Current Diagnosis and Management of Female Genital Tuberculosis

Abstract

Female genital tuberculosis (FGTB) is an important cause of significant morbidity, short-and longterm sequelae especially infertility whose incidence varies from 3 to 16 % cases in India. Mycobacterium tuberculosis is the etiological agent for tuberculosis. The fallopian tubes are involved in 90-100 % cases, endometrium is involved in 50-80 % cases, ovaries are involved in 20-30 % cases, and cervix is involved in 5-15 % cases of genital TB. Tuberculosis of vagina and vulva is rare (1-2 %). The diagnosis is made by detection of acid-fast bacilli on microscopy or culture on endometrial biopsy or on histopathological detection of epithelioid granuloma on biopsy. Polymerase chain reaction may be false positive and alone is not sufficient to make the diagnosis. Laparoscopy and hysteroscopy can diagnose genital tuberculosis by various findings. Treatment is by giving daily therapy of rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) for 2 months followed by daily 4 month therapy of rifampicin (R) and isoniazid (H). Alternatively 2 months intensive phase of RHZE can be daily followed by alternate day combination phase (RH) of 4 months. Three weekly dosing throughout therapy (RHZE thrice weekly for 2 months followed by RH thrice weekly for 4 months) can be given as directly observed treatment short-course. Surgery is rarely required only as drainage of abscesses. There is a role of in vitro fertilization and embryo transfer in women whose fallopian tubes are damaged but endometrium is healthy. Surrogacy or adoption is needed for women whose endometrium is also damaged.

Sacroiliitis preceding disseminated pelvic and peritoneal tuberculosis

“…TB may involve the gynecologic tract by many forms like ovarian tuberculomas, cervical lesions and chronic salpingitis. [21] Symptoms like infertility, dyspareunia, menstrual irregularity, ascites and abdominal mass present on variable fashion. Constitutional complaints may or may not be present.…”

Mesenchymal stem cells of the bone marrow in treatment of genital tuberculosis in rabbits (experimental research with morphological control)

“…Поиск путей восстановления проходимости ма-точных труб и необратимого повреждения эндо-метрия, развивающихся как исход туберкулеза женских гениталий, -важнейшая задача терапии последнего, поскольку генитальный туберкулез яв-ляется важным этиологическим фактором беспло-дия у женщин репродуктивного возраста [9,23,25]. Эта редко встречающаяся патология (с частотой не выше 1-2 % в популяции) протекает латентно, чаще всего в виде туберкулезного сальпингита, под ма-ской какой-либо иной гинекологической патологии, не имеет склонности к генерализации, характерной для многих других форм туберкулеза, распростра-няется главным образом в полость матки (в 50 % случаев).…”

Tuberculosis in Pap samples with emphasis on LBC: Caught only when thought

“…India shares the largest burden of tuberculosis (TB) cases in the world . Despite being a major health problem, the diagnosis of TB remains difficult at unusual sites like the uterine cervix, where it is often confused as malignancy on clinical assessment . Findings of granulomatous inflammation with giant cells in tubercular cervical samples are described in the literature not only on biopsy samples but Pap smears as well .…”

“…1 Despite being a major health problem, the diagnosis of TB remains difficult at unusual sites like the uterine cervix, where it is often confused as malignancy on clinical assessment. 2,3 Findings of granulomatous inflammation with giant cells in tubercular cervical samples are described in the literature not only on biopsy samples but Pap smears as well. 4,5 However, in our experience diagnosis of cervical TB on Pap samples specially LBC samples is not as easy and straightforward as is at other usual locations like lymph nodes or lungs.…”