Genital tuberculosis is almost always secondary to a focus elsewhere in body. Genital tuberculosis is spread through blood stream. In childhood, tubercular peritonitis is frequently due to bovine organism.
The primary infection ascends to the upper genital tract in 1-2% of cases. Infertility is due to either blockage of fallopian tube or due to loss of tubal function even though the tubes are patent.
Signs and Symptoms: Besides infertility, nearly 40% of women suffer from menstrual disorders especially excessive bleeding and 105 complain of secondary amenorrhea, the latter being a sign of extensive endometrial disease. It is also one of the primary causes of post-menopausal bleeding.
Pain is uncommon unless secondary infection sets in. A secondary infection in tuberculous salpingitis is characterized by all the symptoms of pyosalpinx (pus in the Fallopian tubes)- pain, nausea, vomiting and fever.
A tender, fixed mass is felt in the pelvis. If virginal girl suffers from a pelvic inflammatory mass, it is almost always of tuberculous origin. Blood stained vaginal discharge; post-coital bleeding, leucorrhoea and painful ulcer are characteristic features of lower genital tract tuberculosis.
Treatment: Most patients enjoy good health and there is no need for hospitalization. Only those who have fever and abdominal pain are admitted to the hospital in the initial stages of treatment.
The first line of treatment is with anti-tubercular drugs. Isoniazid, rifampicin, pyrazinamide, ethambutol and/or streptomycin are the first line drugs usually given during the initial two-month phase of intensive drugs therapy.
This is followed by a seven to ten months phase of drug therapy with isoniazid and rifampicin only. The success of this regimen is popular worldwide.Surgery is indicated if there is progression of disease, persistent lesion, persistence of large inflammatory masses, i.e., pyosalpinx and pyometra.
Prognosis: Nearly 905 get cured by chemotherapy. Fertility however, is resorted in 105 of cases of those who conceive, 50% have a tubal pregnancy, 20-30% abort. Only 2% of women with genital tuberculosis will have live birth.
Infertility that occurs due to disfigurement of Fallopian tube often requires corrective laparoscopic surgery involving tubal reconstruction. Success rate is poor as healing leads to formation of new adhesions in the tube.