In genital tuberculosis, the gold standard for diagnosis is culture on Lowenstein-Jensen medium. However, in a patient with suspected genital TB with Asherman syndrome and amenorrhoea, which investigation provides the highest diagnostic yield?
- A Menstrual blood AFB smear
- B Serum ADA (adenosine deaminase) level alone
- C Laparoscopy with peritoneal biopsy in all cases
- D Endometrial biopsy with histology for granulomas + AFB culture + NAAT (Xpert MTB/RIF) on curettings ✓
Explanation
In genital tuberculosis, endometrial biopsy timed in the premenstrual phase (day 22–24) provides the best diagnostic yield for histology (Langerhans-type granulomas with caseation) and bacteriology (AFB culture on Lowenstein-Jensen or MGIT liquid medium). Adding NAAT (Xpert MTB/RIF) to the curettings significantly improves sensitivity compared to smear microscopy alone; the combination of histology + NAAT + culture on endometrial tissue is the current gold standard approach. Menstrual blood culture was used historically but has lower yield than endometrial curettage. Serum ADA is a supportive marker but not diagnostic. Laparoscopy is complementary for tubo-peritoneal disease assessment.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.