A clinicoradiological profile in confirmed and probable cases of genital tuberculosis in a tertiary care centre

Abstract

Background: Female genital tuberculosis (FGTB) is an important cause of infertility and chronic gynecological morbidity in tuberculosis-endemic regions. Diagnosis is often difficult because of nonspecific symptoms and the low sensitivity of conventional tests. This study evaluated the clinical, laboratory, radiological, histopathological, and hysterolaparoscopic findings in women with suspected FGTB.

Methods: This hospital-based observational study included 70 women with clinically suspected FGTB. Participants underwent clinical assessment, microbiological investigations including mycobacterial culture and GeneXpert, histopathological examination of endometrial samples, pelvic ultrasonography, magnetic resonance imaging (MRI), and diagnostic hysterolaparoscopy where indicated. Data were analyzed using descriptive statistics, and categorical variables were compared using the Chi-square or Fisher’s exact test.

Results: Women aged 31-40 years formed the largest age group (44.3%), while 45.7% belonged to the lower socioeconomic group. Clinical suspicion of FGTB was recorded in 74.3% of participants, whereas microbiological confirmation was obtained in 32.9%. Histopathology showed the highest positivity (37.1%), followed by GeneXpert (32.9%) and mycobacterial culture (25.7%). Tubal thickening was the most common radiological finding on both ultrasonography and MRI. Hysterolaparoscopy commonly showed periostial fibrosis, pale endometrium, intrauterine adhesions, hydrosalpinx, and pelvic adhesions. On integrated assessment, 32.9% of women had confirmed FGTB, 18.6% probable FGTB, 35.7% possible FGTB, and 12.8% had no evidence of FGTB.

Conclusions: FGTB remains difficult to diagnose using a single investigation. An integrated approach combining clinical assessment, histopathology, microbiological testing, imaging, and hysterolaparoscopy may improve diagnostic confidence and facilitate earlier diagnosis.