Genital Tuberculosis in Women; A Systematic Review

Aims: Female genital tuberculosis is an infrequent form of tuberculosis that is often underestimated due to its low prevalence in developed countries, difficult and delayed diagnosis, and misleading clinical presentation. This systematic review aimed to describe the epidemiology, clinical presentation, diagnosis, and treatment of female genital tuberculosis during 2000-2021. Information Methods: The current study is a systematic review that was conducted through exploration of English keywords like “female genital tuberculosis”, “vulva tuberculosis”, “tuberculosis”, and “genital system” as well as, Persian keywords. Furthermore, a similar search methodology was employed in various international databases, including PubMed, Scopus, and Web of Sciences, as well as in certain Iranian databases, like Irandoc and Magiran, between 2000 and 2021. Findings: Most patients (37.5%) were from India. Upper genital tuberculosis was more common among women of reproductive age, and the most involved upper genital organs were the endometrium and fallopian tubes. In contrast, vulvar tuberculosis was more prevalent in postmenopausal women, and the vulva was the most common site involved in lower genital tuberculosis. Weight loss (31.25%) and vaginal discharge (31.25%) were the most common symptoms reported by the study participants. The main histologic finding in female genital TB was the presence of epithelioid cell granulomas (81.25%). 29 (90.6%) patients received the standard antibiotic therapy (combination of rifampicin, isoniazid, ethambutol, and pyrazinamide), all of whom responded positively. Conclusion: Most patients experience prolonged vulva ulcers and inadvertently receive various antibiotics. The typical lesions are epithelioid cell granulomas, which may be accompanied by Langerhans giant cells.