Abstract

PIP: Female genital tuberculosis is not uncommon in countries where pulmonary tuberculosis is widespread. Improved diagnostic techniques (e.g., endometrial curettage and biopsy, histologic examination of curettage, hysterosalpingography, bacteriologic examination of menstrual blood, laparoscopy, and ultrasonography) have resulted in increased awareness of genital tuberculosis. Another trend has been heightened awareness of the potential role of female genital tuberculosis in infertility; this infection has been implicated in 5-10% of infertility cases. Genital organs most frequently affected include fallopian tubes (95-100%), endometrium (50-60%), and ovaries (20-30%). In 92% of cases, genital tuberculosis is secondary to a focus in the lungs, lymph nodes, urinary tract, bones, or joints. Given the hormone-dependent nature of female genital tuberculosis, 90% of cases involve women under 40 years of age. The major presenting symptoms are infertility (45-55%), pelvic pain (50%), poor general health (25%), and menstrual disturbances (20%). The differential diagnosis includes chronic pelvic inflammation, mycotic infection, enterobiasis, lipid salpingitis, and carcinoma. Female genital tuberculosis is treated with the same long-term, combined drug therapy used in pulmonary and extrapulmonary tuberculosis. Surgery should be undertaken only after continuous drug treatment of 12-18 months' duration. In women of childbearing age, an attempt can be made to preserve one ovary. Successful pregnancy is unlikely, however, after complete antituberculosis treatment or tuboplastic surgery.