Introduction to fournier gangrene

What is fournier gangrene?

Fournier Gangrene (FG) is a bacterial infection that affects the soft tissue around the genitals, anus and perennials (area between your genitals and anus). Therefore, if you are a female from birth this will present around the vagina and vulva. If you are a male from birth symptoms will occur around the scrotum and the shaft of the penis.

Males at birth are more likely to become infected with FG, where a study showed women to account for less than 10% of FG cases.¹ The infection is mostly caused by a group of different species of bacteria, but that does not mean that FG is not sometimes caused by a single species of bacteria. We encourage you to look at the FAQ section below to inform yourself of how to reduce your chances of bacterial infection. Regarding the bacteria that cause FG, some of them are listed here:

•  E coli
•  Streptococcus
• Staphylococcus
•  Bacteroides

FG is mostly caused by a previous infection in the body that has spread through your bloodstream. Therefore, it is important to recognise and manage infections very quickly to prevent this from happening.² The fatality rate associated with FG is unfortunately very high at a staggering 40%.³ This is most likely due to the infection being under the skin, so the soft tissue above looks unharmed. Clinicians often get FG confused with cellulitis at early stages, so if any similar symptoms appear, do not hesitate to get this checked.

Who does fournier gangrene affect

https://my.clevelandclinic.org/health/diseases/22025-fourniers-gangrene

•  There are a staggering 20-70% of patients with FG who already have type 2 diabetes. Diabetics can develop neuropathy, which means they are less likely to feel pain from an injury. This often means you won’t realise you are injured, and if the wound is left untreated, this can be the perfect environment for infection to thrive²
• There are also around 50% who have an alcohol abuse disorder. The NHS advises you to drink no more than 14 units a week⁴
• Cardiovascular disorders

You are also at higher risk of FG if you are challenged with the following disorders:

• Cirrhosis
• HIV
• Hypertension (high blood pressure)
• Kidney Failure

Symptoms of fournier gangrene

Systemic symptoms

Systemic just means that the symptoms are not specific to FG and will present as more general indications that your body has an infection. If you like, these symptoms will affect your body as a whole.

Systemic symptoms will most likely appear around a week before you see visible signs of FG. You can expect to feel a change in the following.⁵

• Your heart rate may increase compared to normal, which is referred to as tachycardia
• You will likely have extreme discomfort and pain in and around the genital area
• Your blood pressure may become too low, also known as hypotension
• You may experience a fever and general weakness or tiredness
• You might become confused at times
• There may be discomfort, such as itching, at the site of infection

Primary symptoms

Pain and swelling

• You may be experiencing a high level of pain around the genitalia or the anus which can either gradually increase or very suddenly reach an intolerable amount of pain
• You may also have swelling of the genitalia or anus. If you are experiencing this, you are likely to also experience the discomfort of tenderness. Swelling and tenderness can reach other areas of the body near the site of infection, such as the thighs and lower abdomen.6 In extreme cases, infection can spread as far as the chest, where the muscles, nerves and surrounding arteries will be destroyed⁷

Changes in the skin

The major challenges and discomfort are linked to the changes in your skin. These symptoms will result in one of two different types of FG:

• Wet gangrene will be associated with the formation of blisters and ulcers, as well as a foul smell. There may also be discharge from the infected area. You must be cautious with wet gangrene as this is highly infectious to others who come into physical contact⁸
• Dry gangrene is caused by ischemia, which is the lack of oxygen supply to areas of the body, causing discolouration that appears purple/blue. Infection occurs within the blood vessels, which leads to inflammation around the blood vessels, which causes a reduced oxygen supply. Therefore, this symptom is not infectious to others. If untreated, this will lead to necrosis, which is where body tissue dies and turns black³

There are also other skin-related symptoms with FG:

• You may be experiencing some redness at the sight of infection, which is located around the genitalia, perennial or anus. This may also cause the site to be especially warm to touch compared to the rest of your body.³ If you are experiencing redness, it is expected that other illnesses may be confused with FG. This includes erysipelas and impetigo. The main difference is that the borders of redness are more visible with these illnesses, whereas FG redness presents as patchy with less abrupt outlines
• Rubbing the infected site may sound like a crackling noise, which is called crepitus. This occurs because gas and tissue are moving against each other⁹

Summary

FG is referred to as a secondary infection, which often spreads from an abscess through your bloodstream. This infection is manageable and can have little impact on your quality of life, but this massively relies on being caught at an early stage. Since FG is a bacterial infection, there are certainly avoidable risk factors that will prevent you from developing it, with diabetes and alcohol abuse being a couple of them. It is advised that you drink no more than 14 units per week, and for diabetes, you should visit the type 2 diabetes link in the test to gain valuable insight into this disorder.

Since there is a very high fatality rate with FG, being 40%, catching the signs early could not be more important. This especially relates to you if you have found yourself challenged by the factors within this article. Other than the general ‘ill feeling’ you must be vigilant when spotting the tell-tell signs such as swelling, redness and discoloration of the genitalia, perennials and the anus areas. As well as this, if you are currently undergoing treatment such as chemotherapy or any immunosuppressive therapy, then you are at higher risk of FG. Other disorders involve HIV, cirrhosis and kidney failure.

If FG is not caught in the stages of early symptoms, then you are going to experience extreme pain and a sudden reduction in your quality of life. This is because necrosis will take effect at the site of infection and eventually areas as high as your chest.

FAQs

How can I reduce my risk of bacterial infection?¹⁰

• Maintain good hygiene, such as washing your hands and wearing clean clothes
• When you cut yourself, make sure to keep it clean. You can get help with this by visiting the Cleveland Clinic
• Have protective sex, using a condom or a dental dam
• Keep on top of vaccinations as this will be a highly effective way to reduce bacterial diseases, which can lead to bloodstream infection, and then possibly FG.

What symptoms are more common with FG?¹

A study looked into how FG appeared when looking at symptoms through screening techniques such as CT scan or MRI. There were multiple symptoms that had very high prevalence among those suffering from FG, which were as follows:

• The highest was scrotal swelling at 79%.
• Next from the top was tachycardia (61%) and oozing from the wound (60%).
• Symptoms that were the lowest but still had a very high chance were crepitus (54%) and fever (41%).

It is important to mention that fever was the least likely symptom shown in the cases of this study. Fever is usually the very first sign of an infection, but this study says otherwise. Therefore, it is important to stress that FG symptoms are sudden, and so by recognising and managing these quickly, you are greatly improving your chances of being the least impacted by FG.