Gonococcal Conjunctivitis

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What is Gonococcal Conjunctivitis (Pink Eye)?

Gonococcal conjunctivitis (GC) is a type of bacterial conjunctivitis, or "pink eye." Pink eye is an eye infection caused by a bacteria or virus.

GC is caused by a bacteria (the gram-negative diplococcus Neisseria gonorrhoeae). It usually affects two groups of people:

  • Newborns
  • Sexually active adults

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

Gonococcal Conjunctivitis 1
Gonococcal Conjunctivitis 2

In the first image, you'll see discharge and swollen red eyelids. The patient had a hard time opening their eyes. The second image was taken 3 days after treatment. Discharge and swelling are reduced but still not disappeared. Source

GC is most commonly associated with the STD gonorrhea. It is transmitted through contact with infected genital secretions or urine. Newborns can get it from the birth canal.

Inclusion conjunctivitis is another form of pink eye caused by Chlamydia trachomatis. Doctors will often test to see if patients have coexisting gonorrheal and chlamydial infections.

If left untreated, GC can lead to serious health problems. For example, gonococcal conjunctivitis may scar the conjunctiva. This scarring can result in irregularities in the tear film.

conjunctiva

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. 

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) is caused by contact with N. gonorrhoeae-infected urine or genital secretions. 

Neonatal conjunctivitis of this kind may occur during birth delivery. 

For all other individuals, this type of transmission may be due to two 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.

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. 

Urethral symptoms will usually occur first. These are followed by ocular sysmptoms for about one to several weeks. 

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 infection (red eyes) 

If someone has any of these symptoms, they should schedule a consultation with an eye doctor immediately. If symptoms are severe or reappearing, samples of infected secretions may 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 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 — this risk increases when people maintain sexual contact with multiple partners or have unprotected sex. 
  • Contact lens wear — due to the synthetic material of contact lenses, bacteria can remain on these surfaces. 
  • Being immunodeficient or immunosuppressed — individuals with this type of immune state are much more susceptible to infections. 
  • Prior ocular disease — previous infections can increase the risk of secondary infections occurring more easily. 
  • History of STIs — an untreated STI may make it easier for bacteria to enter tissues. 
  • 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 judgment. 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. 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 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 cause corneal perforation, blindness, and other severe medical conditions

Less severe cases in adults may be treated on an outpatient basis with antibiotics 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 pools
  • Avoidance of contact between the infected and healthy eye

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

Resources
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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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