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Adult Gonococcal Conjunctivitis

Adult Gonococcal Conjunctivitis is a type of bacterial conjunctivitis that is caused by the bacteria Neisseria gonorrhoeae, which is responsible for sexually transmitted diseases (STDs) in adults.

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

  • Adult Bacterial Conjunctivitis – Gonococcal
  • Gonococcal Ophthalmia – Adult
  • Gonorrhea Conjunctivitis

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

  • The cause factors for Conjunctivitis are many; however, Bacterial Conjunctivitis is caused by any of the several types of bacteria, such as staphylococcus aureus, streptococcus pneumoniae, and hemophilus influenzae among others. It is one of the most common types of Conjunctivitis that affects healthy individuals
  • Adult Gonococcal Conjunctivitis is a type of bacterial conjunctivitis that is caused by the bacteria Neisseria gonorrhoeae, which is responsible for sexually transmitted diseases (STDs) in adults. The highly acute and dangerous eye disorder is also termed as Gonorrheal Conjunctivitis
  • Conjunctivitis is inflammation of conjunctiva of the eye, which is the membrane covering the white region of the eye
  • In Conjunctivitis the white part of the eye turns red or pink, and hence it is also 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
  • Urgent and aggressive care with medication is essential to prevent permanent blindness and other potential complications (like severe corneal damage) from developing, due to the infection

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

  • Individuals in any age group are vulnerable to Gonococcal Conjunctivitis; but, sexually active individuals are at a high risk
  • Newborns may acquire a certain type of the infection from their infected mothers, known as Neonatal Gonococcal Conjunctivitis
  • Both male and female genders are equally affected

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

The risk factors for Adult Gonococcal Conjunctivitis, which is a rare type of infectious Conjunctivitis affecting adults, include:

  • Contact with a person affected by the infection, or the use of infected (shared) items
  • This infection spreads in offices, crowded spaces, hospitals
  • Exposure to pathogens that cause STDs. In case of Conjunctivitis due to Neisseria bacteria; the sexually active individuals are at high risk
  • Young, sexually active adults below age 25 years, have a high risk; more so if they have multiple sexual partners, and do not practice safe sex (lack of condom usage)
  • Bacterial Conjunctivitis may also be associated with inflammatory diseases like sinusitis and immunodeficiency conditions
  • Eye disorders such as blepharitis, dryness of the eye, anatomic/structural abnormalities may predispose one to Adult Gonococcal Conjunctivitis

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 Adult Gonococcal Conjunctivitis? (Etiology)

  • Bacterial Conjunctivitis is caused by a variety of bacteria, usually in adults. In Adult Gonococcal Conjunctivitis the cause is Neisseria gonorrhoeae, which is an extremely dangerous bacterium. Conjunctivitis may often be one of the many presentations of other underlying diseases/disorders
  • The disorder is highly contagious and the infectious phase may last for 10-14 days, until the eye returns to normal color
  • In adults, the bacteria are mainly transmitted during sex through infected fluids, semen, with an individual who has STD
  • It could also spread through direct contact with items used by the infected individual; by touch (hand-to-eye route), use of shared spaces (like swimming pools), and through respiratory or nasal droplets

What are the Signs and Symptoms of Adult Gonococcal Conjunctivitis?

Common signs & symptoms of Adult Gonococcal Conjunctivitis (that last for about 3 weeks) are:

  • Itching and redness of the eye(s); this may develop suddenly
  • Profuse discharge of green or yellow color, pus-like fluid from the eyes with formation of crusts (usually seen in the morning, on waking-up). Sticky eyelids, which are difficult to keep open
  • Eye pain and eyelid inflammation (usually severe); with gritty feeling of sand-like particles inside the eye
  • Blurred vision
  • Swollen lymph nodes in front of the ears
  • Burning sensation, stinging pain while urinating (observed in both men & women); watery discharge from vagina
  • Women may have a history of other disorders affecting their reproductive system, like pelvic inflammatory disease, inflammation of the vagina/urethra

How is Adult Gonococcal Conjunctivitis Diagnosed?

Adult Gonococcal Conjunctivitis is diagnosed using the following tools:

  • The ophthalmologist or physician performs an eye examination and evaluates the patient’s medical history
  • Slit lamp exam (if necessary), for a detailed study of the eye
  • Conjunctival scrapings, culture of eye discharge to diagnose the bacteria type
  • Differential diagnosis to eliminate other conditions; since there are several bacterial or other cause factors for Conjunctivitis

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 Adult Gonococcal Conjunctivitis?

Severe complications may arise if the cornea is involved, or if Adult Gonococcal Conjunctivitis is not treated. It is also dependent upon the presence of secondary conditions (if any). The complications include:

  • Corneal ulcer, scar, and perforation; corneal injury may develop very rapidly without treatment
  • Bonding of eyelids to the eyeball, which may be partial or total
  • Permanent eye damage, loss of vision
  • Higher risk for other complications like central nervous system problems, pneumonia, septicemia
  • Inflamed intraocular cavities
  • Chronic recurrence of the condition

How is Adult Gonococcal Conjunctivitis Treated?

Early diagnosis and speedy treatment is extremely important to prevent permanent complications from hyperacute Adult Gonococcal Conjunctivitis. The underlying health factors also require treatment. Some management measures include:

  • Topical antibacterial ointments (erythromycin) are generally prescribed. Systemic antibiotics are vital in case the disorder is acute and caused by STD-linked bacterial microorganisms
  • Medications used are: Antibiotic ceftriaxone injection administered directly into the muscles. Other antibiotics include orally-administered tetracycline and erythromycin
  • Application of warm compress can help reduce discomfort
  • Clean the eye crusts carefully using soft and wet cotton wool
  • The eyes may be cleaned regularly with saline solution to remove mucus formation
  • Use of lubricating drops may soothe the eyes, and are helpful if eyes remain dry
  • Corticosteroids are not used, since they worsen the condition
  • In case of severe and intense (chronic) infection leading to loss of vision; a corneal transplant may be necessary to restore vision
  • Avoid the use of contact lens during this period; wear eye glasses instead
  • Management of underlying health conditions is mandatory; and these could be STDs, sinusitis, immune disorders
  • Follow-up care is regularly required after 1-3 weeks; more so if the condition aggravates

How can Adult Gonococcal Conjunctivitis be Prevented?

  • Adult Gonococcal Conjunctivitis is highly infectious. It is best to keep away from work or crowded places, if you suffer from the condition
  • Prevent spread of the condition by maintaining hygiene, washing hands regularly, avoiding sharing of pillows, towels, make-up, and by limiting physical contact
  • 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
  • Abstain from sex with multiple partners; or have a monogamous partner, if you are planning for a child
  • Prevent aggravation of the condition by staying out of the sun, keeping away from dust and smoke. Also, avoid touching or rubbing the eyes (this may be difficult when the affected individuals are very young children)
  • Stop or restrain yourself from smoking tobacco, or drinking alcohol

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

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

Additional and Relevant Useful Information for Adult Gonococcal Conjunctivitis:

  • 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 (Chlamydia & Neisseria) occur together in an infected sexually mature individual

What are some Useful Resources for Additional Information?

American Academy of Family Physicians (AAFP)
11400 Tomahawk Creek Parkway Leawood, KS 66211-2672
Phone: (913) 906-6000
Toll-Free: (800) 274-2237
Fax: (913) 906-6095
Email: fp@aafp.org
Website: http://www.aafp.org

References and Information Sources used for the Article:

http://kidshealth.org/kid/ill_injure/sick/conjunctivitis.html (accessed on 02/26/13)

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002005/ (accessed on 02/26/13)

http://www.mayoclinic.com/health/pink-eye/DS00258/DSECTION=causes (accessed on 02/26/13)

http://www.ccjm.org/content/75/7/507.full (accessed on 02/26/13)

http://www.kellogg.umich.edu/theeyeshaveit/red-eye/chlamydial-conjunctivitis.html (accessed on 02/26/13)

http://webeye.ophth.uiowa.edu/eyeforum/cases/68-Adult-Chlamydial-Conjunctivitis-Red-Eyes-Chronic.htm (accessed on 02/26/13)

Helpful Peer-Reviewed Medical Articles:

Hoffman, J. J., & Ali, B. (2015). Gonococcus–The culprit of refractory, severe conjunctivitis in an elderly patient. Contact Lens and Anterior Eye, 38(6), 468-470.

Hoffman, J., Ali, B., Hoffman, A., & Sheikh, I. (2015). Gonococcal conjunctivitis: the importance of good-quality conjunctival swabs. Br J Gen Pract, 65(639), 552-553.

Peters, R. P., Verweij, S. P., McIntyre, J. A., & Schaftenaar, E. (2016). Gonococcal Conjunctivitis Despite Successful Treatment of Male Urethritis Syndrome. Sexually transmitted diseases, 43(2), 120-121.

McAnena, L., Knowles, S. J., Curry, A., & Cassidy, L. (2015). Prevalence of gonococcal conjunctivitis in adults and neonates. Eye, 29(7), 875-880.

McAnena, L., Knowles, S. J., Curry, A., & Cassidy, L. (2015). Prevalence of gonococcal conjunctivitis in adults and neonates. Eye, 29(7), 875-880.

Wang, X., & Gao, Y. (2015). Gonorrhea. In Radiology of Infectious Diseases: Volume 2 (pp. 103-112). Springer Netherlands.

Alfonso, S. A., Fawley, J. D., & Lu, X. A. (2015). Conjunctivitis. Primary Care: Clinics in Office Practice, 42(3), 325-345.

McElnea, E., Stapleton, P., Khan, S., Stokes, J., & Higgins, G. (2015). Challenges in the management of Neisseria gonorrhoeae keratitis. International ophthalmology, 35(1), 135-140.