Fitz-Hugh-Curtis Syndrome

What is Fitz-Hugh-Curtis syndrome?

Fitz-Hugh-Curtis syndrome (FHCS) is inflammation of your liver capsule from pelvic inflammatory disease (PID). PID happens when bacteria infect your reproductive tract, causing pain and swelling.

In FHCS, the inflammation reaches the tissue surrounding your liver, producing violin-string-like, sticky strands. These sticky strands attach your liver capsule to the insides of your belly or breathing muscle (diaphragm). Although it doesn’t happen very often, FHCS is a complication of sexually transmitted infections (STIs) like gonorrhea and chlamydia.

Your healthcare provider may call Fitz-Hugh-Curtis syndrome by another name: perihepatitis.

How common is this condition?

Overall, Fitz-Hugh-Curtis syndrome is rare in people of childbearing age. Among women and people assigned female at birth (AFAB) with PID, about 4% to 14% develop Fitz-Hugh-Curtis syndrome. This rate is higher in teens with PID — at 27% — because their less mature reproductive organs make it easier for them to get infections. FHCS is rare in men and people assigned male at birth (AMAB).

What are the symptoms of Fitz-Hugh-Curtis syndrome?

The most common symptom of Fitz-Hugh-Curtis syndrome is right upper belly pain. This pain is due to swelling from infection and your liver capsule sticking to the inside of your belly. The pain usually gets worse when you breathe and move around. Other symptoms include:

• Lower belly pain.
• Pelvic pain.
• Back pain.
• Fever.
• Chills.
• Nausea and vomiting.
• Vaginal discharge.
• Painful sexual intercourse.
• Painful urination.
• Cramping.
• Bleeding after sexual intercourse.
• Headaches.
• Hiccups.

What causes Fitz-Hugh-Curtis syndrome?

Fitz-Hugh-Curtis syndrome is caused by pelvic inflammatory disease (PID). PID is often caused by sexually transmitted infections, like gonorrhea and chlamydia. But other types of bacteria can also cause it.

As its name implies, pelvic inflammatory disease usually affects organs in your pelvis like your uterus, fallopian tubes or ovaries. But sometimes, the infection — or the inflammation it causes — spreads outside your pelvis. In FHCS, the infection affects the tissue around your liver.

What are the risk factors for Fitz-Hugh-Curtis syndrome?

The risk factors for Fitz-Hugh-Curtis syndrome include:

• Multiple sexual partners.
• Unprotected sex.
• History of sexually transmitted infections (STIs).
• History of PID.
• Use of an intrauterine device (IUD).
• Vaginal douching.
• Being under the age of 25 and assigned female at birth.

What are the complications of Fitz-Hugh-Curtis syndrome?

Complications from Fitz-Hugh-Curtis syndrome include:

• Endometritis.
• Salpingitis (swelling of your fallopian tubes).
• Tubo-ovarian abscess.
• Pelvic peritonitis.

Long-term complications include:

• Infertility.
• Pain that doesn’t go away (chronic pain).
• Bowel obstruction.
• Ectopic pregnancy.

How does Fitz-Hugh-Curtis syndrome affect fertility?

If not treated, Fitz-Hugh-Curtis syndrome can cause infertility, but indirectly. PID, the main cause of FHCS, is the main cause of infertility. PID can create scar tissue in your fallopian tubes. This scar tissue can block your tubes and prevent fertilization.

How is Fitz-Hugh-Curtis syndrome diagnosed?

Fitz-Hugh-Curtis syndrome is often hard to diagnose because the symptoms are like many other conditions. Your provider may have to give you several laboratory tests and rule out other conditions to reach an accurate diagnosis.

Laboratory tests may include the following:

• Pregnancy test.
• Complete blood count.
• Comprehensive metabolic panel (a blood test that gives your provider detailed information about your body’s functions).
• Vaginal smear.
• Tests for sexually transmitted infections.

Radiological exams might include:

• CT scan.
• Transvaginal ultrasonographic scan.
• MRI.

Medical conditions with similar symptoms include:

• Ectopic pregnancy.
• Cholecystitis.
• Viral hepatitis.
• Renal colic.
• Kidney infection.
• Pulmonary embolism.
• Appendicitis.

If the diagnosis still isn’t clear, your provider will perform laparoscopic or traditional surgery. Identifying the violin string-like strands will confirm Fitz-Hugh-Curtis syndrome.

How is Fitz-Hugh-Curtis syndrome treated?

Your healthcare provider will use antibiotics to treat the infection. They may also prescribe medication for pain.

If antibiotics don’t work, your provider will remove the sticky strands with laparoscopic or traditional surgery.

What should I do after treatment?

To avoid medical complications, you’ll need to follow these guidelines:

• Avoid sexual activity during treatment and until your provider says it’s safe.
• Take all of your prescribed antibiotics as directed.
• Use a heating pad for pain.
• Rest until your fever and pain have improved.
• Talk to any sex partners you had during the two months before you started to feel ill. Tell them to get tested for STIs.
• Follow up with your healthcare provider in three days to check your progress.

How can I decrease my chances of getting it?

The best ways to prevent Fitz-Hugh-Curtis syndrome is to:

• Use condoms.
• Get tested regularly for STIs if you’re sexually active.
• Ask your sexual partners to get tested.
• Avoid douching.

This advice will also decrease your risk of PID.

What can I expect if I have Fitz-Hugh-Curtis syndrome?

Antibiotics usually cure Fitz-Hugh-Curtis syndrome, and there aren’t any significant side effects.

When should I see my healthcare provider?

You should contact your healthcare provider right away if:

• You have a new or higher fever.
• You have unusual vaginal bleeding.
• You have new or worse belly or pelvic pain.
• You have vaginal discharge that has increased in amount or smells bad.
• You’re dizzy or light-headed or feel like you may faint.

Call 911 if you pass out (faint) or have symptoms of sepsis, like:

• Shortness of breath.
• Feeling very sick.
• Severe pain.
• A fast heart rate.
• Cool, pale, or clammy skin.
• Feeling confused.
• Feeling very sleepy, or you are hard to wake up.

Is Fitz-Hugh-Curtis syndrome an STI?

No, Fitz-Hugh-Curtis syndrome isn’t exactly a sexually transmitted infection (STI). But it’s related to pelvic inflammatory disease, which STIs usually cause. The two most common STIs that lead to PID are chlamydia and gonorrhea. PID and FHCS are ways your body may react to an infection, but they aren’t the infection itself.