Tuberculosis of the female genital tract in Iran

Considering the outbreak of different types of tuberculosis including genital tract tuberculosis in developing countries, and due to the differences in the symptoms of this disease, this study has been carried out in Imam Khomeini Hospital (affiliated to Tehran University of Medical Sciences), Tehran, Iran, for the last 20 years. This retrospective study was conducted with fifty-two patients with the definite pathological diagnosis of genital tract tuberculosis. In this study the clinical symptoms, marital status, organ involvement, hysterosalpingography (HSG), chest X-ray, and age were variables that were all taken into consideration. The highest incidence of the disease was between the ages of 26 and 30, but the ages of the patients ranged from 17 to 80 years. The mean age was 31 years. One unmarried 17-year-old patient (2%) had no sexual activity. The other 51 patients (98%) were married. Twenty-seven (52%) patients had infertility problems for a period of between 1 and 25 years, twenty-three cases (85%) of the primary, and 4 (15%) of secondary type. In thirteen patients HSG was conducted of whom 2 cases were normal and in the remainder the fallopian tubes had been occluded. Chest X-rays in two patients showed primary pulmonary tuberculosis. The second and third symptoms of genital tract tuberculosis were abdominal pain and pelvic mass (38%), and abnormal uterine bleeding (AUB) (29%), respectively. The pathological studies indicated that the area affected in most cases was endometrium (59%). Tuberculous salpingitis counted as the second cause of pathology in these patients (34%). Tuberculosis of the genital tract is more common in patients between the ages of 26 to 30 years. The most affected area is the endometrium. Infertility is the most common clinical symptom of pelvic tuberculosis even if the fallopian tubes are not obstructed. Tuberculosis should be considered in differential diagnosis of causes of infertility, pelvic mass, and AUB, particularly in areas where tuberculosis is common.