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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
- chloramphenicol eye drops must not be given to a child less than 2 years old as it contains boron and may impair fertility in the future (3)
- (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) electronic medicines compendium (emc) - chloramphenicol Eye Drops BP 0.5% W/V (Accessed 23/3/2021)
Last edited 03/2021 and last reviewed 03/2021