Fournier’s gangrene is a severe bacterial infection that causes tissue death in the skin, fat, and other layers around the scrotum, penis, and anus. It can lead to gangrene with intense, ongoing pain, swelling, and a very strong odor.
In some cases, the affected area can spread to the upper thighs and the lower abdomen. It is more likely to occur when hygiene in the genital or perineal area is poor, which can allow bacteria to multiply and release toxins that damage tissue.
Fournier’s gangrene is treatable and it is not contagious. Treatment needs to start as soon as possible to lower the risk of amputation and prevent the infection from spreading to other organs, which can be life-threatening.
Main symptoms
The main symptoms of Fournier’s gangrene include:
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Redness in the genital or perineal area that can progress to dusky, purple, or necrotic discoloration;
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Severe, constant pain;
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Crepitus, which is a crackling sensation or sound when the skin is pressed, caused by air trapped in the tissues;
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A very strong odor from the affected area;
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Blisters in the area;
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Swelling of the pelvic region;
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Fever above 100.4°F (38°C);
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Extreme fatigue.
As soon as the first signs of skin changes or sores in the genital area appear, it is important to see a urologist, an infectious disease specialist, or a gynecologist (for women). Early evaluation allows treatment to begin promptly, reducing the risk of infection progression.
Fournier’s gangrene in women
Fournier’s gangrene is less common in women but can occur, typically causing gangrene in the vulva and groin area.
Confirming a diagnosis
A healthcare provider usually diagnoses Fournier’s gangrene first by reviewing the person’s symptoms and examining the affected area. Lab tests are also recommended, such as a complete blood count (CBC) to look for signs of infection, and blood cultures to check for microorganisms in the bloodstream.
The provider may also order imaging tests, such as a CT scan or MRI, to evaluate how far the infection has spread and whether there is gas in the tissues.
Main causes
Fournier’s gangrene is caused by bacteria that grow in the area and trigger tissue death by producing and releasing toxins. The main bacteria linked to this condition include:
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Staphylococcus aureus;
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Escherichia coli (E. coli);
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Proteus mirabilis;
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Streptococcus species;
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Enterococcus;
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Pseudomonas species.
Some conditions can make these bacteria more likely to multiply and increase the risk of Fournier’s gangrene, such as:
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Poor hygiene;
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Skin folds that trap moisture and bacteria;
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Diabetes mellitus;
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Class III obesity;
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Malnutrition;
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Sepsis;
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Acquired Immunodeficiency Syndrome (AIDS);
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Urinary tract infection (UTI).
Other factors, such as cirrhosis, alcohol use disorder, high blood pressure, drug use, and taking antibiotics without medical guidance, may also increase the risk. These factors can make it easier for more resistant bacteria to persist in the body.
Treatment options
Treatment for Fournier’s gangrene should always be directed by a urologist or gynecologist, and surgery is usually needed. This surgery is called debridement, and it removes dead or infected skin and tissue to stop the disease from spreading.
Early aggressive debridement combined with broad-spectrum IV antibiotics, such as vancomycin, penicillin, clindamycin, metronidazole, or cephalosporins, is standard, per CDC and WHO guidelines. Common regimens include broad-spectrum agents plus clindamycin (add vancomycin for suspected MRSA) or ceftriaxone/metronidazole.
In more severe cases, a large amount of skin and tissue may need to be removed, and reconstructive surgery of the genital area may be necessary.
How to prevent
Because Fournier’s gangrene involves bacteria that can naturally be present in the genital area, prevention focuses on limiting bacterial overgrowth. Good genital hygiene is important, and limiting high-sugar foods may help reduce bacterial growth.
It is also important to address risk factors by maintaining a healthy diet, avoiding alcohol and drug use, and not taking antibiotics unless they are prescribed.