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Ophthalmology · Conjunctiva: hyperacute gonococcal conjunctivitis
Sample itemA sexually active young man has profuse purulent discharge, severe lid swelling and chemosis since 24 hours, with a Gram stain showing Gram-negative intracellular diplococci. Which treatment is essential in addition to local saline irrigation?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Systemic ceftriaxone
Neisseria gonorrhoeae can penetrate intact corneal epithelium and cause perforation, so systemic ceftriaxone is needed along with topical antibiotics. Partners must also be treated and chlamydial coinfection covered. Delay can result in loss of the eye.
Option by option
A. Systemic ceftriaxone (correct)
Correct. Systemic ceftriaxone is required to prevent corneal perforation.
B. Topical steroid drops alone
Steroids would worsen a bacterial infection.
C. Oral acyclovir
Acyclovir is for herpetic disease.
D. Topical lubricants only
Lubricants do not treat infection.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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