Gonorrhea is one of the most frequent sexually transmitted diseases (STDs) encountered in clinical practice, and ocular infections are one of the possible manifestations [1] [2] [3]. Gonococcal conjunctivitis is primarily diagnosed in the neonatal population who contract the bacteria from the infected secretions of the cervix during birth [1] [4]. In most cases, symptoms in the form of nonspecific redness and serous discharge are followed by prominent eyelid erythema, purulent discharge and conjunctival swelling (chemosis) after an incubation period of about 2-6 days from delivery [1] [4] [5]. Without early recognition, gonococcal conjunctivitis in neonates might lead to ophthalmia neonatorum, a severe form of infection in which scarring and ulceration of the cornea can develop within 24 hours, whereas panophthalmitis, formation of synechiae, perforation of the globe, and even blindness are reported in severe cases [1] [5] [6]. In adults, gonococcal conjunctivitis is usually a result of autoinoculation or orogenital contact, and the clinical presentation ranges from mildly symptomatic to marked light sensitivity (photophobia) and significant purulent exudation of the affected eye [4] [5]. Furthermore, the eye is reported to be extremely painful, and similarly to the neonatal presentation, severe conjunctival swelling and hyperemia are observed. Moreover, corneal ulceration, as well as perforation, can develop in the absence of early therapy [4] [5].

• Galactorrhea

  […] anthracis anthrax Bacteroides species abscess Bordetella pertussis whooping cough Borrelia burgdorferi Lyme disease Campylobacter species… … Universalium List of diseases (G) — A list of diseases in the English wikipedia.DiseasesTOC G* G syndromeGaGal Gap* Galactorrhea [medicine.academic.ru]

• Calcinosis Cutis

  cutis (see also CREST… … Wikipedia Types of bacteria that cause disease in humans — Table Types of bacteria that cause disease in humans bacteria primary diseases in humans bacillus anthracis anthrax Bacteroides species abscess Bordetella pertussis whooping [medicine.academic.ru]

• Conjunctival Injection

  All patients presented with unilateral conjunctival injection and purulent discharge. Eight cases had visual impairment at presentation and their mean visual acuity was 6/15. Corneal involvement was present in 25% of patients. [ncbi.nlm.nih.gov]

  Slit-lamp examination demonstrated bilateral intense conjunctival injection, chemosis, diffuse conjunctival vessel dilatation, with small subconjunctival haemorrhages. There were copious purulent exudates with evidence of early keratitis. [bjgp.org]

  Contact ophthalmology Trauma Consider if hyphema or focal conjunctival injection. Consider penetrating injury (see penetrating eye injury guidelines). Contact ophthalmology. [rch.org.au]

  Figure 2 2A: Conjunctival injection, follicles, and chemosis were evident. 2B: Magnified view of the palpebral conjunctiva. Course: Conjunctival scrapings were obtained and sent for culture. Growth of Chlamydia trochomatis resulted. [webeye.ophth.uiowa.edu]

• Foreign Body Sensation

  • Eye irritation • Foreign body sensation inside the eye • Red eye • Affected eye may be difficult to open due to the sticky discharge. • In severe cases, peripheral subepithelial corneal infiltrates may be present which can result in marginal ulceration [optometrist.com.au]

  Symptoms include lacrimation, mild foreign body sensation, and lid fullness. Histologically, an exudates of neutrophils and monocytes develop in one or both eyes, with edema and congestion of the lids. [histopathology-india.net]

  Other classic features are burning, foreign body sensation, excessive tearing, and photophobia. [amboss.com]

  Patients complain of pink/red eye, mucous discharge, crusting of lashes, lids stuck together, swollen lids, tearing, photophobia, foreign body sensation, and decreased vision. [webeye.ophth.uiowa.edu]

  The symptoms of chronic bacterial conjunctivitis vary and can include itching, burning, a foreign-body sensation and morning eyelash crusting. [aafp.org]

• Blepharitis

  […] right upper eyelid H01002Unspecified blepharitis right lower eyelid H01003Unspecified blepharitis right eye, unspecified eyelid H01004Unspecified blepharitis left upper eyelid H01005Unspecified blepharitis left lower eyelid H01006Unspecified blepharitis [cms.gov]

  […] risk; more so if they have multiple sexual partners, and do not practice safe sex (lack of condom usage) Bacterial Conjunctivitis may also be associated with inflammatory diseases like sinusitis and immunodeficiency conditions Eye disorders such as blepharitis [dovemed.com]

  "Blepharitis: current strategies for diagnosis and management". Can J Ophthalmol. 43 (2): 170–79. doi:10.3129/i08-016. PMID 18347619. Bradley JC, Yang W, Bradley RH, Reid TW, Schwab IR (July 2010). "The science of pterygia". [en.wikipedia.org]

  Mild itching can also be a feature of blepharitis, dry eyes and, occasionally, bacterial or viral conjunctivitis. [aafp.org]

  Definition : disease of the eye surface caused by underproduction or changes in the composition of lacrimal fluid or by increased evaporation Epidemiology Very common in the US, especially 40 years Etiology Environmental factors Often associated with blepharitis [amboss.com]

• Excessive Tearing

  Other classic features are burning, foreign body sensation, excessive tearing, and photophobia. [amboss.com]

  They may also have excessive tearing and sensitivity to light. These people may have damage to the epithelium, the layer of cells that covers and protects the cornea. [nyulangone.org]

  Conjunctivitis is usually associated with redness of the white part of the eyes, light sensitivity (photophobia), excessive tearing, ocular discomfort (gritty sensation, itching, burning), and/or discharge. [visionaware.org]

  Enterovirus : Acute hemorrhagic conjunctivitis (AHC): an epidemic form of highly contagious conjunctivitis characterized by sudden onset of painful, swollen, red eyes, with conjunctival hemorrhaging and excessive tearing. [hopkinsguides.com]

  Rarer symptoms associated with simple adenovirus viral conjunctivitis include foreign body sensation, ocular discomfort, excessive tearing and sticky eyelids which are worse in the morning. Herpes simplex conjunctivitis is usually unilateral. [intechopen.com]

• Conjunctival Hyperemia

  Differential Diagnosis for Conjunctival Hyperemia (Red Eye) Because of its location (Fig. 1), the conjunctiva is exposed to numerous microorganisms, potential irritants, and allergens, all of which can cause conjunctivitis. [pedsinreview.aappublications.org]

  Clinical features General signs and symptoms of conjunctivitis Conjunctival hyperemia with dilatation of blood vessels (injection) “pinkeye” Discharge and crust formation Chemosis Foreign-body sensation Photophobia Bacterial vs viral conjunctivitis Bacterial [amboss.com]

  Anterior segment examination often reveals mucous discharge, conjunctival hyperemia, and chemosis. Follicular reaction is a key feature of chlamydial conjunctivitis and typically involves the bulbar conjunctiva and semilunar folds. [webeye.ophth.uiowa.edu]

  Regardless of etiology some features are shared: red eye due to conjunctival hyperemia foreign body sensation discharge eyelids sticking (worse in the morning) Conjunctivitis is termed acute if the duration is Q2. [lifeinthefastlane.com]

• Neurologic Manifestation

  Manifestations of HIV 910 Chapter 77 Gastrointestinal Manifestations of HIV Infection and AIDS 927 Chapter 78 Renal Manifestations of HIV Infection and AIDS 951 Chapter 79 HIV and Endocrine Manifestations 960 Chapter 80 AIDS Associated Malignancies and [books.google.com]

• Sexual Dysfunction

  Dysfunction 1203 Chapter 104 Womens Sexual Dysfunction 1210 Chapter 105 Sexuality Education for Young People 1221 A CultureBound Sex Related Disorder in Indian Subcontinent 1225 Chapter 107 Clinical Services for Sexually Transmitted Infections and HIV [books.google.com]

Because the differential diagnosis of conjunctivitis includes numerous bacterial and viral pathogens, data obtained during history taking and findings from physical examination are essential for including gonorrhea in the differential diagnosis. The mothers who gave birth to possibly infected neonates and other adults showing the symptoms should be inquired about their history of sexual activity, and determine if they were potentially exposed to N. gonorrhoea-infected individuals in recent years. The progression of symptoms, as well as their onset, needs to be evaluated as well, and their observation during the physical exam can significantly narrow the list of potential pathogens. In any case, microbiological testing is necessary to confirm the underlying cause. Ideally, the purulent discharge seen in gonococcal conjunctivitis should be tested by performing a gram stain smear (a basic microbiological method that distinguishes bacteria into gram-positive and gram-negative), which will rapidly identify the typical appearance of gram-negative diplococci and an elevated white blood cell count [1] [3] [6]. In addition, cultivation of the exudate is an effective method to confirm N. gonorrhoea as well, while more advanced methods, such as polymerase chain reaction (PCR) and nucleic acid amplification testing (NAAT) are more commonly used for genitourinary and other types of gonococcal infections [4] [5] [7].

• Bordetella Pertussis

  pertussis whooping cough Borrelia burgdorferi Lyme disease Campylobacter species… … Universalium List of diseases (G) — A list of diseases in the English wikipedia.DiseasesTOC G* G syndromeGaGal Gap* Galactorrhea * Galactocoele * Galactokinase deficiency [medicine.academic.ru]

• Borrelia Burgdorferi

  burgdorferi Lyme disease Campylobacter species… … Universalium List of diseases (G) — A list of diseases in the English wikipedia.DiseasesTOC G* G syndromeGaGal Gap* Galactorrhea * Galactocoele * Galactokinase deficiency * Galactorrhoea Hyperprolactinaemia [medicine.academic.ru]

• Eikenella

  There has been one reported case of Eikenella corrodens neonatal conjunctivitis. [5] Infants of low birth weight and low gestational age with clinical signs of conjunctivitis in the neonatal intensive care unit (NICU) should be evaluated and treated for [emedicine.medscape.com]

All patients responded to treatment, and all six- and 12-hour posttreatment cultures were negative for N. gonorrhoeae. [ncbi.nlm.nih.gov]

[…] herpes simplex virus (HSV), varicella-zoster virus ( VZV ), picornavirus, molluscum contagiosum, HIV (highly contagious) Clinical features See “Clinical features” above Epidemic keratoconjunctivitis Herpes simplex conjunctivitis Diagnosis Treatment Prognosis [amboss.com]

Prognosis: Prognosis of neonatal conjunctivitis is generally good as long as early diagnosis is made and prompt medical therapy is instituted. Most cases of infectious neonatal conjunctivitis respond to appropriate therapy. [nhp.gov.in]

Prognosis of viral conjunctivitis Viral conjunctivitis is extremely contagious and remains so for 14 days, which also is often how long the symptoms remain. The prognosis is very good for viral conjunctivitis. [intechopen.com]

Prognosis [ 11 ] Eyelid and conjunctival lesions tend to resolve over 1-2 weeks. Epithelial keratitis resolves over two weeks and has a good prognosis. Stromal keratitis is more likely to result in corneal scarring. [patient.info]

The etiology of neonatal conjunctivitis can be chemical or microbial. [emedicine.medscape.com]

Galactocoele * Galactokinase deficiency * Galactorrhoea Hyperprolactinaemia * Galactosamine 6 sulfatase deficiency * Galactose 1 phosphate… … Wikipedia Credé procedure — is a medical procedure performed on newborns, associated with protection from the etiologic [medicine.academic.ru]

Traditionally teachings about etiologies: Chemical – day #1, mild conjunctivitis; less common now (less silver nitrate use) GC – days #2-7, SEVERE conjunctivitis; can become disseminated (problem)! [pedemmorsels.com]

Etiology…Herpes simplex can cause neonatal keratoconjunctivitis rare and is associated most often with a generalized herpes simplex infection 14. [slideshare.net]

References: [1] [2] [3] [4] [5] [6] [7] [8] [9] Bacterial conjunctivitis General Etiology : Staphylococc us aureus (most common in adults), Streptococcal pneumoniae, Haemophilus influenzae, Pseudomonas, Haemophilus, and Moraxella catarrhalis Clinical [amboss.com]

Developed for current and future healthcare professionals, the text offers vital coverage of antibiotics and other antimicrobial agents, epidemiology and public health, hospital-acquired infections, infection control, and the ways in which microorganisms [books.google.com]

Epidemiology of ophthalmia neonatorum in Kenya. Lancet 1986;2(8516):1145-9. Galega FP, Heymann DL, Nasah BT. Gonococcal ophthalmia neonatorum: The case for prophylaxis in tropical Africa. [cps.ca]

Epidemiology of chlamydial eye diseases in a mixed rural/urban population of West Germany. Ophthalmology 1986; 93: 757. Google Scholar 16. Olafsen LD, Storvold G, Melby K. [link.springer.com]

fever, lymphadenopathy, pharyngitis See additional features of certain causes below References: [1] [2] [3] [4] [5] [6] Viral conjunctivitis Epidemiology Most common type of conjunctivitis Incidence rises during the late fall and early spring Etiology [amboss.com]

Epidemiologic aspects of the control of penicillinase-producing Neisseri gonorrhoeae. Sex Transm Dis 1988; 15 : 211–216 3 Wan WL, Farkas GC, May WN, Robin JB. The clinical characteristics and course of adult gonococcal conjunctivitis. [nature.com]

Prognosis Usually chronic progression ( 10–30 years from symptom onset to end stage) with periods of remission and exacerbation Individual progression on or off treatment is unpredictable ( long term follow-up is vital) Epidemiology : common in young adults Pathophysiology [amboss.com]

Credé’s contribution to preventive medicine. Am J Dis Child 1971;121(1):1-3. U.S. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR 2010;59(No. [cps.ca]

Preventive Services Task Force (USPSTF) recommended prophylactic ocular topical medication for the prevention of gonococcal ophthalmia neonatorum in all newborns ( grade A recommendation ), noting that there is good evidence that blindness due to gonococcal [uspreventiveservicestaskforce.org]

[…] picture & laboratory diagnosis Infants should be hospitalized to monitor response to treatment especially those w/ septic neonatal conjunctivitis Systemic treatment is usually given rather than topical drugs in order that systemic dissemination may be prevented [specialty.mims.com]

OBJECTIVES AND METHODS: In order to improve primary treatment, prevention, and control of infection caused by these organisms, an analysis of all cases presenting from July 2002 to December 2006 at a major Irish regional teaching hospital was performed [ncbi.nlm.nih.gov]

1. Ng L-K, Martin IE. The laboratory diagnosis of Neisseria gonorrhoeae. Can J Infect Dis Med Microbiol. 2005;16(1):15-25.
2. Mayor MT, Roett MA, Uduhiri KA. Diagnosis and management of gonococcal infections. Am Fam Physician. 2012;86(10):931-938.
3. Shim BS. Current Concepts in Bacterial Sexually Transmitted Diseases. Korean J Urol. 2011;52(9):589-597.
4. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
5. Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e. New York, NY: McGraw-Hill; 2016.
6. Matejcek A, Goldman RD. Treatment and prevention of ophthalmia neonatorum. Can Fam Physician. 2013;59(11):1187-1190.
7. Moore DL, MacDonald NE, Canadian Paediatric Society, Infectious Diseases and Immunization Committee. Preventing ophthalmia neonatorum. Can J Infect Dis Med Microbiol. 2015;26(3):122-125.