Tuberculosis (TB) is a major public health problem worldwide despite a declining trend in mortality, with effective diagnosis and treatment.
About 60 percent of TB cases and deaths occur among males, but the disease burden is high among women also. Genital TB in females is well recognized as an important aetiological factor for infertility in countries with a high prevalence of TB.
Genitourinary TB is a common form of extrapulmonary TB (EPTB) worldwide (27%) with genital TB alone accounting for 9 percent of all EPTB cases. However, the burden of genital TB in females is underestimated as most of the patients are asymptomatic and usually diagnosed during evaluation for infertility.
Genital TB is mostly secondary to pulmonary TB or extrapulmonary foci such as kidneys, meninges, skeletal system, and gastrointestinal system. TB bacilli infect the genital tract by four routes – hematogenous route (with lungs as the common primary focus), descending direct spread, lymphatic spread, and rarely as primary infection of the genitalia through sexual transmission.
Tuberculosis affects the female genital organs, especially the fallopian tubes, and thereby causes infertility. The genital organs affected by Mycobacterium tuberculosis (in descending order of frequency) are as follows: fallopian tubes (95-100%), uterine endometrium (50-60%), ovaries (20-30%), cervix (5-15%), uterine myometrium (2.5%) and vagina/vulva (1%).
It can occur in any age group, but women in the reproductive age group (15-45 years) are the most affected. In most cases, the disease is asymptomatic or can present with a few symptoms among which infertility is the most common.
Menstrual irregularities such as oligomenorrhoea, hypomenorrhea, amenorrhoea, menorrhagia, dysmenorrhoea, metrorrhagia, pelvic pain, and abnormal vaginal discharge are the other symptoms reported to it. In postmenopausal women, genital TB presents with symptoms resembling endometrial malignancy, such as postmenopausal bleeding, persistent leucorrhoea, and pyometra.
Genital TB can mimic or coexist with other gynecological and abdominal pathologies such as genital carcinomas, acute appendicitis, ovarian cysts, PID, or ectopic pregnancy. Genital TB is a major cause of infertility in women, and prevalence is generally underestimated because of the asymptomatic nature of the infection and diagnostic challenges.
Clinicians need to be aware of this important cause of infertility and menstrual dysfunction in women. Screening for genital TB needs to be a part of an evaluation of infertility and menstrual abnormalities. Early diagnosis and correct treatment are vital to avoid complications and restore fertility.