Tuberculosis is an infection caused by M. Tuberculosis bacteria. It mainly affects lungs and infection can spread through the blood stream to other organs including the uterus, fallopian tubes and ovaries. It starts with cough that lasts more than 3 weeks, blood in sputum, night sweats, fever, weakness, loss of appetite and weight loss. Being underweight, malnourished increases the risk, people with compromised immunity are more likely to contract it e.g. diabetics, cancer patient, unsanitary living conditions, smoking, alcohol intake all make a person more prone to getting the infection. The WHO TB statistics, 2016 estimates 2.79 million new cases per year of TB for India.
TB can also affect other organs – lymph nodes, spine, intestines, skin. Worryingly it can also affect the uterus, fallopian tubes and the ovaries rendering a woman infertile. 1-2% women seeing a gynaecologist will have Genital TB. The biggest challenge of genital TB is that it remains silent until too late and the chances of natural conception are bleak.
Genital TB primarily affects the Fallopian tubes first and in almost 100 % of cases some degree of tubal damage happens as a result. Thus the egg and the sperm cant meet naturally and infertility results.
The endometrium when affected can get scarred and adhesions can develop inside the uterine cavity making it very difficult for an embryo to implant even in IVF cases.
The ovaries damaged by TB can develop sterile pus filled cysts and eggs will be permanently lost. Premature ovarian failure and menopause may also follow.
Pain in the pelvic area and Irregularity in menstrual cycles on a background of any of the other symptoms described earlier in a woman suffering infertility should warrant investigations for pelvic TB.
Diagnosing pelvic TB is also a challenge as blood, sputum tests, Mantoux and chest X ray may not show anything. We would generally suggest the following tests to diagnose / rule out pelvic TB
Hysteroscopy, laparoscopy and Endometrial biopsy: sometimes tubercles may be seen on the endometrium at hysteroscopy and on the uterus or tubes at laparoscopy and the biopsy can confirm this. Scopy allows us a direct assessment of the degree of damage too.
Culture of menstrual blood: may also be done but is effective only in active fulminant infection and not in cases where healing stage has completed and residual damage has happened.
TB PCR test on blood can be a very sensitive test for detection but is better for active infections.
Treatment is multi pronged and comprises of -
Anti TB medication (AKT / ATT) -- This typically will have to be given for 6 months to up to a year. If started in good time some patients may escape the scarring of TB, but most will be, unfortunately left with residual scarring despite treatment.
Building up on general health – the better the nutrition status and general body weight of a patient the better the recovery from TB. A good diet and nutrition plan helps a great deal.
Reconstructive surgery --- this may sometimes be needed to restore the genital tract to near normalcy. Results of surgery greatly vary depending on the degree of damage caused by the TB infection.
Prevention is better than cure is an adage so very true for TB. Vaccination of all new born children will help them develop antibodies against TB and offer immunity.
Keeping general health and immunity high helps. A healthy lifestyle, proper nutrition and diet, regular exercise, avoiding alcohol and smoking and staying fit, will ward off TB. Good personal hygiene and covering the mouth while coughing, refraining from public spitting will help control spread of the infection.
Early diagnosis and correct treatment is the key to combating TB. It’s best treated by specialists and one should follow the AKT medication protocol diligently for a satisfactory cure.
TB damage to the reproductive tract can be immense. Newer ART – IVF treatments bring hope to patients despite the TB damage. In case where the damage is extensive, donor treatments or surrogacy may be an option as indicated. There is hope of motherhood even after TB.
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