<prompt> The mode of transmission of tuberculosis to the endometrium is ___HematogenousLymphatic spreadRetrograde spreadLocal spread  <response>: Endometrial tuberculosis is most commonly accquired by direct spread from the fallopian tubes. Genital Tuberculosis: Female genital tuberculosis is an impoant cause of significant morbidity, sho and long-term sequelae especially infeility. Genital tuberculosis usually occurs secondary to pulmonary commonest or Extrapulmonary TB like gastrointestinal tract, kidneys, skeleta; system, meninges, and miliary TB. However, Primary genital TB can rarely occur in women whose male paners have active genitourinary TB e.g., tuberculosis epididymis by transmission through infected semen Most common site involved in secondary genital TB is Fallopian tube 90-100 Endometrium 50-80 Ovaries 20-30 Cervix 5-15 Vulva The most common symptom of genital TB is infeility Causes of infeility in Genital TB : Tubal blockage If tubes are patent, then also infeility occurs due to loss of tubal function Tubercular endometritis causes uterine scarring resulting in the destruction of the endometrium Ovarian damage with poor ovarian reserve and volume Hematogenous spread is thought to be the process by which the tubercle bacillii implant into the mucosa of the fallopian tubes and subsequently affect the endometrium by direct extension. A laparoscopy and dye hydrotubation lap and dye test is the most reliable tool to diagnose genital TB, especially for the tubal, ovarian and peritoneal disease. The test can be combined with hysteroscopy. Multiple drug therapy ATT regimen provided by DOTS in adequate doses and for sufficient duration is the mainstay in the treatment of TB including genital tuberculosis. Ref: Shaw;s textbook of Gynaecology 17th edition Pgno: 348 