I. Definition. Infection with Neisseria gonorrhoeae (a Gram-negative diplococcus) is a reproductive tract infection that is an important infection in pregnancy because of transmission to the fetus or neonate.
II. Incidence. The prevalence of gonococcus infection among pregnant women is ~1–8 in 1000. If routine ophthalmic prophylaxis was not used, it is estimated that a third of newborn infants born to infected mothers would become infected.
III. Pathophysiology.N. gonorrhoeae primarily affects the endocervical canal of the mother. The infant may become infected during passage through an infected cervical canal or by contact with contaminated amniotic fluid if rupture of membranes has occurred.
IV. Clinical presentations
A. Ophthalmia neonatorum. The most common clinical manifestation is gonococcal ophthalmia neonatorum. This occurs in 1–2% of cases of positive maternal gonococcal infection despite appropriate eye prophylaxis. For a description of this disease, see Chapter 47.
B. Gonococcal arthritis. The onset of gonococcal arthritis can be at any time from 1–4 weeks after delivery. It is secondary to gonococcemia. The source of bacteremia has been attributed to infection of the mouth, nares, and umbilicus. The most common sites are the knees and ankles, but any joint may be affected. The infant may present with mild or moderate symptoms. Drainage of affected joint and antibiotics are necessary.
C. Amniotic infection syndrome occurs when there is premature rupture of membranes, with inflammation of the placenta and umbilical cord. The infant may have clinical evidence of sepsis. This infection is associated with a high infant mortality rate.
D. Sepsis and meningitis.
E. Scalp abscess is usually secondary to intrauterine fetal monitoring.
A. Mother. Endocervical scrapings should be obtained for culture.
2. Culture. Material may be obtained by swabbing the eye or nasopharynx or the orogastric or anorectal areas. Blood should be obtained for culture. Cultures for concomitant infection with Chlamydia trachomatis should also be done. Gonococcal cultures from nonsterile sites (eg, the pharynx, rectum, and vagina) should be done using selective media.
3. Spinal fluid studies. Cell count, protein, culture, Gram stain, and others should be ordered.
VI. Management. Isolation precautions for all infectious diseases, including maternal and neonatal precautions, breast-feeding, and visiting issues, can be found in Appendix F.
A. Hospitalization. Infants with clinical evidence of ophthalmia neonatorum, scalp abscess, or disseminated infection should be hospitalized. Complete sepsis evaluation including lumbar puncture should be performed. Tests for concomitant C. trachomatis, congenital syphilis, and HIV infection should be performed. Results of the maternal tests for hepatitis B surface antigen should be confirmed.
B. Antibiotic therapy
1. Maternal infection. Most infants born to mothers with gonococcal infection do not experience infection; however, because there have been some reported cases, it is recommended that full-term infants receive a single injection of ceftriaxone (125 mg intravenously [IV] or intramuscularly [IM]) and that premature infants receive 25–50 mg/kg (maximum, 125 mg).
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPediatrics Full Site: One-Year Subscription
Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.
Pay Per View: Timed Access to all of AccessPediatrics
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.