What is the treatment for Fitz-Hugh-Curtis syndrome?

Treatment of Fitz-Hugh-Curtis Syndrome

The treatment for Fitz-Hugh-Curtis syndrome (FHCS) consists of appropriate antibiotic therapy targeting the underlying pelvic inflammatory disease (PID), primarily caused by Chlamydia trachomatis and/or Neisseria gonorrhoeae. 1, 2

Diagnostic Considerations

• FHCS is characterized by inflammation of the liver capsule (perihepatitis) associated with genital tract infection 1
• Common presenting symptoms include:
  • Sharp, pleuritic right upper quadrant pain (84% of patients) 3
  • Right-sided chest pain in some cases 4
  • Lower abdominal tenderness (20% of patients) 3
  • Vaginal discharge (52% of patients) 3
• Laboratory findings often include:
  • Elevated ESR and CRP (76% and 92% respectively) 3
  • Elevated white blood cell count (60% of patients) 3
  • Normal liver function tests in most patients 3
• Chlamydia trachomatis is identified as the pathogen in 87-89% of cases 2, 3

Antibiotic Treatment Regimens

Outpatient Treatment

For mild to moderate cases, recommended regimens include:

Recommended Regimen A:

• Ceftriaxone 250 mg IM in a single dose
• PLUS
• Doxycycline 100 mg orally twice a day for 14 days 5

Recommended Regimen B:

• Cefoxitin 2 g IM in a single dose and Probenecid 1 g orally administered concurrently
• PLUS
• Doxycycline 100 mg orally twice a day for 14 days
• WITH or WITHOUT
• Metronidazole 500 mg orally twice a day for 14 days 5

Inpatient Treatment

For severe cases requiring hospitalization:

Recommended Parenteral Regimen A:

• Cefotetan 2 g IV every 12 hours
• OR
• Cefoxitin 2 g IV every 6 hours
• PLUS
• Doxycycline 100 mg orally or IV every 12 hours 5

Recommended Parenteral Regimen B:

• Clindamycin 900 mg IV every 8 hours
• PLUS
• Gentamicin loading dose IV or IM (2 mg/kg), followed by maintenance dose (1.5 mg/kg) every 8 hours 5

Treatment Duration and Follow-up

• Parenteral therapy should be continued for at least 24-48 hours after clinical improvement begins 5
• After parenteral therapy, transition to oral therapy with doxycycline 100 mg twice daily to complete 14 days of total therapy 5
• Follow-up examination should be performed within 72 hours for patients on outpatient therapy to ensure clinical improvement 5
• If no improvement is seen within 3 days, hospitalization for parenteral therapy and further evaluation is recommended 5

Management of Sexual Partners

• Sexual partners should be examined and treated if they had sexual contact with the patient during the 60 days preceding symptom onset 5
• Partners should be treated empirically with regimens effective against both Chlamydia trachomatis and Neisseria gonorrhoeae, regardless of the identified pathogen 5
• Patients and partners should abstain from sexual intercourse until therapy is completed (7 days after single-dose regimens or after completion of 7-day regimens) 5

Special Considerations

Pregnancy

• Pregnant women with suspected FHCS should be hospitalized and treated with parenteral antibiotics due to high risk for maternal morbidity and fetal complications 5
• Quinolones and tetracyclines are contraindicated in pregnancy 5
• Cephalosporins are the recommended treatment for pregnant women with gonococcal infection 5

HIV Infection

• Patients with FHCS who are also HIV-positive should receive the same treatment regimen as HIV-negative patients 5

Clinical Outcomes

• With appropriate antibiotic therapy, most patients show significant improvement 1, 2
• Early diagnosis and treatment are essential to prevent chronic complications such as persistent adhesions 4
• In a study of 52 hospitalized patients with FHCS, all improved after treatment combining antibiotic therapy with conservative care 2