Diagnosis of genital tuberculosis: correlation between polymerase chain reaction positivity and laparoscopic findings

Abstract

Background: Female genital tuberculosis (GTB) leads to infertility in young women as it involves the fallopian tube and the endometrium. Since it does not produce any dramatic symptoms, disease remains untreated until the female fertility is totally compromised. Diagnostic hystero-laparoscopy is an integral part of management of infertile women. Visual manifestations of pelvic TB are well described, but subtle signs of subclinical disease are not identified nor correlated with laboratory tests. PCR has been described as a rapid, highly sensitive and specific test for detecting DNA of MTB. Hence it’s worth studying whether positive PCR test will help make early diagnosis of GTB. This study correlates laparoscopic visual inspection (LVI) findings with endometrial TB-PCR positivity to diagnose GTB.Methods: A prospective observational study was done in which infertile women who had clinical and HSG findings suggestive of GTB underwent endometrial TB-PCR and hysterolaparoscopy. Among them 69 endometrial TB-PCR positive cases were included in the study. Clinical and hysterolaparoscopy findings in these cases were reviewed.Results: GTB is the disease of young women and most commonly present with primary infertility (65.2%). On laparoscopy 60% of cases showed positive correlation with endometrial TB- PCR and tubal involvement was seen in majority of cases.Conclusions: Even though PCR is a very valuable tool in diagnosing genital TB, by itself it can neither confirm nor exclude genital TB. The routine application of endometrial TB-PCR assays in addition to clinical and laparoscopic evaluation carries a great potential in improving diagnosis of genital TB.