TB questions and answers

Dr Richard Coker answers your TB questions

HIV and TB
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In this section

Is kissing safe?

Does a grade 4 Heaf Test mean I need treatment?

I am scared the Heaf test might scar my arm, can I have it elsewhere?

I've just finished a 6 month course of TB medicine, does it mean that I will never get TB again?

My wife has TB in her lungs - is it safe to sleep in the same room?

I've got TB in the glands in my neck - will the lumps go away?

I had the BCG 20 years ago, will it still protect me?

I am pregnant and have TB - will the tablets harm my baby?

I am going to Africa - do I need to take any TB preventative tablets?

My wife has TB in her uterus, is it safe to have sex with her?

How do I know I can't give TB to my grandchildren once I get home from hospital after two weeks of TB medication?
Since experiments were conducted in the 1950's it has been clear that isolating people with infectious tuberculosis from their close contacts has little or no effect on the transmission of TB. The reason for this is that most close contacts, if they're going to be exposed, have already been so before the diagnosis was made! Another point to remember is that after 2 weeks of effective treatment almost all the TB germs you were coughing up are now dead. Only in some exceptional circumstances do a very small number of people remain infectious and it is usually straightforward for the doctor to tell who they are and advise accordingly.

I have TB in my lungs, is it OK for me to kiss my partner?
Yes. TB germs are not in saliva but in the stuff you cough up from inside your lungs. So even if your TB is 'infectious', that is if you have got the TB germs in the stuff you cough up, kissing is not going to cause you to pass it on.

I was told that I have a grade 4 Heaf test, does it mean I need treatment?
A grade 4 Heaf test usually means you've been in contact with somebody with TB, but Heaf tests are not a perfect tool to prove you've been exposed and they are not 100% reliable. Things that affect your response include your age, how strong your immunity is, whether you have had a BCG immunisation, and where you have lived in the past. So a strong reaction says that you've probably been exposed, but doesn't explain whether you have got TB itself. There are several things that might be suggested. One is that you may need treatment, another is that you may be advised to take 'preventative' treatment - to prevent you getting full blown TB, or another scenario may be that you're told there's nothing that needs to be done because although you have probably been exposed to TB germs it was so long ago your risk of getting TB itself is tiny.

I am scared that the Heaf test might scar my arm for life - can I have the test done on my leg or backside?
This is a difficult one! Reading and interpreting Heaf tests is as much an art as a science. And the results are dependent on many things, one of which is probably the site at which the test is done. If the test is done on thicker, hairier skin it may be more difficult to read and know what the reading means - so to get the best and most useful results it's probably best to have it done on the inside of the forearm. The good news is that the Heaf test usually doesn't scar. If they do, the scars are small and usually disappear over time - although it can take quite a while.

I have just finished a 6 month course of TB medicine - does it mean I will never get TB again?
Unfortunately no. But your chances are slim. You can get it again in two ways. One is that if the TB you had originally hasn't been completely treated it might return - this is one of the main reasons that it's important to complete the full course of treatment (and especially not stop some of the tablets because this might lead not only to a recurrence of your TB but also make it harder to treat the second time around).The other way is if you get re-exposed, that is you become re-infected. If this happens you can go on to get TB again. Having had it before doesn't protect you from getting it again.

My wife has TB in her lungs and is on treatment at home - is it OK for us to sleep in the same room?
Yes, if the doctor's said it's safe for you to be at home with her then it is safe to sleep in the same room. The only time this may not be the case is if you haven't seen your wife for a long time and she was diagnosed with TB in that time then if she has TB germs in her cough, she might be infectious to you. It's important that the doctor looking after your wife knows if this is the case. If you have been sleeping in the same room as your wife all along, then you may have been exposed to the TB germs before the diagnosis was made - and you need to get checked out yourself anyway as a close contact of your wife. Pretty soon after treatment is started people with infectious TB become non-infectious. The 'rule of thumb' on this is two weeks, so if your wife has been on treatment for longer than this then there's no risk of infection.

I have got TB in the glands in my neck. I am on treatment but the lumps will not go away! Will they go away?
TB is a funny disease! Some peoples' lumps, which are swollen because of TB, get bigger despite effective treatment. Sometimes they get bigger again before they actually shrink. The lumps can take an awful long time to shrink back down and sometimes there is a lot of scarring going on so they stay hard and a bit big forever. Usually they shrink almost completely though, but it can take months or even years.

I have had my BCG 20 years ago at the age of 11; will it still protect me against TB?
The effectiveness of BCG to prevent TB has been a controversial topic for decades. This is because the effectiveness of the vaccine varies considerably for reasons not completely understood. For instance, in Britain it produces about 70% protection, whereas in Argentina or the USA, studies showed it offered little protection from TB. This is why some countries have adopted its use whilst others have not. Just as the protection offered by the vaccine varies - so too does the duration of the protection offered. The widely held belief is that BCG is substantially less effective at protecting against TB fifteen years or more after it is given. This doesn't mean, however, that you need to be re-vaccinated! If you live in a community where there is a small number of people with active TB then your chance of being exposed is consequently very low. In addition, the chance of active TB developing after exposure varies - depending upon age. As a rule of thumb you are more susceptible to developing TB at the extremes of age - so it might be that your chances of getting TB are very low anyway.

I am pregnant and have TB, will the tablets harm my baby?
There is no evidence that the drugs commonly used to treat tuberculosis will harm your unborn baby. Some of the older drugs, for example streptomycin should, however, be avoided if at all possible.

I am going to travel in Africa for a few months, do I need to take any TB preventive tablets?
Probably not. Although some parts of the world have higher rates of TB than others, individually your chances of getting TB are very slim. There is a flip side to the coin of preventive therapy, and that is the side effects of the treatment you would have to take. No treatment is without the possibility of side effects and this risk might be higher than getting TB. For some people, however, if they are to be for a long period of time in a country where TB rates are high, it might be worth, on your return, to think about taking preventive treatment. If, for example, you are HIV positive, you should speak to your doctor about these risks.

My wife has TB in her uterus, can I get TB through having sex with her?
It is possible but would be very unlikely. Using a condom might be the best thing to do for the first couple of weeks whilst she's on treatment.