Three days later, he showed significant clinical improvement with almost no urethral discharge and an obvious reduction of ocular discharge ( Figure 2). The patient was treated with 1 g of intravenous ceftriaxone once per day. Urethral secretions were also collected for laboratory examination of Mycoplasma genitalium, C. A diagnosis of GC and GU was established for the patient. The patient confirmed that his wife was his only recent sexual partner and suggested that the infection may have been acquired from the airport toilet seats. The patient’s wife was also screened using the same test but on vaginal discharge and the results were negative. Genital examination showed mild redness and a small amount of genital discharge. gonorrhoeae, and susceptibility to ceftazidime and gatifloxacin, moderate susceptibility to levofloxacin, moxifloxacin, and gentamicin, and resistance to amikacin and ciprofloxacin. Microbial culture of the conjunctival pus on chocolate agar revealed growth of N. Ophthalmic examination showed no corneal abnormalities by slit-lamp examination and fundoscopy was normal. The symptoms of urethritis had alleviated after intermittent oral administration of levofloxacin for seven days.įigure 1 A profuse mucopurulent discharge on the right eye with redness and swelling, difficult to open the eye. The patient reported symptoms including urethral discharge, and urinary frequency, urgency, and dysuria, when he went abroad for his honeymoon about 10 days previously. However, he was still unable to open his right eye because of conjunctival chemosis and marked eyelid swelling. He was therefore suspected of having a GC infection and was treated with norfloxacin (0.5%) ophthalmic ointment. An excess of polymorphonuclear leucocytes and Gram-negative intracellular diplococci were observed following a stained smear of the discharge performed by another ophthalmic hospital two days previously. He complained of progressive redness and swelling of the right eye, ocular discharge, and mild pain. CaseĪ 27-year-old newly married man presented to the Dermatology department of our hospital with a two-day history of a profuse mucopurulent discharge from his right eye ( Figure 1). Here, we present a rare case of GC with improved urethritis after oral levofloxacin therapy, associated with an infection of urethral Chlamydia trachomatis. 4, 5 Antimicrobial resistance remains an important consideration in the treatment of gonorrhea. 3 GU and chlamydia are the most frequently reported STIs in developed countries, and concurrent treatment for chlamydia is now part of the recommended treatment regimen for GU. GC is often associated with STIs but can also present without evidence of concomitant genital infection, 2 or present despite successful treatment of urethritis syndrome. GC in adults is generally thought to result from auto-inoculation of infected genital secretions through hand contact or contaminated towels from the patient or his/her partner. Few reports have estimated the prevalence of GC however, a recent study in Ireland showed that the prevalence of GC was 0.19 cases per 1000 patients evaluated for eye emergencies, with the majority of cases presenting in young adult males. In non-neonatal populations, GC is rare and usually associated with gonococcal urethritis (GU) and other sexually transmitted infections (STIs). This condition is due to ophthalmic infection with Neisseria gonorrhoeae and was considered predominantly a disease of neonates. Gonococcal conjunctivitis (GC) is characterized by severe mucopurulent discharge associated with conjunctival injection, eyelid edema, tenderness, and often preauricular lymphadenopathy.
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