Genitourinary Tuberculosis (GUTB)

What is Genitourinary Tuberculosis?

Genitourinary Tuberculosis is a disease of the genitourinary system. This includes the entire urinary tract and reproductive system. This is an extrapulmonary form of tuberculosis infection.

Statistics on Genitourinary Tuberculosis?

Tuberculosis is primarily a medical problem of third world, affecting between 3.5 and 4 million people per year worldwide, 90% of them within developing countries. In 1998, an incidence rate of 6.8 per 100,000 was reported in the US. In the western world, the condition is most common among HIV infected individuals, marginalised ethnic groups and immigrant populations. Genitourinary tuberculosis accounts for around 15% all extrapulmonary cases of tuberculosis.

Risk Factors for Genitourinary Tuberculosis

1. Primary infection with tuberculosis: Pulmonary or extrapulmonary. The development of genitourinary tuberculosis usually arises from the spread of pulmonary tuberculosis. 2. Previous exposure to patients infected with tuberculosis: People in close contact with tuberculosis may develop dormant infection which may activate in later life with deterioration of the immune system.3. Immunosupression: Acquired (e.g. HIV infection) or congenital.4. Demographic: Tuberculosis is more common in migrants and others disadvantaged or marginalised groups of society.5. Location of residence: Tuberculosis is more common in the Asian subcontinent and Africa than the Western nations of the US, UK and Australia.

Progression of Genitourinary Tuberculosis

Genitourinary tuberculosis results from the spread of pulmonary tuberculosis through the blood to the genitourinary tract. The bacteria lodge within the tissues of the genitourinary tract and form caseating granulomas. Local urinary symptoms usually predominate (dysuria, haematuria, flank pain) but the patient may be completely asymptomatic until large destructive granulomas have formed. Large abscesses and fistulae may form if the condition is allowed to continue untreated. Severe ureteric strictures may result in urinary tract obstruction and permanent renal damage. Without treatment, the condition will progress and may spread to other parts of the body resulting in widespread miliary tuberculosis. The condition responds well to antimicrobial therapy, which is the mainstay of therapy outlined below.

How is Genitourinary Tuberculosis Diagnosed?

1. Bloods: FBC, culture for AFBs. 2. Radiology: To find radiological evidence of pulmonary tuberculosis.3. Sputum Culture: If the patient is suspected of active pumonary tuberculosis infection. The specimen should be sent for detection of acid fast bacilli (AFB) culture and sensitivity.

Prognosis of Genitourinary Tuberculosis

The prognosis of this condition is good when the infection is caused by an antibiotic-susceptible strain of the organism. In recent times, antibiotic resistant strains of tuberculosis are emerging which may require an intensive or longer duration antibiotic regime. Anti-tuberculosis drugs must be taken for minimum period of six months to eradicate infection. These drugs have many undesirable side-effects, that may limit patient adherence to therapy and reduce the likelihood of recovery.

How is Genitourinary Tuberculosis Treated?

Long-term antibiotic therapy:As the bacteria is capable of inducing the formation of granulomas, it remian relatively protected from the action of most antibiotics. Therefore, multiple antibiotics are used fora long period to ensure the protecting granulomas are well penetrated such that the organism and disease are eradicated. The standard antibiotic regime in Australia includes the following oral antibiotic agents:

Rifampicin, Isoniazid, Pyrazinamide and Ethambutol for two months

Rifampicin and Isoniazid for the next four months

Other regimes are used should the patient experience intolerable side-effects from the above regime or if the bacteria proves resistant to these agents on sensitivity testing.Response to antibiotic therapy in genitourinary tuberculosis is difficult and usually assessed clinically by the severity of symptoms. Periodic urine testing can be performed to assess disease eradication following the six-month antibiotic course.

Genitourinary Tuberculosis References

[1] Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison's Principles of Internal Medicine. 15th Edition. McGraw-Hill. 2001.[2] Cotran, Kumar, Collins 6th edition. Robbins Pathologic Basis of Disease. WB Saunders Company. 1999.[3] Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002 Pg 545-549.[4] Longmore M, Wilkinson I, Torok E. OXFORD HANDBOOK OF CLINICAL MEDICINE. Oxford University Press. 2001.