What is Genital Tuberculosis? | Causes & Symptoms

What is Genital Tuberculosis?

Genital tuberculosis is a rare form of tuberculosis that affects the genital organs. It can affect both men and women and may cause pain, swelling, and ulcers in the genital area. It is also possible to develop a discharge from the vagina or penis.

Genital TB can spread through skin-to-skin contact with an infected person or sexual intercourse. It usually occurs in people who have weakened immune systems, such as those who are HIV positive. In some cases, genital TB has been misdiagnosed as PID (Pelvic Inflammatory Disease) due to overlapping symptoms.

The bacteria can spread from the genitals or anus to the mouth, fingers or other body parts during sexual intercourse. Or someone who has genital TB may pass it on to others through contact with their mucous membranes — for example, by having oral sex with a partner who has the condition.

Male genital TB symptoms usually present as a slowly developing lesion on the penis or scrotum, which may become ulcerated and painful if left untreated. In rare instances, genital TB can spread to other body parts such as the liver or lungs; this may result in life-threatening illnesses.

Symptoms of Genital Tuberculosis

Genital tuberculosis symptoms can vary depending on your infection type and location.

• You may have a discharge from your penis, vagina, or anus if you have a bacterial infection. This discharge may be clear or bloody and may smell bad.

• You might also feel pain when urinating or during sexual intercourse. Genital tuberculosis can cause swelling and redness of the skin around your genitals and pain in that area.

• If there are large numbers of germs in your bloodstream (bacteremia), you might experience fever and chills, night sweats, weight loss, fatigue and muscle aches.

• You might get a genital ulcer, a firm, indurated lesion with irregular borders and an erythematous base. The ulcer may be single or multiple, ranging from 0.5 cm to several centimetres in diameter. Ulcers are usually painless unless they become infected with bacteria or fungi. They tend to heal slowly over several weeks without treatment but may take months to heal if left untreated entirely.

• You might have a low-grade fever, with a temperature between 37°C-38°C (99°F-100°F) lasting more than 24 hours with no other identifiable cause such as infection or inflammation. This often occurs when multiple ulcers are present.

• Some women with genital TB may also suffer from endometriosis, as the infection can lead to chronic inflammation and scarring in the uterus.

Genital Tuberculosis and Infertility

Genital tuberculosis is a serious condition that may lead to female infertility. It may affect the reproductive organs, including the fallopian tubes and endometrium, often causing blockages, adhesions, and ovarian dysfunction. Many women struggling with infertility may have undiagnosed genital TB, making it a major concern in regions where TB is common, like India.

How Genital Tuberculosis Affects Fertility

Genital TB interferes with reproductive health in multiple ways:

• Immune system issues that disrupt normal reproductive function
• Changes in growth factors and hormones affecting fertility
• Endometrial damage that makes implantation difficult
• Reduced ovarian reserve, leading to fewer healthy eggs

Women with genital TB may also be at increased risk of miscarriage due to the compromised condition of the uterus.

Causes of Genital Tuberculosis

The bacteria Mycobacterium tuberculosis causes genital TB.It can infect the urogenital tract (the urinary tract and reproductive organs) through direct contact with an infected person or by inhaling infectious droplets from an infected person’s coughs or sneezes.

The bacteria may also spread to your lungs if you have a weakened immune system due to another illness, such as HIV/AIDS. If left untreated, this infection can lead to a lung disease that may become active TB in some people.

Genital TB may be caused by one of two forms of TB:

• Extrapulmonary TB — Extrapulmonary TB refers to TB that occurs outside the lungs but in another organ system, such as the kidney or lymph nodes. Extrapulmonary TB can affect any organ system in the body, including the genitourinary system.

• Miliary TB — Miliary TB refers to hard nodules that form within an organ or tissue due to infection with Mycobacterium tuberculosis bacteria (MTB). Miliary TB may also occur in other body areas, such as skeletal muscle and lymph nodes.

Genital organs are prone to get infected with TB if they are already infected with another sexually transmitted disease like syphilis or gonorrhea.

In addition, people with weakened immune systems due to HIV/AIDS or taking medications such as steroids can also be susceptible to TB infections in the genital tract.

Types of Genital Tuberculosis in Women

The types of genital tuberculosis can be classified based on the site of involvement:

• Tuberculous Salpingitis (Fallopian Tube TB): This type of TB affects the fallopian tubes, which are essential for transporting eggs to the uterus. It can cause blocked fallopian tubes due to fluid buildup, pus formation, or lumps in the pelvis.

• Endometrial Tuberculosis (Uterus TB): When TB spreads to the uterus, it can damage the lining, leading to scarring and complications like Asherman’s syndrome. This can cause irregular periods, pain, and problems with implantation, making it harder to sustain a pregnancy.

• Ovarian Tuberculosis: TB in the ovaries often appears alongside fallopian tube infection and can form lumps, leading to pelvic pain. Since the ovaries release eggs for fertilisation, any damage may disrupt ovulation and reduce fertility.

• Cervical Tuberculosis (Cervix TB): This form of TB affects the cervix, sometimes causing unusual vaginal discharge, pain, or sores.

• Vulval and Vaginal Tuberculosis (External Genital TB): TB can rarely affect the outer genital areas, causing swelling, lumps, or ulcer-like sores.

Treatment of Genital Tuberculosis

Treatment for genital tuberculosis can be challenging due to the severity of the symptoms and difficulty in diagnosing the disease early on. This condition must not be confused with other types of infections or sexually transmitted diseases (STDs).

In most cases, genital TB treatment involves a combination of antibiotics and surgical removal of infected tissue. Surgery may be necessary to prevent the further spread of infection into other parts of your body, such as your bladder or kidneys.

Genital tuberculosis treatment involves taking four to six months of medication. The drugs used may include:

• Isoniazid (INH) or rifampin (RIF) for two months, followed by INH for another two months. RIF may cause side effects like nausea and vomiting, but it’s safe to use during pregnancy.

• Pyrazinamide (PZA) for up to one month, followed by ethambutol (EMB) for up to one month. EMB can cause liver damage in some people if they take it with alcohol or certain medications, so be sure to tell your doctor if you’re pregnant or breastfeeding before starting treatment with this drug.

The drugs are taken for two weeks, followed by two weeks without treatment. This cycle is repeated until the course is complete.

People diagnosed with genital tuberculosis should be advised to stop having sex until they’re no longer contagious and have finished treatment. They should also avoid having sex while they have any symptoms or signs of an STD since it could spread to others while they are ill.

Genital TB and IVF Treatment

In vitro fertilisation (IVF) can be a hopeful option for women whose fertility has been affected by genital TB. When the fallopian tubes or endometrium are damaged, IVF bypasses natural conception barriers by fertilising eggs outside the body and implanting embryos directly into the uterus.

If the uterus is still healthy and the ovaries are functional, IVF can significantly improve pregnancy chances. Many women with genital TB-related infertility have had successful pregnancies through this method.

However, there are some important challenges and risks involved:

• Extent of Damage: IVF success depends on how much genital TB has affected the reproductive organs. If the endometrium is severely scarred, implantation may be difficult.

• Risk of TB Reactivation: Women with a history of genital TB need thorough screening to ensure the infection is fully treated before starting IVF.

• Pregnancy Complications: There may be higher risks during pregnancy, such as poor placental function or complications affecting maternal and baby health.

What Complications Can Genital TB Cause?

Genital TB can lead to some serious issues:

• Infertility: Both men and women can have trouble getting pregnant because of damage to their reproductive organs.

• Period problems: Women might have irregular periods or no periods at all.

• Ectopic pregnancies: If the fallopian tubes are blocked, the baby might start growing in the wrong place, which can be dangerous.

How Can You Prevent Genital TB?

There are a few things you can do to lower your risk of getting genital TB:

• Safe sex: Using condoms can help prevent the spread of genital TB through sexual contact.

• BCG vaccine: In countries with a high burden of TB, such as India, the Bacillus Calmette-Guérin (BCG) vaccine is administered as a preventive measure. While it may not prevent all forms of TB, it is effective in reducing severe cases.

• Early treatment: If you have TB in your lungs, getting treated right away can stop it from spreading to your reproductive organs.

• Good hygiene practices: Keeping the genital area clean helps prevent bacteria from entering the body and lowers the risk of infections, including TB. Regular washing and proper care are simple yet effective ways to maintain hygiene.

• Prompt Treatment of Pulmonary TB: Since genital TB often spreads from other TB infections in the body, treating any TB symptoms early can prevent complications.

• Maintain overall health: A strong immune system is your best defence. Eating well, staying active, and managing stress can help your body fight infections more effectively.