Gonococcal Keratoconjunctivitis in Adults : A Case Report

Abstract

     Gonococcal conjunctivitis in adults is an uncommon extragenital gonococcal infections. It is most commonly acquired after direct contact with infected genital secretions or urine, may be indirect contact by fomite transmission. Inappropriate and delayed treatments can result in severe ocular complications such as ulcerative keratitis and corneal perforation leading to permanent visual loss or blindness. Prompt diagnosis and effective treatment are essential in important in the current era of increases antibiotic resistance.
     A 60-year old woman presented with redness and ocular discharge from both eyes for 10 days before admission, At first, the left conjunctiva was inflamed with mucopurulent discharge. The right eye was normal. She was treated with topical antibiotic four times a day and eye cleaning but clinical was not improved. Three days later, both eyes presented with upper eyelid swelling, redness and mucopurulent ocular discharge with keratitis at left eye. Conjunctival swab was reported gram-negative intracellular diplococci and positive conjunctival cultures for Neisseria gonorrhoeae. The patient was treated with 1 g of Ceftriaxone intramuscularly daily for 5 days, oral Azithromycin 1 g single dose and topical antibiotic and non-preservative artificial tears. After treatment for 5 days, conjunctival was minimal redness and ocular discharge had nearly disappeared. Repeated conjunctival swab and culture for 5 days after topical and systemic treatment was negative. The patient was examined continuously. No recurrence after discontinued antibiotics for 1 week.