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Yes, genital TB can lead to infertility in both men and women as it affects the genital organs. In female, it affects fallopian tubes, cervix, uterus, vagina, ovaries and the pelvis lymph nodes. While in men, it affects the prostate gland and testes, ureters, urinary bladder and kidney.
Since thousand years, Tuberculosisexists in the developing countries like India. It has plagued many and surged great epidemics by behaving like other infectious diseases. Tuberculosis is a serious bacterial infection which directly affects the lungs along with the other body partsbecause of Mycobacterium tuberculosis bacteria. The bacteria areresponsible for causingtuberculosis spread from one person to another through the released tiny droplets into the air while sneezing and coughing. It means it can easily spread from infected person to someone else who is not infected.
What is Pulmonary Tuberculosis?
Pulmonary Tuberculosis isa type of tuberculosis, which is caused because of contagious bacterial infection in lungs. Once you are infected with TB, it moves through blood to the other parts of the body. Most of the people recover from primary TB infection without any further disease evidence. This infection might stay inactive for years while in some cases it can get active again.
TB further causes secondary infections in the kidney, genital tract, pelvic area, spine and brain. When the bacterium reaches the genital tract it causes genital tuberculosis or pelvic TB. In both male and female, it affects the genital tract, uterus, fallopian tubes and ovaries. While in other cases it might also affect the cervix, vagina and vulva.
What is Genital Tuberculosis?
The female age group which are prone to this disease are between the age of 20 and 40 years. Genital TB is responsible for infertility in 5-10% of all women around the globe.It affects the reproductive organs of females like fallopian tube, ovary, uterus etc. In men, it affects the prostate gland and testes, kidneys, ureters and urinary bladder (in both male and female). It mainly affects the women during pregnancy and is usually detected incidentally during infertility treatment.
How does TB affect fertility?
Although the initial exposure to tuberculosis is through the lungs as bacillus is inhaled but most of us fight the disease and it remains inactive in the body, causing no harm. But sometimes, the latent bacilli reactivate and spread through the blood stream into the entire body. It can get deposited in any part of the body causing infection. It comes into picture,when it can get deposited and infects the genital tract to cause infertility.
- In males, it causes tuberculous epididymo-orchitis which blocks the passage and hence leads to azoospermia (where no sperm enters the semen because of the blocked tract) in males.
- In case of women, it causes tuberculous endometritis (uterus infection) and salpingitis (tubes infection)which lowers the chance of conception.
- If fallopian tubes get affected due to TB, then it causes structural and functional damage which also includes tubal obstruction.
- Uterus TBcan cause damage tothe inner lining called the endometrium which results in scanty periods and infertility. While in some situations, the menstrual periods may completely stop due to the badly affected uterine lining.
The TB is diagnosed by performing the culture of the tubercle bacillus from the tissue and then it is sent to the lab for testing.
What are the symptoms of Genital TB?
Being a silent infection, Genital TB shows no apparent symptoms because the bacteria may remain inactive in the body for 10 to 20 years. However, there are some of the symptoms to look out:
- Systemic symptoms such as Fatigue, Weight loss and Low grade fever
- Menstrual Disturbances
- Amenorrhea (Absence of periods)
- Menorrhagia (Heavy bleeding at menstruation)
- Metrorrhagia (Abnormal bleeding from the uterus)
- Oligomenorrhea (Infrequent periods)
- Swelling in lower abdomin
- Postcoital bleeding
- Vaginal Discharge
- Dyspareunia (Painful intercourse)
Sometimes, due to lack of undetectable symptoms, it becomes difficult to diagnose genital tuberculosis. The doctor will advise you to go for diagnosis after seeing your above mentioned symptoms and signs.
Diagnosis of TB
Analysis is done to confirm the genital tuberculosis where the test includes
- Complete blood count
- Chest radiographs
- Tuberculin test
- Endometrial curettage
- Menstrual blood for the culture
- Culture for Mycobacterium tuberculosis
- Histological examination
- Peritoneal fluid for culture
- Peritoneal biopsy for culture and histology
- Cervical cytology
How to detect Tubal Scarring?
There are several ways of detecting the tubal involvement.
- Sonography: It helps in detecting the pus in the tubes.
- Hysterosalpingography: It helps in diagnosing the blocked tubes.
- Laparoscopy: It provides direct visualization of tubes and helps in taking biopsyfrom suspected lesions.
- TB-PCR: It is a new test for diagnosing tuberculosis. In this test, a tissue is taken from the endometrium or the uterus’s inner lining which is then cultured for detecting the genetic makeup of bacteria.
- For assisting in the diagnosis process, routine blood tests like CBC and ESR are done.
If a patient has started the use of anti-tubercular drugs in the early phase of disease then there are chances of minimizing the permanent damage.
But if the disease is detected at the later stagethen it is advised to resort to assisted reproduction depending upon extent of damage to the genital parts.
Visit a gynaecologist if you don’t have any of the above symptoms and confirm whether you are able to conceive. You need to get yourself diagnosed if you are unable to get pregnant within six months of trying actively for a baby.
And if you notice any of the above signs then it is better to treat genital tuberculosis as early as possible.
Treatment Options for genital TB
- Genital TB treatment includes a course of antibiotics and medication which lasts for about 6 to 9 months. To minimize the high chances of infection relapsing, it is important to complete the entire course of the treatment.
- Once the TB is detected and initiated early, then it is possible to deal with the problem with the right treatment. But if the diagnosis is performed late, then there can be severe and irreversible damage to the reproductive system. Once the anti-TB treatment courseis completed then there are good chancesof conceiving as any other infertile person.
Genital TB is the cause of infertility among 10% women and doesn’t show any symptoms at all. There are high chances of abortion even if a woman conceives. So, early detection followed bystandard treatmentcan solve the problem. But if diagnosed late, there are chances of reproductive system damage. And once the woman starts the anti-TB treatment course for 6 to 9 months, her pregnancy chances are high in comparison to the infertile women.
Couples who are looking forward to pregnancy and trying for more than 6 months with no positive results are advised to go through Genital TB test. Also, get to know trying to conceive tips to fasten your process of conceving.
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