Fournier’s Gangrene

What is Fournier’s gangrene?

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.

Is Fournier’s gangrene an emergency?

Fournier’s gangrene is an emergency. Go to the emergency department if you have one or more symptoms of Fournier’s gangrene, including:

• Red genitals or perineum.
• Tender genitals or perineum.
• Swollen genitals or perineum.

And one or both of the following symptoms, including:

• A fever of at least 100.4 degrees Fahrenheit.
• A general feeling of sickness.

Who does Fournier’s gangrene affect?

Anyone at any age can get Fournier’s gangrene. Males are 10 times more likely to get Fournier’s gangrene than females. You’re at a higher risk if you have any of the following conditions, including:

• Diabetes. Between 20 and 70% of people with Fournier’s gangrene also have diabetes.
• Alcohol abuse disorders. About 25 to 50% of people with Fournier’s gangrene also have an alcohol use disorder.
• Cardiovascular disorders.
• Cirrhosis.
• HIV.
• High blood pressure (hypertension).
• Kidney (renal) failure.

You’re also at a higher risk of Fournier’s gangrene if:

• You’re age 50 or older.
• You have obesity.
• You smoke or use other tobacco products.
• You’re receiving chemotherapy.
• You’re taking steroids.
• You had some sort of trauma to the area.
• Your immune response is slow or it fails (immunosuppression).

Fournier’s gangrene is an emergency. Get an ambulance or take yourself to the emergency department if you observe symptoms.

What does Fournier’s gangrene do to my body?

When bacteria enter your perineum, scrotum or penis, they infect your subcutaneous tissue and muscle fascia. The subcutaneous tissue is the deepest layer of your skin. It contains connective tissues and fat cells. Fascia is a type of connective tissue. It covers every one of your organs, blood vessels, bones, nerve fibers and muscles and holds them in place.

There are arteries (blood vessels) within your subcutaneous tissue and muscle fascia. Your arteries transport nutrients and oxygen from your heart to your body's tissues. The pudenal artery that takes blood to your sex organs, to the skin of your perineum and to your scrotal skin. When bacteria enter the subcutaneous tissue and muscle fascia, they kill the branches of your pudendal artery. When the pudendal arterial tree is dead, that's when the bacteria spread further. They travel to the muscles and skin of your perineum, scrotum and penis and start destroying the arteries there, too. From there, they can go through the fascia to other areas of your body, such as your thighs, stomach and chest.

Please pay attention to the early symptoms of Fournier’s gangrene. By the time the bacteria affect the outer layer of your skin, they have already killed the arteries in your subcutaneous tissue and muscle fascia. Fournier’s gangrene gets worse (progresses) quickly. It’s so dangerous that just a few hours can mean the difference between life and death. But you can reduce your risk of getting it and, if you do get Fournier’s gangrene, there are treatments.

How common is Fournier’s gangrene?

Fournier’s gangrene is rare. About 1.6 out of 100,000 males will get Fournier’s gangrene. It is unclear how many females and children get this disease.

Do medications for people with Type 2 diabetes cause Fournier’s gangrene?

If you take diabetes medications called sodium-glucose cotransporter-2 (SGLT2) inhibitors, you have a higher chance of getting Fournier’s gangrene. Examples of these inhibitors include:

• Canagliflozin.
• Dapagliflozin.
• Empagliflozin.
• Ertugliflozin.

Fournier’s gangrene is a rare disease. Very few people with diabetes should get this bacterial infection.

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:

• Abscess.
• Anal fistula and diverticulitis.
• Genital piercing.
• Infection of the bladder or urinary tract.
• Injury that causes a scratch or burn.
• Insect bite.
• Rectal cancer.
• Sex.
• Ulcer.

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:

• Changes in mental activity.
• Dehydration.
• Fever and chills.
• Inflammation.
• Low energy (lethargy).
• Nausea and vomiting.
• Pain that is moderate to severe and starts around the abdomen.
• Putrid smell.
• Sepsis.

Fournier’s gangrene can also affect your blood and heart. Examples of symptoms and conditions include:

• Anemia.
• Disseminated intravascular coagulation.
• Fast heart rate (tachycardia).
• Hypotension (low blood pressure).

There are some skin symptoms as well, including:

• 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 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:

• What are your symptoms?
• How long have you had these symptoms?
• What medications do you take?
• What color is your skin?
• Are you in pain?
• How are your thinking processes?
• Do you have a fever? Chills?
• Do you have nausea, or have you been vomiting?
• Does your skin itch?

Have you had any recent trauma to the area?

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 can I prevent Fournier’s gangrene?

Experts have not yet found a way to prevent Fournier’s gangrene. However, there are a few ways to reduce your risk of Fournier’s gangrene, or at least catch it early. You can try to catch Fournier’s gangrene early by consistently checking your perineum, penis and scrotum for early symptoms, including:

• Redness.
• Swelling.
• Tenderness.

You might reduce your risk of Fournier’s gangrene by taking the following precautions, including:

• Practice good hygiene. Keeping your genitals and perineum clean reduces your risk of Fournier’s gangrene. Additionally, use a clean razor when you shave to help prevent minor injury.
• Care for any wounds in the area. Bacteria can enter your body through scratches and cuts.
• Maintain a healthy weight.
• Stop smoking or using other tobacco products.

What is the prognosis (outlook) for Fournier’s gangrene?

Fournier’s gangrene is life-threatening — as many as 50% of people with Fournier’s gangrene die because of it. But there are treatments, and there are ways to reduce your risk of Fournier's gangrene so that you're not part of that 50%.

Several factors affect the riskiness of your Fournier's gangrene, including:

• How early you see a healthcare provider. The faster you get care, the better. Hesitating is a big risk.
• How much tissue is infected or dead. The longer you wait, the more tissues get infected.
• How long the tissues have been infected or dead. Again, do your best to notice the symptoms early and get care right away.

Ask your healthcare providers for a detailed prognosis. It’s important to get treated right away to prevent serious outcomes.

What are the complications/side effects of Fournier’s gangrene?

There are many possible complications of Fournier’s gangrene. They include:

• Acute kidney (renal) failure.
• Acute respiratory distress syndrome.
• Arterial occlusion.
• Colostomy bag.
• Decreased quality of life, which can contribute to clinical depression.
• Heart failure and arrhythmia.
• Ileus, the absence of normal muscle contractions in your intestines.
• Sexual dysfunction.
• Stroke.
• Urinary tract infections.

When should I see my healthcare provider?

Don’t hesitate to see a healthcare provider at the emergency department if your genitals or perineum are red, tender or swollen, and you have a fever or just generally feel unwell.

What questions should I ask my healthcare provider about Fournier’s gangrene?

• How did I get this infection?
• What type of bacteria is it?
• How far has the infection spread?
• Do I need emergency surgery?
• What antibiotics do I need?
• Do I need reconstructive surgery?
• Do I need hyperbaric oxygen therapy?
• Will I have sexual dysfunction?
• Will I need a colostomy?

A note from Cleveland Clinic

Looking at the symptoms and statistics of Fournier’s gangrene would frighten anyone. But remember — Fournier’s gangrene is a very rare type of necrotizing fasciitis. Fewer than two out of every 100,000 males should get this bacterial infection of the scrotum, penis or perineum.

Fournier's gangrene is a life-threatening disease, but there are ways you can reduce your risk. There are also treatments. Be especially careful if you have diabetes. Check the skin of your genitals and perineum regularly for any redness, tenderness or swelling. Also, look back at the "Prevention" section of this article for ways to reduce your risk of Fournier's gangrene.

Fournier’s gangrene is an emergency. It’s very important to get checked out right away if you have symptoms.