A neonate develops profuse purulent conjunctivitis 3 days after birth. The discharge is thick yellow-green and copious. Gram stain shows gram-negative diplococci inside polymorphs. The causative organism and recommended treatment are:

• A Chlamydia trachomatis; topical tetracycline and oral erythromycin
• B Staphylococcus aureus; topical tobramycin eye drops
• C Herpes simplex virus; topical acyclovir and IV acyclovir
• D Neisseria gonorrhoeae; IV ceftriaxone 50 mg/kg single dose ✓

Explanation

Neonatal gonococcal conjunctivitis (ophthalmia neonatorum) appears 2-5 days after birth (versus chlamydial conjunctivitis which appears 5-14 days after birth) and produces hyper-acute copious purulent discharge. Gram-negative intracellular diplococci on smear are diagnostic of Neisseria gonorrhoeae. Because of the risk of corneal perforation and blindness, treatment requires systemic ceftriaxone (single IM/IV dose); topical antibiotics alone are insufficient. Prophylaxis at birth with 1% silver nitrate (Credé's method) or topical antibiotics is standard.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.