About Tuberculosis (TB) of the Genital Tract
When Tuberculosis affects the genital organs like the uterus and fallopian tubes in females, it is known as genital tuberculosis. In India, it is very common, seen in up to 24% of patients coming for IVF and up to 49 % of patients with problems with their fallopian tubes requiring IVF.
Those who have never conceived and those who have one or more children may suffer from genital TB. 40-80% of females with Genital TB face difficulty in getting pregnant.
What causes Genital Tuberculosis?
Tuberculosis is caused by bacteria Mycobacterium tuberculosis.
What causes Genital TB?
- Spread of TB from lungs and other sites through blood or lymph
- Direct spread from infection in the abdomen from gut loops etc.
What sites are affected in Genital TB?
- Fallopian tubes are affected by 100% of women. Usually, both tubes are affected. Due to infection, there may be the formation of scar tissue and the tubes get blocked. The tubes, ovaries, and uterus, etc may also get stuck together.
- Uterus: The lining of the uterus is affected in 70% of women. First ulcers are formed, later the shape of the uterine cavity gets distorted and the lining is destroyed. So the walls of the uterus get stuck together. That’s why the periods stop.
What are the causes of difficulty in conceiving after Genital TB?
- The lining of the uterus is affected so the embryo doesn’t implant
- Egg development is poor
- Tubes are damaged because of-
- Blockage of tubes
- Ovaries and tubes get stuck together
- Tubes get filled with fluid or pus forming Hydrosalpinx which affects the embryo and ovaries.
- Cilia are damaged.
What symptoms you may have with Genital tuberculosis?
Up to 10 % of women have no symptoms
General Symptoms- You may have
- Low-grade fever
- Loss of weight
- Loss of appetite
Menstrual Problems like:
- Heavy menstrual bleeding in the beginning and delayed/scanty periods later on.
- Complete stoppage of menses in some women
- Difficulty in conceiving
- Pain in pelvis
- Pain during intercourse
- Vaginal infection
- Sometimes severe pain in the lower tummy area
How will your doctor confirm that you have genital Tuberculosis?
History: First the doctor will try to understand your history
- if you have any old history of Tuberculosis yourself or in your family,
- any features related to TB
Check Up: The doctor will check you to look for
- Any fever
- Lymph nodes may be enlarged in size
- Particular breath sounds
- Any features of TB in bones/skin
- You may have a lump in your belly
- Abdomen/Belly may be enlarged or distended.
- The lump may be felt on pelvic examination
- The uterus may be increased in size.
- to check blood counts and ESR
- Serological tests for TB are not recommended now.
- X-ray chest
- Mantoux test- Not very sensitive
- CT scan
- Hysterosalpingogram- it is not done in a known case of genital TB as the infection may flare up if undiagnosed. HSG may show bilateral block or calcification.
- Endometrial biopsy- A small piece of tissue is taken from the uterus and tested for TB bacteria by various methods.
- Endoscopy- A keyhole surgery can be done to check the status of the uterus and tubes. Adhesions and scar tissue in the uterus can be removed.
What is the treatment process for Genital tuberculosis?
- Antitubercular treatment for genital tuberculosis is available for treating tuberculosis. The course generally lasts from 6-8 months.
- You need to adhere to the course of treatment and complete it.
- Take proper diet at the time.
- Report to the doctor, if you have any side effects.
- Surgery may be required to drain any pus collection. Surgery for repairing the tubes is generally not recommended as the surgery may lead to flare up of disease and there are increased chances of having an ectopic pregnancy.
How can you conceive after treatment of Genital Tuberculosis?
- If your uterus and tubes are healthy and there are no other problems, you may conceive naturally also.
- If your fallopian tubes are blocked you will require IVF or test tube baby treatment.
If your uterus is scarred and unhealthy you might require Hysteroscopic surgery for breaking adhesions or surrogacy to help you conceive.