiotics and surgery.
How long does it take to recover from Fournier’s gangrene?
You could be in the hospital for three to six weeks. How long it takes to recover after that is unclear. Talk to your healthcare providers about a timeline.
How is Fournier’s gangrene diagnosed?
Your healthcare provider will evaluate your symptoms and examine your skin. If there’s time, they’ll likely order some imaging tests, including:
A computed tomography (CT) scan to find gases and fluids in your body and identify the source of the infection.
An ultrasound to confirm if it’s Fournier’s gangrene or a similar disorder like epididymitis or orchitis. It also checks for air in the soft tissues.
An X-ray to locate how far the air in the soft tissues has spread.
Blood work, including a complete blood count (CBC) test with differential, a comprehensive metabolic panel (CMP) and lactate to look for an elevated white blood count, electrolyte abnormalities, septic shock and arterial blood gas.
Often, there is no time for tests. Immediate surgery might be necessary if the Fournier's gangrene has progressed to a dangerous point.
What questions might a healthcare provider ask to diagnose Fournier’s gangrene?
Part of your healthcare provider’s process to diagnose Fournier’s gangrene is to ask you questions. Those questions might include:
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