In contrast to neighboring Switzerland, most of the contacts with LTBI referred to private pulmonologists or general practitioners in Germany by the public health authorities are left untreated. A recent survey in the state of Lower Saxony demonstrated that only 29% of healthy contacts with a positive TST or IGRA test result at the time of contact investigation received preventive chemotherapy. In a large observational cohort study performed by the public health authorities in the city of Hamburg, even under study conditions only 21% of contacts with LTBI received preventive chemotherapy. The low acceptance of preventive chemotherapy contradicts the expenses and efforts by the public health authorities in Germany to NVP-BEZ235 PI3K inhibitor identify individuals at risk for the future development of TB. To develop a basis for improvement of TB prevention we aimed to gain a better insight about the knowledge of physicians working within the German health care system about risk factors for TB and their attitude towards preventive chemotherapy. TB has become a rare disease in Germany and most other Western European Countries. As the World Health Organization and the European Center for Disease Prevention and Control now aim for TB elimination, prevention of TB will focus especially on risk groups. However, currently available tests are poor prognostic markers for the identification of individuals who will develop TB in the future and the definitions of “risk groups for TB” are not universally applicable. We evaluated the knowledge about TB risk factors and attitudes towards TB prevention among physicians involved in TB prevention and care in Germany. The key findings of this study are a surprisingly low proportion of individuals with LTBI belonging to classical risk groups for TB receiving preventive therapy and substantial gaps in the knowledge on the risk for TB in a country of low TB incidence resulting in uncertainties and non-stringent management of TB prevention. Pulmonologists are more likely to note that physicians have no insight into the efficacy of preventive therapy than non-pulmonologists. This is likely due to the better knowledge of pulmonologists on tuberculosis, compared to non-pulmonologists. Although pulmonologists are more motivated to test HIV-infected individuals and other immunocompromised hosts for LTBI compared to non-pulmonologists, and they are better aware of the gaps in TB control in Germany, stringency to provide preventive chemotherapy for individuals with positive test results is lacking in all groups of professionals. In the absence of available data from Germany, national recommendations for TB contact tracing report that people living with HIV-infection have a risk of developing active TB of 35–162 per 1000 person-years. However these data originate from studies conducted before the advent of modern antiretroviral therapies and refer to high prevalence countries of TB, where M. tuberculosis exposure for PLWH is much higher than in Germany. Results from the Swiss HIV cohort reported a lower incidence of active TB of 16 per 1000 personyears in TST positive individuals in the absence of preventive therapy. Furthermore, the country of origin was of substantial importance for the risk of TB in that study.