Skip to main content

Advertisement

SpringerLink
Log in

Current Diagnosis and Management of Female Genital Tuberculosis

  • Invited Review Article
  • Published:
The Journal of Obstetrics and Gynecology of India Aims and scope Submit manuscript

Abstract

Female genital tuberculosis (FGTB) is an important cause of significant morbidity, short- and long-term sequelae especially infertility whose incidence varies from 3 to 16 % cases in India. Mycobacterium tuberculosis is the etiological agent for tuberculosis. The fallopian tubes are involved in 90–100 % cases, endometrium is involved in 50–80 % cases, ovaries are involved in 20–30 % cases, and cervix is involved in 5–15 % cases of genital TB. Tuberculosis of vagina and vulva is rare (1–2 %). The diagnosis is made by detection of acid-fast bacilli on microscopy or culture on endometrial biopsy or on histopathological detection of epithelioid granuloma on biopsy. Polymerase chain reaction may be false positive and alone is not sufficient to make the diagnosis. Laparoscopy and hysteroscopy can diagnose genital tuberculosis by various findings. Treatment is by giving daily therapy of rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) for 2 months followed by daily 4 month therapy of rifampicin (R) and isoniazid (H). Alternatively 2 months intensive phase of RHZE can be daily followed by alternate day combination phase (RH) of 4 months. Three weekly dosing throughout therapy (RHZE thrice weekly for 2 months followed by RH thrice weekly for 4 months) can be given as directly observed treatment short-course. Surgery is rarely required only as drainage of abscesses. There is a role of in vitro fertilization and embryo transfer in women whose fallopian tubes are damaged but endometrium is healthy. Surrogacy or adoption is needed for women whose endometrium is also damaged.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Dye C, Watt CJ, Bleed DM, et al. Evolution of tuberculosis control and prospects for reducing tuberculosis incidence, prevalence and deaths globally. JAMA. 2005;293:2790–3.

    Article  Google Scholar 

  2. World Health Organization. Global tuberculosis control: a short update to the 2009 report. WHO/HTM/TB 2009, 426. Geneva: WHO; 2009.

  3. WHO Report on the TB epidemic. TB a global emergency. WHO/TB/94.177. Geneva: World Health Organization; 1994.

  4. TB India 2014. Revised National Tuberculosis Control Programme (RNTCP) Status Report. Central TB Division, Directorate General of Health Services. Ministry of Health and Family Welfare. Nirman Bhavan, New Delhi, India. www.tbcindia.nic.in.

  5. Kumar S. Female genital tuberculosis. In: Sharma SK, Mohan A, editors. tuberculosis. 3rd ed. Delhi: Jaypee Brothers Medical Publisher Ltd.; 2015. p. 311–24.

    Google Scholar 

  6. Neonakis IK, Spandidos DA, Petinaki E. Female genital tuberculosis: a review. Scand J Infect Dis. 2011;43:564–72.

    Article  PubMed  Google Scholar 

  7. Schaefer G. Female genital tuberculosis. Clin Obstet Gynaecol. 1976;19:223–39. 1985; 237(suppl):197–200.

  8. Sharma JB. Tuberculosis and obstetric and gynecological practice. In: Studd J, Tan SL, Chervenak FA, editors. Progress in obstetric and gynaecology, vol. 18. Philadephia: Elsevier; 2008. p. 395–427.

    Google Scholar 

  9. Oosthuizen AP, Wessels PH, Hefer JN. Tuberculosis of the female genital tract in patients attending an infertility clinic. S Afr Med J. 1990;77:562–4.

    CAS  PubMed  Google Scholar 

  10. Tripathy SN, Tripathy SN. Infertility and pregnancy outcome in female genital tuberculosis. Int J Gynecol Obstet. 2002;76:159–63.

    Article  Google Scholar 

  11. Jindal UN. An algorithmic approach to female genital tuberculosis causing infertility. Int J Tuberc Lung Dis. 2006;10:1045–50.

    CAS  PubMed  Google Scholar 

  12. Parikh FR, Nadkarni SG, Kamat SA, et al. Genital tuberculosis—a major pelvic factor causing infertility in Indian women. Fertil Steril. 1997;67:497–500.

    Article  CAS  PubMed  Google Scholar 

  13. Gupta N, Sharma JB, Mittal S, et al. Genital tuberculosis in Indian infertility patients. Int J Gynecol Obstet. 2007;97:135–8.

    Article  CAS  Google Scholar 

  14. Singh N, Sumana G, Mittal S. Genital tuberculosis: a leading cause for infertility in women seeking assisted conception in North India. Arch Gynecol Obstet. 2008;278:325–7.

    Article  PubMed  Google Scholar 

  15. Neonakis IK, Gitti Z, Krambovitis E, Spandidos DA. Molecular diagnostic tools in mycobacteriology. J Microbiol Methods. 2008;75:1–11.

    Article  CAS  PubMed  Google Scholar 

  16. Duggal S, Duggal N, Hans C, Mahajan RK. Female genital TB and HIV co-infection. Indian J Med Microbiol. 2009;27:361–3.

    Article  CAS  PubMed  Google Scholar 

  17. Sharma JB, Pushparaj M, Gupta N, et al. Genital tuberculosis: an important cause of Asherman’s syndrome in India. Arch Gynecol Obstet. 2008;277:37–41.

    Article  PubMed  Google Scholar 

  18. Sharma JB, Malhotra M, Pundir P, et al. Cervical tuberculosis masquerading as cervical carcinoma: a rare case. J Obstet Gynaecol Ind. 2001;51:184.

    Google Scholar 

  19. Sharma JB, Sharma K, Sarin U. Tuberculosis: a rare cause of rectovaginal fistula in a young girl. J Obstet Gynaecol Ind. 2001;51:176.

    Google Scholar 

  20. Sharma JB, Jain SK, Pushparaj M, et al. Abdomino-peritoneal tuberculosis masquerading as ovarian cancer: a retrospective study of 26 cases. Arch Gynecol Obstet. 2010;282:643–8.

    Article  PubMed  Google Scholar 

  21. Koc S, Beydilli G, Tulunay G, et al. Peritoneal tuberculosis mimicking advanced ovarian cancer: a retrospective review of 22 cases. Gynecol Oncol. 2006;103:565–9.

    Article  PubMed  Google Scholar 

  22. Dwivedi M, Misra SP, Misra V, et al. Value of adenosine deaminase estimation in the diagnosis of tuberculous ascites. Am J Gastroenterol. 1990;85:1123–5.

    CAS  PubMed  Google Scholar 

  23. Jeffry L, Kerrou K, Camatte S, et al. Peritoneal tuberculosis revealed by carcinomatosis on CT scan and uptake at FDG-PET. Br J Obstet Gynecol. 2003;110:1129–31.

    Article  Google Scholar 

  24. Sharma JB, Karmakar D, Kumar R, et al. Comparison of PET/CT with other imaging modalities in women with genital tuberculosis. Int J Gynecol Obstet. 2012;118:123–8.

    Article  Google Scholar 

  25. Sharma JB, Malhotra M, Arora R. Fitz-Hugh–Curtis syndrome as a result of genital tuberculosis: a report of three cases. Acta Obstet Gynecol Scand. 2003;82:295–7.

    Article  PubMed  Google Scholar 

  26. Sharma JB, Roy KK, Gupta N, et al. High prevalence of Fitz-Hugh–Curtis Syndrome in genital tuberculosis. Int J Gynecol Obstet. 2007;99:62–3.

    Article  CAS  Google Scholar 

  27. Sharma S. Menstrual dysfunction in non-genital tuberculosis. Int J Gynecol Obstet. 2002;79:245–7.

    Article  CAS  Google Scholar 

  28. Malhotra N, Sharma V, Bahadur A, et al. The effect of tuberculosis on ovarian reserve among women undergoing IVF in India. Int J Gynecol Obstet. 2012;117:40–4.

    Article  Google Scholar 

  29. Sharma JB, Karmakar D, Hari S, et al. Magnetic resonance imaging findings among women with tubercular tubo-ovarian masses. Int J Gynecol Obstet. 2011;113:76–80.

    Article  Google Scholar 

  30. Sharma JB, Pushparaj M, Roy KK, et al. Hysterosalpingographic findings in infertile women with genital tuberculosis. Int J Gynecol Obstet. 2008;101:150–5.

    Article  Google Scholar 

  31. Bhanu NV, Singh UB, Chakraborty M, et al. Improved diagnostic value of PCR in diagnosis of female genital tuberculosis leading to infertility. J Med Microbiol. 2005;54:927–31.

    Article  CAS  PubMed  Google Scholar 

  32. Grosset J, Mouton Y. Is PCR a useful tool for the diagnosis of tuberculosis in 1995? Tubercl Lung Dis. 1995;76:183–4.

    Article  CAS  Google Scholar 

  33. Jindal UN, Verma S, Bala Y. Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. Hum Reprod. 2012;27:1368–74.

    Article  CAS  PubMed  Google Scholar 

  34. Sharma JB, Roy KK, Pushparaj M, et al. Hysteroscopic findings in women with primary and secondary infertility due to genital tuberculosis. Int J Gynecol Obstet. 2009;104:49–52.

    Article  Google Scholar 

  35. Sharma JB, Roy KK, Pushparaj M, et al. Increased difficulties and complications encountered during hysteroscopy in women with genital tuberculosis. J Minim Invasive Gynecol. 2011;18:660–5.

    Article  PubMed  Google Scholar 

  36. Sharma JB, Roy KK, Pushparaj M, et al. Laparoscopic finding in female genital tuberculosis. Arch Gynecol Obstet. 2008;278:359–64.

    Article  PubMed  Google Scholar 

  37. Sharma JB, Mohanraj P, Roy KK, et al. Increased complication rates associated with laparoscopic surgery among patients with genital tuberculosis. Int J Gynecol Obstet. 2010;109:242–4.

    Article  Google Scholar 

  38. Mittal S, Sharma JB. Dilemmas in diagnosis of female genital tuberculosis. In: Mukherjee GG, Tripathy SN, Tripathy SN, editors. Gential tuberculosis. 1st ed. Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2010. p. 83–91.

    Google Scholar 

  39. Arora R, Rajaram P, Oumachigui A, et al. Prospective analysis of short course chemotherapy in female genital tuberculosis. Int J Gynecol Obstet. 1992;38:311–4.

    Article  CAS  Google Scholar 

  40. American Thoracic Society. Centers for Disease Control and Prevention, Prevention/Infectious Diseases Society of America. Controlling tuberculosis in United States. Am J Respir Crit Care Med. 2005;172:1169–227.

    Article  Google Scholar 

  41. National Institute for Health and Clinical Excellence. Tuberculosis. Clinical diagnosis and management of tuberculosis, and measures for its prevention and control. Clin Guidel 33. 2006. www.nice.org.uk/CGO33.

  42. Sharma JB, Mohanraj P, Jain SK, et al. Increased complication rates in vaginal hysterectomy in genital tuberculosis. Arch Gynecol Obstet. 2011;283:831–5.

    Article  PubMed  Google Scholar 

  43. Sharma JB, Mohanraj P, Jain SK, et al. Surgical complications during laparotomy in patients with abdominopelvic tuberculosis. Int J Gynecol Obstet. 2010;110:157–8.

    Article  Google Scholar 

  44. Sharma JB, Naha M, Kumar S, et al. Genital tuberculosis: an important cause of ectopic pregnancy in India. Indian J Tuberc. 2014;61(4):312–7.

    PubMed  Google Scholar 

  45. Dam P, Shirazee HH, Goswami SK, et al. Role of latent genital tuberculosis in repeated IVF failure in Indian clinical settings. Gynecol Obstet Invest. 2006;61:223–7.

    Article  PubMed  Google Scholar 

  46. Malik S. IVF and tuberculosis. In: Mukherjee GG, Tripathy S, Tripathy SN, editors. Gential tuberculosis. 1st ed. Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2010. p. 135–40.

    Google Scholar 

  47. Samanta J, Goswami SK, Mukherjee GG, et al. Gestational surrogacy in gential tuberculosis. In: Mukherjee GG, Tripathy S, Tripathy SN, editors. gential tuberculosis. 1st ed. Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2000. p. 141–54.

    Google Scholar 

  48. Tripathy SN, Tripathy SN. Tuberculosis Manual for Obstetricians and Gynaecologists. 1st ed. Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2015. p. 249–65.

    Google Scholar 

Download references

Acknowledgments

I am thankful to Prof. Alka Kriplani, Prof. S Kumar, faculty and residents of Obstetrics and Gynecology at AIIMS, New Delhi, and Dr. Sangeeta Sharma (National Institute of Tuberculosis and Respiratory Diseases, New Delhi, for their help in preparing this manuscript. I am also thankful to Sona Dharmendra, Senior Research Fellow (AIIMS), Dr Asmita (SRF, AIIMS) and Mr. Pawan Kumar for their help in data, typing and writing of manuscript.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Jai B. Sharma Professor, MD FRCOG (London) FAMS

Authors
  1. Jai B. Sharma Professor, MD FRCOG (London) FAMS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jai B. Sharma Professor, MD FRCOG (London) FAMS.

Ethics declarations

Conflict of interest

There is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharma, J.B. Current Diagnosis and Management of Female Genital Tuberculosis. J Obstet Gynecol India 65, 362–371 (2015). https://doi.org/10.1007/s13224-015-0780-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13224-015-0780-z

Keywords

Search

Navigation