Genital tuberculosis in women

Abstract

A study has been made of 325 cases of genital tuberculosis in women. A history of previous extragenital tuberculosis was obtained in 177 of these, and 77 further patients showed radiological or bacteriological evidence of such conditions. Of 294 married patients, only 38 gave a history of previous pregnancy.The principal complaints were infertility in 142 cases, abdominal pain in 76 cases, uterine bleeding in 48 cases, amenorrhea in 26 cases, and vaginal discharge in 19 cases. Of the 325 cases in the series, the endometrium was involved in 318, the Fallopian tubes only in 5, and the cervix only in 2.Diagnosis was based initially on the histological findings, but bacteriological confirmation was usually sought and has so far been obtained in 198 cases. The organism has so far been typed in 147 cases, all of these being of the human type.Thirty-eight control patients with endometrial infection were observed for one year without treatment. In 79 per cent the infection persisted or recurred or treatment was required during the control year because of clinical deterioration.One hundred sixty-five patients with endometrial tuberculosis were treated with streptomycin and PAS, and 67 per cent remained negative after an average follow-up period of 31 months. An additional 70 patients with endometrial involvement were treated with streptomycin and isoniazid, and 84 per cent remained negative after an average follow-up period of 25 months. PAS and isoniazid were used in 50 other patients with involvement of the endometrium. Of 29 who were followed for an average period of 16 months, all have so far remained negative. Toxic drug reactions sufficient to necessitate cessation of treatment before the end of the course developed in 39 cases (13 per cent).Surgery was employed in 18 patients, all of whom had at least one course of drug therapy previously. Apart from patients complaining primarily of infertility, the symptomatic results after drug treatment were generally satisfactory.