Gonococcal Conjunctivitis: A Case Report of an Unusual Mode of Transmission

In Vitro Models of Eye Infection with Neisseria gonorrhoeae

Prophylaxis with silver nitrate and later antibiotics has significantly reduced the cases of infant blindness from gonococcal infection at birth to the point where it has all but been forgotten in the developed world as the devastating disease that it was in the pre-antibiotic era. As a result, while it is known that the bacteria are transmitted to the eyes during passage through the infected birth canal, little is known about Neisseria gonorrhoeae colonization of the eye and the establishment and progression of keratitis. Treatment failures due to rising antimicrobial resistance necessitate investigations into all aspects of gonococcal disease, including eye infections, so that new treatment strategies can be developed. Here we present models for N. gonorrhoeae eye infection using excised bovine corneas and coculture of gonococci with primary human corneal epithelial cells. These models can be used to explore the interactions of the bacteria with corneal tissues and cells and to investigate novel therapeutics against infection.

Documentation of Sexual and Menstrual Histories for Adolescent Patients in the Inpatient Setting

STUDY OBJECTIVE

In this study, we aimed to determine the frequency of menstrual history and sexual history documentation in the inpatient setting.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective chart review was conducted for 307 female patients ages 11-18 years admitted from the emergency department at a single institution within a 7-month period. These charts were reviewed for documentation of menstrual and sexual history.

INTERVENTIONS AND MAIN OUTCOME MEASURES

Rates of menstrual and sexual history documentation were compared according to patient age, chief complaint, admitting specialty, and medical complexity.

RESULTS

Sexual history documentation was noted in 158 (45.9%) of the 344 reviewed charts. Sexual history documentation rates were higher for patients with mental health symptoms (62.9%; 61 of 98 charts; P = .02) and lower for patients admitted to surgical services (30.6%; 19 of 62 charts; P = .04). At least 1 aspect of menses was documented in 113 (32.8%) of the 344 reviewed charts. Last menstrual period was the most commonly documented aspect of menstrual history, appearing in 100 (29.1%) of the 344 reviewed charts. Menarche (4.4%; 15/344), menses frequency (7.0%; 24/344), menses duration (2.6%; 9/344), flow quantity (4.9%; 17/344), and dysmenorrhea (4.4%; 15/344) were rarely documented, regardless of chief complaint or admitting service. Menstrual history documentation rates were significantly higher for patients requiring a gynecology consultation (73.3%; 11 of 15 charts; P < .01).

CONCLUSION

Menstrual and sexual history documentation rates for adolescent patients requiring inpatient admission were low, with fewer than half of patients having a documented menstrual or sexual history.

Gonococcal conjunctivitis: A case report

We report a case of acute gonococcal conjunctivitis in a 36-year-old woman who presented with eye redness and a history of discharge for one month. Prior to presenting to us, she was treated for bacterial conjunctivitis with three courses of local antibiotics by three different clinics after brief assessments and without improvement. The final diagnosis of gonococcal conjunctivitis was made after a complete history was elicited and supported by the presence of Neisseria Gonorrhoeae in the eye swab culture test. She and her sexual partner were treated successfully with intramuscular Ceftriaxone and oral Azithromycin. This case highlights the importance of complete history taking, including sexual history, which translates into early recognition and treatment, thus preventing complications.