Comparative Study of Polymerase Chain Reaction of Endometrial Aspirate/ Biopsy and Menstrual Blood in Suspected Cases of Genital Tuberculosis in Females

Female genital tuberculosis is an important cause of infertility in developing countries like India. Due to paucibacillary nature of genital tuberculosis, the routine diagnostic modalities do not remain conclusive; need much sensitive procedure like PCR for diagnosis. Therefore, we have planned to investigate the role of PCR in various genital specimens like endometrial aspirate (EA), endometrial biopsy (EB), and menstrual blood (MB). Total 200 patients with complaint of infertility and menstrual irregularities were enrolled. All the specimens were collected as per standard protocol and processed accordingly. Among 200 patients we were able to get all type of genital specimens (EA, EB, MB) in only 138 patients. Overall PCR positivity was 83 out of 138 patients (60%). On comparison among specimens, only MB was positive in 40/138 (29%), only EA was positive in 21/138 (15%), only EB was positive in nil patient. While both MB and EA was positive in 10/138 (7%), both EA and EB was positive in 9/138 (6.5%). All the three specimens were positive in only 3/138 (2%) cases. In the present study, PCR for tuberculosis showed a very high sensitivity to detect genital tuberculosis. Tissues from MB yielded maximum positive cases by PCR. The overall positivity of EA by PCR was nearly equivalent to MB PCR; however the positivity of EB by PCR was very less. The difference was statistically significant. Moreover, on combining the samples (EA+MB or EA+EB), the sensitivity of PCR has increased. Our study showed very low positivity by AFB (8%) and liquid culture (7%). Moreover many authors have concluded that ATT on the basis of PCR have resulted in reversal of infertility. Therefore the present study concluded that a non invasive sample (MB) of first 12 hour may be good alternative to invasive EA or EB samples for diagnosis of genital tuberculosis by PCR.