Gonococcal infection/Ophthalmia neonatorum

Identification

The gonococcal infection (gonococcal urethritis, gonococcal vulvovaginitis, gonococcal cervicitis, gonococcal bartholinitis, blenorrhagia, gonorrhea) represents a sexually transmitted bacterial infection (STIs), often asymptomatic in women. The infection can complicate if the bacteria gets to disseminate into the bloodstream. Complications could be:

• Chronic infection that can lead to infertility,
• Chronic infection that can lead to ectopic pregnancy,
• Arthritis
• Sepsis
• Endocarditis
• Meningitis
• Pelvillitis with infertility risk. ^[1]CDC. Heymann D.L. Manual de management al bolilor infecțioase. 2012 ^[2]Popa GL, Popa MI. Microbiologie medicală curs – 2010.

 To the pregnant woman may appear: 

• Abnormal vaginal leakage,
• Vaginal bleeding after sexual intercourse.

To the newborn

If pregnant gives birth naturally, without being treated, neonatal gonococcal conjunctivitis, neonatal gonococcal ophtalmia or ophtalmia neonatorum, a bacterial condition that is characterized by reddening flushing and acute edema of the conjunctiva in one or both eyes, with purulent or mucopurulent secretion, typically occurring in 1-5 days after birth. Untreated can lead to:

• Corneal ulcer,
• Corneal perforation,
• Keratitis with blindness. ^[3]CDC. Heymann D.L. Manual de management al bolilor infecțioase. 2012` ^[4]Popa GL, Popa MI. Microbiologie medicală curs – 2010

 

Diagnosis

 

To the pregnant woman is made by: ^[5]***.CDC Recommendations for the Laboratory-Based Detection of Neisseria gonorrhoeae – 2014.

• Microscopic examination of vaginal secretion (in Gram stain, GIEMSA),
• Microscopic examination of the secretion collected from the cervix (Gram stain)
• Bacterial culture on selective environments of secretions collected from the cervix and rectum during pregnancy and especially in the 3rd quarter
• Molecular diagnostic tests (identifying the presence of gonococcal nucleic acid).

 

To the newborn 

• Microscopic examination (Gram stain) of conjunctival secretion,
• Bacterial culture on selective media in conjunctival secretion,
• Molecular diagnostic tests (determination of the presence of gonococcal nucleic acid). 

Nota Bene.

In this document, the laboratory diagnosis was not treated in the gonococcal infection, but there were several elements related to the diagnosis of pregnancy and the newborn. For the complete diagnosis of this infection, those interested will be addressed to infectionists doctors or microbiologists.

Infectious agent

Neisseria Gonorrhoeae (Gonococcus) a bacterium of the genus Neisseria, the Neisseriaceae family. ^[6]Popa GL, Popa MI. Microbiologie medicală curs – 2010

 

Incidence and prevalence

The disease equally affects men and women especially active sexual teenagers and young adults. The incidence and prevalence appear to be higher in communities with low socio-economic status. If the pregnant screening is not made before birth, the prophylaxis of the infection in the newborn should be done immediately after birth. The disease continues to represent an important cause of blindness throughout the world. ^[7]CDC. Heymann D.L. Manual de management al bolilor infecțioase. 2012~

Source 

Strictly human bacterium; for the newborn genital infection of the maternal tract (uterine cervix) represents the potential source. ^[8]CDC. Heymann D.L. Manual de management al bolilor infecțioase. 2012|

Method of transmission

 

It can be transmitted:

• By contact with the mucous membranes exudates of the infected persons as a result of sexual activity,
• Perinatal, by passing, at birth, through the Pelvi-genital infected canal. ^[9]CDC. Heymann D.L. Manual de management al bolilor infecțioase. 2012||

 

Risk groups

• Any newborn by natural childbirth, if the mother is infected with Gonococcus, or by caesarean in patients with ruptred membranes,
• People with homosexual activities,
• Some racial minorities,
• Some ethnic groups,
• People who practice sexual activity with multiple partners, sexual activity through perversion. ^[10]CDC. Heymann D.L. Manual de management al bolilor infecțioase. 2012`'

Incubation period

• Between 1-14 days for pregnancy infection.
• Between 1-5 days for the child’s newborn infection. ^[11]CDC. Heymann D.L. Manual de management al bolilor infecțioase. 2012`~

Infectiousness Period

• It can extend months to untreated individuals. Effective treatment, with antibiotics and chemotherapy to which gonococcus is sensitive (it is recommended both standardised diffusometric antibiogram and CMI testing) can stop infectiveness relatively fast.
• The untreated newborn is contagious as long as untreated ocular secretion persists; and for about 24 hours after initiation of specific treatment. ^[12]CDC. Heymann D.L. Manual de management al bolilor infecțioase. 2012\\ ^[13]Popa GL, Popa MI. Microbiologie medicală curs – 2010`

Prophylaxis 

 

To the pregnant woman

• Screening people with risk activities, or on request, by examination of vaginal secretion and rectal fingerprint for gonococcus and other bacteria that can be transmitted sexually,
• Screening through vaginal secretion examination and rectal fingerprint for gonococcus in all pregnant women, at least in the weeks 35-37 of gestation,
• Treatment of pregnant and sexual partners according to Antibiogram (accompanied by CMI  testing),
• Monogamy with an uninfected partner,
• Safer sexual practices (use of condom for protection),
• Avoiding multiple sexual contacts,
• Avoiding sexual contacts with unknown partners,
• Investigation of contacts and the source of infection,
• Notification of sexual partners in case of a positive outcome for Gonococcus,
• Testing and treatment of sexual contacts if the last supposedly infected contact occured 60 days prior to the onset of symptoms. ^[14]CDC. Heymann D.L. Manual de management al bolilor infecțioase. 2012(

 

To the newborn

• The use of an effective preparation for the ophthalmic protection of newborns in the first hour of birth, depending on the way of birth (vaginal or caesarean) e.g. ophthalmic creams with erythromycin (0.5%) or tetracycline (1%),
• Instillation of ophthalmic 1% aqueous silver nitrate. ^[15]CDC. Heymann D.L. Manual de management al bolilor infecțioase. 2012)

 Vaccination

There’s no vaccine.

Birth to genitally infected woman with Gonococcus

It is recommended:

• Treatment of pregnant women according to Antibiogram because Gonococcus rapidly develops resistance to antimicrobials ^[16]***. CDC Antibiotic-Resistant Gonorrhea.
• Caesarean birth.

Breastfeeding

There are no special recommendations.

Treatment

 

To the pregnant woman

• Pregnant women infected with gonococcus should be treated according to Antibiogram, preferably accompanied by the CMI result.
• CDC recommends dual therapy consisting of 250 mg Ceftriaxone i.m. in a single dose and orally as a single dose 1 g azithromycin.
• When hypersensitivity to cephalosporins or other considerations excludes treatment with this regimen it is recommended to consult with a specialist in infectious diseases and allergology, but it is essential to take into account the results obtained from the test of sensitivity to antibiotics and chemotherapeutics for isolated strain. ^[17] Popa GL, Popa MI. Microbiologie medicală curs – 2010. ^[18]***. CDC 2015 Gonococcal Infections.

 

To the newborn

• In newborns of untreated mothers, a single dose of Ceftriaxone of 25-50 mg/kg body weight is administered without exceeding 125 mg v. or i.m.,
• Newborns with gonococcal ophtalmy should be hospitalized and evaluated for sepsis, arthritis, meningitis. ^[19]***. CDC 2015 Gonococcal Infections`.