Prevalence of Microbiologically Confirmed Female Genital Tuberculosis in a Tertiary Care Hospital in Faridabad, Haryana, India

Aim: This study aimed to determine the prevalence of microbiologically confirmed female genital tuberculosis (FGTB) infection in patients attending a tertiary care hospital in North India.

Materials and methods: A total of 623 endometrial biopsy samples were processed in the mycobacteriology laboratory from the outpatient and inpatient gynecology departments between May 2022 and February 2024. Ziehl-Neelsen (ZN) smear was performed on all samples. Each sample was subsequently subjected to cartridge-based nucleic acid amplification test (CBNAAT) Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) Ultra (Cepheid, Sunnyvale, California), and LJ culture irrespective of the ZN smear result and demographic details of the patients were recorded simultaneously.

Results: Of the 623 endometrial biopsy samples tested, 17 (2.73%) samples were positive for MTB by CBNAAT Ultra. The disease was most commonly observed in the reproductive age group between 21 and 35 years. ZN smear and culture were negative for all the samples received for endometrial TB. Of these 17 positive samples, one (5.9 %) was MTB detected (medium), four (23.5 %) (low), two (11.8 %) (very low), and 10 (58.8 %) (trace). RIF resistance was detected in one (5.9 %) of these 17 samples. However, the 10 samples that were detected as MTB trace and RIF indeterminate ideally need to be processed further by culture or by line probe assay to determine the drug resistance.

Conclusion: Genital TB is characterized by a low bacterial load. Therefore, a highly sensitive and specific molecular test is essential for confirming the diagnosis microbiologically. Our study found that Xpert MTB/RIF Ultra is particularly valuable because it detected 58.8% of cases as "TRACE," which might be missed by other testing methods. Early diagnosis using this test can significantly impact patient management, especially in cases related to infertility. This study effectively highlights the role of GeneXpert Ultra in documenting extra-pulmonary TB, including genital TB.