When are “Sticky Eyes” a Neonatal Emergency? Neonatal Gonococcal Conjunctivitis: Case Report and Literature Review

Background: Opthalmia neonatorum as a result of Neisseria Gonorrhoeae infection is rarely encountered in modern neonatal practice. It is, however, a sight threatening medical emergency and an awareness of this pathogen, the consequences of infection and up to date management strategies is paramount. We present the first reported case from a maternity hospital in Ireland.

Objective: The objective of this report was to describe a case of neonatal gonococcal conjunctivitis and review the literature relating to this condition.

Case Report: We present the case of a 2 day old term infant who was noted to have bilateral purulent exudate and periorbital oedema, more pronounced on the right side. An ophthalmological assessment revealed right haemorrhagic conjunctivitis and left conjunctivial injection with no corneal involvement or evidence of endopthalmitis. A history of paternal genital infection requiring antibiotics during pregnancy was given, however the infant’s mother was not investigated or treated. Investigations included eye swabs for culture and sensitivity, Chlamydia and Gonococcus PCR. Empiric treatment was commenced with IV Cefotaxime, PO Azithromycin and Chloromycetin ophthalmic drops. Neisseria Gonorrhoeae was grown and RT-PCR was also positive for N. Gonorrhoeae. Antibiotic therapy was rationalized and the baby received 1 dose of IV Ceftriaxone and topical Azithromycin. Clinical improvement was noted within 12 hours of initial therapy and had completely resolved by 48 hours.

Conclusion: The incidence of gonorrhea notifications has been increasing among the Irish population. From 2009 to 2014 there was a 200% increase in notifications. This reflects European trends where there was a 19% increase in gonorrhea cases between 2013 and 2014 with 55% of cases occurring in the young heterosexual population. Potential consequences of gonococcal infection include keratitis, endopthalmitis, globe perforation and visual loss. An awareness of this serious neonatal complication is necessary as prompt recognition and treatment are sight saving interventions.