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PID and Fitz-Hugh-Curtis syndrome
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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PID and Fitz-Hugh-Curtis syndrome

Dear Doc H, I am in chronic pain after a diagnosis of PID from Chlamydia 6 months ago. Although the STD was treated and clear, pain remains from my liver area to my ovaries, to the psoas and the mid and lower back--basically the whole "bowl". I'm in physical therapy and undergo deep tissue/visceral massage which has brought some relief and freed up some range of motion.

I have been diagnosed btw these months with everything from Pyelonephritis to Salpingitis, had a non contrasted CT scan and transvag ultrasound, and the docs have not mentioned any possibility of FHC. Antibiotic therapies (outpatient) aplenty have been given. My next step would be laparoscopy to really see what the damage is. I can't sleep, or get comfy.

My question is, if I had a diagnosis of FHC from my case of PID, would lysing adhesions be more pain than its worth, or can massage break up the scar tissue I believe is causing my persistent pain just as effectively? What tests might help?

Thanks!
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Following PID 15-20% of women experience continuing pelvic pain.  This pain is though to be due to adhesions (Fitz-Hugh Curtis syndrome is just and eponym for adhesions between the liver and the diaphragm).  As has been your experience, antibiotics are of little help.  For some patients lysis of adhesions is quite helpful but this should be done with care and only after other, less invasive efforts (message, anti-inflammatory medications like naprosyn or ibuprofen) have been tried.  This is in part because lysis of adhesions is, after all, surgery, and because in some cases the laparoscopy leads paradoxically to more adhesions, not fewer.  Thus, while there are no head-to-head trials of conservative therapy such as message vs surgical lysis of adhesions, my recommendation would be to try the most conservative measure first.  Hope this helps.  EWH
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