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DipGUM > MGen > Flashcards

MGen Flashcards

1
Q

Can you Gram stain MGen?

A

No. Lacks a cell wall.

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2
Q

Is MGen culture possible?

A

Yes but MGen is fastidious so typically requires weeks or months to culture

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3
Q

Where can MGen infect?

A

Genitourinary system
Rectal
Respiratory

(Throat carriage rare)

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4
Q

Prevalence in general population

A

1-2% (higher in women)

Prevalence peaks later than CT particularly men

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5
Q

Risk factors

A

Younger age
Non-white ethnicity
Smoking
Increasing no sexual partners

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6
Q

Transmission

A

Genital-genital
Penile-anal

Carriage in oropharynx uncommon, therefore contribution from oral sex likely to be very small

Risk per coital act unknown, likely to be smaller than CT

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7
Q

Clinical associations

A

NGU
PID
PCB
Cervicitis
Endometritis

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8
Q

Prevalence in NGU

A

15-25%

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9
Q

Prevalence in NCNGU

A

10-35%

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10
Q

Prevalence in persistent / recurrent NGU

A

40%

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11
Q

Risks in pregnancy

A

Pre-term birth
Miscarriage

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12
Q

Prevalence in PID

A

10-13%

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13
Q

Affect on fertility

A

Can cause epithelial cilia damage in human fallopian tube culture

Association with tubal factor infertility not yet demonstrated in studies

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14
Q

Is asymptomatic screening a good idea?

A

Majority of people infected with MGen in genital tract do not develop the disease

Current tx imperfect and a/w development of resistance

No evidence that screening aSx individuals of benefit (likely to do harm at population level)

Only current partners of MGen index Pt to be tested/offered epidemiological tx

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15
Q

Sx / Si men

A

Majority aSx
Urethral discharge
Dysuria
Penile irritation
Urethral discomfort
Urethritis (acute, persistent, recurrent)
Balanoposthitis (in one study)

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16
Q

Complications in men

A

SARA + EO (possible)
Prostatitis (data lacking)

17
Q

SX/Si women

A

Majority aSx

Dysuria
PCB
Painful IMB
cervicitis
Lower abdo pain

18
Q

Complications in females

A

PID
tubal factor infertility (uncertain association)
SARA
Pre term delivery

19
Q

Who do you test for MGen?

A

Based on Sx:

NGU
PID

Consider:
- mucopurulent cervicitis, particularly PCB
- EO
- sexually acquired proctitis

Based on risk factors:

  • current sexual partners of MGen infected
20
Q

Window period for MGen

A

No data on incubation period

It is likely that sensitive tests will detect early infection

21
Q

Management of uncomplicated urogenital infection (urethritis, cervicitis)

A

1.
7/7 doxycycline 100mg BD
then
Azithromycin 1 g then 500mg OD (3/7)

  1. Moxifloxacin 400 OD 10/7
    (If macrolide resistant or treatment failure)
22
Q

Management of complicated MGen (PID / EO)

A

Moxifloxacin 400mg OD 14/7

23
Q

How long should patients avoid SI ?

A

14/7 after start of tx and until Sx resolved

Where azithromycin has been used this is especially important because of its long half life, and is likely to reduce the risk of selecting / inducing macrolide resistance if the patient is re-exposed to MGen.

24
Q

who should have a TOC and when

A

Everyone
5/52

25
Q

Partner notification

A

Current partner only (to reduce risk of re infection to index patient)

Partner should be given same Abx as index patient unless there is available resistance info to suggest otherwise.

26
Q

Rate of MGen macrolide resistance in UK

A

40%

27
Q

Azithromycin treatment failure and MGen sensitive to macrolides

A

Do not repeat azithromycin as resistance is likely to have developed on treatment

28
Q

Role of doxycycline in MGen treatment

A

Doxycycline as mono therapy has poor efficacy and eradication rates are low (30-40%).
There is evidence that prior tx with doxycycline may improve tx success when given with, or followed by extended azithromycin regimen
(Doxy reduces organism load and hence the risk of pre-existing macrolide mutations being present).

29
Q

Efficacy of moxifloxacin

A

Excellent efficacy in Europe
Increasing resistance in Asia-Pacific (where it’s use is greater)

Data shows more tx failures with 7/7 course than 10/7

30
Q

How long after completed doxycycline can give azithromycin?

A

Within 2/52
- If longer repeat doxy

31
Q

Counselling points when commencing moxifloxacin

A

Can cause tendon rupture

Stop if any pain

32
Q

Which MGen treatments can increase QT interval

A

Azithromycin
Moxifloxacin

(Caution if already on medications that prolong QT)

33
Q

What class of drugs is moxifloxacin

A

Fluroquinolone

34
Q

Alternative MGen treatments (3rd line)

A
  • Doxycycline 100mg BD 7/7 then pristinamycin* 1g PO QDS 10/7
  • Pristinamycin* 1g PO QDS 10/7 (75% effective as mono tx)
  • Doxycycline 100mg BD 14/7
  • Minocycline 100mg PO BD 14/7

*not currently available in the UK and must be imported against a prescription (2-3 week lead time)

35
Q

Management of MGen proctitis

A

Same as urogenital

Severe proctitis - 14/7 moxifloxacin can be considered

36
Q

Treatment of uncomplicated MGen in pregnancy / BF

A

Azithromycin 3/7 course (1g, 500mg, 500mg)

37
Q

Management of MGen in pregnancy with macrolide resistance or upper genital tract infection

A

Options are limited

Moxifloxacin is contraindicated in pregnancy and BF

DipGUM (5 decks)

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