[Question #13326] FHCS

8 days ago

Dr. Handsfield. I’m a 52 y/o male concerned about Fitz-Hugh-Curtis syndrome (FHCS). I had an escort encounter on 8/26/23. Fellatio w/ condom (provided and put on by her), intercourse with same condom. Condom stayed on and looked intact after sex, but I didn’t see a semen deposit in there. On 10/25/24 I woke up at night w/ irritation at inside tip of penis. Seemed to go away if nothing was touching it, but symptoms lasted at least a month. Had some feeling that I needed to pee all the time, but that went away after a few days. Got tested through stdcheck.com on 11/6/23 (LabCorp – syphilis, chlamydia, gonorrhea, HIV 1 & 2, herpes 1 & 2, Hepatitis A B C, - all negative results).

On 4/5/24 wife woke up with sever upper right epigastric pain. Took her to ER with nausea, she vomited while there. They did CBC, CMP, UA, CT abdomen and pelvic US. Found trace bacteria (they diagnosed possible subclinical UTI), small volume of pelvic free fluid, probable right adnexal cystic lesion. Pelvic US found normal uterus and endometrium and right (poss hemorrhagic) ovarian cyst. Symptoms resolved after about 6 hours.

She had another episode of pain on 4/12/24 that resolved in a couple of hours. Two or 3 more episodes since then that resolve in about an hour.

In May 24, US found stones in her gallbladder. Despite that, could she have FHCS? I haven't disclosed the escort to anyone, but should I talk to the GI doc?

H. Hunter Handsfield, MD

7 days ago

Welcome to the forum. Apologies for a somewhat longer than usual delay in responding.

There is no chance you have gonorrhea or chlamydia, the only STIs known to cause pelvic inflammatory disease (PID), of which Fitz-Hugh Curtis syndrome is a rare complication. And even if you had been infected, your description of your wife's symptoms do not fit well with FHCS. Details to follow.

As you apparently know but for readers not familiar, FHCS is inflammation of the surface of the liver due to gonorrhea or chlamydia extending upward in the abdominal cavity in women with fallopian tube infection (PID).

You describe a zero risk sexual exposure for practical purposes; your symptoms don't fit well with an STI; and your negative test results were solid proof you were not infected with either gonorrhea or chlamydia. And FCHC is very rare; and is not likely to cause on and off symptoms like you describe for your wife -- and never would cause episodic pain lasting only an hour or so. On the other hand, those are exactly the symptoms expected with gallstones.

Your wife's symptoms have nothing to do with the escort event and there is no need at all to mention that your wife or her doctors. Her symptoms have nothing to do with thDon't worry about it. I also would advise you cease online investigation of these issues. You really must have gotten deep into the weeds to come up with a concern about FHCS to begin with! It's a very rare problem (and to my recollection this is the first time in the 21 years of this and our preceding forum that anyone has asked about it).

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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3 days ago

Thank you for answering my question, Dr. Handsfield.

I guess I did get deep in the weeds on this, mostly because I did start to experience sensations I had never felt before (penile irritation), and the relatively close proximity between the events. But I think the best thing you said was that the symptoms my wife experiences do not fit FHCS but do fit gallstones. That seems definitive to me.

Researching these things online is confusing and scary. They always list symptoms that are shared by other conditions, and lead you to fear that maybe you DO have this rare condition. I will stop researching FHCS.

I will ask these follow ups just so I don't remember them later and feel the need to come back here:

I was on 100mg 2x/day doxycyclene from about 8/19/23 to 9/14/23 for bad acne, folliculitis, etc. After that I found a boil on my L inner thigh near my groin area, so my dermatologist gave me Bactrim DS 800 160 mg 2x/day for 10 days because of that. I had unprotected sex with my wife 1 or 2 weeks after the escort event, then once maybe a couple of weeks later. Could this confuse things? For example, could I have gotten chlamydia or gonorrhea and passed it to my wife, only for the meds to kill the infections in me afterward and give me negative tests on 11/6/23?
My wife's ER visit was 7 months after the escort event and 5 months after my negative tests. Is that a realistic time period for FHCS to occur anyway? Maybe it's too long after to be a consideration?

3 days ago

3. My wife got a BV panel in late 2024 that included chlamydia and gonorrhea and she tested negative for all. The FHCS article said that if someone has FHCS, you treat for the underlying infection. So even if she did have FHCS, the infection is gone and nothing could be done anyway, right?
4. My wife doesn't have chlamydia or gonorrhea, but supposing she had had FHCS back in 4/24, could it still progress? Like could liver adhesions continue to form? I asked my own GI about FHCS and he said they sometimes discover it long after (years or decades) it occurs and that adhesions could continue to form. But that's not what I saw online. Is he wrong?
5. What would FHCS symptoms look like if someone has it? Would the pain be so obvious and persistent that someone would definitely seek treatment?

I really appreciate your advice and knowledge and will do as you advise.

H. Hunter Handsfield, MD

3 days ago

Wow -- talk about into the weeds! All these issues are irrational nonsense. OCD? Counseling?

1. You cannot catch chlamydia while taking doxycycline. And if you took doxy after catching chlamydia, it would have been cured within days of the first dose.

2. The time frame would be OK but unlikely. There are plenty of other reasons to be 100% confident your fears are unfounded.

3. The opening sentence makes no sense. Gonorrhea and chlamydia have nothing to do with BV.

4. I don't follow this one and you likely misunderstood your GI doc or she misunderstood the question. To my knowledge, FCHC cannot last for years, although scars from it (e.g. adhesions) could be lifelong.

5. Steady pain in the upper right of the abdomen.

That all for this thread.

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2 days ago

Clarifications:

3. Sorry I wasn't clear. The test said vaginitis/vaginosis profile and included tests for BV, trich, chlamydia, and gonorrhea. All came back negative. My point was that since she does not currently have chlamydia or gonorrhea, even if she did have FHCS back in 4/24, there is nothing that could be done about it now.

4. My question was: If someone had FHCS but cured the underlying chlamydia or gonorrhea infection, could more adhesions continue to form, or does treating the infection halt the formation of adhesions?

New Q:

Can you explain to me why gonorrhea is not a concern here? Doxy is only 50% effective against it, so it seems possible if I was exposed, I could have been infected, passed it to my wife, but was later cured by the doxy or Bactrim - then FHCS shows up 7 mos. later.

Summary:

Most importantly, my wife’s symptoms do not match FHCS symptoms, so she doesn’t have it. Her symptoms match gallstones, which we know she has.

I appreciate your help.

H. Hunter Handsfield, MD

2 days ago

3. True. And she never had either one anyway. Neither did you.

4. No. Adhesions could only develop while the infection is active, before cure.

Your risk of gonorrhea was nil; asymptomatic urethral infection is rare; if you had it and it were resistant to doxycycline, your immune system would have cleared it long ago.

There are many reasons beyond your wife's symptoms that make Fitz-Hugh Curtis essentially impossible, now or any time in the past.

You might consider counseling for self awareness why you are so irrationally obsessed with all this despite all the reasoned, science based advice you have had, probably from your own doctors as well as this forum. We advise many obviously obsessed questioners, but yours are well beyond almost all others I can recall. My suggestion that there is an underlying emotional/psychological issue is made with compassion, not criticism. But I hope you will consider it.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Also please note the forum rule against repeated questions, especially when anxiety driven. You can be certain there is nothing else that will come to mind that has any chance of changing our assessment and advice. Thank you.

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