What to know about genitourinary tuberculosis

What is it?

GUTB is when tuberculosis affects the genitals or urinary tract.

While tuberculosis can affect any organ, it most often involves the lungs, known as pulmonary tuberculosis. However, about 5–45% of cases affect other body parts. Of these, 30–40% involve one or more components of the urinary tract or genitals.

Learn more

Find out more about the genitourinary tract, including:

• the anatomy of the genital tract
• the anatomy of the female reproductive system
• the anatomy of the male reproductive system

What causes genitourinary tuberculosis?

The microbe that usually leads to GUTB is M. tuberculosis. However, other bacteria can also cause it. These include:

• Mycobacterium bovis
• Mycobacterium pinnipedii
• Mycobacterium africanum
• Mycobacterium caprae
• Mycobacterium microti

In rare cases, the tuberculosis vaccine bacillus Calmette-Guérin can lead to GUTB.

The most frequent cause involves the spread of pulmonary tuberculosis through the blood to the urogenital tract during the initial infection. The infection can remain inactive — or latent — but becomes active if a person develops immune system suppression.

Less commonly, a person can acquire the infection through the lymphatic system — part of the body’s immune system — or via sexual transmission.

Risk factors

Aside from having a weakened immune system, risk factors that increase the likelihood of a latent GUTB infection becoming active include:

• older age
• diabetes
• low body mass index
• cooccurring cancer

What are the symptoms of genitourinary tuberculosis?

A 2021 review notes that when GUTB affects a kidney, it does not often produce symptoms but can heavily damage the organ. Symptoms generally start when the infection involves the bladder.

These may include:

• increased urinary frequency
• blood in the urine
• difficulty urinating
• pain in the abdomen, lower back, and lower pelvis area

GUTB can affect the ureter and cause severe narrowing — strictures — that can lead to kidney damage due to obstruction. The ureter is the narrow tube that carries urine from the bladder to the outside of the body.

Other symptoms may entail an ulcer in the penis or a mass in the scrotum or epididymis in males. They may also include pelvic pain and irregularities in the menstrual cycle in females.

Diagnosis

According to a 2021 review, GUTB poses a diagnostic challenge as it can affect any part of the genitourinary system, and symptoms vary broadly.

Diagnostic tools include:

• medical history
• physical examination
• cultures to determine the presence of the bacterium
• blood tests
• imaging tests

The gold standard for diagnosis entails detecting M. tuberculosis in body samples, such as:

• urine
• pus
• massage fluid from the prostate gland in males
• discharge fluid
• biopsy, which is tissue that a doctor has removed to examine under a microscope

Treatment

Options for treating GUTB include:

Medications

Medications are the usual treatment. This typically consists of a 6-month medication regimen, starting with 2 months of:

• rifampicin
• ethambutol
• isoniazid
• pyrazinamide

Following this, the treatment entails 4 months of rifampicin and isoniazid.

The 2021 review above cites a 2016 case study that discusses the use of corticosteroids. It states that in people with tuberculosis of the urinary tract, strictures of the ureter can deteriorate and cause an obstruction during treatment. Therefore, doctors may prescribe concurrent treatment with the corticosteroid prednisolone (Orapred, Orapred ODT, Prelone). This may help prevent the worsening of a stricture.

Surgery

More than 50% of people with GUBT need surgery. As the condition can affect individuals differently, there is no standard for the type or timing of surgery.

In instances involving complications of a blockage or narrowing of the ureters, either of two surgical options may be necessary:

• stenting, which involves inserting a tube into the ureter
• percutaneous nephrostomy, which consists of creating an artificial opening between the kidney and the skin to allow urine to drain out

In some circumstances — such as in kidney cancer or extensive kidney damage — surgical removal of a kidney may be necessary.

For a person with GUTB and kidney damage, renal transplantation may be an option for those who are receiving or have received antituberculosis therapy.

Is it curable?

With early detection and prompt standard medication treatment, the cure rate for GUTB is around 90%.

Outlook

A 2018 review notes that M. tuberculosis is usually eradicated within 2 weeks of treatment.

The outlook is excellent with early detection and good adherence to drug treatment. However, relapses occur in 6.3% of cases after an average of 5.3 years following treatment.

Summary

Genitourinary tuberculosis occurs when pulmonary tuberculosis travels through the bloodstream to one of the organs in the genitourinary tract.

Symptoms may include urinary frequency, blood in urine, difficulty urinating, and pain in the abdomen.

The gold standard of diagnosis involves detecting M. tuberculosis in samples, such as blood culture, urine, or a biopsy.

Treatment usually entails a 6-month course of various antituberculosis medications. Surgery is sometimes necessary. The cure rate is around 90%. Although the outlook is excellent if caught early, relapses may still occur.