M Gen

Question 1

Adverse outcomes of MGen?

Answer 1

Miscarriage (‘spontaneous abortion’)and preterm birth, PID, SARA, tribal factor infertility

In men: EO, SARA

Question 2

Symptoms/signs of MGen

Answer 2

Onbvious ones, but don’t forget:
Painful IMB, PCB, balanitis,

PID symptoms and signs of indistinguishable from other PID causes.

Question 3

Diagnosis of MGen? (Which tests)

And who should you be testing?

Answer 3

NAAT , not culture. And macrolide resistance mediating mutations.
Men- FPU (not swab), women vaginal swab

• Test all NSU! (Not currently doing this)
• All PID
• and consider testing people with signs/sx of cervicitis (particularly if they have PCB), consider if EO, consider if proctitis.
• test all current partners of m gen index case

Question 4

General advice when diagnosing MGen

Answer 4

Detailed explanation, particularly focusing on long term implications, and given written PIL to back up.

Not known if causes male infertility.
Females pid can cause infertility and pain.

Question 5

Window period for testing for MGen?

Answer 5

Not known

Question 6

Abstinence advice after Rx for MGen?

Answer 6

2w and until sx resolved

Question 7

Treatment for MGen
1st line
Alternatives

Answer 7

Ext azithro unless known macrolide resistant (40%)

2nd line: moxiflox 400mg Od 10d

Doxycycline, can be helpful before a macrolide as it reduces the organism load and therefore chance of resistance. But resistance to doxy is 60% and not recommended 1st line but could be an alternative, consider using for 2w but no evidence

Question 8

Treatment for MGen positive NSU

Answer 8

If had doxy and MGen Pos, but macrolide (MRAM) resistant, give moxi

If above but not macrolide resistant, give extended azithro. If >2w since doxy, repeat doxy first.

If had azitrho and MGen Pos, and macrolide resistant then give moxi

If above but not macrolide resistant, do TOC in >3, < 5w

Question 9

Treatment for complicated MGen infections

Answer 9

Moxiflox

Question 10

Rectal MGen treatment?

Answer 10

Same as urogenital

Question 11

MGen treatment if pregnant?

Answer 11

Azithro safe and recommended if uncomplicated infection.

Moxi- NOT safe

Doxy consisted safe in first trimester according to FDA, but not BNF.

Question 12

MGen Rx if BF’ing?

Answer 12

Azithro- small amount in milk but considered safe. Monitor infants for SE including GI sx, pyloric stenosis if one first 2w postpartum.

Doxy- NO! Tooth discolouration and bone growth.

Question 13

Adverse effects of macrolides?

Fluroquinolones?

Answer 13

Azithro/: Common- GI,
Also prolongs QT interval

Moxi:
Prolongs QT
Muscle/tendon/bone/nerve problems.
But only absolute contraindication is allergy.