Genital Tuberculosis

What is Genital Tuberculosis (TB)?

It is an infectious disease caused by a bacteria called  Mycobacterium tuberculosis. It is a cause of significant morbidity leading to infertility in 3-16% of the females in India.
Genital TB is that form of tuberculosis that can affect any of the female genital organs – ovaries, fallopian tubes, uterus, cervix and vagina and surrounding lymph nodes in the pelvic region.

Uterine-Prolapse

Uterine-Prolapse

Minimal pelvic tuberculosis is usually asymptomatic (except for infertility) and pelvic examination fails to reveal evidence of tubal enlargement or tubal-ovarian masses. The incidence of pelvic tuberculosis is difficult to assess as many patients are asymptomatic for 10 to 20 years, therefore the disease often comes to light only during the period of investigation for the gynaecological complaint like difficulty in conceiving.

Common Symptoms of Genital Tuberculosis:

In women with genital TB, the major complaints are:

  • Infertility, (most common)
  • Abnormal bleeding,
  • Pelvic pain (Lower abdominal pain)
  • Amenorrhea( Menstrual irregularities)
  • General Malaise

The first and most affected genital organs in women are fallopian tubes which are in about 90-100% of cases, followed by endometrium in 50-60% of the cases and ovary in 20-30% cases.

Diagnosis:

Following are Some Methods of Diagnosis:

  1. Histopathological detection of the epithelioid granuloma on biopsy
  2. Polymerase chain reaction may be false positive and alone is not sufficient to make the diagnosis
  3. Diagnoses of genital tuberculosis through Laparoscopy and Hysteroscopy can be done by different findings..
  4. TB gold test
  5. The diagnosis is made by detection of acid-fast bacilli on microscopy
  6. Culture on endometrial biopsy
  7. All other tests are non-specific

What is Gold Test?

The Quanti FERON-TB Gold test (QFT-G) is a whole-blood test for diagnosing Mycobacterium tuberculosis infection, including latent tuberculosis infection (LTBI) and tuber culosis (TB) disease.

Treatment:

  • Treatment is by giving daily therapy of rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) for 2 months followed by daily 4 month therapy of rifampicin (R) and isoniazid (H).
  • Alternatively, 2 months intensive phase of RHZE can be carried on the daily basis by alternate day combination phase (RH) of 4 months. As directly observed treatment of short-course, three weekly dosing throughout the therapy can be given.
  • Surgery is hardly required, just in case of drainage of abscesses.
  • IVF and embryo transfer in women play the important role when fallopian tubes are damaged but the endometrium is healthy. In fact, in patients with damaged tubes due to TB; IVF is needed in most cases after treatment of tuberculosis.
  • Adoption and Surrogacy are recommended to the women, who have the damaged endometrium.

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