Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
Department of Paediatrics, National Institute of TB & Respiratory Diseases, New Delhi, India.
Indian J Med Res. 2018 Dec;148(Suppl):S71-S83. doi: 10.4103/ijmr.IJMR_648_18.
Female genital tuberculosis (FGTB) is caused by Mycobacterium tuberculosis (rarely Mycobacterium bovis and/or atypical mycobacteria) being usually secondary to TB of the lungs or other organs with infection reaching through haematogenous, lymphatic route or direct spread from abdominal TB. In FGTB, fallopian tubes are affected in 90 per cent women, whereas uterine endometrium is affected in 70 per cent and ovaries in about 25 per cent women. It causes menstrual dysfunction and infertility through the damage of genital organs. Some cases may be asymptomatic. Diagnosis is often made from proper history taking, meticulous clinical examination and judicious use of investigations, especially endometrial aspirate (or biopsy) and endoscopy. Treatment is through multi-drug antitubercular treatment for adequate time period (rifampicin, isoniazid, pyrazinamide, ethambutol daily for 60 days followed by rifampicin, isoniazid, ethambutol daily for 120 days). Treatment is given for 18-24 months using the second-line drugs for drug-resistant (DR) cases. With the advent of increased access to rapid diagnostics and newer drugs, the management protocol is moving towards achieving universal drug sensitivity testing and treatment with injection-free regimens containing newer drugs, especially for new and previously treated DR cases.
女性生殖器结核（FGTB）由结核分枝杆菌（罕见分枝杆菌牛和/或非典型分枝杆菌）引起，通常继发于肺部或其他器官的结核病，感染通过血行、淋巴途径或直接从腹部结核传播。在 FGTB 中，90%的女性输卵管受到影响，70%的子宫内膜受到影响，约 25%的女性卵巢受到影响。它通过损害生殖器官导致月经功能障碍和不孕。有些病例可能无症状。诊断通常通过适当的病史采集、细致的临床检查和明智地使用检查，特别是子宫内膜抽吸（或活检）和内窥镜检查来进行。治疗是通过多药抗结核治疗在足够的时间内（利福平、异烟肼、吡嗪酰胺、乙胺丁醇每日 60 天，然后利福平、异烟肼、乙胺丁醇每日 120 天）。对于耐药（DR）病例，使用二线药物治疗 18-24 个月。随着快速诊断和新药的广泛应用，管理方案正在朝着实现普遍药物敏感性测试和无注射方案治疗的方向发展，这些方案包含新药，特别是用于新的和以前治疗过的 DR 病例。
