Gonococcal Conjunctivitis

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What is Gonococcal Conjunctivitis (Pink Eye)?

Gonococcal conjunctivitis (otherwise known as “pink eye”) is an ocular infection caused by Neisseria gonorrhoeae. It primarily affects two groups of the general population, namely neonates (newborns) and sexually active adults. 

While the infection is rare, it can lead to serious health problems when left untreated. For example, gonococcal conjunctivitis may scar the conjunctiva (the mucous membrane that covers the exterior part of the eye and borders the eyelids’ interior area). This scarring can result in irregularities in the tear film (helps to manage tear production and protect the cornea). 

In other cases, this type of conjunctival infection may spread to the cornea and contribute to blindness or even lead to systemic infections like meningitis. 


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However, gonococcal conjunctivitis is treatable. Early identification and effective management can lessen the risk of unwanted health problems, such as vision loss.

What Causes Gonococcal Conjunctivitis?

Gonococcal conjunctivitis (GC) arises when the individual has been in contact with N. gonorrhoeae-infected urine or genital secretions. 

For example, neonatal conjunctivitis of this kind may occur during birth delivery. 

For all other individuals, this type of transmission may be due to two reasons. The first may be autoinoculation (when infection in one area of the body spreads to other areas of the same body). The second may be inoculation (introducing the bacteria into the body to stimulate a response from the immune system) of infected genital secretions from a sexual partner. 

In the latter example, gonococcal conjunctivitis is a sexually transmitted infection (STI) like chlamydia or hepatitis B.

The bacteria N. gonorrhoeae will not usually live longer than a few minutes when outside the body. 

Lastly, some evidence has suggested that different strains of gonococci unrelated to STIs may cause gonococcal conjunctivitis.

Symptoms of Gonorrhea Conjunctivitis 

A gonococcal infection has an incubation period of 3 to 19 days. This means that individuals may not show signs or symptoms of the infection until at least three days have passed from the time of transmission. 

Similarly, ocular symptoms related to the infection will follow urethral symptoms for about one to several weeks. 

An ophthalmology consultation may be necessary to determine if an individual has bacterial conjunctivitis of this kind. If symptoms are severe or reappearing, samples of infected secretions may be tested in a laboratory for confirmation.  

When individuals have gonococcal conjunctivitis, symptoms can quickly progress. Some symptoms of this ocular infection include:

  • Chemosis (swelling of the conjunctiva) 
  • Purulent discharge (stringy, mucus-like discharge that is white or yellow in color)
  • Eyelid swelling
  • Conjunctival injection (red eyes) 

When the infection is severe, general health can worsen. For example, swelling of the eyelids may restrict extraocular movements (how the eye moves) and result in a misdiagnosis of orbital cellulitis (infection of the soft tissue and fat that maintains the eye in the socket). Ulcerative keratitis may also occur, leading to corneal perforation. 

A delay in diagnosing gonococcal conjunctivitis may happen because genitourinary symptoms are subtle or absent. 

Risk Factors of Gonococcal Conjunctivitis

Different risk factors exist for gonococcal conjunctivitis, including:

  • Exposure to infected urinary or genital secretions — the risk of exposure to such secretions can increase when individuals maintain sexual contact with multiple partners or have unprotected sex. 
  • Contact lens wear — due to the synthetic material of contact lens, bacteria can more easily remain on these surfaces. 
  • Being immunodeficient or immunosuppressed — individuals with this type of immune state are much more susceptible to infections than individuals with a healthy immune system. 
  • Prior ocular disease — previous infections can increase the risk of secondary infections occurring more easily. 
  • History of STIs — an untreated STI may, in some cases, cause inflammation of mucosal areas and make it easier for the bacteria to enter the tissue. 
  • Young age — approximately half of all STIs occur in individuals aged 15 to 24. 
  • Alcohol misuse or recreational drug use — using drugs or misusing alcohol can influence cognitive skills and impair better judgement. This means that individuals can be more susceptible to partaking in risky behaviors. 

In the United States (U.S.), specific estimates of gonococcal conjunctivitis have yet to be well studied. However, STI surveillance places the number of cases of gonorrhea at approximately 146 per 100,000 U.S. inhabitants. 

Gonococcal Conjunctivitis Treatment & Management

Gonococcal conjunctivitis requires prompt and adequate antibiotic therapy. Disease severity at the time of treatment can influence the outcome of the infection. 

When gonococcal conjunctivitis is not appropriately treated, it can even cause corneal perforation, blindness, and other severe medical conditions. 

Less severe cases in adults may be treated on an outpatient basis with ceftriaxone and azithromycin. High-risk cases may require hospitalization and treatment with antibiotics such as cefoxitin, ceftriaxone, cefotaxime, or spectinomycin. 

Health care providers administer silver nitrate eye drops or topical erythromycin ointment to prevent conjunctivitis in neonates.  

Additionally, individuals with gonococcal conjunctivitis can take some steps to maintain good eye health and ensure a faster, safer recovery. Some examples include:

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

In any case, it is always best to consult a medical care provider or an infectious disease specialist.

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Author: Anthony Armenta | UPDATED November 20, 2020
Medical reviewer: MELODY HUANG, O.D. 
Resources

Belga S;Gratrix J;Smyczek P;Bertholet L;Read R;Roelofs K;Singh AE; Gonococcal Conjunctivitis in Adults: Case Report and Retrospective Review of Cases in Alberta, Canada, 2000-2016. www.pubmed.ncbi.nlm.nih.gov/30044333/.

Costumbrado, John. Gonococcal Conjunctivitis. 14 Sept. 2020, www.ncbi.nlm.nih.gov/books/NBK459289/.

Lee, J S, et al. Gonococcal Keratoconjunctivitis in Adults. 27 Aug. 2002, www.nature.com/articles/6700112.

Roat, Melvin I. “Infectious Conjunctivitis - Eye Disorders.” Merck Manuals Consumer Version, Merck Manuals, Dec. 2019, www.merckmanuals.com/home/eye-disorders/conjunctival-and-scleral-disorders/infectious-conjunctivitis.

“Sexually Transmitted Diseases (STDs).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 Oct. 2019, www.mayoclinic.org/diseases-conditions/sexually-transmitted-diseases-stds/doctors-departments/ddc-20351248.

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