FEMALE GENITAL TUBERCULOSIS: A NEGLECTED CAUSE OF INFERTILITY IN DEVELOPING COUNTRIES

Abstract

Background: Female genital tuberculosis (FGTB) is an important form of extrapulmonary tuberculosis and a leading, yet often under recognized, cause of infertility in women of reproductive age, particularly in developing countries. The disease is frequently asymptomatic and under diagnosed due to its nonspecific clinical presentation, contributing to delays in management and poor reproductive outcomes.

Methods: This review summarizes current knowledge on the epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, treatment strategies, drug resistance, and public health implications of FGTB. Data were synthesized from epidemiological studies, clinical reports, and molecular diagnostic research.

Results: FGTB primarily affects the fallopian tubes (90–100%), followed by the endometrium (50–60%) and ovaries (20–30%), with rare involvement of the cervix, vagina, or vulva. Clinical presentation ranges from infertility, menstrual irregularities, and pelvic pain to asymptomatic cases. Diagnosis requires a combination of imaging (hysterosalpingography, ultrasonography, laparoscopy), histopathology, microbiological testing (Ziehl–Neelsen staining, culture), molecular methods (PCR, gene amplification, BACTEC), and immunological tests. Standard antitubercular therapy (ATT) for 6–9 months remains the cornerstone of treatment, with surgical intervention reserved for complicated cases. Drug-resistant tuberculosis, particularly multidrug-resistant TB (MDR-TB), poses a significant therapeutic challenge. FGTB causes structural and functional damage to the reproductive tract, resulting in tubal obstruction, endometrial destruction, pelvic adhesions, and ovarian dysfunction, leading to infertility in 40–80% of affected women, often necessitating assisted reproductive techniques such as in vitro fertilization.

Conclusion: FGTB represents a significant reproductive health burden in endemic regions. Early detection through improved awareness, screening of infertile women, and use of molecular diagnostics is essential to prevent irreversible reproductive damage. Strengthening tuberculosis control programs and public health strategies is critical for reducing the incidence of this neglected cause of female infertility.