Gonorrhoea (congenital)

Seek expert advice.

• congenital gonorrhoea infection is acquired intrapartum, and it leads to ophthalmia neonatorum
• gonococcal ophthalmia neonatorum presents with a severe conjunctivitis and keratitis usually in the first 48 hours of life. There may be purulent discharge. If untreated blindness may result. It is frequently bilateral (1)
• also, there can be disseminated neonatal gonorrhoea infection
• diagnosis is by Gram stain smear and culture of conjunctival discharge
• treatment involves both topical (e.g. chloramphenicol eye ointment) and intramuscular benzylpenicillin. In view of increasing antimicrobial resistance, the following alternative options may need to be considered (2):
  • ceftriaxone IV or IM as a single dose OR
  • cefotaxime as a single dose
• frequent conjunctival irrigation with saline is recommended (2)
• both parents of the child should also be assessed
• ocular prophylaxis is no longer routinely administered in the UK, though it is still given in parts of the USA and third world where incidence rates are higher.
• in cases where the infant is born to those with known gonorrhoea then prophylactic treatment IM benzylpenicillin 30mg/kg stat and chloramphenicol eye ointment is initiated within the first hour after birth

A review suggests (3):

• consider neonatal conjunctivitis in all infants presenting with eye discharge within the first 4 weeks of life
• carefully examine the conjunctiva: if red, refer to hospital eye services for same day review
  • NICE recommends urgent referral to ophthalmology for all cases of "sticky eye with redness in a neonate"
    
    
• investigations and treatment for suspected neonatal conjunctivitis in primary care are not necessary and may interfere with subsequent microbiology sampling
  
  
• eye discharge with normal conjunctiva is likely due to congenital nasolacrimal duct obstruction

Reference:

1. Brocklehurst P. Antibiotics for gonorrhoea in pregnancy. Cochrane Database of Systematic Reviews2002; 2:CD000098.
2. Bignell C. 2009 European (IUSTi/WHO) guideline on the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS 2009;20(7), 453-7.
3. Manasseh G S L, Amarakoon S, Photiou V, Arruti N, Borman A D. Approach to conjunctivitis in newborns BMJ 2022; 376 :e068023 doi:10.1136/bmj-2021-068023