Bovine tuberculosis (BTB) is a chronic infectious disease characterized by the formation of granulomatous lesions in organs, mainly lungs and lymph nodes. BTB is caused by slowly growing bacilli, mainly M. bovis. In developed countries, BTB in animals is significantly in decline with rates that reached down to <0.001% in cattle herds in the United States. In developing countries, BTB represent a major problem with a prevalence that could reach up to 10 to 15% of cattle herds in some parts of Africa. In Egypt, BTB transmission among animals and from animals to humans represents a major problem because of the complexity of animal husbandry and animal trade. In this study, our teams in both the United States and Egypt used the single intradermal comparative skin test (SICST) to examine the herd level prevalence of BTB in 5 different regions within the Nile Delta of Egypt. During the years of 2012–2015, several farms were visited where SICST was conducted on all animals in the herd alongside collecting all of the historical background of disease prevalence in these farms. As expected, farms with a known history of risky management behavior (e.g., introduction of new animals without testing, or not testing at all for BTB) were associated with high level of BTB prevalence that reached up to 45% in some herds. Interestingly, clinical health condition of animals and milk yield were not associated with the BTB herd-level prevalence. However, where BTB was enzootic, the highest percentage of SICST-positive animals (average 14%) were among the 6–12 mo of age while newly testing farms identified the highest percentage of SICST positive (60%) in animals above 24 mo of age. This result highlights the importance of periodical testing and intervention to control BTB in dairy herds. Overall, the prevalence of BTB among total number of 2799 examined animals was 7.3% during the 3 years screening project. Recommendation to reduce the BTB in these herds included the frequent testing of animals using SICST, especially before restocking of a dairy herd.