Fitz Hugh Curtis Syndrome

Overview

Fitz-Hugh–Curtis syndrome is inflammation of the thin, clear cover that wraps around your liver, plus the lining of the belly area next to it. Doctors sometimes call it perihepatitis (say: perry-hep-ah-TIE-tis). It almost always starts with an infection in the pelvis — usually pelvic inflammatory disease (PID), which is an infection of the womb, fallopian tubes and ovaries. Bacteria travel up from the pelvis to the surface of the liver. The important thing to know is that the liver itself is usually not damaged. It is the outer covering that is sore and inflamed.

It is uncommon but not rare. It is found in a small number of people who have pelvic inflammatory disease, and doctors think it is often missed because the pain can be mistaken for gallbladder problems or a muscle strain.

It most often affects sexually active young women, usually under about 30. It can happen to anyone who develops a pelvic or abdominal infection. It is rare in men and in children, and when it does occur in children it is usually linked to a different abdominal infection that needs urgent care.

Symptoms

Common symptoms

• Sharp, stabbing or aching pain in the upper right part of the belly, just under the ribs
• Pain that gets worse when you breathe deeply, cough, sneeze or twist your body
• Pain that may spread to your right shoulder or your back
• Fever and chills
• Pain in the lower belly, often on both sides
• Unusual vaginal discharge, pain during sex, or bleeding between periods
• Feeling sick, being sick, or going off food
• Feeling generally unwell and tired

Symptoms in children

• This is very rare in children. When it happens, it is usually linked to a serious belly infection such as appendicitis.
• Children may not be able to describe where the pain is — they may just say their tummy hurts or point to the right side.
• Fever, refusing food, vomiting or being very sleepy should always be checked quickly by a doctor.

Symptoms in older adults

• It is uncommon after the menopause, so doctors will usually check for other causes of upper right belly pain, such as gallbladder problems.
• Symptoms can be less typical — there may be less fever and more general tiredness or vague discomfort.
• Any new, lasting upper belly pain in an older adult should be checked by a doctor.

Causes

Main causes

• An infection spreading up from the pelvis — most often pelvic inflammatory disease (PID), which is commonly caused by sexually transmitted bacteria such as chlamydia or gonorrhoea, or by other bacteria that normally live in the vagina and cervix
• Bacteria travelling upward along the outside of the bowel or through the bloodstream to the surface of the liver
• Less often, infection spreading from a nearby problem such as appendicitis, a bowel infection or a gallbladder infection

Risk factors

• Being sexually active under the age of about 25, or having a new sexual partner or more than one partner
• A partner who has a sexually transmitted infection
• Having had PID or a sexually transmitted infection before
• Not using condoms or other barrier protection
• Recent childbirth, miscarriage, abortion or pelvic surgery
• Having an intrauterine device (IUD) put in — there is a small, short-lived rise in the risk of pelvic infection around the time of insertion
• Untreated vaginal infections such as bacterial vaginosis

When to see a doctor

See a doctor urgently if:

• Fever with pain in the upper right part of your belly
• Lower belly pain with unusual discharge, bleeding between periods or pain during sex
• Pain that makes it hard to take a deep breath
• You have been told a sexual partner has a sexually transmitted infection
• Vomiting that stops you keeping fluids down

Book a routine appointment if:

• Mild or coming-and-going pain in the upper right belly that lasts more than a few days
• Ongoing discomfort in the lower belly, or pain during sex
• You would like advice or testing for sexually transmitted infections, even with no symptoms
• You have had PID before and want to talk about protecting your future fertility

Diagnosis

There is no single test for Fitz-Hugh–Curtis syndrome. Your doctor will ask about your symptoms, your sexual history and your general health, then examine your belly. They will look for signs of infection in the pelvis and run tests to rule out other causes of upper right belly pain, such as gallstones, a urine infection or liver problems. In some cases the diagnosis only becomes clear when a keyhole operation (laparoscopy) shows the typical thin scars, sometimes described as looking like violin strings, between the liver and the wall of the belly.

Tests that may be done

• Blood tests to look for infection, inflammation markers and liver enzyme levels
• A pregnancy test, where relevant
• A urine sample to check for a urine infection
• Swabs from the vagina or cervix, or a urine test, to check for chlamydia and gonorrhoea
• A pelvic examination, which may include an internal examination
• An ultrasound scan of the pelvis and upper belly
• Sometimes a CT scan of the belly
• Occasionally a laparoscopy — a small keyhole operation done under anaesthetic — which can confirm the diagnosis and, rarely, treat scar tissue at the same time

What to expect at your appointment

You will usually need a few appointments and some tests, and results can take a few days. Because waiting is frustrating, your doctor may start treatment for a likely pelvic infection before all the results are back. If you feel anxious or embarrassed about swabs or questions about sex, it may help to know that sexual health clinics do this every day, are confidential, and are used to talking about these things kindly and without judgement.

Treatment

The main aim is to clear the infection that caused the inflammation. That means a course of antibiotics, rest and pain relief, plus testing and treating any sexual partners so the infection does not come back. Most people start to feel better within a few days of beginning treatment.

Self-care at home

• Take the antibiotics exactly as prescribed and finish the whole course, even if you feel better early
• Rest as much as you need, and return to normal activity gradually
• A warm heat pack on the sore area may ease the pain
• Ask your pharmacist or doctor what pain relief is suitable for you
• Drink plenty of fluids, especially if you have a fever
• Avoid sex until you have finished treatment and any partners have been treated — your clinician will tell you when it is safe
• Keep a note of your symptoms so you can tell your doctor whether things are improving
• Do not share antibiotics or use leftover ones from before

Medical treatments

Treatment usually means a course of antibiotic medicine chosen to cover the bacteria that most often cause pelvic infections. If you are very unwell or have a high fever, you may be given the first doses in hospital so they reach your body quickly, then continue with tablets at home. Your clinician will also offer testing for other sexually transmitted infections, arrange treatment for current partners, and ask you to come back for a check-up to make sure the infection has cleared. Pain relief and fluids are part of the plan too. If you are pregnant, tell your clinician straight away, because the choice of treatment is different.

When is surgery considered?

Surgery is not usually needed. Occasionally a keyhole operation is used if the diagnosis is unclear, or if scar tissue is causing long-lasting pain that does not settle — but this is uncommon. Rarely, an abscess (a pocket of pus) may need to be drained in hospital.

Living with this condition

Most people find the sharp pain eases within a few days of starting treatment, and feel back to normal within a couple of weeks. Some people have a dull ache in the upper right belly for a bit longer. Follow-up appointments matter, so do go back even if you feel fine — they are a chance to confirm the infection has cleared.

Lifestyle tips

• Use condoms with new or casual partners, and consider them with regular partners until you have both been tested
• Have regular sexual health checks if you have new partners — tests are quick, often free, and confidential
• Get any unusual discharge, pelvic pain or bleeding checked early rather than waiting
• Avoid douching and perfumed products inside the vagina, as these can upset the natural balance
• If you smoke, stopping is good for your general health and your recovery
• Make sure any current partners are tested and treated, even if they have no symptoms

Diet and exercise

There is no special diet for this condition. Eat normally and drink enough fluids, especially while you have a fever. Gentle movement such as short walks can help you feel better and reduce stiffness, but avoid hard exercise or heavy lifting until the pain has settled. Build your activity back up gradually over a week or two.

Mental health and emotional wellbeing

It is very common to feel worried, embarrassed or upset — especially if a sexually transmitted infection is involved. You may be anxious about pain, about future fertility, or about telling a partner. These feelings are understandable and nothing to be ashamed of. If at any point you feel overwhelmed, hopeless, or unable to cope, please reach out — contact your doctor, a local sexual health or mental health service, or your local crisis line. If you ever feel you are in danger of harming yourself, contact your local emergency number straight away.

Prevention

Largely, yes — because it usually starts with a pelvic infection, and pelvic infections can often be prevented or treated early. Using condoms, having regular sexual health checks, and getting symptoms checked quickly all lower the risk. Treating partners matters too, because people can carry infections without any symptoms and pass them back.

Vaccines

There is no vaccine for Fitz-Hugh–Curtis syndrome, and there are currently no routine vaccines against chlamydia or gonorrhoea. Routine vaccines such as HPV and hepatitis B protect against other infections but do not prevent this one.

Screening programmes

There is no screening programme for this condition. What does help is regular sexually transmitted infection testing — for example when you have a new partner, and at least once a year if you have more than one partner. Testing is often free and confidential at sexual health clinics, and many areas offer online test kits. Ask your doctor or pharmacist what is available locally.

Complications

If left untreated

• The pelvic infection can spread further, causing an abscess (a pocket of pus) in the pelvis or abdomen
• A severe whole-body infection (sepsis), which is a medical emergency
• Long-lasting pelvic pain
• Scarring of the fallopian tubes, which can make it harder to get pregnant and slightly raises the risk of an ectopic pregnancy
• Thin bands of scar tissue (adhesions) between the liver and the wall of the belly — these are usually harmless but can cause ongoing discomfort in some people

Long-term outlook

The outlook is good. With prompt treatment, most people recover fully and the liver is not permanently damaged. The risk of fertility problems is much lower when an infection is treated quickly, which is exactly why getting seen early is worth it. If you have had this condition and are worried about fertility, talk to your doctor — there is support and, if needed, testing available.

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