From the Guidelines
Ovarian tuberculosis typically presents with symptoms such as chronic pelvic pain, irregular menstrual cycles, infertility, and sometimes a palpable pelvic mass, and its treatment follows standard TB protocols with a multi-drug regimen. The symptoms of ovarian tuberculosis can be non-specific and may include menstrual irregularities and pelvic pain, as well as systemic TB symptoms like low-grade fever, night sweats, fatigue, and weight loss 1.
- The diagnosis of ovarian tuberculosis is challenging and relies on a high index of suspicion according to patient history, along with microbiological, molecular, and histological testing, as well as imaging findings.
- Treatment of ovarian tuberculosis involves a daily regimen for 6 months, with an initial intensive phase of 2 months with isoniazid, rifampicin, pyrazinamide, and ethambutol, followed by a 4-month continuation phase with isoniazid and rifampicin, as recommended by the World Health Organisation 1.
- It is essential to monitor patients for response to therapy and manage side effects, with regular follow-up and assessment of adherence to the treatment regimen 1.
- Surgery may be necessary in cases with large tubo-ovarian masses, abscess formation, or when malignancy cannot be ruled out.
- The extended treatment duration is necessary because Mycobacterium tuberculosis is slow-growing and can persist in tissues, requiring prolonged antibiotic exposure to ensure complete eradication and prevent relapse or drug resistance.
From the FDA Drug Label
Although there have not been the same kinds of carefully conducted controlled trials of treatment of Extra pulmonary tuberculosis as for pulmonary disease, increasing clinical experience indicates that a 6 to 9 month short-course regimen is effective Bacteriologic evaluation of Extra pulmonary tuberculosis may be limited by the relative in accessibility of the sites of disease. The use of adjunctive therapies such as surgery and corticosteroids is more commonly required in Extra pulmonary tuberculosis than in pulmonary disease.
The symptoms of ovarian tuberculosis (TB) are not directly mentioned in the drug label.
- Treatment of ovarian TB is not explicitly stated, but it can be inferred that a 6 to 9 month short-course regimen may be effective for extra-pulmonary tuberculosis, which includes ovarian TB.
- Adjunctive therapies such as surgery may be necessary to obtain specimens for diagnosis and to treat the disease.
- The drug label does not provide information on the specific symptoms of ovarian TB, only that bacteriologic evaluation may be limited and clinical and radiographic findings are used to judge response to treatment 2.
From the Research
Symptoms of Ovarian Tuberculosis
- Chronic pelvic pain
- Weight loss
- Ovarian mass on ultrasound
- Elevated CA-125 level, which can be raised in both ovarian tuberculosis and ovarian carcinoma 3
- Menstrual irregularity
- Infertility
- Pregnancy loss
Treatment of Ovarian Tuberculosis
- Antitubercular drugs, including isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin, can be used to treat ovarian tuberculosis 4
- Treatment regimens may vary depending on the severity of the disease and the presence of any drug resistance
- Early diagnosis and treatment are crucial to prevent long-term complications, such as infertility 3
- In cases of multidrug-resistant tuberculosis, alternative treatment regimens may be necessary, such as the use of capreomycin, levofloxacin, and para-aminosalicylic acid 5
Diagnostic Challenges
- Ovarian tuberculosis can mimic ovarian carcinoma, making diagnosis challenging 3
- Imaging and CA-125 levels may not be conclusive, and intraoperative frozen section of tissue specimens may be helpful in diagnosis 3
- Clinicians need to be "Tuberculosis Minded" and consider tuberculosis as a possible diagnosis in patients presenting with symptoms of ovarian disease, especially in endemic areas 6