Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. It remains a significant global health concern, affecting millions of people globally. While TB most commonly impacts the lungs, it is a systemic disease, meaning it can affect almost any organ system. The primary way TB spreads is through airborne particles.
Is Tuberculosis a Sexually Transmitted Infection?
Tuberculosis is not categorized as a sexually transmitted infection (STI). The bacterium Mycobacterium tuberculosis primarily spreads through the air when a person with active TB disease in their lungs or throat coughs, sneezes, speaks, or sings. These actions release tiny infectious droplets, which can remain suspended in the air for several hours. People nearby can inhale these airborne germs and become infected.
Other modes of TB transmission are less common. Direct sexual contact, kissing, or sharing personal items like toothbrushes do not spread TB germs. While very rare sexual transmission of genital TB has been reported, this is not the typical route for the disease. The main difference lies in how the pathogens are transmitted: TB is predominantly airborne, while STIs are spread through direct sexual contact.
Tuberculosis Affecting Reproductive Organs
Though primarily a respiratory disease, tuberculosis can disseminate throughout the body, including to the reproductive organs. This condition is known as genital tuberculosis (GTB). The spread to the genital tract occurs through the bloodstream or the lymphatic system from a primary infection site elsewhere, most commonly the lungs. Direct extension from infected urinary organs can also spread.
In females, genital TB most frequently affects the fallopian tubes. The uterine endometrium is commonly affected, followed by the ovaries, and less commonly the cervix, uterus, or vagina/vulva. Symptoms in women can include low-grade fever, sudden weight loss, menstrual irregularities, pelvic pain, and abnormal vaginal discharge. Diagnosis involves:
- Abdominal and pelvic examinations
- Cervical swabs
- Ultrasonography
- Hysterosalpingography
- Biopsy
- Culture of tissue or fluid samples
For males, the epididymis is the most commonly affected genital organ, often with secondary involvement of the prostate. Isolated testicular TB is rare due to the blood-testis barrier. Male symptoms can include pain in the groin or testicles, penile discharge, fever, and weight loss. Genital ulcers may also be present. Similar to females, diagnosis in men can involve physical examination, imaging like ultrasound, and laboratory tests including biopsy and culture for Mycobacterium tuberculosis.
Impact on Sexual Health and Fertility
Genital tuberculosis can have significant consequences for both sexual health and fertility. In women, damage caused by TB to the fallopian tubes can lead to tubal blockages, a major cause of infertility. This damage can also increase the risk of ectopic pregnancies. Involvement of the uterus may result in scarring of the endometrial lining, leading to intrauterine adhesions, all contributing to infertility.
For males, GTB can cause inflammation and scarring that obstructs the epididymis or vas deferens, preventing sperm transport and leading to obstructive azoospermia. Damage to the testes can impair sperm production and quality. While timely diagnosis and adherence to multi-drug antitubercular treatment are important to prevent or mitigate these complications, significant damage may have already occurred by the time GTB is detected. Assisted reproductive technologies can offer a pathway to parenthood for individuals with GTB-related infertility, especially when tubal damage is present but the endometrium is relatively preserved.