Genital TB cases on rise, result in female infertility

Mumbai: Hema Saha, a 31-year-old woman, suddenly started experiencing a mild pain in her abdomen and irregular periods. Her condition further aggravated when the pain gradually increased. Finally, when she consulted a doctor, to her shock, she was diagnosed with genital tuberculosis.

Despite repeated attempts, the couple had been unable to conceive. After the diagnosis, her reports showed that she was infertile and her condition had aggravated due to the delay in diagnosis.

“People generally perceive that TB is always pulmonary but TB can occur in any part of the body including the genitals. Last year, we received 11 such cases and in 2014, we received eight genital TB cases,” said a doctor from Sewri TB Hospital, one of the largest TB hospitals in Asia.

“But in most of the cases, the condition is diagnosed at a late stage. This is mainly due to ignorance of the patients and and it is tough to identify symptoms of this kind of TB because of its rarity,” she added.

However, city gynaecologists said that this is just the tip of the iceberg. Most of the patients get diagnosed when they visit gynaecologists with complaints of vaginal bleeding, irregular menstruation, and abdominal pain.

“These numbers are much lower than the real ones as most of the patients get to know about genital TB only after they visit gynaecologists or other doctors. And often we prescribe TB medicines to them that are a 9-months’ course,” said Dr Nilesha Chitrel, gynaecologist from SRV Hospital.

Genital TB is usually detected in patients between 15 and 40 years of age. And in 90 per cent of the cases, women diagnosed with genital TB face problems in conceiving.

“TB is a bacterium that can affect any part of the body. In genital TB, it moves through the blood to the genital tract. It affects the fallopian tubes followed by the endometrium in 50 per cent of the cases. At times the ovaries, cervix and vagina are also affected by genital TB,” said Dr M.J. Jassawalla, a gynaecologist from Wadia Hospital. “When it infects the genital tract, the bacteria can cause infertility as it affects the genital parts and blocks the fallopian tubes,” he added.

However, the cases of genital TB are increasing across the globe. A study published in Indian Journal of Tuberculosis stated that there are an estimated 8-10 million cases with rising incidents in industrialised and developing countries. This is partly as a result of its association with HIV infection. Reportedly, about nine per cent of all extra-pulmonary tuberculosis cases are genital tract TB.

“Patients with HIV infection and malnutrition are most vulnerable to genital TB as the bacteria that remains in dormant form may get activated due to low immunity and affect their genital tract,” said Dr Chitrel.