gonorrhoea (congenital)

Last edited 03/2022

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  • 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