USPSTF Reaffirms Advice on Prevention of Gonococcal Eye Infections in Newborns

By Reuters Staff

January 31, 2019

NEW YORK (Reuters Health) - The U.S. Preventive Services Task Force (USPSTF) continues to recommend that all newborns be treated with a topical antibiotic ointment to prevent gonococcal eye infections.

This "A" recommendation, meaning there is high certainty that the net benefit is substantial, matches the task force's recommendation put forth in 2011.

In the United States, the rate of gonococcal ophthalmia neonatorum was estimated to be 0.4 cases per 100,000 live births per year from 2013 to 2017. However, this is likely an underestimate, the task force notes in their January 29 online report in JAMA.

Gonococcal ophthalmia neonatorum can cause corneal scarring, ocular perforation, and blindness as soon as 24 hours after birth. Without ocular prophylaxis, transmission rates of gonococcal infection from mother to newborn range from 30% to 50%.

The task force commissioned a "reaffirmation evidence update" to identify any new evidence sufficient enough to change their 2011 recommendation. There wasn't any, and so the recommendation remains that all newborns receive topical ocular prophylaxis to guard against gonococcal eye infections.

The Centers for Disease Control and Prevention, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the World Health Organization all recommend universal topical ocular prophylaxis to prevent gonococcal ophthalmia neonatorum.

Currently, 0.5% erythromycin ophthalmic ointment is the only drug approved by the US Food and Drug Administration for this purpose, and it's not known whether Neisseria gonorrhoeae has developed resistance to erythromycin ointment in the U.S.

"However, given increased antimicrobial resistance noted in other countries, further research is needed to find safe and effective alternatives to erythromycin. Another area for research is whether risk-based prophylaxis of newborns, based on maternal risk factors, is as effective as universal prophylaxis," the task force says.

The USPSTF also has a longstanding recommendation to screen for gonorrhea in all sexually active women aged 24 and younger and in older women at increased risk for infection, as well as pregnant women.

"Although gonococcal infection rates have declined since national screening programs were implemented in the 1970s, reported gonorrhea cases have increased recently, from 105.3 cases to 171.9 cases per 100,000 population from 2013 to 2017, respectively," the task force notes.


JAMA 2019.