What is Genital Tuberculosis (TB)?
It is an infectious disease caused by 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
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:
For female genital tuberculosis, 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 for female 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 of Genital Tuberculosis:
Following are Some Methods of Diagnosis:
- Histopathological test for the epithelioid granuloma on biopsy
- Polymerase chain reaction(PCR) false positive alone is not sufficient to make the diagnosis
- Diagnoses of genital tuberculosis through Laparoscopy and Hysteroscopy can be done by various findings.
- TB gold test
- The diagnosis is made by detection of acid-fast bacilli on microscopy
- Culture on endometrial biopsy
- 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 tuberculosisinfection, 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 Altruistic Surrogacy are recommended to the women, who have the damaged endometrium.
What is MOTT disease?
Mycobacteria Other Than Tuberculosis (MOTT) are mycobacteria which do not cause tuberculosis or leprosy but can cause other pulmonary diseases that resemble tuberculosis. These bacteria do not cause any problem and live as commensals. But they do interfere with treatment of infertility. Once detected, we treat them for nine months or till the patient is free of the bacteria and only then we start IVF treatment.
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