1
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Milligan AL, Randag AC, Lekkerkerk S, Fifer H. Increased incidence of adult gonococcal keratoconjunctivitis at two tertiary eye hospitals in Western Europe: clinical features, complications and antimicrobial susceptibility. Br J Ophthalmol 2024; 108:788-792. [PMID: 38365428 DOI: 10.1136/bjo-2023-324750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/19/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Gonorrhoea is on the rise: between 2021 and 2022, a 50% and a 33% increase in diagnoses was seen, respectively, in England and the Netherlands. A concurrent rise in gonococcal keratoconjunctivitis (GKC) is a serious concern due to the potentially devastating visual complications. METHODS This is a retrospective case series of adult GKC from two Western European tertiary ophthalmology centres between 2017 and July 2023. The clinical features, ocular complications and antimicrobial susceptibilities are reported within. RESULTS An increased incidence was recorded at both centres, with 11 confirmed cases in the first 7 months of 2023, compared with ≤3 per year in 2017-2022. CONCLUSION The notable increase of GKC cases in our centres in 2023 may indicate a rise across Western Europe. Enhanced, sustained, national surveillance of GKC is essential to establish incidence and antimicrobial susceptibility, to inform treatment guidelines and guide appropriate public health response.
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Affiliation(s)
- Alice L Milligan
- Corneal and External Diseases Department and Emergency Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Anna C Randag
- Corneal and External Diseases Department, Eye Hospital Rotterdam, Rotterdam, The Netherlands
| | - Sybren Lekkerkerk
- Department of Medical Microbiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Helen Fifer
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
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2
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Wai KM, Wolkow N, Yoon MK. Infectious Dacryoadenitis: A Comprehensive Review. Int Ophthalmol Clin 2022; 62:71-86. [PMID: 35325911 DOI: 10.1097/iio.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 784] [Impact Index Per Article: 261.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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4
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Unemo M, Ross J, Serwin AB, Gomberg M, Cusini M, Jensen JS. Background review for the '2020 European guideline for the diagnosis and treatment of gonorrhoea in adults'. Int J STD AIDS 2020; 32:108-126. [PMID: 33323071 DOI: 10.1177/0956462420948739] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gonorrhoea is a major public health concern globally. Increasing incidence and sporadic ceftriaxone-resistant cases, including treatment failures, are growing concerns. The 2020 European gonorrhoea guideline provides up-to-date evidence-based guidance regarding the diagnosis and treatment of gonorrhoea. The updates and recommendations emphasize significantly increasing gonorrhoea incidence; broad indications for increased testing with validated and quality-assured nucleic acid amplification tests (NAATs) and culture; dual antimicrobial therapy including high-dose ceftriaxone and azithromycin (ceftriaxone 1 g plus azithromycin 2 g) OR ceftriaxone 1 g monotherapy (ONLY in well-controlled settings, see guideline for details) for uncomplicated gonorrhoea when the antimicrobial susceptibility is unknown; recommendation of test of cure (TOC) in all gonorrhoea cases to ensure eradication of infection and identify resistance; and enhanced surveillance of treatment failures when recommended treatment regimens have been used. Improvements in access to appropriate testing, test performance, diagnostics, antimicrobial susceptibility surveillance and treatment, and follow-up of gonorrhoea patients are essential in controlling gonorrhoea and to mitigate the emergence and/or spread of ceftriaxone resistance and multidrug-resistant and extensively drug-resistant gonorrhoea. This review provides the detailed background, evidence base and discussions, for the 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults (Unemo M, et al. Int J STD AIDS. 2020).
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Affiliation(s)
- M Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jdc Ross
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - A B Serwin
- Department of Dermatology and Venereology, Medical University of Białystok, Białystok, Poland
| | - M Gomberg
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - M Cusini
- Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milano, Italy
| | - J S Jensen
- Infection Preparedness, Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark
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5
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Richmond A, Pfieffer ML, Henry-Okafor Q. Update on Guidelines for Sexually Transmitted Infection Treatment and Management in the Adult and Adolescent Population. Nurs Clin North Am 2020; 55:307-323. [PMID: 32762852 DOI: 10.1016/j.cnur.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Sexually transmitted infections (STIs) are a prevalent global health care problem. Incidence rates are rising yearly. STI incidence is highest for adolescents and young adults ages 15 to 24, who are diagnosed with half of all new STIs. Chlamydia trachomatis and Neisseria gonorrhea are common STIs caused by bacteria. Treatment guidelines change frequently as a result of antimicrobial resistance and public health trends. It is important for primary care providers to remain up to date with new guidelines. This article provides updates on pharmacologic treatment as well as patient education and follow-up specific to the primary care setting.
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Affiliation(s)
- Anna Richmond
- Vanderbilt University School of Nursing, 356 Frist Hall, 461 21st Avenue South, Nashville, TN 37240, USA.
| | - Mary Lauren Pfieffer
- Vanderbilt University School of Nursing, 354 Frist Hall, 461 21st Avenue South, Nashville, TN 37240, USA
| | - Queen Henry-Okafor
- Vanderbilt University School of Nursing, 354 Frist Hall, 461 21st Avenue South, Nashville, TN 37240, USA
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6
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Unemo M, Ross J, Serwin AB, Gomberg M, Cusini M, Jensen JS. 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS 2020:956462420949126. [PMID: 33121366 DOI: 10.1177/0956462420949126] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gonorrhoea is a major public health concern globally. Increasing incidence and sporadic ceftriaxone-resistant cases, including treatment failures, are growing concerns. The 2020 European gonorrhoea guideline provides up-to-date evidence-based guidance regarding the diagnosis and treatment of gonorrhoea. The updates and recommendations emphasize significantly increasing gonorrhoea incidence; broad indications for increased testing with validated and quality-assured nucleic acid amplification tests and culture; dual antimicrobial therapy including high-dose ceftriaxone and azithromycin (ceftriaxone 1 g plus azithromycin 2 g) OR ceftriaxone 1 g monotherapy (ONLY in well-controlled settings, see guideline for details) for uncomplicated gonorrhoea when the antimicrobial susceptibility is unknown; recommendation of test of cure (TOC) in all gonorrhoea cases to ensure eradication of infection and identify resistance; and enhanced surveillance of treatment failures when recommended treatment regimens have been used. Improvements in access to appropriate testing, test performance, diagnostics, antimicrobial susceptibility surveillance and treatment, and follow-up of gonorrhoea patients are essential in controlling gonorrhoea and to mitigate the emergence and/or spread of ceftriaxone resistance and multidrug-resistant and extensively drug-resistant gonorrhoea. For detailed background, evidence base and discussions, see the background review for the present 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults (Unemo M, et al. Int J STD AIDS. 2020).
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Affiliation(s)
- M Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jdc Ross
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - A B Serwin
- Department of Dermatology and Venereology, Medical University of Białystok, Białystok, Poland
| | - M Gomberg
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - M Cusini
- Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milano, Italy
| | - J S Jensen
- Infection Preparedness, Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark
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7
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Churchward CP, Al-Kinani AA, Abdelkader H, Swinden J, Siwoku O, Varnakulasingam T, Alany RG, Snyder LAS. Monocaprin eye drop formulation to combat antibiotic resistant gonococcal blindness. Sci Rep 2020; 10:12010. [PMID: 32694582 PMCID: PMC7374094 DOI: 10.1038/s41598-020-68722-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/01/2020] [Indexed: 01/30/2023] Open
Abstract
Neisseria gonorrhoeae bacteria are acknowledged as an urgent threat to human health because this species has developed resistances to all of the antibiotics used clinically to treat its infections. N. gonorrhoeae causes the sexually transmitted disease gonorrhoea, but also causes blindness when the bacteria infect the eyes. Infants are particularly susceptible, acquiring the infection from their mothers at birth. We have shown that the monoglyceride monocaprin rapidly kills N. gonorrhoeae and other bacterial species and is non-irritating in ocular assays. Here we show that the physical and chemical properties of monocaprin make it ideal for use in a thickened eye drop formulation to combat eye infections. Monocaprin-containing formulations were assessed using analytical techniques and for antimicrobial activity in vitro and in ex vivo infections. Monocaprin-containing formulations retained activity after three years and are non-irritating, unlike preparations of povidone iodine in our assays. A recommended formulation for further development and investigation is 0.25% monocaprin in 1% HPMC with 1% polysorbate 20.
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Affiliation(s)
- Colin P Churchward
- School of Life Sciences, Pharmacy, and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, UK
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Royal Brompton Campus, London, SW3 6LY, UK
| | - Ali A Al-Kinani
- School of Life Sciences, Pharmacy, and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, UK
| | - Hamdy Abdelkader
- School of Life Sciences, Pharmacy, and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, UK
- Pharmaceutics Department, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Julian Swinden
- School of Life Sciences, Pharmacy, and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, UK
| | - Opeoluwa Siwoku
- School of Life Sciences, Pharmacy, and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, UK
| | - Thinuba Varnakulasingam
- School of Life Sciences, Pharmacy, and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, UK
| | - Raid G Alany
- School of Life Sciences, Pharmacy, and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, UK
| | - Lori A S Snyder
- School of Life Sciences, Pharmacy, and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, UK.
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8
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Fifer H, Saunders J, Soni S, Sadiq ST, FitzGerald M. 2018 UK national guideline for the management of infection with Neisseria gonorrhoeae. Int J STD AIDS 2020; 31:4-15. [PMID: 31870237 DOI: 10.1177/0956462419886775] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Helen Fifer
- Consultant Microbiologist, National Infection Service, Public Health England
| | - John Saunders
- Consultant in Sexual Health, National Infection Service, Public Health England and Central and North West London NHS Foundation Trust
| | - Suneeta Soni
- Consultant in Sexual Health, Brighton & Sussex University Hospitals NHS Trust
| | - S Tariq Sadiq
- Professor of Molecular Medicine, Institute for Infection and Immunity, St George's, University of London
| | - Mark FitzGerald
- Consultant in Sexual Health, Clinical Effectiveness Group, BASHH
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9
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Linton E, Hardman L, Welburn L, Rahman I, Chidambaram JD. Adult conjunctivitis secondary to dual infection with Chlamydia trachomatis and Neisseria gonorrhoeae - A case report. Am J Ophthalmol Case Rep 2019; 13:6-8. [PMID: 30505977 PMCID: PMC6247407 DOI: 10.1016/j.ajoc.2018.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/02/2018] [Accepted: 11/12/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Although Chlamydia trachomatis and Neisseria gonorrhoeae are the commonest sexually transmitted infections in England, reports of ocular co-infection in the literature are limited. We report such a case which responded well to treatment, and discuss the literature and evidence currently available with regards to management of these cases. OBSERVATIONS The patient is a 48-year-old bisexual gentleman who presented to the eye clinic of a UK hospital with redness, discharge and blurred vision in his left eye for one week. Initially he had mucopurulent discharge but his cornea was clear. He did not comply with prescribed treatment and returned two days later with bilateral symptoms and corneal thinning in his left eye peripherally.PCR tests for Chlamydia trachomatis and Neisseria gonorrhoeae were positive and the patient was commenced on intravenous ceftriaxone, oral and topical levofloxacin eye drops. After 48 hours of inpatient treatment the patient showed clinical improvement. CONCLUSIONS AND IMPORTANCE Ophthalmologists should be aware of the possibility that Chlamydia trachomatis and Neisseria gonorrhoeae can cause co-infection in adult conjunctivitis, and of the straightforward method of treatment for such individuals. Delayed diagnosis and treatment of affected patients can lead to corneal complications and potential blindness. It is advisable to discuss these cases with the local microbiology service wherever possible, and referral to a sexual health service is imperative.
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Affiliation(s)
- Emma Linton
- Dept. of Ophthalmology, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, FY3 8NR, UK
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Lisa Hardman
- Dept. of Microbiology, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, FY3 8NR, UK
| | - Lynn Welburn
- Dept. of Microbiology, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, FY3 8NR, UK
| | - Imran Rahman
- Dept. of Ophthalmology, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, FY3 8NR, UK
| | - Jaya Devi Chidambaram
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
- Dept. of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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10
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Gonococcal Conjunctivitis in Adults: Case Report and Retrospective Review of Cases in Alberta, Canada, 2000–2016. Sex Transm Dis 2019; 46:47-51. [DOI: 10.1097/olq.0000000000000897] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Jenkins TL, Zhang MM, Patel NS, Huggins AB, Carrasco JR. Dacryoadenitis due to gonococcal conjunctivitis complicated by corneal perforation. Orbit 2018; 38:84-86. [PMID: 29565715 DOI: 10.1080/01676830.2018.1452948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Adnexal and periocular involvement in Neisseria gonorrhoeae (NG) infection is rare. This report describes the case of a patient with a delayed diagnosis of gonococcal dacryoadenitis with contiguous conjunctivitis and corneal involvement. She underwent extensive inpatient laboratory and infectious workup but rapidly progressed to corneal perforation requiring emergent penetrating keratoplasty prior to a positive culture confirming the diagnosis. To date, this is the first reported case of ophthalmologic NG infection with associated conjunctivitis, dacryoadenitis, and corneal perforation.
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12
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Al-Madboly L, Gheida S. Case Report of Urethritis in a Male Patient Infected with Two Different Isolates of Multiple Drug-Resistant Neisseria gonorrhoeae. Front Med (Lausanne) 2017; 4:194. [PMID: 29167794 PMCID: PMC5682295 DOI: 10.3389/fmed.2017.00194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 10/25/2017] [Indexed: 11/13/2022] Open
Abstract
We report a brief description of a case suffering from bacterial urethritis, conjunctivitis, and arthritis, caused by two different isolates of multiple drug-resistant Neisseria gonorrhoeae. Initial diagnosis was dependent on the patient history, clinical findings, symptoms, and the bacteriological data. Polymerase chain reaction confirmed the identification of the pathogens. Random amplified polymorphic DNA revealed two different patterns. Susceptibility testing was performed using Kirby-Bauer disk diffusion method and the minimum inhibitory concentration was also determined. It revealed multiple drug resistance associated with β-lactamase production. Only gentamicin, rifampicin, and azithromycin were active against the test pathogens. A dual therapy was initiated using gentamicin as well as azithromycin to treat the possible co-infection with Chlamydia trachomatis. Complete recovery of the patient achieved with resolved symptoms a week later.
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Affiliation(s)
- Lamiaa Al-Madboly
- Faculty of Pharmacy, Department of Pharmaceutical Microbiology, Tanta University, Tanta, Egypt
| | - Shereen Gheida
- Faculty of Medicine, Department of Dermatology and Venereology, Tanta University, Tanta, Egypt
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13
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Bodurtha Smith AJ, Holzman SB, Manesh RS, Perl TM. Gonococcal Conjunctivitis: A Case Report of an Unusual Mode of Transmission. J Pediatr Adolesc Gynecol 2017; 30:501-502. [PMID: 27871917 DOI: 10.1016/j.jpag.2016.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/23/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Outside of the newborn period, development of gonococcal conjunctivitis is rare and predominantly occurs through autoinoculation. We report an unusual case of gonococcal conjunctivitis in a young woman exposed through direct inoculation. CASE A 19-year-old woman presented with purulent ocular discharge, severe pain, and decreased vision unresponsive to topical antibiotics or ganciclovir approximately 3 weeks after accidental ocular exposure to seminal fluid during unprotected oral sex. Cultured ocular drainage grew Neisseria gonorrhea; vaginal and throat cultures were negative. She was successfully treated with ceftriaxone and doxycycline for 10 days. SUMMARY AND CONCLUSION Clinicians should be aware of the potential for vision-threatening gonococcal conjunctivitis from exposure during sexual contact.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Samuel B Holzman
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Reza Sedighi Manesh
- Department of Medicine, Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Trish M Perl
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Abstract
We report a case of progressive, cephalosporin-susceptible, Neisseria gonorrhoeae conjunctivitis despite successful treatment of male urethritis syndrome. We hypothesize that conjunctival infection progressed due to insufficient penetration of cefixime and azithromycin and point out that extragenital infection and male urethritis may not be cured simultaneously in settings where the syndromic approach is used.
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Samira N, Bani AP, Susiyanti M. Rare case of bilateral perforated corneal ulcer due to gonococcal infection, managed with temporary periosteal graft. BMJ Case Rep 2016; 2016:bcr-2015-213547. [PMID: 26907819 DOI: 10.1136/bcr-2015-213547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 17-year-old female patient was referred to Kirana Ophthalmology Unit, Cipto Mangunkusumo Hospital, with a 10-day history of redness and swelling of the eyes, and inability to open them. Other symptoms included pain, blurred vision and excessive yellowish-white discharge from both eyes. There was a history of multiple sexual partners. The patient was assessed with bilateral perforated corneal ulcer due to gonococcal infection, based on the findings of intracellular and extracellular Gram-negative diplococci found on the Gram staining examination. The cornea in both eyes showed perforation with iris prolapse inferiorly. The perforations were treated with temporary periosteal grafts. The grafts remained in place after the surgery. Final uncorrected visual acuity was 6/20 in the right eye and 6/24 in the left eye, a few months after surgery.
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Affiliation(s)
- Nuriadara Samira
- Department of Ophthalmology, Cipto Mangunkusumo Kirana Hospital, Jakarta, Indonesia
| | | | - Made Susiyanti
- Department of Ophthalmology, Cipto Mangunkusumo Kirana Hospital, Jakarta, Indonesia
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Pérez CE, Bravo JS, Espinal A, Rodríguez AE, Botero-García CA, Durán MJ, Mateus JC, Morales-Pertuz C, Faccini-Martínez ÁA. A 30-year-old male with corneal opacity and a rapidly progressing ulcer. INFECTIO 2016. [DOI: 10.1016/j.infect.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Hoffman JJS, Ali B. Gonococcus - The culprit of refractory, severe conjunctivitis in an elderly patient. Cont Lens Anterior Eye 2015; 38:468-70. [PMID: 25980791 DOI: 10.1016/j.clae.2015.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/07/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
Abstract
We present a highly unusual case of microbiologically-confirmed adult gonococcal conjunctivitis in an elderly patient with the absence of genital co-infection and no sexual risk factors. Possible routes of infection are discussed, together with diagnosis and management of gonococcal keratoconjunctivitis. This case serves to highlight the possibility of gonococcal conjunctivitis as a diagnosis in severe, refractory conjunctivitis, even if the patient demographics, lack of pre-existing genital infection or sexual risk factors make gonococcus seem unlikely.
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Affiliation(s)
- Jeremy J S Hoffman
- Department of Ophthalmology, East Surrey Hospital, Redhill, Surrey RH1 5RH, United Kingdom.
| | - Bazga Ali
- University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom
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18
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Challenges in the management of Neisseria gonorrhoeae keratitis. Int Ophthalmol 2014; 35:135-40. [PMID: 25544662 DOI: 10.1007/s10792-014-0032-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 12/13/2014] [Indexed: 10/24/2022]
Abstract
We describe the presentation and subsequent management of a case of keratitis caused by Neisseria gonorrhoeae. A thirty-nine year old gentleman presented with a purulent ocular discharge. Corneal melt with corneal perforation occurred. Neisseria gonorrhoeae was cultured. Systemic and topical antibiotics were given. Deep lamellar keratoplasty was performed for corneal perforation. At three months post treatment no recurrence of infection was noted. The possibility of Neisseria gonorrhoeaea keratitis should always be considered in patients with a purulent ocular discharge even if the case history is not immediately suggestive of the same. Severe gonococcal keratitis may be unilateral. Deep lamellar keratoplasty can be considered as a therapeutic option in patients with severe gonococcal keratitis.
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19
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Tappe D, Mueller A, Weißbrich B, Schubert J, Schargus M, Stich A. Severe conjunctivitis due to multidrug-resistant Neisseria gonorrhoeae and adenovirus 53 coinfection in a traveler returning from Thailand. J Travel Med 2013; 20:403-6. [PMID: 24118571 DOI: 10.1111/jtm.12071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 08/05/2013] [Indexed: 11/29/2022]
Abstract
A male traveler returning from Thailand with severe bilateral conjunctivitis was tested for causative pathogens by culture and polymerase chain reaction in late 2010. The culturally grown Neisseria gonorrhoeae strain was resistant against penicillin, ciprofloxacin, and tetracycline. The patient was also found to have an eye infection with the unusual and likely recombinant adenovirus type 53. Besides multidrug-resistant gonococcal strains the unusual adenovirus strain is found circulating in Asia and both pathogens may be a risk for travelers.
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Affiliation(s)
- Dennis Tappe
- Institute of Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
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20
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Walker CK, Sweet RL. Gonorrhea infection in women: prevalence, effects, screening, and management. Int J Womens Health 2011; 3:197-206. [PMID: 21845064 PMCID: PMC3150204 DOI: 10.2147/ijwh.s13427] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Indexed: 12/02/2022] Open
Abstract
Gonorrhea is a set of clinical conditions resulting from infection with the sexually-acquired bacterial pathogen Neisseria gonorrhoeae. Acquisition may involve multiple mucosal sites in the lower female genital tract, including the urethra, cervix, Bartholin’s and Skene’s glands, as well as the anorectal canal, pharynx, and conjunctivae. It may spread to the upper genital tract, uterine tubes, abdominal cavity, and other systemic sites. Gonorrhea is the second most commonly reported sexually-transmitted infection in the US and rates are higher among women than men. Women and infants are affected disproportionately by gonorrhea, because early infection may be asymptomatic and also because extension of infection is often associated with serious sequelae. Screening is critical for infection identification and the prevention or limitation of upper genital tract spread, and horizontal and vertical transmission. Routine genital screening is recommended annually for all sexually active women at risk for infection, including women aged < 25 years and older women with one or more of the following risks: a previous gonorrhea infection, the presence of other sexually transmitted diseases, new or multiple sex partners, inconsistent condom use, commercial sex work, drug use, or human immunodeficiency virus infection with sexual activity or pregnancy. Pharyngeal gonococcal infections are common in adolescents, and direct culture screening is necessary to identify affected individuals. Nucleic acid amplification tests (NAATs) are considered the standard for screening and diagnosis. Although urine NAAT testing is most commonly used, there is growing support for vaginal swabs collected by providers or patients themselves. Resistance to all antibiotics currently recommended for the treatment of gonorrhea has been documented and complicates therapeutic strategies. The Centers for Disease Control and Prevention recommend treatment of gonorrhea with a single class of drugs, ie, the cephalosporins.
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Affiliation(s)
- Cheryl K Walker
- Women's Center for Health, Department of Obstetrics and Gynecology, University of California, Davis School of Medicine, Sacramento, CA, USA
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“Ophthalmia Venerea”: A Dreadful Complication of Fluoroquinolone-Resistant Neisseria gonorrhoeae. Sex Transm Dis 2010. [DOI: 10.1097/olq.0b013e3181c95dc6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hegde V, Smith G, Choi J, Pagliarini S. A case of gonococcal kerato-conjunctivitis mimicking orbital cellulitis. ACTA ACUST UNITED AC 2005; 83:511-2. [PMID: 16029283 DOI: 10.1111/j.1600-0420.2005.00501.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- H M Leibowitz
- Department of Ophthalmology, Boston University School of Medicine, MA 02118, USA
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Thielen TL, Castle SS, Terry JE. Anterior ocular infections: an overview of pathophysiology and treatment. Ann Pharmacother 2000; 34:235-46. [PMID: 10676832 DOI: 10.1345/aph.19136] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To provide a review of the pathophysiology and treatment of anterior ocular infections. DATA SOURCE A MEDLINE search (from 1970 to October 1998) as well as a review of the tertiary literature was performed to identify pertinent literature on pathophysiology and treatment of ocular infections. STUDY SELECTION AND DATA EXTRACTION All articles were considered for possible inclusion in the review. Relevant studies were selected for discussion in the article. DATA SYNTHESIS Ocular infections are common and vary from self-limiting to sight-threatening. Infections occur in different eye structures; presentation and treatment vary accordingly. Infections can occur when tissues of the eye are exposed to pathogens not normally present, when the eye is damaged, allowing pathogens to overcome the natural defenses of the eye, or in immunosuppressed patients where normal flora may become opportunistic. In deciding on appropriate treatment, both the causative pathogen and the structure(s) affected must be considered. The most likely pathogen can often be determined based on clinical signs and symptoms, patient history, or, in some cases, may need to be determined microbiologically. Differences in drug absorption, penetration, and availability to the various structures of the eye affect treatment decisions. Severity of infection, efficacy and safety of medication, and cost/benefit ratios must be taken into consideration in choosing the proper pharmacologic management of various ocular infections. CONCLUSIONS Treatment of ocular infections depends on knowledge of the pathophysiology and drug disposition at the site of infection. An understanding of the current concepts surrounding the management of the anterior ocular infections presented will aid in the provision of optimal patient care.
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Affiliation(s)
- T L Thielen
- WJB Dorn Veterans Affairs Medical Center, Columbia, SC, USA
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Hoang KD, Pollack CV. Antibiotic use in the emergency department. IV: Single-dose therapy and parenteral-loading dose therapy. J Emerg Med 1996; 14:619-28. [PMID: 8933325 DOI: 10.1016/s0736-4679(96)00141-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There are a number of infectious diseases that can be treated efficaciously with a single dose of an antimicrobial agent. Other infections that can be treated with oral antibiotics on an outpatient basis may resolve more quickly if a parenteral loading dose is given in the emergency department (ED) prior to discharge. This article reviews the supporting literature and indications for single-dose and parenteral first-dose-loading antimicrobial therapy in the ED. This approach may be appropriate for such diverse infections as streptococcal pharyngotonsillitis, otitis media, urinary tract infections, chlamydial genital infections, vaginitis due to yeast, bacteria, or trichomoniasis, pneumonia, gonorrhea and pelvic inflammatory disease, and pediatric fever without a source.
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Affiliation(s)
- K D Hoang
- Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona
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Pellerano RA, Bishop V, Silber TJ. Gonococcal conjunctivitis in adolescents. Recognition and management. Clin Pediatr (Phila) 1994; 33:114-6. [PMID: 8200153 DOI: 10.1177/000992289403300209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- R A Pellerano
- Department of Adolescent and Young Adult Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC 20010
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