Comprehensive Review of Genital Tuberculosis: Epidemiological Patterns, Causal Agents, Diagnostic Strategies, Symptomatology and Fertility Consequences

Female genital tuberculosis (FGTB), a form of extrapulmonary tuberculosis caused by Mycobacterium tuberculosis (MTB), is an under-recognized but significant cause of female infertility, particularly in developing countries. It primarily spreads through the hematogenous route and often presents with non-specific or asymptomatic clinical features, complicating early diagnosis. Latent tuberculosis (LTB) is increasingly being identified among women with unexplained infertility and may impair reproductive outcomes by affecting ovarian reserve, endometrial receptivity, and implantation. Traditional diagnostic methods-such as smear microscopy, culture, imaging, and histopathology-suffer from low sensitivity and long turnaround times. Newer molecular techniques, including GeneXpert MTB/RIF and nucleic acid amplification test (NAAT), offer faster and more accurate detection. A comprehensive, multimodal diagnostic approach is essential for timely intervention. This review highlights the epidemiological trends, diagnostic advancements, clinical manifestations, and fertility implications of FGTB. Improved awareness and accurate detection strategies are critical for enhancing fertility outcomes in affected women.