Genital tuberculosis in females

G Angeline Grace, D Bella Devaleenal, Mohan Natrajan, G Angeline Grace, D Bella Devaleenal, Mohan Natrajan

Abstract

The morbidity and mortality due to tuberculosis (TB) is high worldwide, and the burden of disease among women is significant, especially in developing countries. Mycobacterium tuberculosis bacilli reach the genital tract primarily by haematogenous spread and dissemination from foci outside the genitalia with lungs as the common primary focus. Genital TB in females is a chronic disease with low-grade symptoms. The fallopian tubes are affected in almost all cases of genital TB, and along with endometrial involvement, it causes infertility in patients. Many women present with atypical symptoms which mimic other gynaecological conditions. A combination of investigations is needed to establish the diagnosis of female genital TB (FGTB). Multidrug anti-TB treatment is the mainstay of management and surgery may be required in advanced cases. Conception rates are low among infertile women with genital TB even after multidrug therapy for TB, and the risk of complications such as ectopic pregnancy and miscarriage is high. More research is needed on the changing trends in the prevalence and on the appropriate methods for diagnosis of FGTB.

Conflict of interest statement

Conflicts of Interest: None.

Figures

Figure
Figure
Diagnostic algorithm for female genital tuberculosis (FGTB). PID, pelvic inflammatory disease; ESR, erythrocyte sedimentation rate; TST, tuberculin skin test; AFB, acid-fast bacilli; NAAT, nucleic acid amplification test; PCR, polymerase chain reaction.

References

    1. WHO. WHO global tuberculosis report 2016. [accessed on April 27, 2017]. Available from:
    1. Aliyu MH, Aliyu SH, Salihu HM. Female genital tuberculosis: A global review. Int J Fertil Womens Med. 2004;49:123–36.
    1. Namavar Jahromi B, Parsanezhad ME, Ghane-Shirazi R. Female genital tuberculosis and infertility. Int J Gynaecol Obstet. 2001;75:269–72.
    1. Golden MP, Vikram HR. Extrapulmonary tuberculosis: An overview. Am Fam Physician. 2005;72:1761–8.
    1. Sharma JB. Current diagnosis and management of female genital tuberculosis. J Obstet Gynaecol India. 2015;65:362–71.
    1. Gupta N, Sharma JB, Mittal S, Singh N, Misra R, Kukreja M. Genital tuberculosis in Indian infertility patients. Int J Gynaecol Obstet. 2007;97:135–8.
    1. Singh N, Sumana G, Mittal S. Genital tuberculosis: A leading cause for infertility in women seeking assisted conception in North India. Arch Gynecol Obstet. 2008;278:325–7.
    1. Indian Scientists Developing Diagnostic Algorithm for Female Genital TB. Hans India. [accessed on March 18, 2016]. Available from: .
    1. Tripathy SN, Tripathy SN. Infertility and pregnancy outcome in female genital tuberculosis. Int J Gynaecol Obstet. 2002;76:159–63.
    1. Jindal UN. An algorithmic approach to female genital tuberculosis causing infertility. Int J Tuberc Lung Dis. 2006;10:1045–50.
    1. Shaheen R, Subhan F, Tahir F. Epidemiology of genital tuberculosis in infertile population. J Pak Med Assoc. 2006;56:306–9.
    1. Nadgouda SS, Mukhopadhyaya PN, Acharya A, Nagee A, Kunjadia PD. A study on genital tuberculosis and infertility in Indian population. Clin Pract. 2010;2:1.
    1. Khanna A, Agrawal A. Markers of genital tuberculosis in infertility. Singapore Med J. 2011;52:864–7.
    1. Shahzad S. Investigation of the prevalence of female genital tract tuberculosis and its relation to female infertility: An observational analytical study. Iran J Reprod Med. 2012;10:581–8.
    1. Abdelrub AS, Al Harazi AH, Al-Eryani AA. Genital tuberculosis is common among females with tubal factor infertility: Observational study. Alex J Med. 2015;51:321–4.
    1. Das P, Ahuja A, Gupta SD. Incidence, etiopathogenesis and pathological aspects of genitourinary tuberculosis in India: A journey revisited. Indian J Urol. 2008;24:356–61.
    1. Rajamaheswari N. Pelvic tuberculosis. Int J Microbiol. 2008;27:361–3.
    1. Qureshi RN, Samad S, Hamid R, Lakha SF. Female genital tuberculosis revisited. J Pak Med Assoc. 2001;51:16–8.
    1. Arakeri SU, Sinkar P. An unusual gross appearance of vulval tuberculosis masquerading as tumor. Case Rep Obstet Gynecol. 2014;2014:815401.
    1. Sachan R, Patel ML, Gupta P, Verma AK. Genital tuberculosis with variable presentation: A series of three cases. BMJ Case Rep 2012. 2012 pii: Bcr2012006665.
    1. Akbulut S, Arikanoglu Z, Basbug M. Tubercular tubo-ovarian cystic mass mimicking acute appendicitis: A case report. J Med Case Rep. 2011;5:363.
    1. Agrawal S, Madan M, Leekha N, Raghunandan C. A rare case of cervical tuberculosis simulating carcinoma cervix: A case report. Cases J. 2009;2:161.
    1. Lobo FD, Wong MY. Coexistence of benign ovarian serous cystadenoma and tuberculosis in a young woman. Singapore Med J. 2013;54:e154–7.
    1. Kokkayil P, Rawre J, Malhotra N, Dhawan B. Co-infection of Mycoplasma genitalium and Chlamydia trachomatis in an infertile female patient with genital tuberculosis. Indian J Pathol Microbiol. 2013;56:457–9.
    1. Neonakis I, Mantadakis E, Gitti Z, Mitrouska I, Manidakis LG, Maraki S, et al. Genital tuberculosis in a tamoxifen-treated postmenopausal woman with breast cancer and bloody vaginal discharge. Ann Clin Microbiol Antimicrob. 2006;5:20.
    1. Gascón J, Acién P. Large bilateral tubercular pyosalpinx in a young woman with genitourinary malformation: A case report. J Med Case Rep. 2014;8:176.
    1. Güngördük K, Ulker V, Sahbaz A, Ark C, Tekirdag AI. Postmenopausal tuberculosis endometritis. Infect Dis Obstet Gynecol. 2007;2007:27028.
    1. Shirazi M, Shahbazi F, Pirzadeh L, Mohammadi SR, Ghaffari P, Eftekhar T. Tuberculosis endometritis presenting as a leiomyoma. Int J Fertil Steril. 2015;8:481–4.
    1. Zajaczkowski T. Genitourinary tuberculosis: Historical and basic science review: Past and present. Cent European J Urol. 2012;65:182–7.
    1. Bhanothu V, Theophilus JP, Rozati R. Use of endo-ovarian tissue biopsy and pelvic aspirated fluid for the diagnosis of female genital tuberculosis by conventional versus molecular methods. PLoS One. 2014;9:e98005.
    1. Varma TR. Tuberculosis of the female genital tract. Glob Libr Women's Med 2008. [accessed on March 18, 2016]. Available from: .
    1. Chowdhury NN. Overview of tuberculosis of the female genital tract. J Indian Med Assoc. 1996;94:345–6. 361.
    1. Bose M. Female genital tract tuberculosis: How long will it elude diagnosis? Indian J Med Res. 2011;134:13–4.
    1. Hoppe LE, Kettle R, Eisenhut M, Abubakar I Guideline Development Group. Tuberculosis—diagnosis, management, prevention, and control: Summary of updated NICE guidance. BMJ. 2016;352:h6747.
    1. Diagnostic Standards and Classification of Tuberculosis in Adults and Children. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999. Am J Respir Crit Care Med. 2000;161(4 Pt 1):1376–95.
    1. Sengupta VB. Gynaecology for postgraduate and practitioners. India: Elsevier; 2007.
    1. Raut VS, Mahashur AA, Sheth SS. The Mantoux test in the diagnosis of genital tuberculosis in women. Int J Gynaecol Obstet. 2001;72:165–9.
    1. Shah HU, Sannananja B, Baheti AD, Udare AS, Badhe PV. Hysterosalpingography and ultrasonography findings of female genital tuberculosis. Diagn Interv Radiol. 2015;21:10–5.
    1. Ahmadi F, Zafarani F, Shahrzad G. Hysterosalpingographic appearances of female genital tract tuberculosis: Part I. Fallopian tube. Int J Fertil Steril. 2014;7:245–52.
    1. Khalaf Y. ABC of subfertility. Tubal subfertility. BMJ. 2003;327:610–3.
    1. Ahmadi F, Zafarani F, Shahrzad GS. Hysterosalpingographic appearances of female genital tract tuberculosis: Part II: Uterus. Int J Fertil Steril. 2014;8:13–20.
    1. Merchant SA, Bharati AH, Badhe PB. Female genital tract tuberculosis: A review of hysterosalpingographic appearances part 2-the uterus. J Womens Imaging. 2004;6:153.
    1. Netter A, Musset R, Lambert A, Salomon Y, Montbazet G. Tuberculous endo-uterine symphysis; an anatomo-clinical and radiologically characteristic syndrome. Gynecol Obstet (Paris) 1955;54:19–36.
    1. Farrokh D, Layegh P, Afzalaghaee M, Mohammadi M, Fallah Rastegar Y. Hysterosalpingographic findings in women with genital tuberculosis. Iran J Reprod Med. 2015;13:297–304.
    1. Danforth WC. Tuberculosis of the cervix. Ann Surg. 1937;106:407–12.
    1. World Health Organization. Manual of diagnostic ultrasound. Geneva: WHO; 2013.
    1. Khurana A, Sahi G. OC14.04: Ultrasound in female genital tuberculosis: A retrospective series. Ultrasound Obstet Gynecol. 2013;42:28.
    1. Gatongi DK, Gitau G, Kay V, Ngwenya S, Lafong C, Hasan A. Female genital tuberculosis. Obstet Gynaecol. 2005;7:75–9.
    1. Schaaf HS, Zumla A. Tuberculosis: A comprehensive clinical reference. St Louis (MO): Elsevier Health Sciences; 2009.
    1. Sharma JB, Roy KK, Pushparaj M, Kumar S, Malhotra N, Mittal S. Lapar oscopic findings in female genital tuberculosis. Arch Gynecol Obstet. 2008;278:359–64.
    1. Baxi A, Neema H, Kaushal M, Sahu P, Baxi D. Genital tuberculosis in infertile women: Assessment of endomet rial TB PCR results with laparoscopic and hysteroscopic features. J Obstet Gynecol India. 2011;61:301–6.
    1. Mondal SK. Histopathologic analysis of female genital tuberculosis: A fifteen-year retrospective study of 110 cases in Eastern India. Turk J Pathol. 2013;29:41–5.
    1. Altchek A, Deligdisch L, Kase N. Diagnosis and management of ovarian disorders. San Diego (CA): Academic Press; 2003.
    1. Norbis L, Alagna R, Tortoli E, Codecasa LR, Migliori GB, Cirillo DM. Challenges and perspectives in the diagnosis of extrapulmonary tuberculosis. Expert Rev Anti Infect Ther. 2014;12:633–47.
    1. Thangappah RBP, Paramasivan CN, Narayanan S. Evaluating PCR, culture & histopathology in the diagnosis of female genital tuberculosis. Indian J Med Res. 2011;134:40–6.
    1. Kashyap B, Srivastava N, R Kaur I, Jhamb R, K Singh D. Diagnostic dilemma in female genital tuberculosis- staining techniques revisited. Iran J Reprod Med. 2013;11:545–50.
    1. Simon HB, Weinstein AJ, Pasternak MS, Swartz MN, Kunz LJ. Genitourinary tuberculosis. Clinical features in a general hospital population. Am J Med. 1977;63:410–20.
    1. Tortoli E, Cichero P, Piersimoni C, Simonetti MT, Gesu G, Nista D. Use of BACTEC MGIT 960 for recovery of mycobacteria from clinical specimens: Multicenter study. J Clin Microbiol. 1999;37:3578–82.
    1. Goel G, Khatuja R, Radhakrishnan G, Agarwal R, Agarwal S, Kaur I. Role of newer methods of diagnosing genital tuberculosis in infertile women. Indian J Pathol Microbiol. 2013;56:155–7.
    1. Arora S, Merchant R, Allahbadia GN. Reproductive medicine: Challenges, solutions and breakthroughs. New Delhi: JP Medical Ltd; 2014.
    1. Bhanu NV, Singh UB, Chakraborty M, Suresh N, Arora J, Rana T, et al. Improved diagnostic value of PCR in the diagnosis of female genital tuberculosis leading to infertility. J Med Microbiol. 2005;54(Pt 10):927–31.
    1. Shrivastava G, Bajpai T, Bhatambare GS, Patel KB. Genital tuberculosis: Comparative study of the diagnostic modalities. J Hum Reprod Sci. 2014;7:30–3.
    1. Rana T, Singh UB, Kulshrestha V, Kaushik A, Porwal C, Agarwal N, et al. Utility of reverse transcriptase PCR and DNA-PCR in the diagnosis of female genital tuberculosis. J Med Microbiol. 2011;60(Pt 4):486–91.
    1. Bhanothu V, Theophilus J, Lakshmi V, Rozati R, Aiman AV, Rosaline M, et al. Detection of female genital tuberculosis by using endo-ovarian tissue biopsy. Octa J Biosci. 2013;1:98–107.
    1. Arora R, Sharma JB. Female genital tuberculosis – A diagnostic and therapeu tic challenge. Indian J Tuberc. 2014;61:98–102.
    1. Steingart KR, Ramsay A, Dowdy DW, Pai M. S erologic al tests for the diagnosis of active tuberculosis: Relevance for India. Indian J Med Res. 2012;135:695–702.
    1. Raj A, Singh N, Mehta PK. Gene Xpert MTB/RIF assay: A new hope for extrapulmonary tuberculosis. IOSR J Pharm. 2012;2:83–9.
    1. Tripathy SN, Sapkal R. Tuberculosis manual for obstetricians & gynecologists. New Delhi: Jaypee Brothers Medical Publisher (P) Ltd; 2015.
    1. Lee JY. Diagnosis and treatment of extrapulmonary tuberculosis. Tuberc Respir Dis (Seoul) 2015;78:47–55.
    1. WHO. Guidelines for treatment of tuberculosis. Geneva: WHO; 2010.
    1. Standards for TB Care in India : Ministry of Health and Family Welfare. [accessed on March 23, 2016]. Available from: .
    1. Kulshrestha V, Kriplani A, Agarwal N, Singh UB, Rana T. Genital tuberculosis among infertile women and fertility outcome after antitubercular therapy. Int J Gynaecol Obstet. 2011;113:229–34.
    1. Abbara A, Davidson RN. Medscape. Etiology and management of genitourinary tuberculosis. Nat Rev Urol. 2011;8:678–88.
    1. Sharma JB, Sneha J, Singh UB, Kumar S, Roy KK, Singh N, et al. Comparative study of laparoscopic abdominopelvic and fallopian tube findings before and after antitubercular therapy in female genital tuberculosis with infertility. J Minim Invasive Gynecol. 2016;23:215–22.
    1. Bahadur A, Malhotra N, Mittal S, Singh N, Gurunath S. Second-look hysteroscopy after antitubercular treatment in infertile women with genital tuberculosis undergoing in vitro fertilization. Int J Gynaecol Obstet. 2010;108:128–31.
    1. Naredi N, Talwar P, Narayan N, Rai S, Vardhan S, Panda S. Spontaneous conception following anti-tubercular treatment for sub-fertile women with multiple imaging markers suggesting genital tuberculosis. Fertil Sci Res. 2014;1:44–9.
    1. Jindal UN, Verma S, Bala Y. Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. Hum Reprod. 2012;27:1368–74.
    1. Sutherland AM. Surgical treatment of tuberculosis of the female genital tract. BJOG Int J Obstet Gynaecol. 1980;87:610–2.
    1. Sharma JB. In vitro fertilization and embryo transfer in female genital tuberculosis. IVF Lite. 2015;2:14–25.
    1. Sharma JB, Mohanraj P, Roy KK, Jain SK. Increased complication rates associated with laparoscopic surgery among patients with genital tuberculosis. Int J Gynaecol Obstet. 2010;109:242–4.
    1. Tripathy SN, Tripathy SN. Gynaecological tuberculosis - an update. Indian J Tuberc. 1998;45:193–8.
    1. Sharma JB, Mohanraj P, Jain SK, Roy KK. Increased complication rates in vaginal hysterectomy in genital tuberculosis. Arch Gynecol Obstet. 2011;283:831–5.
    1. Botha MH, Van der Merwe FH. Female genital tuberculosis. S Afr Fam Pract. 2008;50:12–6.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren