Overview
Female genital tuberculosis (FGTB) is a form of extra-pulmonary tuberculosis affecting reproductive organs, commonly seen in developing countries, causing infertility, ectopic pregnancy, and miscarriage. It can mimic gynecologic malignancies due to elevated CA 125 levels and non-specific symptoms 14.Diagnosis
Clinical Presentation: Non-specific symptoms often leading to misdiagnosis as gynecologic malignancies or endometriosis 1.
Laboratory Tests: Elevated CA 125 levels may indicate FGTB, warranting further investigation 1.
Imaging: Ultrasound, CT, or MRI can reveal characteristic findings such as tubo-ovarian masses 14.
Definitive Diagnosis: Requires histopathological examination from biopsies of affected tissues (e.g., peritoneum, uterus, ovaries) 14.Management
Surgical Intervention: Laparotomy with biopsy and possible resection of affected tissues 14.
Antitubercular Therapy: Standard regimen includes a combination of isoniazid, rifampicin, ethambutol, and pyrazinamide for initial phase, followed by continuation phase with isoniazid and rifampicin (specific doses not detailed in abstracts) 14.
Monitoring: Regular follow-up to assess treatment efficacy and manage complications 1.Special Populations
Pregnancy: No specific guidance provided in the abstracts 12345.
Elderly: Management principles similar to general population but may require tailored surgical approaches considering comorbidities 12.
Comorbidities: Presence of advanced prolapse may complicate management, necessitating careful consideration of surgical versus non-surgical options 23.Key Recommendations
Consider genital tuberculosis in the differential diagnosis for patients presenting with abdomino-pelvic masses and elevated CA 125 levels (Evidence: Moderate) 1.
Definitive diagnosis of FGTB requires histopathological examination from affected tissues (Evidence: Moderate) 14.
Employ local anesthesia with sedation for vaginal reconstructive surgeries in carefully selected patients with advanced genital prolapse, noting high patient satisfaction (Evidence: Weak) 2.
Initiate standard antitubercular therapy with a combination of isoniazid, rifampicin, ethambutol, and pyrazinamide for initial phase, followed by continuation phase (Evidence: Expert opinion) 14.References
1 Yates JA, Collis OA, Sueblinvong T, Collis TK. Red Snappers and Red Herrings: Pelvic Tuberculosis Causing Elevated CA 125 and Mimicking Advanced Ovarian Cancer. A Case Report and Literature Review. Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health 2017. link
2 Buchsbaum GM, Duecy EE. Local anesthesia with sedation for transvaginal correction of advanced genital prolapse. American journal of obstetrics and gynecology 2005. link
3 Sasso K. Case study: challenges of pessary management. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society 2003. link
4 Svendsen JH, Mikkelsen AL, Siemssen OJ. Peritonitis due to genital tuberculosis. Annales chirurgiae et gynaecologiae 1985. link
5 Naik KG. Pattern of tumors of the male genitalia in Zambia. International surgery 1977. link