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Do I have genital tuberculosis?

Q: My friend has been suffering from pain in his testes mainly on touch for the past 3 months. He took two ultrasounds on medical advice but nothing abnormal was found except a few echogenic particles and minimal free fluid in the second ultrasound. He took an anti-parasite for 30 days and found no relief. He again took an ultrasound today and the report said that he had spermatic cord thickening, a calcification in the epididymis, free fluid and echogenic particles. He has been having fever occasionally for quite sometime but there is no weight loss or other associated features. He is quite healthy otherwise. His doctor is suspecting genital tuberculosis and has advised a biopsy. Is there any other cause, which may lead to similar manifestations? Is there any test available in India, which can give an accurate diagnosis? What is the prognosis?

A:The differential diagnosis of epididymal or genital tuberculosis in males, or other causes of such symptoms, include the following conditions:

  • Epididymitis
  • Hydrocoele
  • Scrotal Trauma
  • Spermatocoele
  • Testicular Seminoma
  • Testicular Torsion
  • Testicular Trauma
  • Testicular Tumours: Nonseminomatous
In the laboratory the following investigations could be done:
  • Microscopic analysis of urine, which often reveals pyuria or haematuria.
  • Urine for routine culture should be done to exclude bacterial infection.
  • For genitourinary tuberculosis, 3-5 consecutive early morning urine samples should be cultured for acid-fast bacilli.
  • Molecular probes as well as nucleic acid amplification tests, like PCR and NASBA, also are available for more rapid identification of the organisms in urine.
  • Blood tests include complete blood count, serum electrolytes, and erythrocyte sedimentation rate. Elevation in erythrocyte sedimentation rate is common, and its normalisation can be used to follow the course of therapy. The ultimate prognosis is determined by the degree of systemic illness.

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