Tuberculosis of the female genital organs is always a secondary disease. It occurs when the infection is transferred from the primary focus (lungs) by the hematogenous route or through the lymphatic vessels from the mesenteric lymph nodes and peritoneum.
The fallopian tubes are most often affected, less often the endometrium and ovaries, very rarely the cervix, vagina and vulva.
There are exudative, productive and caseous forms.
Symptoms and course
The symptoms are not often masked. The disease is taken for inflammation of the uterine appendages caused by pyogenic microbes.
To some extent, the general symptoms are expressed: malaise, weakness, easy fatigue, hypotension, loss of appetite, sweating, subfebrile temperature.
Menstrual function is disturbed: more often there is hypooligomenorrhea, less often acyclic bleeding, amenorrhea or algomenorrhea. As a rule, primary infertility develops. The pain is indefinite.
Diagnosis
The diagnosis can be made by a carefully collected history (including information about contact with tuberculosis patients), an intradermal test with tuberculin, the use of a tuberculin provocative Koch test with an assessment of a focal reaction, a histological examination of endometrial scrapings (detection of tuberculous tubercles) and appendages removed during surgery, found in time of operation tuberculous tubercles on the peritoneum of the tubes.
An important indication of the likelihood of tuberculosis infection is the exacerbation of chronic inflammation of the appendages under the influence of thermal physiotherapy procedures.
It is very difficult to detect tuberculosis mycobacteria in secretions from the uterus, menstrual blood. The X-ray method (hysterosalpingography) can provide additional information, since the rigidity of the tubes, their strictures, obstruction in the ampullary sections, intrauterine synechia are often found in genital tuberculosis.
Treatment
Normalization of work and rest, good nutrition, vitamins. If the diagnosis is established for the first time, specific antibacterial therapy is carried out with a continuous course lasting 1-1.5 years, during which a number of products are alternated while at least 2 are prescribed.
Treatment is carried out under the supervision of a doctor of the anti-tuberculosis dispensary, then – sanatorium treatment, autumn and spring courses of antibiotic therapy. In adhesive processes, corticosteroids are sometimes prescribed.
Surgical treatment is indicated only for encysted, long-term inflammatory formations.
The prognosis for timely and adequate treatment for life is favorable; for menstrual and generative function – unfavorable.