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Genital Tuberculosis And Its Impact On Male And Female Infertility

Tuberculosis is infectious especially pulmonary tuberculosis which is primary site followed by genital organs which are secondary site and for the uninitiated, TB spreads by nasal route to lungs then spreads by blood to any part of body - brain, skin, glands, genital organs etc when the immunity is reduced but few know that it can lower the sperm count in men and is a frequent cause of infertility among women too. Genital tuberculosis is an infection caused by Mycobacterium tuberculosis, which affects the female genital organs and it can cause endometrial involvement and lead to infertility in women but female genital tuberculosis is much less common than male genital tuberculosis.

Genital tuberculosis and its impact on male and female infertility (Photo by Twitter/touchENDOCRINE/MyIndiainfo)

In an interview with HT Lifestyle, Dr Suparna Bhattacharya, Fertility Consultant at Nova IVF Fertility East at Kolkata's Uttam Kumar Sarani, explained, "The reproductive organs may suffer irreparable harm if untreated. Prompt therapy is highly beneficial, and many couples who receive it promptly go on to have healthy spontaneous pregnancies. Male reproductive organs (like testis, epididymis, vas deferens, seminal vesicles, prostrate) are infected by genital TB, which usually results in distortion and obstruction of the normal anatomy preventing sperm from being ejaculated resulting in azoospermia. Epididymitis, a swelling of the epididymis (tube near the testicles), can result from it. Beading can also develop on the spermatic cord, which supports the testicles in the scrotum."

She elaborated, "The conception is hampered by GTB in females, which mostly affects the fallopian tubes, uterus and occasionally the ovaries.Fallopian tubes may become damaged by tuberculosis and obstruct the fertilized egg's entry into the uterus or possibly prevent fertilization altogether. 90% of women who have genital TB have damaged fallopian tubes. Symptoms of uterine TB - irregular menstruation, pelvic pain, inadequate endometrial lining resulting in infertility and persistent infection can potentially harm the uterine cavity causing synechia and result in amenorrhea (complete cessation of menses). A disorder known as "Premature Ovarian Failure" may develop when one or both ovaries being affected. Before the age of 40, the ovaries begin to malfunction, generate less oestrogen and may stop producing eggs. If the eggs are released, they might not be of good quality to be fertilised."

Talking about genital tuberculosis and its impact on male and female infertility, Dr DS Sowjanya, Senior Pulmonologist at Kamineni Hospitals in Hyderabad, said, "The infection usually starts in the fallopian tubes and spreads to other parts of the female reproductive tract, such as the uterus, ovaries, cervix and vagina. Genital tuberculosis (TB) is an active genitourinary form of TB and is caused by the mycobacterium tuberculosis. It is a primary infection of the female genital organs, and can cause bilateral fallopian tube infection, as well as infection of the uterine myometrium and endometrium. Infected women often experience pain in their abdomen that worsens with movement or sexual intercourse. Symptoms also include fever, weight loss, night sweats and irregular periods or heavy bleeding. In some cases, it may lead to infertility due to blockage of the fallopian tubes or scarring of the uterus or ovaries."

The health expert revealed, "If not treated early, genital TB can spread from the genital tract to other parts of a woman's body such as her lungs (pulmonary TB). This type of TB can be more difficult to treat than other types since it involves multiple organ systems. Genital tuberculosis affects both male and female reproductive organs, however its impacts are more severe in women due to its ability to spread throughout the entire genital tract including into her uterus, ovaries and vagina. Mycobacterium tuberculosis is the major cause of genital tuberculosis and is one of the most common causes of high tuberculosis prevalence in many parts of the world. Asymptomatic nature and diagnostic challenges associated with genital tb makes it difficult to diagnose and treat, leading to severe consequences for female patients, including infertility. Symptoms can include abdominal pain, irregular periods, discharge from vagina and painful intercourse."

Highlighting that there are tests which are used to investigate TB, Dr Suparna Bhattacharya concluded, "It can be effectively treated with antibiotics given by a medical professional. It is advised that anyone who exhibits symptoms of genital TB undergo a test for the condition. With good antitubercular therapy women can be helped to try naturally to conceive or try through ART."

Tuberculosis As 'Hidden Pandemic': Persistent Cough That Goes Beyond Three Weeks Must Raise Brows, Say, Experts

Interestingly, a person can test positive for TB even when the infection might be latent. So, sometimes the blood tests can also be confusing. Timely diagnosis of TB and finding a working treatment for the condition is a challenge. Many people drop treatment prematurely due to high economic burden.

Tuberculosis can be considered a silent and forgotten pandemic. As per WHO, about a quarter of the global population is estimated to have been affected by the bacteria (Mycobacterium) that causes the disease. While most people self-clear the infection but 5 to 10 per cent may go on to develop the disease. The disease is both curable and preventable. Unfortunately, the condition remains a significant cause of illness and death.

Just like COVID-19 (which is caused by a virus), TB also primarily affects the lungs (however, it is caused by bacteria). Both diseases are passed primarily through aerosols when infected people might cough and the germs get into the surrounding air and are inhaled by other people. The trajectory of the two diseases however differs significantly. TB unlike COVID-19 is not extremely contagious and gets hardly gets transmitted in fleeting contact. However, it also doesn't mean that the disease cannot be passed from one person to another. Early detection and diagnosis of drug-sensitive and drug-resistant tuberculosis are essential for disease control. However, diagnosis of TB and finding a working treatment for the condition is a long journey.

TB unlike COVID-19 takes a long window between a person getting infected and the symptoms showing up. The infection can stay in the body dormant for years before the person starts feeling unwell. Due to the delayed emergence of symptoms and firm diagnosis, the person cannot be isolated from the family and might infect others in the family.

Another blockage on the road to recovery is the time required for treatment which crosses over a year. In the process, many people might change treatments, and abandon older medicines prematurely, thus leading to the emergence of drug-resistant strains. Also, the economic burden of the disease is also worrisome for many. Regular travels to the city, routine visits to clinics and medicine costs might make people abandon or fail treatment and eventually die. Lack of awareness of the disease can also lead to people overlooking symptoms and can fasten the progression of the disease to a stage from which the damage can't be reversed.

A persistent cough must raise brows, says expert

Our knowledge of Tuberculosis is also evolving with time. Today researchers know that mycobacteria divide asymmetrically, generating a population of cells that might be growing at different rates, have different sizes and might also differ in their response to antibiotics. It means that is possible that there might be no universal treatment for the condition that can be applied to everyone.

Also, the BCG vaccine is a live vaccine and can't be given to people with compromised immunity such as those having HIV. As per studies, the protective effects of the vaccine also wane with time. It might not be effective in protecting adults from active infection.

So, early detection of the symptoms and a quick course of action is the most effective way in our battle against the disease.

Dr Avi Kumar, senior consultant, Pulmonology at Fortis Escorts (Okhla, New Delhi) informed that a cough that persists for more than 3 weeks must be taken seriously. He said that people must understand that the effects of the disease are not limited to the lungs alone.

Dr Kumar said: "TB generally spreads through particulate material. If one cough or sneezes the particulate material spreads in the air and can spread to another person. It's very important to prevent TB by having educated respiratory etiquette. The most common symptoms in TB patients are cough with sputum production, fever, weight loss, decreased oral intake, and blood in sputum. If the cough persists for more than 3 weeks, one must try to undergo a TB test. It can affect the brain, lungs, pleura, heart, pericardium, intestine, kidneys, or joints and can affect many organs."

When TB might be progressing beyond the lungs, it can manifest symptoms like swollen lymph nodes, abdominal pain, joint pain, persistent headaches and even seizures in some cases.

Diagnosis of Tuberculosis

Interestingly, a person can test positive for TB even when the infection might be latent. So, sometimes the blood tests can also be confusing. However, people who might know that they have been staying or working with people who have a history of TB or are in an environment where TB might be present must show extra vigilance. A doctor might also pick up signs by listening to their lungs or observing swollen lymph nodes. Generally, a sputum test and an X-ray are often recommended on suspicion.

Dr Kumar informed about the ways the condition can be diagnosed.

He said: "The most common diagnosis is microscopy, ZN staining to detect the bacteria. Fluorescent microscopy is also being used to detect AFB bacterium. There is a radiological diagnosis in the form of an X-ray or CT scan where we can easily detect the lesions. There are advanced tests in the form of bronchoscopy where the patient is not producing any sputum, and we can go inside the lungs and a respiratory sample can be taken for examination, culture tests can also be done which is the goal standard of diagnosis for drug-resistant tuberculosis. These days multi-drug resistance or XDR TB is on the rise."

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Koch Discovers The Cause Of Tuberculosis

Portrait of Robert Koch from a photograph.Photo Credit: WELLCOME LIBRARY, LONDON

Tuberculosis (TB) is one of the leading causes of death worldwide and the second leading infectious killer, only behind COVID-19. It spreads from one person to another through the air and when someone develops active TB disease, it most often affects their lungs.

As of 2020, eight countries account for two-thirds of the total TB cases in the world, with India holding the ignominy of leading the count. The fact that TB is both curable and preventable is the only silver lining, something for which we need to be thankful to Robert Koch, a German physician who discovered the bacteria that causes the disease.

Born to a mining family in Germany in 1843 as the third of 13 children, Koch attended the University of Gottingen and graduated studying medicine in 1866. After serving as a physician in various provincial towns, he was appointed the district medical officer in Wollstein in 1872.

Starts with anthrax

Wool production was a major industry in this region and that meant that Koch saw a fair amount of anthrax patients, with various degrees of severity. Koch believed that these patients were workers who unknowingly ingested a microscopic organism that was in the hide of animal carcasses. Finding himself to be helpless at their sides, Koch was driven to find out the cause of anthrax and even a cure, if possible.

Living in a small home, Koch's consulting area was in the house's parlour. He used a curtain to divide this room in half and set up a small laboratory for himself. When the last patient was out of his consulting room every evening, the doctor then worked in his makeshift laboratory and conducted his research. It took a few months, but in 1876 Koch was able to identify a microbe named bacillus anthracis as the cause of anthrax.

Despite this success, Koch struggled to find a university position that would have enabled him to pursue full-time research. It wasn't until 1880 that he finally got his wish as he was appointed the government advisor to the Imperial Department of Health in Berlin.

Works alone

Equipped with time and the necessary tools, he decided to investigate TB. Even though the dominant thought at that time considered TB to be hereditary, Koch was convinced that it had to be infectious.

Koch locked himself in his lab on an everyday basis, worked alone, and had his answer after almost six months. Koch isolated and determined how to culture mycobacterium tuberculosis, the germ that we now know causes TB.

Special lecture

Far from a convincing lecturer, Koch had his audience spellbound when he presented his findings at the Physiological Society of Berlin on March 24 1882. The sheer beauty and pure logic left them awestruck, leaving them in no doubt that they were witnesses to scientific history. German medical scientist Paul Ehrlich, who went on to win the Nobel Prize for Physiology or Medicine in 1908, was among those in attendance, and he later mentioned it as "the most gripping experience" of his scientific life.

Koch published his lecture "The Etiology, or Cause, of Tuberculosis" in The Berlin Clinical Weekly on April 10, 1882. The deadly nature of TB meant that the discovery wasn't only carried in leading medical journals, but also made it to the front pages of newspapers worldwide, making Koch popular overnight

Koch also found out the cause of cholera, even though he was unaware that it had already been achieved decades earlier. He also believed that he had a cure for TB when he developed tuberculin. Even though it turned out to be not therapeutic, tuberculin did emerge as a diagnostic tool. Koch's tireless efforts in the field led to him winning the 1905 Nobel Prize in Physiology or Medicine "for his investigations and discoveries in relation to tuberculosis."

Koch's discovery 140 years ago was an important step towards making TB both preventable and curable. The disease, however, continues to wreak havoc as an estimated 10 million people worldwide fell ill and 1.5 million people died because of TB in 2020. There is still plenty to do before TB can become a thing of the past.

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