Tuberculosis (TB) is not conventionally categorized as a sexually transmitted disease (STD). It is an infectious condition caused by the bacterium Mycobacterium tuberculosis, primarily affecting the lungs. While not an STD, the bacteria can spread to reproductive organs, impacting sexual health.
Tuberculosis Transmission Explained
Tuberculosis spreads through airborne particles when an infected individual with pulmonary (lung) TB coughs, sneezes, or speaks. These actions release tiny droplets containing Mycobacterium tuberculosis into the air, which can then be inhaled by others in close proximity. Transmission requires close and prolonged contact with an infectious person. This airborne route is the primary mode of TB infection, and it is not spread through casual contact like shaking hands or kissing.
Understanding Genital Tuberculosis
Genital tuberculosis is a form of extra-pulmonary tuberculosis, meaning the infection occurs outside the lungs. This condition develops when Mycobacterium tuberculosis travels from an initial infection, often in the lungs, to the reproductive organs through the bloodstream or lymphatic system. While extremely rare, sexual transmission is theoretically possible if one partner has active, open infectious sores on their genitals. Genital TB can also spread through infected semen.
Symptoms of genital TB can be subtle or absent, particularly in women, making diagnosis challenging.
Symptoms in Men
Scrotal swelling
Pain in the groin or testicles
Epididymitis
Discharge from the penis
Fever
Weight loss
Ulcerative penile lesions (rare cases)
Symptoms in Women
Chronic pelvic pain
Menstrual irregularities (absent, scanty, or heavy periods)
Abnormal vaginal discharge
Postmenopausal bleeding (resembling endometrial malignancy)
Impact on Reproductive Health and Fertility
Genital tuberculosis can affect reproductive health and lead to infertility in both men and women. In women, the infection targets the fallopian tubes, causing scarring, blockages, and damage to cilia that transport eggs. This damage can result in hydrosalpinx (fluid accumulation) and increase the risk of ectopic pregnancies or make natural conception difficult. The uterine lining (endometrium) can also be affected, leading to intrauterine adhesions (Asherman’s syndrome) and impaired embryo implantation. Ovarian involvement, though less common, can lead to adhesions, cysts, and impaired egg production, further impacting fertility.
In men, genital TB causes blockages in the epididymis, the coiled tube that stores and carries sperm, leading to obstructive azoospermia (absence of sperm in ejaculate). The infection can also affect the prostate, seminal vesicles, and vas deferens, resulting in fibrosis and anatomical distortion that impede sperm transport. While testicular function may be affected, sperm produced in the testes are often viable, meaning assisted reproductive techniques, such as in vitro fertilization (IVF), might be an option.
Diagnosis and Treatment Considerations
Diagnosing genital tuberculosis can be complex due to its often vague or absent symptoms. Healthcare providers use methods like imaging tests, such as ultrasound, which can reveal thickened fallopian tubes or fluid collections. Laparoscopy, an invasive procedure for direct visualization of pelvic organs, and hysteroscopy, for examining the uterine cavity, are reliable diagnostic tools, often combined with biopsies. Laboratory analysis of tissue samples (biopsy) or genital fluids detects Mycobacterium tuberculosis by microscopy, culture, or PCR (polymerase chain reaction).
Treatment for genital TB involves a multi-drug antibiotic regimen, similar to that used for pulmonary TB. A standard course lasts six to nine months, beginning with an intensive phase of four drugs (rifampicin, isoniazid, pyrazinamide, and ethambutol) for two months, followed by a continuation phase of two drugs (rifampicin and isoniazid) for four months. Surgical intervention is limited to specific cases, such as draining large abscesses or addressing severe anatomical damage. It is advisable to consult a healthcare provider for personalized guidance regarding sexual activity during treatment, as the risk of transmission may be low once medication is initiated, but individual circumstances vary.