Conjunctiva

Gonococcal Conjunctivitis

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Gonococcal Conjunctivitis, Gonorrhea Conjunctivitis, Gonorrheal Conjunctivitis, Hyperacute Bacterial Conjunctivitis

  • See Also
  1. Bacterial Conjunctivitis
  2. Conjunctivitis
  • Causes
  1. Neisseria gonorrhoeae
  • Signs
  1. Profuse purulent exudate ("waterfall of pus")
  2. Profound lid edema
  3. Chemosis
  4. Corneal Ulceration
  5. Occurs in newborns within 24-48 hours of birth
  • Management
  • Newborns
  1. Ophthalmology Consultation
  2. General Measures
    1. Frequent saline Eye Irrigation until no discharge
    2. Treat mother and partners for Gonorrhea and Chlamydia
    3. Treat newborn also for Chlamydia Conjunctivitis
  3. Antibiotic
    1. Ceftriaxone (Rocephin) 25 to 50 mg/kg up to 500 mg IV/IM x1 dose (preferred) OR
    2. Cefotaxime (Claforan) 100 mg/kg IV/IM x1 dose
  4. Alternative if Cephalosporin allergy
    1. Gentamicin IM and Azithromycin orally
  • Management
  • Adults
  1. Ophthalmology Consultation
  2. Gonorrhea management
    1. Systemic antibiotics
      1. Ceftriaxone 500 mg IM/IV for 1 dose (1 gram IM/IV if weight > 150 kg, dose increased in 2020) OR
      2. Gentamicin 240 mg IM and Azithromycin 2 g orally for one dose OR
      3. Cefixime 800 mg orally once is an alternative but NOT recommended due to Antibiotic Resistance
    2. Topical Medications
      1. Saline Eye Irrigation four times daily
      2. Ciprofloxacin eye ointment 4x/day was previously recommended but GC resistance is high
  3. Chlamydia treatment if not excluded (not indicated for Gonorrhea treatment without Chlamydia as of 2020)
    1. Doxycycline 100 mg twice daily for 7 days (preferred as of 2020) OR
    2. Azithromycin 1 g orally for 1 dose
  4. References
    1. Cyr (2020) MMWR Morb Mortal Wkly Rep 69(50): 1911-6 [PubMed]
      1. https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm
  • Complications
  1. Corneal perforation (high risk)
  • References
  1. Williams (2017) Crit Dec Emerg Med 31(2): 3-12
  2. Yanoff (1999) Ophthalmology, Mosby, p. 1.7
  3. Fuloria (2002) Am Fam Physician 65(1):61-8 [PubMed]