Prevalence of gonococcal conjunctivitis in adults and neonates

Abstract

Purpose To report the prevalence of gonococcal conjunctivitis (GC) presenting to a tertiary referral maternity hospital (NMH) and a tertiary referral ophthalmic hospital (RVEEH) from 2011 to 2013 and describe the demographics, clinical presentation, and antibiotic susceptibility of Neisseria gonorrhoeae ocular infections. Methods Demographic, clinical, and microbiological data were collected from patients with laboratory confirmed GC. Results There were 27 556 live births at NMH during the study period, and no case of neonatal GC was identified. Fourteen cases of GC were identified at RVEEH in this period, representing a prevalence of 0.19 cases per 1000 eye emergency attendees. Antibiotic susceptibility data were available on nine cases, of which, all were ceftriaxoneand ciprofloxacin sensitive. 64.3% of patients were male, with a mean age of 18 years. The mean duration of symptoms was 3 days. All patients presented with unilateral conjunctival injection and purulent discharge. Eight cases had visual impairment at presentation and their mean visual acuity was 6/15. Corneal involvement was present in 25% of patients. Uveitis was not detected. On receipt of positive culture and/or PCR results, treatment was altered in two thirds of patients. All patients were referred for full STI screening and all patients showed a full clinical recovery 1 week posttreatment. Conclusion We observed that GC presented in young adults with a male predominance and was rare in neonates. In cases of unilateral purulent conjunctivitis, there should be a high clinical suspicion of GC, early swab for PCR and culture, and knowledge of current CDC-recommended antibiotic guidelines.

A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiologya

“…When tests are requested, diagnosis of bacterial conjunctivitis is often compromised by the prior use of empiric antibacterial therapy [40,41]. Sexually active patients who present with bacterial conjunctivitis should have an aggressive diagnostic workup with Gram stain and cultures because of their risk for N. gonorrhoeae conjunctivitis [43]. This is a sight-threatening infection which can result in perforation of the globe.…”

Gonococcal Conjunctivitis: A Case Report of an Unusual Mode of Transmission

“…[1][2][3] In Ireland, cases of conjunctivitis secondary to sexually-transmitted infections (STI's) recently doubled in correlation with a rise in urogenital infections. 1 Although adult cases of gonococcal conjunctivitis have largely been attributed to auto-inoculation in men with asymptomatic urogenital gonorrhea, changing sexual practices could lead to increased occurrence in young women.…”

Invasive Neisseria gonorrhoeae producing pre‐septal cellulitis and keratoconjunctivitis: diagnosis and management

“…N. gonorrhoeae typically produces a hyperacute unilateral conjunctivitis. While the source of infection in this patient is unclear, in most cases infection is acquired via sexual transmission and reaches the conjunctiva through hand–eye auto‐inoculation 1 , 2 . The bacteria can invade the corneal epithelium, producing keratitis and corneal melting necessitating therapeutic keratoplasty 1 , 2 .…”

“…While the source of infection in this patient is unclear, in most cases infection is acquired via sexual transmission and reaches the conjunctiva through handeeye autoinoculation. 1,2 The bacteria can invade the corneal epithelium, producing keratitis and corneal melting necessitating therapeutic keratoplasty. 1,2 Gonococcal periorbital infection is rare, with only three cases of pre-septal cellulitis and two cases of post-septal cellulitis reported.…”

“…1,2 The bacteria can invade the corneal epithelium, producing keratitis and corneal melting necessitating therapeutic keratoplasty. 1,2 Gonococcal periorbital infection is rare, with only three cases of pre-septal cellulitis and two cases of post-septal cellulitis reported. 3 All patients were successfully treated with parenteral antibiotics.…”