Tuberculosis (TB) is a major public health problem in India and records one of the largest numbers of TB cases in the world every year. 

Although TB is present in all groups across all countries, its prevalence is significantly higher in men than in women. 

Let's take this opportunity to address a few commonly asked questions about TB in men.

1. What causes TB and what are its common symptoms?

It is a serious droplet infection caused by Mycobacterium tuberculosis (Mtb), which mainly affects the lungs. Its typical symptoms include a chronic cough, fever, fatigue, weight loss, and night sweats. 

2. What are the stages of TB?

a) Exposure: This happens when a person has come in contact with or been exposed to, another person who has TB. 

The exposed person will have a negative skin test, a normal chest X-ray, and no signs or symptoms of the disease.

b) Latent TB infection (LTBI): This happens when a person has already been exposed to TB but has no symptoms of the disease. The infected person's immune system walls off the TB organisms due to which it stays inactive throughout life in most infected people. 

This person can have a positive skin or blood test for TB but a normal chest X-ray or one that only shows old scarring from the disease. They would have no signs of active infection in other parts of the body. 

About 1/3rd of the world’s population has LTBI and approximately 10% of those will develop active disease in their lifetime.

c) Active infection: This person shows all the signs and symptoms of the disease. The person could have a positive or negative skin or blood test for TB and a positive chest X-ray, biopsy, or other disease-specific findings of an active infection. 

3. What is the prevalence of the disease? Is there any gender bias?

According to Global TB Report 2018, a higher proportion of the 27.4 lakh diagnosed with TB in India are men and the ratio is approximately 2:1 between men and women.

4. If men are at higher risk of TB, what is the age group that is commonly affected?

Studies show that the factors influencing the risk of TB are more frequent in men older than 20 years and that coincided with the observed prevalence ratio of 2:1 (male: female). 

5. What are the most common risk factors that make men more prone to TB?

HIV (human immunodeficiency virus) infection has been reported frequently in younger men, and lung cancer and chronic obstructive pulmonary disease (COPD) in middle-aged and older men. 

Smoking is the most important risk factor for COPD and lung cancer and is also associated with pulmonary TB. Generally, men smoke more than women. Consequently, smoking is a larger contributor to the TB disease burden for men. 

Alternatively, alcohol abuse is higher in men than women in all age groups and is also the leading cause of non-adherence to the treatment of TB in men.

6. What are the behavioural differences that can have an effect on the increased risk of TB in men?

The gender differences in social roles like - men are more likely to travel frequently; have more social contacts; spend more time in social settings that may be conducive to transmission, lack of healthcare-seeking behaviour in men, and engagement in professions associated with a higher risk for tuberculosis, such as mining, construction industries, etc., make them more vulnerable to the disease.

7. Are there any constitutional/physiological differences between men and women that increase the susceptibility of men towards TB infection?

The male gender bias in TB detection rate may have something to do with the sex hormones as it becomes apparent after sexual maturity (especially after the age of 20). This suggests that sex hormones may play a part in protection and susceptibility towards TB bacilli. 

The possible role of sex hormones in TB is also strengthened by the fact that the disease progression and mortality rates are higher in females during their reproductive years, after which such rates turn again to be higher in men.

8. Do men only have an increased risk of TB infection or any other TB-like respiratory infections?

The gender bias among respiratory/pulmonary infectious diseases is not restricted to TB. 

For example, it has been shown that men have a 4-times higher risk than women of developing nosocomial pneumonia caused by Legionella pneumophila infection.

9. Is there a role of gender in the treatment of TB?

Traditionally, women tend to have better adherence to treatment protocol as compared to men. 

The pressure to get back to work and lifestyle habits such as smoking or consumption of alcohol often leads to non-adherence to treatment, which in turn has a serious impact on the treatment outcome and the number of active TB cases in men. 

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