Diagnosing genital tuberculosis in female infertility by clinical, histopathological, culture and polymerase chain reaction techniques: an evaluative study

Background: In developing countries, the genital tract tuberculosis is one of the common causes of tubal damage leading to infertility. Objective of present study was to evaluate the efficacy of Histopathological examination (HPE), culture and Polymerase Chain Reaction Technique in diagnosing genital tuberculosis.Methods: It was a prospective evaluative study. 173 women were subjected to investigations for tuberculosis. AFB smear, culture and HPE examination and PCR testing were carried out on 173 endometrial samples, 81 POD fluid and 52 urine samples. Based on the clinical profile and laparoscopic findings a diagnostic criterion was derived to suspect GTB and the specific diagnostic tests were evaluated against this diagnostic criterion.Results: Based on the diagnostic criteria, tuberculosis was suspected in 61 of the 153 cases. AFB smear was positive in 4.6%, culture was positive in 3.5%, HPE positive in 4.0% and PCR was positive in 28.1% of cases. On evaluating against the diagnostic criteria, the sensitivity of PCR, HPE, culture and AFB smear were; 44.3%, 8.2%, 6.6% and 6.7% respectively. PCR was positive in 18 of the 92 cases in whom GTB was not suspected. The PCR results were negative in 34 of the 61 clinically suspected cases.Conclusions: This study has shown that HPE, AFB smear and culture have low pick up rates. PCR is found to be useful in confirming diagnosis in clinically suspected cases. False negative PCR was an important limitation in this study