TB of genital tract Flashcards
C/F, Dx, Tx
What are causative agents of genital TB? (2)
- Mycobacterium TB (95%)
- M. bovis (5%)
What are the primary causes of secondary genital TB? (3)
- TB foci in lungs
- Lymph nodes
- GIT
What are the modes of spread of genital TB from primary TB focus to genital tract? (3)
- hematogeous
- lymphatics
- rarely direct
What are the causes of primary genital TB? (1)
(rare) if sexual partner is affected
What kind of cells are formed in genital TB?
Granuloma
What is the most affected part of fallopian tubes in genital TB?
ampulla
What are the C/F of genital TB?
- Fever, malaise
- Abdominal pain= lump, chronic pelvic pain
- Menstrual= oligo/amenorrhea, menorrhagia, postmenopausal bleeding
- Infertility
- Vaginal discharge= blood stained, leucorrhea, seropurulent discharge
- FIstula formation
- Ectopic pregnancy
What can happen in endometrium in genital TB?
- descending infection from fallopian tube
- shrunken cavity d/t fibrosis
- narrowed tubal ostia
- endometrial lesions f(ocal and immature cuz shed monthly)
What all happens in fallopian tubes in genital TB?
- Bilateral endosalpingitis= thick, whip-like consistency
- exosalpingitis
=Tobacco pouch app- ampulla dilated, fimbrae end open
=miliary tubercles on serosa - yellowish-gray caseous material or serosangious fluid in lumen= tuberculous hemato-salpinx
- Fitz-Hugh-Curtis syndrome
What is the most affected part of uterus in genital TB?
Cornua of uterus
What happens in ovaries in genital TB?
- Perioophoritis (spread from adjacent tube)
- Caseating granuloma within ovarian parenchyma by hematogenous spread
What happens in cervix in genital TB?
no gross changes, also rarely primary genital TB from intercourse
What happens in vulva & vagina in genital TB?
direct extension from genital tract lesions & exogenous infection from sputum or sexual intercourse
1. bartholin glands maybe affected
2. vulval lesions= discharging ulcer/ sinus or nodular hypertrophic lesion
Dx of genital TB?
- CBC= lymphocytosis
- increased ESR
- Mantaux test +ve
- Quantiferon test +ve
- Hysterosalpingography
- ELISA
- USG guided FNAC
- Endometrial histology & PCR testing in late premenstrual phase
- Hysteroscopy
- Laparoscopy
- CXR
- Radiography of bones
- NAAT
- Gas chromatography
- BACTEC
- Semen culture
What will hysterosalpingography reveal in genital TB?
- lead pipe appearance
- beading & filling defect
- calcification of tube
- cornual block
- tobacoo pouch appearance of hydrosalpinx & pyosalpinx
What does ELISA reveal in genital TB?
IgM, IgG
What can hysteroscopy reveal in genital TB?
- presence of synctiae
- narrowed tubal ostia
- partial obliteration of cavity
Name ATT (anti-tuberculosis therapy) drugs for 1st 2 months in genital TB.
- Isoniazid (INH)
- Rifampicin (Rcin)
- Pyrazinamide
- Ethambutol
Name ATT for next 4 months in genital TB.
- INH
- Rifampicin
Name ATT for resistant cases,
(which don’t resolve even in 8 months)
- Capreomycin
- Kanamycin
- Ethionamide
- Cycloserine
- Para-amino salicylic acid
What are the Sx Tx for genital TB and in which specific cases?
- Vulvectomy in hypertrophied vulva
- removal of adnexal mass in young females
- drainage of pyometra
- fistula repair
- hysterectomy with oophorectomy
Which Sx is c/i in genital TB?
tuboplasty
What can be the complications of genital TB?
- peritubal abscess
- TB peritonitis
- Ascites
