Necrotizing fasciitis, often referred to as the “flesh-eating” disease, is a rare but severe bacterial infection. Recent reports from the UK indicate a concerning rise in cases affecting the vulva, the external female genitalia. This article explores this alarming trend, highlighting the need for increased awareness and prompt medical intervention.
Doctors at the Shrewsbury and Telford Hospital NHS Trust documented three cases of vulvar necrotizing fasciitis in a paper published in BMJ Case Reports. Tragically, one of these cases resulted in death. This alarming cluster of cases, coupled with a broader increase in necrotizing fasciitis infections in the UK and the US, warrants attention.
Necrotizing fasciitis is characterized by the rapid destruction of soft tissues beneath the skin, particularly the fascia. Although the infection’s appearance might evoke the imagery of flesh being consumed, the bacteria themselves don’t actually eat the tissue. The destructive process can swiftly spread, leading to life-threatening complications such as sepsis. Without prompt treatment, death can occur within as little as 12 hours of symptom onset.
While several different bacteria can cause this infection, its overall occurrence remains rare. However, the report’s authors noted a significant increase in vulvar cases at their hospital, including the three detailed in their paper. Two women were diagnosed with vulvar necrotizing fasciitis in the emergency room, while the third developed the infection as a complication from an infected surgical wound.
One of the women had consulted a doctor five days prior due to a spot on her mons pubis and received antibiotics. Sadly, the treatment proved ineffective, and the infection spread to her labia majora, lower abdomen, and left hip. Despite surgical removal of the infected tissue (debridement) and intensive care, she succumbed to sepsis just 28 hours after diagnosis.
The other two women survived, but their recovery was arduous. Both required extensive surgical debridement, with one undergoing three separate surgeries followed by reconstructive procedures.
These cases highlight a disturbing trend observed by the doctors, who identified 20 cases treated at their hospital between 2022 and 2024, a stark increase from the 18 reported over the entire preceding decade. This rise isn’t isolated; a recent CDC study revealed that invasive group A Streptococcus (GAS) infections, the most common cause of necrotizing fasciitis, more than doubled in the US between 2013 and 2022. Several European countries, including the UK, have also reported a similar surge in GAS infections.
While necrotizing fasciitis remains statistically rare, the authors emphasize the importance of raising awareness among ob-gyns, particularly given the need for rapid medical intervention to prevent fatalities. They stress the limited familiarity with this condition within the gynecological community.
Vulvar necrotizing fasciitis carries a particularly high mortality rate, reaching up to 50% without prompt treatment. Although the infection can be fatal regardless of its location, the vulvar variant presents unique challenges and necessitates swift, decisive action.
In conclusion, the increasing incidence of vulvar necrotizing fasciitis calls for heightened vigilance. Early diagnosis and aggressive treatment are crucial to improving patient outcomes. Increased awareness among healthcare professionals, particularly gynecologists, is essential to combat this rare but devastating infection.
