It is common knowledge, that tuberculosis of the fallopian tubes is also an asymptomatic disease, causing severe anatomical changes in the fallopian tubes such as irreversible nodous salpingitis in 20 % patients with hydrosalpinx type 60 %. At the same time, the possibility of damage to the fallopian tubes similar to nodous salpingitis in endometriosis cannot be ruled out.. According to our data, tuberculous salpingitis is not often detected during laparoscopy in women with infertility.

So, tuberculous salpingitis and pelvioperitonitis were detected in only one patient with primary amenorrhea. From 1500 In patients with a regular rhythm of menstruation, tuberculous nodous salpingitis was found in 3.

With damage to the internal genital organs in women, Epidemiological situation of tuberculosis incidence in Minsk, the hematogenous or lymphogenous route of spread of infection from the primary focus predominates (lungs – including those diagnosed for the first time after infection 70-85%, gastrointestinal tract – including those diagnosed for the first time after infection 15%) The fallopian tubes are most often affected (including those diagnosed for the first time after infection 70-80 % sick), less often – endometrium (including those diagnosed for the first time after infection 15-30%), even less often – cervix and external genitalia (1-3 %). Ovarian involvement is extremely rare.

Assumption of the absence of peritoneal cover and poor vascularization, preventing infection from entering the ovarian tissue, very doubtful and requires further proof.

The descending route of spread of infection to the female genital organs is shown: from the fimbrial sections of the fallopian tubes to the endometrium along the mucous membrane.

The incidence of genital tuberculosis in areas with high infection rates is 0,5 % from all gynecological patients. However, these data are not entirely accurate, since diagnosis is difficult due to oligobacillarity, a large number of strains and difficulties in collecting material directly from the lesion.

Symptoms of genital tuberculosis

Manifestation of genital tuberculosis most often occurs at the age of 20–30 years; less often - during puberty and postmenopause. The course of genital tuberculosis is often blurred and variable, which is explained by the variety of morphological changes.

Often the leading and even the only symptom of genital tuberculosis is infertility, caused by damage to the endometrium and fallopian tubes.

Most women experience changes in menstrual function: develops oligomenorrhea, amenorrhea, irregular periods, algodismenorrhea, less often - metrorrhagia and menorrhagia. Menstrual irregularities in genital tuberculosis are caused by involvement of the ovarian parenchyma, endometrium, intoxication.

The course of genital tuberculosis is accompanied by pain in the lower abdomen of a pulling and aching nature due to the development of adhesions in the pelvis, vascular sclerosis, damage to nerve endings. Tuberculosis intoxication is characteristic – low-grade fever, sweating at night, weakness, weight loss, loss of appetite.

When the peritoneum is involved, genital tuberculosis often manifests with an acute abdomen., in connection with which patients end up on the operating table with suspicions of apoplexy of the ovary, ectopic pregnancy, appendicitis.

Tuberculosis of the fallopian tubes often leads to their obliteration, development pyosalpinx, formation of tubercles in the muscle layer. Tuberculosis of the appendages may affect the peritoneum and intestinal loops, which leads to ascites, adhesion formation, fistula formation. Tuberculous endometritis is also characterized by the presence of tubercles, areas of caseous necrosis. With genital tuberculosis, damage to the urinary tract is often observed.

Diagnosis of genital tuberculosis

Suspicion of tuberculous etiology of inflammation of the genitals may arise when a history indicates pleurisy, pneumonia, bronchoadenitis, pulmonary tuberculosis or other localization. In young patients, not sexually active, may indicate genital tuberculosis adnexitis, combined with amenorrhea and prolonged low-grade fever.

Data gynecological examination usually uninformative. Vaginal examination may reveal signs inflammation of the appendages, adhesions in the pelvis. Ultrasound pelvis and Ultrasound hysterosalpingoscopy for genital tuberculosis have an auxiliary diagnostic value.

To confirm genital tuberculosis, tuberculin tests – subcutaneous injection of tuberculin with assessment of general and focal reaction. The general response to genital tuberculosis is manifested by a temperature reaction, tachycardia (>100 ud. per minute), изменениями формулы крови. Местная реакция в очаге туберкулезного поражения включает усиление болей в животе, увеличение болезненности и отечности придатков матки при пальпации, увеличение температуры в области шейки матки. Противопоказаниями к проведению туберкулиновых проб служат активный туберкулез, diabetes, недостаточность функции печени, почечная недостаточность.

Наиболее точным методом диагностики генитального туберкулеза гинекология считает бактериологическое исследование выделений из половых путей, менструальной крови, аспирата из полости матки, соскобов эндометрия, and ПЦР-выявление микобактерии туберкулеза.

В ходе проведения диагностической лапароскопии обнаруживаются специфические изменения в малом тазу – туберкулезные бугорки на брюшине, спаечные процессы, казеозные очаги, воспаление придатков. Лапароскопия позволяет произвести забор материала длягистологического исследования, выполнить хирургическую коррекцию последствий генитального туберкулеза: лизис спаек, восстановить проходимость маточных труб или произвести удаление придатков.

Гистология тканей, полученных в результате biopsy или раздельного диагностического выскабливания, при генитальном туберкулезе обнаруживает наличие в образцах периваскулярных инфильтратов, туберкул с явлениями казеозного распада или фиброза. При цитологическом анализе аспирата из полости матки, соскобов шейки матки выявляются многоядерные клетки Пирогова-Лангханса.

Рентгенограммы, полученных при генитальном туберкулезе в ходе гистеросальпингографии, указывают на смещение матки вследствие спаечного процесса, наличие внутриматочных синехий, облитерацию и изменение контуров труб, кальцинаты в яичниках, трубах, лимфоузлах.

Prognosis for genital tuberculosis

Relapses of genital tuberculosis are observed in 7% female patients. The disease may be complicated by adhesive disease, свищевыми формами генитального туберкулеза.

Восстановление репродуктивной функции наблюдается у 5-7% женщин. Ведение беременности у пациенток, перенесших генитальный туберкулез, involves risks spontaneous abortion, premature birth, development of fetal hypoxia.

Prevention of genital tuberculosis

К специфической профилактике первичного туберкулеза относится vaccination новорожденных вакциной БЦЖ, ревакцинация детей и подростков, проведение реакции Манту, профилактической флюорографии, изоляция пациентов с активными формами. Мерами неспецифической профилактики служат общеоздоровительные мероприятия, полноценный отдых и питание.

Длительные, вялотекущие и плохо откликающиеся на обычное лечение воспаления половых органов, сочетающиеся с нарушениями менструальной функции и бесплодием, требуют обследования на генитальный туберкулез.