Female genital tuberculosis
Tuberculosis (TB) is one of the most common disease worldwide including India. Recent years have seen a resurgence of the disease and the incidence is increasing day by day. Lungs are the most common organs involved but TB is a systemic illness and any organ of the body can be affected. The most common route of entry is through lungs; contrary to common belief it does not spread by touch, close contact or sharing of utensils, etc. The disease is caused by a type of bacteria called Mycobacterium tuberculosis. These bacteria spread by droplet infection. Patient with active disease release bacteria in air during coughing, sneezing, spitting, etc. These bacteria remain suspended in air for long time. Thus, the disease is more common in crowded, dark and unhygienic places. These bacteria enter the body through lungs. From here they can travel to any organ of the body and cause disease in that organ. Female genital organs are one of the common sites to be involved in women.
TB is a chronic disease and bacteria may remain for a long time slowly destroying the organs. The disease may remain totally symptomless or may lead to pelvic pain, fever, menstrual disturbances or vaginal discharge. Sometimes fluid may accumulate in the abdomen. In very advance disease large pus filled masses may form in the tubes or ovaries. Infertility may be caused even by early or minimal disease. Fallopian tubes which transport eggs from the ovaries to the uterus are the most common organs involved and thus block the passages and lead to permanent infertility. It is quite difficult to diagnose genital tuberculosis. The most important test is endometrial biopsy i.e. testing the menstrual blood taken from the uterus. This can be obtained with the help of a thin instrument inserted in the uterus. The material thus obtained is sent to the laboratory for confirmation with conventional culture techniques. The newer tests based on molecular techniques like PCR can pick up 60 – 70 % of cases. This test is positive in only 50 – 60 % of cases. Other tests like X-ray chest, blood test, a skin test (Mantoux test), etc. are helpful but do not definitely prove or exclude the disease. Ultrasound is another test which can give clues to the clinician. Endoscopic procedures i.e. laparoscopy and hysteroscopy, also can pick up the signs of disease and also provide an opportunity to take samples for laboratory testing from various suspicious sites.
Very effective medicines are now available, commonly called antitubercular therapy or ATT. The medicines are very effective in killing the bacteria. The treatment has to continue for a minimum of 6 months. In advanced cases prolonged treatment may be required. However, the drugs can’t repair the damage done by TB. Fallopian tubes which are commonly damaged by the disease remain blocked and function can’t easily be restored even by surgery. All other symptoms like fever, pain, discharge, etc. respond very well to the treatment. For large pus collection which does not respond to medicines, surgical treatment has to be done.
Infertility is the commonest presentation. Almost 60 – 70 % cases of genital TB present with infertility. In India almost 5 % – 10 % of all infertility is caused by genital TB. Medical treatment may restore fertility in early cases while for cases with tubal damage due to TB, IVF – ET (in – vitro-fertilization and embryo-transfer) is the only technique which is successful. A success rate of almost 30 – 40 % cases can be expected.