Gonococcal Conjunctivitis

7 sources cited
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What is Gonococcal Conjunctivitis (Pink Eye)?

Gonococcal conjunctivitis (GC) is a type of bacterial conjunctivitis, or "pink eye." It's caused by the bacteria Neisseria gonorrhoeae.

It usually affects 2 groups of people:

  • Newborns
  • Sexually active adults

This eye infection is rare. A study conducted in 2 Dublin hospitals showed a prevalence of 0.19 cases per 1000 eye emergency attendees.7 The majority of these cases occurred in young males.

Images of Gonococcal Conjunctivitis
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GC is most commonly associated with the STD gonorrhea. If left untreated, it can lead to serious health problems.

For example, GC may scar the conjunctiva (the outer membrane of the eyeball). This scarring can result in irregularities in the tear film.

In other cases, the infection can spread to the cornea, causing blindness or meningitis.

However, GC is treatable. Early identification and treatment can lessen the risk of more serious health problems.

What Causes Gonococcal Conjunctivitis?

GC is caused primarily by unprotected sex. Babies can contract neonatal conjunctivitis through contact with the birth canal during delivery.

For everyone else this type of transmission may be due to 2 reasons:

  • Autoinoculation is when an infection in one area of the body (genitals) spreads to other areas of the same body (eyes).
  • Inoculation is spreading the infection to a sexual partner.

Gonococcal conjunctivitis via inoculation is a sexually transmitted infection (STI) like chlamydia or hepatitis B.

Gonococcal bacteria usually don't live for more than a few minutes outside the body.

Symptoms of Gonorrhea Conjunctivitis 

The infection has an incubation period of 3 to 19 days. This means someone may not show signs or symptoms until at least 3 days after contracting the infection.

Infection symptoms include:

  • Chemosis (swelling of the conjunctiva)
  • Purulent discharge (stringy, mucus-like white or yellow substance around the eyes)
  • Eyelid swelling
  • Conjunctival infection (red eyes) 

If someone has any of these symptoms, they should promptly consult an eye doctor. If symptoms are severe or reappearing, samples can be tested in a laboratory for confirmation.

When the infection is severe, general health can worsen. For example, swelling of the eyelids may restrict eye movements.

This may cause a misdiagnosis of orbital cellulitis (infection of the soft tissue and fat in the eye socket). Ulcerative keratitis may also occur, leading to corneal perforation.

Risk Factors of Gonococcal Conjunctivitis

Different risk factors exist for gonococcal conjunctivitis, including:

  • Unprotected sex
  • Wearing contact lenses (bacteria can remain on these surfaces)
  • Having a compromised immune system
  • Prior ocular disease
  • History of STIs/STDs
  • Alcohol misuse or recreational drug use

In the United States (U.S.), specific estimates of gonococcal conjunctivitis are not well studied. STI surveillance places the number of cases of gonorrhea at around 146 per 100,000 U.S. inhabitants

Gonococcal Conjunctivitis Treatment & Management

GC requires prompt antibiotic therapy. If it goes untreated, corneal perforation, blindness, and other severe conditions can result.

The type of antibiotic(s) needed depends on whether the person is treated on an inpatient or outpatient basis.

Outpatient antibiotics include:

  • Ceftriaxone
  • Azithromycin

High-risk cases require inpatient treatment.

Medication used here includes:

  • Cefoxitin
  • Ceftriaxone
  • Cefotaxime
  • Spectinomycin

Health care providers can administer antibiotic eye drops to prevent GC in newborns.

Examples of steps someone can take to maintain good eye health and recover faster include:

  • Washing the eyelid and applying warm, wet compresses 
  • Frequent use of hand sanitizers
  • No swimming in pools
  • Avoidance of contact between the infected and healthy eye

In any case, it's always best to consult a medical care provider.

7 Cited Research Articles
  1. Belga Sara, et al. "Gonococcal Conjunctivitis in Adults: Case Report and Retrospective Review of Cases in Alberta, Canada, 2000-2016."
  2. Costumbrado, John. "Gonococcal Conjunctivitis." 14 Sept. 2020.
  3. Lee, J S, et al. "Gonococcal Keratoconjunctivitis in Adults." 27 Aug. 2002.
  4. Roat, Melvin I. “Infectious Conjunctivitis - Eye Disorders.Merck Manuals Consumer Version, Merck Manuals, Dec. 2019.
  5. Sexually Transmitted Diseases (STDs).Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 Oct. 2019.
  6. "Gonococcal Conjunctivitis - an Overview | ScienceDirect Topics." ScienceDirect.\
  7. McAnena, L et al. “Prevalence of gonococcal conjunctivitis in adults and neonates.” Eye (London, England) vol. 29,7 : 875-80. doi:10.1038/eye.2015.57
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