Tuberculosis of the Uterus

Pulmonary Tuberculosis (TB) primarily affects the lungs, but can also spread and cause secondary infections to the uterus and the fallopian tubes, which can reduce the chances of falling pregnant.

What is alarming is that TB is the top infectious killer worldwide, claiming approximately 4000+ lives a day.

How prevalent is Uterine TB?

TB of the Uterus, also referred to as Genital TB, although not a very common condition, is a severe problem, and can be a cause of infertility if not treated early enough. TB can severely damage the fallopian tubes, so if not addressed in the initial stages, it can lead to serious health complications, resulting in infertility.

Treating Uterine TB must be treated as soon as it is detected. There is, unfortunately, a social stigma attached to TB, which makes it difficult for women to talk about it candidly.

What happens if I am diagnosed with Uterine TB?

When the Mycobacterium tuberculosis (Mtb) bacteria attacks the uterus, it causes uterine tuberculosis (also known as TB of the uterus), which mostly affects women who are trying to fall pregnant and may be diagnosed during an infertility check-up.

The blood transports Mtb bacteria to other organs, including reproductive organs, which causes infection in fallopian tubes, uterus, or the endometrial lining.

In extreme cases, the uterine lining becomes so thin that it is unable to support an implantation, which can result in miscarriage.

What are the symptoms of Uterine TB?

Genital TB can be difficult to diagnose as a woman will not have any other symptoms of pulmonary tuberculosis, such as coughing or chest pain.

Many women have varied symptoms or absolutely no symptoms at all. In some cases, the infection is dormant, with the immune system keeping the bacteria under control, so people will not show signs and won’t be contagious.

Symptoms of Uterine TB includes the following:

Infertility
Abnormal Bleeding
Pelvic Pain
Amenorrhea (unusual absence of menstruation)
Continuous discharge
Bleeding after intercourse

Statistics to consider:

95% of women with Uterine TB have fallopian tubes issues
50% have problems with the endometrium (the lining of the uterus, which thickens during the menstrual cycle, in preparation for the implantation of an embryo)
30% have affected ovaries
Nearly 75% of women with Genital TB are infertile

Once treated, will I be able to have a baby?

Various investigations can be performed in order to accurately diagnose the condition:

Imaging Techniques:
- The two imaging techniques useful in the diagnosis of Female Genital TB are hysterosalpingography (HSG) and ultrasonography (USG)
- HSG evaluates the internal formation of the female genital tract and tubal patency whereas USG allows simultaneous evaluation of ovarian, uterine and extra-pelvic involvement
Laparoscopy:
- Although laparoscopy is an invasive procedure, it aids in visual inspection of the ovaries, fallopian tubes, peritoneal cavity and biopsy of the tuberculous lesions
Histopathological examination (HPE):
- HPE of the specimens shows typical features of TB infection in the form of granulomatous caseous lesions
- TB of the cervix is frequently misdiagnosed as carcinoma (cancer); it is critical to differentiate both in the early stages
- For maximizing the yield in HPE, specimens should be collected from multiple sites as the infecting organisms are scarce in genital TB; the sampling site may not be the infected site, and cyclical shedding leads to inadequate granuloma formation in the endometrium
- The ideal time for endometrial sampling is in the late secretory phase of the menstrual cycle
Bacteriological Evaluation:
- Acid-fast bacilli (AFB) staining and culture:
  - The definitive diagnosis of TB requires the isolation of TB bacilli
  - Conventional methods for diagnosis of TB include microscopy and culture
  - Microscopy for AFB is a rapid test for diagnosis but with variable sensitivity
  - Acid-fast [Ziehl–Neelsen (ZN), Kinyon] staining or fluorescent (auramine, rhodamine) staining is generally used – This testing is done using menstrual blood
  - For diagnostic tests on menstrual blood, menstrual fluid can be collected from the vagina on the first day of menstruation
Culture methods:
- The diagnosis of TB is confirmed based on the identification of M. tuberculosis in culture
- The advantages of liquid culture include its sensitivity, identification of Mycobacterium species and ability to perform phenotypic drug susceptibility tests and genotyping for further molecular epidemiology studies
- The disadvantage of culture methods is the time needed for the growth of mycobacteria
- Liquid cultures require at least 9-10 days for positive results and six weeks for being considered negative
Molecular methods:
- Molecular techniques for the detection of TB are increasingly evaluated and used nowadays
- The nucleic-acid amplification tests provide results in a few hours
- PCR is a rapid molecular method for identification of nucleic acid sequences specific to M. tuberculosis
- PCR assays can detect <10 bacilli/ml including dead bacilli and has a testing time of 8-12 h60
- Sensitivity of PCR is higher than culture and histopathology and specificity may be as high as 100 per cent
- However, PCR has higher specificity and sensitivity, faster turnaround time but limited by high false-positive rates
Serology:
- The World Health Organisation (WHO) have banned the usage of serological tests in individuals suspected of any form of active TB, regardless of their HIV status

So yes, with the correct testing and medication, you can conceive through Artificial Reproduction Treatment (ART), with either IVF or IUI, where intervention will take place to repair any damage caused by TB.

How can I prevent Uterine TB?

Although we cannot guarantee that this disease is entirely preventable, we must take measures to protect ourselves from any infection or virus by doing the following:

Hygiene, hygiene, hygiene! This, as we know, through these trying times with the COVID-19 epidemic, is VITAL. Both personal and house-hold hygiene should be a priority
Improve your immunity by taking good-quality vitamins and supplements
Sort out your diet and ensure you are eating well-balanced and healthy meals every day

Conclusion:

Please be assured, TB is a treatable and curable disease.

Active, drug-susceptible TB disease is treated with a standard 6-month course of 4 antimicrobial drugs that are provided with information and support you as a patient by your Doctor/Fertility Specialist. Without this support, treatment adherence can be more difficult.

Research shows that between 2000 and 2018, an estimated 58 million lives were saved through TB diagnosis and treatment. Anti-TB medicines have been used for decades and strains that are resistant to one or more of the medicines have been documented in every country surveyed.

Drug resistance emerges when anti-TB medicines are used inappropriately, through incorrect prescription by health care providers, poor quality drugs, and patients stopping treatment prematurely.

Be sure to speak to your Doctor and your Fertility Specialist should you have any concerns regarding Uterine TB.