From a public health point of view gonococcal ophthalmia neonatorum (GCON) is important as it can rapidly lead to blindness. The frequency of GCON is determined by the prevalence of maternal gonococcal infection. In most industrialized countries the prevalence of gonorrhoea in pregnant women is less than 1%; in developing countries the rates are between 3% and 15%, more than 50% being due to penicillinase-producing Neisseria gonorrhoeae strains (PPNG). The rate of transmission from mother to newborn is between 30% and 50%. Strategies for the control of GCON include: (1) prevention of gonococcal infection in women of childbearing age, (2) detection and treatment of gonococcal infection in pregnant women, (3) eye prophylaxis in the newborn at birth, and (4) diagnosis and treatment of GCON. Eye prophylaxis by the instillation immediately after birth of either 1% silver nitrate eye drops or 1% tetracycline eye ointment is very effective. This reduces the GCON incidence by 80% to 95% and is highly cost-effective, particularly in high-risk settings.
PIP: Ophthalmia neonatorum is a purulent conjunctivitis in infants less than 30 days old, where the Gram stain of an eye smear shows at least one polymorphonuclear leukocyte per high-power field. The two main causes of the condition are Neisseria gonorrhoea and Chlamydia trachomatis. Gonococcal ophthalmia neonatorum (GCON), however, tends to appear earlier and to be more severe than chlamydial infection. GCON can rapidly lead to blindness. The frequency of GCON is determined by the prevalence of maternal gonococcal infection. In most industrialized countries, the prevalence of gonorrhea in pregnant women is less than 1%. In developing countries, however, prevalence is in the range of 3-15%, with more than 50% of cases caused by penicillinase-producing Neisseria gonorrhoea strains. There is a 30-50% mother-to-newborn transmission rate. Strategies to control GCON include the prevention of gonococcal infection in women of childbearing age, detection and treatment of gonococcal infection in pregnant women, eye prophylaxis in the newborn at birth, and diagnosis and treatment of GCON. Eye prophylaxis by the instillation immediately after birth of either 1% silver nitrate eye drops or 1% tetracycline eye ointment is very effective, reducing the incidence of GCON by 80-95%. The approach is highly cost-effective, especially in high-risk settings.