Getting Pregnant

Female Genital Tuberculosis

Genital tuberculosis is a secondary type of infection that stems from primary tuberculosis. Tuberculosis occurs due to the presence of a specific bacterium in the lungs. When this spreads to the other organs like kidneys, pelvic areas, and finally, to the genitals – you get genital tuberculosis. This condition has been known to cause infertility and difficulty conceiving when fully developed. Female genital tuberculosis is a prevalent condition in developing countries.

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What Is Genital Tuberculosis?

Female genital tuberculosis is caused by the agent Mycobacterium tuberculosis. Many patients of genital tuberculosis present with atypical symptoms, which are similar to some gynaecological conditions. The condition is known to cause menstrual irregularities, lower abdominal pain, chronic pelvic pain, and infertility. In vaginal tuberculosis, the bacterium mainly targets the fallopian tubes. TB spreads from the lungs to the pelvis and genital regions and shows low-grade symptoms. It’s a chronic medical condition that also affects the endometrial lining, ovary, and cervix and leads to infertility. What makes TB in the uterus challenging to treat is its increasing resistance to drugs. Genital TB isn’t detected directly but emerges when a woman undergoes medical diagnostic tests only to find out she’s become infertile.

How Does Genital TB Spread?

Genital tuberculosis primarily spreads from the lungs or other organs. This transmission typically occurs through the bloodstream or lymphatic system, and in some cases, it can directly spread from nearby organs such as the bowel or lymph nodes. It’s worth noting that there is a possibility of sexual transmission when a male partner has active genitourinary tuberculosis, and infected semen may play a role in this mode of transmission.

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How fast tuberculosis of the female genital tract spreads depends on whether the bacterium remains active or latent. Latent TB cases could later become active and start spreading, which could happen in any period of 10 to 20 years. Where active TB that becomes genital TB is concerned, it spreads if the victim comes in sexual contact with the infected person. Additionally, if you spend long enough time with the infected person and breathe in the cough they let out, the virus could enter your lungs and infect you. However, brief contact with an infected person with no talking or sharing of things will not make you the target.

Causes of Genital Tuberculosis

The main cause of genital tuberculosis is regular tuberculosis. This ends up spreading to the ovaries and uterus, which leads to scarring and damage to the fallopian tubes. When left untreated, it advances into later stages, and infertility becomes a reality, after which that cannot be reversed, making conception impossible.

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Other causes of genital tuberculosis include having a low immunity coming into contact for a long period of time with infected persons, and breathing in the bacterium.

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Early Symptoms of Genital TB

The early ovarian tuberculosis symptoms go undetected or unnoticed since they are difficult to pinpoint. However, watch out for these signs and do a thorough investigation if you’ve got a nagging suspicion:

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  • Pain in the abdomen and pelvis
  • Pain or bleeding after intercourse
  • Primary infertility, tubal infertility, or being unable to conceive on your first try
  • Abnormal vaginal discharge or bleeding
  • Lack of periods
  • Irregular menstrual cycles
  • In males, genital TB symptoms include irritation, pain in the groin/testicles, pain while urinating, and inflammation
  • Systemic symptoms of genital TB include weight loss, fatigue, and low-grade fever

If any of your family or extended family members have a medical history of genital TB, get yourself medically evaluated to see if you’re infected for early treatment or prevention.

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Diagnosis of Genital Tuberculosis

Your doctor may order the following diagnostic tests for evaluating and staging your genital tuberculosis:

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  • Tuberculin Skin Exam – This method involves inserting antigens (TB protein) into your inner forearm. If your skin has already been exposed to TB, it will react by creating a reddish bump in 2 to 3 days. However, this skin exam doesn’t tell you how long you’ve had TB or if the type is latent or active. It simply detects its presence, and that’s it.
  • Hysteroscopy – This diagnosis method involves inserting a thin tube into your uterus to diagnose if you have any signs of abnormal bleeding in the uterine tube. Hysteroscopy is categorized into operative hysteroscopy and diagnostic hysteroscopy. The former is used to correct any abnormalities found during diagnosis, thus eliminating the requirement for consecutive surgeries. The conditions this procedure corrects are adhesions or bands of scar tissue (tubal scarring) forming in the uterus (which are known to cause infertility), polyp and fibroid growths, and removing some of the uterine linings to prevent abnormal bleeding. Hysteroscopy can also help you determine if you’ve had any defects or malformations in the uterus since birth.
  • Laparoscopy – This is the least invasive procedure out of the options listed above. A surgeon makes tiny incisions on your abdomen to peer into your organs and examine them. A camera scans the images and transmits them over the monitor. The procedure is used to find out and determine the cause of pelvic pain, and biopsy samples are also collected in the process.
  • Cystoscopy – This procedure is used to diagnose genital TB in males. A thin tube is inserted into the urethra to examine the insides of the bladder. Doctors order this exam if males experience urinary problems.
  • Ultrasound scans of the pelvic region – High-frequency sound waves are used to scan the insides of your organs, including the pelvic and genital regions. These do not cause pain and image your affected areas in real time. Although ultrasound scans are used to detect the movement and condition of the fetus in pregnancies, they are also used in the diagnosis of genital TB.
  • A lab analysis of your menstrual blood by collecting a sample
  • Complete blood count test
  • Chest radiographs
  • PCR Test for TB Uterus, which takes a few hours and involves reproducing RNA or DNA sections for analysis
  • Cervical smear tests and endometrial curettage diagnostics

Complications of Genital TB

Complications involved with genital TB include damage to the fallopian tubes, scarring, and structural deformities in the uterus and genital organs. These lead to infertility which means women became unable to conceive, despite treatment with anti-TB medicines. Other complications include tubal malfunctioning, ectopic pregnancies, poor health of the embryo and alterations in the endometrial markers which are a factor for proper embryonic implantation.

Treatment & Management of Genital TB

Genital tuberculosis is treated the same way as other types of tuberculosis. Anti-TB medicines are prescribed to the patient, which runs from six to eight months. The symptoms won’t appear like before once treatment starts because the antibiotics kill the bacterium present in the affected regions.

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Patients get administered anti-TB medicines for up to 8 months, sometimes going up to a year, depending on the severity of the condition. After this treatment, whether or not the fallopian tubes get repaired influences the outcome of pregnancies. In some cases, surgery may be recommended to repair the tubes, while other resorts include Intracytoplasmic Sperm Injections (ICSI) and IVF procedures. Death is a fatal consequence of genital TB when left untreated.

How to Prevent Genital TB Infection?

You can prevent getting a genital TB infection by taking note of the following tips:

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  • Avoid sexual intercourse with partners who have tuberculosis infections. Practice safe sex and hygiene, and always wear female condoms, plus use contraceptives just to be safe.
  • Keep your immunity strong by eating healthy and making sure you get plenty of fruits and vegetables in your meals. Avoid processed foods and eat clean, basically, because it influences the chances of catching infections indirectly when you’re exposed to the outdoor environment.
  • If you are in the early stages of genital TB or TB, don’t hesitate to get treated. Consult a doctor and start taking anti-TB medications before the condition progresses.
  • Start taking a BCG vaccine early on, preferably from the age of 14.

Genital Tuberculosis and Infertility

“Can genital TB affect fertility?” – Yes. Genital tuberculosis leads to infertility, and most women find out they have this condition later when they get medically evaluated to uncover details about their infertility. The best way to prevent getting infertile via genital TB is to get screened every year and stay away from sources of infection. Women should take the BCG vaccine since it’s mandatory for prevention, and it should start from a young age. For sexual partners who have any form of TB, they should get clinically treated and ask the doctor for advice on safe sex practices.

Can I Conceive After Genital TB Treatment?

Yes, you can. There have been cases recorded where severe genital TB conditions were treated all year round with anti-TB medicines. IVF rounds were administered, and embryos from the female patient were frozen for later use. The patient eventually went on to become pregnant and gave birth to a healthy baby with decent weight gain. However, whether you conceive or not after genital TB will depend on how your fallopian tubes and endometrial lining heal. In some cases, anti-TB medicines may not work well, and the doses or rounds have to be increased. Other factors like your lifestyle and nutritional diet also influence how you recover post-treatment. It is important to continue with annual follow-ups even if the chances of relapse are low.

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Not all hope is lost when you are diagnosed with genital TB. You have to be patient and give your genital organs enough time to heal. Sometimes this may require anti-TB therapy for a few months to a year. If you become infertile and your condition doesn’t improve post-treatment, you’ll have to look into other medical options. We recommend going for a second medical opinion to evaluate how it goes. If you have a weak immune system, then your doctor might prescribe you a series of antibiotics before you undergo the listed diagnostic tests. You will also have to keep urine samples aside and should rest after the procedures.

References/Resources:

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1. Sharma. J. B; Current Diagnosis and Management of Female Genital Tuberculosis; J Obstet Gynaecol India.; PubMed Central; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4666212/; December 2015

2. Female Genital Tuberculosis; Radiologic Clinics of North America; ScienceDirect; https://www.sciencedirect.com/topics/medicine-and-dentistry/female-genital-tuberculosis.

3. Sharma. J. B, Sharma. E, Sharma. S, Dharmendra. S; Female genital tuberculosis: Revisited; Indian Journal of Medical Research; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469382/.; December 2018

4. Grace. G. A, Devaleenal. D. B, Natrajan. M; Genital tuberculosis in females; Indian Journal of Medical Research; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5663156/; April 2017

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5. Yadav. S, Singh. P, Hemal. A, Kumar. R; Genital tuberculosis: current status of diagnosis and management; All India Institute of Medical Sciences; Translational Andrology and Urology; https://tau.amegroups.org/article/view/13854/14808; April 2017

6. Tjahyadi. D, Ropii. B, Tjandraprawira. K. D, et al.; Female Genital Tuberculosis: Clinical Presentation, Current Diagnosis, and Treatment; Infectious Diseases in Obstetrics and Gynecology; Hindawi; https://www.hindawi.com/journals/idog/2022/3548190/; November 2022

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7. Kesharwani. H, Mohammad. S, Pathak. P, Tuberculosis in the Female Genital Tract; Cureus; https://www.cureus.com/articles/109199-tuberculosis-in-the-female-genital-tract#!/; September 2022

8. Tzelios. C, Neuhausser. W. M, Ryley. D, et al.; Female Genital Tuberculosis; Open Forum Infectious Diseases, Volume 9, Issue 11; Oxford Academic; https://academic.oup.com/ofid/article/9/11/ofac543/6768037; November 2022

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9. Wang. Y, Shao. R, Chen. L, et al.; Emerging progress on diagnosis and treatment of female genital tuberculosis; Journal of International Medical Research; Sage Journals; https://journals.sagepub.com/doi/10.1177/03000605211014999; May 2021

10. Djuwantono. T, Permadi. W, et al.; Female genital tuberculosis and infertility: serial cases report in Bandung, Indonesia and literature review; BMC Research Notes; https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-017-3057-z; December 2017

Also Read:

Luteal Phase
Polycystic Ovarian Syndrome (PCOS)
Guide to Ovarian Hyperstimulation Syndrome

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This post was last modified on November 29, 2023 10:21 pm

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