Conjunctivitis gonococcal

Chlamydia trachomatis can cause a variety of diseases in humans, for example trachoma, conjunctivitis and non-gonococcal urethritis. It is sensitive to the rifampicins, the tetracyclines and erythromycin. 

Hyperacute bacterial conjunctivitis is associated with gonococcal infections in sexually active patients. The causative agents are Neisseria gonorrhoeae or N. meningitidis. Prompt work-up and treatment is required, as corneal perforation occurs in 10% of cases within 48 hours.12 An ophthalmologist should complete a conjunctival scraping and susceptibility testing.10... 

For prophylaxis of ophthalmia neonatorum, various groups have proposed the use of erythromycin (0.5%) or tetracycline (1%) ophthalmic ointment in lieu of silver nitrate. Although silver nitrate and antibiotic ointments are effective against gonococcal ophthalmia neonatorum, silver nitrate is not effective for chlamydial disease and may cause a chemical conjunctivitis. 

A fixed-combination ointment containing oxytetracy-cline and polymyxin B is available for topical ocular use (see Table 11-6). The Centers for Disease Control and Prevention recommends ophthalmic ointments containing a tetracycline or erythromycin as an effective alternative to silver nitrate for prophylaxis of gonococcal ophthalmia neonatorum. A major advantage of using an antibiotic ointment such as oxytetracycline-polymyxin B is that it does not canse the chemical conjunctivitis typically produced by silver nitrate. 

Severe infection such as gonococcal conjunctivitis requires systemic therapy, which may be used in conjunction with topical agents. Treatment of viral infections often is directed at relieving patient symptoms, because specific antiviral agents do not currently exist in most cases. Chlamydial disease requires systemic therapy frequently combined with adjunctive topical therapy. 

Gonococcal conjunctivitis usually is unilateral and progresses rapidly, often with periocular involvement. 

Neisseria gonorrhoeae Ophthalmia Neonatorum. Gonococcal neonatal conjunctivitis is characterized by the neonate s development of hyperacute conjunctivitis between 2 and 5 days postpartum. Most cases of neonatal gonococcal conjunctivitis are bilateral periorbital edema, chemosis, and purulent exudate are prominent (Figure 25-18). 

Prevention. The best method for preventing neonatal conjunctivitis is the diagnosis and treatment of infections in pregnant women through appropriate prenatal care. In 1881 Crede first described the advantage of silver nitrate prophylaxis for the prevention of gonococcal infection. Since that time the incidence of infection from... 

Culture is considered the most reliable means of diagnosing gonococcal infections. Anatomic sites to be cultured depend on the individual s sexual preferences and body areas exposed. In women, because the urethra and other sites are rarely the sole locus of infection, cervical cultures produce the highest yield and frequently are performed in conjunction with rectal cultures. Urethral cultures are recommended in women who have had hysterectomies and heterosexual men. In MSM, anorectal cultures generally produce the highest yields, and pharyngeal and urethral cultures are considered optional. ° " ... 

A negative test result does not exclude the possibility of gonococcal infection because test results may be affected by improper specimen collection. Results from the Gen-Probe PACE 2 assay should be interpreted in conjunction with other laboratory and clinical data. 

Though silver nitrate causes chemical conjunctivitis in about 90% of the infants in the first 24 hours of life, obvious conjunctivitis is rare after this period. The chemical conjunctivitis does not increase the risk of secondary infection, nor does it mask bacterial infection. Rinsing will not prevent the development of conjunctivitis. Discontinuation of the prophylactic use of silver nitrate appears to result in a significant rise of gonococcal ophthalmia neonatorum in high-risk populations. 

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