Correlation of hysteroscopic findings, GeneXpert, and histopathology in the evaluation of genital tuberculosis in women with infertility and abnormal uterine bleeding

Abstract

Introduction: Genitaltuberculosisisasignificantbutoftenunderdiagnosedcauseoffemaleinfertilityandmenstrualirregularities, especiallyinTB-endemic regions. Its nonspecific presentation and paucibacillary nature make timely diagnosis challenging. This study compares the diagnostic value of hysteroscopy, GeneXpert, and histopathology in identifying GTB. Aims and Objective: To evaluate the diagnostic accuracy of hysteroscopy, GeneXpert, and histopathology in detecting genital tuberculosis (GTB) among women presenting with infertility and abnormal uterine bleeding (AUB). Materials and Methods: This prospective observational study at Banaras Hindu University included 120 women aged 20–45 years with infertility or AUB. All underwent hysteroscopy, endometrial GeneXpert testing, and histopathology. Diagnostic performance was assessed using sensitivity, specificity, and accuracy, with hysteroscopic findings correlated with confirmed TB cases. Results: Among the 120 women, 87.5% presented with infertility and 12.5% with AUB. The overall incidence of GTB was 28.3%, with 88.2% of cases identifiedinwomenwithinfertility. GeneXpertdetectedTBin13.3%ofpatientsandshowedhighspecificity(95.5%)butlowsensitivity(26.67%),suggesting its role as a confirmatory tool. Histopathology demonstrated the highest diagnostic accuracy (93.3%) with sensitivity of 83.3% and specificity of 97.06%. Hysteroscopy revealed moderate sensitivity (73.3%) and lower specificity (52.9%). Common hysteroscopic findings included Asherman syndrome, fundal scarring, and pale endometrium. A statistically significant correlation was found between hysteroscopic abnormalities and GTB diagnosis. Conclusion: Hysteroscopy is a valuable screening tool for suspected GTB, particularly in women with unexplained infertility. Due to its limited specificity, confirmation by histopathology or GeneXpert is essential. An integrated diagnostic approach can improve early diagnosis, fertility outcomes, and prevent long-term complications in TB-endemic settings.