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World Tuberculosis Day: Female genital tuberculosis and fertility

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Tuberculosis (TB) is one of the most widely spread diseases with one-quarter of the world’s population already under its grasp. In the last five years, the number of women battling genital TB has increased by more than 10 percent. The morbidity and mortality cases due to tuberculosis have been increasing at a rapid pace worldwide, and the epidemic among women is significant.

Female genital tuberculosis (FGTB) is a form of tuberculosis that primarily affects the female reproductive system. The most common site of extrapulmonary TB in women is genital TB, which can affect the fallopian tubes, uterine lining, ovaries, cervix, and vagina/vulva.

Tuberculosis and fertility

Tuberculosis often affects the lungs, but it can also infect the kidneys, and gastrointestinal tract, brain, and pelvic (genital) organs. In women, genital TB can affect the fallopian tubes and uterus, as well as the endometrium lining, and cause uterine wall adhesion, a condition known as Asherman’s syndrome. It infects the fallopian tubes, leading to fallopian tube blockage. Genital tuberculosis also affects the uterine lining, resulting in endometrium thinning and scant menstruation.

genital tuberculosis
Tuberculosis may be more harmful to your vagina than you think! Image Courtesy: Shutterstock

Genital tuberculosis is said to be a silent killer as its symptoms generally go undetected and manifest very late, often much later than required. Hence, It is critical to treat genital TB as soon as it is discovered. Genital tuberculosis can also result in ectopic pregnancy. If left untreated, tuberculosis can cause preterm labor, low birth weight, ectopic pregnancy, and increased neonatal mortality.

How female genital tuberculosis can be diagnosed?

Female genital tuberculosis is a difficult disease to diagnose, as it can mimic many other reproductive system disorders. Weight loss, fatigue, pelvic pain, abnormal vaginal discharge, and mild fever are common symptoms, as well as no menstrual bleeding or abnormally heavy bleeding, and infrequent menstrual periods. Some women with genital TB may experience symptoms such as irregular periods, blood stained vaginal discharge, pain during intercourse, and chronic pelvic pain.

Also read: World TB Day: How to differentiate between a common cough and tuberculosis?

A combination of examinations is required to make the diagnosis of female genital tuberculosis. One way to diagnose FGTB is through a tuberculin skin test or Mantoux test. This test involves injecting a small amount of TB antigen under the skin and monitoring the reaction. A positive test result indicates exposure to TB, but it does not confirm FGTB. Other diagnostic tests include chest X-rays, CT scans, and endometrial biopsies.

An endometrial biopsy and menstrual blood culture can aid in the diagnosis of genital tuberculosis. Along with these producers, laparoscopy can also assist in understanding the damage to the genital organs. All of these methods are intended to detect active tubercles. Tubercles are nodules that contain caseous necrosis, which is common in tuberculosis patients. All of these procedures aid in the detection of bacteria in places such as the uterus and tubes.

Treatment of female genital tuberculosis

Early detection of primary tuberculosis can reduce infertility and the extent of genital tract damage. Therefore, it is crucial to initiate treatment for genital TB as soon as it is detected.

genital tuberculosis
Female genital tuberculosis can increase the risk of infertility. Image courtesy: Shutterstock

According to the World Health Organisation (WHO), TB patients are recommended to receive a six-month regimen containing rifampicin (R): a two-month intensive phase with isoniazid (H), R, ethambutol (E), and pyrazinamide (Z), followed by a four-month continuation phase with HR. TB patients may receive a daily intensive phase followed by a thrice weekly continuation phase.

Moreover, the main treatment for FGTB includes multiple drug therapy in adequate doses and duration. A 6-9 month course of combination therapy is also an effective medical treatment for FGTB.

For women with blocked tubes, the best choice of treatment is In Vitro Fertilization and Embryo Transfer (IVF-ET). Women with a thin uterine lining or Asherman’s syndrome may require hysteroscopy before beginning an IVF cycle. Several studies illustrate that the most successful IVF treatment for women with genital TB has been embryo transfer.

How to reduce the risk of female genital tuberculosis?

Being on the lookout for signs of infection such as an irregular menstrual cycle, swelling in the genital area, vaginal discharge with blood, bleeding, or pain after intercourse help reduce the infection from escalating further as it is completely curable within 6-9 months of treatment if detected in the early stages. Adopting safe sexual practices and receiving vaccines can help both men and women avoid infection. Furthermore, well-ventilated rooms, natural light, and good hygiene practices are required to prevent infection.

It is crucial to understand that although medicines for tuberculosis can eradicate the bacterial infection but cannot reverse the damage it has caused, hence being vigilant and alert about the early signs of TB infection and gaining knowledge is important to ensure undertaking the right steps and directions in the future.

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