Gonococcal conjunctivitis: the importance of good-quality conjunctival swabs.

552 British Journal of General Practice, October 2015 IntroduCtIon Adult gonococcal conjunctivitis is a relatively rare disease in the UK. It ‘typically’ presents in young adult men who have sex with men, and usually is preceded by a symptomatic urethritis.1 Examination shows unior bilateral conjunctival injection, chemosis, subconjunctival haemorrhages, and copious mucopurulent discharge. If there is corneal involvement, there may be associated epithelial defects and stromal infiltrates, which, if left untreated, can rapidly lead to corneal perforation. It is easily treated and therefore a diagnosis not to be missed.2 Case hIstory A discharging red eye is a common presentation to general practice, and is often diagnosed and treated as bacterial conjunctivitis.3 We were referred a 76-yearold male patient with severe bilateral conjunctivitis, unresponsive to treatment with topical chloramphenicol and fusidic acid.4 He developed photophobia and reduced visual acuity to 6/18 in both eyes from 6/9 1 year previously. Slit-lamp examination demonstrated bilateral intense conjunctival injection, chemosis, diffuse conjunctival vessel dilatation, with small