Mycoplasma genitalium

Question 1

When was mycoplasma genitalium first isolated?

Answer 1

1981

Question 2

Where was m. gen first cultured from?

Answer 2

2 urethral samples from men with NGU

Question 3

Which class of organism does m gen belong?

Answer 3

Mollicutes

Question 4

What is unique about m gen?

Answer 4

Smallest self-replicating bacterium

Question 5

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

Answer 5

lacks a cell wall = not visible by gram stain

fastidious organism = slow to culture

Question 6

How long can it take to culture m gen?

Answer 6

weeks to months

Question 7

Where in the body has m gen been detected?

Answer 7

genito-urinary
rectal
respiratory tract

Question 8

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

Answer 8

ADHERE to and INVADE EPITHELIAL cells

Question 9

How does m gen evade the adaptive immune system?

Answer 9

ability to establish INTRA-CELLULAR infection

antigenic and phase VARIATION of its surface-exposed proteins

Question 10

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

Answer 10

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

Question 11

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

Answer 11

1-2%

Question 12

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

Answer 12

WOMEN > Men

Question 13

What are the risk factors for m gen infection?

Answer 13

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

Question 14

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

Answer 14

4-38%

Question 15

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

Answer 15

Chlamydia trachomatis

Question 16

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

Answer 16

HIV transmission

Question 17

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

Answer 17

15-35%

Question 18

What percentage of persistent or recurrent NGU m gen identified?

Answer 18

up to 40%

Question 19

What complications is m gen associated with in females?

Answer 19

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

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

What complications is m gen associated with in the men?

Answer 22

Sexually acquired reactive arthritis
Epididymo-orchitis
Proctitis (possibly)

Question 23

What percentage of men with m genitalium will develop symptoms?

Answer 23

<10%

Question 24

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

Answer 24

Asymptomatic
dysuria
post coital bleeding
cervicitis 
lower abdominal pain

Question 25

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

Answer 25

post coital bleeding

Question 26

What signs on speculum are suggestive of m gen infection?

Answer 26

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

Question 27

When should testing for m genitalium be CONSIDERED?

Answer 27

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

Question 28

When is testing for m genitalium RECOMMENDED?

Answer 28

NGU | signs and symptoms of PID

Question 29

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

Answer 29

First void urine (98-10% sensitive)

Question 30

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

Answer 30

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

Question 31

What INCREASES the sensitivity of m gen testing in women?

Answer 31

Performing both VVS and endocervical swab

Question 32

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

Answer 32

Macro- lide resistance-mediating mutations

Question 33

What is the window period for testing for m gen?

Answer 33

no data on the incubation period the likely window period | it is likely that sensitive tests will detect early infection.

Question 34

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

Answer 34

14 days from start of treatment

Question 35

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

Answer 35

40%

Question 36

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

Answer 36

may be less likely to select for macrolide resistance

Question 37

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

Answer 37

30-40%

Question 38

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

Answer 38

Asia-pacific

Question 39

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

Answer 39

Limited future therapeutic options

Question 40

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

Answer 40

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

Question 41

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

Answer 41

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

Question 42

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

Answer 42

Moxifloxacin 400mg OD 10 days

Question 43

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

Answer 43

Extended MOXIFLOXACIN 400mg Daily FOURTEEN days

Question 44

What alternative regimens are there for treatment of m gen?

Answer 44

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

Question 45

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

Answer 45

will reduce M. genitalium load and therefore | the risk of pre-existing macrolide mutations being present

Question 46

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

Answer 46

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

Question 47

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

Answer 47

Prolong QT interval

Question 48

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

Answer 48

5 weeks after treatment