OG27.2 | Genital Tuberculosis — Summary & Reflection

KEY TAKEAWAYS

Genital Tuberculosis — Summary

Aetiology: Mycobacterium tuberculosis; haematogenous spread from primary pulmonary/lymph node focus. India — major burden; common cause of tubal-factor infertility.

Sites (frequency): Fallopian tubes ~90-100% (always bilateral) → endometrium ~50-60% → ovaries ~20-30% → cervix ~5-15% → vulva/vagina (rare).

Clinical presentations: Primary infertility (most common, 45-60%); hypomenorrhoea/amenorrhoea (endometrial TB); chronic pelvic pain; incidental laparoscopic finding. Constitutional symptoms (fever, night sweats, weight loss) present in minority.

Diagnosis (combination required — paucibacillary):
- Endometrial curettage day 21-25 → histopathology (granulomas + Langhans cells + caseation) + AFB culture (LJ/BACTEC)
- CBNAAT/GeneXpert: detects MTB DNA + rifampicin resistance; sensitivity ~60-80%
- Laparoscopy: beaded tubes, miliary tubercles, peritubal adhesions, cold tubo-ovarian mass
- HSG: pipe-stem/beaded tubes, cornual block, calcification, Asherman synechiae
- TST/IGRA: positive = latent/past TB (supportive, not diagnostic)

Management:
- ATT: 2RHEZ + 4RH = 6 months (RNTCP/NTEP Category I)
- Cures bacteria, does NOT reverse structural damage
- Fertility: endometrial TB = 20-40% pregnancy; bilateral tubal block = <5-10%; IVF-ET = realistic option

Prevention: BCG at birth; contact tracing + IPT; early treatment of pulmonary TB.

REFLECT

The woman in the opening scenario has irreversible bilateral tubal block — ATT will clear her infection but she will need IVF to conceive. Her disease began with a primary pulmonary infection years ago, before she even considered pregnancy. Consider how this chain of events — a silent primary TB infection in childhood or adolescence, haematogenous seeding of the fallopian tubes, years of subclinical destruction, and now presentation with infertility — illustrates the long shadow that untreated or under-diagnosed TB casts over a woman's reproductive life. Reflect on how the same conversation about ATT, fertility prognosis, and IVF referral would need to be handled sensitively in your clinical setting. What are the social and psychological dimensions of an infertility diagnosis in a young married woman in rural India? How does this case make you think about the importance of TB control as a women's health issue? Document your reflections.