Emerging progress on diagnosis and treatment of female genital tuberculosis

Abstract

Female genital tuberculosis (FGTB) is an infection caused by Mycobacterium tuberculosis and usually occurs secondary to pulmonary tuberculosis (TB) through the blood circulation, lymph circulation, or direct spreading from abdominal TB. FGTB is an uncommon type of TB that can destroy genital organs, and lead to menstrual disorders and infertility. The diagnosis of FGTB is often made by detection of acid-fast bacilli under microscopy, culture with endometrial biopsy, or histopathological examination of epithelioid granuloma on a biopsy. A multidrug anti-TB regimen is the major management of FGTB, including rifampicin, isoniazid, pyrazinamide, and ethambutol, while surgery is proposed in more deteriorated cases. However, the conception rate in infertile women with FGTB is still low, even after multidrug anti-TB therapy. Additionally, the risk of complications, such as ectopic pregnancy or miscarriage, remains high. In this review, we summarize the characteristics of FGTB, present current epidemiological data, and focus on its early diagnosis and effective management.

Left pleural effusion in a young woman with genital tuberculosis

“…It is a rare form of extrapulmonary TB in Europe, but a common cause of infertility in countries with a high incidence of disease. Salpinx and endometrium are the most frequently involved organs [7,8]. During the last years, intensified migration flows from Africa to Europe have raised the number of extrapulmonary TB cases, which may be characterized, in low TB incidence countries like Italy, by unusual clinical presentations [9].…”

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“…Newer vaccines, diagnostics and drugs (such as bedaquiline, delamanid) and stem cell therapy are being developed and tested. 13,15,26,27,29,47,[51][52][53]…”

Female Genital Tuberculosis Can Cause Infertility in Women or Not?

“…For the treatment of female genital tuberculosis, multidrug therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol is used, while in more severe cases, surgery is recommended [5]. However, even after using multidrug therapy, infertile women with genital tuberculosis are less likely to be fertilized, and if they do become pregnant, the consequences of pregnancy such as ectopic pregnancy or miscarriage remain high [5].…”

“…For the treatment of female genital tuberculosis, multidrug therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol is used, while in more severe cases, surgery is recommended [5]. However, even after using multidrug therapy, infertile women with genital tuberculosis are less likely to be fertilized, and if they do become pregnant, the consequences of pregnancy such as ectopic pregnancy or miscarriage remain high [5]. Since, untreated tuberculosis causes extrapulmonary tuberculosis, preventative measures such as BCG vaccination at birth, identification of people with tuberculosis, early diagnosis, and treatment of tuberculosis can prevent extrapulmonary tuberculosis [2].…”