Genitourinary tuberculosis (GTB) is a form of tuberculosis that affects the urinary and reproductive tracts in both men and women. Unlike pulmonary tuberculosis, GTB often progresses silently, with symptoms developing slowly or remaining non-specific for extended periods. This insidious nature underscores the importance of understanding the condition for timely recognition and management.
Understanding Genitourinary Tuberculosis
Genitourinary tuberculosis is caused by Mycobacterium tuberculosis, the same bacterium responsible for pulmonary tuberculosis. It is typically a secondary infection, arising from a primary infection elsewhere in the body, most commonly the lungs. The bacteria spread to the genitourinary system primarily through hematogenous dissemination (bloodstream).
Following this spread, the bacteria can lie dormant for years, with a latency period ranging from 5 to 40 years before active disease manifests. The kidneys are frequently the first genitourinary organs affected due to their rich blood supply, often followed by the ureters and bladder as the infection descends.
In men, other commonly involved sites include the prostate, epididymis, and testes. For women, the fallopian tubes are most frequently affected, occurring in over 90% of cases, often bilaterally. The infection can then spread to the endometrium, which is involved in about 50-80% of cases, and less commonly to the ovaries, cervix, vagina, or vulva. This widespread potential within the genitourinary system highlights the varied presentations of the disease.
Recognizing the Signs and Symptoms
The symptoms of genitourinary tuberculosis are often varied and non-specific, making diagnosis challenging. Urinary symptoms are common, including increased urination frequency, painful urination (dysuria), and blood in the urine (hematuria). Patients may also experience flank pain, particularly if the kidneys are involved. These symptoms can mimic more common urinary tract infections, but in GTB, they often persist despite conventional antibiotic treatment.
A characteristic indicator of genitourinary tuberculosis is “sterile pyuria,” referring to the presence of pus cells in the urine despite routine bacterial cultures showing no growth. This finding should raise suspicion for the condition, especially when accompanied by persistent urinary complaints. Constitutional symptoms like low-grade fever, night sweats, fatigue, and unexplained weight loss can also occur, though they are not always present.
In men, reproductive system involvement may lead to scrotal swelling or a palpable mass in the epididymis. Other potential signs include reduced semen volume or even infertility due to obstruction of the vas deferens. Women might experience pelvic pain, menstrual irregularities, or infertility, particularly if the fallopian tubes or uterus are affected. The insidious development of symptoms over time is a hallmark of the disease.
Diagnosing Genitourinary Tuberculosis
Diagnosing genitourinary tuberculosis requires a high degree of suspicion due to its non-specific and often delayed presentation. Urine tests are fundamental for diagnosis, involving acid-fast bacilli (AFB) smear and culture to detect Mycobacterium tuberculosis. Polymerase chain reaction (PCR) tests for Mycobacterium tuberculosis DNA in urine offer a more rapid detection method. Traditional urine cultures for common bacteria are usually negative in GTB, which contributes to diagnostic delays.
Imaging studies play a significant role in assessing the extent of organ involvement and identifying characteristic changes. These include ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) of the kidneys, bladder, and reproductive organs. Imaging can reveal abnormalities such as strictures in the ureters, hydronephrosis (swelling of the kidney due to urine backup), or calcifications within the affected tissues. A small, contracted bladder is also a common finding in advanced bladder tuberculosis.
In some cases, a biopsy of affected tissues may be necessary to confirm the diagnosis, allowing for histological examination to identify granulomas and, if possible, the presence of the bacteria. This direct tissue analysis can provide definitive evidence of tuberculosis when other tests are inconclusive. The combination of clinical suspicion, urine analysis, and imaging helps guide the diagnostic process toward confirming genitourinary tuberculosis.
Treatment and Management
Treatment for genitourinary tuberculosis primarily involves a prolonged course of anti-tuberculosis medications, similar to the regimen used for pulmonary tuberculosis. The standard approach typically includes a combination of four drugs: isoniazid, rifampicin, pyrazinamide, and ethambutol. This intensive phase usually lasts for the first two months, followed by a continuation phase where isoniazid and rifampicin are continued for several more months.
Adherence to the full treatment regimen, which commonly spans 6 to 12 months, is important to ensure eradication of the bacteria and prevent recurrence or the development of drug-resistant strains. In some instances, the treatment duration may be extended based on the severity of the disease or the patient’s response. Regular follow-up with healthcare providers is necessary to monitor treatment effectiveness, manage potential side effects, and assess for any long-term complications.
Surgery may be considered in specific situations, such as to relieve obstructions caused by scarring, like ureteral strictures, or to remove severely damaged tissue. For example, surgery might be needed to address hydronephrosis or to manage a non-functioning kidney. The goal of surgical intervention is to preserve organ function and alleviate symptoms that do not respond to medication alone.