Engaging affected women is key in fighting genital TB

Meaningful community engagement is so central to addressing tuberculosis (TB) of all forms. In preventing, diagnosing and treating genital TB it becomes no less valuable. "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?" said Margaret Namaganda, a noted health advocate. "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" said Kennedy Kassaza from Uganda.

Genital TB can happen to men and women both - but due to already existing gender-based inequalities and other factors, the impact of genital TB is likely to be severe on a woman. 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, Director, Foundation for Medical Research in Mumbai. 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.

An alarming number of women report very late for diagnosis of genital TB which further compounds the problem and also does more damage to her. "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 genital TB, like the symptoms, how its transmitted, and other basic facts. May be it could help to have early diagnosis" said Margaret Namaganda.

"Genital TB in females is found in 0.75 to 1 per cent of gynaecological admissions in India (Arora R Rajaram et al, 1992) with considerable variation from place to place (Varma TR; Genital tuberculosis and subsequent fertility; International Journal of Gynaecology and Obstetrics, 1991)" said Kennedy Kassaza.

The disease is responsible for 5 per cent of all female pelvic infections and occurs in 10 per cent cases of pulmonary TB. Although most of the affected women 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 HIV 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 VK et al, Tuberculosis of the vagina in HIV sero-positive case;1994)" said Kennedy Kassaza.

Genital tuberculosis (TB) is a major cause of tubal infertility. 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. 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. 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 per cent of genital TB in women is post-menopausal.

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.

Raising awareness about genital TB is surely a key. Genuinely 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.

Bobby Ramakant - CNS 

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