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].

• Pneumonia

  Chlamydia pneumonia, not conjunctivitis, is the most serious consequence of neonatal C. trachomatis infection (4). The pneumonia is usually mild and deaths attributed to chlamydial pneumonia have not been reported (5). [hawaii.edu]

  Other bacteria The most commonly identified gram-positive organisms include Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus viridans, and Staphylococcus epidermidis. [emedicine.medscape.com]

  Other bacteria that can cause neonatal conjunctivitis include Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae. 2 In children, bacterial conjunctivitis is most often caused by H influenzae or S pneumoniae, which accounted for [mdedge.com]

  The underlying causes of conjunctivitis are variable but bacterial bacterial conjunctivitis is developed due to some kind of infection caused by some kind of staphylococcus aureus, streptococcus pneumoniae or hemophilus influenzae etc. [healthcaretip.com]

• Pharyngitis

  Cultures of pharyngeal, rectal, and genital specimens on selective media excluded infection at other sites. Detailed social evaluation revealed no evidence or suspicion of sexual abuse. [ncbi.nlm.nih.gov]

  Wallin, J., Siegel, M.S.: Pharyngeal Neisseria gonorrhoeae: coloniser or pathogen? Br. Med. J. 1, 1462–1463 (1979) PubMed CrossRef Google Scholar 16. Wiesner, P.J.: Gonococcal pharyngeal infection. Clin. Obstet. [link.springer.com]

  The place, if any, of pharyngeal carriage as a reservoir for transmission does need to be further considered. [health.gov.au]

  Exudative pharyngitis is rare. Symptoms of pharyngeal infection may include pharyngitis, tonsillitis, fever, and cervical adenitis. Ocular Infection Gonococcal infection of the eye, when it does occur, typically presents as conjunctivitis. [std.uw.edu]

  Other gonococcal eye infection A54.4 Gonococcal infection of musculoskeletal system A54.41 Gonococcal spondylopathy A54.42 Gonococcal arthritis A54.43 Gonococcal osteomyelitis A54.49 Gonococcal infection of other musculoskeletal tissue A54.5 Gonococcal pharyngitis [icd10data.com]

• 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]

  injection OU, follicular reaction involving the bulbar conjunctiva and semilunar folds, absence of conjunctival membrane. [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]

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

  "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]

  […] 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]

  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

  Conjunctivitis varies in severity from mild hyperemia with epiphora (tearing) to subconjunctival hemorrhage or chemosis (conjunctival edema) with copious purulent discharge and concomitant eyelid edema. [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 [amboss.com]

  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]

  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]

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].

A treatment schedule for acute gonococcal conjunctivitis is presented. [ncbi.nlm.nih.gov]

Principles of Therapy Treatment is basically based on the clinical picture & laboratory diagnosis Infants should be hospitalized to monitor response to treatment especially those w/ septic neonatal conjunctivitis Systemic treatment is usually given rather [specialty.mims.com]

The format includes the CPT codes for billing purposes, short description of the condition, etiology/incidence, course/prognosis, laboratory findings, differential diagnosis; prophylaxis, treatment (local and systemic, surgical or other), miscellaneous [books.google.de]

[…] 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 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: 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 [ 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]

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]

The format includes the CPT codes for billing purposes, short description of the condition, etiology/incidence, course/prognosis, laboratory findings, differential diagnosis; prophylaxis, treatment (local and systemic, surgical or other), miscellaneous [books.google.de]

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]

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]

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]

References: [18] [19] Non-infectious conjunctivitis Ocular cicatricial pemphigoid ( OCP ) Etiology : autoimmune Epidemiology : predominantly affects older women Pathology : subepithelial blistering with subsequent scarring Symptoms/Clinical features Paroxysmal [amboss.com]

Mothers of affected infants were found to have inclusions in their cervical epithelial cells, fathers of such infants had inclusions in their urethral cells, and the epidemiology of sexually transmitted chlamydial infections was revealed. [histopathology-india.net]

Epidemiology… The risk of corneal complications from ophthalmia neonatorum ishigher among the poor. Between 1,000 and 4,000 infants are blinded each year. 5. [slideshare.net]

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]

Early diagnosis and speedy treatment is extremely important to prevent permanent complications from hyperacute Adult Gonococcal Conjunctivitis. The underlying health factors also require treatment. [dovemed.com]

[…] solution (2.5%) is effective in preventing neonatal ophthalmia. [emedicine.medscape.com]

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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.