Genital Tuberculosis

FEATURES:
  • Primary focus in lungs-50%
  • Fallopian tube is the most frequently involved part (100%).followed by uterus (70-80%), ovaries (30%)
  • The lesions are often bilateral.
  • Blood stream is the commonest method of spread
  • Initial site- submucosal layer of ampulla.
SYMPTOMS:
  • Infertility
  • Cause of infertility : 
Blockage of the fallopian tube or Altered tubal and Endometrial function in presence of patent tubes.
  1. Ectopic pregnancy : Every woman who had or has, a tubal pregnancy should be suspected of having tubal tuberculosis active or healed.
  2. Dysmenorrhea : Shaw does not specify whether dysmenorrhea is common or uncommon in TB. "Dysmenorrhea rarely, if occurs."
  3. For diagnosis : Dilatation and curettage is done in the premenstrual phase and specimen sent for histo pathological examination and culture.
  • Commonest menstrual disturbance: Menorrhagia
DIAGNOSIS:
  • Mycobacterium can be grown from menstrual blood in TB patient showing pelvic inflammation
  • The commonest type of genital tuberculosis is Endosalpingitis
  • The following findings on hysterosalpingogramstrongly suggest tubercular salpingitis:
  1. A rigid nonperistaltic pipe like fallopian tube called lead pipe appearance
  2. Beading and variation in filling density
  3. Clubbing of ampula
  4. Calcification of the tube
  5. Cornual block
  6. A jagged fluffiness of the tubal outline
  7. Vascular or lymphatic intravasation of the dye
  8. Tobacco - pouch seen at naked eye examination.
  • Endometrial Biopsy:
  1. Perforation can occur
  2. Sound / curette meets no resistance at the point expected.
  3. Management
  • In hemodynamically stable patients, laparoscopy is the method of choice for evaluating perforation size and site.
  • Most of the patients require only expectant treatment. Only in those who bleed internally laparotomy may be required.
Exam Question
  • Mycobacterium can be grown from menstrual blood in TB patient showing pelvic inflammation
  • In patient with infertility hysterosalpingography reveals 'Bead – like' fallopian tube & clubbing of ampulla is suggestive of genital tuberculosis
  • Most common site of genital tuberculosis is Fallopian tube
  • Perforation of the uterus while doing endometrial biopsy in a case of suspeccted genital tuberculosis can be treated by Laparascopy & Immediate laparotomy
  • The commonest type of genital tuberculosis is Endosalpingitis
  • Blood stream is the commonest method of spread of genital tuberculosis
  • Primary focus is most often in the lung 
  • The commonest complication of pregnancy after complete treatment of genital tuberculosis is Ectopic pregnancy

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