What is Gonococcal Conjunctivitis?
Gonococcal conjunctivitis, often associated with newborns, is an infectious eye disease that is increasingly affecting people of all age groups. When it appears in newborns, it’s also known as gonococcal ophthalmia neonatorum and is mainly transmitted from the mother during childbirth. In older age groups, this eye infection often results from sexually transmitted infections, although it can occur even without any signs of a genital infection.
It’s crucial to identify and treat this condition because if left untreated, it can have serious consequences, including life-threatening conditions such as meningitis (a severe infection affecting the brain and spinal cord), and lead to other negative outcomes like blindness.
What Causes Gonococcal Conjunctivitis?
GC, which stands for gonococcal conjunctivitis, is an eye infection caused by a type of bacteria known as Neisseria gonorrhoeae. This bacteria is normally associated with sexually transmitted infections.
In newborn babies, the most common way this bacterial infection happens is during childbirth. If the mother has a Neisseria gonorrhoeae infection in her cervix or urethra, they can be passed onto the baby during birth. This can happen even if the birth is via cesarean section (a surgical operation where the baby is taken out through the mother’s abdomen). Despite precautions, about 10% of babies who come into contact with the bacteria during birth can still develop GC.
In groups other than newborns, the infection can be spread through sexual contact. Another potential method is indirect transmission via contaminated objects, although this is much less likely because the bacteria can’t survive outside the human body for more than a few minutes.
There is also evidence to suggest that some cases of GC might be due to specific kinds of this bacteria that are not commonly associated with sexually transmitted infections.
Risk Factors and Frequency for Gonococcal Conjunctivitis
Gonococcal infection in newborns is quite rare worldwide – less than 1% of newborns are affected. This is especially true in developed countries where good healthcare systems allow for regular screenings and adequate treatment options. That said, developing countries tend to have higher incidences of the disease, with up to 5% of pregnant women in certain regions of Africa being infected.
In the United States, 1-2% of newborns have conjunctivitis, and less than 1% suffer from gonococcal (GC) infection. Despite proper treatment, 10% of newborns still develop GC, compared to a whopping 48% who do not receive appropriate treatment.
- Globally, less than 1% of newborns get gonococcal infection.
- It’s more common in developing countries with up to 5% of pregnant women in some parts of Africa being infected.
- In the U.S., 1-2% of newborns have conjunctivitis, and less than 1% get gonococcal infection.
- Despite proper treatment, 10% of newborns develop GC, compared to 48% who do not get ideal treatment.
In non-newborn populations, GC is uncommon. In the United States, there are approximately 146 cases of gonorrhea per 100,000 people. The exact number of GC cases is unclear due to a lack of studies. However, a study conducted in Ireland found that out of every 1000 patients who came for eye emergencies, 0.19 cases had GC and it was mostly seen in young adult men.
Signs and Symptoms of Gonococcal Conjunctivitis
Neonatal GC, or gonorrheal infection in newborns, is typically contracted during childbirth and is commonly associated with a history of maternal gonorrhea. This type of bacterial eye infection can show up at any time, but in newborns, it’s mainly considered after the first day, usually between day 2 and day 5. This is because any eye infection noted in the first 24 hours of life is often due to chemical conjunctivitis, which can result from eye drops used at birth.
The signs of Neonatal GC might include:
- Redness and swelling of the white part of the eye
- Swollen eyelids
- A thick yellow or green discharge from the eye
- Pain or tenderness in the eyeball
- Swelling in front of the ear
For older people, any sexually active individuals presenting with conjunctivitis, with or without genital symptoms, should be considered for GC. Regardless, a thorough sexual history of the mother and anytime conjunctivitis is diagnosed should be documented to help pinpoint the cause of the eye inflammation.
Testing for Gonococcal Conjunctivitis
If you have symptoms of eye infection, which could be Gonococcal conjunctivitis (GC), your doctor may suggest some tests to confirm the diagnosis. They might take samples from your eye and send them for different tests.
These tests can include:
* A Gram stain test. This test uses a special stain to make bacteria visible under a microscope. In case of GC infection, the test may reveal a specific type of bacteria, called gram-negative intracellular diplococci.
* A culture test. In this test, your sample is placed on a medium that helps bacteria to grow. There are different types of culture tests, like Thayer-Martin and chocolate agar, which specifically help to grow and identify GC bacteria, and blood agar for non-GC species.
* A test called Polymerase chain reaction (PCR). This test is used to detect genetic material of bacteria N gonorrhoeae and Chlamydia trachomatis, which are common causes of eye infections.
* Testing for other sexually transmitted infections (STIs) including HIV. This is recommended as these infections can often occur together.
* Your doctor might also suggest taking samples from your genital area and throat, especially if you have risk factors for STIs.
These tests are helpful in making sure you get the right treatment for your condition.
Treatment Options for Gonococcal Conjunctivitis
Neonates, or newborn babies with Gonorrhea infection, may be at risk for a more widespread infection to occur. This makes it essential to treat them as emergency cases who need to be admitted for care and closely observed. The best way to manage Gonorrhea is to prevent it. It’s recommended that high-risk women, including those who have had a sexually transmitted infection (STI) before or who are involved in sex work, be tested for Gonorrhea and other STIs and treated if necessary.
However, even with proper preventive measures, newborns can get Gonorrhea. There are different treatments doctors might use to help these babies. For example, some babies might get erythromycin or tetracycline ointments to help prevent them from getting Gonorrhea.
If a newborn is showing symptoms or is considered a high-risk for Gonorrhea, they might be given antibiotic medications like Ceftriaxone or Cefotaxime. These medications can be delivered through an IV or a muscular injection. Cefotaxime might be preferred because there is a risk that Ceftriaxone could raise bilirubin levels – a condition that can lead to a type of jaundice in the baby. The medical team might also use a saline solution to clean the baby’s eyes every hour.
People older than newborns, who show symptoms of Gonorrhea, might receive different treatments. They can be given Ceftriaxone through a muscular injection, and Azithromycin that can be taken orally. Azithromycin is added because there’s often a co-occurrence of another STI called Chlamydia trachomatis in cases of Gonorrhea. The use of a saline solution to clean the patient’s eyes may also be considered, but it might not always be necessary.
What else can Gonococcal Conjunctivitis be?
When looking at symptoms related to gonococcal conjunctivitis, doctors need to consider and rule out other conditions that might have similar symptoms. These conditions include:
- Adult blepharitis (an inflammation of the eyelid)
- Allergic conjunctivitis
- Acute angle-closure glaucoma (a sudden increase in eye pressure)
- Chemical burns in the eye
- Contact lens conjunctivitis (an infection caused by wearing contact lenses)
- Dry eyes
- Epidemic keratoconjunctivitis (a highly contagious eye infection)
- Episcleritis (an inflammation of the outer coating of the white of the eye)
- Iritis and uveitis (types of eye inflammation)
- Pharyngoconjunctival fever (a type of conjunctivitis accompanied by a fever)
- Scleritis (an inflammatory disease that causes the white part of the eye to turn red)
- Squamous cell carcinoma (a type of skin cancer that can affect the eye)
- Subconjunctival hematoma (bleeding under the conjunctiva, the clear covering of the white part of the eye)
