1- Department of Obstetrics and Gynecology, Santhiram Medical College and General Hospital, Nandyal, India
2- Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry, India
3- Department of Obstetrics and Gynecology, Gandhi Medical College and Hospital, Secunderabad, India ,research.nmch1@rediffmail.com
2- Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry, India
3- Department of Obstetrics and Gynecology, Gandhi Medical College and Hospital, Secunderabad, India ,
Abstract: (422 Views)
Background: Diagnosis of genital tuberculosis (TB) as a risk factor for infertility remains a diagnostic dilemma for clinicians. Employing the best clinical practices for diagnosing and treating genital TB may help optimize fertility rate. The current study aimed to evaluate the molecular and conventional methods to diagnose genital TB in women with infertility.
Methods: A comparative study was conducted on 100 infertile women between 20-35 years of age. Routine laboratory assays and other investigations, such as cervical swab gonorrhea and Chlamydia, Nested TB Polymerase Chain Reaction (TB-PCR), histopathological examination (HPE), culture by Bactec method, and hysterosalpingography (HSG) were performed.
Results: The majority of the cases (52%) were between 21 and 25 years. Moreover, 68% of the participants had patent tubes on HSG, 7% had a right tubal block, 9% had a left tubal block, 14% had a bilateral tubal block, and 2% had a unicornuate uterus. Additionally, 9% of the participants were TB-PCR-positive. Hysterolaparoscopy results suggested a likelihood of TB observed among 8% of the participants. Also, 25% of the patients with TB and 7.9% of the patients without genital TB had positive Mantoux test results. Furthermore, 75% of the patients with genital TB had HSG results suggestive of TB, whereas 23.8% of the patients without genital TB had such results. Laparoscopy (75%) and TB-PCR (75%), as well as HSG (75%), were the most specific tests for ruling out genital TB. The most sensitive tests for diagnosing genital TB were TB-PCR (100%), HPE (100%), and laparoscopy (100%).
Conclusion: Hysterolaparoscopy is useful for early diagnosis of genital TB. PCR is highly helpful in paucibacillary vaginal TB. Positive findings can be obtained with as few as 10 bacteria/ml of material. In addition to clinical and endoscopic examination, the routine use of endometrial bacteriological PCR testing may be significantly promising for enhancing the diagnosis of genital TB. For the best results, early detection and timely treatment are essential.
Methods: A comparative study was conducted on 100 infertile women between 20-35 years of age. Routine laboratory assays and other investigations, such as cervical swab gonorrhea and Chlamydia, Nested TB Polymerase Chain Reaction (TB-PCR), histopathological examination (HPE), culture by Bactec method, and hysterosalpingography (HSG) were performed.
Results: The majority of the cases (52%) were between 21 and 25 years. Moreover, 68% of the participants had patent tubes on HSG, 7% had a right tubal block, 9% had a left tubal block, 14% had a bilateral tubal block, and 2% had a unicornuate uterus. Additionally, 9% of the participants were TB-PCR-positive. Hysterolaparoscopy results suggested a likelihood of TB observed among 8% of the participants. Also, 25% of the patients with TB and 7.9% of the patients without genital TB had positive Mantoux test results. Furthermore, 75% of the patients with genital TB had HSG results suggestive of TB, whereas 23.8% of the patients without genital TB had such results. Laparoscopy (75%) and TB-PCR (75%), as well as HSG (75%), were the most specific tests for ruling out genital TB. The most sensitive tests for diagnosing genital TB were TB-PCR (100%), HPE (100%), and laparoscopy (100%).
Conclusion: Hysterolaparoscopy is useful for early diagnosis of genital TB. PCR is highly helpful in paucibacillary vaginal TB. Positive findings can be obtained with as few as 10 bacteria/ml of material. In addition to clinical and endoscopic examination, the routine use of endometrial bacteriological PCR testing may be significantly promising for enhancing the diagnosis of genital TB. For the best results, early detection and timely treatment are essential.
Article Type: Research |
Subject:
Obstetrics and Gynecology
References
1. Meenu S, Ramalingam S, Sairam T, Appinabhavi A, Panicker S, Oommen S, Sankaran R. Comparison of polymerase chain reaction (PCR), microbiological and histopathological observations in the diagnosis of endometrial tuberculosis. J Obstet Gynaecol India. 2020;70(6):510-5. [View at Publisher] [DOI] [PMID] [Google Scholar]
2. Dua M, Pandey K, Arya S, Verma A. Evaluation of endometrial polymerase chain reaction in diagnosis of female genital tuberculosis. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. Informação e Conhecimento para a Saúde. 2019;8(11):4424-9. [View at Publisher] [DOI] [Google Scholar]
3. Jayarajah U, Gunawardene M, Willaraarachchi M, Chandrasiri S, Udayakumaran P, Sosai C, Abeygunasekera A. Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: an observational study. BMC Infect Dis. 2021;21(1):1279. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. Muneer A, Macrae B, Krishnamoorthy S, Zumla A. Urogenital tuberculosis-epidemiology, pathogenesis and clinical features. Nat Rev Urol. 2019;16(10):573-98. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. Melkamu K, Damie A, Ashenafi S, Sori M, Girma S, Yimam S, et al. Histopathologic patterns of female genital tuberculosis with clinical correlation: a 10-year (2013-2022) retrospective cross-sectional study. BMC Womens Health. 2024;24(1):370. [View at Publisher] [DOI] [PMID] [Google Scholar]
7. Bicha MM, Kebede TZ, Arefeaynie AL, Meressa EW. Female genital tuberculosis presenting as a protruding anterior vaginal wall mass: a case report. Front Med (Lausanne). 2025;11:1502969. [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Malhotra N, Singh UB, Iyer V, Gupta P, Chandhiok N. Role of laparoscopy in the diagnosis of genital TB in infertile females in the era of molecular tests. J Minim Invasive Gynecol. 2020;27(7):1538-44. [View at Publisher] [DOI] [PMID] [Google Scholar]
10. Gai X, Chi H, Li R, Sun Y. Tuberculosis in infertility and in vitro fertilization-embryo transfer. Chin Med J (Engl). 2024;137(20):2404-11. [View at Publisher] [DOI] [PMID] [Google Scholar]
11. Tal R, Lawal T, Granger E, Simoni M, Hui P, Buza N, et al. Genital tuberculosis screening at an academic fertility center in the United States. Am J Obstet Gynecol. 2020;223(5):737-e1-10. [View at Publisher] [DOI] [PMID] [Google Scholar]
12. Nemati Shahri F, Pouresmaeil O, Sharifi A, Mardani F, Mardaneh J. Genital Tuberculosis in Women; A Systematic Review. J Clinic Care Skill. 2024;5(1):49-54. [View at Publisher] [DOI] [Google Scholar]
13. Yadav S, Puri M, Agrawal S, Chopra K. Genital footprints of extragenital tuberculosis in infertile women: Comparison of various diagnostic modalities. Indian J Tuberc. 2022;69(2):151-6. [View at Publisher] [DOI] [PMID] [Google Scholar]
14. Aggarwal A, Das CJ, Manchanda S. Imaging spectrum of female genital tuberculosis: a comprehensive review. Curr Probl Diagn Radiol. 2022;51(4):617-27. [View at Publisher] [DOI] [PMID] [Google Scholar]
15. Gan H, Mely M, Zhao J, Zhu L. An analysis of the clinical, endoscopic, and pathologic features of intestinal tuberculosis. J Clin Gastroenterol. 2016;50(6):470-5. [View at Publisher] [DOI] [PMID] [Google Scholar]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0).