Neonatal and childhood gonococcal infections.

Maternal, fetal, and neonatal morbidity and mortality can be significantly decreased by selective screening of prenatal patients for gonorrhea, early treatment, and follow-up cultures after treatment for gonorrhea. Ophthalmia is the most significant neonatal gonococcal infection. Administration of silver nitrate at delivery is the best prophylaxis against gonococcal ophthalmia. Treatment of gonococcal ophthalmia, however, requires parenteral penicillin, conjunctival antimicrobial therapy, and hospitalization. Treatment of the gonococci-infected mother is also indicated. Childhood gonorrhea is most commonly manifested as vulvovaginitis in girls or urethritis in boys, usually without associated disseminated gonococcal infection. Transmission can occur by indirect contact with an infected parent or involuntary or voluntary sexual activity: in children over age 10 years transmission of gonococci most commonly involves voluntary sexual activity. Emphasis should be placed on early treatment of the infected child, follow-up cultures, and contact tracing. Diagnosis of gonococcal infection requires adequate specimens, gram stains, and cultures for N. gonorrhoeae. In disseminated neonatal gonococcal disease, gram strains and cultures of the conjunctiva, oropharynx, orogastric aspirates, anogenital area, umbilicus, and external ear canal frequently aid in the diagnosis. Frequently, a gram strain of the urethral discharge in boys is sufficient for diagnosis of gonorrhea; in girls cultures are necessary. Since the incidence of gonorrhea in children has increased, the importance of epidemiologic analysis and follow-up after treatment can not be overemphasized.