Genital Tuberculosis in Children

General Considerations

• Part of extrapulmonary tuberculosis
• Usually secondary to hematogenous spread
• Rare in prepubertal children
• Can affect future fertility

Risk Factors

• Primary pulmonary TB
• Immunocompromised status
• Malnutrition
• Close contact with TB patients
• Endemic areas residence

Testicular Tuberculosis

Pathogenesis

• Routes of Infection
  • Hematogenous spread (most common)
  • Retrograde spread from prostate/epididymis
  • Direct extension from nearby structures
• Anatomical Considerations
  • Usually begins in epididymis
  • Spreads to testis later
  • Can be unilateral or bilateral

Clinical Features

• Common Presentations
  • Painless scrotal swelling
  • Scrotal mass
  • Constitutional symptoms
  • Infertility concerns
• Physical Examination
  • Hard, nodular epididymis
  • Testicular enlargement
  • Scrotal skin changes
  • Sinus formation (late)

Ovarian Tuberculosis

Pathogenesis

• Routes of Spread
  • Hematogenous dissemination
  • Direct spread from fallopian tubes
  • Lymphatic spread
• Pattern of Involvement
  • Usually bilateral
  • Associated tubal involvement common
  • Can form tubo-ovarian masses

Clinical Features

• Presenting Symptoms
  • Abdominal pain
  • Pelvic pain
  • Menstrual irregularities
  • Constitutional symptoms
• Physical Findings
  • Adnexal masses
  • Ascites
  • Pelvic tenderness

Diagnostic Approach

Laboratory Studies

• Basic Investigations
  • Complete blood count
  • ESR and CRP
  • Mantoux test
  • HIV testing
• Specific Tests
  • AFB smear and culture
  • PCR for MTB
  • GeneXpert MTB/RIF
  • Hormonal assays when indicated

Imaging Studies

• Ultrasound
  • First-line imaging
  • Assess organ involvement
  • Guide biopsy
  • Monitor treatment response
• CT/MRI
  • Extent of disease
  • Complex cases
  • Pre-surgical planning

Tissue Diagnosis

• FNAC/Biopsy
  • Histopathology
  • AFB staining
  • Culture
  • PCR testing

Treatment Protocol

Medical Management

• Anti-tubercular Therapy
  • Initial Phase (2 months)
    • HRZE regimen
    • Daily supervised therapy
  • Continuation Phase (4-7 months)
    • HR regimen
    • Extended in complex cases
• Supportive Care
  • Pain management
  • Nutritional support
  • Psychological support

Surgical Management

• Indications
  • Diagnostic uncertainty
  • Failed medical treatment
  • Complications
  • Mass effect
• Procedures
  • Testicular TB
    • Epididymectomy
    • Orchiectomy
    • Drainage of abscess
  • Ovarian TB
    • Cystectomy
    • Oophorectomy
    • Adhesiolysis

Complications and Sequelae

Immediate Complications

• Testicular TB
  • Abscess formation
  • Sinus formation
  • Scrotal destruction
• Ovarian TB
  • Pelvic abscess
  • Adhesions
  • Peritonitis

Long-term Sequelae

• Fertility Issues
  • Primary infertility
  • Reduced fertility potential
  • Need for assisted reproduction
• Hormonal Imbalances
  • Endocrine dysfunction
  • Growth issues
• Psychological Impact
  • Body image concerns
  • Anxiety about future fertility
  • Need for counseling

Follow-up Care

• Regular monitoring
  • Clinical assessment
  • Imaging studies
  • Hormonal evaluation
• Fertility preservation planning
• Long-term endocrine follow-up
• Psychological support