A 28-year-old woman presents with a 3-day history of bilateral conjunctival injection, copious purulent discharge, and severe eye pain. She reports recent unprotected sexual contact. On examination, both eyes show chemosis, lid edema, and thick yellowish discharge. Gram stain of the discharge reveals gram-negative diplococci. What is the most appropriate immediate management?

Explanation

## Diagnosis: Gonococcal Conjunctivitis **Key Point:** Gram-negative diplococci (Neisseria gonorrhoeae) in a sexually active patient with acute purulent conjunctivitis is gonococcal conjunctivitis — a medical emergency requiring systemic therapy. ### Why Systemic Therapy Is Mandatory Gonococcal conjunctivitis carries risk of corneal perforation and blindness if treated with topical antibiotics alone. The organism can invade the corneal epithelium and cause rapid scarring. ### Recommended Regimen **Systemic:** Ceftriaxone 1 g IM (single dose) — first-line for gonococcal infection (covers penicillin-resistant strains). **Topical:** Erythromycin ointment (for comfort and local control) or bacitracin. **High-Yield:** Systemic fluoroquinolones alone are no longer recommended due to resistance; cephalosporins are the gold standard. ### Additional Management - Frequent saline irrigation to remove purulent discharge - Topical lubricants - Treat sexual partner(s) with same systemic regimen - Screen for concurrent chlamydia and other STIs - Report to public health authorities **Clinical Pearl:** Neonatal gonococcal ophthalmia (silver nitrate prophylaxis failure) presents similarly but in newborns; maternal history and timing are key differentiators. [cite:Harrison 21e Ch 163]