Case 3: Two-Day-Old Infant with Purulent Eye Discharge

Abstract

A term male infant born via spontaneous vaginal delivery has Apgar scores of 9 and 9. Two days after birth, he is noted to have copious purulent discharge with mild conjunctival edema of the left eye and mild discharge from the right eye. Erythromycin eye ointment is administered to the neonate shortly after birth per routine protocol. Maternal medical history is noncontributory, with her obstetric record showing no history of sexually transmitted infections (STIs). Warm compresses and tear duct massage are ordered based on a suspicion of nasolacrimal duct obstruction. Overnight the infant develops increased eye drainage. On physical examination, the upper eyelids appear edematous and erythematous (left greater than right) with purulent discharge bilaterally, similar to the infant in the Fig. The conjunctivae are noted to be beefy red. Eye cultures are performed and gentamicin ointment administered. Figure. Newborn with gonococcal ophthalmia neonatorum caused by a maternally transmitted gonococcal infection. (Courtesy of Centers for Disease Control and Prevention Public Health Image Library (PHIL), identification number #3766. CDC/ J. Pledger.) Three days after birth, in the setting of worsening bilateral edema and copious drainage, the parents are questioned in greater detail regarding their STI history. At this time, the mother discloses that 3 days before delivery she had undergone STI testing because the infant’s father had been recently treated empirically for an STI. The mother is currently unaware of her test …