Endometrial tuberculosis - Gynecology

What is Endometrial Tuberculosis?

Endometrial tuberculosis is a form of genital tuberculosis affecting the lining of the uterus, known as the endometrium. It is a rare but significant cause of infertility, especially in developing countries where tuberculosis is more prevalent.

How is it contracted?

Endometrial tuberculosis typically occurs as a secondary infection from a primary site, such as the lungs. The bacteria Mycobacterium tuberculosis can spread through the bloodstream or lymphatic system to the genital tract. Immunosuppressed individuals and those with a history of pulmonary tuberculosis are at higher risk.

What are the symptoms?

The symptoms of endometrial tuberculosis can be nonspecific and may include:

Irregular menstrual cycles or amenorrhea (absence of menstruation)
Chronic pelvic pain
Infertility
Abnormal vaginal discharge
General symptoms of tuberculosis, such as fever, night sweats, and weight loss

How is it diagnosed?

Diagnosis can be challenging due to nonspecific symptoms but includes:

Endometrial biopsy: Histopathological examination of endometrial tissue can reveal the presence of tuberculous granulomas.
Polymerase Chain Reaction (PCR): A highly sensitive and specific test for detecting Mycobacterium tuberculosis DNA in endometrial tissues.
Cultures and staining: Ziehl-Neelsen staining and culture methods can identify the bacteria.
Imaging: Ultrasound and hysterosalpingography may be used to assess the extent of the disease.

What are the treatment options?

Treatment consists of a combination of anti-tuberculous drugs, typically for 6-9 months. The regimen often includes:

Isoniazid
Rifampin
Ethambutol
Pyrazinamide

In some cases, surgical intervention may be required to remove damaged tissue or to correct anatomical abnormalities that contribute to infertility.

What is the prognosis?

With timely and appropriate treatment, the prognosis is generally good. However, the extent of the disease and the presence of complications such as scarring can affect the outcome, particularly in terms of fertility. Early detection and comprehensive treatment are crucial for improving reproductive outcomes.

How can it be prevented?

Prevention strategies focus on controlling the primary infection and include:

Timely and complete treatment of pulmonary tuberculosis
Screening and early detection in high-risk individuals
Maintaining good general health and immunity

Conclusion

Endometrial tuberculosis is an important but often overlooked cause of infertility and other gynecological issues. Awareness, timely diagnosis, and appropriate treatment are key to managing this condition effectively. For further reading and updates, you can refer to reputable sources such as the World Health Organization and Centers for Disease Control and Prevention.