A 23-year-old sexually active female with painless bilateral eye exudates and gram-negative diplococci with corneal sparing: most appropriate management?

• A. Ceftriaxone (Rocephin)
• B. Polymyxin ophthalmic drops (Aerosporin)
• C. Ciprofloxacin (Cipro)
• D. Doxycycline (Doryx)

Answer: (A)

Gonococcal conjunctivitis in an sexually active young adult is suggested by a hyperpurulent, bilateral eye discharge and Gram-negative diplococci seen on Gram stain, with corneal involvement often spared early. The key treatment principle is to use systemic antibiotics because the infection is due to Neisseria gonorrhoeae, which requires drug levels achieved in the bloodstream and tissues to reliably eradicate the organism and prevent rapid progression or dissemination.

Ceftriaxone, given systemically (usually an intramuscular dose), provides reliable activity against gonococcus and penetrates ocular tissues well. This makes it the best choice for this scenario, addressing both local ocular infection and potential reservoir or systemic spread. Topical antibiotics alone are insufficient for gonococcal conjunctivitis, and other agents like polymyxin drops or fluoroquinolones do not provide the necessary systemic coverage or have fallen out of favor due to resistance. If chlamydial co-infection is a possibility, adding doxycycline can be considered, but the cornerstone remains systemic ceftriaxone.