What is tuberculosis?
Tuberculosis (TB) is an ancient condition that just refuses to go away. It is also called the ‘great mimic’ as it can present with symptoms of many other conditions. It is a bacterial infection caused by Mycobacterium tuberculosis – the same genus that causes leprosy – that primarily affects the lungs.
It has been estimated that each year in India 12 lakh new cases of TB are diagnosed, and about 2.7 lakh people succumb to the illness. According to the statistics released by the Revised National TB Control Programme, the prevalence of TB has been reduced from 465/lakh/year in 1990 to 211/lakh/year in 2013, and the mortality rate has come down from 38/lakh/year to 19/lakh/year during the same period. Still, TB remains a scourge that is difficult to tackle because of its ability to develop multidrug resistance (MDR-TB), and its propensity to affect multiple organs of the body.
What is genital tuberculosis?
Genital TB is that form of the disease that predominantly affects the female genital organs – ovaries, fallopian tubes, uterus, cervix, and vagina – or the surrounding lymph nodes in the pelvis. In men, it can affect the prostate gland and testes; and the kidneys, ureters and urinary bladder in both sexes. It is usually a result of the spread of infection from other parts of the body, most often the lungs. It mainly affects women during the childbearing period and is often detected incidentally during a workup for infertility.
What are the early symptoms of genital TB?
Genital TB can be notoriously difficult to detect in the early stages. A high index of suspicion is required to consider investigating for this condition. This suspicion should be especially aroused if the woman presents with primary infertility (inability to conceive the first time), and gives a history of early exposure to the disease through contact with affected family members. A history of poor overall general condition lasting several months or years, associated with fatigue, low-grade fever, vague lower abdominal discomfort or pain, vaginal discharge, and menstrual irregularities should warrant a thorough investigation to detect the condition.
How is genital TB diagnosed?
A tuberculin skin test can be performed to detect the presence of TB anywhere in the body. Also, depending upon the site of infection, chest X-ray, pelvic ultrasound scan, endometrial curettage, cervical smear examination, menstrual blood analysis and laparoscopic or endoscopic examination of the genital organs may also have to be done to diagnose the condition.
How is genital TB treated?
As per the Directly Observed Treatment (DOTS) scheme, the treatment of genital tuberculosis is given in 2 phases; initial therapy with at least 3 anti-TB drugs for 2 months, and a continuation phase with at least 2 anti-TB drugs for another 4-10 months. Rarely, surgical treatment of the affected genital parts may be required in the advanced stages of the condition, or if there is drug resistance.
It is important to make sure you follow the instructions accurately during the treatment regimen. All the drugs prescribed should be taken regularly for the recommended duration, so as to prevent MDR-TB from developing.
How can genital TB be prevented?
Unfortunately, the rates of infertility remain very high even after a complete course of treatment for genital TB. Genital TB can only be prevented by making sure that no other part of the body is affected by TB. This means that women should take precautions against lung TB even at a young age. Since TB spreads through droplets brought out during coughing and sneezing, it is important to avoid living in close proximity to those with a diagnosed case of lung TB. BCG vaccine should be compulsorily given for all infants, and those from TB endemic areas should undergo screening for the condition. Sexual partners of those affected with genital TB should seek advice on safe-sex techniques.
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