Genital tuberculosis major cause of tubal infertility in women

Genital tuberculosis (TB) is a major cause of tubal infertility, said Mamta Jacob of Global Health Advocates (GHA) at a meeting on importance of addressing TB in context of women's health in New Delhi, India, to mark the International Women's Day (8th March). Only two per cent of women with genital TB have live births. It is usually asymptomatic so needs higher degree of suspicion so that proper diagnosis can be made and standard treatment provided as early as possible, said Dr Nerges Mistry, Director, The Foundation for Medical Research, Mumbai, who was another keynote speaker at the above mentioned meet.

Genital TB is responsible for infertility in 5-10 per cent of women. In Australia, 1 per cent infertility in women is attributed to genital TB but in India, 19 per cent infertility in women is attributed to genital TB, said Dr Nerges Mistry.

Also the impact of genital TB is more severe on lives of women because mostly genital TB impacts women of age group 15-35 years. Only 10% of genital TB in women is post-menopausal, said Dr Nerges Mistry.

Women with genital TB present with bleeding discharge, ulcers, among other symptoms if any. Genital TB is always hard to diagnose, because of the fact that it is a silent invader of the genital tract. For diagnosing genital TB, AFB smears, polymerase Chain Reaction (PCR) tests, CT or MRI scanning or ultrasound might be used as appropriate, said Dr Nerges Mistry. The treatment of genital TB is same in case of drug-susceptible TB - 6 months of WHO recommended directly observed treatment shortcourse (DOTS). However, 2 per cent of genital TB cases are likely to be of multidrug-resistant TB (MDR-TB). Surgery might be required if medicines fail said Dr Nerges Mistry.

The solution lies in early case detection and providing standard treatment for genital TB. Sadly if women with genital TB are diagnosed late, the infertility risk and other harm done to their tissue are likely to be much more severe.

In 2008, 3.6 million women were sick with TB. "Compared to pregnant women without TB disease, pregnant women with TB have more severe impact on pregnancy outcomes. Rates per 1000 pregnancies of low birth weight (< 2.5 kg) for women without TB is 165, and for women with TB is double at 342; for prematurity (< 37 weeks) the rate for women without TB is 111 and for those with TB is 228 (twice); for perinatal death, the rates for women without TB is 16, but for those with TB is nearly five times higher at 101; for foetal death (16-28 weeks), the rates for women without TB is 2, but for those with TB is nearly ten times higher at 20" said Mamta Jacob.

Raising awareness about genital TB is surely a key. Engaging women with TB or who have successfully completed TB treatment as equal partners in addressing the challenge posed by genital TB will go a long way in saving human agony, morbidity and lives.

2 comments:

  1. Margaret Namaganda15 March, 2011

    I would wish to take this opportunity to thank you all for the tireless efforts you are making to fight TB. For sure the issue of genital TB caused me to flashback on the number of women who have had several miscarriages, and despite the investigations the cause is still unknown! Could this be Genital TB?

    As we think of creating awareness on genital TB, I think there is a great need to build capacity of the non-medical personnel that implement health related programs to equip them with basic knowledge on this kind of TB, like the symptoms, how its transmitted, and other basic facts. May be it could help to have early diagnosis.

    Thanks and the effort continues.

    Margaret Namaganda
    Email: margaretnamaganda@yahoo.com

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  2. Kennedy Kassaza, Uganda17 March, 2011

    I would like to thank everyone who has given the precious time to this cause of addressing genital TB, this is a global fight and we must all join hands, all peoples of the world!

    The magnitude of this problem is enormous, in most cases, Genital TB has caused a lot of suffering amongst the population without being noticed, and in most cases blamed on other causes, below are some important facts to note:

    Genital tuberculosis (TB) in females is found in 0.75 to 1% of gynaecological admissions in India (*Arora R.. Rajaram et al, 1992.38.311*) with considerable variation from place to place (*Varma T.R.; Genital tuberculosis and subsequent fertility; In J Gynecol Obstet 1991,35*).

    The disease is responsible for 5% of all female pelvic infections and occurs in 10% cases of pulmonary tuberculosis. Although most of the affected belong to reproductive age-group, the disease has been reported in postmenopausal females as well.

    Lately, an increase in the trend of the disease has been reported which may be partly due to increase in the population with overall rise in tuberculosis cases. The other contributory factor may be H1V infection with increased incidence-of pulmonary and extra-pulmonary forms of tuberculosis including the drug resistant forms. A rare case of vaginal tuberculosis in an HIV seropositive female had been earlier reported by the author (Arora V.K. et al,*Tuberculosis of the vagina in an H I V sero-positive case;1994.75,239*).

    Kennedy Kassaza, Uganda
    Email: kennedy.kass@gmail.com

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