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DipGUM > Mycoplasma genitalium > Flashcards

Mycoplasma genitalium Flashcards

1
Q

When was mycoplasma genitalium first isolated?

A

1981

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2
Q

Where was m. gen first cultured from?

A

2 urethral samples from men with NGU

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3
Q

Which class of organism does m gen belong?

A

Mollicutes

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4
Q

What is unique about m gen?

A

Smallest self-replicating bacterium

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5
Q

Why is it difficult to identify m gen with standard M,C &S?

A

lacks a cell wall = not visible by gram stain

fastidious organism = slow to culture

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6
Q

How long can it take to culture m gen?

A

weeks to months

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7
Q

Where in the body has m gen been detected?

A

genito-urinary
rectal
respiratory tract

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8
Q

The specialised tip-like structure of m gen enables it to do what?

A

ADHERE to and INVADE EPITHELIAL cells

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9
Q

How does m gen evade the adaptive immune system?

A

ability to establish INTRA-CELLULAR infection

antigenic and phase VARIATION of its surface-exposed proteins

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10
Q

What is the potential mechanism through which m gen causes disease of Fallopian tube?

A

M genitalium can be DIRECTLY TOXIC to cells resulting in CILIAL DAMAGE.
Disease resulting from host immune response

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11
Q

What is the prevalence of M genitalium infection in men and women?

A

1-2%

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12
Q

Who is the higher prevalence in of M genitalium - men or women?

A

WOMEN > Men

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13
Q

What are the risk factors for m gen infection?

A

Younger age
Non-white ethnicity
Smoking
Increasing number of sexual partners

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14
Q

What is the prevalence of M gen infection in STI clinic attendees?

A

4-38%

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15
Q

What is the most common co-organism isolated with m gen infection?

A

Chlamydia trachomatis

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16
Q

What other infection is there a potential association with m gen, supported by some studies in sub-Saharan Africa?

A

HIV transmission

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17
Q

What is the prevalence of m gen in men with NGU?

A

15-35%

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18
Q

What percentage of persistent or recurrent NGU m gen identified?

A

up to 40%

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19
Q

What complications is m gen associated with in females?

A 
endometritis
PID
pre-term birth
spontaneous abortion
sexually acquired reactive arthritis
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20
Q

Is there an association between tubal infertility and m gen infection?

A

NO - an association with tubal factor infertility has not yet been demonstrated

21
Q

What symptoms or signs may be present for men with m gen infection? (7)

A 
Asymptomatic
Urethral discharge
Dysuria
Penile irritation
Urethral discomfort
Urethritis
Balano-posthitis (one study)
22
Q

What complications is m gen associated with in the men?

A

Sexually acquired reactive arthritis
Epididymo-orchitis
Proctitis (possibly)

23
Q

What percentage of men with m genitalium will develop symptoms?

A

<10%

24
Q

What symptoms or signs may be present for women with m gen infection? (5)

A 
Asymptomatic
dysuria
post coital bleeding
cervicitis 
lower abdominal pain
25
Q

What is the most common symptom for symptomatic women with m gen?

A

post coital bleeding

26
Q

What signs on speculum are suggestive of m gen infection?

A

mucopurulent cervical dis- charge
cervical friability
elevated numbers of PMNLs on cervical sample Gram staining

27
Q

When should testing for m genitalium be CONSIDERED?

A

signs or symptoms of mucopurulent CERVICITIS, particularly post-coital bleeding
EPIDYDIMO-ORCHITIS
sexually-acquired PROCTITIS

28
Q

When is testing for m genitalium RECOMMENDED?

A

NGU

signs and symptoms of PID

29
Q

What is the recommended specimen type for m gen testing in men?

A

First void urine (98-10% sensitive)

30
Q

What is the recommended specimen type for m gen testing in women?

A

VULVOVAGINAL swab (85.7% sensitive) vs endocervical (74.3% sensitive)

31
Q

What INCREASES the sensitivity of m gen testing in women?

A

Performing both VVS and endocervical swab

32
Q

What should all m genitalium-positive specimens be tested for?

A

Macro- lide resistance-mediating mutations

33
Q

What is the window period for testing for m gen?

A

no data on the incubation period the likely window period

it is likely that sensitive tests will detect early infection.

34
Q

How long should patients abstain from sex following treatment for m gen?

A

14 days from start of treatment

35
Q

What is the rate of m gen with macrolide resistance in the UK?

A

40%

36
Q

Why is an extended course of azithromycin potentially better than a single dose?

A

may be less likely to select for macrolide resistance

37
Q

What are the eradication rates of m gen with doxycycline as monotherapy?

A

30-40%

38
Q

Where in the world is m gen resistant to moxifloxacin increasing?

A

Asia-pacific

39
Q

Why is moxifloxacin NOT recommended as first line in all cases of M. genitalium?

A

Limited future therapeutic options

40
Q

If m genitalium infection is NOT resistance to macrolide or resistance is unknown what is first line treatment?

A

DOXYCYCLINE 100mg BD 7 days then AZITHROMYCIN 1g STAT ten 500mg daily for 2 days

41
Q

When should azithromycin be given in relation to doxycycline for m gen treatment?

A

azithromycin should be given immediately after doxycycline
within 2 weeks of doxycycline
most individuals will have had doxycycline as first-line treatment for uncomplicated infection, a repeat course is not necessary unless > 2 weeks since treatment

42
Q

What dosing schedule is used for treatment of m gen with moxifloxacin?

A

Moxifloxacin 400mg OD 10 days

43
Q

What is the treatment for complicated m gen infection? (includes EO, PID, proctitis)

A

Extended MOXIFLOXACIN 400mg Daily FOURTEEN days

44
Q

What alternative regimens are there for treatment of m gen?

A

Doxycycline 100 mg bd for seven days*then pristi- namycin 1 g orally four times daily for ten days
Pristinamycin 1 g orally four times daily for 10 days
Doxycycline 100 mg orally twice daily for 14 days
Minocycline 100 mg orally twice daily for
14 days

45
Q

What is the benefit of treatment with doxycycline prior to azithromycin for m gen?

A

will reduce M. genitalium load and therefore

the risk of pre-existing macrolide mutations being present

46
Q

In pregnancy and breast feeding mothers what are the treatment options for m gen?

A

Limited options - AZITHROMYCIN can be used; monitor for GI side effects in infants

47
Q

What cardiac complication can occur as a result of administering azithromycin or moxifloxacin?

A

Prolong QT interval

48
Q

When should a patient have a test of cure following treatment for m gen?

A

5 weeks after treatment

DipGUM (39 decks)

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