Manifestations of genital tuberculosis in women, why is it difficult to diagnose and what are the principles of treatment?

About the disease

Example of fluorography of the lungs
At first, a woman may not understand how fluorography is related to the diagnosis of genital tuberculosis.

The fact is that pathology affecting the lungs is almost always the main cause of the disease in the structures of the reproductive system.

That is, this is a secondary pathology spreading from the primary focus, which can be localized not only in the lungs, but also in other organs.

It’s just that the tuberculosis pathogen most often enters the respiratory system.

Mycobacterium tuberculosis, the pathogenic microorganism that causes this disease, spreads from the site into which it entered from the external environment through hematogenous, lymphogenous and contact routes. In most cases, tuberculosis is transmitted to the genitals through the blood.

Genital tuberculosis can occur at any age, but mainly occurs in mature women. Among extrapulmonary forms, it occupies a leading position and can affect all parts of the female reproductive system with varying frequencies. The most common localization of tuberculosis:

1. fallopian tubes (up to 100%);
2. endometrium (up to 30%);
3. uterus and ovaries (no more than 10%);
4. vagina and perineum.

Important! The time period between infection and the first manifestations of the disease can range from 5 to 20 years. During this time, the girl may not notice any signs of pathology, except for possible infertility. Only against the background of certain factors can genital tuberculosis make itself felt.

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Clinical picture

The first clinical signs of genital tuberculosis may appear during puberty, but, as a rule, the manifestation of the disease occurs between 20 and 30 years of age. Symptoms may also appear later, in pre- and postmenopause. In older women, the disease is asymptomatic or has few manifestations, even if both the tubes and the uterus are simultaneously affected.

Genital tuberculosis often occurs against the background of other gynecological pathologies (fibroids, endometriosis) and is combined with signs of both genital and general infantilism.

Tuberculosis of the reproductive system is characterized by variability in clinical manifestations, which is associated with various histological changes in the affected tissues (productive form and fibrosis, calcification and caseous necrosis, scarring).

Symptoms of typical tuberculosis intoxication do not occur in all cases:

• Low-grade body temperature (up to 38 degrees),
• night sweats,
• weight loss,
• loss of appetite,
• leukocytosis with a shift to the left is observed in only 22% of patients.
• The clinical picture is very sparse and often there is only one complaint - the inability to get pregnant or failure of menstrual function .

Genital tuberculosis is prone to a chronic course, either without a rise in temperature or with a periodic rise in temperature. In the acute course of the disease, one should look for the cause in secondary infection of the genital organs with other microorganisms.

• Patients complain of pain in the lower abdomen , which is either short-term or bothersome for a long time. It is extremely rare that the pain can become very intense, which is considered by doctors to be an emergency (appendicitis or ectopic pregnancy).
• Patients also experience menstrual irregularities (with tuberculous salpingitis and endometritis). Cycle disorders manifest themselves in the form of erratic intermenstrual bleeding, decreased menstruation or absence of menstruation, pain during menstruation and premenstrual syndrome. Menstrual irregularities are observed in more than 50% of patients, which is associated with a decrease in the endocrine function of the ovaries and damage to the endometrium.
• The pathognomic symptom of genital tuberculosis is female infertility often primary. Secondary infertility with tuberculous salpingitis develops after a complicated abortion or childbirth. Infertility due to tuberculosis of the genital organs: on the one hand, it is caused by anatomical (obstruction) and functional (impaired peristalsis) changes in the fallopian tubes,
• on the other hand, neuroendocrine disorders that inhibit the hormonal function of the ovaries.

It becomes clear that there is no characteristic clinical picture for genital tuberculosis , which leads to difficulties in diagnosing it. Often, more than one year passes from the moment the first signs of the disease appear until tuberculosis infection of the genitals is detected.

Tuberculous salpingitis

Tuberculous tubal damage is almost always bilateral due to the hematogenous spread of infection. First, the mucous membrane of the tubes is affected, which has pronounced folding in the ampullary section (closer to the ovary), which is explained by the developed circulatory network in this section and the significant sedimentation of mycobacteria in it.

The mucous membrane thickens, tubercles form in it, and exudate accumulates in the lumen of the tube. The affected epithelium begins to be rejected, which leads to gluing of the fimbriae of the tube and the formation of a sactosalpinx. In this case, the pipe lengthens, and its ampullary end expands in a retort-like manner. At this stage, the process can stabilize, subside or progress.

If the infection progresses, it spreads to the muscularis and serosa. Infiltrates and tubercles appear in the muscular layer, and multiple tubercles appear on the serosa. Next, adhesions begin to form between the pelvic organs, first loose, then more dense.

If the tuberculous process lasts a long time, caseous disintegration of tuberculosis occurs and the cavity of the tube is filled with necrotic masses. Caseous necrosis is severe and occurs rarely. In women of reproductive age, caseous necrosis leads to the formation of pyosalpinx.

Symptoms of tuberculosis of the fallopian tubes in this case are characteristic of the clinical picture:

• Acute abdomen (significant increase in temperature, severe symptoms of intoxication - nausea, vomiting, symptoms of peritoneal irritation, sharp pain in the lower abdomen). Palpation is detected in the left or right groin area as a conglomerate, sharply painful when palpated, with a soft-elastic consistency.
• With the exudative form of salpingitis, throbbing pain in the lower abdomen and liquid, colorless discharge (periodic emptying of the sactosalpinx), intermenstrual bleeding and infertility are troubling. During a gynecological examination, saccular formations are palpated on both sides, located behind the uterus, which have limited mobility and are painful when pressed.

Symptoms of the productive form of salpingitis are few and erased. The disease occurs as chronic nonspecific adnexitis. During a gynecological examination, thickened fallopian tubes with clear contours are palpated, which are sensitive to pressure.

Tuberculous metroendometritis

With tuberculosis of the uterus, as a rule, its mucous membrane is affected (endometritis), while the myometrium is less often involved in the process (endomyometritis). At the stage of productive tuberculosis, the process is located in the functional layer, which is rejected during menstruation.

After the functional layer is rejected, the tuberculous process spreads deeper, reaching the basal layer. The long course of the disease leads to the development of fibrotic processes and the formation of intrauterine synechiae (adhesions), which is clinically manifested by scanty menstruation or its complete absence.

In the case of the caseous form, bloody discharge with copious amounts of crumbly, triangular mass is observed. Filling the uterine cavity with this mass leads to blockage of the cervical canal, the addition of a secondary pyogenic infection and the formation of pyometra (uterus filled with pus).

Symptoms of pyometra include:

• high temperature (above 38),
• sharp, often cramping pain in the lower abdomen,
• signs of intoxication.

Many patients experience only focal (areas) lesions of the endometrium, which are asymptomatic. Uterine tuberculosis, as a rule, occurs secondary to tubal damage.

Other forms of genital tuberculosis

Tuberculosis of the cervix occurs after damage to the endometrium and occurs in a descending manner (infection from the uterus “descends” to the cervix). It can occur in two forms:

• productive - the formation of tubercles under the epithelium of the visible part of the cervix;
• ulcerative - completes the productive stage - ulcers of irregular shape and with undermined edges are formed, the bottom of which is covered with a whitish crust.

Ovarian tuberculosis is rare. Tuberculosis bacteria infect the integumentary epithelium of the ovaries and the nearby peritoneum. The parenchyma (inner layer of the ovaries) is involved in the process during the period of ovulation (rupture of the follicle) and during the formation of the corpus luteum.

New small foci of tuberculosis form in the parenchyma, which are prone to fusion and subsequent destruction of ovarian tissue. Clinically manifested by disruptions of the menstrual cycle, pain of varying intensity in the lower abdomen, and hormonal disorders. In case of caseous disintegration of the affected foci, pus is formed and pyovar is formed (purulent melting of the ovaries).

Tuberculous lesions of the vulva and vagina are extremely rare and occur in the form of an ulcerative form.

Causes of genital tuberculosis

How to boost immunity?
Undoubtedly, for the disease to appear, infection must first occur.

Mycobacteria enter the body.

In the place where they have penetrated, a primary focus appears.

It should be noted that genital tuberculosis is not transmitted during sex, since the endometrium is resistant to the effects of these pathogenic microorganisms.

Therefore, tuberculosis of the female genital organs is always a secondary disease that occurs in the presence of contributing factors.

These include:

1. poor state of the immune system - it can be caused by chronic diseases, poor nutrition, some kind of immune pathology, and frequent stress. Against the background of reduced protective properties of the body, the likelihood of it being damaged by various bacteria, including the causative agent of tuberculosis, increases;
2. a decrease in local immunity - this means that with long-term pathology, for example, an inflammatory nature in the uterus, its tubes and appendages, their resistance to infectious processes worsens.

Causes of the disease

As mentioned earlier, the disease is not primary, but a consequence of introduced infection from the original affected area. Tuberculosis of the appendages can be provoked by factors that lead to the migration of mycobacteria and the progression of the disease of the genitourinary system. Reasons for appearance:

• dysfunction of the immune system in the genital organs due to an infectious and inflammatory process in the organs of the reproductive system. The presence of adnexitis, endometritis or salpingoophoritis;
• fairly close communication with a person who has tuberculosis. (If the patient lives nearby or works together);
• if a woman has a progressive form of the disease, regardless of where the pathology develops;
• eating low-quality food products;
• frequent stressful conditions.

Since the vulva and cervix contain multilayered epithelium that is not susceptible to Koch's bacillus, it is extremely difficult to contract tuberculosis through sexual contact.

Symptoms of genital tuberculosis

Tuberculosis of the female reproductive organs often has a hidden course. Its first possible sign may be infertility, indicating that the uterus, its tubes or ovaries are involved in the pathological process. The girl may not notice other subjective symptoms of genital tuberculosis. But in the presence of negative factors, the disease can progress, causing more obvious symptoms.

Common symptoms of tuberculosis of the genitourinary system include:

1. intoxication syndrome, manifested by general weakness, low-grade fever;
2. characteristic sweating at night;
3. weight loss as a result of loss of appetite.

A pathological process located in certain structures of the reproductive system will have more specific manifestations.

Uterine tuberculosis will be characterized by:

1. amenorrhea, i.e. lack of menstruation;
2. irregularity of the menstrual cycle;
3. nagging pain in the lower abdomen;
4. painful sensations during menstruation.

With ovarian pathology, the following occurs:

1. irregular menstruation;
2. reduction of bleeding during menstruation;
3. pain syndrome accompanying menstruation.

With tuberculosis of the external genitalia, the following are observed:

1. ulcerative defects on the mucous membrane of the vagina and vulva;
2. itching and burning in this area.

If a secondary disease manifests itself specifically on the vulva or perineum, the patient can consult a specialist, since she will be bothered by these signs of the disease.

Note! The inability to conceive a child is often associated with involvement of the fallopian tubes and ovaries in pathology. Most likely, the cause of infertility in this case is chronic inflammation and, as a consequence, the adhesive process provoked by tuberculosis with a latent and long-term course.

Classification

The following clinical and morphological forms are distinguished (symptoms and histological picture):

• chronic – symptoms are mildly expressed, histologically productive inflammation with the formation of tubercles;
• subacute – proliferation/exudation processes predominate, clinical manifestations are pronounced;
• caseous – death of tissue areas (in the form of a cheesy mass), clinically manifests itself acutely and has a difficult course;
• completed process - the lesions are calcified and encapsulated.

By localization they distinguish:

• tuberculous salpingitis;
• tuberculous adnexitis (tubes and ovaries);
• tuberculous metroendometritis;
• tuberculous cervicitis;
• tuberculosis of the vulva and vagina.

Depending on the degree of activity:

• active genital tuberculosis (first 2 years);
• subsiding (after 2 years and up to 4);
• inactive genital tuberculosis – lasts for an indefinite amount of time and is characterized as a consequence of previous genital tuberculosis.

Exacerbation/recurrence:

• worsening of symptoms within 4 years after diagnosis of genital tuberculosis - exacerbation;
• worsening of symptoms after 4 years – relapse.

Detection/absence of mycobacteria in tests:

• MBT(-);
• MBT(+).

Forms of genital tuberculosis

Pelvic tuberculosis can be classified according to several criteria.

According to clinical and morphological features, the following forms are distinguished:

1. chronic - the main feature is productive inflammation without clinical manifestations;
2. subacute - progression of the lesion with exudation and manifestation;
3. caseous - characterized by destructive changes in tissue, manifested by a severe course;
4. ending - the foci of pathology are calcified and covered with a capsule.

Tuberculosis exists in the affected area:

1. uterine appendages - characterized by salpingo-oophoritis, the formation of tubercles and fistulous tracts in advanced cases;
2. endometrium - may be focal or widespread;
3. cervix;
4. vagina;
5. vulva;
6. crotch.

Symptoms of the disease

Ovarian tuberculosis in women does not develop as often as infection of the cervix. In this pathological form, the mycobacterium infects the outer membrane of the glands of the reproductive organs. The development of the disease can also occur in the abdominal cavity. During the period of infection of ovarian tissue, the course of the disease stabilizes. As a result, the symptoms of the pathology disappear, and the woman begins to feel much better. But this state is only short-term.

A patient’s infection can be determined by the presence of the following signs:

• menstrual irregularities. There is a failure in the cycle itself and a delay of more than a month. In some cases, there is a complete absence of menstruation. Treatment using hormones has negative results;
• significant reduction in the amount excreted;
• the presence of pain during menstruation;
• infertility (in 82% of cases, patients had no pregnancies at all);
• pain in the lower abdomen that is not associated with menstruation;
• low-grade fever that does not respond to medications intended to treat inflammation;
• intoxication of the body. Manifested by lack of appetite, fatigue and general weakness.

Diagnostic methods

To diagnose genital tuberculosis, you need to go to a gynecologist. Only he can check for the presence of the disease.

Identification of this disease consists of several successive stages, starting with the collection of complaints and anamnesis, and ending with a more detailed diagnosis. If the patient has specific health problems or contact with a tuberculosis patient, the doctor can already draw certain conclusions. If the pathological process has been going on for a long time, during examination you can determine compaction, enlargement, pain in the affected internal organs, and see ulcers on the vulva or vaginal mucosa.

Expert opinion

Natalya Matveeva

Obstetrician-gynecologist, Gynecologist, Ultrasound specialist

In the absence of complaints and the latent course of the disease, pathological changes can be detected using ultrasound, although this method does not give an accurate idea of ​​the nature of the disease. Therefore, to clarify the diagnosis, one should resort to laboratory diagnostics - collecting mucus from the vagina, washing water, and biopsy material to determine the pathogen using a bacteriological method.

Instrumental methods also include diagnostic laparoscopy, with which you can see primary lesions, tuberculomas and adhesions. In addition, X-rays, magnetic resonance imaging, and computed tomography may be performed to rule out other diseases and determine the extent of the lesion.

Tuberculin diagnostics plays an important role in identifying tuberculosis with different localizations. It consists of conducting special tests with tuberculin, a substance containing weakened antigens of the pathogen. If the patient has tuberculosis, after the test, a deterioration in her condition will be noted due to the progression of clinical symptoms - increased temperature, intensity of pain.

A histological diagnostic method is also used, which is based on the study of pathologically altered tissues, and the polymerase chain reaction is a complex but highly informative method.

Important! Regular visits to the gynecologist and annual fluorography allow you to diagnose tuberculosis in the early stages and prevent the development of complications.

Diagnostics

The simplest method for diagnosing tuberculosis of any organ is to conduct a tuberculin test. After a positive result is obtained, a microbiological examination of vaginal discharge and menstrual blood is carried out.

Scraping from the endometrium can also help in detecting bacteria. If necessary, swabs are taken from the uterine cavity, especially if there is a suspicion of tuberculosis affecting this organ. The final diagnosis can be established after laparoscopy.

The final point in establishing a diagnosis can be made after histological examination of tissues. They almost always contain tuberculous tubercles. An ultrasound of the pelvic organs will not answer the question of whether the patient has tuberculosis of the uterine appendages or not.

Only a specialist who has worked for a long time with patients with a similar pathology can detect changes characteristic of tuberculosis during an ultrasound examination. If genital tuberculosis is suspected, the patient is referred for consultation to a phthisiatrician.

Possible complications

Undiagnosed genital tuberculosis for a long time can lead to the following consequences:

1. the formation of adhesions - the fusion of tissues of different structures of the body involved in prolonged inflammation;
2. the formation of fistulas - the resulting suppuration provokes the formation of channels through which pus can come out or spread to other areas of the body;
3. bleeding from organs destroyed by tuberculosis;
4. infertility.

Note! Women who have had genital tuberculosis have an increased risk of miscarriage. The probability of relapse of the disease is about 7%.

Symptoms

What are the symptoms of tubal tuberculosis? A patient with this type of pathology complains of nagging pain in the lower abdomen, but this symptom is characteristic of many diseases of the genital organs, so it is impossible to diagnose tuberculosis of the fallopian tubes using it.

In this case, we can only assume that the pain appeared as a result of adhesive disease in the fallopian tubes. These pains are accompanied by symptoms characteristic of intoxication, namely night sweats and weakness.

Tuberculosis is characterized by a sharp loss of body weight. Sometimes genital tuberculosis can manifest itself as symptoms of an acute abdomen. The patient is preparing for surgery for an ectopic pregnancy or appendicitis, and only then is the true diagnosis revealed. A feature of tuberculosis of the fallopian tubes is the attachment of intestinal loops and peritoneum to the inflammatory process. As a result, ascites may develop.

Prevention

To reduce the risk of infection, a girl must first take care of her own health. To do this, you need to strengthen the body - eat right, play sports, toughen up, give up bad habits. If there is a chronic pathology in the reproductive system, do not neglect it and treat it. A very important role in the prevention of tuberculosis is played by timely vaccination and revaccination, as well as visiting a gynecologist twice a year, even if nothing worries you.

Despite modern diagnostic methods, tuberculosis is still very common in medical practice. An important role in its spread is played by people’s poor awareness of the routes of infection, the diversity of the clinical picture and methods of prevention. Therefore, it is worth studying this issue in more detail so that if suspicion arises, treatment can be started in a timely manner. This will allow a woman to avoid negative health consequences and break down barriers to building family happiness.

Treatment methods

Ovarian tuberculosis, like tuberculosis localized in other organs, needs to be treated in a specialized medical institution. Treatment requires compliance with certain conditions:

• high-calorie and vitamin-rich diet;
• mandatory hygiene;
• taking painkillers, antipyretic medications and antispasmodics;
• taking vitamin supplements;
• increasing immunity (treatment in a sanatorium using balneological, mud and other procedures, receiving special medications);
• if necessary, surgical intervention is used;
• the use of physiotherapeutic treatment to resolve adhesions.

Chemotherapy use

The basis of treatment is the use of chemotherapy. It is necessary to start treatment as early as possible. The doctor prescribes a comprehensive regimen of antibacterial medications. Products are prescribed that have bactericidal (destroy bacteria) and bacteriostatic (stop the development of mycobacteria) effects. The drugs are taken only in combination, since Koch's wand instantly adapts if one drug is used.

You need to choose the right dose of medication. If combination chemotherapy is used, the doctor must periodically change the drugs. This is due to the effectiveness of treatment and the patient’s tolerability of medications.

The presence of a positive result after the initial period is assessed by:

• reducing inflammation in the uterus and tubes;
• stabilization of body temperature;
• improvement of general condition.

The medications are taken approximately according to the following system:

• 1 time a day every 2 days;
• 2 times per week;
• every day as a course in spring and fall. Antibacterial treatment is taken in combination with vitamins (B vitamins and vitamin C).

The course of treatment lasts from 6 months to 2 years. Upon completion, hysterosalpingography is performed for control. Treatment is prescribed to resolve adhesions.

Surgical intervention

Treatment with surgical intervention for ovarian tuberculosis is carried out only if there are strict indications:

• if there are no results in chemotherapy treatment;
• fistula formation;
• a large number of adhesions in the pelvic area, which is accompanied by difficulties in defecation and urination.

Before and after surgery, the doctor prescribes anti-tuberculosis chemotherapy and medical procedures to improve the health of the body.

Mechanism of development and course of genital tuberculosis

There are tuberculosis of female and male genital organs. This localization of infection develops secondary to damage to the lungs or intestines. The route of spread of mycobacteria from the primary focus is through the blood. Dissemination of the process occurs under favorable conditions in the body: the presence of foci of chronic infection, malnutrition. Histological changes in the affected tissues include exudative and proliferative processes in combination with caseous necrosis. Based on the morphological features, together with the clinical picture of the disease, the following types of genital tuberculosis are distinguished:

• subacute - with a predominance of exudative and proliferative changes and a large area of ​​damage;
• chronic - characterized by mild clinical symptoms;
• caseous - the presence of decay cavities and severe symptoms;
• the completed process is encapsulation of pathological foci.

Tuberculosis of the female genital organs most often affects the fallopian tubes and endometrium. Localization of the process in the ovaries and cervix is ​​considered more rare, and the external genitalia and vagina are affected extremely rarely. The disease is detected mainly during reproductive age. Men are susceptible to genital tuberculosis no less often than women. In older men, pathology is detected more often than in young men. Primary inflammation begins in the epididymis. Then it spreads to the testicle itself, the vas deferens, and the prostate gland. Tuberculosis in men is often combined with infection of the urinary tract and kidneys. This occurs due to the anatomical features of the male genitourinary system - the connection of the urethra with the vas deferens and the excretory ducts of the prostate.

Tuberculosis is an infectious disease caused by the tuberculosis bacillus. Genital tuberculosis is one of the forms of manifestation of this infection in the human body. The most common cases of damage to the fallopian tubes, in more rare cases, the ovaries and uterus, and from time to time the vulva and vagina.

One way or another, a person encounters the tuberculosis pathogen at least once in his life, but in about 90-93% of cases the infection does not develop further. In the part where the tuberculosis bacillus has entered the body, be it the lungs or the gastrointestinal tract, a focus of primary inflammation begins to form. As a rule, this is where the inflammatory processes end without further development. However, if conditions favorable for the disease are present in the body, such as poor immunity, the pathogen is overly active, and there is also a possibility of transfer of the tuberculosis bacillus to other parts of the body, including the genitals, through the bloodstream or lymph. Once in the genitals, the infection, as a rule, settles in the sections of the fallopian tubes, where there is excellent microcirculation and is localized there, and then from already prepared positions it spreads to the uterus, ovary and other parts.

For the active process of disease development to begin, the penetration of infection into the genitals is not enough. Once inside, the tuberculosis bacillus can remain there for some time and not manifest itself at all, and only with the appearance of a favorable situation for it, or as a result of the influence of a number of factors, it is activated and leads to the development of tuberculosis, called secondary.

For the active progress of the disease, it is necessary to create comfortable conditions for infection; first of all, immunity must decrease, thereby worsening the body’s defenses. The reason for the creation of such conditions may be:

• improper nutrition, which will not provide the body with the necessary substances.
• unfavorable environment and unsanitary living conditions.
• consequences of recently suffered diseases, including infectious ones.

The development of tuberculosis can take a new turn during hormonal changes during puberty and the beginning of active sexual life, as well as as a result of childbirth or abortion. It has been proven that transmission of genital tuberculosis during sexual intercourse is impossible.

Signs and symptoms of tuberculosis of the female genital organs

Damage to the genital organs by tuberculosis is not a separate disease, but is just part of the tuberculosis infection in the body.
Most often, tuberculosis progresses simultaneously in the genitals and lungs. If we consider the age categories of women most often exposed to the disease, then these are representatives of the fairer sex from 20 to 40 years old. Compared to other infectious diseases, tuberculosis is quite rare, but you should not relax, especially women, since according to statistics, about 25% of all cases of infertility are the result of this disease occurring in the genital area. In most cases, tuberculosis bacillus damage occurs in the fallopian tubes. The ovaries and uterus are much less likely to become infected, and cases of the disease entering the vulva and vagina are very rare. As a rule, the disease behaves very passively and does not manifest itself, only in 30% of those infected the health condition becomes worse, there is an increase in body temperature, rapid onset of fatigue, general weakness, a significant decrease in body weight and excessive sweating during sleep.

Quite often it happens that a woman whose genitals are affected by tuberculosis, when visiting a doctor, pays attention only to changes in the menstrual cycle and the problem of the inability to conceive a child. Why do these problems appear? A woman can have infertility for various reasons, and one of them is obstruction of the fallopian tubes, due to the fact that inflammatory processes occur in them. Inflammation of the appendages due to tuberculosis of the genital organs, as a rule, is bilateral in nature and spreads throughout all tissues of the tube, creating a large number of tuberculous tubercles in it, as well as adhesions on the outside and inside of the tube.

Initially, the adhesions are thin and loose, but later they become thicker, transforming into very strong adhesions between the uterus, intestines, pipes and pelvic organs. Twisting and deformation of the fallopian tubes occurs, often forming large inflammatory formations in the pelvic cavity. In addition, the cause of infertility is changes in hormonal properties and failure of the function responsible for the menstrual cycle, as a result of inflammatory processes in the pelvis. The production of sex hormones, estrogens and progesterone in the ovaries is also disrupted, problems appear with the appearance of eggs, and ovulation periodically does not occur at all.

The spread of tuberculosis to the uterus also poses a great danger, which increases the risk of impossibility of further development of pregnancy due to rough adhesions that greatly change the shape of the cavity. The processes of inflammation taking place in the internal genital organs and the formation of adhesions in the pelvic area are sometimes accompanied by dull and nagging pain in the lower abdomen, as well as pain during sexual intercourse.

Diagnosis and detection of genital tuberculosis

Detection of the disease can occur during a woman’s visit to a gynecologist, which was planned for completely different reasons.
Due to the development of inflammatory processes, significant changes occurred in the appendages, the fallopian tubes became deformed and became thicker, and tubercles appeared on the surface, and this is revealed during an ultrasound examination. During an examination, a gynecologist may suspect the presence of a tuberculosis infection in the genital area, then in this case, in addition to standard procedures, a referral to a tuberculosis clinic is issued for additional examination. At the tuberculosis dispensary, a complete diagnosis will be carried out with various procedures and tests, special skin samples will be taken, which will make it possible to understand whether there are inflammatory processes in the body caused by tuberculosis infection. Secretions from the genital tract are taken for culture in order to identify the tuberculosis bacillus. In addition, cultures of urine and blood excreted during menstruation are carried out, also to detect infection. In order to detect pathogens, it is possible to conduct a polymerase chain reaction.

In order to identify possible changes that have occurred in the fallopian tubes and the uterine cavity due to the disease, hysterosalpingography is performed, which makes it possible to discern all narrowings, adhesions, changes in the patency of the fallopian tubes and their deformation, as well as adhesions between the walls. In addition, hysteroscopy involves an examination and subsequent curettage of the uterine cavity with further microbiological and histological study of the resulting material.

Since the disease tuberculosis can affect not only the genitals, but also the respiratory organs, to identify possible foci, mandatory radiography of the lungs is carried out, and, if necessary, of the urinary tract and gastrointestinal tract. It is possible to visually examine the internal organs in order to detect tuberculous inflammation on the surface, and understanding how large the adhesive formations are in the pelvic cavity and in the abdominal cavity - this requires laparoscopy.

Understanding how many different diagnostic procedures and examinations have to be completed, it is easy to understand that this is a very long and labor-intensive process, which will require great patience and a clear understanding of the importance and necessity of all upcoming activities.

In the case when a woman is diagnosed with tuberculosis of the genital organs, she is sent to an anti-tuberculosis dispensary, where special medications are used for treatment and the course duration is from six months to a year. The main guarantee of successful treatment is the timeliness of its initiation, the use of the latest chemotherapy drugs, the correct selection of the necessary volume of medications and the timeliness of their administration. During the course of treatment, medications are used that are aimed at eliminating adhesions in the pelvic area. In some cases, in order to completely eliminate the foci of the disease, it is necessary to perform surgery.

Content:

Tuberculosis of the female genital organs is a disease that develops when Mycobacterium tuberculosis is introduced into the organs of the reproductive system from the primary focus (lungs) through the lymph or bloodstream.

Koch's bacillus most often affects the mucous parts of the fallopian tubes (almost 90%), since they have good microcirculation, or the uterus itself (up to 15%). The ovaries may also be involved in inflammation, but lesions are found here in only 10-12% of patients. Infections of the vagina, vulva and cervix are rare in advanced forms. Almost half of the patients have simultaneous damage to the tubes and uterus.

Therapeutic methods

In most cases, treatment of ovarian tuberculosis in women is carried out in a hospital setting. This allows you to speed up the recovery process and, if necessary, timely adjust the treatment regimen.

A few months after discharge from the hospital, the patient is recommended to undergo sanatorium treatment at a center specializing in the elimination of tuberculosis. This will speed up the rehabilitation process and increase immunity. It is recommended to visit such sanatoriums 2-3 times a year.

Chemotherapy

Prescribed for all patients with the exception of women who have contraindications to such treatment.
Bactericidal and bacteriostatic agents are used as chemotherapy. It is prohibited to interrupt the course - this reduces the effectiveness of taking medications to zero and is highly likely to cause a relapse of the disease. The course of treatment for ovaries lasts from six months to two years. All this time the patient’s condition is monitored. During therapy, the following improvements are noted:

• normalization of body temperature;
• reduction of inflammation in the ovaries;
• improvement of well-being;
• reduction in the number of tubercles.

Low effectiveness of conservative treatment in the treatment of ovarian tuberculosis is observed when mycobacteria are resistant to the effects of medications.

There is a possibility of return of reproductive function after chemotherapy. Pregnancy is possible with early detection of the disease, restoration of patency of the fallopian tubes and functionality of the ovaries.

Course of the disease

• In the fallopian tubes. Hematogenous (through the lungs) spread of infection contributes to bilateral damage to the fallopian tubes. First, the mucous membrane, which has longitudinal folds, is affected. A large number of capillaries and anastomoses contribute to the sedimentation of microbacteria in the ampullar region. In the initial stage, the mucous membrane thickens, lupomas form in it, and abundant exudate forms in the lumen. The epithelium of the integument is torn away in places, and the fimbriae (villi at the end of the fallopian tubes) merge, which leads to the formation of sactosalpinx - an accumulation of serous fluid. During the first period of the disease, the serous cover of the tube and its muscular layer are not affected by infection. The inflammation process may stop or begin to progress. When the tuberculosis process is activated, the infection spreads to the muscular layer and nearby areas in the peritoneum, if there is no adhesion at the end of the tube. Sometimes caseous masses in the lesions become calcified.
• Tuberculosis of the uterus. Koch's microbacteria attack the mucous membrane of the organ, less often the myometrium, and the cervix. In the advanced stage, fibrotic processes develop and adhesions form, which leads to deformation of the uterine cavity or obliteration of the cavity. The caseous form is characterized by sedimentation of cheesy masses and purulent infection.
• Ovarian damage. Microbacteria infect the integument of the ovaries and adjacent areas of the peritoneum. At the stage of damage to the ovarian parenchyma, the process can stabilize.
• Ulcers may appear in the vagina and vulva. Cases of localized infection in these areas are rare.

Epidemiology

Everything in the world is constantly evolving, new medicines and vaccines are being created every day, robotic interventions are being carried out and the lives of thousands of people are being extended. But in the case of this disease, the situation is still deplorable, although treatment methods exist.

Until now, in countries with a low social standard of living, the prevalence of the disease caused by Koch's bacillus continues to increase. Tuberculosis of the genital organs ranks first among all extrapulmonary forms.

But, unfortunately, it is still not clear what the real prevalence of this particular form is, since it often remains undetected during life.

Tuberculosis of the female genital organs and male genitalia occurs approximately equally. But unlike women, in men genital tuberculosis is also accompanied by kidney damage due to the anatomical structure.

Genital tuberculosis in women is most often detected between 20 and 35 years, and in men from 20 to 50 years. In women, the first symptoms often occur during puberty even before the onset of sexual activity, while in men this form began to be detected at a later age.