Is gonococcal conjunctivitis a disease of newborns in the 21st century?

Session Details

Session Title: Inflammation in Ocular Infections

Session Date/Time: Wednesday 17/09/2014 | 08:00-09:30

Paper Time: 09:00

Venue: Capital Hall A

First Author: : L.McAnena IRELAND

Co Author(s): :    S. Knowles   L. Cassidy           

Abstract Details

Purpose:

This study aims to (a) investigate the incidence of gonococcal conjunctivitis (GC) in the National Maternity Hospital (NMH) and the Royal Victoria Eye & Ear Hospital (RVEEH) from 2011-2013 inclusive; (b) examine the demographics and patterns of clinical presentation and outcome.

Setting:

The National Maternity Hospital and Royal Victoria Eye and Ear Hospital, Dublin, Ireland

Methods:

Cases were identified from the laboratory information system. We performed a retrospective chart analysis on patients diagnosed with GC, based on a positive conjunctival culture and/or PCR

Results:

Fourteen cases of GC were identified out of a total of 74,814 presentations to Eye Casualty at RVEEH during this period. There were no neonatal cases identified among 27,556 births at the NMH. Charts were available for 12 patients.64.3% of patients were male, with an average age of 18 years. The mean duration of symptoms at presentation was 3 days (range 1-7 days) and all cases were unilateral. Eight cases (66.6%) had visual impairment at presentation, the mean acuity of these patients was 0.4 LogMar (6/15 Snellen). 8 patients had significant lid swelling. Conjunctival injection and purulent discharge were reported in all patients. Chemosis was present in 50%. Corneal involvement was seen in 25% of cases, and this was exclusively mild punctate epitheliopathy. There was no incidence of uveitis. Two thirds of patients had lid involvement and two patients were admitted for presumed preseptal cellulitis. The average time for swab results was 5.4 days. On receipt of positive culture and/or PCR results, treatment was altered in two thirds of patients All patients showed full clinical recovery one week post-treatment. All patients were referred for STI screening.

Conclusions:

Gonococcal conjunctivitis presents in young, sexually active adults, with 1.8:1 male:female gender distribution. GC is very rare among neonatal patients. Conjunctival injection and purulent discharge were present in all patients, with only mild keratitis in a quarter of patients. Visual acuity was reduced in two thirds, but this was largely due to copious discharge in those without keratitis. Lid involvement was common, and probably prompted the diagnosis and treatment of preseptal cellulitis, including two patients who were admitted for parenteral treatment of cellulitis. It is important to take swabs for both PCR and culture. The bacteria does not typically survive for more than 12 hours ex vivo, thus, culture may be falsely negative. PCR is both highly sensitive and specific, but cannot be used for antibiotic susceptibility testing which is important as antibiotic-resistant gonococcus is increasing. The current recommendation for treatment of gonococcal conjunctivitis is combination therapy with a single intramuscular dose of ceftriaxone 1g plus a single dose of azithromycin 2g orally. Confirmed patients should be referred for appropriate STI screening and contact tracing

Financial Interest:

NONE