Abstract
Introduction
As gonococcal infections continue to increase, we wanted to review the number and clinical course of recent ocular gonococcal cases presenting to ophthalmology departments in NHS Greater Glasgow and Clyde.
Methods
A 5-year retrospective review of adult ocular gonococcal cases, where the diagnosis of Neisseria gonorrhoeae was made on microbiological culture, was undertaken.
Results
Fifteen cases were identified (80% male). Average age was 26 years (range 17–42; median 24). Most common presenting features included purulent discharge (14/15; 93%), haemorrhagic conjunctivitis (10/15; 67%) and pre-septal cellulitis (9/15; 60%). Corneal involvement was documented in 5 (33%), with marginal ulceration in 1 (7%) but none had corneal perforation. Most common systemic treatment was IV ceftriaxone, alone or in combination with another antibiotic (6/15; 40%), followed by IM ceftriaxone, alone or in combination with another antibiotic (5/15; 33%). Median time from presentation to treatment was 1 day (0–23). All patients were referred or recommended to attend sexual health services. Seven patients (47%) attended and received complete sexually transmitted infection (STI) testing and contact tracing: 3 patients had systemic treatment initiated or changed at this visit and 1 patient had concurrent syphilis identified.
Conclusions
This series confirms purulent conjunctivitis and cellulitis as the main presenting features of ocular gonococcal infection requiring hospital review. Early identification with appropriate systemic antibiotic treatment avoided corneal melting in this cohort. As concurrent STIs were identified and/or treatments changed in 4/7 (57%) following sexual health review, we recommend a shared care approach between ophthalmology, microbiology and sexual health services to effectively address all management issues.
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Acknowledgements
A version of this paper was an oral presentation at the UK Bowman Club meeting in March 2021 and a poster at the Virtual Annual Congress of the Royal College of Ophthalmologists in May 2021.
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D.L. had the original idea. L.B. and M.S. performed the data collection, initial literature review and drafted the article. L.C., A.W. and D.L. provided direction and senior support, additional literature input and revised the article into the final version.
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Butler, L., Shah, M., Cottom, L. et al. Five-year review of ocular Neisseria gonorrhoeae infections presenting to ophthalmology departments in Greater Glasgow & Clyde, Scotland. Eye 36, 1442–1447 (2022). https://doi.org/10.1038/s41433-021-01658-z
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DOI: https://doi.org/10.1038/s41433-021-01658-z
