Efficacy of Cartridge-based Nucleic Amplification Test vs Histopathology of Genital Tissues in Diagnosing Female Genital Tuberculosis

Background: Female genital tuberculosis (FGTB) serves as a main factor contributing to infertility in high-prevalence tuberculosis (TB) countries, usually secondary to pulmonary TB.It often remains undiagnosed following nonspecific symptoms and diagnosis difficulties.For this reason, the cartridge-based nucleic amplification test (CBNAAT) is used for its low-resource settings for early and accurate TB diagnosis.Hence, the objective of this study was to estimate the prevalence for FGTB in infertile females, analyze the clinical and reproductive profiles of women diagnosed with FGTB, and compare the efficacy of CBNAAT with histopathological examination.Methodology: This observational cross-sectional study was conducted over a period of 22 months at a tertiary care hospital.A total of 100 consenting females aged 18-45 years with primary or secondary infertility were enrolled in the present study.Results: The results demonstrated dysmenorrhea (29%) as the most frequent presenting complaint.All patients were tested negative for acid-fast bacilli (AFB) on microscopy and culture sensitivity in Löwenstein-Jensen medium.Two patients tested positive on CBNAAT, two were positive on histopathology, and one patient positive on both.There was moderate agreement between CBNAAT and histopathology (κ = 0.49, p < 0.01).Using histopathology as the gold standard, CBNAAT had a sensitivity of 50% (95% CI: 18.2-88.7%),specificity of 98.9% (95% CI: 84.4-91.9%),positive predictive value of 50% (95% CI: 8.3-91.6%),negative predictive value of 98.9% (95% CI: 96-99.7%),and overall diagnostic accuracy of 92% (95% CI: 88.9-99.7%). Conclusion:The study concludes that the prevalence of FGTB among infertile females was low.Dysmenorrhea was the most common symptom, and a contact history of TB was significant.When using histopathological diagnosis as the gold standard, CBNAAT demonstrated moderate sensitivity and good overall diagnostic accuracy.