What are the other Names for this Condition? (Also known as/Synonyms)

• Gonococcal Ophthalmia Neonatorum
• Ophthalmia Neonatorum caused by Neisseria
• Ophthalmia Neonatorum due to Gonococcus

What is Neonatal Gonococcal Conjunctivitis? (Definition/Background Information)

• Conjunctivitis is inflammation of conjunctiva of the eye, which is the membrane covering the white region of the eye
• In this condition the white part of the eye turns red or pink, and hence it is known as Pink Eye. The infection may affect either one, or both the eyes, and is accompanied by inflammation, irritation, with watery discharge from the eyes. Under normal circumstances, Conjunctivitis does not affect vision
• Neonatal Conjunctivitis can be a severe disorder that occurs shortly after delivery in newborns (within a period of 30 days). It may be caused due to bacterial, viral microorganisms, or even on exposure to certain chemical substances (which is quite infrequent)
• If it is caused by the bacteria neisseria gonorrhoeae that is responsible for sexually transmitted diseases (STDs), the highly acute and dangerous neonatal disorder is termed as Gonococcal Conjunctivitis
• Urgent and aggressive care with medication is essential to prevent permanent blindness and other potentially serious complications from developing in the infant

Who gets Neonatal Gonococcal Conjunctivitis? (Age and Sex Distribution)

• Newborn babies, during the course of delivery
• Both male and female genders are equally affected

What are the Risk Factors for Neonatal Gonococcal Conjunctivitis? (Predisposing Factors)

The risk factors for Neonatal Conjunctivitis – Gonococcal, which is a slightly infrequent type of infectious Conjunctivitis affecting newborn babies, include:

• Exposure to dangerous STD-causing pathogens, which are present in the infected mother’s vagina or genital tract. The newborns are at a high risk during the time of their birth and may acquire the infection from their mother
• Neglecting to administer anti-microbial eye drops (or use of improper, inadequate eye drops by the healthcare provider), in the period immediately following birth of the child
• Premature delivery (preterm)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Neonatal Gonococcal Conjunctivitis? (Etiology)

• Neonatal Conjunctivitis (mild or acute) is caused by a variety of bacteria
• Neisseria gonorrhoeae is an extremely dangerous bacterium that causes acute strains of Conjunctivitis in the newborn. Such an infective Conjunctivitis is contagious and it could be one of the many symptoms of other underlying diseases/disorders
• It is estimated that about 1% of mothers are regularly infected with neisseria bacteria; and it chiefly resides in the female genital tract, among other regions
• As the infant passes through the cervix during delivery, transmission of the pathogen occurs. The probability of bacterial transmission from a mother to the infant child is between 30-40%

What are the Signs and Symptoms of Neonatal Gonococcal Conjunctivitis?

Common signs & symptoms of Neonatal Gonococcal Conjunctivitis are:

• Tenderness, inflammation, and redness of the eye(s); this may begin in one eye and slowly progress to the other
• Discharge of thick pus-like fluid from the eyes with formation of crusts
• Inflammation of nasal mucous membranes, cough
• The onset of symptoms may take place anywhere within 2-5 days, post-delivery

How is Neonatal Gonococcal Conjunctivitis Diagnosed?

Gonococcal Conjunctivitis is diagnosed using the following tools:

• The ophthalmologist or physician performs an eye examination, evaluates the child’s and mother’s medical history, and the time period for onset of symptoms in the newborn child is noted (this factor could often be conclusive)
• Slit lamp exam (if necessary), for a detailed study of the eye
• Examination of conjunctival scrapings
• Differential diagnosis of other types of Conjunctivitis should be considered, in order to eliminate other eye conditions

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Neonatal Gonococcal Conjunctivitis?

Severe complications may arise if the cornea is involved, or if there is a late recognition of the condition, leading to a delayed treatment. It is also dependent upon the type of bacteria causing the infection, and the presence of other secondary conditions. The complications from Gonococcal Conjunctivitis include:

• Corneal ulcer, scar, and perforation
• Bonding of eyelids to the eyeball, which may be partial or total
• Permanent eye damage, loss of vision in newborns
• Higher risk for other complications like central nervous system problems, pneumonia, septicemia
• Inflamed intraocular cavities
• Chronic recurrence of the condition

How is Neonatal Gonococcal Conjunctivitis Treated?

Early diagnosis with prompt and rapid treatment is the key to prevent permanent damage from acute Gonococcal Conjunctivitis. The underlying health disorders (if any) also require treatment. Some management measures include:

• Use of lubricating eye drops may soothe the eyes, and helps remove crust formation
• The eyes may be cleaned regularly with saline solution to remove mucus formation
• Application of warm compress can help reduce discomfort
• Treatment with erythromycin eye ointment should begin even before the culture test results are available, in order to prevent severe corneal damage (in the future). This is then continued further, once the diagnosis is established
• Intravenous administration of the antibiotic penicillin (or erythromycin) is provided, once the diagnosis for neisseria is confirmed
• Systemic antibiotics are vital in case the disorder is acute and has affected the entire body
• In case of severe and intense (chronic) infection leading to loss of vision; a corneal transplant may be necessary to restore vision
• Management of underlying health conditions is mandatory, which could include STDs, sinusitis, and immune disorders
• Follow-up care is important and regularly required; more so if the condition aggravates
• Both the parents have to be treated for STDs (if any)

How can Neonatal Gonococcal Conjunctivitis be Prevented?

• To avoid Gonococcal Conjunctivitis, a newborn child should be treated with erythromycin antibiotic eye ointment, shortly after birth
• The disorder is highly infectious; therefore, adequate precaution must be observed by the healthcare providers to prevent it from spreading
• Control spread of the condition by washing hands regularly, maintaining hygiene and cleanliness. This instruction is mainly directed towards the medical staff and mother of the child
• The onus is on all sexually mature individuals to ensure that they are generally well-informed of the sexually transmitted diseases (either by their healthcare providers, or public health authorities); and are aware of the preventive measures and precautions, more so if you are planning for a child
• In case you are aware of any STDs that are untreated, do inform your healthcare provider about the condition. This must be done as early as possible, particularly if you are pregnant
• In case the mother is diagnosed with STD; then a C-section delivery may be an option to prevent infection of the baby, which might otherwise occur from a natural birth

What is the Prognosis of Neonatal Gonococcal Conjunctivitis? (Outcomes/Resolutions)

• Acute Conjunctivitis triggered by neisseria bacteria has a potential to cause blindness and even life-threatening illnesses, such as STDs, pneumonia; if the condition is not quickly diagnosed and suitably managed
• With early diagnosis and appropriate treatment, the outcome is good
• Gonococcal Conjunctivitis can be a chronic infection and can recur periodically, if conditions are conducive for their recurrence. Besides, the disorder may sometimes persist for an extended period of time, usually many years, if treated inadequately

Additional and Relevant Useful Information for Neonatal Gonococcal Conjunctivitis:

• Eye ointments containing silver nitrate is not very effective against Neonatal Conjunctivitis caused by neisseria gonorrhoeae
• Chlamydial Conjunctivitis (which is caused by the bacteria chlamydia trachomatis) occurs around 10 times more frequently than Gonococcal Conjunctivitis
• Studies have established that typically both the pathogenic bacteria (namely chlamydia & neisseria), occur together in a sexually mature individual, who is infected
• In some geographical regions of the world where access to healthcare is limited; the rate of gonococcal infection among pregnant women is in the order of 10-15%
• Low birth weight and a preterm delivery, accompanied by signs of Conjunctivitis, may often indicate infection by certain bacterial types