Female genital tuberculosis (FGTB) may result in significant morbidity and infertility. Thus clinicians should take a detailed history and careful examination and conduct suitable investigations to reach a diagnosis of FGTB. 

Its paucibacillary nature makes Gold-standard diagnosis by demonstration of acid-fast bacilli on microscopy or culture or detection of epithelioid granuloma on histopathology of endometrial or peritoneal biopsy to be positive in only a few cases.

This issue can be solved by utilizing Gene-Xpert on endometrial or peritoneal biopsy as it has improved sensitivity of diagnosis. Composite reference standard (CRS) is a substantial milestone in its diagnosis in which variety of factors like AFB on microscopy or culture, positive Gene-Xpert, epithelioid granuloma on endometrial or peritoneal biopsy, demonstration of definite or probable findings of FGTB on laparoscopy or hysteroscopy. 

FGTB management has witnessed many advances and changes recently. The program is known by the name- National Tuberculosis Elimination Program (NTEP), and the categorization of TB has been ceased. Nowadays, patients are divided into drug-sensitive FGTB for which rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) are given orally daily for 2 months followed by three drugs (rifampicin, isoniazid and ethambutol (RHE) orally daily for next 4 months. Multi-drug-resistant FGTB is managed with a shorter MDR TB regimen of 9–11 months or a longer MDR TB regimen of 18–20 months with reserved drugs. 

In vitro fertilization and embryo transfer have shown promising results for blocked tubes and receptive endometrium, while surrogacy or adoption is suggested for severe stages of Asherman’s syndrome.

Newer molecule tests like genomics and nucleus receptors are being designed to aid in the early diagnosis of TB including FGTB. Development of Novel biotechniques, nanoparticles and stem cell transplantation can bring new hope for regeneration of endometrium (in Asher man’s syndrome), fallopian tubes (fallopian tubes blockage and damage) and ovaries (damaged ovaries).

Source- J Obstet Gynaecol India. 2021;71(5):476-487. doi:10.1007/s13224-021-01523-9