Abstract
Purpose :
Gonococcal infections are rising in the Western world, as reflected in both the UK where case rates have increased by 90.3% from 2016 to 2019, and the United States, where rates have risen by 63.2% from 2014 to 2018. We suspect a corresponding increase in the incidence of adult gonococcal conjunctivitis (GC), and thus aim to investigate the incidence of the condition in a tertiary hospital in the UK, and further describe its clinical characteristics.
Methods :
We report a retrospective, non-comparative, consecutive case series of all adult patients with either confirmed gonococcal growth on culture or positive gonococcal PCR, presenting to the Eye Emergency Department (EED) at the Royal Victoria Infirmary, Newcastle upon Tyne, UK between January 2014 and November 2019.
Incidence, demographics and clinical course of these patients are presented, including clinical features, complications and organism sensitivities. Three cases are described further to illustrate the complications of pseudo-pterygia and secondary orbital inflammation.
Results :
Of 122,694 EED attendances, 15 patients were included. Incidence increased in the latter years of the period, with 11 cases (73.3%) occurring in 2018-2019. The average patient was 21.3 years old (SD 6.2; range 18-28) and male (73.3%). Of twelve patients with adequate documentation, all presented with unilateral conjunctival injection and purulent discharge. Eight (66.6%) had reduced best corrected visual acuity, of which three (25%) were marked (20/60 or worse). Significant periorbital swelling occurred in eight patients (66.6%), and photophobia, malaise and painful eye movements were seen infrequently. Four patients (26.7%) required admission, including two with features of orbital inflammation. One patient remains under review for severe corneal scarring secondary to a large pseudo-pterygium, but the others recovered fully. Each organism identified was susceptible to ceftriaxone and ciprofloxacin.
Conclusions :
Adult gonococcal conjunctivitis is a rare but sight threatening disease most common in young, sexually active males, and its incidence is expected to rise in concert with increasing rates of gonorrhoea internationally, as seen in our series. As such, GC remains an important consideration in adults with unilateral purulent conjunctivitis, who may have reduced visual acuity and periorbital swelling, and thus warrants a low threshold for exploring a sexual history.
This is a 2021 ARVO Annual Meeting abstract.