19M sexually active, HIV(-), in the ER w 2 d progressive L eye pain, swelling & discharge. Also has had 5 d penile burning and discharge. O/E: L eye ➡️ red, severe lid swelling, +purulent discharge; GU ➡️ + mild penile discharge. What is the recommended one-time treatment? #meded
(1/5)Answer: C, ceftriaxone 1 g IM + azithromycin 1 g PO. Patient most likely has gonorrheal urethritis and 🌟conjunctivitis🌟. The latter is uncommon in adults but potentially devastating; caused by inoculation of bacteria into the eye from contaminated hands. #meded #gonorrhea
(2/5) Gonorrheal conjunctivitis ➡️ also known as 🌟hyperactive conjunctivitis (incubation period can be as short as a few hours, progresses rapidly, often leads to severe eye manifestations, urgent Optho consult when suspected). #meded
(3/5) Most rapid way to dx, obtain a swab of the eye discharge ➡️ gram neg diplococci under the microscope. Rx is ceftri 1 g (🌟NOT the usual dose of 250 mg) + azithro PO. A 1989 study showed ceftri monoRx is adequate 📌but combination recommended 🌟due to advent of resistance.
(4/5) Chlamydia can also lead to 🌟acute conjunctivitis but is usually mild (sometimes not even apparent) ➡️ leads to 🌟trachoma (chronic form), the most devastating complication seen in underdeveloped countries (one of the 📌most common causes of blindness in the world).
(5/5) For additional pearls and other important clinical/public health info on gonorrhea, I’ll hand you over to our STI expert @hrenoID 🌟📌💡🙏🏻
Error: Hyperacute conjunctivitis NOT hyperactive. 🌟📌💡
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