A Newborn with a Purulent Ocular Discharge

An 11-day-old girl, who was diagnosed with Neisseria gonorrhoeae ophthalmia neonatorum, presents with a purulent ocular discharge. Although rare in regions with high implementation rates of ocular prophylaxis, ophthalmia neonatorum remains an important diagnostic consideration, especially in developing countries and areas of low socioeconomic status. In this article, we review the evolving epidemiology, diagnostic considerations, prevention, and treatment of ophthalmia neonatorum. [Pediatr Ann. 2022;51(5):e206-e208.].

Diagnosis of a neonatal ophthalmic discharge, Ophthalmia neonatorum, in the molecular age: investigation for a correct therapy

An early double case of acute Ophthalmia neonatorum in 3-day-old twins is reported. Culture of eye swabs showed a wide bacterial polymorphism, in which common bacteria, such as Klebsiella pneumoniae, Streptococcus pneumoniae, Corynebacterium ulcerans and other Enterobacteriaceae, coexisted with atypical Mycoplasmataceae and Chlamydiaceae from resident cervical-vaginal maternal microbiota. The neonates were in an apparently healthy state, but showed red eyes with abundant greenish-yellow secretion, mild chemosis and lid edema. The maternal cervical-vaginal ecosystem resulted differently positive to the same common cultivable, atypical bacteria culturally and molecularly determined. This suggested a direct maternal-foetal transmission or a further foetal contamination before birth. An extended culture analysis for common bacteria to atypical ones was decisive to describe the involvement of Mycoplasmas (M. hominis and U. urealyticum) within the scenario of the Ophthalmia neonatorum in a Caucasian couple. The introduction of a routine PCR molecular analysis for Chlamydiaceae and N. gonorrhoeae allowed to establish which of these were present at birth, and contributed to determine the correct laboratory diagnosis and to define an adequate therapeutic protocol obtaining a complete resolution after one year for culture and atypical bacteria controls. This study suggests to improve the quality of laboratory diagnosis as unavoidable support to a correct clinical diagnosis and therapy, in a standardized modality both for swabbing and scraping, to check the new-born microbial programming starting in uterus, overtaking the cultural age to the molecular age, and to revise the WHO guidelines of SAFE Strategy for trachoma eye disease, transforming it into SAFES Strategy where the S letter is the acronym of Sexual ecosystem and behavioural valuation/education.

Gonococcal infections in newborns and in adolescents

Gonococcal infections are now an uncommon problem in newborns in industrialized countries but remain a serious problem in developing countries due to ongoing high infection rates in pregnant women. Prompt diagnosis in the newborn with appropriate treatment can minimize sequelae. The mother and her partner(s) also require investigation and treatment. Adolescents are a core group fuelling the ongoing gonococcal epidemic in industrialized countries. This is unlikely going to change unless sexual behaviour changes substantially. Education is a critical step along with access to more youth friendly STI care. As noted in the 2001 Institute of Medicine Report, learning about sex, sexuality and prevention of STI is a basic human right of adolescents (DiClemente and Crosby 2006).

The management of common ocular infections

Bacterial and viral infections involving the anterior segment of the eye and ocular adnexa present commonly in general practice, affecting patients of all ages. Careful assessment of the patient is necessary to distinguish between benign conditions and those with more serious complications. An understanding of the microbiology and pathogenesis of these conditions is helpful in rationalising current therapeutic approaches. This article focuses on the clinical presentation of common infections of the lids, conjunctiva and cornea, with a discussion of relevant therapeutic regimens for each condition.

The ocular manifestations of sexually transmitted diseases

The problem of ocular involvement in sexually transmitted diseases is encountered by ophthalmologists in everyday practice. This paper reviews the ocular manifestations of some of the more common sexually transmitted diseases including AIDS, syphilis, gonorrhea and infections caused by herpes simplex, Chlamydia trachomatis and Phthirus pubis. Current methods of diagnosis and treatment are discussed. Neonatal infections associated with sexually transmitted diseases are also reviewed.

An approach to the management of gonorrhea in the pediatric age group

Gonorrhea is becoming more important to the pediatrician. Not only is the incidence of this disease greatest in the adolescent group, but it has become more frequent in young children as well. The author outlines an approach to managing gonococcal disease in the pediatric and adolescent age groups.

[Extragenital gonococcal infections. A review]

In many cases gonorrhea is overlooked and not treated due to an unusual course of the disease. The longer this infection exists the greater is the danger of dissemination of the gonococci. Gonorrhea, if not diagnosed, may cause a series of local and general clinical manifestations, such as: the dermatitis-arthritis syndrome whose pathogenesis is not yet completely clarified: the Fitz-Hugh-Curtis syndrome which is often seen in females with chronic gonococcal adnexitis;gonococcal pharyngitis which nowadays occurs more often due to less conventional sexual practices of contemporary society; gonococcal conjunctivitis which represents the best known extragenital gonococcosis. This paper deals with the clinical manifestations and their treatment.