Chlamydial vs Gonococcal Eye Infections
Introduction
Sexually acquired conjunctivitis is an important emergency department (ED) presentation. The common pathogens are Chlamydia trachomatis and Neisseria gonorrhoeae. Both cause conjunctival inflammation but differ in time course, severity and risk of complications.
In the ED you must recognise hyper‑acute, potentially sight‑threatening gonococcal infection; obtain appropriate ocular and genital samples; start empirical therapy when indicated; and arrange timely ophthalmology, microbiology and sexual‑health follow‑up (NICE NG221; NICE NG195; UKHSA/GRASP; RCEM).
Clinical features
Chlamydia trachomatis
- Organism: obligate intracellular bacterium (serovars D-K cause adult inclusion conjunctivitis). Neonatal disease may follow perinatal exposure.
- Typical course: indolent/subacute - symptoms commonly persist for weeks and often >2 weeks before presentation.
- Typical signs and symptoms: low‑grade irritation, foreign‑body sensation, mucous/mucoid discharge (not purulent), conjunctival hyperaemia; usually unilateral initially; preauricular lymphadenopathy may be present.
- Complications: chronic conjunctivitis and scarring if untreated; neonatal infection can be associated with pneumonitis.
Neisseria gonorrhoeae
- Organism: gram‑negative intracellular diplococcus; invasive with rapid corneal tropism.
- Typical course: hyper‑acute - symptoms often develop within 12-48 hours of exposure.
- Typical signs and symptoms: copious mucopurulent/purulent discharge, marked eyelid oedema, pain, tender preauricular nodes; bilateral involvement common.