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Paper text:
it is the second most common bacterial sexually transmitted infection ( sti ) in the us .
this infection may be transmitted to other organs such as eyes by contact via unclean hands . as gonococcal eye infection in the adults is very rare , the clinical diagnosis may be delayed .
gonococcal keratoconjunctivitis is a potentially devastating infection because neisseria gonorrhoeae can cause a rapid , severe , ulcerative keratitis resulting in visual loss .
the therapeutic decision making process is complicated by the necessity for prompt , effective parenteral therapy , frequent coinfection with other sexually transmitted diseases , and emergence of antibiotic resistance .
the genital infection in a patient presenting with red eye may be missed if not questioned , specifically for , by the physician to whom the case presents initially .
reported herein is a case with unilateral gonococcal conjunctivitis with intracellular gram - negative diplococci and gonococcal urethritis , without any adverse outcome in the eye owing to a prompt diagnosis and treatment .
a 22-year - old omani male presented with redness in right eye [ figure 1 ] and was referred from the ophthalmologist to screen for sexually transmitted diseases .
the patient had unprotected sexual intercourse with a commercial sex worker  1 week ago and noticed yellow stains on the clothes second day onward ; however , he had minimal discomfort while passing urine . the redness in the eye developed on the third day .
thick yellow purulent discharge was observed from urethra , urethral meatus did not show any signs of inflammation .
urethral smear and a swab from right eye were stained with grams stain and both were found to show numerous gram - negative intracellular diplococci . throat swab was negative for diplococci .
the patient was screened for venereal disease research laboratory test and human immunodeficiency virus and was found to be negative for both .
redness in the right eye eye examination showed severe conjunctival congestion in right eye with chemosis , subconjunctival hemorrhage .
he was hospitalized and treated with ceftriaxone 1 g i / m as per cdc guidelines along with doxycycline 100 mg bd for 7 days .
he recovered well and without any remaining stigma or visual loss in the affected eye .
gonorrohea infects mucous membranes viz . , urethra , cervix , rectum , pharynx , synovium , and eye .
gonococcal ocular infection can be divided into two distinct forms , one affecting neonates and the other sexually active adults .
an instance of ocular gonococcal infection in an adult even in the absence of genital infection has been reported in the literature .
gonorrhoea causes profuse , hyperacute purulent discharge accompanied by severe conjunctival chemosis and dilatation of the conjunctival vessels , eyelid swelling , and epithelial or stromal keratitis .
corneal melting , subepithelial infiltrates , edema of cornea , and corneal perforation may be seen .
gonococcal conjunctivitis is an emergency , requiring aggressive management to be fully codified . without proper treatment ,
it can evolve and lead to fulminant ocular perforation within 24 h. frequently ocular saline lavage and topical antibiotics have been recommended as ancillary therapy in the treatment of gonococcal ophthalmia , but are not essential for successful treatment of n. gonorrhoeae conjunctivitis in adults . unlike the majority of conjunctivitis , the treatment is not only locally , but relies on antibiotic therapy and in some cases , an initial hospital surveillance .
indeed , the possible onset of a purulent corneal melting , which is the severity of the disease justifies this support .
if aggressive parenteral antibiotic therapy is instituted before severe corneal destruction occurs , it appears the risk of serious sequelae and visual loss is greatly reduced .
hence , centers for disease control had issued the recommendation that all patients with adult gonococcal conjunctivitis be treated with hospitalization and a 5-day course of high doses of parenterally administered antibiotics which stands revised and the 2010 guidelines recommend single intramuscular dose of 1 g of ceftriaxone and lavage of the affected eye with saline once .
urethral symptoms precede the ocular symptoms from 1 week to several weeks , it was unusual of the patient in our case to present for ocular symptoms rather than the urethral symptoms and the ophthalmologist ordered a gram stain of the eye discharge to ascertain the diagnosis which revealed the cause and the patient was referred to us to screen for gonorrhoea and other sexually transmitted diseases .
gonorrhoea is a sexually transmitted disease marked by urethritis in males ; it may also be transmitted to other organs through contact with infected genital secretions or urine , although rare in this era of modern antibiotics and rapid diagnostic tools . 
 it could pose a difficult situation when we encounter emerging resistant strains . 
 this paper reports a male who presented initially with unilateral gonococcal conjunctivitis contracted via autoinoculation and was found out to be suffering from gonococcal urethritis .