Keith Ong1,2,3,4 Daniel Lai5,6

Purpose: Gonococcal conjunctivitis is rare and may potentially be a blinding condition if not treated promptly because of risk of corneal perforation. This case highlights the need to consider the possibility of gonococcal conjunctivitis when formulating guidelines for the treatment of conjunctivitis.

Method: A 52 year old male presented with severe mucopurulent conjunctivitis of the right eye. Cornea was clear and anterior chamber was quiet. Swabs were taken for MCS and PCR. Neisseria gonorrhoeae was positive on PCR before MCS results were available. He had been initially commenced on Chloramphenicol eye drops by the referring GP, and oral Doxycycline 100mg daily was given when there was concern that the worsening conjunctivitis could be Chloramphenicol allergy. Once the diagnosis of gonococcal conjunctivitis was made on microbiology he was given the recommended treatment of Ceftriaxone 500mg IM/IV and Azithromycin 1g as single doses. When he developed corneal ulcers he was commenced on Ocuflox eye drops hourly to the right eye.

Results: The conjunctivitis improved with treatment. It is fortunate that PCR and MCS were performed. The results of the PCR were available earlier than MCS which allowed for earlier administration of the recommended treatment.

Neisseria gonorrhoeae can invade an intact corneal epithelium to cause ulceration and perforation. Prompt treatment with Ocuflox eye drops hourly prevented progression of corneal abscess.

Conclusion: PCR should be considered in certain cases of conjunctivitis due to earlier availability of results which may allow for earlier commencement of appropriate therapy.