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Module: Foul-Smelling Vaginal Discharge (Pelvic Tuberculosis)

Quilala
PELVIC TUBERCULOSIS
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Tutor: Dr. R.

Primarily chronic salpingitis and chronic endometritis,


Rare disease in the United States.
Rise in pulmonary tuberculosis incidence = rise in pelvic tuberculosis
Frequent cause of chronic PID and infertility
Affects premenopausal women; 10% among postmenopausal women.

Etiology:
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Mycobacterium tuberculosis
Mycobacterium bovis

Pathophysiology:
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Lung - Primary site of infection.


Pulmonary infection Hematogenous spread oviducts gets infected
oviducts (primary and predominant site of pelvic tuberculosis) bacilli
spread to endometrium (less commonly to the ovaries).
In developing countries without pasteurization of milk
o Bovine tuberculosis source of primary infections in the human
gastrointestinal tract.
Lymphatic or hematogenous dissemination pelvic
tuberculosis.
In general, extrapulmonary tuberculosis may present as an insidious or
rapidly progressing disease.

Clinical Manifestations:
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Similar to the chronic sequelae of nontuberculous acute PID.


o 2 predominant presentations
Infertility
Abnormal uterine bleeding
Mild to moderate chronic abdominal and pelvic pain 35% of women
Ascites in advanced cases
Some may be asymptomatic
Mild adnexal tenderness and bilateral adnexal masses with an inability to
manipulate the adnexa because of scarring and fixation
Tuberculous salpingitis - suspected when a woman is not responding to
conventional antibiotic therapy for acute bacterial PID.
Tuberculin skin test - positive.
1 out of 3 women does not have evidence of pulmonary tuberculosis on chest
radiographic films.

Diagnosis:
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Endometrial biopsy - late in the secretory phase of the cycle may be used
to establish a diagnosis.

Depalobos, DJ.; Lived, JK.; Naungayan, M.


UNPMED3 2015 Page | 1

Module: Foul-Smelling Vaginal Discharge (Pelvic Tuberculosis)


Tutor: Dr. R.
Quilala
o Should be sent for culture and animal inoculation and other portion
examined histologically.
- Presence the following findings confirm the diagnosis:
o Classic giant cells
o Granulomas
o Caseous necrosis
- 2 out of 3 women with tuberculous salpingitis will have concomitant
tuberculous endometritis
- Approximately 10% of affected women have concomitant urinary tract
tuberculosis
- Pelvic tuberculosis may not be diagnosed until laparotomy or celiotomy.
- The distal ends of the oviduct remain everted (tobacco pouch
appearance).
- After diagnosis, the patient should undergo the following:
o Chest radiographic examination
o IV pyelography
o Serial gastric washings
o Urine cultures for tuberculosis.
Principles of Management:
Treatment of pelvic tuberculosis is medical.
Initial Therapy: Five drugs
o Multidrug-resistant (MDR) Tuberculosis is an infection from a
strain of M. Tuberculosis that is resistant to two or more agents,
including Isoniazid.
- Mortality rate of HIV-negative patients who develop MDR infection is 80%.
- CDC Recommendation:
o Start on Multidrug Regimen
Until culture results yield specific sensitivity.
Medications may decrease to two or three
o Infections from MDR strains are usually kept on a five-drug regimen.
- Operative Therapy
o Reserved for women with:
Persistent pelvic masses
Endometrial cultures remain positive
Resistant organisms
Age older than 40 years
Sequela:
Infertility is the major sequela.
Occasionally a woman will become pregnant after medical therapy.
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Depalobos, DJ.; Lived, JK.; Naungayan, M.


UNPMED3 2015 Page | 2