Tuberculosis of male and female genital organs

Tuberculosis of the male genital organs occurs with a frequency of 11.1-79.3%. Tuberculosis of the female genital organs can occur under the guise of cystic formations of the ovaries, appendicitis, ectopic pregnancy.

Forms

Tuberculosis of the genital organs in men

Isolated lesions of the scrotum organs (epididymis, testicles, vas deferens) are observed in 30% of cases, and tuberculosis of the genital organs located intrapelvicly (prostate gland, seminal vesicles) - in 15.6%. Combined tuberculosis of the genital organs and scrotum organs is detected in 54.4% of cases. Tuberculosis of the reproductive system in children is almost never encountered, and is extremely rare in young men before reaching puberty. Thus, these diseases affect men during the period of greatest sexual activity, i.e., between the ages of 21 and 50.

The combination of tuberculosis of the genital organs and urinary anatomical structures occurs in men in 11.1-79.3%. The frequency of combination of tuberculosis of the male genital organs with tuberculosis of other localizations, according to different authors, varies widely. Most often, tuberculosis of the genital organs is combined with tuberculosis of the urinary system (34.4%) and pulmonary tuberculosis (14.4%). According to autopsy data, tuberculosis of the genital organs in men occurs in 4.7-21.7% of those who died from pulmonary tuberculosis, but among those who died from other diseases - only in 0.4%.

[ 1 ], [ 2 ], [ 3 ]

Classification of tuberculosis of the genital organs in men

• Localization: epididymis, testicle, vas deferens, seminal vesicle, prostate, urethra, penis.
• Form: productive, destructive (abscess formation, fistula).
• Phase: exacerbation, attenuation.
• Degree of compensation of body functions: compensated; subcompensated; decompensated.
• Bacillary: BK(+), BK(-).

[ 4 ], [ 5 ], [ 6 ]

Tuberculosis of the genital organs in women

High incidence of tuberculosis in women of childbearing age and children, as well as high tuberculosis rates in pathological studies characterize the unfavorable epidemiological situation and indicate insufficient lifetime detection of tuberculosis. Statistics show the significance of the problem. More than 650 million women are infected with tuberculosis and 3 million fall ill annually. Due to the lack of screening diagnostic tests, the disease is detected at late stages with irreversible anatomical changes and in 1/3 of cases in the general medical network on the operating table. The incidence of tuberculosis of the genital organs in women is 3.2-3.5 per 100 thousand of the population.

Tuberculosis of the genital organs in women can be hidden under the guise of an ovarian cyst, acute appendicitis, peritoneal carcinomatosis, omentum, ovaries, ectopic pregnancy, etc. Although tuberculosis of the genital organs in women does not exceed 1% of the population and ranks 3-4th among extrapulmonary forms, this disease entails social and psychological consequences and deserves close attention from gynecologists, phthisiologists, pediatricians and oncologists. A rejuvenation of the patient population is noted, polyorgan forms of tuberculosis are more often registered with the involvement of not only the structures of the genital area, but also the bone and joint system, kidneys, eyes, etc.

Tuberculosis of the female genital organs is the 7th most common disease of the female genital tract. Among patients with pulmonary and other forms of tuberculosis, tuberculosis of the female genital organs is detected in 10-30% of cases. In risk groups, tuberculosis of the female genital organs is diagnosed in 10-20% of patients. The disease begins at a young age during the period of primary hematogenous dissemination of tuberculosis. Hematogenous generalization can occur against the background of progression or healing of the primary lesion. Primary foci, in addition to the lungs, can be located in various organs. With primary hematogenous dissemination, the primary lesion in the lung may not be visible later and disappear without a trace. However, 15-20% of patients still have traces of the transferred process in the form of an increase in intrathoracic lymph nodes, thickening of the pleura, small calcifications, etc.

Tuberculous salpingitis

In case of hematogenous damage to anatomical structures, the process begins in those sections where there is sufficient blood supply and an extensive microcirculation zone - these are the fimbrial sections of the fallopian tubes, the mucous and submucous membranes of the oviducts. The process becomes latent if there are no provoking factors, and the only complaint of patients may be infertility. The initial stage of the disease is the most difficult to diagnose and occurs under the flag of chronic adnexitis. At this stage, tubal pregnancy is also often encountered. In the fallopian tubes, the contractility of muscle tissue is impaired, they become rigid, edematous, then the fimbrial sections close and the ampullar sections expand. The accumulation of exudate contributes to the formation of sactosalpinx. If the lumen of the tube is filled with caseous-necrotic masses, a caseoma of the fallopian tube occurs.

Tuberculous salpingoophoritis

With further progression, the inflammatory process may involve the adjacent ovaries, the second fallopian tube, the intestines, the omentum, and the urinary bladder. Tuboovarian formations may form. Such a formation with caseous decay inside is itself a source of infection. The processes of infiltration, scarring, and calcification may proceed in parallel to each other and cause a variety of morphological and clinical pictures. The spread of the process is facilitated by a mixed infection, which is often present when female anatomical structures are affected.

Tuberculous oophoritis

In 1/3 of cases, the ovaries are affected. This can occur hematogenously, lymphogenously, or by extension. The protein coat of the ovary is a dense tissue and is more resistant to the penetration of mycobacteria than the tissues of the fallopian tubes and uterus. The cortex of the ovary can be affected with the formation of multiple tubercles or ovarian caseoma with a dense capsule. The formed caseous focus itself serves as a source of tuberculous infection, from which there are seedings by the hematogenous-lymphogenous route or by contact. The course of isolated tuberculous ovarian lesion is favorable, since the process rarely spreads further.

Tuberculous endometritis and metroendometritis

As the process progresses, it spreads to the uterine cavity. This is facilitated by provoking factors - intrauterine interventions, spontaneous miscarriages, tubal pregnancy, artificial abortions, after childbirth the placental site may be affected. The course of tuberculous endometritis depends on the depth of the lesion. When the functional layer of the endometrial mucosa is involved in the process, the course is favorable, since its monthly rejection prevents further spread of tuberculosis. Timely treatment and physiological characteristics contribute to recovery.

When the process spreads to the basal and muscular layers of the uterus, the recovery process is delayed and can end with the formation of intrauterine adhesions, complete or partial obliteration of the uterine cavity and fallopian tubes. This is facilitated by intrauterine interventions. Primary hematogenous dissemination can proceed particularly unfavorably with the occurrence of an adhesive process, when the uterine cavity is obliterated during the onset of menarche and primary amenorrhea of uterine genesis occurs. Chronic inflammation contributes to the development of hyperplastic processes of the endometrium, which are observed in 70-84% of our patients - glandular hyperplasia, glandular-cystic hyperplasia, endometrial polyposis.

Tuberculosis of the cervix and vagina

Tuberculosis of the cervix and vagina is more common in older women, they are the final stage of tuberculous lesions of the genitals. Tuberculosis of the genitals, namely in the vaginal part of the cervix, can look like pseudo-erosion or a hyperemic area around the external os. In the dome of the vagina and on the vaginal portion of the cervix, millet-like rashes can be seen in the form of single lesions or merging into ulcers. Diagnosis of tuberculosis of the cervix and vagina consists of bacteriological, cytological and morphological methods.

Tuberculosis of the peritoneum

It is necessary to highlight the processes with predominant damage to the peritoneum, including the covering of the pelvic organs. The fallopian tubes may not be changed, but infertility in this case is caused by the violation of the villous epithelium of the peritoneum, which facilitates the transport of the gonads. In the exudative phase, small millet-like rashes and serous exudate can be observed on the serous surface of the pelvic organs. These phenomena can be accompanied by ascites. Patients often end up on the operating table with suspected ovarian cancer. In the proliferative phase, multiple pockets and cysts filled with serous fluid are formed in the pelvis, which can change in size depending on the day of the menstrual cycle or due to other factors and cause the corresponding clinical picture. The formation of flat adhesions between adjacent organs contributes to the development of pain syndrome, complicates diagnosis and treatment. Tuberculosis of the peritoneum most often manifests itself in reproductive age.