In females, TB (tuberculosis) most commonly refers to genital tuberculosis, a chronic infection affecting the reproductive organs. It is a significant cause of infertility.
Understanding Genital TB
Genital TB in women is typically a secondary infection, meaning it spreads from a primary site of TB infection, usually the lungs, through the bloodstream or lymphatic system. While less common in developed countries, it remains a significant health concern in areas where pulmonary TB is prevalent.
Affected Organs
The fallopian tubes are most commonly affected (almost always), followed by the endometrium (lining of the uterus). Other organs that can be involved include:
- Uterus: Endometritis (inflammation of the uterine lining) is frequent.
- Ovaries: Less frequently affected, but can lead to tubo-ovarian masses.
- Cervix and Vagina: Rarely involved.
Symptoms
Genital TB often presents with vague or atypical symptoms, making diagnosis challenging. Common symptoms include:
- Infertility: A primary reason for seeking medical attention.
- Pelvic pain: Often chronic and nonspecific.
- Menstrual irregularities: Including amenorrhea (absence of menstruation), oligomenorrhea (infrequent menstruation), or menorrhagia (heavy menstruation).
- Vaginal discharge: May be present.
- Postmenopausal bleeding: Could occur if the endometrium is involved in postmenopausal women.
- Weight loss and fever: Less common, but possible, especially if the primary TB infection is active.
Diagnosis
Diagnosing genital TB can be difficult due to the nonspecific symptoms. Diagnostic methods include:
- Endometrial Biopsy: The most common and effective method. A sample of the uterine lining is taken and examined for the presence of TB bacteria or granulomas (small collections of immune cells characteristic of TB).
- Hysterosalpingography (HSG): An X-ray procedure using dye to visualize the uterus and fallopian tubes. It can reveal abnormalities such as tubal blockages or hydrosalpinx (fluid-filled fallopian tubes).
- Laparoscopy: A surgical procedure in which a small incision is made in the abdomen and a camera is inserted to visualize the pelvic organs. Biopsies can be taken during laparoscopy.
- Polymerase Chain Reaction (PCR): PCR testing can detect the presence of TB DNA in tissue samples or menstrual blood.
- TB Culture: Culturing the bacteria from menstrual blood or endometrial tissue is another method of detection.
Treatment
The treatment for genital TB is the same as for pulmonary TB: a course of anti-tuberculosis medications, typically lasting six to nine months. Early diagnosis and treatment are crucial to prevent long-term complications, such as infertility. Surgical intervention may be necessary in some cases, particularly if there are tubo-ovarian abscesses or significant scarring.
Impact on Fertility
Genital TB can severely impair fertility by:
- Damaging the fallopian tubes: Leading to blockages that prevent fertilization.
- Damaging the endometrium: Preventing implantation of a fertilized egg.
- Causing adhesions: Scar tissue that can distort the pelvic organs.
