Mycobacteria tuberculosis bacilli are the cause of genitourinary tuberculosis (GUTB), which typically occurs in conjunction with lung tuberculosis (TB). The haematogenous route accounts for the majority of the spread. Reactivation of previously dormant tuberculous bacilli is frequently the cause of symptoms in complex infections caused by Mycobacterium tuberculosis. Female genital tuberculosis (FGTB) continues to be a major cause of tubal blockage and infertility, particularly in developing nations. It causes abnormal menstruation and infertility by causing damage to the genital organs. Infertile women with genital TB face a significant risk of complications like ectopic pregnancy and loss even after receiving multimodal treatment for TB.
Secondary pulmonary TB infection is the cause of genital infection. It typically affects immunocompromised individuals and spreads directly via the hematogenous or lymphatic channels. It also occurs in individuals who have been afflicted by chronic illnesses like HIV and coronavirus disease 2019 (COVID-19). During sexual contact with a male partner who has genitourinary TB (GUTB), a rare primary infection, genital TB can be directly transmitted. It has been reported that the infection quickly spread from the vulva, cervix, and vagina.
The majority of cases of genital tuberculosis have been reported in infertile individuals aged 20 to 45. Genital tuberculosis can manifest in a variety of clinical signs, but it is typically asymptomatic and is initially discovered during infertility tests. Infertility is the most common symptom that is seen; Additional symptoms include pain in the pelvic area, abnormal vaginal discharge, and irregular changes in the menstrual cycle (such as hypomenorrhea, heavy menstrual bleeding, dysmenorrhea, and metrorrhagia). It can also be asymptomatic at times.
Causes of infertility
In almost all cases of FGTB, one or both of the fallopian tubes are affected, resulting in infection, inflammation, and tube obstruction. Asherman’s syndrome, which causes continuous endometrial destruction and the development of synechiae inside the uterus, further increases the hostility of the uterine endometrium by increasing levels of tumor necrosis factor (TNF)-alpha and IL-2, resulting in latent FGTB, which causes recurrent implantation failure and miscarriages. TB can also destroy the ovaries and cause oophoritis, a condition in which the ovary has less reserve and needs more gonadotropins to start the ovulation process.
Investigations Imaging techniques for typical structural abnormalities are essential for the diagnosis of tuberculosis, and several tests are used to confirm the infection. The WHO states that a single specimen with a positive culture, a positive histology result, or significant clinical evidence of active extrapulmonary TB is required to confirm the diagnosis of extrapulmonary TB.
FGTB treatment lasts for a total of six months, just like pulmonary TB treatment. Four oral medications—rifampicin (R), isoniazid (H), pyrazinamide (Z), and ethambutol (E)—are given during the first two months of the intensive phase. For the next four months, a three-drug regimen was used in the continuation phase instead of the previous two: isoniazid (I), rifampicin (R), and ethambutol (E). An extended oral regimen for 18 to 20 months or a shorter regimen for at least 9 to 12 months is prescribed for individuals with primary or secondary FGTB who are drug resistant.
Anti-tubercular therapy (ATT) is recommended as a treatment option for FGTB due to the numerous risks associated with surgery. The drainage of the abscess is the only type of limited surgery that can be performed. However, diagnostic laparoscopy and hysteroscopy are carried out initially for diagnosis and later for prognosis prediction. Then, after the TB treatment is finished, more infertility treatment can be given.
Primary TB prevention includes measures to lessen the likelihood of coming into contact with mycobacteria. As a result, patients with pulmonary tuberculosis must be advised to continue receiving the prescribed treatment and to practice good respiratory hygiene both at home and in public settings. Safe sex practices can lower the risk of genital infections, particularly genital tuberculosis. In countries with a high prevalence of tuberculosis, such as India, the BCG vaccine is used as a preventative measure. Although the BCG vaccination can prevent the onset of advanced TB up to 80% of the time, its effectiveness as a preventative measure varies significantly between demographic groups.