Sexually Transmitted Diseases - I. I. Mavrov 2005

Non-venereal inflammatory diseases of the genital organs
Fulminant gas gangrene

Fulminant gas gangrene, or Fournier's gangrene (gangraena Fournier), is a rare form of gangrene characterized by acute tissue Necrosis of the Penis and Scrotum in men, and much less commonly of the external genitalia in women. The onset of the disease is sudden and fulminant.

Etiology AND Pathogenesis. The disease is caused by streptococci, staphylococci, fusospirochetes, and other associations of anaerobic and aerobic Bacteria. In some cases, Milian isolated Bacillus gangreanasus and successfully reproduced Fournier's gangrene in animals using this microorganism. One of the main factors contributing to the progression of gangrene is staphylococcal hyaluronidase. Sometimes the condition is preceded by acute or chronic Inflammatory Diseases (such as anaerobic paraproctitis or ischiorectal abscess), or serves as an entry port for infection through scratches, abrasions from urethrotomy or urethral dilation, diaper rash, or chafing.

Clinical manifestations. Severe ulceration occurs in the area of the glans penis, prepuce, penile Skin, or scrotum. Within a few hours, the skin becomes intensely erythematous, followed by rapid tissue sloughing (gangrene). The process is accompanied by high fever and a severe General condition of the patient.

The rapidly developing necrosis leads to extensive tissue sloughing. The disease typically lasts 5–8 days. Once the tissue sloughing ceases, reparative processes with granulation and epithesialization are observed, leaving scars in place of the lost tissue and resulting in deformity of the genitalia. The prognosis is guarded, as the outcome is fatal in 3–5% of cases.

Diagnosis is established based on clinical examination findings. Blood tests reveal high leukocytosis and other signs of an inflammatory process. Differential diagnosis should primarily rule out phagedena associated with Syphilis and Chancroid, gangrenous balanitis caused by fusospirochetosis, and balanitis in diabetic patients; in women, it must be differentiated from gangrenous diabetic vulvitis, certain ulcerative and gangrenous forms of inguinal lymphogranulomatosis, and acute vulvar ulcers.

Treatment. Broad-spectrum Antibiotics and sulfonamides are prescribed. Locally, antiseptic compresses with Rivanol are applied, and wounds are irrigated with a 4% hydrogen peroxide solution or potassium permanganate solution. Urgent multiple incisions of the skin of the scrotum, Perineum, and penis must be performed, followed by necrotomy. Anti-gangrene sera are administered intravenously.