NC — Key Facts & Diagnosis

Clinical description

Neonatal conjunctivitis (ophthalmia neonatorum) is infection of the eyes in the first 4 weeks of life.

• Main symptoms: discharge, swelling, redness of lid/conjunctiva in one or both eyes during the first 4 weeks of life.
• NC is a very serious condition that can cause blindness if not appropriately managed — refer immediately to District or Central Hospital.
• STI causes (most common): Neisseria gonorrhoea, Chlamydia trachomatis, HSV-2.
• Non-STI causes: Staphylococcus, Pseudomonas aeruginosa, chemical irritation.
• NC is more common in neonates of HIV-infected mothers.

Prevention

• Routinely screen pregnant women for cervicitis and treat.
• Apply antibiotic or antiseptic eye ointment as part of routine newborn care: tetracycline 1% or erythromycin 0.5% or silver nitrate 1%.

Treatment

Medical emergency. Treat by experienced clinician/nurse at District or Central Hospital. Look for disseminated disease. Rinse eyes with sterile isotonic saline every 2 hours until improved. Do not cover/patch eyes. Do not give topical antibiotics or antiseptic drops/ointments.

Standard treatment — neonate

• Ceftriaxone 50 mg/kg IM stat.
• Azithromycin 20 mg/kg oral OD for 3 days.
• Rinse eyes: saline 2-hourly until cleared.

Partner treatment

Standard treatment — mother and all sex partners

• Ceftriaxone 500 mg IM stat.
• Azithromycin 1000 mg oral stat.

If symptoms not improved at 7 days: refer to specialist.

At every visit

HIV & ART status

• Ascertain HIV + ART status from health passport or self-report.
• Offer new HIV test for all unless previously diagnosed. Do not use coercion.
• New positive: active referral for ART initiation.
• New negative: refer/offer PrEP, VMMC, consistent condom use.
• Known positive: reinforce ART adherence or refer for re-initiation.

Hepatitis B

• Offer HBV rapid test for all patients born before 2002.
• HBsAg negative: refer for HBV vaccination unless previously completed 3 doses.
• HBsAg positive: refer for clinical and treatment assessment.

Syphilis screening

• Offer syphilis rapid test for concurrent asymptomatic syphilis (except in GUD/ARI where it does not influence treatment decisions).

Risk reduction & condoms

• Risk reduction counselling. Promote and dispense condoms.
• Promote VMMC for all non-circumcised men. Schedule appointment in 2 weeks.