The possibility of being infected with tuberculosis is a concern that is shared by sexual partners. This is particularly so if one of the partners has chronic cough or has been diagnosed with tuberculosis. And this concern is justified considering the fact that 1 in every 3 persons (i.e. 2 billion people) worldwide has tuberculosis (latent infection). In them, there are no symptoms as the body’s immune system is in control of the infection. In the events that the body’s immune system fails to contain the infection, the bacteria grow and cause symptoms. This is called active TB. However, only the active form of the disease is contagious. Every year, 9 million people develop active TB. Up to 15 new TB infections can result from 1 untreated active TB in just a year. Sadly, at present, 3 million of the 9 million active TB are unable to access the right treatment.
There is also a concern of latent tuberculosis advancing to active disease or TB complications under favourable conditions. These include diabetes, kidney disease, haemodialysis for end-stage kidney disease, HIV, poor nutrition and certain cancer.
How is TB transmitted?
Tuberculosis has been established to be a disease mainly transmitted by coughing, sneezing, singing and laughing, the first being the main mean/means of transmission. These activities are possible means of transmission because of the potential of releasing the “tuberculosis bacteria” (mycobacterium tuberculosis) into the air in the form of air droplets. However, TB is not transmitted by kissing, hugging, eating together and holding hands.
Can TB be contracted through sex?
Generally, the risk of transmission of tuberculosis through sexual intercourse has not been established except rarely for a type of tuberculosis called genital tuberculosis. Although sexual means have been demonstrated, the usual means of transmission of genital TB may be through the blood or lymph. The hypothesis of sexual transmission of genital TB was considered when partners of individuals diagnosed with genital TB came down with genital TB within a short period of time after the diagnosis. In order to test this hypothesis, researchers used special molecular techniques to compare the bacteria found in the genitals of the partners. The bacteria were discovered to be of the same origin. Going by this evidence, it was concluded that sexual intercourse is a possible means of transmission of genital TB. Moreover, the symptoms and signs of tuberculosis elsewhere in the body were absent in the couple. Moreover, TB in other parts of the body was equally ruled out by chest x-ray and abdominal ultrasound scan.
Sharing a bed does not pose risk of transmission of tuberculosis except when some conditions are present. These conditions include:
- Poor ventilation
- Coughing without covering the mouth
- Poor nutrition
Active TB in so many ways affects the sex-life of partners affected. In the weeks or months before treatment and the first two weeks of treatment, the risk of transmission of active TB is high. However, beyond 2 weeks of treatment with anti-tuberculous drugs, an infected individual is unlikely to transmit the disease. Typically, treatment of TB takes 6 months. However in complicated cases e.g. TB in parts of the body like bone other than the chest (extrapulmonary TB), the duration of treatment is longer.
The capacity to breathe well may be affected by tuberculosis and this may diminish the stamina and ability of a person to tolerate exercise (and sex!). Although TB commonly affects the lungs, it can also affect critical organs involved in sex. When tuberculosis affects the bone, the strength to take on activities like sex may be affected. It may result in fracture of the bone(s). Tuberculosis of the spine (TB spine) is one critical example of this.
Back pain is the most common symptom of TB spine. Back pain that results from TB spine may bring about phobia and apathy for sex. The back pain may worse with sexual activity. In a recent online survey, 72% of sexually active respondents reported having less frequent sex since their back pain started. A similar number also complained of reduced sexual satisfaction.
Tuberculosis can also lead to low blood level (anemia). Anemia is a cause of fatigue, reduced libido (sexual interest) and erectile dysfunction.
Psychologically, an individual with tuberculosis may lapse into depression, anxiety, performance anxiety and reduced libido just like people with other chronic illnesses do. However, for tuberculosis, the good news is that it is curative. Also, an individual with tuberculosis may wall himself/herself from social interactions because of the fear of infecting others. They may want to avoid the guilt of infecting their beloved partner. At another level, heightened self-consciousness may result. For example, the free expression that comes with sex like gasping, laughing, singing, sighing and sometimes coughing may be avoided or suppressed. In the overall, sexual freedom and enjoyment is therefore affected.
A little more light on genital tuberculosis
Genital TB is a type of TB that affects the genitals. Although believed to be rare, clinicians nowadays are raising awareness on it being a hidden cause of many cases of infertility. Genital Tb is believed to be responsible for 2-10% of infertility. The disease has a special preference for the tubes. Without healthy fallopian tubes, the transport of eggs from the ovaries to the womb becomes impossible. Similarly, sperms will not be able to travel from the womb to meet the eggs in the tubes.
Genital TB also affects the inner side of the womb (the endometrium) and the ovaries. It has been found to cause pus collection in the tubes and ovaries (tubo-ovarian abscess). Given its occult nature, it is not surprising that the outer part of the genitals (the external genitalia) are only affected in less than 5% of the cases of genital TB.
Besides infertility, affected women may present with bleeding via the vagina ( unprovoked, after sex or after menopause) and menstrual abnormalities – heavy or reduced flow, irregular menses etc.
From the description above, one may erroneously think that genital TB is a disease of women. No! Genital TB has been found in men too. In fact, some of the established cases of sexual transmission has been from male to their female partners. It can affect the testes, epididymis and rarely the penis.
Being the most obvious, genital TB of the penis (penile TB) is a finding that warrants screening of the female partner. It presents with a painless ulcer (sore/wound) on the penis. The appearance of the ulcer may be preceded by a painless lump that progressively increased in size on the penis. It may lead to erectile dysfunction/impotence.
When the testes or epididymis are affected, the patient usually presents with a painless swelling of the testes or its adjoining tubes (i.e. epididymis). The general symptoms of tuberculosis like weight loss, night sweat, low-grade fever, may be present. Because of the close relationship of these structures with the urinary tract, the patient may present with difficulty in passing urine.
In either penile or testicular TB, urine and blood samples, and a biopsy/sample of the ulcer or swelling may help to establish the diagnosis and also exclude the possibility of a cancerous growth. The regular anti-tuberculous drugs are equally effective against genital TB. Surgery is only required in a very few instances.
Some conditions have been found to particularly favour the occurrence of genital TB. These include:
- Aplastic anaemia
- Intravenous drug abuse
- Immunosuppression from diseases like HIV
In conclusion, sexual abstinence for the initial period of treatment of genital TB (1 month) is advised.