A challenge to Gynecologist , may not be ART specialists but question remains “ How accurately and specifically we diagnose Genital Koch’s.” !!-.-a difficult task indeed!!!

What are the usual methods that are currently used for diagnosis of genital Koch’s? We usually proceed in the following ways :-a) to esquire ask for kochs contact in family/ Peers/ classmates /neighbors -maintaining confidentiality and due respect ,b) own history of Koch's in childhood c) Chest X"ray -and then to proceed for Lap-Hysteroscopy:- Endometrium for A) H-E stain(giant Cells), B) Acid Fast stain-Z-N stain,( Ziehl-Nelsen ), c) Rapid culture(Bactec--460,-Radiometric System, in CO2 Media, ), d) Delayed culture, in L. J Media--4-8 weeks,. Delayed culture will be +ve in 75% cases-even in paucibacillary states From Lap findings ; visual e) -tubo-peritoneal overview f) peritoneal & Omental biopsy, Pathological –Histological, Lymph node biopsy. -proceed for Culture and PCR from Ly. Node
Serum markers are nonspecific as is Monteux . Test. Overall I am a bit hesitant to proceed for ATD based solely on M test. g) MGIT (mycobacterium Growth Indicator Tube) may be used. h) PET scan for genital Koch’s is on trial. I) Genexerpt (GeneXpert family of systems )from peritoneal washing or endometrium is still to be proved to be of benefit –Time will speak.

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Remembering the fact that the so called AFB stains will be only +ve in endometrium sample if the density of bacilli are > 100,000 per ml. of tissue. 
Main hesitation in Lap-Hyts procedure-a) if no definite clue is established either by viewing in scope or by above six stains & culture method .MRSA surveillance testing with the GeneXpert®System, GeneXpert Systems » GeneXpert IV:-fit, form, and function of the most popular molecular diagnostic platform on the market. GeneXpert System technology is the cornerstone of our unique approach to a molecular diagnostics product suite, which allows us to offer a complete menu of tests on a single, fully scalable, consolidated workstation.

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