Gonococcal conjunctivitis is a severe bacterial eye infection, also known as gonococcal ophthalmia neonatorum when it affects newborns. It is caused by Neisseria gonorrhoeae, the bacterium responsible for gonorrhea. This condition requires immediate medical attention due to its potential to cause serious complications, including permanent vision loss.
Causes and Transmission
Gonococcal conjunctivitis is typically transmitted through direct contact with infected secretions.
For newborns, transmission usually occurs during passage through an infected birth canal if the mother has untreated gonorrhea.
In adults, it often results from autoinoculation, where infected genital secretions are transferred to the eyes, frequently through sexual contact.
Recognizing the Symptoms
Symptoms of gonococcal conjunctivitis manifest rapidly and are severe in both newborns and adults. In newborns, symptoms usually appear within 2 to 5 days after birth. These signs include severe bilateral conjunctival inflammation, along with copious amounts of purulent discharge that may be yellow-green. Eyelid swelling and redness are also prominent features, and the infant may exhibit sensitivity to light.
Adults experience an acute onset of severe conjunctivitis, characterized by marked redness of the eye and significant purulent discharge. Eyelid swelling, tenderness, and discomfort or pain are also commonly reported. The inner linings of the eyelids may swell, a condition known as chemosis. There can also be swelling of the lymph nodes near the ears, referred to as preauricular lymphadenopathy.
Diagnosis and Treatment
Diagnosing gonococcal conjunctivitis primarily involves laboratory testing of eye discharge. A Gram stain of the conjunctival discharge can reveal gram-negative intracellular diplococci, which are characteristic of Neisseria gonorrhoeae. Culture on specialized media, such as Thayer-Martin or chocolate agar, is also used to confirm the presence of the bacterium. Nucleic acid amplification tests (NAATs) are another sensitive method for detecting Neisseria gonorrhoeae DNA in eye swabs.
Due to the rapid progression and potential for serious complications, diagnosis and treatment must be initiated urgently. Standard medical treatment typically involves systemic antibiotics, administered intravenously or intramuscularly. Ceftriaxone is a commonly used antibiotic for this infection. In some cases, topical antibiotics may be combined with systemic treatment, although systemic therapy is usually necessary.
Hospitalization may be required for severe cases, particularly in newborns, to ensure close monitoring and effective administration of antibiotics. For adults diagnosed with gonococcal conjunctivitis, screening and treatment for co-occurring sexually transmitted infections are important, and their sexual partners also need evaluation and treatment to prevent reinfection. For infected infants, screening and treatment of the parents are also recommended.
Complications and Prevention
If left untreated, gonococcal conjunctivitis can lead to severe and irreversible consequences. The infection can rapidly progress to corneal ulceration, where open sores form on the clear front surface of the eye. This can result in scarring of the cornea and ultimately lead to permanent vision loss or blindness. The risk of corneal perforation is particularly high in newborns, occurring as early as 24 hours after birth.
For infants, there is an additional risk of the infection spreading beyond the eye, leading to a systemic infection known as disseminated gonococcal infection. This can manifest as serious conditions like septic arthritis, meningitis (inflammation of the membranes surrounding the brain and spinal cord), or sepsis (a dangerous blood infection).
Prevention strategies are important to reduce the incidence of gonococcal conjunctivitis. For newborns, routine prophylactic eye drops, such as erythromycin ophthalmic ointment, are administered shortly after birth in many regions. This practice aims to prevent bacterial conjunctivitis, including that caused by Neisseria gonorrhoeae.
For adults, practicing safe sex, including consistent condom use, is a primary method to prevent the initial gonococcal infection. Additionally, screening and treatment of pregnant individuals for gonorrhea are important to prevent mother-to-child transmission during birth. Many healthcare guidelines recommend screening pregnant women, especially those at increased risk of infection.