Genital Tuberculosis in a Reproductive-Age Woman: A Diagnostic Challenge

Abstract

Genital tuberculosis (GTB) is a rare but serious form of extrapulmonary tuberculosis (EPTB) that significantly affects female reproductive health in endemic areas. It often presents as infertility or chronic pelvic pain, mimicking other gynecological disorders. A 31-year-old woman presented with fever, chronic pelvic pain, and secondary infertility. Pelvic ultrasound revealed bilateral tubo-ovarian masses, initially treated with antibiotics as a bacterial inflammatory disease, but GeneXpert on a sample of ultrasound-guided drainage confirmed Mycobacterium tuberculosis. She was started on a 6-month antitubercular therapy (HRZE regimen: isoniazid, rifampicin, pyrazinamide, and ethambutol) and is currently at the 3-month mark with noticeable clinical and sonographic improvement. GTB should be suspected in women with unexplained infertility, especially in tuberculosis-endemic countries. Early diagnosis and prompt antitubercular therapy are essential to prevent irreversible reproductive damage.