Genital tuberculosis caused by the Mycobacterium tuberculosis bacteria in women is rampant across the country.
According to an ICMR study, the prevalence of female genital tuberculosis (FGTB) increased from 19% in 2011 to 30% in 2015.
“Most of the time, the bacteria remains latent in the body and flares up only when the immunity is low,” says Dr. Priti Arora Dhamija, Consultant Obstetrician-Gynecologist & Fertility Expert at Sitaram Bhartia Hospital.
“Genital tuberculosis remains unidentified for long periods of time because of its asymptomatic nature. When women do show symptoms, they are usually in the form of scanty periods (less flow), pain during intercourse (dyspareunia), vaginal discharge and infertility. These symptoms are not specific to genital tuberculosis and are associated with other gynecological conditions, which makes the condition hard to diagnose.”
How is genital tuberculosis detected?
To specifically diagnose genital tuberculosis, your doctor will suggest a few investigations and tests primarily if you are unable to conceive within six to twelve months.
- X-ray, which is used to evaluate any signs of an old TB infection.
- Hysterosalpingography (HSG) in women, in which a dye is injected into the uterus and fallopian tubes to evaluate any blockages or a ragged uterine cavity. “HSG is a crude modality for diagnosis and may also sometimes worsen the TB.”
- Ultrasound is helpful in observing fluid in the abdomen, bowel inflammation, hydrosalpinx (retort shaped fallopian tubes) or enlarged lymph nodes.
- Endometrial biopsy wherein a small sample of the endometrium lining of the uterus is taken and evaluated. It is a simple procedure that can be done in the OPD.
- Genexpert, which is a test based on a new technology.
The Mantoux or Tuberculin Skin Test (TST), CBC and ESR tests are not specific tests for the diagnosis of tuberculosis as they only detect inflammation.
It is possible for a patient to test positive for Tuberculosis even if she has been vaccinated at birth.
“It is difficult to grow the bacteria in the lab conditions, which is why investigations are not very helpful.”
“We make it a point to ask detailed questions to understand whether an immediate family member is suffering from TB , whether the patient has been exposed to a carrier or has a history of ectopic pregnancies, which may raise the suspicion of TB.”
Diagnosis of Tuberculosis in Men
“Like in women, Genitiurinary (GU) Tuberculosis in men is usually dormant for a long period after exposure. It usually presents between 20 – 40 years,” says Dr. Anurag Puri, Consultant, Urology at Sitaram Bhartia.
A urine culture and Acid-fast bacilli (AFB) test as well as PCR for mycobacterium may be advised to diagnose GU TB.
Amongst the imaging tests, an ultrasound is suggested to assess the presence of hydronephrosis in the kidney or a small capacity thimble bladder, wherein the bladder has a limited capacity which is why patients frequently go to the toilet (with TB).
“If all these tests are inconclusive then an endoscopic biopsy is performed.”
“The earlier genital tuberculosis is detected, the more likely it is to respond to treatment,” says Dr. Priti.
Is genital tuberculosis curable?
Yes. When genital tuberculosis is suspected/confirmed in a patient, she/he is recommended anti-tuberculosis treatment (ATT). The medications for TB may affect the functioning of the liver, which makes close monitoring essential.
“The proper usage of masks due to the coronavirus pandemic may help lower the transmission of airborne Tuberculosis.”
What is the treatment for genital tuberculosis?
The initial phase of treatment must have atleast 3 drugs, comprising medicines which have different effects on the bacteria. The recommended modes of treatment include anti-tuberculosis medications for a duration of six to nine months.
Women with a mass in the pelvic region or constant pain and heavy bleeding may be suggested surgery.
Men may have to undergo surgery in case they do not respond to medical methods or in the case of abscess formation.
“In GU TB patients, the ureters may have to be stented before starting TB treatment because drugs can cause the ureters to narrow,” says Dr. Anurag.
Untreated tuberculosis poses problems for those trying to conceive, which is why you should get medical help as soon as possible.
How does genital tuberculosis affect fertility?
Genital tuberculosis affects the male reproductive organs (testicles) and prevents the sperm from mixing into the semen, which is needed for fertilization.
It can cause the epididymis (tube near the testicles) to swell up leading to a condition known as epididymitis. The spermatic cord that supports the testes in the scrotum may also become beaded. These conditions can obstruct the passage of the sperms, and lead to infertility.
In females, GTB mostly affects the fallopian tubes, uterus and sometimes the ovaries, and hence interferes with conception in the following ways.
Fallopian tubes, which may get scarred in Tuberculosis and hinder the fertilized egg from travelling into the uterus or may prevent the egg from getting fertilized at all.
“The fallopian tubes are affected in 90% of women suffering from Genital tuberculosis.”
Uterus in which the bacteria destroy the endometrium lining which is necessary for implantation of the fertilized egg. The uterus isn’t able to hold the fertilized egg in place, and so pregnancy does not occur. A long-standing infection can also damage the uterine cavity such that it causes Amenorrhea (complete cessation of menses).
Ovary where one or both ovaries are affected and may result in a condition called ‘Premature Ovarian Failure’. The ovaries stop functioning properly before the age of 40, produce less estrogen and may not release eggs. If released, the eggs may be of poor quality and may not be suitable for fertilization.
Cervix, vagina or vulva, where any infection or large masses may obstruct the sperm from entering the uterus and fallopian tubes leading to infertility.
Can I get pregnant if I have tuberculosis?
The chances of spontaneous conception vary greatly from 31 to 59% as per studies.
Women who receive anti-tuberculosis treatment in time show better conception rates but have a possibility of still births, ectopic pregnancy or abortions.
Women who are unable to conceive after treatment are recommended assisted reproductive techniques (ART) to improve their chances of having a baby.
“When a couple comes to us with conception problems, we treat the underlying condition and guide them towards attaining pregnancy naturally. Only after we have given them a fair trial at that, or in case the recommended treatment does not help, do we suggest ART, “ says Dr. Priti.
“ART involves a broad spectrum of techniques, many of which help overcome the difficulties posed by genital tuberculosis.”
In the case of blocked fallopian tubes, for example, if surgery does not help clear the tubes, we may suggest IVF as the tubes are bypassed.
When implantation isn’t possible due to a hostile uterus, surrogacy becomes an option.
If the ovaries aren’t producing mature eggs, we may suggest egg donation.
Multiple options exist for male infertility too.
In case the sperm is of low motility or fewer in number, Intracytoplasmic Sperm Injection (ICSI) could be considered. Through this, a single sperm is injected into an egg.
Therapeutic Donor Insemination (TDI) is proposed when sperm is of poor quality and not fit for fertilization. Donor sperm is injected into the uterus around the time of ovulation.
TESE/TESA may be suggested for blocked spermatic cord/ epididymis where semen has no sperms (azoospermia) but testes has sperms.
“The best outcomes occur when genital tuberculosis is diagnosed early and treated on time, which is why it is important to watch out for symptoms,” shares Dr. Priti.
“Women may experience weight loss, severe and persistent tiredness, low grade fever and menstrual irregularities apart from problems in conception. Men on the other hand may feel swelling or pain in the testicles or frequent urination, blood in urine, weight loss and fever, which are characteristic of TB.”
Is genital TB communicable?
Genital TB may spread through sexual contact.
Tuberculosis can be prevented through the BCG vaccine which is given soon after birth in India. Research shows it is upto 80% effective but the efficacy varies from individual to individual.
“Don’t lose hope because you can have a baby provided you seek medical help early and begin treatment before the condition aggravates,” reassures Dr. Priti.
Learn more about Fertility Services at Sitaram Bhartia
This article has been medically reviewed by
Dr. Priti Arora Dhamija, MBBS, MD, DNB (Obstetrics & Gynecology)
Dr. Anurag Puri, MBBS. MS (General Surgery)
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