Causes and treatment of ovarian tuberculosis in women. Genital tuberculosis Tuberculosis of the female reproductive system

Tuberculosis infection can affect any organ, the infection can be asymptomatic, or, conversely, have vivid clinical manifestations. Often there is a relapsing course of the disease.

Tuberculosis was known as early as 1000 BC, but only in 1744 Morgagni, after the autopsy of a 20-year-old woman who died after childbirth, described the first case of a disease that had signs of genital tuberculosis. The term "tuberculosis" itself appeared in 1834, although the causative bacillus was discovered by Koch in 1882.

The battle against tuberculosis infection in the world is not considered won, in developed countries there has been a trend towards a decrease in the incidence of tuberculosis in general and tuberculosis of the genital organs. However, genital tuberculosis in women is the cause in 10% of cases. If pregnancy occurs against the background of infection with mycobacterium, then the risks of ectopia and other pathologies increase significantly.

Genital tuberculosis in women is not uncommon, especially if there were prerequisites for the disease:

contact with a tuberculosis patient;
antisocial lifestyle;
being in places of detention;
lung or other extrapulmonary form in history;
concomitant pathology associated with immunodeficiency states;
chronic malnutrition, etc.

Where is sexual tuberculosis most common?

The highest incidence of tuberculosis is in India, where almost half of the population suffers from this disease, and one person dies every minute from tuberculosis.

It should be noted that the true incidence of genital tuberculosis in women is not known, since the process is not so easy to diagnose.

The incidence varies by country.

According to scientists, genital tuberculosis is mostly secondary, i.e., initially, the infection often affects the lungs.

Tuberculosis of the female genital organs, as a rule, is diagnosed by 80 - 90% in young women aged 20 to 40 years, when conducting a comprehensive examination for.

The incidence of genital tuberculosis in women is 0.69% in Australia, 0.07% in the United States, less than 1% in Finland, 4.2% in Saudi Arabia, 5.6% in Scotland, 19% in India. In Russia, this figure is about 1.5%.

Statistics are presented on the basis of postpartum examination, examination of postoperative tissue samples and endometrial biopsy taken from patients with infertility. The results of pathoanatomical studies by various authors show that 4-12% of women who died from pulmonary tuberculosis also had signs of genital tuberculosis.

Pathogenesis of urogenital tuberculosis in women

Genital tuberculosis in women is almost always secondary, the primary focus is localized in the gastrointestinal tract, in; sometimes tuberculosis of the genitals in a woman is only part of the overall process (miliary tuberculosis). If bacilli cannot be eliminated from the body, there is a lifelong risk of reactivation, especially in immunocompromised states. . These include:

taking steroid hormones;
long
taking drugs that suppress the immune system.

How can you get TB

Infection with tuberculosis of the genital organs occurs by the hematogenous or lymphogenous route.

Genital tuberculosis in women can have a long latent course, and one day be reactivated under the influence of favorable factors.

Hematogenous spread of infection

After the primary lesion of the lung tissue, mycobacteria with the systemic circulation spread through the organs and systems. This condition can persist for up to 6 weeks or more if pathogenetic therapy with the appointment of anti-tuberculosis drugs is not started.

No human organ is immune from infection, although the frequency of damage in different organs and systems is variable.

In the fallopian tubes, the conditions for settling and reproduction of pathogens are most favorable. As a rule, the lesion is 2-sided, in the future the infection spreads to other organs of the female reproductive system and the peritoneum. There are cases of tuberculous peritonitis, when the body did not cope with the infection or the caseous lymph node ruptured.

Lymphatic spread of tuberculosis infection

Lymphatic spread, a less common mode of infection, occurs when the primary site is in the abdominal cavity.

Direct spread from adjacent organ

Direct infection of the genital organs from the bladder, rectum, appendix, and intestines has been described.. Peritoneal spread may also be the result of breakthrough of infected material from the fallopian tubes; thus, the localization of the primary process is not always clear. It can also occur as a result of adhesions, when the bladder or intestines stick together with the fallopian tubes, and perforation of the tuberculous ulcer leads to direct spread to the genitals.

After seeding of the genital tract, specific tuberculosis granules begin to form, which do not give clinical symptoms from 1 to 10 years. Often the primary focus cannot be established.

In the literature there are data on the primary infection of the vagina, cervix and vulva during sexual contact with a sick partner.

Fallopian tube tuberculosis

In the early stages, minor changes occur in the pipes, but as they progress, their diameter decreases, up to complete obstruction.

The statistical picture is as follows:

Fallopian tubes 90 - 100%;
Endometrium 50 - 60%;
Ovaries 20 - 30%;
Neck 5 - 15%;
Vulva and vagina 1%.

Types of tuberculous salpingitis

Exudative. With exudative salpingitis, the tube is significantly enlarged against the background of an acute process. In the lumen there is a large amount of caseous-purulent material.
Adhesive. This type is diagnosed with or with an open intervention; the tubes are dotted with nodules and fit snugly against the surrounding tissues. The wall of the tube is edematous, thickened. Subsequently, calcification and fibrosis occur.

After initial tubal involvement, Mycobacterium tuberculosis spreads to the uterus and ovaries. The enlargement of the uterus occurs due to the endometrium and, less often, the myometrium.

The ovaries are drawn into the pathological process by the direct spread of bacilli from neighboring organs. In most cases, the infection spreads from the tubes, and the lesion is observed on the surface of the ovaries. Less commonly, infection comes from the peritoneum.

The infection enters the cervix from the endometrium or hematogenously. Microtrauma contributes to tuberculous infection of the vagina and vulva, and bacilli enter from the uterus, tubes, intestines or lungs.

Tuberculosis of the endometrium

At first glance, the size and shape of the uterus does not differ from normal. The tuberculous process is localized mainly in the endometrium, the incidence of lesions is 50 - 60%, according to various sources. Often formed, complete damage to the endometrium leads to the appearance of secondary and the likelihood of pyometra, with obstruction of the internal pharynx.

Tuberculosis of the ovaries

Usually the process is two-way. There are two forms of ovarian tuberculosis: periophoritis, in which the ovary is surrounded by adhesions and "strewn" with specific tubercles caused by direct infection from the tube; and oophoritis, in which the infection begins in the ovary itself, presumably having entered hematogenously from a caseous granuloma.

Tuberculosis of the cervix

The cervix is involved in 5-15% of cases, while involvement of the vulva is rare.

There are no macroscopic changes characteristic of tuberculosis. In the early stages, the cervix is not changed or there are signs of inflammation. The most common type is the ulcerative form, although papillomatous and miliary forms are also found.

The diagnosis is established only by histological and/or bacteriological examination.

Cytology of the cervix can reveal multinucleated giant cells, histiocytes, and epithelioid cells arranged in clusters, mimicking the appearance of granulomats characteristic of a Pap smear in cervical TB. Epithelial atypia may be present.

Histology with sexual tuberculosis in women, it demonstrates granulomatous inflammation, sometimes there is inflammatory atypia with hyperplastic changes in the mucous membrane and cheesy necrosis.

Tuberculosis of the vulva and vagina

Tuberculosis of the vulva and vagina is the rarest form of genital tuberculosis, occurring in less than 1.5% of cases. In most cases, the lesions are secondary, but it is extremely rare to get infected from a partner with tuberculosis of the appendages or seminal vesicles.

In the vulva or in the vestibular region, a seal is formed, which eventually turns into an ulcer with the release of caseous masses and pus.

Tuberculosis of the Bartholin gland is also a rare pathology. The defeat of the vulva is manifested in the form of hypertrophy, the defeat of the vagina can mimic carcinoma.

Tuberculous peritonitis

Tuberculous is combined with tuberculosis of the female genitalia in about 45% of cases and leads to a massive adhesive process. The exudative form and the adhesive form are distinguished, on which the clinical manifestations depend:

inflammation of the sheets of the peritoneum;
temperature;

Signs and symptoms of genital tuberculosis in women

When collecting an anamnesis, attention is paid to the possibility of contact with a tuberculosis patient. About 20% of patients with genital tuberculosis confirm tuberculosis infection in relatives.

50% of women had a history of pulmonary tuberculosis or some form of extrapulmonary tuberculosis.

With infertility, all women, regardless of history, should be examined by a phthisiogynecologist.

Indications for examination, in addition to fertility disorders, consider the following:

causeless weight loss;
weakness;
pain syndrome;
prolonged subfebrile condition.

The main symptoms of sexual tuberculosis:

(absence of menstruation);
meager bleeding ();
bleeding after intercourse;
excessive vaginal secretion;
dyspareunia (pain during sex);
(primary or secondary);
postmenopausal bleeding;
ulcers in the vulva, vagina, cervix;
enlarged uterus with pyometra;
fistula formation;
pain in the pelvis.

Statistics show that 85% of women with genital tuberculosis have never been pregnant.

Pelvic pain accompanies the process in 25 - 50% of women. Painful sensations are present for several months. Pain in tuberculosis of the genitals is dull, aching, may be accompanied by an increase in the abdomen. With the addition of a secondary infection, the pain syndrome intensifies. As the process spreads during physical exertion, sexual intercourse and menstruation, the pain is more pronounced.

Genital tuberculosis can mimic ovarian cancer: ascites, elevation, organ changes.

Diagnosis of genital tuberculosis in women

The absence of changes on chest X-ray does not rule out the diagnosis of genital TB in women, since most lesions resolve spontaneously by the time the genitals are involved.

There are no pathognomonic changes, although lymphocytosis and anemia are sometimes present.

In the general analysis of urine, hematuria and / or abacterial pyuria are sometimes observed with the addition of secondary microflora.

The diagnosis of genital tuberculosis is established by detecting Mycobacterium tuberculosis or tuberculosis complexes.

We list a set of measures for the diagnosis of tuberculosis in women:

The severity of lesions of the genitals is minimal and common. The minimal lesion is asymptomatic (an exception is infertility). Pelvic examinations do not reveal any abnormalities. With a common process, instrumental diagnostics show changes, but do not allow confirming the cause.

The diagnosis is established bacteriologically, by histological examination or by PCR diagnostics of menstrual blood.

What are the complications of genital tuberculosis in women

. Even despite ongoing anti-tuberculosis therapy, significant damage to the fallopian tubes leads to persistent infertility.
. The same damage to the fallopian tubes in 33 - 37% of cases leads to an ectopic pregnancy.
Congenital tuberculosis in a child. This is a rare, but in terms of prognosis, a very serious complication. The infection is often generalized, leading to death if left untreated.

After confirmation of the diagnosis, it is important to exclude tuberculosis of other organs. An x-ray of the lungs is performed, morning sputum, aspirate of gastric contents, urine are examined three times, excretory urography is performed.

note

There is evidence that 10% of women with tuberculosis of the genital tract have a lesion of the urinary organs.

Treatment of genital tuberculosis in women

Before prescribing treatment, the following aspects are evaluated:

the degree of damage to the genital tract;
the presence of active TB elsewhere;
whether there is a need for surgical treatment;
concomitant pathology;
previous treatment and its effectiveness;
Is it possible to get pregnant in the future?

Before the advent of effective chemotherapy, the mainstay of treatment for genital tuberculosis was surgery, which had many complications, and mortality from the primary disease was high.

For the treatment of tuberculous lesions of the genital organs, standard anti-tuberculosis drugs in various combinations, hepatoprotectors, and vitamins are used.

Some experts believe that the concentration of pathogenic organisms in extrapulmonary forms of tuberculosis is less, and access to the foci for drugs is better, so extrapulmonary forms are easier to treat.

If there was no effect from conservative therapy, fistulas, abscesses appeared, the infection spread to new organs - surgical treatment and long-term use of anti-tuberculosis drugs in the future are indicated.

Mishina Victoria, urologist, medical commentator

Tuberculosis of the female and male genital organs: symptoms.

Tuberculosis is a disease caused by mycobacterium, the so-called.

Genital tuberculosis is not an independent disease.

It develops secondarily, when infected from the focus of the primary lesion.

This pathology is formed against the background of a primary infection that develops in the tissues of the lungs or intestines.

Bacteria enter the genital organs when they are transferred by lymph, blood or by contact, in case of contact with affected intestinal tissues.

Epidemiology

is growing all over the world, despite the development of medicine.

Every year, 8 million more people become infected with this infection, of which about three million die.

Most people get sick in underdeveloped countries.

Lesions of the organs of the genitourinary system account for about 2.2% among patients with gynecological diseases.

You need to know that the real numbers are much higher, because the lifetime diagnosis of this infection is only 6.5%.

In women suffering from infertility, this disease was detected in almost 22% of cases, in those suffering from menstrual irregularities - in almost 10%, and among those who were diagnosed with inflammation of the internal genital organs - about 11% of the cases.

Over the past few years, there has been a slight increase in the detection of diseases.

This is due to the improvement of methods for diagnosing this disease.

Classification of genital tuberculosis

Infection with this type of infection is classified according to several criteria:

caseous - the disease in this form is severe with frequent and painful exacerbations;
the chronic form has mild symptoms of the course of the disease;
subacute - with it, a significant part of the organ is affected and exudative-proliferative changes occur in it;
a complete process - with this form of infection, encapsulation of foci of infection occurs.

Patients with active tuberculosis are isolated.

Mycobacterium tuberculosis, or, as it is called, Koch's bacillus, is an unusual bacterium. Once in the body (and this often happens even in childhood or adolescence), it can be inactive, or cause such weak and non-specific symptoms - fatigue, a rare dry cough, and others - that they are attributed to overwork and do not pay attention to them.

Often, the tuberculous process in the body remains unrecognized. A woman learns about the presence of the disease when she cannot become pregnant. This is how tuberculosis of the uterus and fallopian tubes makes itself felt (in 10-22% of cases of infertility). In some cases, this disease proceeds as an acute process, and then it is very difficult to distinguish it from acute appendicitis, ectopic pregnancy, seeding of the peritoneum, ovaries, or fatty omentum with cancer cells.

Causes of the disease

The causes of uterine tuberculosis are the ingestion of Koch's bacillus into the body of a woman, followed by its spread from the primary focus to the genitals.

The disease develops when several conditions are met:

a certain amount of mycobacterium tuberculosis that got into the body did not die (this is possible with insufficient immunity activity);
bacteria have entered the respiratory system or (very rarely) the intestines;
at first, due to the sufficient activity of the nervous, cardiovascular, immune and endocrine systems, the bacterium could not cause disease;
then, against the background of various diseases, bacteria began to spread throughout the body, or the primary focus in the lungs began to heal, and Koch's sticks infected the genitals.

How is the infection transmitted?

The bacterium that causes this disease enters the body through airborne droplets. So it enters the bronchi, and then the lungs. This is confirmed by the discovery in 15-20% of women of "traces" of the disease in the form of a thickening of the pleura, foci of calcium accumulation, and an increase in intrathoracic lymph nodes. From the lungs to the internal genital organs, the tuberculosis bacillus enters with the blood stream, or through the lymphatic vessels.

In some cases, infection of the uterus occurs through the intestines. Mycobacteria enter the intestines with pulmonary tuberculosis, when sputum is swallowed, which is coughed up, or when infected foods are consumed.

Tuberculosis of the female reproductive organs does not occur every time an inflammatory focus occurs in the intestines, lungs or peritoneum. Pregnancy, childbirth, severe stress, hormonal and immunodeficiency diseases can provoke the spread of infection to the genitals.

The likelihood that Koch's wand will fall on the uterus increases if a woman suffers from chronic inflammation of the uterus () or appendages, if she already had menstrual irregularities (irregular, painful, scanty or heavy periods), operations on the uterus, abortions.

Infection through sexual contact (from a partner who has genital tuberculosis) is extremely unlikely. Most scientists who have studied this issue have come to the conclusion that the mucous membrane of the external genital organs, the vagina and the lower part of the cervix will reject Koch's wand.

Most cases of the disease develop in childhood, but the first signs of uterine tuberculosis can be seen only during the formation of menstruation. The disease is diagnosed, mainly at the age of 20-35.

Classification

According to the nature of the course, tuberculosis of the genital organs can be acute, subacute and chronic. The acute course of the process is extremely rare, mainly with the addition of a secondary infection. In 15-17% of cases, subacute tuberculosis is observed, when the inflammation is not so active. The chronic variant is the most common.

There are also different activity of the tuberculosis process in the genitals. So, in the first 2 years, it is considered active, the stage of fading lasts 2-4 years, inactive - for an arbitrarily long time. The last stage is also called the consequence of tuberculosis. If in the first 4 years from the moment of the disease, its symptoms become more pronounced, this is called an exacerbation. When the same phenomenon develops later than the first 4 years, it is a recurrence of uterine tuberculosis.

There is also a classification that takes into account the localization of the process. So, there may be tuberculosis of the uterine appendages, and it occurs more often - in 90-100%. This is due to the fact that the fallopian tubes receive nutrition from two arteries - the uterine and ovarian, which branch into many branches. The blood flow in such vessels is slow, and this makes it possible for Mycobacterium tuberculosis to settle in tissues fed by small-diameter arteries. And this is mainly the mucous membrane of the fallopian tubes.

Separately, tuberculous lesions of the body of the uterus are recorded in 25-30%. It can capture only a portion of the inner membrane of the organ (focal endometritis), the entire endometrium (total endometritis) and even spread to the muscular membrane of the organ (metroendometritis).

Inflammation of other structures develops quite rarely: the cervix - in 0.8-6%, the ovaries - in 6-10%, the vagina or external genitalia - less than 0.4% of cases, and is considered a criterion for the late detection of the process.

Depending on what picture the histologist finds in the biopsied tissue, uterine tuberculosis can be:

Chronic with productive changes: cells in the focus of inflammation grow and divide, which is why tubercles (lupomas) appear on the mucous membrane.
Subacute with exudative-proliferative changes: cells not only divide, but also secrete an inflammatory fluid - exudate.
Caseous, when the death of a tissue site looks like a white curd mass, which crumbles easily. This tissue change is typical for acute and severe forms.
Finished, in which the foci of inflammation are impregnated with calcium salts (calcified) and are themselves limited to the capsule.

Clinical picture

Acute course

Symptoms of uterine tuberculosis depend on the nature of the course of inflammation. So, in an acute course, a woman notes constant pain in the lower abdomen. They are amplified if you perform electrophoresis with anesthetic medicine, magnetotherapy or other physiotherapy. In addition, there is an increase in body temperature, weakness, night sweats.

Pain in the acute form of the disease can be so severe that doctors diagnose appendicitis, ovarian apoplexy, and operate on the patient. And if the form of the disease is such that during the operation, the death of sections of the uterus is visible, the surgeon removes them and sends them for histological examination. This way, a correct diagnosis can be made and treatment can be prescribed.

If, while conducting an intraoperative examination of the abdominal organs, the surgeon does not see any changes in them and does not make any removals, then tuberculosis may not be diagnosed for a long time.

Subacute course

Subacute course implies not intense, but constant pain above the pubis. This is due not only to inflammation, but also to the fact that it becomes difficult for the intestines and pelvic organs to contract due to the restriction of their movement by scars and adhesions. The temperature rises to 37.2-37.3°C, may remain within normal limits. General weakness, fatigue and loss of appetite are alarming, but given the rhythm of the life of a modern woman, this rarely leads to a visit to a doctor and further diagnosis.

chronic process

With tuberculosis of the body of the uterus, which has a chronic course, a woman may not be bothered by anything (a little fatigue, a periodic increase in temperature to small numbers is attributed to a viral infection, stress, work). Only infertility can induce her to start an examination. It may not develop immediately: a woman may have time to have an abortion or give birth to a child (and this may provoke the spread of tuberculosis to the genitals).

Most cases of infertility are due to the fact that, due to the peculiarities of local circulation, the tuberculosis bacterium first enters the fallopian tubes and causes inflammation. Flowing for a long time and hardly noticeable, it causes a narrowing of the oviducts, as a result, the egg cannot pass into the uterine cavity and become fertilized. The patency of the fallopian tubes can be disturbed when it is filled with curdled masses formed by their own dead cells.

Pregnancy also does not occur if the tuberculous process has led to partial or complete infection, scarring of the uterine cavity.

Approximately half of women with uterine tuberculosis experience menstrual irregularities. Usually these are meager and short periods (3-4 days), the interval between menstruation is 35 or more days. There may be a prolonged absence of menstrual flow. The tendency to uterine bleeding for this inflammation is not typical.

Tuberculosis of the cervix is a complication of inflammation of the body of the uterus. It develops more often in older women after the endometrium of the body of the uterus has died with the formation of curdled masses, and the inflammatory process has moved to the myometrium. There are no specific symptoms that distinguish cervical tuberculosis. The disease can be diagnosed at run time as productive (formation of tubercles) or ulcerative (ulcers are visualized) forms.

Establishing diagnosis

Diagnosis of tuberculosis of the uterus or other reproductive organs is extremely difficult. This is due to the fact that tuberculous inflammation does not have any special symptoms, is not "on hearing" from gynecologists, and is also rarely detected by standard bacteriological cultures of vaginal discharge and is not always noticeable even during surgery.

It can be suspected only if you have a long and thorough conversation with a woman, and it turns out that she was in contact with a person with tuberculosis, or in childhood and adolescence she often had diseases of the bronchi or lungs (especially if such diagnoses were made as bronchoadenitis, pleurisy).

How to identify the disease using instrumental and laboratory methods?

Diagnosis will help:

X-ray or computed tomography of the lungs: they reveal accumulations in the lungs of calcium, enlarged thoracic lymph nodes, which indicates a tuberculous process.
Examination on a gynecological chair. A sedentary and fixed uterus may be revealed, with damage to the appendages, the doctor can feel them in the form of enlarged, painful and tuberous strands.
Tuberculin test: tuberculin is injected under the skin, after which changes in the appearance of the cervix (according to colposcopy), body temperature, pulse, and deviations in the blood test are noted.
Cultures of vaginal discharge or menstrual blood.
- X-ray of the uterus and appendages after pre-filling them with a contrast agent.
, which is carried out 2-3 days before menstruation.
- a method when a hole is made in the front wall of the abdomen, through which video equipment is inserted, which allows you to examine the uterus and appendages, take a biopsy.

Therapy

Treatment of uterine tuberculosis is carried out in anti-tuberculosis dispensaries. It includes the appointment of specific antibiotics (Isoniazid, Streptomycin), drugs that gently stimulate the immune system, and vitamins (anti-tuberculosis antibacterial agents cause vitamin deficiency in the body).

Without fail, a woman should begin to eat a balanced and proper diet, get enough rest and walk in the fresh air.

If fistulas appeared in the reproductive organs, areas of caseous necrosis formed in them, or the uterine cavity was filled with pus, an operation is performed. Surgical intervention is also resorted to in the presence of adhesions and scars in the uterine cavity so that a woman can become pregnant.

The course of treatment necessarily includes physiotherapy and spa treatment.

Tuberculosis of the ovaries in women is a disease that occurs due to infection of the genital organs with Mycobacterium tuberculosis. Genital tuberculosis often causes intoxication, constant pain in the pelvic organs, menstrual dysfunction, subfebrile condition. To make such a diagnosis, a complete patient history is taken, a tuberculin test is prescribed, swabs from the cervix and endometrial scrapings, laparoscopy, and ultrasound are prescribed. Genital tuberculosis today is a completely curable disease. The main thing is to detect and start treatment in a timely manner.

Genital tuberculosis and its causes

Tuberculosis of the female genital organs, in particular the ovaries, is a lesion of a secondary nature. This means that this sexually transmitted infection is transmitted from the primary lesions, which can be the lungs or intestines. According to statistics, genital tuberculosis is much more common than other types of disease that occurs outside the lungs. Most often, the disease affects the fallopian tubes. Often, mycobacteria develop in the endometrium. The cervix, ovaries, and other pelvic organs become infected much less frequently.

Infection occurs due to the presence of chronic infections of the reproductive system, poor nutrition, stress, low immunity and factors that provoke lymphogenous or hematogenous drift. A disease appears due to the ingress of mycobacterium tuberculosis into the pelvic organs from a primary source. It is almost impossible to get infected sexually. This is due to the fact that the vulva, cavity and cervix are lined with stratified epithelium, which is not susceptible to these mycobacteria.

Varieties of tuberculosis of the genital organs

Genital tuberculosis, affecting the ovaries and other organs, leads to the appearance of changes in the morphological and histological type that are characteristic of this disease. The disease is usually divided into the following forms:
chronic without pronounced symptoms, but with productive inflammation;
subacute, proceeding in a pronounced form with proliferation and exudation;
caseous, accompanied by severe acute processes;
complete, in which foci of calcification are encapsulated.

Note: Depending on the affected genital organ, the development of salpingo-oophoritis, salpingitis or endometritis is possible. According to the level of activity, tuberculosis of the female genital organs is divided into:
active, lasting about two years;
subsiding;
inactive.

If in the first four years the defeat of the fallopian tubes, ovaries or uterine cavity is considered as an exacerbation, at a later date the disease is perceived as a relapse. Depending on the type of Mycobacterium tuberculosis, there is MBT (+) or MBT (-). The defeat of the ovaries by this mycobacterium is rare. Most often, the disease occurs along with an infection of the fallopian tubes. On microscopic examination, tubercles are observed on the outer part of the ovary. Sometimes the inner region of the corpus luteum, and even a bursting follicle, is subjected to seeding with burgorka. Tubercles tend to increase and merge, which leads to caseous decay. This form often does not require treatment and goes away spontaneously.

Symptoms of the disease

As a rule, the disease is latent. However, there are some symptoms that require you to see a doctor as soon as possible in order to exclude or confirm the presence of the disease. Infertility is considered the main manifestation of pathology. More than eighty percent of women who have experienced lesions of the ovaries, fallopian tubes, and cervix with tuberculosis mycobacteria have never been able to conceive a child. Violation of menstrual function was observed in 30-70 percent of patients with this diagnosis. At the same time, women face delays in menstruation for more than a month, jumps in the cycle, up to the absence of menstruation. In this case, hormone therapy does not bring any effect. This leads to intoxication and damage to ovarian cells.

The main symptoms of the disease:
the appearance of acute or dull pain in the lower abdomen, not associated with the days of the menstrual cycle;
an increase in temperature to 37.5 degrees, which cannot be brought down by anti-inflammatory drugs;
general deterioration due to intoxication, including loss of appetite, weakness, fatigue.

The disease is much less likely to cause discharge than other inflammatory processes. In the initial form, when the disease is at a progressive stage, the patient has vomiting, fever and acute pain in the lower abdomen. Because of these signs, some doctors prescribe surgery, suspecting an exacerbation of appendicitis, an ectopic pregnancy, or ovarian apoplexy. If the disease is in a chronic form, a woman faces frequent periods of exacerbation, accompanied by mild symptoms. The causes of pain are adhesive processes, lack of oxygen in the tissues, vascular sclerosis or damage to the nerve endings.

An exacerbation of the tuberculous process causes an artificial termination of pregnancy, an inflammatory process in the uterine cavity, ovaries or fallopian tubes, as well as improperly selected physiotherapy. Tuberculosis in most patients proceeds latently, without disturbing the woman for a long time. The reason for going to the hospital is the inability to become pregnant or a violation of the cycle.

Diagnostic methods

Infection of the female reproductive system with tuberculosis mycobacteria is determined using laboratory research methods. During the examination, the doctor takes into account the information of the anamnesis, including data on possible contacts with sick people and infections of the respiratory system that were previously transferred. During the examination, it is possible to identify a number of signs characteristic of chronic or acute damage to the uterine appendages. However, to date, such a study is considered ineffective. To make a diagnosis, Koch's tests are used: tuberculin is injected under the skin and the focal and general reactions to the drug are evaluated. If a general reaction is detected, an increase in temperature is observed in the cervix. The patient's pulse and body temperature increase; characterized by high ESR, a change in the number of leukocytes in the blood and other indicators.

The manifestation of a focal reaction is observed in the affected area. So, the patient may complain of pain in the lower abdomen and painful palpation. The tuberculin test is not recommended for patients with diabetes and impaired kidney or liver function. Microbiological studies remain the most accurate method for making a diagnosis, which makes it possible to identify Koch's sticks in the tissues. To conduct a test, menstrual blood is taken, secretions from the uterine appendages, material from foci of inflammation; scraping of the endometrium. Sowing material is performed at least three times.

Another effective diagnostic method is laparoscopy. This method allows you to determine whether there are changes characteristic of the tuberculous process. Laparoscopy will show the presence of an adhesive process, caseous foci, a loop on the peritoneum covering the uterus. During the operation, the doctor may take materials for bacteriological and histological examination. Often in the diagnosis, the method of biopsy and cytological examination is used. Hysterosalpingography is also an important method to identify obstruction of the fallopian tubes and lesions affected by mycobacteria. The results of the study allow us to see calcifications in the ovaries, lymph nodes, damage to the fallopian tubes and places where caseous decay has occurred.

In young patients who have not begun sexual activity, a sign of genital infection may be adnexitis, which occurs in combination with prolonged amenorrhea and subfebrile condition. If an ultrasound is performed, the doctor can detect inflammation and adhesions. The PCR method also allows detecting mycobacteria. If you suspect or identify a disease, it is recommended to contact a phthisiatrician.

Treatment Methods

Treatment of this disease is carried out exclusively in specialized institutions. Only complex treatment based on anti-tuberculosis physiotherapy and chemotherapy can get rid of genital tuberculosis. It is important to increase the protective characteristics of the body. For this, the patient is prescribed vitamin complexes, a complete diet and rest. If it was not possible to overcome tuberculosis mycobacteria, you will have to resort to surgical intervention. Methods of treatment are selected individually, taking into account the forms of tuberculosis, its tolerance, and the possible addiction of mycobacteria to the drugs used. To reduce the negative impact of chemotherapy treatment, drugs containing calcium, vitamins C and B are prescribed in parallel.

Surgical treatment is used if conservative therapy has not brought results or tubo-ovarian inflammation is observed. It is possible to re-examine for the presence of genital tuberculosis only some time after the end of the course of drugs. This is due to the fact that the infection does not immediately disappear. Patients are also shown sanatorium treatment, during which pathogenetic methods, climatotherapy, balneotherapy, air baths, and heliotherapy are used.

What to expect after treatment

Recurrent processes after the end of therapy are observed in only seven percent of patients. Complications are caused by the adhesive process and the formation of fistulous forms of the disease. 5-7 percent of patients manage to restore the reproductive system. It is important to remember that pregnancy in women who have had the disease and undergone treatment often ends in spontaneous miscarriages, premature births and fetal hypoxia. Therefore, the entire period of bearing a baby should be under the supervision of specialists. The recovery process directly depends on the patient's resistance to the drugs used.

How to avoid infection

Vaccination is used as a preventive measure for this disease. Vaccination is carried out in the first months after birth, as well as in adolescence. Timely detection of the disease allows the Mantoux reaction and prophylactic fluorography. It is recommended to avoid contact with people with active tuberculosis. The most susceptible to mycobacteria are women with low immunity, who are in a constant state of stress. As soon as symptoms such as menstrual irregularities, inability to conceive, persistent inflammation of the pelvic organs are noticed, one should be screened for tuberculosis infection.

Tuberculosis is a common infectious disease that can affect a person of any age and gender. Tuberculosis pathogens can localize and multiply, causing disease, in any part of the body and in any organ, with the exception of hair and nails. As a rule, this infection affects the bronchopulmonary system (pulmonary tuberculosis), but there are many types of extrapulmonary lesions, a special place among which is tuberculosis of the female genital organs.

To date, the situation with tuberculosis around the world remains unfavorable, even despite significant progress in medicine. The incidence of this infection is growing year by year, especially in countries with unstable economies, including Russia. Drug-resistant forms are emerging, and extrapulmonary forms, including genital tuberculosis, are difficult to suspect and diagnose.

Incorrect treatment of detected tuberculosis causes the infectious agent to pass into L-forms, which makes it impossible to detect them in the future. In addition, not all clinics have sufficient equipment and know how to diagnose tuberculosis, which also increases the true (not officially recorded) number of patients and creates an unfavorable epidemiological situation.

Particular attention in this article is paid to tuberculous lesions of the fallopian tubes (salpingitis), which ranks first among other forms of genital tuberculosis and is one of the causes of persistent female infertility.

Statistics on genital tuberculosis

Genital tuberculosis: causes and mechanism of development

Despite the fact that tuberculosis is a common infectious disease, the possibility of damage to the reproductive system, both in women and men, is not excluded. Tuberculous lesion of the female reproductive system is secondary. That is, the causative agents of tuberculosis enter the reproductive system from the primary focus of infection, more often by hematogenous (with blood flow) and less often by lymphogenous routes. Primary lesions are usually located either in the lungs (more often) or in the intestines (less often). But migration of causative agents of tuberculosis is also possible from other organs (bones, kidneys, lymph nodes).

The reasons

Mycobacterium tuberculosis causes the disease, the discovery of which belongs to Robert Koch, therefore the causative agents of tuberculosis are also called Koch's bacillus. Mycobacterium tuberculosis really under the microscope look like thin straight or several curved sticks, rounded at the ends. Young mycobacteria look like long sticks, while older ones branch.

Due to the content of fatty substances in the cell walls, mycobacteria are resistant to acids, which allows them to survive in aggressive environments and be resistant to drying. These properties cause the danger of mycobacteria - they remain viable in dust or dried sputum for up to six months, and in the body for up to several years. In the treatment of this disease, as a rule, inadequate, Koch's bacillus is converted into L-forms, which are not amenable to staining with known dyes, which makes it difficult to diagnose them, and, consequently, leads to the spread of infection among the population.

How is the infection transmitted and developed?

Infection with tuberculosis occurs by airborne droplets (the lungs are affected) or (less often) by alimentary, when the patient swallows sputum or when eating contaminated foods. In order for Koch's wand to enter the female reproductive system from the primary site of the lesion, certain factors are needed that reduce overall immunity:

exacerbation of chronic infections;
stress;
poor living conditions;
malnutrition;
functional disorders;
pregnancy and childbirth;
hormonal disorders and more.

Mycobacterium tuberculosis penetrates into the reproductive system with blood or lymph flow. Theoretically, sexually transmitted tuberculosis is allowed when a sexual partner has genital tuberculosis, but this applies more to casuistic cases than to the norm. Most authors generally deny the sexual transmission of this infection, explaining the resistance of the stratified squamous epithelium of the vulva, vagina and cervix to the penetration of mycobacteria.

It is also possible for Koch's sticks to enter the internal genital organs from the infected peritoneum.

Migration of mycobacteria in the body, as a rule, begins either during childhood or during puberty, but clinically genital tuberculosis can debut at any age, depending on factors that reduce immunity.

Most often, the fallopian tubes are involved in the process. This is due to their peculiarities of blood circulation and the structure of the circulatory network. Since the tubes are supplied with blood by the uterine and ovarian arteries, which have numerous anastomoses (bridges), the blood circulation in them is slowed down. This feature leads to the settling and accumulation of mycobacteria in the tubes, first on their mucosa, and then spreading deeper (into the muscular and serous layers).

Exudation (liquid release into the tissue) and proliferation (tissue growth) occur in the lesion (tube mucosa), and then caseous necrosis is formed. With tuberculosis of the fallopian tubes, they are usually obliterated (passages in the tubes overgrow), and exudative and proliferative processes can contribute to the development of pyosalpinx (accumulation of pus in the tube cavity). If the process extends into the muscular layer of the tubes, then tubercles (tubercles) are formed in it.

When the uterus is affected, tubercles and caseous necrosis are also formed. With tuberculosis of the appendages, the peritoneum and intestinal loops are often involved in the process, which leads to the formation of multiple adhesions.

Classification

There are the following clinical and morphological forms (symptoms and histological picture):

chronic - the symptoms are mild, histologically productive inflammation with the formation of tubercles;
subacute - the processes of proliferation / exudation predominate, clinical manifestations are pronounced;
caseous - the death of tissue sites (in the form of a curdled mass), clinically manifests itself acutely and is difficult;
complete process - the foci are calcified and encapsulated.

According to localization, there are:

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);
fading (after 2 years and up to 4);
inactive genital tuberculosis - lasts an indefinite amount of time and is characterized as the consequences of transferred genital tuberculosis.

Exacerbation/recurrence:

aggravation of symptoms within 4 years after the diagnosis of genital tuberculosis - exacerbation;
aggravation of symptoms after 4 years - relapse.

Detection / absence of mycobacteria in the analyzes:

MBT(-);
MBT(+).

Clinical picture

The first clinical signs of genital tuberculosis may occur during puberty, but, as a rule, the manifestation of the disease occurs in 20-30 years. Symptoms may also appear later, in pre- and postmenopause. In older women, the disease is asymptomatic or with a small number of manifestations, even if both the tubes and the uterus are affected at the same time.

Genital tuberculosis often occurs against the background of another gynecological pathology (myoma, endometriosis) and is combined with signs of both genital and general infantilism.

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

The symptoms of typical tuberculous intoxication are far not in all cases:

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

Genital tuberculosis is prone to a chronic course, either without fever or with its periodic rise. In the acute course of the disease, the cause should be sought in the secondary infection of the genital organs with other microorganisms.

Patients complain about pain in the lower abdomen aching / pulling nature, which are either short-term or disturbing for a long time. Extremely rarely, pain can become very intense, which is taken by doctors for emergency conditions (appendicitis or ectopic pregnancy).
Also, patients have menstrual irregularity(with tuberculous salpingitis and endometritis). Disorders of the cycle are manifested in the form of erratic intermenstrual bleeding, a decrease in menstruation or their absence, there are pains during menstruation and premenstrual syndrome. Violation of the menstrual cycle is 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.
A pathognomic sign in genital tuberculosis is female infertility often primary. Secondary infertility in tuberculous salpingitis develops after a complicated abortion or childbirth. Infertility with tuberculosis of the genital organs:
- on the one hand, it is due to 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.
Many patients develop headache and dizziness, weakness and fatigue, vague pain in the lower abdomen, disruption of the intestines and menstrual cycle.

It becomes clear that there is no characteristic clinical picture in genital tuberculosis which makes it difficult to diagnose. Often, more than one year passes from the moment the first signs of the disease appear to the detection of tuberculosis infection of the genital organs.

Tuberculous salpingitis

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

The mucosa 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 tube lengthens, and its ampullar end retort-like expands. At this stage, the process can stabilize, subside or progress.

In the case of progression, the infection spreads to the muscular membrane and serous. Infiltrates and tubercles appear in the muscular membrane, and multiple tubercles appear on the serosa. Further, adhesions begin to form between the organs of the small pelvis, first loose, then more dense.

If the tuberculous process lasts for a long time, caseous decay of the tubercle 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 a pyosalpinx.

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

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

The symptomatology of the productive form of salpingitis is small and erased. The disease proceeds according to the type of chronic nonspecific adnexitis. During a gynecological examination, thickened with clear contours of the fallopian tubes, which are sensitive to pressure, are palpated.

Tuberculous metroendometritis

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

After rejection of the functional layer, the tuberculous process spreads in depth, reaching the basal layer. The long course of the disease leads to the development of fibrous processes and the formation of intrauterine adhesions (fusions), which is clinically manifested by scanty menstruation or their complete absence.

In the case of the caseous form, bloody discharge is observed with an abundant amount of a crumbly, trovor-like mass. Filling the uterine cavity with this mass leads to blockage of the cervical canal, the attachment 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.

In many patients, there are only focal (spots) lesions of the endometrium, which is asymptomatic. Tuberculosis of the uterus, as a rule, occurs a second time after the defeat of the tubes.

Other forms of genital tuberculosis

Tuberculous lesion of the cervix occurs after the defeat of the endometrium and occurs in a descending way (infection from the uterus "descends" to the cervix). It can take two forms:

productive - the formation of tubercles under the epithelium of the visible part of the neck;
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.

In the parenchyma, new small foci of tuberculosis are formed, which are prone to fusion and subsequent destruction of the ovarian tissue. It is clinically manifested by disruptions in the menstrual cycle, pains of varying intensity in the lower abdomen, hormonal disorders. In the case of caseous decay of the affected foci, pus is formed and pyovar is formed (purulent fusion of the ovaries).

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

Diagnostics

Due to the absence of characteristic clinical signs and, as a rule, an asymptomatic or erased course of the disease, it is extremely difficult to suspect tuberculosis of the genital organs. But even if this infection is suspected, it is very difficult to identify Koch's bacillus in the histological material due to L-shapes and inactivity of the process. Diagnosis of genital tuberculosis should be comprehensive, thorough and include anamnesis data, complaints, results of gynecological examination and laboratory and instrumental studies.

History data

When collecting an anamnesis, it is important to indicate tuberculosis patients in the family, close contacts with tuberculosis patients, the presence of tuberculosis of any localization in the past, a high percentage of infectious diseases in childhood and adolescence, especially the bronchopulmonary system (pleurisy, pneumonia and bronchoadenitis).

They also find out the presence of residual specific phenomena or consequences in the lungs, bones and other organs. Attention should be paid to the development of the inflammatory process in the appendages in adolescents and young women who are not sexually active, as well as to amenorrhea against the background of bilateral adnexitis at a young age and whether the patient is in a specialized (anti-tuberculosis) dispensary.

In addition, the duration of the gynecological inflammatory process (adnexitis, endometritis), body temperature and its jumps, the presence / absence of night sweats, the formation and nature of the menstrual cycle are specified.

Gynecological examination

When conducting a gynecological examination, signs of inflammatory and adhesive processes in the small pelvis are revealed to varying degrees. In the case of a productive form, significant changes in the appendages are noted: their increase and pastiness, slight soreness or painlessness on palpation, limited mobility. The tubes have a clear retort-like shape and are often of considerable size. In some cases, an infiltrate is palpable in the parametria (fatty tissue behind the uterus), and the uterus is too dense and inactive.

Tuberculin tests

It helps to clarify the diagnosis by conducting tuberculin tests (Koch's tests), which are performed necessarily in a hospital. After the introduction of tuberculin (subcutaneously), local (focal) and general reactions are evaluated. With a local reaction, the presence of changes in the affected organ (appendages, uterus) is of great importance.

Methodology: 20 TU (tuberculin units) are injected subcutaneously or under the mucous membrane of the cervical canal. If there are no general and local reactions, then the test is repeated after 7 days with an increase in dose to 50 IU. After the introduction of tuberculin, the blood is examined, and the sampling is repeated after 24 hours, 48 and 72.

Manifestations of a general reaction:

an increase in temperature by 0.5 degrees or more;
increased heart rate (more than 100 per minute);
KLA: increase in stab leukocytes, monocytes and acceleration of ESR, decrease in lymphocytes.

The general reaction develops at any localization of the tuberculous process. With a local reaction, pain syndrome appears or intensifies, soreness of the appendages and their pastosity (swelling) occur. Koch's tests cannot be performed in cases of active tuberculosis, diabetes mellitus, and hepatic and renal disorders.

Tank. cultures of discharge from the genital tract

The result is evaluated after three sowings. Vaginal discharge, menstrual blood, scraping or washing of the endometrium, the contents of foci of inflammation (for example, from ulcers on the cervix) are taken for sowing. Even carrying out a triple sowing gives a low percentage of sowing of Koch's sticks. In addition, PCR of the obtained biological material is used.

Hysterosalpingography

Hysterosalpingography or HSG is an x-ray examination of the uterine cavity and tubes with the introduction of contrast. If genital tuberculosis is suspected, water-soluble contrasts (urotrast, cardiotrast) are used, since the use of oil contrasts is dangerous (the formation of encysted oleomas is possible, which aggravate the adhesive process).

X-ray signs of tuberculosis of the uterus and appendages:

lengthening / expansion of the cervical canal and isthmus;
intrauterine synechia, deformation of the uterine cavity, its partial or complete infection (obliteration);
tube rigidity (no peristalsis);
diverticula (extensions) at the ampullar end of the tubes;
the presence of calcifications and caseous foci in the pelvis (pathological shadows);
incorrect location (displacement to one side or the other) of the uterus and
uneven pipe pattern;
cyst-like or fistula-like cavities in the tubes;
changes in the tubes in the form of a rosary, beads or segments (the presence of multiple strictures in the tubes).

HSG is carried out only in the "cold" period (no symptoms of acute / subacute inflammation) and with 1-2 degrees of purity of vaginal smears.

Laparoscopy

An indispensable method for diagnosing tuberculosis of the pelvic organs is laparoscopy. With the help of laparoscopic examination, it is possible to identify specific changes in the pelvic cavity and internal genital organs.

First of all, a pronounced adhesive process is visualized, and on the peritoneum covering the uterus and appendages, tuberculous tubercles, caseous foci, combined with chronic inflammatory changes in the tubes and ovaries. Laparoscopic examination allows the sampling of material for histology and bacteriological analysis and, if necessary, surgical correction (separation and excision of adhesions, restoration of tubal patency, etc.).

Histological examination

Histological examination is carried out upon receipt of the functional layer of the endometrium during curettage of the uterine cavity, with a biopsy of suspicious areas on the cervix, vagina and vulva, after diagnostic laparoscopy. Diagnostic separate curettage (cervical canal and uterine cavity) is performed on the eve of menstruation (2 to 3 days before), when tuberculous tubercles begin to grow actively. In the test material, characteristic signs of tuberculosis are revealed: perivascular infiltrates, tubercles with fibrosis or caseous decay. Cytological analysis reveals cells specific for tuberculosis - huge Langhans cells.

Ultrasound procedure

It is used as an additional method and is indispensable in assessing the focal reaction to tuberculin tests. Ultrasound signs of a local reaction: an increase in the size of the ovaries, "blurring" of their contours and a decrease in the echogenicity of ovarian tissues, the formation or increase in the volume of sactosalpinxes, the appearance of free fluid behind the uterus.

Other Methods

They also use serological (ELISA and RIA) and immunological diagnostic methods, laser and fluorescent diagnostics, urine cultures are carried out on the Koch stick (urine is taken by a catheter), an X-ray of the lungs is required, and, if indicated, the digestive tract.

Treatment

Therapy of genital tuberculosis, like any other localization, is long-term and should be carried out comprehensively in specialized medical institutions (anti-tuberculosis hospitals and dispensaries, sanatoriums). The complex of therapeutic measures includes:

diet (high-calorie and fortified);
hyena observance;
symptomatic therapy (painkillers, antipyretics, antispasmodics);
vitamin therapy;
strengthening immunity (taking non-specific drugs, good rest, spa treatment, including balneological, mud and other procedures);
surgical treatment (according to indications);
physiotherapy (resorption of adhesions).

Chemotherapy

Anti-tuberculosis treatment is based on chemotherapy, the effect of which is greater, the earlier treatment is started. A complex of antibacterial drugs is prescribed, some of which have a bactericidal (kill microorganisms), and others bacteriostatic (inhibit the growth of tuberculosis pathogens) action.

The appointment of one drug does not have the desired effect, since Mycobacterium tuberculosis quickly becomes resistant to it. Of great importance is the correct dosage of drugs. In the case of prescribing small doses, not only is the therapeutic effect not achieved, but drug resistance develops in Koch's sticks, that is, the treatment is not only ineffective, but also harmful.

In the process of combined chemotherapy, the doctor is forced to constantly change the complexes of drugs, which depends on the effectiveness of the treatment and the tolerance of the patient.

The basis of anti-tuberculosis chemotherapy drugs are GINK derivatives: tubazid, ftivazid, saluzide and others. These funds are combined with streptomycin or its analogues (kanamycin, biomycin). The effectiveness of the first stage of therapy is assessed by:

resolution of the inflammatory process in the tubes and uterus;
temperature normalization;
improvement in general condition.

The second stage of chemotherapy involves one of three options:

taking drugs once a day every other day;
taking drugs twice a week;
taking medications daily in courses in spring and autumn.

Antibacterial therapy is combined with the appointment of vitamins (ascorbic acid, group B). Completion of the course of chemotherapy, which can last from six months to two years, requires a control hysterosalpingography and the appointment of absorbable adhesions.

Surgery

Surgical intervention for genital tuberculosis is performed according to strict indications:

caseous melting of the appendages (tubo-ovarian formations);
lack of effect of chemotherapy in case of active tuberculosis;
fistula formation;
significant adhesive process in the small pelvis, accompanied by disruption of the pelvic organs (problems with defecation and urination).

Anti-tuberculosis chemotherapy and restorative treatment measures are prescribed before and after surgery.

Question answer

Question:
What is the prognosis for tuberculosis of the genital organs?

The prognosis is disappointing. Relapse of the disease is possible in 7% of cases. Reproductive ability (restoration of the hormonal function of the ovaries and patency of the tubes) is restored only in 5-7% of cases of treatment of genital tuberculosis.

Question:
Are people with genital tuberculosis being disabled?

Yes, they are required to be taken out. In the absence of severe consequences, this is the 3rd (working) disability group, and with a significant adhesive disease or the formation of fistulas - the 2nd group.

Question:
In the last 2 - 3 months, she began to wake up at night covered in sweat. I also noticed that I feel overwhelmed and lethargic from the very morning, although the temperature, especially in the evenings, is kept at around 37 degrees. I have chronic adnexitis, can it be of tuberculous origin?

It's possible, but it's impossible to say for sure. The signs you describe fall under the intoxication syndrome in tuberculosis, but it is likely that you had some other infectious disease 3-4 months ago, which led to a weakening of the immune system. Consult a doctor, if necessary, he will prescribe tuberculin tests for you and recommend strengthening your immunity (vitamins, rest, good nutrition).

Question:
I was treated for tuberculous salpingitis. After the end (9 months have passed), I am given a complete cure, but still I can’t get pregnant (obstruction of the tubes, confirmed by the HSG). Can I use the IVF method and will my genital tuberculosis be a contraindication to this?

No, if mycobacteria are not sown and there are no clinical symptoms, then you can try to get pregnant with IVF.