Female Genital Tuberculosis: Meaning, Causes, Symptoms, Treatment

Written by Medicover Team and Medically Reviewed by Dr Kiranmai Gottapu , Gynecologists

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Female genital tuberculosis (FGTB) is a type of TB that spreads to a woman's reproductive organs from the lungs or other infected parts of the body through the blood or lymph system. It most often affects the fallopian tubes, followed by the uterus lining (endometrium), ovaries, cervix and in rare cases, the vagina or vulva.

Since the fallopian tubes and uterus are essential for pregnancy, FGTB can cause serious fertility problems. It is most commonly seen in women between the ages of 15 and 45, which is also the key reproductive age. This makes the link between female genital tuberculosis and infertility very important to understand.

Different Types of Genital Tuberculosis in Females

Female genital tuberculosis can affect one or multiple parts of the reproductive system. Based on the areas involved, it can be classified into the following types:

Fallopian Tubes (Tubercular Salpingitis)

The fallopian tubes are most often affected in female genital tuberculosis. Infection causes scarring and blockages, preventing the egg from reaching the uterus. This damage is a major cause of infertility in affected women.

Endometrium Tuberculosis

Endometrial TB affects the lining of the uterus, causing thinning, adhesions and menstrual problems. It often leads to repeated implantation failures, making pregnancy difficult.

Ovarian Tuberculosis

Ovarian TB damages the ovarian tissue, which may disturb ovulation. In severe cases, it can cause cysts, abscesses, or even loss of ovarian function, reducing fertility chances.

Cervical Tuberculosis

Although rare, cervical TB can look like cervical cancer. Common symptoms include vaginal discharge, bleeding after sex or persistent cervicitis that does not improve with usual treatments.

Vaginal and Vulvar Tuberculosis

This form is extremely rare and usually spreads from nearby organs. It may cause ulcers, sores, or infections in the vaginal or vulvar area that do not respond to normal treatment.

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Symptoms of Genital Tuberculosis in Females

FGTB is often called a silent disease because it may not produce clear symptoms in the early stages. However, as the infection progresses, the following signs may appear:

• Pelvic pain or discomfort, often chronic and dull.
• Persistent vaginal discharge, which may be foul-smelling or blood-stained.
• Pain during sexual intercourse (dyspareunia).
• Abdominal swelling or bloating in some cases.
• Low-grade fever, night sweats, and unexplained fatigue.

Because many of these symptoms overlap with other gynecological conditions, genital TB is frequently misdiagnosed or detected late.

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Causes of Genital Tuberculosis

Genital tuberculosis in women develops when Mycobacterium tuberculosis spreads from another infected part of the body. This usually happens through different medical pathways and is also influenced by certain risk factors.

• Hematogenous Spread: TB bacteria travel through the bloodstream from a primary site, usually the lungs, to the reproductive organs.
• Lymphatic Spread: Infection spreads through the lymphatic system from nearby infected lymph nodes.
• Direct Extension: TB infection from nearby organs such as the urinary tract or intestines can extend into the genital organs.
• Reactivation: Dormant TB infection can become active again and spread to the reproductive tract.

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Risk Factors for Female Genital Tuberculosis

Not every woman exposed to TB develops genital TB. Certain factors increase the likelihood of infection:

• Previous TB in the lungs, abdomen, or urinary tract increases the risk of genital TB.
• HIV, diabetes, or malnutrition make women more vulnerable.
• Living with or caring for someone with active TB raises infection chances.
• Overcrowding and unhygienic environments promote TB spread.
• Late diagnosis or incomplete treatment increases genital TB risk.

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What are the Impact of Female Genital Tuberculosis?

FGTB affects a woman's overall health beyond the reproductive system. Its major impacts include:

• Emotional and Social Impact: Infertility and chronic illness can cause stress, anxiety, and depression. Social stigma may add further emotional burden in some cultures.
• General Health: Chronic pelvic pain and fatigue reduce quality of life.
• Advanced Disease: Untreated or severe FGTB may lead to complications such as abscess formation or pelvic adhesions.

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When to See a Doctor

It is important for women to consult a gynecologist or specialist if they experience:

• Persistent pelvic pain or unusual discharge.
• Menstrual disturbances that do not improve with standard treatment.
• Inability to conceive despite trying for more than a year.
• History of TB in the past (lungs, abdomen or other organs).
• Repeated pregnancy losses without a clear reason.

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Diagnosis of Female Genital Tuberculosis

Diagnosing genital TB can be challenging because its symptoms mimic other conditions. A combination of tests and imaging techniques is usually needed.

Medical History and Clinical Examination:

Doctor will ask about past TB infection, infertility history, menstrual irregularities, and family history of TB.

Laboratory Tests

• Endometrial biopsy: Small tissue sample taken from the uterus to detect TB bacteria under a microscope or through PCR (Polymerase Chain Reaction).
• Culture tests: To grow and identify TB bacteria from genital samples.

Imaging Tests:

• Ultrasound: May show pelvic masses, fluid, or adhesions.
• Hysterosalpingography (HSG): X-ray test using dye to check blockages in fallopian tubes.
• MRI/CT Scan: In selected cases to identify abscesses or pelvic disease.

Laparoscopy and Hysteroscopy

• Minimally invasive procedures that allow direct visualization of reproductive organs.
• Can confirm scarring, adhesions, or tubal damage.

Genital Tuberculosis Treatment

The treatment of genital TB is similar to that of pulmonary TB and involves anti-tubercular therapy (ATT).

Medications

Anti-TB drugs kill bacteria, prevent complications, and protect fertility, forming the cornerstone of genital TB treatment.

• Use Isoniazid, Rifampicin, Pyrazinamide and Ethambutol for 6 to 9 months.
• Complete the full course to avoid relapse or drug resistance.

Surgical Treatment

Surgical treatment is used in advanced genital TB to remove damage and restore reproductive function.

• Perform surgery for severe scarring or abscesses.
• Remove damaged fallopian tubes if necessary.
• Drain abscesses to prevent infection spread.
• Clear adhesions to improve fertility outcomes..

Supportive Care

Supportive care helps recovery, improves immunity, and eases emotional stress in women with genital TB.

• Follow a nutritious diet and get adequate rest.
• Adopt immune-boosting lifestyle changes.
• Seek counseling to manage stress and emotional challenges.

Infertility Management

Infertility management in genital TB helps women conceive using natural methods or assisted reproductive techniques like IVF, depending on organ damage and tubal condition.

• Severe organ damage may make natural conception difficult.
• Assisted techniques like IVF can be considered.
• Success depends on the extent of uterine and tubal damage.

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Conclusion

Genital tuberculosis is a hidden but serious threat to women's reproductive health. While it often goes unnoticed in its early stages, the long-term effects, especially on fertility, can be life-changing. Understanding its symptoms, risk factors, and impact on fertility helps women seek timely medical care.

With proper diagnosis and treatment, the infection can be cured, but prevention of permanent reproductive damage requires early intervention. Raising awareness about genital TB is essential to reduce its burden on women's health and fertility worldwide.

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