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Fitz Hugh Curtis Syndrome

Last updated Sept. 14, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Fitz Hugh Curtis Syndrome is a secondary infection caused by opportunistic bacteria that initially affects the pelvic region and later spreads to upper abdomen region, affecting the liver.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Fitz-Hugh and Curtis Syndrome
  • Gonococcal Perihepatitis
  • Perihepatitis Syndrome

What is Fitz Hugh Curtis Syndrome? (Definition/Background Information)

  • Fitz Hugh Curtis Syndrome is a secondary infection caused by opportunistic bacteria that initially affects the pelvic region and later spreads to upper abdomen region, affecting the liver
  • The characteristic feature of this disorder is a painfully inflamed liver, causing an intense pain in the upper right abdomen portion, accompanied by fever, vomiting, and nausea
  • With proper medications and the use of laparoscopic surgery (if necessary), the condition can be effectively managed

Who gets Fitz Hugh Curtis Syndrome? (Age and Sex Distribution)

  • The incidence of Fitz Hugh Curtis Syndrome is fairly common in adult women with pelvic inflammatory disease (PID). About 1 in 3-6 women with PID, may be affected
  • Nevertheless, it may affect other women too. Younger women seem to have a higher risk
  • This condition is highly infrequent in men
  • There is no racial preference noted. But, individuals in certain geographical regions with poor access to a healthcare system, portray an increased complication rate for the disorder

What are the Risk Factors for Fitz Hugh Curtis Syndrome? (Predisposing Factors)

Infection of the pelvis, termed as pelvic inflammatory disease, which affects the reproductive tract, including the uterus and fallopian tube, are frequent in sexually active women (with multiple partners, and those prone to sex-related infections).

Many of the risk factors for Fitz Hugh Curtis Syndrome are similar to those for PID, and these include:

  • Having multiple sex partners; not practicing safe sex
  • Individuals previously affected by sexually transmitted diseases. Those living/staying in areas with a high incidence of sexually transmitted diseases
  • Those with a history of sexual abuse (usually from a young age)
  • Sometimes, certain gynecological procedures or surgeries (such as curettage, hysteroscopy, endometrial biopsy, and even abortion), may open the region to opportunistic infections
  • Regular vaginal douching may be a risk factor
  • Bacterial vaginosis
  • Pregnant women seem to have a lower risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Fitz Hugh Curtis Syndrome? (Etiology)

  • Untreated or neglected gonorrhea/chlamydia infections (which are sexually transmitted bacterial infections) that affect the female reproductive tract, may spread from the vagina to the tissues surrounding the liver, due to a thinning of the cervical mucus. This is the main reason for the occurrence of Fitz Hugh Curtis Syndrome
  • Pelvic inflammatory disease is sometimes asymptomatic in women. Many of them remain unaware of the problem, until additional complications develop. Fitz Hugh Curtis Syndrome is one such complication of PID
  • Lack of contraception, having many sex partners, staying or being in a sexually-transmitted disease zone, are some of the factors contributing to PID

What are the Signs and Symptoms of Fitz Hugh Curtis Syndrome?

Signs and symptoms of Fitz Hugh Curtis Syndrome (similar to those for a pelvic infection) include the following:

  • Dull and constant pain in the upper abdominal region (sometimes near the gallbladder location), with a feeling of tenderness is observed
  • Breathing, sneezing, or coughing makes the pain more severe; the pain appearing to shift to the right shoulder
  • Liver tissue inflammation, leading to surface adhesion between the liver and abdomen (a string-like attachment pattern forms, which is called violin-string adhesion)
  • Nausea, vomiting
  • Fever and headache

How is Fitz Hugh Curtis Syndrome Diagnosed?

Diagnostic tests for detecting Fitz Hugh Curtis Disorder may include the following:

  • The physician conducts a thorough physical examination and evaluates the individual’s medical history. Upper abdominal pain in women with PID, is a strong indicator of the syndrome
  • Laparoscopic examination to establish the condition (the typical violin-string adhesions may be observed on outer surface of the liver)
  • Cervical culture
  • Blood test to determine WBC count and ESR

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis

What are the possible Complications of Fitz Hugh Curtis Syndrome?

Complications of Fitz Hugh Curtis Syndrome are usually due to an absence of, or a delayed treatment of PID, and these include:

  • Infertility
  • Severe liver inflammation (peritoneal coating around the liver is affected); permanent scarring may occur
  • Severe pain necessitating hospitalization
  • Presence of other illnesses, like jaundice and HIV, may aggravate the condition

How is Fitz Hugh Curtis Syndrome Treated?

Treatment measures for Fitz Hugh Curtis Syndrome include the following:

  • Laparoscopically incising and removing the scar tissue, to relieve pain and restore function. This process is called ‘lysis of adhesion’
  • Use of antibiotics and pain-relief medication
  • Avoidance of sexual contact until the infection is completely cured; treatment of the partner(s) is also strongly advised

How can Fitz Hugh Curtis Syndrome be Prevented?

  • Fitz Hugh Curtis Syndrome can be prevented if the underlying causative factor of PID, and sex-related diseases are averted, or are managed properly
  • Women who are sexually-active should protect themselves (using contraceptives) and take precautionary steps to avoid contracting sexually transmitted diseases/infections
  • Avoid multiple sex partners, and always insist on regular medical evaluation (of sexual health) of your male partners

What is the Prognosis of Fitz Hugh Curtis Syndrome? (Outcomes/Resolutions)

  • Fitz Hugh Curtis Syndrome normally follows an incidence of pelvic infection. With timely and active treatment administration, the bacterial infection can be effectively managed and controlled. A lack of treatment may cause infertility in women
  • PID can recur, if proper precautions are not considered (like practicing safe sex, using contraceptives, avoiding multiple partners, etc.). This is especially true for women, falling in the high-risk categories. Fitz Hugh Curtis Syndrome is an extended complication of pelvic inflammatory disease
  • Some individuals may experience extreme pain, necessitating hospitalization

Additional and Relevant Useful Information for Fitz Hugh Curtis Syndrome:

  • Regular screening tests, education and awareness creation of safe sex practices, examination and treatment of male partners, are the common essentials for women in high-risk sexually active groups
  • This is particularly important for individuals with a limited access to a proper healthcare system

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Oct. 16, 2013
Last updated: Sept. 14, 2018