Mycoplasma genitalium. Answer.

Lead-in.
BASSH launched a new, “NICE-accredited” guideline on MG in July 2018 This makes it a hot topic and
it is one that most people will know nothing about. There are enough “buzz words” to catch the
attention of MRCOG examiner sand make its inclusion in the exam databases irresistible! It would be
a killer “structured discussion” in the April Part 3 and would sink most candidates in the July Part 2.
Many of the questions are not true EMQs as they have more than one correct answer. I have tried to
include all the facts I think might feature in the exam and packing more than one into a question
reduces the total number of questions and makes the document a bit more manageable. It also
reduces the amount of typing I have to do.
Abbreviations.
BASHHMG: British Association for Sexual Health and HIV’s “National guideline for the management
of infection with Mycoplasma genitalium”. 2018
BASHHNGU: British Association for Sexual Health and HIV’s. “ UK National Guideline on the
management of non-gonococcal urethritis”. 2015, updated 2018.
MG: Mycoplasma genitalium.
MP: Mycoplasma pneumoniae.
NHSCS: NHS Cervical Screening Programme
PCB: postcoital bleeding.
PMB: postmenopausal bleeding.
PID: pelvic inflammatory disease.
PTB: preterm birth.
SARA: Sexually-Acquired Reactive Arthritis.
Scenario 1.
Which, if any, of the following statements are true in relation to MG? This is not a true EMQ as there
may be more that one correct answer.
Option list.
A MG was first isolated in 2001
B MG was first isolated from men with non-gonococcal urethritis (NGU)
C MG belongs to the Cutemollies class
D MG is the smallest known yeast with the ability to self-replicate
E MG is the smallest known bacterium with the ability to self-replicate
F MG has an unusual, double-layered cell wall
G MG has an unusual protrusion at one end
H MG’s protrusion enables it to adhere to epithelial cells
I MG’s protrusion enables it to invade epithelial cells
J MG is best seen on a Gram stain
Scenario 2.
Which, if any, of the following statements are true in relation to Mycoplasmas?
Option list.
A are the largest known bacteria
B have no cell wall
C have no nuclei
D are resistant to ß-lactam antibiotics
E are resistant to sulphonamides
F colonies show a ‘scrambled egg’ appearance on culture on agar
Scenario 3.
Which, if any, of the following statements are true in relation to Mg?
Option list.
A when the organism was originally found, culture took 50 days
B Mg is facetious

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 C Mg is a facultative aerobe
D Mg is a facultative anaerobe
E Mg is a facultative aerobe & anaerobe
F Mg is fastidious
Scenario 4.
Which, if any, of the following are true in relation to the approximate prevalence of MG?
Option list.
A it is ~ 0.1%
B it is ~ 1.0%
C it is ~ 5.0%
D it is ~ 5-10%
E it is > 10%
F none of the above
Scenario 5.
Which, if any, of the following is true in relation to screening for MG? This is a true EMQ with only
one correct answer.
Option list.
A screening for MG is now included in the NCSP
B screening for MG is now offered as part of the NHSCS
C screening should be offered to all sexually active women < 30 years old
D screening should only be offered to those with symptoms suggestive of infection
E screening should be offered to all partners of those with MG infection
F none of the above
Scenario 6.
Which, if any, of the following are included in BASHHMG as risk factors for infection with MG?
Option list.
A Cigarette smoking
B Multiple dancing partners
C Multiple sexual partners
D Non-white ethnicity
E Younger age
F None of the above
Scenario 7.
Which of the following statements is true in relation to MG and co-infection with other organisms?
Option list.
A MG excretes bactericidal toxins and co-infection is rare
B MG co-infection is most often with chlamydia
C MG co-infection is most often with E. coli
D MG co-infection is most often with HIV
E MG co-infection is most often with TB
F None of the above
Scenario 8.
Which of the following statements is true in relation to MG and men?
Option list.
A It is the most common cause of NGU
B It is the most common cause of epididymitis
C It is the most common cause of prostatitis
D It is a well-recognised cause of male sub-fertility
E Most men with MG infection are asymptomatic
E None of the above

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Scenario 9.
Which, if any, of the following statements are true in relation to MG and women?
Option list.
A MG is linked to an ↑ risk of cervicitis
B MG is linked to an ↑ risk of endometritis
C MG is linked to an ↑ risk of female infertility
D MG is linked to an ↑ risk of miscarriage
E MG is linked to an ↑ risk of otitis media
F MG is linked to an ↑ risk of pelvic inflammatory disease
G MG is linked to an ↑ risk of postcoital bleeding
H MG is linked to an ↑ risk of postmenopausal bleeding
I MG is linked to an ↑ risk of preterm birth
J MG is linked to an ↑ risk of damage to Fallopian tube cilia
K MG is linked to an ↑ risk of puerperal psychosis
L MG is linked to an ↑ risk of puerperal sepsis
M Most infected women are asymptomatic
N None of the above
Scenario 10.
Which, if any, of the following statements are true in relation to current concerns about Mg?
Option list.
A It could become a ‘superbug’, resistant to most antibiotics, within a decade
B Infection is often misdiagnosed as chlamydia with ↑ risk of antibiotic resistance
C ‘superbug’ status would be likely to lead to an ↑ in renal failure
D ‘superbug’ status would be likely to lead to an ↑ in female infertility
E ‘superbug’ status would be likely to lead to an ↑ in male infertility
Scenario 11.
Which, if any, of the following methods are used in the recommended test for MG infection in
women?
Option list.
A blood testing for MG IgG
B blood testing for MG IgM
C cervical smears checked microscopically for the diagnostic intracellular inclusion bodies
D culture and sensitivity of cervical swab specimens using MG-specific culture medium
E culture and sensitivity of 1st. void MSSU using MG-specific culture medium
F culture and sensitivity of vaginal swab specimens using MG-specific culture medium
G NAATs that detect the MG G-antigen
H NAATs that detect MG DNA
I NAATs that detect MG RNA
J serum testing for MG-specific antigen
K vaginal swabs taken by the woman
L none of the above
Scenario 12.
Which, if any, of the following statements are true in relation to testing for antibiotic resistance after
initial tests are +ve for MG?
Option list.
A % are resistant to cephalosporins
B % are resistant to macrolides
C % are resistant to penicillin
D % are resistant to quinolones
E % are resistant to macrolides

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 F % are resistant to streptomycin
F % are resistant to sulphonamides
F % are resistant to tetracyclines
G None of the above
Scenario 13.
Which, if any, of the following statements are true in relation to estimates of antibiotic resistance in
current strains of MG in the UK?
Option list.
A 20% are resistant to cephalosporins
B 40% are resistant to macrolides
C 50% are resistant to penicillin
D 50% are resistant to quinolones
E 10% are resistant to streptomycin
F 90% are resistant to sulphonamides
F 40% are resistant to tetracyclines
F None of the above
Scenario 14.
Which, if any, of the following is BASHHMG’s recommended 1 st. line treatment of uncomplicated
MG?
Option list.
A azithromycin 1 gram daily for 7 days
B doxycycline 100 mg twice daily for 7 days
C doxycycline 100 mg twice daily for 10 days
D doxycycline 100 mg twice daily for 7 days
E doxycycline 100 mg twice daily for 7 days then azithromycin 1 gram daily for 2 days
F moxifloxacin 400mg orally once daily for 7 days
G moxifloxacin 400mg orally once daily for 10 days
H none of the above
Scenario 15.
Lead-in
Which, if any, of the following is BASHHMG’s recommended 1 st. line treatment of complicated MG?
Option list.
A doxycycline 100 mg twice daily for 10 days
B doxycycline 100 mg twice daily for 14 days
C moxifloxacin 400mg orally once daily for 10 days
D moxifloxacin 400mg orally once daily for 14 days
E none of the above
Scenario 16.
Lead-in
This is not an EMQ or SBA!
Fill in the gaps in the table below, using option list.
Option list.
A aminoglycoside
B cephalosporin
C macrolide
D penicillin
E quinolone
F tetracycline
Table.
Drug name Category of drug

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 azithromycin
doxycycline
moxifloxacin
Scenario 17.
Which, if any, of the following statements is true in relation to test of cure (TOC) after treatment of
MG?
Option list.
A TOC should be offered to everyone who has been treated for MG
B TOC should only be offered to those who had signs of infection before treatment
C TOC should only be offered to those who had symptoms of infection before treatment
D TOC should only be offered to those who had signs and symptoms before treatment
E TOC should only be offered to those who continue to have signs or symptoms two weeks or
more after the start of treatment
F none of the above
Scenario 18.
Which, if any, of the following statements are true in relation to the timing of test of cure (TOC) after
treatment of MG?
Option list.
A TOC is best done at 3 weeks after start of treatment
B TOC is best done at 4 weeks after start of treatment
C TOC is best done at 5 weeks after start of treatment
D TOC is best done at 6 weeks after start of treatment
E TOC should not be done < 2 weeks from the start of treatment
F TOC should not be done < 3 weeks from the start of treatment
G TOC should not be done < 4 weeks from the start of treatment

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