## Gonococcal Conjunctivitis: Diagnosis and Treatment ### Clinical Presentation The gram-negative diplococci on Gram stain are pathognomonic for *Neisseria gonorrhoeae*. Gonococcal conjunctivitis presents with: - Acute onset (24–48 hours) - Severe purulent discharge - Bilateral involvement common - Risk of corneal perforation if untreated ### Drug of Choice: Ceftriaxone **Key Point:** Ceftriaxone 1 g IM as a single dose is the gold standard for gonococcal conjunctivitis [cite:Park 26e Ch 10]. **Rationale:** - Achieves high aqueous and tear film concentrations - Single-dose regimen ensures compliance - Covers penicillinase-producing *N. gonorrhoeae* (PPNG) - Prevents serious sequelae (corneal scarring, perforation) **High-Yield:** Systemic therapy is mandatory for gonococcal conjunctivitis because topical antibiotics alone do not achieve adequate intraocular concentrations to prevent anterior uveitis and keratitis. ### Adjunctive Management - Frequent saline irrigation (every 1–2 hours initially) - Topical fluoroquinolone (e.g., ofloxacin) four times daily for 7 days - Prophylaxis for chlamydia (doxycycline 100 mg twice daily × 7 days) if not ruled out - Contact tracing and partner treatment ### Comparison with Other Agents | Agent | Indication | Limitation | |-------|-----------|----------| | Ceftriaxone 1 g IM | Gonococcal conjunctivitis (first-line) | None | | Ciprofloxacin oral | Mild bacterial conjunctivitis (non-gonococcal) | Inadequate intraocular penetration for systemic gonococcal disease | | Tetracycline ointment | Chlamydial conjunctivitis, prophylaxis | Topical only; ineffective for systemic gonococcal infection | | Acyclovir | HSV conjunctivitis | No activity against *N. gonorrhoeae* | **Clinical Pearl:** Neonatal gonococcal ophthalmia neonatorum requires the same systemic ceftriaxone regimen (25–50 mg/kg IM/IV once, max 125 mg) plus topical saline irrigation and prophylactic topical antibiotics.
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