As documented by some accounts on Reddit, Fournier’s gangrene manifests as an extreme bacterial infection of the tissue under the skin around the pelvic regions. Men are considered ten times more likely to develop the condition than women.
Once the tissue cells that surround muscles, nerves, fat, and blood vessels of the perineum are affected, usually by a cut or break in the skin, everything gets infected — and death tolls are very high, according to a U.S. Food and Drug Administration announcement.
The FDA announced in August that male diabetic patients may have to watch out for certain class of type 2 diabetes called sodium-glucose cotransporter-2 inhibitors, known as SGLT2.
The report explained that between March 2013 to May 2018, there were 12 cases of Fournier’s gangrene in patients taking the SGLT2 medication.
“All 12 patients were hospitalized and required surgery,” the report stated. “Some patients required multiple disfiguring surgeries, some developed complications, and one patient died.”
The fatality rate is believed to be between 20-30 percent of those infected. As of now, there are a little under 2,000 reported cases of the disease ever — and no known cure, as the condition is still too rare to document in an exact way.
Historical figures such as Herod the Great, his grandson Herod Agrippa and Puerto Rican abolitionist and pro-independence leader Segundo Ruiz Belvis have died from ‘conditions related to gangrene in the genitals’ themselves. And they’re not the only ones, centuries later, to have issues in that regard.
Research from the FDA has shown that there's about 1.6 Fournier’s gangrene cases per 100,000 males annually, and most frequently occur in men 50-79 years old. Although the condition is extremely rare, it is still dangerous if developed.
What are these SGLT2 inhibitors that may cause this?
Typically, SGLT2 inhibitors are FDA-approved prescription medicines for lowering the blood sugar in adults with type 2 diabetes. They are officially approved to lower the risk of death from heart attack and stroke in adults with type 2 diabetes and heart disease.
Medicines in the SGLT2 inhibitor class include canagliflozin, dapagliflozin, and empagliflozin. Common brand names include Invokana, Jardiance, Farxiga and more.
They are paired with diet and exercise to help the kidneys exert urine and remove glucose from the body at the same time.
The FDA said that more than 1.7 million patients filled a prescription for an SGLT2 inhibitor in 2017. The risk of Fournier’s gangrene is small in context, but the possibility of unreported cases and high mortality rates associated with the condition is serious.
It starts with a cut
Similar to other types of gangrene, Fournier’s gangrene is a bacterial infection that spurs from a wound, even one as small as a minor cut from shaving or a recent surgery.
The cut is close to the genital area and is a gateway for bacteria to spread into crevices on men’s genitals, where they can incubate for long periods of time.
The tissue then begins dying and can spread to the thighs, testes, stomach and chest.
According to some Reddit accounts, some men have reportedly gotten the gangrene from masturbation — however, extensive masturbation doesn’t in of itself cause the gangrene. Rather, abrasions to a man’s penis caused from masturbation may exacerbate bacteria in a cut that was already there. The soft tissue around the scrotum makes developing the condition even easier.
Women may also develop Fournier’s gangrene, but it's much less common because of the lack of crevicing around the vagina.
The combination of excess glucose in the bloodstream and urine being expelled can feed infection if the area with abrasions is contaminated — and result in the apparent ‘decay’ of those areas.
Symptoms and Treatment
Usually, doctors say feverish tendencies, tenderness, redness and soreness in the genital area is a sign one should seek medical treatment.
If there is cracked skin and an odor at the infection site, symptoms may even worsen quickly. The infection can move very fast and spread upward to other parts of the body, such as the chest or thighs, if left untreated.
Usually Fournier’s gangrene is fought with antibiotics and surgery to remove the dead tissue from the infected area. Patients may need to receive doses of pure oxygen, known as hyperbaric oxygen therapy, to kill bacteria.
According to an article in Postgraduate Medical Journal, a person with Fournier's gangrene typically requires 3.5 procedures to reduce the spread.
The best way to prevent the gangrene in the first place is to keep your genitals clean and treat wounds immediately, especially if you are on SGLT2.
“Seven cases out of 7 million prescriptions,” Gary Scheiner, MS, CDE, founder of Integrated Diabetes Services, author of “Think Like a Pancreas,” and a 2014 diabetes educator of the year, told Healthline. “That makes it literally a one-in-a-million event.”
Any medication that passes glucose through urinary tracts, beyond SGLT2, could cause conditions such as Fournier’s gangrene or other urinary tract infections.
“Patients have to be on the lookout for signs of UTI and seek treatment. It should never get to a point as serious as gangrene,” Scheiner told Healthline. “It is incumbent on prescribing physicians to teach this to their patients.”