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].

• Sepsis

  Do the full sepsis work-up. Rationalize that, in the ED, there is not a clinical way to determine whether you are dealing with GC and because of the potential concerns, cover all of your bases. This is the most conservative certainly. [pedemmorsels.com]

  Alternative pathway complement activation: a possible mechanism inducing skin lesions in benign gonococcal sepsis. Br. J. Dermatol. 95, 303–309 (1976) PubMed CrossRef Google Scholar 13. [link.springer.com]

  […] culture) PCR también está disponible y de hecho es el método más eficaz, pero no se suele usar por costo y disponibilidad Newborns with conjunctivitis are at risk for secondary infections, such as pneumonia, meningitis, and septicemia, which can lead to sepsis [es.slideshare.net]

  Newborns with conjunctivitis are at risk for secondary infections, such as pneumonia, meningitis, and septicemia, which can lead to sepsis and death and thus should be admitted for full workup and treatment. [emedicine.medscape.com]

  (Outcomes/Resolutions) Acute Conjunctivitis triggered by neisseria bacteria has a potential to cause blindness and even life-threatening illnesses, such as meningitis and sepsis; if the condition is not quickly diagnosed, and suitably managed With early [dovemed.com]

• Chronic Infection

  (Predisposing Factors) The risk factors for Adult Gonococcal Conjunctivitis, which is a rare type of infectious Conjunctivitis affecting adults, include: Contact with a person affected by the infection, or the use of infected (shared) items This infection [dovemed.com]

  Left untreated, chlamydia conjunctivitis will subside within 2-3 weeks, but chronic infection is common. Chlamydia pneumonia is the most serious consequence of neonatal C. trachomatis infection. [hawaii.edu]

  Ocular Chlamydial Infections Ocular Chlamydia trachomatis infection can occur in two distinct clinical forms: trachoma (associated with serotypes A through C) and inclusion conjunctivitis (associated with serotypes D through K). 12 Trachoma, a chronic [aafp.org]

• Malaise

  Serious problems Acute glaucoma : reduced visual acuity, hazy cornea, fixed pupil and systemic malaise. [patient.info]

  Constitutional sx include fever, malaise, nausea and vomiting. [hopkinsguides.com]

• Pallor

  Dilated fundus exam (DFE): No pallor or edema of either disc. [webeye.ophth.uiowa.edu]

• Ulcer

  Moreover, corneal ulceration, as well as perforation, can develop in the absence of early therapy. [symptoma.com]

  Gonococcal conjunctivitis can be a severe disease with sequelae of corneal ulceration, hypopyon, and global perforation. Current recommended therapy is hospitalization and repeated courses of parenteral antibiotics. [ncbi.nlm.nih.gov]

  Corneal ulceration May be caused by trauma (including foreign body) or herpes simplex infection. Visible after fluroscein staining. If traumatic apply chloramphenicol ointment and review in 24 hours. If dendritic ulcer contact ophthalmology. [rch.org.au]

  It can also penetrate an intact corneal epithelium which increases the risk of ulceration and corneal infection. [optometrist.com.au]

  Long persistance of gonorrheal conjunctivitis may lead to corneal ulcer or damages deep tissues of eyes. Eye redness may incrase with passage of time Pus like fluid may produce may produce in some cases. [healthcaretip.com]

• Erythema

  Classic neonatal gonococcal ophthalmia usually manifests during the first week of life with a purulent ocular discharge accompanied by periorbital edema and erythema. [ncbi.nlm.nih.gov]

  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. [symptoma.com]

  Clinical Difficult to know cause on clinical ground only Significant overlap in presentation Main findings are erythema, chemosis & purulent eyedischarge Therefore Lab studies are Important 16. [slideshare.net]

  Erythema of the eyelid was seen in 85% of patients. 2.1.3. Complications of bacterial conjunctivitis Bacterial keratitis is a well known but rare complication of bacterial conjunctivitis [ 11 ]. [intechopen.com]

  Orbital cellulitis : systemic malaise with red eye, blurred vision, headache, diplopia, eyelid oedema and erythema, restricted ocular motility and pain on movement. The sinuses are often involved. Requires urgent admission. [patient.info]

• Chemosis

  Clinical Difficult to know cause on clinical ground only Significant overlap in presentation Main findings are erythema, chemosis & purulent eyedischarge Therefore Lab studies are Important 16. [slideshare.net]

  Symptoms of both are bilateral, intense papillary conjunctivitis with eyelid edema, chemosis, and mucopurulent discharge. [merckmanuals.com]

  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]

  The inflammation of the conjunctiva may cause blood vessel dilation, potentially dramatic chemosis, and excessive secretion. [es.slideshare.net]

• Photophobia

  Iritis Presents with pain, photophobia, blepharospasm and lacrimation. Pupil may be small and poorly reactive. May occur in association with juvenile chronic arthritis. Contact ophthalmology. [rch.org.au]

  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 [symptoma.com]

  There may be mild photophobia. Significant photophobia suggests severe adenoviral conjunctivitis or corneal inflammation. History Ask about contact lens wear: establish whether this could affect the cornea. [patient.info]

  […] general practice, and is often diagnosed and treated as bacterial conjunctivitis. 3 We were referred a 76-year-old male patient with severe bilateral conjunctivitis, unresponsive to treatment with topical chloramphenicol and fusidic acid. 4 He developed photophobia [bjgp.org]

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

• Blurred Vision

  Blurred vision – if you are experiencing blurred vision, then you need to meet up with your doctor and get yourself checked out as soon as possible. Your doctor would run a few tests and identify the underlying cause for the blurred vision. [findatopdoc.com]

  This discharge may also cause the vision to blur. Vision improves when the discharge is blinked away. If the cornea is infected, vision also blurs but does not improve with blinking. [merckmanuals.com]

  History of Present Illness: 23-year-old healthy white male presented with 6-week duration of red eyes associated with mild discharge, foreign body sensation, tearing, blurred vision, and swollen eye lids. [webeye.ophth.uiowa.edu]

  Sticky eyelids, which are difficult to keep open Eye pain and eyelid inflammation (usually severe); with gritty feeling of sand-like particles inside the eye Blurred vision Swollen lymph nodes in front of the ears Burning sensation, stinging pain while [dovemed.com]

  vision Entropion or ectropion Diagnosis Primarily a clinical diagnosis Slit-lamp examination Also see Sjögren's syndrome Treatment References: [1] [20] [21] [22] [23] [24] [25] [26] [amboss.com]

• Irritability

  Eye Irritants If you’re exposed to smoke, chemical fumes, or other irritants, you may develop a type of conjunctivitis that is not contagious. [nyulangone.org]

  […] to smoke or fumes and this can cause an irritation of the conjunctiva with discomfort, redness and watering. [netdoctor.co.uk]

  Conjunctivitis caused by an irritant often clears up by eliminating the irritant. If you develop conjunctivitis and you wear contacts, stop using them temporarily until the conjunctivitis resolves. [hertzogfamilyeyecare.com]

  A common non-external source is trapped eyelashes, which continually irritate the conjunctiva. Treatment of irritant conjunctivitis is thorough cleansing of the eye and removing the irritant. 2. [intechopen.com]

  Chemical irritants, Neisseria gonorrhoeae, and Chlamydia trachomatis are the most common causes. [hawaii.edu]

• Vaginal Discharge

  Symptoms of cervicitis vary and may include a nonspecific vaginal discharge, intermenstrual bleeding, dysuria, lower abdominal pain, and dyspareunia. [std.uw.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].

• Streptococcus Pneumoniae

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

  Acute bacterial conjunctivitis caused by Streptococcus pneumoniae. FIGURE 5. Acute bacterial conjunctivitis caused by Streptococcus pneumoniae. [aafp.org]

  The following are the most common causes: Bacteria, including: Staphylococcus aureus Haemophilus influenza Streptococcus pneumoniae Neisseria gonorrhea Chlamydia trachomatis Viruses, including: Adenoviruses Herpes virus Chemicals (seen mostly in the newborn [stanfordchildrens.org]

  Neonatal conjunctivitis is less frequently attributable to other bacteria such as Pseudomonas aeruginosa, Haemophilus, Staphylococcus aureus and Streptococcus pneumoniae, or to herpes simplex. The infection occurs at birth. [alpfmedical.info]

• Gram-Positive Bacteria

  […] treatment of associated pneumonitis & also being more effective than topical in preventing relapse of conjunctivitis A second course of treatment may be required thus monitoring the response to treatment is necessary Also used for treatment of other gram-positive [specialty.mims.com]

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.