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

Treatment of Fitz-Hugh-Curtis Syndrome

For Fitz-Hugh-Curtis syndrome, the recommended treatment is ceftriaxone 250 mg IM in a single dose plus doxycycline 100 mg orally twice daily for 14 days. 1

Understanding Fitz-Hugh-Curtis Syndrome

• Fitz-Hugh-Curtis syndrome is defined as perihepatitis (inflammation of the liver capsule) associated with pelvic inflammatory disease (PID) 2, 3
• Most commonly caused by Chlamydia trachomatis and Neisseria gonorrhoeae 3, 4
• Characterized by sharp, pleuritic right upper quadrant pain that can mimic acute cholecystitis, pleurisy, or other hepatobiliary conditions 5, 2

Treatment Regimens

Outpatient Treatment (Mild to Moderate Cases)

• First-line regimen: Ceftriaxone 250 mg IM in a single dose, plus doxycycline 100 mg orally twice daily for 14 days 1
• Alternative regimen: Cefoxitin 2 g IM in a single dose with probenecid 1 g orally administered concurrently, plus doxycycline 100 mg orally twice daily for 14 days, with or without metronidazole 500 mg orally twice daily for 14 days 1

Inpatient Treatment (Severe Cases)

• Parenteral regimen option 1: 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 1
• Parenteral regimen option 2: 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 1
• Continue parenteral therapy for at least 24-48 hours after clinical improvement begins, then transition to oral doxycycline to complete 14 days of total therapy 1

Follow-Up Recommendations

• Patients on outpatient therapy should be re-examined within 72 hours to ensure clinical improvement 1
• Patients typically show marked clinical improvement within 5 days of appropriate antibiotic treatment 2

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 1, 6
• Partners should receive treatment effective against both Chlamydia trachomatis and Neisseria gonorrhoeae, regardless of whether pathogens were isolated from the infected patient 6
• Recommended regimen for partners: Ceftriaxone 500 mg IM in a single dose plus azithromycin 1 g orally in a single dose 6
• Both patient and partners should abstain from sexual intercourse until therapy is completed (7 days after single-dose regimens or after completion of 7-day regimens) 1, 6

Special Considerations

Pregnancy

• Pregnant women with suspected Fitz-Hugh-Curtis syndrome should be hospitalized and treated with parenteral antibiotics 1
• Quinolones and tetracyclines are contraindicated in pregnancy; cephalosporins are recommended for pregnant women 1

HIV Infection

• Patients with Fitz-Hugh-Curtis syndrome who are HIV-positive should receive the same treatment regimen as HIV-negative patients 1

Diagnostic Pitfalls

• Fitz-Hugh-Curtis syndrome is often misdiagnosed as acute cholecystitis, hepatitis, or other hepatobiliary conditions due to similar presentation 5, 4
• While definitive diagnosis traditionally required invasive procedures like laparoscopy, non-invasive techniques such as ultrasound and CT scans are now available for diagnosis 5, 4
• The syndrome can occur in both women and men, though it is much more common in women of reproductive age 7, 2