CHALLENGES IN THE DIAGNOSIS OF FEMALE GENITAL TUBERCULOSIS

Abstract

Genital tuberculosis (GTB) is a difficult disease to diagnose. It is nearly always secondary to primary elsewhere in the body and after spread to the genital tract it remains dormant in the latent foci to get reactivated at a later date. During periods of immunosuppression or around the time of puberty when the vascularity of the genital organs increases, the dormant bacilli get reactivated and the clinical features develop 10-15 years after the primary infection. In GTB, significant damage is seen in the fallopian tubes and the endometrium. Clinical diagnosis of GTB is difficult, because it is a disease of absent or few symptoms which are non-specific. A high degree of suspicion aided by intensive investigations is important in the diagnosis of the disease. Except when there are typical features such as tubercles/caseation, laparoscopic findings may be non-specific and the early disease can be easily missed when the infection is still confined to the mucosa. Conventional methods of diagnosis such as HPE, AFB smear and culture have low pick up rates. Molecular studies including GeneXpert show good specificity but, the sensitivity is poor to rule out the disease. As on now, there is no single investigation modality with good sensitivity and specificity available to diagnose GTB. These diagnostic difficulties are encountered both in low resource as well as and in high resource countries.