This is a serious condition that requires systemic therapy as well as local irrigation with saline or other appropriate solutions. Irrigation is particularly important when the recommended therapeutic regimens are not available. Careful hand washing by personnel caring for infected patients is essential.

A. ADULT GONOCOCCAL CONJUNCTIVITIS

Recommended regimen

• ceftriaxone, 125mg by intramuscular injection as a single dose

OR

• spectinomycin, 2g by intramuscular injection as a single dose

OR

• ciprofloxacin, 500mg orally, as a single dose.

This regimen is likely to be effective although there are no published data on its use in gonococcal ophthalmia.

Alternative regimen where the recommended agents are not available:

• kanamycin, 2g by intramuscular injection as a single dose.

Follow-up

Careful monitoring of clinical progress is important.

B. NEONATAL GONOCOCCAL CONJUNCTIVITIS

Recommended regimen

• ceftriaxone, 50 mg/kg by intramuscular injection as a single dose, to a maximum of 125mg.

Alternative regimen where ceftriaxone is not available

• kanamycin, 25 mg/kg by intramuscular injection as a single dose to a maximum of 75mg

OR

• spectinomycin, 25 mg/kg by intramuscular injection as a single dose to a maximum of 75mg.

Single-dose ceftriaxone and kanamycin are of proven efficacy. The addition of tetracycline eye ointment to these regimens is of no documented benefit.

Follow-up

Patients should be reviewed after 48 hours.

Prevention of ophthalmia neonatorum

Using timely eye prophylaxis should prevent gonococcal ophthalmia neonatorum. The infant's eyes should be carefully cleaned immediately after birth and the application of 1% silver nitrate solution or 1% tetracycline ointment to the eyes of all infants at the time of delivery is strongly recommended as a prophylactic measure. However, ocular prophylaxis provides poor protection against C. trachomatis conjunctivitis.

Infants born to mothers with gonococcal infection should receive additional treatment as follows:

Recommended regimen

• ceftriaxone 50 mg/kg by intramuscular injection as a single dose, to a maximum of 125mg.

Alternative regimen where ceftriaxone is not available

• kanamycin, 25 mg/kg by intramuscular injection as a single dose, to a maximum of 75mg

OR

• spectinomycin, 25 mg/kg by intramuscular injection as a single dose, to a maximum of 75mg.