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Conclusion

CONCLUSION

Genital tuberculosis remains an important under diagnosed cause of infertility.

The alarming high incidence of genital TB underlines the importance of

investigating and treating this condition in all infertile women.

Though culture is considered as gold standard for diagnosis of genital

tuberculosis, since GTB is paucibacillary there is an urgent need for more

research to come to conclusion whether culture is still gold standard.

Further research is required to detect the most sensitive method for diagnosis

GTB and therefore the diagnostic dilemma continues.

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Summary

SUMMARY

A cross sectional study was done over a period of one year to evaluate the

diagnostic value of culture for TB bacilli using Radiometric Assay and Polymerase Chain

Reaction in detection of genital tuberculosis in infertile women and to correlate the

clinical and hysterolaparoscopic findings in cases found positive for genital tuberculosis

by radiometric assay or/and TB PCR and/or HPR of endometrial curettings.

Hysterolaparoscopy was performed in the pre ovulatory period usually on day

6th-10th of the cycle for evaluation of infertility. At the end of the procedure endometrial

curettings were taken and sent for both BACTEC and for nested TB PCR in normal

saline and for histopathology in formalin.

In cases found to be positive for genital tuberculosis by TB BACTEC and/or TB

PCR and/or HPR of endometrial curettings, the clinical findings were analyzed and video

recordings of the hysterolaparoscopic findings were carefully reviewed and correlated for

the presence of features suggestive of genital tuberculosis.

The diagnosis of genital tuberculosis was confirmed in 14 (22.95%) of the

enrolled cases by either TB BACTEC and/or TB PCR of endometrial curettings. Of

these, TB PCR of endometrial curettings was positive in 13 cases (21.31%) while TB

BACTEC of endometrial curettings was positive in two cases (3.28%). One (1.64%) case

is both TB PCR and BACTEC positive. HPR was negative in all 61 cases.

Out of 14 positive cases, eight cases (57.14%) had positive correlation with

hysterolaparoscopy and all eight cases were positive by PCR. That is, out of 13 PCR

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Summary

positive cases, eight (61.53%) had positive findings suggestive of GTB by

hysterolaparoscopy. None of the BACTEC positive cases had positive findings

suggestive of GTB by hysterolaparoscopy.

This silent invader of the genital tract which is paucibacillary tend to create a

diagnostic dilemma due to varied clinical presentations, diverse results on endoscopy and

limitations of histopathologic, serologic, bacteriologic and culture methods. Hence, there

is an urgent need to develop a definitive diagnostic modality.

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