When should a sexually transmitted etiology of bacterial conjunctivitis (pink eye) be considered?

Updated: Jan 03, 2019
  • Author: Karen K Yeung, OD, FAAO; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Venereal diseases should be considered in patients at a sexually active age. Consider the following:

  • If the conjunctivitis is associated with copious purulence, severe injection, and chemosis, then a discussion of possible exposure to N gonorrhoeae must take place. Bacterial cultures, including Thayer-Martin and chocolate agar, and a Gram stain must be performed, as well as newer nonculture point-of-service immunodiagnostics, if available. Immediate targeted treatment should be initiated.
  • A history of sexual partners must be obtained if the cultures/stain verify this condition so that they also can be treated.
  • The practitioner must be aware that laws require reporting incidences of this disease to the appropriate Board of Health.
  • A similar history must be obtained when chlamydial conjunctivitis is suspected.
  • Clinical suspicion of venereal disease may be present at first presentation or upon treatment failure of an unsuspected case.
  • It may be desirable to have the technician, nurse, or other clinical personnel take the sexual history to avoid a sense of inappropriateness.
  • It is better to ask the patient if they wish friends or family members to leave the room for this aspect of the evaluation.

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