A Ten year Clinicopathological Study of Female Genital Tuberculosis and Impact on Fertility

Santosh Kumar Mondal,Tk Dutta

doi:10.31729/jnma.202

Abstract

To determine the histological pattern of involvement, clinical presentation, impact on fertility in women with genital tuberculosis. A total number of 68 cases of gynaecological tuberculosis affecting different parts of female genital tract from 56 patients were selected. The age range of the patients was 17-36 years with mean age of 25.6 years. The diagnostic procedures used included endometrial curettage and biopsy, histopathological examination, culture and Mycobacterium Tuberculosis Polymerase Chain Reaction (MTB PCR), laparoscopy, Hysterosalpingography (HSG) and Ultrasonography (USG). Most of the specimens received were biopsies of endometrial curettage for evaluation of infertility. In 7 cases, specimens of total hysterectomy with bilateral salpingo-oophorectomy were submitted with lesions involving multiple sites. Patients presented with infertility (65-70%), pelvic/abdominal pain (50-55%), and menstrual disturbances (20-25%). Tuberculosis involved the endometrium in 55.88%, tubes in 23.53%, ovaries in 14.71% and cervix in 5.88% of the 68 cases. The endometrium(38 cases)was in the proliferative phase in 31 cases (81.57%), secretory phase in 4 cases (10.52%) and it was atrophic in 3 cases (7.89%).Caseation was present in 9 out of 68 cases and Ziehl-Neelsen (ZN) stain revealed Acid Fast Bacilli (AFB) in tissue sections in only 4 cases . After therapy, 9 patients conceived of which 8 suffered spontaneous abortions. Only one patient had a successful pregnancy and the baby was born through caesarean section. Genital tuberculosis is an important cause of female infertility in developing countries like India, Nepal, Bangladesh and Pakistan. Successful uterine pregnancy is rare after treatment and chances of ectopic pregnancy are high.

Highlights

To determine the histological pattern of involvement, clinical presentation, impact on fertility in women with genital tuberculosis
Total 68 case of genital tuberculosis were observed in the ten year duration of study
Genital tuberculosis is an important cause of female infertility, especially in developing countries like India, Nepal, Bangladesh, and Pakistan

Summary

Introduction

To determine the histological pattern of involvement, clinical presentation, impact on fertility in women with genital tuberculosis. Genital tuberculosis (TB) predominantly affects individuals below 40 years of age and peak age frequency ranges between 21 to 30 year of age.[1] The disease is responsible for 5% of all female pelvic infections and occurs in 10% cases of pulmonary tuberculosis. Gupta et al, studied 40 infertile women with genital tuberculosis and found pulmonary tuberculosis in 9 of them and positive Mantoux test results in two Mondal et al A Ten year Clinicopathological Study of Female Genital Tuberculosis and Impact on Fertility patients.[2] Tuberculosis of female genital tract uncommon in western world, is still prevalent in developing countries like India, Pakistan.[3] Most cases were detected in infertile women in the reproductive age group and sterility was the predominant motive for consultation.[4,5]. Sexual transmission of the disease is documented but direct spread from other intraperitoneal foci is very rare

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Discussion

Conclusion