Genital Tuberculosis and Infertility

Tuberculosis (TB) is a rampant disease in developing countries like India. Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis and can affect any part of the body, but most often affects the lungs. The primary infection in the lungs is known as pulmonary tuberculosis. TB infection moves through the blood to other parts of the body. It can thus cause secondary infections in the genital tract, pelvic area, kidneys, spine, and brain. When the bacterium reaches the genital tract, it causes genital tuberculosis or pelvic TB. It affects the genital tract (in men and women), fallopian tubes, uterus, and ovaries. It also affects the cervix, vagina, and vulva in some cases. Genital tuberculosis is one of the major causes of tubal disease and female infertility in developing countries. Women between the age of 20 and 40 years are most susceptible. Genital TB is responsible for infertility in 5-10% of women.

When the infection invades the reproductive system (the genital tract), it commonly affects the fallopian tubes and uterus in females and testes and epididymis in males, thereby lowering the chances of conception. When TB affects the fallopian lines, it can cause structural and functional damage, including tubal obstruction. TB of the uterus can cause scarring of the inner lining called the endometrium resulting in scanty periods and infertility. The menstrual periods may completely stop in some because the uterine lining may be badly affected.

The only way to diagnose this TB is by culturing the tubercle bacillus from the tissue and sending it to the lab for testing. While it takes time to grow in the lab, and by the time it shows positive signs, the patient will arrive at an advanced stage.

Genital TB is usually a silent infection with no apparent symptoms as the bacteria may remain latent in your body for as long as 10 to 20 years. However, some of the signs to watch out for include:

• irregular menstrual cycle

• lower abdominal pain

• blood-stained vaginal discharge

• bleeding after intercourse

• infertility

Sometimes, the lack of symptoms makes it difficult to diagnose genital tuberculosis. Quiet often genital TB is an incidental finding while doing infertility workups. Investigations include hysteroscopy, laparoscopy, ultrasonography, Menstrual blood for culture for Mycobacterium tuberculosis organism, Endometrial curettage, Histologic examination, Chest X-ray, and blood test like Complete blood count.

The treatment for genital TB includes antibiotics that last about 6-9 months. It is essential to complete the entire course of medicine. Otherwise, it has a high chance of relapse.

Early detection and initiation of TB treatment could deal with the problem. If the diagnosis is late, the damage to the reproductive system could be much more severe and irreversible. Once anti-TB treatment is completed, the chance of conceiving is as good as any other infertile person.