From the Guidelines
The recommended treatment for ovarian tuberculosis is the standard anti-tuberculosis therapy regimen, which typically consists of a 6-9 month course of multiple antibiotics. The initial intensive phase (first 2 months) includes isoniazid (5 mg/kg/day), rifampin (10 mg/kg/day), ethambutol (15-25 mg/kg/day), and pyrazinamide (15-30 mg/kg/day) 1. This is followed by a continuation phase of isoniazid and rifampin for an additional 4-7 months. Pyridoxine (vitamin B6, 25-50 mg/day) should be given with isoniazid to prevent peripheral neuropathy. Treatment duration may be extended to 9-12 months in complicated cases. Regular monitoring of liver function tests is essential due to potential hepatotoxicity of these medications. Surgery may be required in cases with large tubo-ovarian masses, abscess formation, or when diagnosis is uncertain. Ovarian tuberculosis is typically secondary to infection elsewhere in the body, most commonly the lungs or gastrointestinal tract, so a complete evaluation for other sites of TB infection is necessary. The treatment approach is similar to pulmonary TB because the causative organism, Mycobacterium tuberculosis, responds to the same antibiotics regardless of the infection site. Adherence to the complete treatment regimen is crucial to prevent drug resistance and ensure cure. Some key considerations in the treatment of ovarian tuberculosis include:
- Directly observed therapy (DOT) to ensure adherence to the treatment regimen 1
- Monitoring for potential side effects, such as hepatotoxicity and peripheral neuropathy 1
- Consideration of special populations, such as pregnant women and individuals with HIV infection 1
- The potential need for surgical intervention in complicated cases. It's worth noting that the most recent and highest quality study 1 provides guidance on the use of bedaquiline fumarate for the treatment of multidrug-resistant tuberculosis, but this is not directly applicable to the treatment of ovarian tuberculosis. However, the principles of treatment for multidrug-resistant TB can inform the approach to treatment of ovarian TB in cases where drug resistance is suspected or confirmed.
From the Research
Ovarian Tuberculosis Treatment
The recommended treatment for ovarian tuberculosis (TB) is based on the principles and drug regimens outlined for pulmonary tuberculosis.
- A 6-mo regimen consisting of isoniazid, rifampin, and pyrazinamide given for 2 mo followed by isoniazid and rifampin for 4 mo is the preferred treatment for patients with fully susceptible organisms who adhere to treatment 2.
- Ethambutol (or streptomycin in children too young to be monitored for visual acuity) should be included in the initial regimen until the results of drug susceptibility studies are available, unless there is little possibility of drug resistance 2.
- For patients with multidrug-resistant tuberculosis, treatment must be individualized and based on susceptibility studies 2, 3.
- In cases of isolated ovarian tuberculosis, antituberculosis treatment can lead to full resolution of symptoms and a decrease in CA-125 level 4.
- Surgery may be indicated if a pelvic mass and recurrence of pain or bleeding persist after 9 months of treatment 5.
Special Considerations
- In pregnant women, all 4 first-line drugs (isoniazid, rifampin, ethambutol, and pyrazinamide) have an excellent safety record and are not associated with human fetal malformations 6.
- Pyridoxine (vitamin B6) should be added to the drug treatment of tuberculosis in all pregnant women taking isoniazid 6.
- In postmenopausal women, genital tuberculosis can present with symptoms resembling endometrial malignancy, such as postmenopausal bleeding, persistent vaginal discharge, and pyometra 5.