Gonococcal Conjunctivitis: A Case Report of an Unusual Mode of Transmission

<p>Gonococcal conjunctivitis after incomplete treatment of gonococcal urethritis</p>

“…GC typically presents with severe unilateral eyelid swelling, conjunctival chemosis, and hyperacute purulent discharge, as was the case with our patient, and may be complicated by uveitis or severe keratitis, sometimes leading to corneal ulceration and scarring, or even severe complications such as visual impairment or blindness. 6 The incubation period from N. gonorrhoeae exposure to ocular symptoms varies from 3 to 19 days. 7 In our case, the symptoms of GC developed 10 days after the onset of urethritis in spite of an improvement in urethral symptoms after the intermittent treatment of oral levofloxacin.…”

“…10 Interestingly it is reported that about 50% of the patients with gonorrhea are also infected with C. trachomatis. 4 Even if C. trachomatis testing is negative, azithromycin is recommended for possible chlamydia infection together with ceftriaxone for gonococcal infection. 7 Although in our case, microbial culture revealed that the bacteria were moderately susceptible to levofloxacin, the irregular use of levofloxacin resulted in a reduction in urethral secretions but the new emergence of a secondary eye infection.…”

“…After systematic application of ceftriaxone for 7 days, the conjunctiva was still red, so clinical recovery had not been achieved. Although the Centers for Disease Control and Prevention currently recommends only a single dose of ceftriaxone for GC, 7 our patient took a two-week course of dual therapy for GC with cephalosporin and azithromycin for chlamydia. For our patient, topical treatment alone was inadequate and unnecessary when systemic treatment was given.…”

“…For our patient, topical treatment alone was inadequate and unnecessary when systemic treatment was given. 8 Since fluoroquinolone resistance has become a growing issue, it is no longer recommended for empiric treatment 7,11. Ceftriaxone resistance is rare but has also been recorded.…”

“…Whereas, GU is transmitted through unprotected sexual behavior. In recent years, there have been increasing reports about adolescents having oral sex without condom usage, especially among men who have sex with men (MSM) 7,8. There is also evidence from a systematic review for the non-sexual transmission of infections via communal baths, shared towels, rectal thermometers, and care-giver hands.…”