Gonoccocal ophthalmia neonatorum caused by beta-lactamase-producing Neisseria gonorrhoeae

Adult penicillinase-producing gonococcal keratoconjunctivitis

The case is described of a 22-year-old man who presented with ulcerative keratitis as a complication of conjunctivitis that was caused by penicillinase-producing Neisseria gonorrhoeae. The need for first-line treatment with antibiotic agents that are resistant to beta-lactamase breakdown is discussed.

Gonococcal keratoconjunctivitis

Gonococcal keratoconjunctivitis is a potentially devastating infection, because Neisseria gonorrhoeae can cause a rapid, severe, ulcerative keratitis resulting in visual loss. The therapeutic decision making process is complicated by the necessity for prompt, effective parenteral therapy, frequent coinfection with other sexually transmitted diseases, and emergence of antibiotic resistance. Because of the evolving problem of antibiotic resistance and the need for cost containment, the current recommendations of hospitalization for intravenous penicillin may need to be modified. The third generation cephalosporin, ceftriaxone, has properties that suggest it may be the best available antimicrobial agent as a single-dose treatment of gonococcal conjunctivitis. Spectinomycin may be a useful alternative in the penicillin-allergic adult patient.

Penicillinase-producing Neisseria gonorrhoea as a cause of neonatal and adult ophthalmia

A retrospective analysis of 80 cases of gonococcal ophthalmia revealed six (7.5%) to be due to penicillinase-producing Neisseria gonorrhoeae (PPNG), five neonatal cases and one adult. All six cases were finally cured, but best results were obtained with topical chloramphenicol and single-dose spectinomycin (40 mg/kg) given intramuscularly. All gonococcal isolates should be tested promptly for penicillinase production, and if this is present systemic treatment, modified to spectinomycin or penicillinase-stable cephalosporin, should be given as single-dose treatment.

Single-dose kanamycin therapy of gonococcal ophthalmia neonatorum

117 infants with gonococcal ophthalmia neonatorum, including 27 with infections due to penicillinase-producing Neisseria gonorrhoeae, were treated as outpatients with five different regimens of single-dose intramuscular kanamycin (75 mg or 150 mg) with saline eye washes, gentamicin eye ointment, or chloramphenicol eye drops. There were no treatment failures among 68 patients treated with 75 mg or 150 mg kanamycin and gentamicin eye ointment (for 3 days). However, the minimum and maximum cumulative probabilities of cure of single-dose kanamycin with saline eye washes (for 3 days) were only 60% and 89%. 1 patient of 15 treated with 150 mg kanamycin plus chloramphenicol eye drops did not respond to treatment. Postgonococcal conjunctivitis developed in 14 (12%) infants, of whom 13 had positive cultures for Chlamydia trachomatis. Nasopharyngeal infection with N gonorrhoeae was eradicated in 9 of 11 infants colonised.

Evaluation of drugs used in the prophylaxis of neonatal conjunctivitis

Administration of silver nitrate 1% solution into the eyes of the newborn has proven effective in the prophylaxis of gonococcal neonatal conjunctivitis. Silver nitrate, however, is not active against Chlamydia trachomatis, the most common cause of neonatal conjunctivitis. Also, silver nitrate commonly is associated with substantial chemical irritation. For these reasons, alternative agents are receiving increasing attention. Recently, erythromycin 0.5% and tetracycline 1% ophthalmic ointments were recommended by the Centers for Disease Control Venereal Disease Control Division for prophylaxis of neonatal conjunctivitis. Erythromycin has proven at least as effective as silver nitrate for gonococcal prophylaxis, can prevent chlamydial conjunctivitis in infants born to Chlamydia-positive mothers, and is associated with minimal complications. Clinical studies, however, demonstrating significant differences between erythromycin and tetracycline ophthalmic ointments are lacking. Well-controlled clinical studies comparing silver nitrate, erythromycin, and tetracycline prophylaxis are needed to determine the relative effectiveness of these agents.

Penicillinase-producing Neisseria gonorrhoeae ophthalmia neonatorum in Singapore

The problem of ophthalmia neonatorum due to penicillinase-producing Neisseria gonorrhoeae (PPNG) has grown with the increasing prevalence of PPNG strains in Singapore. The epidemiological trends, clinical features, and treatment of ophthalmia neonatorum due to PPNG have been determined from the case histories of 11 babies with this condition treated between 1978 and 1980. All 11 cases were cured with a single intramuscular injection of kanamycin 0.5 g and 1% kanamycin eyedrops instilled for three days. In six of the 11 mothers, a non-PPNG strain was isolated.

Epidemiology of penicillinase-producing Neisseria gonorrhoeae in Singapore

The number of infections with penicillinase-producing Neisseria gonorrhoeae (PPNG) strains in Singapore has risen from three in 1976 to 1792 in 1979. In the latter year they formed 19.2% of all infections with gonorrhoea, and 1280 of the strains isolated were from female prostitutes. The prevalence of PPNG infections is analysed according to the different sections of the community and racial groups. Despite energetic control measures PPNG strains are not being contained within Singapore. Thus global dissemination from such a busy port and tourist centre is a real danger.

Problems in the surveillance and control of sexually transmitted agents associated with pelvic inflammatory disease in the Far East

Little published data are available on pelvic inflammatory disease in the Far East. Measures available to control gonorrhea in the region are reviewed. The rising incidence of penicillinase-producing Neisseria gonorrhoeae in Singapore and the Far East and its implications concerning the pathogenesis of PID are discussed.