A global overview of genital tuberculosis from gynecologist's respect

Abstract

Tuberculosis (TB) is one of the most common 10 diseases that affect millions of people and result in death all over the world. Nowadays, there has been a significant decrease in mortality rates due to the improvement in TB diagnosis and effective treatment methods. However, TB is still a public health problem that remains important. TB is still among the most common non-obstetric causes of maternal mortality in the developing countries. Genital tuberculosis (GTB) is considered to be one of the important causes of infertility, pelvic pain, chronic pelvic inflammatory disease, dyspareunia and abnormal uterine bleeding. Therefore, negative consequences of GTB can be prevented or minimized by early diagnosis, appropriate and effective treatment. GTB often develops secondary to pulmonary TB or extrapulmonary TB foci in the kidneys, meninges, skeletal system and gastrointestinal system. The TB bacillus infects the genital system in 4 ways: 1-Hematogenous spread, 2-Lymphatic spread, 3-Descending direct spread, 4-Primary infection of the genitalia with sexual intercourse. In addition, the disease can be spread by the peritoneal dialysis in renal failure. The genital organs affected by GTB, in the order of frequency are; Fallopian tubes (90-100%), uterine endometrium (50-60%), cervix (5-15%), uterine myometrium (2-5%), vulva and vagina (1-2%). TB causes infertility by causing tubal damage and impaired endometrial receptivity in the genital tract. Endometrial damage resulting in intrauterine adhesions, menstrual abnormalities and impaired endometrial receptivity increases recurrent pregnancy losses and ectopic pregnancy risks. In addition, GTB should not be ignored for the differential diagnosis of pelvic masses. The most realistic treatment approach for the infertile patients with GTD is to direct the patients to the assisted reproductive techniques after evaluation of the endometrium. However, it should be kept in mind that pregnancy outcomes are not very successful with assisted reproductive techniques. Appropriate screening procedures for high-risk populations are extremely crucial for the prevention of gynecological, obstetric and reproductive adverse outcomes, and TB eradication. Recently, immigration rate has been increasing rapidly in Turkey, as all over the world. Therefore, TB, which is seen as a forgotten disease today, should be kept in mind in our gynecological and obstetric practice. © 2020 Refik Saydam National Public Health Agency (RSNPHA).