A 25-year-old female presented to the infertility OPD with complaints of secondary infertility and pain lower abdomen with watery discharge for the past five days. She had history of undergoing hysterosalpingography in a private hospital ten days back. The interventions included drainage of pyometra, endometrial biopsy for routine and AFB smear/ culture, confirmation of diagnosis by mRNA-based RT-PCR for detection of M. tuberculosis-specific 85B antigen gene, anti-tubercular therapy. Pyometra and tubo-ovarian masses disappeared and patient resumed her normal period post-treatment. Genital tuberculosis was confirmed by mRNA-based RT-PCR and the disease resolved after anti-tubercular therapy. We conclude that a combination of high degree of clinical suspicion and ‘high-precisionʹ gene detection methods (e.g. mRNA) in culture-negative cases may be useful in diagnosis of genital tuberculosis, particularly in infertile patients presenting with pyometra post-hysterosalpingography.