Clin Infect Immun

Clinical Infection and Immunity, ISSN 2371-4972 print, 2371-4980 online, Open Access

Article copyright, the authors; Journal compilation copyright, Clin Infect Immun and Elmer Press Inc

Journal website https://cii.elmerpub.com

Case Report

Volume 000, Number 000, July 2026, pages 000-000

Genital Tuberculosis in a Reproductive-Age Woman: A Diagnostic Challenge

↓ Figure 1. Non-contrast pelvic CT scan image of left (arrow) and right (star) tubo-ovarian abscess. CT: computed tomography.

↓ Figure 2. Contrast-enhanced pelvic CT scan image of left (arrow) and right (star) tubo-ovarian abscess. CT: computed tomography.

↓ Figure 3. Ultrasound image of right (red arrow) and left (orange arrow) tubo-ovarian abscess after 1 month of antitubercular treatment.

↓ Figure 4. Ultrasound image of right (red arrow) and left (orange arrow) tubo-ovarian abscess after 3 months of antitubercular treatment.

↓ Figure 5. Ultrasound image of right (red arrow) and left (orange arrow) tubo-ovarian abscess after 6 months of antitubercular treatment.

↓ **Table 1.** Microbiological and Molecular Diagnostic Tests for Genital Tuberculosis
Modality	Key features	Limitations
PCR: polymerase chain reaction; ZN: Ziehl-Neelsen; MGIT: mycobacteria growth indicator tube.
Histopathology	Epithelioid granulomas with Langhans giant cells and caseous necrosis—diagnostic when present [10]	Requires tissue biopsy; not always available
ZN staining	Detects acid-fast bacilli (AFB); specific when positive	Low sensitivity; misses paucibacillary cases
Culture (gold standard)	Lowenstein-Jensen medium or MGIT liquid culture; highest diagnostic accuracy	Slow growth (up to 8 weeks); delays clinical decision-making
PCR	Detects Mycobacterium tuberculosis DNA with high sensitivity and specificity; particularly useful in paucibacillary samples [7]	Risk of contamination; variable sensitivity across sample types
GeneXpert MTB/RIF	Rapid detection of Mycobacterium tuberculosis and rifampicin resistance; increasingly used as a confirmatory test [11]	Limited sensitivity in extrapulmonary specimens

↓ Table 1. Microbiological and Molecular Diagnostic Tests for Genital Tuberculosis

Modality

Key features

Limitations

PCR: polymerase chain reaction; ZN: Ziehl-Neelsen; MGIT: mycobacteria growth indicator tube.

Histopathology

Epithelioid granulomas with Langhans giant cells and caseous necrosis—diagnostic when present [10]

Requires tissue biopsy; not always available

ZN staining

Detects acid-fast bacilli (AFB); specific when positive

Low sensitivity; misses paucibacillary cases

Culture (gold standard)

Lowenstein-Jensen medium or MGIT liquid culture; highest diagnostic accuracy

Slow growth (up to 8 weeks); delays clinical decision-making

PCR

Detects Mycobacterium tuberculosis DNA with high sensitivity and specificity; particularly useful in paucibacillary samples [7]

Risk of contamination; variable sensitivity across sample types

GeneXpert MTB/RIF

Rapid detection of Mycobacterium tuberculosis and rifampicin resistance; increasingly used as a confirmatory test [11]

Limited sensitivity in extrapulmonary specimens

↓ **Table 2.** Endoscopic Diagnostic Modalities
Modality	Key features	Limitations
TB: tuberculosis.
Laparoscopy [12]	Direct visualization of caseous nodules, beaded tubes, tubo-ovarian masses, and “violin-string” adhesions; allows targeted biopsy for histology and culture	Invasive; requires general anesthesia; operator-dependent
Hysteroscopy	May reveal intrauterine adhesions or pale, atrophic endometrium suggestive of endometrial TB	Findings are nonspecific; require endometrial sampling for confirmation

↓ Table 2. Endoscopic Diagnostic Modalities

Modality

Key features

Limitations

TB: tuberculosis.

Laparoscopy [12]

Direct visualization of caseous nodules, beaded tubes, tubo-ovarian masses, and “violin-string” adhesions; allows targeted biopsy for histology and culture

Invasive; requires general anesthesia; operator-dependent

Hysteroscopy

May reveal intrauterine adhesions or pale, atrophic endometrium suggestive of endometrial TB

Findings are nonspecific; require endometrial sampling for confirmation

↓ **Table 3.** Supportive Diagnostic Tests
Test	Role	Limitations
GTB: genital tuberculosis; ESR: erythrocyte sedimentation rate; IGRAs: interferon-gamma release assays; TB: tuberculosis; CRP: C-reactive protein; BCG: bacillus Calmette-Guerin.
ESR/CRP	Often elevated in active GTB; useful for monitoring treatment response	Nonspecific; elevated in many inflammatory conditions
Tuberculin skin test (Mantoux)	May support diagnosis in the right clinical context	Not specific for genital involvement; false positives in BCG-vaccinated individuals
IGRAs	Useful for diagnosing latent TB infection	Not confirmatory for genital TB; cannot distinguish active from latent disease

↓ Table 3. Supportive Diagnostic Tests

Test

Role

Limitations

GTB: genital tuberculosis; ESR: erythrocyte sedimentation rate; IGRAs: interferon-gamma release assays; TB: tuberculosis; CRP: C-reactive protein; BCG: bacillus Calmette-Guerin.

ESR/CRP

Often elevated in active GTB; useful for monitoring treatment response

Nonspecific; elevated in many inflammatory conditions

Tuberculin skin test (Mantoux)

May support diagnosis in the right clinical context

Not specific for genital involvement; false positives in BCG-vaccinated individuals

IGRAs

Useful for diagnosing latent TB infection

Not confirmatory for genital TB; cannot distinguish active from latent disease