A 28-year-old woman with primary infertility undergoes diagnostic hysteroscopy. Endometrial biopsy shows caseous necrosis with Langerhans giant cells on histology. Mycobacterium tuberculosis PCR on the specimen is positive. Which finding on hysteroscopy is MOST characteristic of genital tuberculosis?

• A Submucous fibroid with hyperaemia
• B Asherman's syndrome — dense intrauterine synechiae obliterating the cavity ✓
• C Irregular endometrium with polypoid areas
• D Cornual polyp at the tubal ostia

Explanation

Genital tuberculosis (GT) affects the endometrium and fallopian tubes primarily. The hallmark hysteroscopic finding in GT is dense, often pale, fibrous intrauterine synechiae (Asherman's syndrome) obliterating the uterine cavity, resulting from tuberculous endometritis with subsequent fibrosis. Other features include 'straw-coloured' pale endometrium, absent/sparse menstruation, and obliterated tubal ostia. GT is the most common cause of Asherman's in developing countries. Submucous fibroids, polyps, and irregular endometrium are non-specific findings.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.