Gonococcal Keratoconjunctivitis In An Adult

Cases of eye infection caused by gonococci are rarely reported in adults without genital infection. Delayed diagnosis or misdiagnosis of infectious corneal conjunctivitis by other causative agents leads to acute pain, corneal perforation, vision loss, and severe eye discharge. A 33-year-old male patient visited the emergency department of Dankook University Hospital complaining of pain in both eyes, edema of the eyelids, hyperemia, and blurred vision, which started four days prior. The subject had sexual intercourse with his girlfriend before the appearance of these symptoms. Preliminary examination of eye secretions using Gram staining revealed the presence of intracellular and extracellular Gram-negative diplococci, thus leading to suspicion of gonococcal keratoconjunctivitis. Blood agar medium and Chocolate agar medium were inoculated with the secretion samples and cultured. Bacterial identification was performed using the VITEK 2 microbial identification system. Neisseria gonorrhoeae was identified by Gram staining and VITEK 2. Subsequent treatments included a 200 mg/day oral dose of doxycycline, 0.5% moxifloxacin eye drops, and 0.3% tobramycin ointment application six times per day. A urine test during hospitalization revealed occult blood (4+) and WBC (2+), along with moderate presence of bacteria. As genital infection was suspected, the urology department prescribed a single dose of azithromycin (1000 mg). The ocular infection likely occurred through hand autoinoculation by the sexually active adult. According to the existing literature, the disease is usually spread from genital-hand-eye contact in the sexually active population.