Female Genital Tuberculosis: Clinical Presentation, Current Diagnosis, and Treatment

Abstract

Female genital tuberculosis is a disease caused by Mycobacterium tuberculosis infection in the female reproductive tract. The disease burden among women leads to infertility is significant, especially in developing countries. The bacteria can spread from the lung into the reproductive organ through lymphatic or hematogenous. Many patients present with atypical symptoms, which mimic other gynecological conditions. Several investigations are needed to establish the diagnosis. Almost all cases of genital TB affect the fallopian tube and cause infertility in patients and endometrial involvement. Current treatment still relies on antituberculosis therapy with a combination of tubal surgery. The present review describes the epidemiological data, clinical presentation, diagnosis, and currently available treatment to cure the disease and for in vitro fertilization.

Genital tuberculosis, infertility and assisted reproduction

“…Genitourinary TB is a common form of extrapulmonary TB (EPTB) worldwide (27%) with GTB alone accounting for 9% of all EPTB cases [4 ▪▪ ,5]. The reported prevalence of FGTB in infertile women in the United States is 1%, whereas it is as high as 20% in certain South Asian countries such as India and Pakistan, where the infection is endemic [5].…”

“…Mycobacterium tuberculosis (MTB) typically affects the lungs; however, it can also spread to other sites including the lymph nodes, pleura, bones, joints, meninges, and urogenital tract. Genital TB (GTB) is a form of extrapulmonary tuberculosis and female GTB (FGTB) is an important cause of female infertility in endemic areas of the world [4 ▪▪ ].…”

“…Although FGTB can affect women of any age, 75% of clinical cases are described in women of reproductive age (20–45 years). Clinical presentation of FGTB can be varied with presentation ranging from asymptomatic to infertility (43–74%), oligomenorrhea (54%), amenorrhea (14%), dysmenorrhea (12%–30%), abdominal pain (42.5%), menorrhagia (19%), dyspareunia (5–12%), and even as postmenopausal bleeding (2%) [4 ▪▪ ,5].…”

“…Indeed, infertility is seen in up to 40–80% of cases of FGTB. Distortion and obstruction of fallopian tubes, involvement of the endometrium with resulting disorders of endometrial receptivity, destruction of normal endometrium and resulting intrauterine synechiae, defective ovarian function caused by involvement of the ovaries in tubo-ovarian inflammatory phlegmon formation, and destruction of normal ovarian tissues with resulting compromise to ovarian reserve has all been described as mechanisms contributing to FGTB-related infertility [4 ▪▪ ,5].…”

Tuberculosis in Regional Australia: Ectopic Pregnancy Complicating Indolent Genital Tract Disease

“…In men, it often produces a painless scrotal mass. In women, it may present as changes to menstruation or abnormal vaginal discharge [3,4] but more often remains hidden, diagnosed by serendipity as part of the investigations for infertility [5].…”