Is an endometrial biopsy necessary to confirm cure of TB?
Q: I am on ATT for pelvic tuberculosis (TB) from the past one year. My uterus, tubes and pelvic peritoneum were affected. My inter-menstrual bleeding which was present before treatment has stopped. Pelvic pain is absent, a scan done last year shows improvement. Is endometrial biopsy necessary to confirm that the disease is cured? I am confused as some doctors say that it is not required and some say it should be done. How to confirm that it is cured and how to prevent relapse?
A:I am happy that symptomatically you are cured and scan shows improvement. However, I advise you to undergo an endometrial biopsy for histopathological examination, AFB smear and culture and PCR for Myc. TB. The biopsy should be done just before your expected menses. If you are not married, the menstrual blood can be sent for the latter 3 tests. The blood should be collected on the day the flow is heaviest/ maximum. You should collect the sample in a presterilized wide-mouthed screw cap bottle (e.g. the bottles available for urine culture). Alternatively the labs doing this test (e.g. Auroprobe Lab in Defence Colony, New Delhi) will give you their lab bottle for the same. You can check their website through google search. It is important the latter 3 tests be done at a reliable lab-otherwise you can get false positive results. The PCR test is a must - it will detect even very little bacteria still persisting - not detected by culture, smear. PCR can be positive when histopathology is negative - because it detects even very small amount of the bacteria. If you are married I guess your husband's semen would have been tested by now for the bacteria - AFB smear, culture and PCR MYC TB. If you are married, you should abstain from sex for atleast 10 days before the endometrial biopsy- especially if your husband also tested positive.