CNS: 5% infertility cases had TB but up to 45% got anti-TB treatment

5% infertility cases had TB but up to 45% got anti-TB treatment

Although evidence of tuberculosis (TB) is seen in less than 5 per cent of infertility cases, up to 45 per cent of infertility cases are put on anti-TB treatment without any confirmatory test, said a news published in the The Times of India. This puts women who might not have TB at high risk of developing anti-TB drug resistance. This is an enormous concern for a country like India which is home to one of the world's largest number of people with anti-TB drug resistance. Genital TB is a major cause of tubal infertility but how far is giving anti-TB treatment without confirmatory tests justified?

In another case reported by The Hindustan Times (Lucknow), a woman with genital TB successfully completed anti-TB treatment and then due to in-vitro fertilisation (IVF) technique, also succeeded in giving births to normal baby (well, two babies in this case!).

So treating TB with confirmatory test save lives - but treating people with anti-TB drugs without confirmatory tests is seriously questionable.

Genital TB is a major cause of tubal infertility, said Mamta Jacob of Global Health Advocates (GHA). Only two per cent of women with genital TB have live births. It is usually asymptomatic so needs higher degree of suspicion so that proper diagnosis can be made and standard treatment provided as early as possible, said Dr Nerges Mistry, Director, The Foundation for Medical Research, Mumbai.

Genital TB is responsible for infertility in 5-10 per cent of women. In Australia, 1 per cent infertility in women is attributed to genital TB but in India, 19 per cent infertility in women is attributed to genital TB, said Dr Nerges Mistry.

Also the impact of genital TB is more severe on lives of women because mostly genital TB impacts women of age group 15-35 years. Only 10% of genital TB in women is post-menopausal, said Dr Nerges Mistry.

Women with genital TB present with bleeding discharge, ulcers, among other symptoms if any. Genital TB is always hard to diagnose, because of the fact that it is a silent invader of the genital tract. For diagnosing genital TB, AFB smears, polymerase Chain Reaction (PCR) tests, CT or MRI scanning or ultrasound might be used as appropriate, said Dr Nerges Mistry. The treatment of genital TB is same in case of drug-susceptible TB - 6 months of WHO recommended directly observed treatment shortcourse (DOTS). However, 2 per cent of genital TB cases are likely to be of multidrug-resistant TB (MDR-TB). Surgery might be required if medicines fail said Dr Nerges Mistry.

The solution lies in early case detection and providing standard treatment for genital TB. Sadly if women with genital TB are diagnosed late, the infertility risk and other harm done to their tissue are likely to be much more severe.

In 2008, 3.6 million women were sick with TB. "Compared to pregnant women without TB disease, pregnant women with TB have more severe impact on pregnancy outcomes. Rates per 1000 pregnancies of low birth weight (< 2.5 kg) for women without TB is 165, and for women with TB is double at 342; for prematurity (< 37 weeks) the rate for women without TB is 111 and for those with TB is 228 (twice); for perinatal death, the rates for women without TB is 16, but for those with TB is nearly five times higher at 101; for foetal death (16-28 weeks), the rates for women without TB is 2, but for those with TB is nearly ten times higher at 20" said Mamta Jacob.

Raising awareness about genital TB is surely a key. Engaging women with TB or who have successfully completed TB treatment as equal partners in addressing the challenge posed by genital TB will go a long way in saving human agony, morbidity and lives.

Putting people on anti-TB treatment without confirmatory tests needs to be urgently checked.