Once the genital tract is colonized, granulomata containing viable tubercle bacilli form within various pelvic organs. After the development of tubercular hypersensitivity, these generally become clinically silent, and intervals of 1–10 years or even longer may pass before infection in this location is reactivated or becomes clinically manifest, if symptoms occur at all. Most foci are of no further significance clinically. Often, there is little or no remaining evidence of infection at the primary site once genital tract disease is established.36, 37 There is some evidence that when primary infection occurs close to the time of menarche, there is an increased likelihood of genital tract involvement.