P184 Female Genital Tuberculosis: The Long Road To Diagnosis

Abstract

Introduction Female genital tuberculosis (TB) is rarely encountered in the UK but early diagnosis and treatment can prevent significant morbidity. Methods We conducted a retrospective study of all patients treated at our institution for female genital TB between 2004 and 2014. Data including demographics, symptoms, microbiological and histological diagnoses and treatment outcomes were recorded. Results 10 cases of female genital TB were identified. These account for approximately 0.71% of our TB cases, giving a local incidence of female genital TB of approximately 0.5/100,000 population. Mean age was 37.9 +/-14.3. Five patients were from Bangladesh, two from India and one from Pakistan, Cyprus and Somalia. Mean duration of symptoms prior to diagnosis was 24.3 months, range: 0–84. Presenting symptoms included infertility (50%), menorrhagia (10%), amenorrhoea (20%), irregular menstrual bleeding (40%), dyspareunia (20%), vaginal discharge (10%), post coital bleeding (10%) and lower abdominal pain (50%). Patients also experienced fevers (30%), night sweats (10%) and weight loss (10%). All patients had either a laparoscopy or hysteroscopy with biopsy of the endometrium in nine cases and the ovary in one case. Seven cases were found to have necrotising granuloma on biopsy of which two were positive for Ziehl-Neelson (ZN) staining, two were negative and three were not performed. Non-necrotising granuloma was seen in one case and histology was unrecorded for two cases but PCR was positive in both these biopsies. Samples were sent for culture in three cases and all had fully sensitive TB. All cases were treated with standard TB treatment. In two cases treatment is ongoing. One patient died from a co-existing condition. Seven patients completed treatment, of which four had full symptom resolution, two remain under the infertility team and one has ongoing abdominal pain. Median treatment duration was six months. Conclusion This case series highlights the delay in diagnosis and the significant morbidity – particularly infertility – experienced by patients with genital TB. Samples were frequently not sent for culture. Raising awareness of TB within obstetrics and gynaecology and highlighting the importance of considering TB in patients from high incidence countries may help reduce diagnostic delay for these women.