Urogenital tuberculosis often remains undetected

Urogenital TB is often overlooked. In regions with high TB prevalence, it is "treated" as a classic UTI. UTIs may mask urogenital tuberculosis frequently, and doctors should be reminded of this scenario.

Many doctors treat UTIs without considering a possible TB case

Urogenital tuberculosis is often overlooked, and in regions with high TB prevalence, it is "treated" as a classic UTI. UTIs actually mask existing urogenital tuberculosis more frequently, and doctors worldwide should be reminded of this scenario.

In a recent Russian prospective cohort study, 265 physicians provided information on the clinical symptoms and the examination for urogenital TB. In addition, doctors were asked about their preferred therapy regimes for Urinary Tract Infections (UTIs).

Interestingly, there was not a single case that answered all the questions in the questionnaire correctly. On the contrary, only one in two respondents knew that TB was one of the world's diseases with the highest number of deaths each year. Less than a third of the doctors were also able to safely take a urine sample for TB diagnosis.

Sixty percent of urologists interviewed agreed with the statement that UTI could often cover urogenital tuberculosis. However, in order to achieve the quickest possible treatment success with UTI present at the same time, they were happy to "overlook" a possible TB. For example, in acute uncomplicated cystitis, 29.7% of physicians prescribed nitrofurans, fluoroquinolones (26.6%) and slightly less frequently fosfomycin (17.1%) and cephalosporins (12.7%).

In addition, urogenital TB is very easily overlooked, especially in the less conspicuous early stages of the disease. In an open prospective cohort study with 84 patients who had been suffering from chronic prostatitis for at least three years, the researchers, therefore, addressed the question of which diagnostic methods would best detect urogenital TB and as early as possible. This would simultaneously make it possible to determine which diagnostic criterion is appropriate for urogenital TB.

As a result of this work, 53.6% of patients tested positive for urogenital TB. According to the study, only 46.4% of the 84 men examined had received the correct diagnosis of "chronic bacterial prostatitis". The microbiological laboratory test confirmed one TB in every third case. The radiological measurement of the prostate, on the other hand, only led to the diagnosis of TB in 24.4% of cases. On closer inspection, 7.7% of men subsequently found further active TB foci in other organs. It is also interesting that 94% of the patients in this study tested positive for multi-resistant uropathogens, both in the prostate secretion and in the ejaculate.

This suggests that symptoms of chronic bacterial prostatitis may indicate multi-resistant uropathogens as well as covert urogenital TB. 

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