Gonorrhea is a pestilence caused by Neisseria gonorrhoeae transmitted through sexual or close contact. Pregnant women with gonorrhea can infect their newborns during childbirth, leading to neonatal gonococcal ophthalmia.

bubble_chart Diagnosis

(1) The mother has a history of sexual promiscuity or gonorrhea. (2) Most newborns develop gonococcal conjunctivitis within 3 days after birth, with a rapid onset. The eyelid is severely swollen and produces copious yellow or green discharge. In severe cases, the cornea may be affected, losing its luster and appearing foggy; in extreme cases, corneal perforation may occur, leading to blindness. If the amniotic membrane ruptures prematurely and the fetus is infected in the uterus, conjunctivitis may manifest immediately after birth, potentially progressing to sepsis. (3) A smear of eye discharge is taken for Gram staining and culture. Isolation of Neisseria gonorrhoeae not only detects the pathogen but also allows for antibiotic susceptibility testing. In recent years, methods such as leukocyte esterase (LE) testing, immunological techniques like enzyme immunoassay (EIA), direct fluorescent antibody (DFA) staining, nucleic acid hybridization, and nucleic acid amplification techniques—including polymerase chain reaction (PCR) and ligase chain reaction (LCR)—have been employed. These methods are highly specific, sensitive, easily automated, accurate, and rapid.

bubble_chart Treatment Measures

﹝Treatment﹞

Systemic medication should also be administered for the treatment of neonatal conjunctivitis. The first-line choice is cephalosporins such as ceftriaxone (Rocephin) 250mg intravenously or intramuscularly for 7 days. For local treatment, one drop of 1% silver nitrate can be instilled into the conjunctival sac immediately after birth, followed by rinsing with saline to avoid chemical irritation. Currently, antibiotic eye drops are routinely used for topical application. Antibiotics should be selected based on bacterial sensitivity.

(1) Pregnant women with gonorrhea should be thoroughly treated before childbirth, and those diagnosed during labor should be given effective antibacterial treatment immediately.

(2) Newborns delivered by mothers with gonorrhea should have their eyes instilled with 1% silver nitrate solution immediately after birth (see above), and systemic antibiotics should be administered.