A 26-year-old woman with primary infertility undergoes hysterosalpingography (HSG) which shows a 'tobacco-pouch' deformity of the fallopian tubes with bilateral hydrosalpinx and calcified lymph nodes. Mantoux test is strongly positive. Which investigation provides the MOST definitive diagnosis of genital tuberculosis?
- A Serum ADA (adenosine deaminase) level
- B Peritoneal fluid AFB smear
- C Endometrial curettage for culture and histology in premenstrual phase ✓
- D HSG findings alone are pathognomonic
Correct answer: C. Endometrial curettage for culture and histology in premenstrual phase
Explanation
Genital tuberculosis most commonly affects the fallopian tubes and endometrium. The most definitive diagnostic test is endometrial curettage (ideally in the premenstrual phase when endometrium is thickest) for culture on Lowenstein-Jensen medium and histology showing caseating granulomas with Langerhans giant cells. Culture may take 4–8 weeks. Newer PCR-based diagnostics (GeneXpert) on endometrial tissue are increasingly used for rapid confirmation.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.