Gonococcal Conjunctivitis (GC)

Microbiological Culture

The gold standard diagnostic procedure for gonococcal conjunctivitis is the use of microbiological cultures. For this purpose, conjunctival swabs are taken, placed on selective media like chocolate agar, and incubated to cultivate Neisseria gonorrhoeae. Initially, the presence of gram-negative diplococci may be detected through a Gram stain. Systematic approaches based upon cultures have better specificity and enable testing of the sensitivities to antibiotics, which is important for specifying therapeutic options.

Polymerase Chain Reaction (PCR)

This method of PCR makes it possible to swiftly and precisely diagnose Neisseria gonorrhoeae by amplifying its DNA from eye samples. Moreover, PCR can identify the bacterium's presence in samples that would otherwise be deemed non-cultivable due to minimal bacterial count or slow bacterial growth. With multiplex PCR, other eye infectious agents like Chlamydia trachomatis can also be detected which improves the accuracy of the diagnosis significantly.

Rapid Antigen Detection Tests

The diagnosis of eye infections caused by Neisseria gonorrhoeae can be done promptly with rapid antigen detection tests that detect specific antigens of the bacterium. The results can be received within minutes, which aids in swift clinical decision-making. However, the tests have a lower sensitivity, specificity, and overall accuracy than PCR or culture methods. Regardless of these disadvantages, rapid antigen tests are appropriate in low resource areas where answers are required quickly.

Systemic Antibiotics

The therapeutics of GC primarily involves the use of systemic antibiotics with the aim of eradicating the causative bacteria. One of the most used options is ceftriaxone, which is effective against Neisseria gonorrhoeae because it is a third generation cephalosporin. It can be given intravenously or intramuscularly which provides broad coverage and fast bactericidal capabilities. Azithromycin is co-administered with ceftriaxone so that possible co-infections with Chlamydia trachomatis are also treated and the development of resistance is minimized.

Topical Antibiotics

Topical antibiotics are essential for the adequate control of local ocular complications and symptoms. The use of fortified tobramycin and cephalosporin eye drops is frequent in order to attain high local concentrations of antibiotics which control inflammation and stave off corneal complications. Severe ocular infections can be treated topically with ciprofloxacin and ofloxacin, which are broad-spectrum fluoroquinolone antibiotics. Such therapy achieves the desired result of effective local treatment without systemically affecting the organism.