Mycoplasma Genitalium Flashcards
What is the prevalence of MGen in the general population?
1-2%
What is the prevalence of mycoplasma genitalium in STI clinic attendees
Reported prevalence is higher from 4-38%
How is mycoplasma genitalium spread?
Spread through direct sexual transmission, Carriage of mycoplasma genitalium in the throat seems very rare and so unlikely to spread through oral sex.
What is the most common STI that mycoplasma genitalium is known to be co-infected with?
Chlamydia trachomatis
Name three risk factors that increase your chance of acquiring mycoplasma genitalium?
- multiple sexual partners
- new sexual partner
- younger age
- low socio-econominc status
- smoking status
What symptoms and signs do men with Mycoplasma genitalium present with?
Asymptomatic Urethral discharge Dysuria Penile irritation Urethral discomfort Urethritis (persistent, recurrent, acute) Balano-posthitis (in one study)
what complications can result in Men infected with Mgen
epididymo-orchitis
SARA
What year was mycoplasma genitalium first discovered?
1981
What class of bacteria does Mycoplasma genitalium belong too?
Mollicutes class, it is the smallest known self-replicating bacterium
Can you culture and stain mycoplasma genitalium?
no - you can’t stain Mgen as it lacks a cell wall, you can’t easily culture MGen as it is fastidious and thus extremely slow growing (takes weeks or months to culture)
List the sites where mycoplasma genitalium been detected
Genito-urinary tract
respiratory
rectal (only one case report of proctitis)
(carriage in the throat seems rare… )
What diagnosis if MGen unequivocally and strongly associated with?
NGU (non-gonococcal urethritis)
what is the prevalence of Mgen in men diagnosed with NGU?
15-25%
What is the prevalence of MGen in men diagnosed with NCNGU (non-chlamydial non-gonococcal urethritis)?
10-35%
what % of men with persistent and recurrent urethritis are found to have MGen?
up to 40% of men
What are the signs and symptoms of Mgen in women?
Asymptomatic Dysuria PCB painful IMB cervicitis lower abdominal pain - PID
what are the potential complications of MGen in women?
PID
tubal factor infertility (uncertain association - more research is needed)
pre-term birth
spontaneous abortion
what percentage of PID cases are due to MGen?
10-13%
List two clinical situations when we should offer testing for Mgen (and the grade of the recommendation)
- Diagnosis of NGU (1B)
2. Diagnosis of PID (1B)
According to BASHH guidelines in what clinical situations should we consider testing for MGen in patients presenting to an STI clinic?
- consider MGen testing in women with signs and symptoms of muco-purulent cervicitis particularly PCB (2B)
- consider Mgen testing in people with epididymo-orchitis (2D)
- consider Mgen testing in people with sexually-acquired procitits (2D)
How do you diagnose Mgen in men and women and what is the reported sensitivities
NAAT is used to detect Mgen
Men - first catch urine (98-100%) (1C)
Women - VVS for PCR (note the sensitivity can increase when taking samples from two places - VVS followed by endocervical but the data is limited and variable) BASHH recommend VVS self taken or clinician is satisfactory - reported 100% sensitive in a recent study (1C)
If NAAT MGen comes back positive according to BASHH guidelines what additional test should be performed on the sample?
macrolide resistance testing (1B)
how would you manage regular sexual partners of patients who have tested positive for Mgen?
offer testing and treatment only if results come back positive for MGen.
What is the first line treatment option for uncomplicated Mgen infection
doxycycline 100mg BD for 7 days followed by azithromycin 1g stat, 500mg OD for 2 days - where the organism is known to be macrolide sensitive or resistance if unknown (1D)
What is the second line treatment option for uncomplicated Mgen infection or only option if macrolide resistance is detected?
moxifloxacin 400mg OD for 7 days ( 1B) (recent update)
if doxycycline has already been given to the patient and the MGen result subsequently comes back positive, in what time frame does the doxycycline course not need to be repeated when treating with azithromycin?
as long as the doxycycline course was not finished more than 2 weeks ago then it doesn’t need to be repeated and azithromycin can be added on for treatment of Mgen.
How should complicated Mgen cases be treated (epididymo-orchitis, PID, severe proctitis)
moxifloxacin 400mg OD for 14 days
List the alternative treatment options for Mgen
- Doxycycline 100mg Bd for 7 days followed by pristinamycin 1g, PO, QDS for 10 days
- Pristinamycin 1g QDS, PO for 10 days
- Doxycycline 100mg PO, BD, for 14 days
- Minocycline 100mg PO, BD, for 14 days
note pristinamycin has only be found to be 75% effective in treatment as mono-therapy
very little evidence exists for the above regimens
List the alternative treatment options for Mgen
- Doxycycline 100mg Bd for 7 days followed by pristinamycin 1g, PO, QDS for 10 days
- Pristinamycin 1g QDS, PO for 10 days
- Doxycycline 100mg PO, BD, for 14 days
- Minocycline 100mg PO, BD, for 14 days
note pristinamycin has only be found to be 75% effective in treatment as mono-therapy
very little evidence exists for the above regimens
What are the complications of MGen during pregnancy
- pre-term birth
- spontaneous abortion
what are the treatment options for Mgen in pregnancy
Azithromycin 1g stat, 500mg OD for 2 days
could consider pristinamycin but MHRA says safe in pregnancy whilst the BNF doesn’t support its use
dependent upon the trimester if first trimester together with obstetrics opinion could consider doxycycline use..
if first line Rx fails guidance is to try and wait to treat until after delivery
