Insight into the diagnosis and management of subclinical genital tuberculosis in women with infertility

Abstract

Genital tuberculosis (GTB) is an important cause of infertility in India. Lack of an accurate diagnostic test has led to an indiscriminate use of antitubercular treatment in infertile women. Apart from concerns of drug toxicity, this may be a contributing factor in the increasing incidence of multidrug-resistant TB reported in India. We conducted a study to analyze whether a combination of tests could help improve diagnostic accuracy. An algorithm for the management of GTB in infertile women based on the use of multiple tests is presented.

Keywords: Genital tuberculosis; Mycobacterium tuberculosis infection; infertility; latent tuberculosis.

Figure 1

The spectrum of Mycobacterium tuberculosis infection outcome. Bacterial burden (dashed orange line) is expected to increase the spectrum of infection. (p) pro- and (a) anti-inflammatory factors in the granuloma. Too much pro-inflammatory or too much anti-inflammatory activity can lead to poor control of bacteria and increased pathology. The purple line reflects the risk of reactivation in the latent spectrum. (Reprinted with permission from Lin PL, Flynn JL. Understanding latent tuberculosis: a moving target. J Immunol 2010;185 (1):15–22.)

Figure 2

Flow chart of study group with results of TB tests