Gonococcal Conjunctivitis Despite Successful Treatment of Male Urethritis Syndrome

Abstract

We report a case of progressive, cephalosporin-susceptible, Neisseria gonorrhoeae conjunctivitis despite successful treatment of male urethritis syndrome. We hypothesize that conjunctival infection progressed due to insufficient penetration of cefixime and azithromycin and point out that extragenital infection and male urethritis may not be cured simultaneously in settings where the syndromic approach is used.

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

“…8 Topical steroids and/or corneal surgery may also be used if corneal injury persists or progresses despite antibiotics. 9,10 Clinicians should consider gonococcal conjunctivitis in sexually-active adolescents with ocular symptoms and in adolescents presenting with urogenital STI. While the vast majority of conjunctival exposures become symptomatic, the incubation period from N. gonorrhea exposure to ocular symptoms varies from three to 19 days compared to two to seven days for urogenital gonorrhea.…”

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

“…Ceftriaxone resistance is rare but has also been recorded. 11 It has been reported that insufficient penetration of some drugs such as cefixime and azithromycin in the conjunctiva may also result in the lack of a treatment effect. 3 Longer treatment times may help to achieve better effects, and the course depends on the recovery of clinical symptoms.…”

“…GC in adults is generally thought to result from auto-inoculation of infected genital secretions through hand contact or contaminated towels from the patient or his/her partner. GC is often associated with STIs but can also present without evidence of concomitant genital infection, 2 or present despite successful treatment of urethritis syndrome. 3 GU and chlamydia are the most frequently reported STIs in developed countries, and concurrent treatment for chlamydia is now part of the recommended treatment regimen for GU 4,5.…”