Fournier's gangrene
Definition and urgency
Fournier’s gangrene is necrotising fasciitis of the perineum, genitalia or perianal region. It is a rapidly progressive, polymicrobial soft‑tissue infection with a high risk of sepsis, multiorgan failure and death if treatment is delayed. Definitive therapy is prompt surgical debridement combined with broad‑spectrum intravenous antibiotics and supportive critical‑care management (GOV.UK; RCEM).
Who gets it - key risk factors
Although classically described in adult males, Fournier’s gangrene can occur in women and children. Common predisposing factors include:
- Diabetes mellitus (most frequent single risk factor)
- Immunosuppression (steroids, chemotherapy, HIV, malignancy)
- Alcoholism, malnutrition and peripheral vascular disease
- Local trauma, perianal or urogenital infection, recent urogenital or anorectal surgery, urinary catheterisation
- Obesity
- SGLT2 inhibitor therapy - rare cases reported; if suspected, stop the drug and report (MHRA/GOV.UK)
Pathogenesis and typical microbiology
Infection usually arises from a local pelvic, anorectal or genitourinary source and spreads rapidly along fascial planes. The process is typically polymicrobial (aerobes plus anaerobes). Anaerobic and gas‑producing organisms contribute to tissue necrosis, vascular thrombosis and subcutaneous emphysema (crepitus).