Tuberculosis is one of the oldest diseases impacting south-east Asian countries including India and Bangladesh, where the bacteria is very rampant.
Female genital tuberculosis is fast emerging as a major health issue that affects fertility levels in women. Up to a decade ago only 10 percent of total tuberculosis patients suffered from genital tuberculosis, but the percentage has now increased to 30 percent due to lack of awareness.
Genital tuberculosis is increasing in incidence among women. It is a major cause of infertility among 25-30% of women in India. However, the diagnosis and treatment of genital tuberculosis remain a challenge.
Usually, tuberculosis first attacks the lungs and then moves on to infect other parts of the body, which could include the genital organs. This is comparatively easier to detect, as lung infection can often be detected by the help of a simple x-ray and can point to the secondary infection in the genital organs.
However, if the disease primarily infects the genital organs the disease is often at an advanced stage if it is detected at all.
One of the major problems is that initially there are no symptoms.
When the disease had advanced it can cause
- Pelvic pain
- Irregular menstrual cycle
- Vaginal discharge that has stained with blood
- Pain after intercourse
- Inability to conceive in females
While in males inability to ejaculate, low sperm motility and pituitary gland not being able to produce sufficient hormones can be seen.
Tuberculosis infection can wreck havoc on the Fallopian tube in females. If not treated at an early stage, it can lead to severe complications. 30% of women with any kind of tuberculosis develop genital tuberculosis out of which 5 to 10 percent develop hydro salpingitis, where water enters the tube, leading to infertility.
The infection can attack the ovaries and uterus along with the Fallopian tubes causing scarring, adhesions and distortions of the structure. If the disease has not treated quickly and adequately, chances of conception in the future become next to nil.
The disease is also becoming more evident among men causing infertility. In almost 50% of infertility cases, tuberculosis is a major reason for infertility. In males, genital tuberculosis causes tuberculous epididymal-orchitis in which the travel of the sperm had blocked leading to infertility.
How does one catch the infection? Brief contacts with infected persons say in a bus, or movie hall, talking or shaking hands will not necessarily infect another. However, if contact with an infected person is close and prolonged and if the immunity is low for any reason, one can contract the disease. Genital TB can also be passed on through sexual contact with an infected person.
Tests for Genital Tuberculosis:
Investigations recommended confirming genital tuberculosis include
- Complete blood count
- Chest radiographs
- Tuberculin test
- The culture of menstrual blood
- Endometrial curettage and a whole host of other tests.
However, a sure shot diagnosis remains a challenge for doctors as most of the tests are not confirmatory in nature.
There are as many false positives as there are tests for genital TB. It is, therefore, advisable to take a second opinion before starting anti-TB medicines as one could end up taking medicines quite uselessly.
Treatment for Genital TB:
The treatment for genital TB is the same as for lung TB or any other form of TB. It is a course of antibiotics that lasts about six to eight months. It is important to complete the entire course of the treatment. While the treatment offers relief from pain, fever or discharge, it cannot repair the fallopian tubes, if they had affected.
If the TB had diagnosed and treatment started early the damage to the uterus or fallopian tubes may heal. If left untreated for long, TB in the fallopian tubes, ovaries and uterus may not heal and lead to scarring.
Scarring of the uterus usually results in scanty periods. In some, the menstrual periods may completely stop because the uterine lining may have badly affected. Unfortunately, in these cases, women may not be able to conceive.
But if detected late, when the damage had already done, women may have to resort to assisted reproduction.