Can someone who is not sexually active contract Fitz-Hugh-Curtis syndrome?

Fitz-Hugh-Curtis Syndrome Can Occur in Non-Sexually Active Individuals

While Fitz-Hugh-Curtis syndrome is primarily associated with sexually transmitted infections, it can rarely occur in individuals who are not sexually active through non-sexual transmission routes or in males through hematogenous or lymphatic spread. 1, 2

Understanding Fitz-Hugh-Curtis Syndrome

• Fitz-Hugh-Curtis syndrome is defined as perihepatitis (inflammation of the liver capsule) that accompanies pelvic inflammatory disease (PID), most commonly caused by Chlamydia trachomatis and Neisseria gonorrhoeae 3, 4
• Classically, it presents with right upper quadrant pain, perihepatitis, and genital tract infection, often mimicking other conditions like acute cholecystitis or pleurisy 5, 4
• The syndrome was originally thought to occur exclusively in sexually active women but has now been documented in men as well 2, 6

Transmission and Risk Factors

• In women, the spread of infection to the liver capsule typically occurs directly from an infected fallopian tube via the right paracolic gutter 1
• In men, the transmission is believed to occur through hematogenous (blood-borne) and lymphatic spread rather than direct extension 1, 6
• While sexual activity is the primary risk factor, other potential routes of transmission include:
  • Contamination through non-sexual contact 2
  • Ascending infection through other mechanisms 1
  • Systemic spread of infection from other sites 6

Clinical Presentation

• The predominant symptoms include sharp, pleuritic right upper quadrant pain and tenderness 5, 4
• The clinical presentation is similar in both men and women 1
• In some cases, particularly in men, the genital symptoms may be minimal or delayed, leading to misdiagnosis 6
• The syndrome may present without obvious signs of pelvic infection in some cases 4

Diagnosis and Management

• Diagnosis is challenging and often requires a high index of suspicion, especially in non-sexually active individuals 5
• Laparoscopy may be needed for definitive diagnosis, though non-invasive approaches are preferred when possible 5, 4
• Treatment involves appropriate antibiotics targeting the causative organisms, typically those effective against Chlamydia trachomatis and Neisseria gonorrhoeae 3, 4
• Early diagnosis and treatment are essential to prevent chronic complications 6

Special Considerations

• In sexually inactive individuals presenting with symptoms suggestive of Fitz-Hugh-Curtis syndrome, clinicians should consider alternative routes of infection 2
• For men with this syndrome, evaluation for epididymitis or other genitourinary infections is important 6
• The CDC recommends that all patients with suspected PID-related complications receive treatment for both gonorrhea and chlamydia 3

Prevention

• While sexual transmission is the primary route, maintaining good hygiene practices may help prevent non-sexual transmission 3
• Regular screening for chlamydial infection and gonorrhea in high-risk populations can prevent progression to complications like Fitz-Hugh-Curtis syndrome 3
• Prompt treatment of any genital tract infection is crucial to prevent spread to the liver capsule 3

In summary, while Fitz-Hugh-Curtis syndrome is strongly associated with sexually transmitted infections, the documented cases in men and the potential for hematogenous spread suggest that it can, albeit rarely, occur in non-sexually active individuals through alternative transmission routes.