Genital tuberculosis and infertility

Genital tuberculosis can affect both men and women, though it is more commonly diagnosed in women. It is a common cause of infertility in women and can affect the sperm count in men. If left untreated, it can cause permanent damage to the reproductive organs. Luckily, timely treatment is very effective and many couples that get treated in time, go on to have successful pregnancies.

What is genital tuberculosis?

Tuberculosis or TB is an infection caused by bacteria that can settle in any part of your body, but most often in the lungs. When the lungs are infected, it is called pulmonary tuberculosis.

The infection can travel with the blood to other parts of the body. If the bacteria reach the genital and reproductive organs, it can cause genital tuberculosis. Genital tuberculosis is more common in women but can affect men too.

The bacteria can stay dormant in the body without causing an active infection for several years. When it gets activated, it can cause symptoms, but not always. Especially in the early stages of the infection, there are often no symptoms and so the infection can go undiagnosed for long.

How does genital tuberculosis lead to infertility?

Genital tuberculosis does not always lead to infertility, but if you are having trouble conceiving, you might find out that it is the cause.

In women, genital tuberculosis most often starts by infecting the fallopian tubes. When it does, the passage gets constricted (known as tubal obstruction) and the egg released by the ovary cannot reach the womb where it needs to go for fertilisation.

Sometimes, though rarely, this can lead to an ectopic pregnancy (when the egg gets fertilised outside the womb). This is a medical emergency that needs immediate treatment.

The infection can also spread to the ovaries, endometrium (lining of the uterus), and more rarely the cervix and vagina. If the infection is in the endometrium, it can make it harder for a fertilised egg to implant and so for the pregnancy to develop even if an egg gets fertilised.

If the TB is diagnosed at an early stage and the infection is treated, the damage to the uterus or fallopian tubes may heal. If left untreated for long, TB in the fallopian tubes, ovaries and uterus may lead to scarring. This cannot be reversed and may cause permanent fertility problems.

Scarring of the uterus can lead to irregular periods. In some cases, the periods may completely stop because the uterine lining is damaged. Unfortunately, in these cases women may not be able to get pregnant.

In men, genital tuberculosis can infect the epididymis (duct through which the sperm travel). If this happens, there can be very little or no sperm that reach the semen, making the man less fertile or infertile. It can also infect the prostrate or testicles.

How did I get genital TB?

If you had pulmonary TB in the past, genital TB can be a secondary infection as a result of it. The bacteria could have travelled to the genital area and stayed dormant there for years before causing an active infection.

If you never had TB before, you might have been exposed to the bacteria if you spent time with an infected person in closed quarters. Only people who have an active infection of TB are infectious. TB bacteria spreads the same way as a common cold – through droplets that an infected person sneezes or coughs out.

Brief contact with an infected person while, say, commuting on buses or trains, watching a movie in a theatre, sharing food, talking or shaking hands, will not give you TB. But if you're in closed spaces with little air circulation with an infected person, you can get exposed to the bacteria.

Someone with genital tuberculosis can pass on the infection through sex because the bacteria are present in body fluids and blood. The sexual partner might not get genital TB in turn, but the bacteria can settle somewhere else in the body and start an infection there.

Can I get genital TB if I had the BCG vaccine?

The BCG vaccine is the only vaccine against TB and it does protect from the worst forms of TB infection. However, you can still get a TB infection after having the vaccine.

What are the symptoms of genital TB?

Very often, especially in the early stages of the infection, there are little or no symptoms.

In women, as the infection grows, you might start to notice one or more of the following:

• irregular periods or no periods
• pelvic pain
• vaginal discharge that is stained with blood or which is persistent, heavy and discoloured
• bleeding after intercourse
• difficulty conceiving

In men, you might notice pain, swelling or irritation in the testicles. You might have pain during or after intercourse as well.

How is genital tuberculosis diagnosed?

You might need to go through several tests if your doctor suspects genital tuberculosis before the diagnosis is confirmed. These may include:

• a blood test
• a culture test of menstrual blood or semen
• an imaging test such as an ultrasound

How is genital TB treated and can I still get pregnant?

The treatment for genital TB is the same as for lung TB or any other form of TB. It is a course of antibiotics that lasts about six to eight months. It is important to complete the entire course of the treatment.

The treatment will get rid of the infection and offers relief from symptoms like pain, fever or discharge. If the infection is caught in time, there might not be any permanent damage to your reproductive organs. However, the treatment cannot repair damage or scarring from the infection. In some cases, this unfortunately means that if the damage to the reproductive organs is causing fertility problems, they might not get resolved.

There are options that might enable you to still have a pregnancy or a baby such as IVF or other assisted conception methods, surrogacy or adoption. Discuss these options with your doctor to see what suits you best.

Read this article in Hindi: जननांग टीबी और प्रजनन अक्षमता

Find out more:

• What chronic illnesses can affect fertility and why?
• Pinpointing a fertility problem
• Infertility treatments