Analytical Review of Diagnostic Methods of Female Genital and Peritoneal Tuberculosis
https://doi.org/10.58838/2075-1230-2026-104-2-110-120
Abstract
This review analyzes 80 publications on female genital tuberculosis (FGTB) and peritoneal tuberculosis (PTB), conditions of significant clinical and social relevance due to their direct impact on reproductive health. Both forms are associated with severe long-term outcomes, including infertility, chronic pelvic pain, recurrent early pregnancy loss, and the risk of disease dissemination during pregnancy, up to miliary tuberculosis. Early diagnosis is hindered by the deep anatomical location of lesions, the limited specificity of imaging methods, and the frequent latent course of the disease. The review summarizes current laboratory and instrumental approaches to diagnosing extrapulmonary tuberculosis (EPTB), with a focus on FGTB and PTB, and provides a critical assessment of the evidence related to clinical verification and treatment monitoring.
About the Authors
P. O. SotskiyArmenia
Pavel O. Sotskiy - Candidate of Medical Sciences, Obstetrician-Gynecologist
34/3 Abovyan St., 0001
Phone: +374 41 188888
O. L. Sotskaya
Armenia
Olga L. Sotskaya - Candidate of Medical Sciences, Associate Professor of Phthisiology Department, Obstetrician-Gynecologist, Phthisiogynecologist of Center of Medical Genetics and Primary Health Care
2 Koryuna St., Yerevan, Armenia, 0025
Phone: + 374 (10) 58253
M. D. Safaryan
Armenia
Marina D. Safaryan - Doctor of Medical Sciences, Honored Doctor of Armenia, Professor, Head of Phthisiology Department
2 Koryuna St., Yerevan, Armenia, 0025
Phone: + 374 (10) 58253
References
1. Bulanov M.N. Differentsialnaya diagnostika v ginekologii. Rukovodstvo dlya vrachey. [Differential diagnostics in gynecology. Doctors' guidelines]. Moscow, Vidar Publ M., 2022, 712 p.
2. Vostrov A.N., Mitina L.A., Kazakevich V.I. et al. The opportunities of ultrasound diagnosis in differentiating abdomen lesions in ovarian cancer and tuberculosis. Ultrazvukovaya i Funktsionalnaya Diagnostika, 2017, no. 3, pp. 60-74. (In Russ.)
3. Demidov V.N., Serov V.N. Ultrasound diagnostics of inflammatory diseases of the appendages: acute and chronic forms. Obstetrics and Gynecology, 2020, no. 4, pp. 18-24. (In Russ.)
4. Klinyshkova T.V., Yakovleva A.A. Female infertility associated with genital tuberculosis. Obstetrics, Gynecology and Reproduction, 2018, vol. 12, no. 1, pp. 74-85. (In Russ.) https://doi.org/10.17749/2313-7347.2018.12.1.074-085
5. Kulchavenya E.V. Extrapulmonary tuberculosis during the COVID-19 pandemic: features of detection and course. Consilium Medicum, 2021, vol. 23, no. 7, pp. 585-589. (In Russ.) https://doi.org/10.26442/20751753.2021.7.201134
6. Plotkin D.V., Kirillova O.V., Nikanorov A.V., Reshetnikov M.N., Shtykhno A.O., Loshkareva E.O., Korotkova E.S., Sinitsyn M.V. Transabdominal ultrasound as a screening stage for the diagnosis of tuberculous peritonitis. Bulletin of RSMU, 2020, no. 2, pp. 39-45. (In Russ.) https://doi.org/10.24075/vrgmu.2020.018
7. Radzinskiy V.E. Besplodnyy brak: versii i kontraversii. [Infertile marriage: versions and controversies]. 2nd ed., reviewed and supplemented, Moscow, GEOTAR-Media Publ., 2020, 432 p.
8. Sotskiy P.O., Gevorkyan L.G., Sotskaya O.L., Safaryan M.D. Drug resistant miliary tuberculosis after in vitro fertilization. Tuberculosis and Lung Diseases, 2021. vol. 99, no. 5, pp. 57-62. (In Russ.) https://doi.org/10.21292/2075-1230-2021-99-5-57-62
9. Sotskiy P.O., Sotskaya O.L., Safaryan M.D., Gevorkyan L.G., Atoyan S.A., Papyan A.V. Infertility associated with female genital tuberculosis and familial Mediterranean fever. Obstetrics and Gynecology, 2020, no. 3, pp. 246-251. (In Russ.) https://doi.оrg/10.18565aig.2020.3.246-251
10. Ahmed M.A.E., Mohammed A.A.A., Ilesanmi A.O., Aimakhu C.O., Bakhiet A.O., Hamad S.B.M. Female genital tuberculosis among infertile women and its contributions to primary and secondary infertility: a systematic review and meta-analysis. Sultan. Qaboos. Univ. Med. J., 2022, vol. 22, no. 3, pp. 314-324. https://doi.оrg/10.18295/squmj.1.2022.003
11. Bagchi B., Chatterjee S., Gon Chowdhury R. Role of latent female genital tuberculosis in recurrent early pregnancy loss: a retrospective analysis. Int. J. Reprod. Biomed., 2019, vol. 17, no. 12, pp. 929-934. https://doi.оrg/10.18502/ijrm.v17i12.5799
12. Baxi A., Neema H., Kaushal M., Sahu P., Baxi D. Genital tuberculosis in infertile women: assessment of endometrial TB PCR results with laparoscopic and hysteroscopic features. J. Obstet. Gynaecol. India, 2011, vol. 61, no. 3, pp. 301-306. https://doi.оrg/10.1007/s13224-011-0
13. Dai W., Ma L., Cao Y., Wu D., Yu T., Zhai J. In vitro fertilization outcome in women with endometrial tuberculosis and tubal tuberculosis. Gynecol. Endocrinol., 2020, no. 36, pp. 819-823. https://doi.оrg/10.1080/09513590.2019.1702639
14. Eeram А., Tiwary Y., Gupta T. A comparative study of various diagnostic modalities for female genital tuberculosis in infertility in a tertiary hospital. Int. J. Reprod. Contracept. Obstet. Gynecol., 2024, no. 13, pp. 3089-3093.
15. Esteban J., MuñozEgea M.C. Mycobacterium bovis and other uncommon members of the Mycobacterium tuberculosis complex. Microbiol. Spectr., 2016, vol. 4, no. 6, TNMI700212016.
16. Farrokh D., Layegh P., Afzalaghaee M., Mohammadi M., Fallah Rastegar Y. Hysterosalpingographic findings in women with genital tuberculosis. Iran J. Reprod. Med., 2015, vol. 13, no. 5, pp. 297-304. PMID: 26221129
17. Goel G., Khatuja R., Radhakrishnan G., Agarwal R., Agarwal S., Kaur I. et al. Role of newer methods of diagnosing genital tuberculosis in infertile women. Indian J. Pathol. Microbiol., 2013, no. 56, pp. 155-157. https://doi.оrg/10.4103/0377-4929.118670
18. Grace G.A., Devaleenal D.B., Natrajan M. Genital tuberculosis in females. Indian J. Med. Res., 2017, no. 145, pp. 425-436. https://doi.оrg/10.4103/ijmr.IJMR_1550_15
19. Gupta P., Bhardwaj S., Chawla R. et al. A retrospective analysis of genital tuberculosis diagnosis in infertile women. J. Gynecol Obstet., 2021, vol. 12, no. 3, pp. 238-243. https://doi.оrg/10.1016/j.jgo.2021.01.005
20. Iyer S., Luthra A., Kaur A. et al. Diagnostic approach to genital tuberculosis in women with infertility: a systematic review. Reprod. Biol. Endocrinol., 2020, vol. 18, no. 1, pp. 91-98. https://doi.оrg/10.1186/s12958-020-00647-z
21. Jabeen S., Siddiqui J., Hussain M. et al. The role of laparoscopy in diagnosis of female genital tuberculosis. Pak. J. Med. Sci., 2019, vol. 35, no. 4, pp. 1013-1017. https://doi.оrg/10.12669/pjms.35.4.1959
22. Jain P., Choudhury M., Sharma B. et al. Assessment of endometrial biopsy and PCR in genital tuberculosis diagnosis. J. Gynecol. Endosc., 2020, vol. 11, no. 4, pp. 101-106. https://doi.оrg/10.1016/j.jge.2020.04.002
23. Kaur M., Kapoor P., Yadav S. et al. A comprehensive review of diagnostic techniques for female genital tuberculosis. Surgical Science, 2021, vol. 12, no. 4, pp. 42-47. https://doi.оrg/10.4236/ss.2021.124008
24. Khatri R., Agrawal S., Sharma G. et al. Application of endometrial culture and histopathology for diagnosis of female genital tuberculosis in infertile women. J. Clin. Obstet. Gynecol., 2018, vol. 11, no. 1, pp. 45-49.
25. Kohli M., Schiller I., Dendukuri N. et al. Xpert(®) MTB/RIF assay for extrapulmonary tuberculosis and rifampicin resistance. Cochrane Database Syst. Rev., 2018, no. 8, pp. CD012768.
26. Kumar S., Khan M., Tiwari P. et al. Laparoscopy and endometrial biopsy in diagnosis of genital tuberculosis in infertile women. Surgical Science, 2020, vol. 11, no. 5, pp. 200-205. https://doi.оrg/10.4236/ss.2020.115032
27. Leonardi M. Noninvasive methods of endometriosis diagnosis: current status and future perspectives. Fertility and Sterility, 2020, vol. 113, no. 5, pp. 895-896.
28. Lewinsohn D.M., Leonard M.K., LoBue P.A. et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin. Infect. Dis., 2017, vol. 64, no. 2, pp. e1-e33.
29. Mat E., Kale A., Yildiz G., Basol G., Gündogdu E.C. Alternative method for the diagnosis of ascites of unknown cause: Transvaginal natural orifice transluminal endoscopic surgery. Journal of Obstetrics and Gynaecology Research, 2020, vol. 47, no. 2, pp. 645-652.
30. Moule M.G., Cirillo J.D. Mycobacterium tuberculosis dissemination plays a critical role in pathogenesis. Front. Cell. Infect. Microbiol., 2020, no. 10, pp. 65.
31. Mukherjee S., Perveen S., Negi A., Sharma R. Evolution of tuberculosis diagnostics: from molecular strategies to nanodiagnostics. Tuberculosis (Edinb.), 2023, no. 140, pp. 102340. https://doi.оrg/10.1016/j.tube.2023.102340
32. Muneeb A., Siddiqui T., Aziz S. et al. Tuberculosis of the female genital tract: clinical presentation, diagnosis, and treatment outcomes. Int. J. Reprod. Fertil., 2017, vol. 23, no. 2, pp. 99-104. https://doi.оrg/10.1016/j.ijrf.2017.02.008
33. Naidoo K., Perumal R., Ngema S.L., Shunmugam L., Somboro A.M. Rapid diagnosis of drug-resistant tuberculosis-opportunities and challenges. Pathogens, 2023, no. 13, pp. 27. https://doi.оrg/10.3390/pathogens13010027
34. Nair S., Manjunath M., Pawar P. et al. The role of Mycobacterium tuberculosis PCR in the diagnosis of genital tuberculosis in infertile women. J. Clin. Microbiol., 2020, vol. 58, no. 12, pp. e01789. https://doi.оrg/10.1128/JCM.01789-20
35. Okaro E., Condous G., Khalid A. et al. The use of ultrasound-based 'soft markers' for the prediction of pelvic pathology in women with chronic pelvic pain--can we reduce the need for laparoscopy? BJOG, 2006, vol. 113, no. 3, pp. 251-256.
36. Osei Sekyere J., Maphalala N., Malinga L.A., Mbelle N.M., Maningi N.E. A comparative evaluation of the new Genexpert MTB/RIF Ultra and other rapid diagnostic assays for detecting tuberculosis in pulmonary and extra pulmonary specimens. Sci. Rep., 2019, no. 9, pp. 16587. https://doi.оrg/10.1038/s41598-019-53086-5
37. Pai M., Behr M.A., Dowdy D. et al. Tuberculosis. Nat. Rev. Dis. Primers, 2016, vol. 27, no. 2, pp. 16076.
38. Palo S., Rawat S., Mishra D. et al. Performance of various pelvic-derived samples for the diagnosis of female genital tract tuberculosis by conventional and molecular methods: a systematic review and meta-analysis. Cureus, 2025, vol. 17, no. 5, pp. e84016. https://doi.оrg/10.7759/cureus.84016
39. Pascoal E. Saline-contrast sonohysterography for diagnosis of pelvic adhesions. Journal of Clinical Ultrasound, 2022, vol. 50, no. 6, pp. 789-795.
40. Patel S., Shah J., Desai K. et al. Female genital tuberculosis: a review of 150 Cases. Indian J. Obstet. Gynecol., 2021, vol. 68, no. 4, pp. 389-394. https://doi.оrg/10.1007/s13224-021-01468-7
41. Pattamapaspong N., Kanthawang T., Peh W.C.G., Hammami N., Bouaziz M.C., Ladeb M.F. Imaging of thoracic tuberculosis: pulmonary and extrapulmonary. BJR Open, 2024, vol. 6, no. 1, pp. tzae031. https://doi.оrg/10.1093/bjro/tzae031
42. Penn-Nicholson A., Gomathi S.N., Ugarte-Gil C. et al. A prospective multicentre diagnostic accuracy study for the Truenat tuberculosis assays. Eur. Respir. J., 2021, no. 58, pp. 2100526. https://doi.оrg/10.1183/13993003.00526-2021
43. Qiu B., Wu Z., Tao B., Li Z., Song H., Tian D., Wu J., Zhan M., Wang J. Risk factors for types of recurrent tuberculosis (reactivation versus reinfection): a global systematic review and meta-analysis. International Journal of Infectious Diseases, 2022, no. 116, pp. 14-20. https://doi.оrg/10.1016/j.ijid.2021.12.344
44. Quesada C. et al. The sliding sign in pelvic ultrasound: a useful tool for detecting adhesions. Journal of Minimally Invasive Gynecology, 2023, vol. 30, no. 1, pp. 97-105.
45. Rai P., Verma A., Arora P. et al. Role of PCR in diagnosis of female genital tuberculosis in infertile women. Int. J. Reprod. Med., 2019, vol. 15, no. 1, pp. 85-91.
46. Ranjan A., Kumar D., Yadav P. et al. Diagnostic role of hysteroscopy and laparoscopy in genital tuberculosis. Surgical Science, 2020, vol. 11, no. 3, pp. 125-130. https://doi.оrg/10.4236/ss.2020.113019
47. Rao P., Puri N., Singh P. et al. Laparoscopy in diagnosis and management of female genital tuberculosis. J. Gynecol. Surg., 2019, vol. 36, no. 2, pp. 49-53. https://doi.оrg/10.1016/j.jgs.2018.12.003
48. Rodriguez Takeuchi S.Y., Renjifo M.E., Medina F.J. Extrapulmonary tuberculosis: pathophysiology and imaging findings. Radiographics, 2019, vol. 39, no. 7, pp. 2023-2037.
49. Romosan G. Ultrasound in diagnosis of tubo-ovarian abscess and pelvic inflammatory disease. Acta Obstetricia et Gynecologica Scandinavica, 2019, vol. 98, no. 10, pp. 1327-1335.
50. Ruiz-Tagle C., García P., Hernández M., Balcells M.E. Evaluation of concordance of new QuantiFERON-TB Gold Plus platforms for Mycobacterium tuberculosis infection diagnosis in a prospective cohort of household contacts. Microbiol. Spectr., 2024, no. 12, pp. e0046924. https://doi.оrg/10.1128/spectrum.00469-24
51. Saxena R., Shrinet K., Rai S.N., Singh K., Jain S., Jain S., Singh D., Anupurba S., Jain M. Diagnosis of genital tuberculosis in infertile women by using the composite reference standard. Dis. Markers, 2022, no. 16, pp. 8078639. https://doi.оrg/10.1155/2022/8078639
52. Sengupta P., Yadav A., Verma K. et al. Role of molecular diagnostic approaches in the detection of female genital tuberculosis. Surgical Science, 2019, vol. 10, no. 2, pp. 42-48. https://doi.оrg/10.4236/ss.2019.102004
53. Shaozae C.K., Rai Y., Jaiswal N., Jais M.B. Cartridge-based nucleic amplification (CBNAAT)/GeneXpert test as a diagnostic modality for the detection of genital tuberculosis in women with infertility. GMS Infect. Dis., 2025, no. 13, pp. 93. https://doi.оrg/10.3205/id000093
54. Sharma J.B., Kumari S., Jaiswal P., Dharmendra S., Hari S., Singh U.B. Hysterosalpingography observations in female genital tuberculosis with infertility. J. Hum. Reprod. Sci., 2022, vol. 15, no. 4, pp. 362-369. https://doi.оrg/10.4103/ijmr.IJMR_648_18
55. Sharma J.B., Sharma E., Sharma S., Dharmendra S. Female genital tuberculosis: revisited. Indian J. Med. Res., 2018, vol. 148, suppl. pp. S71-S83. https://doi.оrg/10.4103/ihrs.ihrs__111_22
56. Sharma J.B., Shefali J., Sona D., Urvashi B. Singh, Manish S., Vidushi K. An evaluation of Composite Reference Standard (CRS) for diagnosis of female genital tuberculosis. Indian Journal of Tuberculosis, 2023, vol. 70, no. 1, pp. 70-76. https://doi.org/10.1016/j.ijtb.2022.03.014
57. Sharma J.B., Dharmendra S., Jain S., Sharma S., Singh U.B., Soneja M., Sinha S., Vanamail P. Evaluation of Gene Xpert as compared to conventional methods in diagnosis of female genital tuberculosis. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 2020, no. 255, pp. 247-252.
58. Sharma S.K., Mohan A., Kohli M. Extrapulmonary tuberculosis. Expert Rev. Respir. Med., 2021, vol. 15, no. 7, pp. 931-948. https://doi.оrg/10.1080/17476348.2021.1927718
59. Sharma S.K., Mohan A. Miliary tuberculosis. Microbiol. Spectr., 2017, vol. 5, no. 2, pp. 101-128. https://doi.оrg/10.1128/microbiolspec
60. Sharma J.B., Khurana A., Hari S., Singh U., RituY., Dharmendra S. Evaluation of role of transabdominal and transvaginal ultrasound in diagnosis of female genital tuberculosis. J. Hum. Reprod. Sci., 2021, vol. 14. no. 3, pp. 250-259 https://doi.оrg/10.4103/jhrs.jhrs_161_20.
61. Sibal M.J. Serous inclusion cysts of the pelvis: diagnosis and significance. Clinical Imaging, 2017, no. 45, pp. 56-62.
62. Siddaiah-Subramanya M., Tiang K.W., Nyandowe M. et al. A new era of minimally invasive surgery: Progress and development of major technical innovations in general surgery over the last decade. J. Surg., 2017, no. 3, pp. 163-166.
63. Singh P., Singh S., Gautam S. et al. Challenges in the diagnosis of genital tuberculosis in the modern era: a clinical review. Am. J. Reprod. Immunol., 2020, vol. 84, no. 1, pp. 12133. https://doi.оrg/10.1111/aji.12133
64. Singh R., Kumar S., Yadav M. et al. Genital tuberculosis in women with infertility: a review of diagnosis and treatment approaches. J. Gynecol. Reprod. Med., 2021, vol. 16, no. 4, pp. 219-225.
65. Sotskiy P.O., Sotskaya O.L., Hayrapetyan H.S., Sarkisian T.F., Yeghiazaryan A.R., Atoyan S.A., Ben-Chetrit E. Infertility causes and pregnancy outcome in patients with familial mediterranean fever and controls. J. Rheumatol., 2021, vol. 48, no. 4, pp. 608-614. https://doi.оrg/10.3899/jrheum.200574
66. Teo T.S.F., Kannivelu A., Srinivasan S., Peh W.C.G. Imaging techniques for tuberculosis. In: Ladeb MF, Peh WCG, editors. Imaging of Tuberculosis. Cham, Springer Nature Publ., 2022, pр. 59-103.
67. Thakur M., Dutta P., Gupta A. et al. Endometrial tuberculosis and its effect on female fertility: a clinical review. Int. J. Gynaecol. Obstet., 2018, vol. 142, no. 2, pp. 153-158. https://doi.оrg/10.1016/j.ijgo.2018.06.035
68. Thangappah R.B., Narayanan S. Diagnosing genital tuberculosis in female infertility by clinical, histopathological, culture and polymerase chain reaction techniques: an evaluative study. Int. J. Reprod. Contracept. Obstet. Gynecol., 2018, no. 7, pp. 1142-1148.
69. Tongsong T., Sukpan K., Wanapirak C., Sirichotiyakul S., Tongprasert F. Sonographic features of female pelvic tuberculous peritonitis. J. Ultrasound Med., 2007, vol. 26, no. 1, pp. 77-82. https://doi.оrg/10.7863/jum.2007.26.1.77
70. Tripathi S., Sharma P., Verma S. et al. Role of laparoscopy in the diagnosis of female genital tuberculosis in infertile women. J. Clin. Diagn. Res., 2018, vol. 12, no. 10, pp. QC01-QC04.
71. Vaidya A., Shah K., Desai S. et al. Female genital tuberculosis and its impact on pregnancy outcomes: a review of 10 years of clinical experience. J. Obstet. Gynaecol., 2021, vol. 40, no. 2, pp. 187-193. https://doi.оrg/10.1080/01443615.2020.1791228
72. Vijay A., Tiwari N., Sharma A., Pandey G. Correlation of female genital tuberculosis and infertility: a comprehensive systematic review, meta-analysis, and female genital tuberculosis infertility pathway analysis. J. Midlife Health, 2023, no. 14, pp. 165-169. https://doi.оrg/10.4103/jmh.jmh_151_23
73. Vijayakumar V., Subramanian S., Rajendran S. et al. Laparoscopic and histopathological findings in female genital tuberculosis. Surgical Science, 2020, vol. 11, no. 6, pp. 283-291. https://doi.оrg/10.4236/ss.2020.116037
74. Wang Y., Shao R., He C., Chen L. Emerging progress on diagnosis and treatment of female genital tuberculosis. J. Int. Med. Res., 2021, vol. 49, no. 5, pp. 3000605211014999. https://doi.оrg/10.1177/03000605211014999
75. World Health Organization. Global tuberculosis report, 2020. Geneva, WHO, 2020. Available: https://www.who.int/publications/i/item/9789240013131 Accessed October 27, 2025
76. World Health Organization. Global Tuberculosis Report, 2023, Geneva, WHO, 2023. Available: https://www.who.int/publications/i/item/9789240083851 Accessed September 16, 2025
77. World Health Organization. Tuberculosis: key facts. 2023. Available: https://www.who.int/news-room/fact-sheets/detail/tuberculosis Accessed September 10, 2025
78. Youn P. Ultrasound features suggestive of deep pelvic adhesions in women with chronic pelvic pain. Ultrasound in Medicine & Biology, 2022, vol. 48, no. 3, pp. 395-402.
79. Zhang D., Yu F., Han D. et al. ddPCR provides a sensitive test compared with GeneXpert MTB/RIF and mNGS for suspected Mycobacterium tuberculosis infection. Front. Cell. Infect. Microbiol., 2023, no. 13, pp. 1216339. https://doi.оrg/10.3389/fcimb.2023.1216339
80. Zhou F., Zhang H., Liu L. et al. A review of endometrial tuberculosis and its role in female infertility. Reprod. Med., 2019, vol. 23, no. 4, pp. 112-118. https://doi.оrg/10.1002/rmd2.12251
Review
For citations:
Sotskiy P.O., Sotskaya O.L., Safaryan M.D. Analytical Review of Diagnostic Methods of Female Genital and Peritoneal Tuberculosis. Tuberculosis and Lung Diseases. 2026;104(2):110–120. (In Russ.) https://doi.org/10.58838/2075-1230-2026-104-2-110-120
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