Current diagnosis and management of female genital tuberculosis

Female genital tuberculosis (FGTB) is an important cause of significant morbidity, short- and longterm sequelae especially infertility whose incidence varies from 3 to 16 % cases in India. Mycobacterium tuberculosis is the etiological agent for tuberculosis. The fallopian tubes are involved in 90-100 % cases, endometrium is involved in 50-80 % cases, ovaries are involved in 20-30 % cases, and cervix is involved in 5-15 % cases of genital TB. Tuberculosis of vagina and vulva is rare (1-2 %). The diagnosis is made by detection of acid-fast bacilli on microscopy or culture on endometrial biopsy or on histopathological detection of epithelioid granuloma on biopsy. Polymerase chain reaction may be false positive and alone is not sufficient to make the diagnosis. Laparoscopy and hysteroscopy can diagnose genital tuberculosis by various findings. Treatment is by giving daily therapy of rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) for 2 months followed by daily 4 month therapy of rifampicin (R) and isoniazid (H). Alternatively 2 months intensive phase of RHZE can be daily followed by alternate day combination phase (RH) of 4 months. Three weekly dosing throughout therapy (RHZE thrice weekly for 2 months followed by RH thrice weekly for 4 months) can be given as directly observed treatment short-course. Surgery is rarely required only as drainage of abscesses. There is a role of in vitro fertilization and embryo transfer in women whose fallopian tubes are damaged but endometrium is healthy. Surrogacy or adoption is needed for women whose endometrium is also damaged. ©Federation of Obstetric & Gynecological Societies of India 2015.