Of all venereal diseases for which statistics are kept in the United States, gonorrhea is the most common. It is caused by Gonococcus bacteria, and its symptoms range from a mild discharge to a widespread infection affecting the joints, the Fallopian tubes in women, the eyes, the throat and other organs.
Gonorrhea is referred to as congenital when it is passed from an infected mother to her newborn baby. A baby with congenital gonorrhea may develop an infection in the eyes, throat and anus. A newborn with a widespread congenital infection may also develop arthritis.
Eye infection (referred to as gonococcal ophthalmia) can lead to blindness. At the turn of the last century, it accounted for almost one fourth of cases of blindness in the United States. Since then its incidence has dropped sharply, because of widespread use of prophylactic treatment in the delivery room. All newborns receive an installation of silver nitrate or erythromycin eye drops to prevent gonococcal opthalmia.
WHAT CAUSES CONGENITAL GONORRHEA?
Gonorrhea is transmitted between adults through sexual activity. A baby born to a mother with gonorrhea can become infected while passing through the infected birth canal. Less commonly, the fetus may become infected while in the womb, if the membranes rupture; some newborns delivered by cesaerean section after membrane rupture may develop gonococcal eye disease. When infection occurs in the womb, no preventive measures can be taken. A newborn baby may also become accidentally infected after birth through contact with an infected mother or another individual with gonorrhea.
WHEN SHOULD I SUSPECT THAT MY CHILD HAS CONGENITAL GONORRHEA?
Obstetricians routinely test expectant mothers for a number of infections, including gonorrhea. If the mother is infected, she will be treated before giving birth.
If the infection is not detected in the mother, the baby may show symptoms of eye disease within three days after delivery. Look for a watery discharge that quickly thickens and may contain pus and blood; the discharge may cause the eyelashes to stick to one another. Usually, both eyes are affected. The baby's eyelids swell; sometimes the swelling spreads to the eye itself or the area around it. Ulcers may appear on the cornea. Early treatment is imperative to cure the disease promptly.
The bacteria may spread through the eye to other organs, causing widespread infection, arthritis or even cardiac inflammation. Symptoms of gonoccocal arthritis usually occur in the first one to four weeks after birth; they may include fever, rash, joint tenderness and swelling.
IS MEDICAL ATTENTION NECESSARY?
Call your pediatrician if the newborn develops any of the following signs:
• A discharge from the eyes
• Swollen eyelids and sticky eyelashes
• Swollen, warm and tender joints
WHAT TREATMENTS ARE AVAILABLE?
As soon as the disease is diagnosed, the infant must be hospitalized. The child will receive injections of penicillin for seven to ten days. The joints of a newborn with gonococcal arthritis usually must be drained of fluids and pus. Eye infection requires frequent baths with a sterile saltwater solution to remove discharge. In addition, an antibiotic ointment may be applied. The eye disorder usually resolves within several days.
In the past 20 years, some strains of gonococcal bacteria have developed resistance to penicillin. If so, the disease will respond to other antibiotics.
PREVENTING CONGENITAL GONORRHEA
The key to preventing congenital gonorrhea is to detect the disease in the expectant mother before it can pass to the baby. These techniques are used:
• Testing material from the cervix for gonococcal infection at the mother's first prenatal visit
• Taking a second cervical culture later in the pregnancy, for women at high risk for gonorrhea
• Taking oral and rectal cultures from infants born to a mother with untreated gonorrhea to check for the presence of infection
• Administering Ceftiaxone to full-term infants born to a mother with gonorrhea
• Treating the eyes of all newborn infants with antibiotic drops or a silver nitrate solution to prevent gonococcal ophthalmia
GETTING HELP
Call your doctor if:
• You are pregnant and you think you have a sexually transmitted disease
