Relevance of semen polymerase chain reaction positive for tuberculosis in asymptomatic men undergoing infertility evaluation

Abstract

OBJECTIVE:Male partners of infertile women with genital tuberculosis (TB) are often screened for genital TB. We aimed to evaluate the clinical significance of a positive screening semen polymerase chain reaction (PCR) for Mycobacterium tuberculosis test (TB-PCR) in asymptomatic men undergoing infertility evaluation and determine the need for a detailed investigation and treatment for TB.MATERIALS AND METHODS:Between March 2012 and January 2013, male partners of 15 infertile women with a diagnosis of genitourinary TB (GUTB) as the cause of infertility, tested positive either on semen PCR for TB (13 cases), or Mycobacterium Growth Indicator Tube-960 test (2 cases). These asymptomatic men underwent infertility evaluation along with evaluation for GUTB. Diagnosis of GUTB was based on standard clinical criteria, which included a high index of suspicion along with clinical, laboratory, and/or radiological evidence of GUTB. Men who had no clinical evidence of GUTB were followed up with clinical evaluation, semen analysis, and repeat semen PCR for TB after 6 months.RESULTS:Fourteen subjects consented for inclusion in the study. One had a history of pulmonary TB 20 years earlier. Another patient was found to have mediastinal lymphadenopathy (tubercular). All except one had a normal semen analysis. None of the patients met the standard clinical criteria for GUTB diagnosis. 8 patients followed up at 6 months with repeat semen analysis, which was similar to the baseline values and no clinical evidence of TB.INTERPRETATION AND CONCLUSIONS:Asymptomatic men with positive screening semen PCR for TB do not have clinical evidence of TB. Male partners of women with infertility and GUTB should not be screened if they have no symptoms.

Genital tuberculosis: current status of diagnosis and management

“…At least 3 but 5 or more samples should be collected and plated within 40 min of collection ( 6 ). But the search of Mycobacterium in semen or EPS samples by these methods is often futile even in diagnosed cases of genital Tb or may be incidentally positive in clinically asymptomatic men undergoing infertility analysis ( 42 ). All other obtainable body fluid specimens from possible sites of infection, such as pus from epididymal or prostatic abscess and discharge from penile lesion or perineal or scrotal sinuses, must be subjected to smear, culture and possibly PCR for detection of bacilli.…”

“…All patients presenting for infertility evaluation must be thoroughly examined, but if there are no features suggestive of genital Tb, extensive laboratory workup in form of semen and EPS smear, culture and PCR is probably not required ( 53 ). Also, although venereal transmission is documented, male partners of females with genital TB with a normal examination and semen analysis should not be evaluated further for genital Tb ( 42 ). Such an extensive search is probably not beneficial, as in patients with azoospermia, no further improvement is expected in semen parameters post anti-tubercular therapy and in patients with normal semen parameters or in those previously treated for Tb, a positive PCR may be indicative of a latent infection or residual DNA of killed bacteria.…”

Adnexal torsion caused by tuberculous pyosalpinx: An uncommon case report of urogenital tuberculosis

“…UGTB is most often the result of blood or lymphatic transmission from latent primary infection primarily from the lungs or other organs, but sometimes directly from adjacent organs (intestine or lymph node) [3] , [4] . It can rarely be sexually transmitted through semen infected with active genitourinary tuberculosis in the male partner [6] , [7] . Our patient was probably infected by her father, then she may have developed a latent primary infection for years which then spread to the genital tract, the sexual route being eliminated because of her virginity.…”