congenital gonorrhoea infection is acquired intrapartum, and it leads to ophthalmia neonatorum
gonococcal ophthalmia neonatorum presents with a severe conjunctivitis and keratitis usually in the first 48 hours of life. There may be purulent discharge. If untreated blindness may result. It is frequently bilateral (1)
also, there can be disseminated neonatal gonorrhoea infection
diagnosis is by Gram stain smear and culture of conjunctival discharge
treatment involves both topical (e.g. chloramphenicol eye ointment) and intramuscular benzylpenicillin. In view of increasing antimicrobial resistance, the following alternative options may need to be considered (2):
ceftriaxone IV or IM as a single dose OR
cefotaxime as a single dose
frequent conjunctival irrigation with saline is recommended (2)
both parents of the child should also be assessed
ocular prophylaxis is no longer routinely administered in the UK, though it is still given in parts of the USA and third world where incidence rates are higher.
in cases where the infant is born to those with known gonorrhoea then prophylactic treatment IM benzylpenicillin 30mg/kg stat and chloramphenicol eye ointment is initiated within the first hour after birth
A review suggests (3):
consider neonatal conjunctivitis in all infants presenting with eye discharge within the first 4 weeks of life
carefully examine the conjunctiva: if red, refer to hospital eye services for same day review
NICE recommends urgent referral to ophthalmology for all cases of "sticky eye with redness in a neonate"
investigations and treatment for suspected neonatal conjunctivitis in primary care are not necessary and may interfere with subsequent microbiology sampling
eye discharge with normal conjunctiva is likely due to congenital nasolacrimal duct obstruction
Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page