Gonococcal Conjunctivitis

Gonococcal Conjunctivitis
SYMPTOMS Hyperacute onset purulent discharge | Pain/discomfort
SIGNS Discharge | Conjunctival redness | Chemosis | Lid swelling | Preauricular lymphadenopathy
WORK-UP Thorough history and detailed slit lamp examination | Urgent gram stain (chocolate agar, Thayer-Martin) and culture & sensitivity testing
1 g ceftriaxone IM (or IV) | 1 g Azithromycin po (single dose) is usually given to cover for chlamydial co-infection | IM gentamicin or oral gemifloxacin may be used in lieu of ceftriaxone in the case of cephalosporin allergy.
Topical fluoroquinolone (i.e. Vigamox) 1 gtt q1h in the affected eye.
FOLLOW-UP Daily until consistent improvement, then every few days.
ADDITIONAL LAB | TESTS Gram stain (chocolate agar, Thayer-Martin) and culture & sensitivity testing
ETIOLOGY Neisseria gonorrhoeae
DIFFERENTIAL DX Chlamydial conjunctivitis (Adult Inclusion Conjunctivitis) | Epidemic keratoconjunctivitis | Pharyngoconjunctival fever
NOTES In neonates, referred to as gonococcal ophthalmia neonatorum | Sexual partner(s) should be notified and evaluated | Neisseria gonorrhoeae is able to penetrate an intact cornea.