Gonococcal conjunctivitis is an infection of the eye’s surface caused by the bacterium Neisseria gonorrhoeae. This condition, which can affect both newborns and adults, results from direct contact with infected genital secretions. This serious infection requires prompt medical treatment but is manageable with antibiotics. Understanding the transmission pathways, recognizing the symptoms, and seeking immediate care are necessary to prevent long-term damage.
How Gonorrhea Infects the Eye
The bacterium Neisseria gonorrhoeae infects the eye through routes that differ between adult and newborn populations. In adults, the most common method of transmission is autoinoculation. This occurs when an individual with a genital gonorrhea infection, which may be asymptomatic, touches infected genital fluids and then their eyes. Because the bacteria do not survive for long outside the human body, this direct transfer is the primary way adults contract the infection.
For newborns, the infection is typically acquired during birth. As the infant passes through the birth canal of a mother with an active gonorrhea infection, they are exposed to the bacteria present in cervical and urethral secretions. This vertical transmission can occur even in deliveries by cesarean section, although it is less common. The mucous membranes of the newborn’s eyes are susceptible to the bacteria, leading to a condition known as gonococcal ophthalmia neonatorum.
Symptoms and Presentation
The signs of gonococcal conjunctivitis appear rapidly and are severe, distinguishing it from more common forms of pink eye. A defining feature is a profuse, thick, pus-like discharge from the affected eye. This discharge, which can be yellow, green, or white, may be so abundant that it causes the eyelids to stick together. The condition is also marked by significant swelling and deep redness of the conjunctiva, the membrane covering the white of the eye.
Accompanying the visible signs are sensations of intense discomfort. Patients often experience eye pain, tenderness, and a gritty feeling of irritation. Swelling can extend to the eyelids and the lymph nodes near the ears, a condition called preauricular lymphadenopathy. Additionally, many individuals develop a pronounced sensitivity to light, known as photophobia, making it difficult to keep the affected eye open.
Medical Diagnosis and Treatment
Diagnosing gonococcal conjunctivitis requires immediate medical attention from a physician or ophthalmologist. To confirm the presence of Neisseria gonorrhoeae, a healthcare provider will take a swab of the purulent discharge. This sample is sent to a laboratory for analysis, which includes a Gram stain to identify the bacteria’s shape and a culture on a special medium to definitively identify the organism.
Due to the aggressive nature of the infection, treatment often starts before lab results are confirmed. The standard of care involves systemic antibiotics, typically an intramuscular injection of ceftriaxone. An oral dose of azithromycin is also prescribed to treat potential co-infection with Chlamydia. This systemic approach is necessary because topical antibiotics alone are not sufficient to eliminate the bacteria.
In addition to systemic medication, treatment includes localized care for the eye. This involves frequent irrigation with a sterile saline solution to wash away the discharge and reduce the bacterial load. Antibiotic eye drops or ointments may be used as adjunctive therapy. Because the eye infection stems from a genital infection, the patient and their sexual partners must also be screened and treated for gonorrhea.
Potential for Vision Damage
Delaying treatment for gonococcal conjunctivitis can lead to severe and irreversible consequences for vision. The Neisseria gonorrhoeae bacterium is aggressive and can invade the cornea, the clear front surface of the eye. This invasion can lead to corneal ulcers, which are open sores that cause pain and can lead to scarring.
If the infection progresses, these ulcers can deepen and may cause a corneal perforation, which is a rupture of the eyeball. This can lead to a widespread internal eye infection, known as endophthalmitis. The scarring from corneal damage can permanently impair vision or lead to blindness.
Ophthalmia Neonatorum Prevention
The prevention of gonococcal conjunctivitis in newborns, or ophthalmia neonatorum, is a routine, prophylactic measure applied to nearly all newborns shortly after birth. This practice involves applying an antibiotic ointment into the infant’s eyes, most commonly erythromycin 0.5% ointment. This procedure is effective at killing Neisseria gonorrhoeae and other bacteria the infant may have been exposed to.
This preventative step was first established in the late 1800s using silver nitrate, a practice that drastically reduced newborn blindness. Today, modern antibiotics are used as a standard of care. The most effective prevention strategy involves screening pregnant individuals for gonorrhea during prenatal care. Treating the infection in the mother before delivery is the best way to prevent transmission.