According to WHO, the incidence of gonorrhea is about200 million cases per year. Currently, for gonorrhea infection hasacquired a number of features:•reduced sensitivity of the gonococcus to traditional antibacterialagents,•uncontrolled use of antibiotics leads to the appearance resistantorganisms,•become frequent the cases of detection of mixed infections,•increases the frequency of isolation of strains ofgonococcus producing penicillinase, which leads to an increase in theseverity of the disease.The social significance of gonorrhea due to high incidence, rapiddevelopment of complications, leading to an increase in thefrequency of male and female infertility.Gonorrhea is a disease whose treatment is supported by thelegislative acts, which include responsibility for the contaminationof the sexual partner, and forced treatment.
Gonorrhea of urogenital organs (the genital)Extragenital gonorrhea (gonorrhea of the rectum,pharynx, mouth, tonsils, eyes)Metastatic (disseminated) is a complication of thefirst two
• Gonorrhea of the lower parts urogenital tractwithout complications• Gonorrhea of the upper urogenital tract withoutcomplications• Gonorrhea other organs:- eye disease (conjunctivitis, iridocyclitis,ophthalmia);- destruction of the joints;- destruction of the pharynx;- destruction of the anus and rectum;- other destructions (gonokokkemiya,gonococcal endocarditis,meningitis, peritonitis).
•Gram-negative diplococcus Neisseria gonorrhoeae are openedby A.Neisseria in 1879•Diplococcus have length from 1.25 to 1.6 microns and 0.7 -0.8 microns in cross-section is shaped like coffee beans, aconcave surface facing each other.•Gonococcus - the main pathogenic microorganisms adaptedduring evolution to destroyed mostly mucous membranescovered with a cylindrical epithelium, resistance of which isextremely low, and a special tropism of gonococci due to thepresence of organelles - pili possessing virulent properties.• In the patient’s body gonococci often undergo L-transformation after using chemotherapeutic drugs or with achronic disease course.
Optimal for thedevelopment ofgonorrhea are thefollowingconditions - pH =7,4; temperature =35.5 C, the CO2content in theenvironment 2-10%.
On the surface ofgonococci revealsthin tubular filaments- fimbriae. They arecredited with theability of gonococcito transmit geneticproperties, such asantibiotic resistance,the ability to stick tothe epithelial cells ofthe owner and otherbiologicalcharacteristics.
In the study ofultrathinsections of agonorrheadetectedfollowingmorphologicalcomponents:•cell wall•mezosoma•nucleoid ofDNA strands•cytoplasm with numerous ribosomes and polyribosomes•cytoplasmic membrane
Gonococci arelocated mainly inthe cytoplasm ofleukocytes -polinukleares, butsometimes they canbe observed, and outof cells. They do notpenetrate theepithelial cells, andare usually on theirsurface or in theintercellular spaces.Gonococci are colored by methylene blue and the Gramstain. Gram stain is required. In this painting gonococci arestained pink.
householdsubjectsHaematogenously throughthe amnioticfluidInfection ofinfantsFlowing from theaffected organ
A single contact with an infected sexual partner leads to infection in 20-30% of cases.Contagiousness in women is much higher than in men, and amounts to 60 - 70%.Probability of infection with gonorrhea, depending on the type of sexualcontact (contact by 1) is:In the cervix,rectum70%;in the throat20-30%In the throatless than 2%to urethra20%;fromthe urethrafromthe cervixto urethra20%to urethraless than 3%fromthe rectumfromthe throat
Gonococci primarily affect parts of the urogenital tract, linedwith columnar epithelium - the mucous membrane of cervix,fallopian tubes, urethra, paraurethral and large vestibulargland. When genital-oral contacts can develop gonorrhealpharyngitis, tonsillitis and stomatitis, with genitalnoanalnyh -gonorrheal proctitis. When a pathogen enters the mucousmembrane of the eye, including the passage of the fetusthrough an infected birth canal, there are signs of gonococcalconjunctivitis.Vaginal wall, covered with stratified squamous epithelium isresistant to gonococcal infection. However, in some cases(during pregnancy, in girls and in postmenopausal women),when the epithelium becomes thinner or becomes friable, maydevelop gonococcal vaginitis.
Gonococci entering the body, quickly fixed on the surface ofepithelial cells with pili, and then penetrate deep into thecells, intercellular gap and the subepithelial space, causingthe destruction of the epithelium and the development ofinflammatory reactions.Gonorrheal infection in the body usually covered by stretch(canalicular) from the lower parts of the upper urinary tract.Adhesion to the surface of the sperm gonorrhea andtrichomonas in enterobiasis promote more rapid progress.Gonococci by lymphogenous way can penetrate into the thelymphatic vessels and nodes located above the urethra in thegenitals.
Entering into the bloodstream, gonococcus cause bacteremia,rarely disseminated to various organs to form metastases(metastatic gonorrhea). Reproduction of gonococci in the bloodstream to the development of sepsis occurs very rarely.Gonococcal inflammation leads to the development ofdegenerative processes in the submucosal layer of the urinaryorgans. In chronic inflammation, cylindrical epithelium can betransformed into stratified squamous with symptoms ofkeratinization causing stricture urethra.In response to the introduction of the causative agent ofgonorrhea in the body produces antibodies, but the immunesystem is ineffective in this case. A person can be infected withgonorrhea, and ill many times. This can be explained by theantigenic variability of gonorrhea.
urethraparaurethral ductslarge gland of vestibule,the cervical canal,vaginathe secret of the prostate, seminal vesicles, glands and urethrallacunaewashings of the rectumscrapings from the urethra and rectumeyes discharge with gonoblenoreesynovial fluid of joints with lesionsFence material produces a doctor.
The symptoms usually appear 3-7 days after infection,but in some cases the incubation period increases up to2-3 weeks.
cutting pains in the beginning of urination, burning,itchinglips external foramen of urethra - sharply hyperemic,edematousthe urethra are infiltratedprofuse purulent discharges of yellowish or greenish color,soiling underwearpain of suspension of urethrapainful erectionsturbid from pus 1st (200 ml) serving of urine
pain throughout urination, pollakiuriaimperative desires to urinatepurulent discharge from the urethra, lips of externalforamen of urethra swollen, hyperemizedterminal hematuria - at the end of urinationdischarged few drops of bloodwith the defeat spermatic tubercle –frequent painful erections,gemospermiya
characterized by a significantreduction of all symptomsoccurs after 3-10 days an acuteurethritismild itching or stinging duringurinationunprofuse, mainly morning sero-purulent dischargelower severity of hyperemia andedema of urethral lips
moderate pain at the beginning of urination, itchingof the external foramen of urethralips of urethral can be a little inflamed, edematous(morning sticking sponges)discharge from the urethra is scarce - either in themorning, or notThompson test:1 cup - clear urine with a small amount of whitefibers2 cup - a lot of long and short fibers
pain when urinating mild or absentitching of the meatusurethral sponge can be a little inflamed, edematousslight discharge from the urethra (usually in theform of "morning drop")threads and flakes of pus are detected in a urineanalysisespecially in chronic gonorrheaoften have a variety of complications
Balanoposthitis -inflammation ofthe inner layer ofthe foreskin andthe glans penis.On the skin of thepenis appear toerosion, mostly inthe bridle, there ispain.
Periuretrit (cavernitis) - inflammation of looseconnective tissue surrounding the urethra.1. restricted - formed a dense, painful infiltrate duringthe urethra2. diffuse - the accumulation of pus in the cavernousbodies
Paraurethral abscess - occurs when the introductionof the pathogen in the periurethral tissue and thecorpus cavernosum, shaped infiltrate can make itdifficult urination. Later, he is often subjected topurulent fusion, exposing to the urethra.
Cooperitis - inflammation of the glands Cooper1. catarrhal - pathological changes capture theexcretory ducts of glands2. follicular - psevdoabstsessy formed, appears a slightpain in gland3. parenchymatous - in the process of parenchyma isinvolved, pain increases4. parakuperitis is characterized by the spread ofinflammatory changes on the surrounding tissue.Determined by the fluctuation of the tumor. Thegeneral condition of the patient deterioratedmarkedly. The body temperature rises to 39CIn secret of Coopers gland are gonococci.
Epididymitis - inflammation of the epididymis, usually arises asa result of introduction of gonococci from the back of theurethra through the ejaculatory ducts and vas in the tail of theepididymis. Less commonly, gonococci penetrate into theepididymis through the lymphatic vessels.Symptoms:1. the presence of blood in the semen2. painful swelling of the scrotum3. febrility4. groin pain5. pain during ejaculation6. pain in the scrotum, which increases during a bowel movement7. discharge from the urethra
Differentitis - inflammation of the vas deferensFuniculitis - inflammation of the spermatic cordUrethral stricture - umbilicus narrowing, usuallymultipleProstatitis - inflammation of the prostate gland.There is usually at the back of the urethral injurydue to contact of gonococci into the prostate throughthe excretory ducts of the glands, sometimeslymphogenous and hematogenous route.
Vesiculitis - inflammation of the seminal vesicle, oftenaccompanied by lesions of the prostate. Catarrhalchanges in the mucous membrane of seminal vesicleaccompanied by desquamation of the epithelium. Incases of involvement in the pathological process of thesubmucosal and muscular layers of the bubble wallshow a deep form of vesiculitis, accompanied by acompleted body of purulent contents. Progression ofdisease leads to the development of empyema, and inthe future - and to paravesiculities. Clinicalmanifestations are diverse: the itching and pain in theurethra combined with the frequent urge to separateurine and terminal hematuria.
Features of gonorrhea in women:1. Gonorrhea in most cases of the disease does notcause significant pain.2. Multifocal disease: foci of inflammation existsimultaneously in the urethra, cervix, large glandsof vestibule , and often in the rectum.
The forms of gonorrhea in women:1) fresh gonorrhea of the lower urinarytract (active, torpid, asymptomatic);2) a fresh rising gonorrhea;3) chronic gonorrhea of the lower urinarytract (active, torpid, asymptomatic);4) chronic rising gonorrhea in the acute stage, in the stage ofrelative stabilization and in the stage of stabilization.The acute stage is determined bythe symptomatic bright lesions of the uterus and appendages(increased body temperature, changes in blood counts,and the appearance of pain, induration and tenderness of theinternal reproductive organs). In the stage of relativestability the changes in the internal sex organs are lessnoticeable. In the stage of stabilization patients have nocomplaints, but objectively observed changes in the uterusand appendages.
Vulvitis and vestibulitis (Vulvovestibulitis)-gonorrhea of the lower parts of the genitourinary system.Vulvovestibulitis - is rare inflammatory process ,because this region ismostly covered by stratified squamous epithelium.Clinically: diffuse hyperemia appears in the acute stage , swelling ofthe mucous membrane and secretions of pus from crypts.Small lips swell and stick together.
Urethritis .Female urethra is short (3.5 - 4 cm) and wide (1.5times wider than the male). Glandular apparatus islocated mainly in the anterior part. Urethritis isessentially a disease of the glands in urethra.In acute gonorrheal urethritis the mostfrequent complaints are on pain andburning during urination. But after a few days,these phenomenons are much smaller.In chronic urethritis complaints are usually absent.Clinically appears hyperemia and swelling ofthe urethral sponges.Urethra is infiltrated , palpation is painful.
Paraurethritis.Paraurethritis is usually asymptomatic. Gonococci oftenbreed on the bottom of lacunar stroke, because it iscovered with columnar epithelium and the walls -stratified squamous epithelium.External opening of lacunar stroke is an extra- orintrauretral in the form of point. There is congested spotaround this point. Purulent discharge appears afterpressing on the mouth of the duct. When the mouth ofthe duct closes by purulent discharge and peelingepithelium an abscess is formed . Periodically, it can beemptied and recurring, remaining a constant focus ofinfection.If paraurethritis becomes chronic, hyperemia around thelacunar strokes is reduced. Gonococci in the cavity ofthe lacunae retain virulence during a lot of months oreven years. That’s why paraurethritis can exist longerthan urethritis.
Bartholinitis - inflammation of the large vestibular glands, often occurs secondarily,after 2 - 3 weeks after infection, but it happens and primarily.There are six forms of gonorrheal lesions of vestibular glands.1. Surface canaliculitis develops after penetration of the pus, flowing from theurethra and cervix to the vulva, into the gland. In this form the peripheral part of theexcretory duct is affected.2.Сanaliculitis affects to the whole excretory duct. The duct thickens due to smallcell infiltration. It is painful on palpation.3. Nodose bartholinitis occurs in patients with chronic gonorrhea as a result of partialsubstitution of infiltration by connective tissue. Tight, usually painless knot is felt inplace of the gland and its duct.
4. False abscess occurs after obstruction of the excretory duct and congestion ofpurulent secretions behind the mouth of the duct. The excretory duct stretchesand compresses the gland, but does not destroy it.Painful, fluctuating tumor is determined on palpation, this tumor locates in thelower third of the genital labia majora. The skin over the protrusion ishyperemic . Quite often can be a low-grade fever of the body. Patients complainon pain in genital organs. False abscess may spontaneously opened, puscontents breaks through the duct or the thinning mucous membrane on the innersurface of the labia minora. After that, swelling, hyperemia and deformity of thelabia disappear. However, over the time the disease can recur.
5.True abscess develops in the case when pyogenic bacteriajoin to gonorrhea , when there is a mixed infection. There isa purulent fusion of the gland and surrounding connectivetissue.Clinically: hyperemia, swelling, severe pain of small andlarge labia, increase of groin lymph nodes. There is high bodytemperature, weakness, patients can not walk. Whenthe abscess softens the pus breaks through, like a false abscess.
6. Excretory duct cyst is formed by the obliteration of the outside ofthe duct of Bartholin’s gland, when the infection has disappeared. Theduct is stretched by the gland’s secret. The part of labia majoraprotrudes in the localization of affected Bartholin’s gland. Tumor isround, painless, fluctuating. The size of tumor is like a pea.
VaginitisThe true gonorrheal vaginitis develops in pregnant ,women atmenopause (in thinning of the vaginal epithelium) and in girls whohave very loose epithelium and does not contain glycogen.Complaints are on the profuse discharge, itching and burning in thevulva. Sometimes granular eruption can be identified with the help ofpalpation . This granularity is due to inflammatory infiltration of the papillarylayer. Also it is marked accumulation of purulent discharge in the rear arch .
Endocervititis.Inflammation of the cervix usually occurs initially.In fresh process the cervix of uterus is swelling,hyperemic. There are profuse mucous discharges from the cervix. Around the mouth there is a bright red surface erosion, whichis then covered with the growing columnar epithelium.In the chronic stage, the cervix is less swelling, discharges are notso profuse.
Endometritis.The penetration of gonococci into the uterus and the development ofendometritis may manifest by symptoms of lesions of the body (bodytemperature 38 - 39C, the appearance of fever, the occurrenceof cutting pain in the abdomen, the sacrum, legs).Discharge fromthe gender gap are abundant, fluid, pus. Regular menstruation occurprematurely, they are heavy, long-term. At gynecologicalexamination is determined by two-handed painful enlarged uterus ofmild consistency. Many patients have increased ESR withnormal white blood cell count. In chronic endometritis patients havecomplaints rarely. Body temperature is usually normal, but it happens.Endomyometritis (Endomyomethritis). When the inflammation ofthe endometrium extends to the muscular layer of the uterus occursendomyometritis. Symptoms of acute endomyometritis are thesame as endometritis, but is more pronounced.Rising gonorrhea
SalpingoophoritisIn the acute stage of the desease, usually in purulent oophoritis, general conditionis deteriorating : there is a high body temperature, rapid pulse, loss of appetite,nausea, and vomiting. Dry tongue , coated. The pains are often cramping , areaccompanied by fever. In the formation of piosalpinks the pain intensify. There arebloating, delayed stool.In some patients who underwent salpingoophoritis, the disease becomeschronic. Patients concerned about constant aching pain in the abdomen, bloating,constipation, decreased libido, impaire reproductive function.
Peritonitis (Peritonitis).Propagating through the mucosa, gonococci with purulentcontents fall in the pelvic peritoneum throughthe ampullar end. There are pelvioperitonitis, which is a formof local peritonitis, and inflammation of theperitoneum beyond the pelvis - the lower and upper floors ofthe abdominal cavity, corresponding to generalizedperitonitis. Diffuse gonorrheal peritonitis is rareand usually ends in recovery.The disease begins abruptly, but the symptoms of acuteabdomen are less pronounced than inother septic inflammation of theperitoneum. Peritoneal effects last no longer than 7days (average2-3 days) and quickly subside. The bodytemperature is high. With the progression of this processthe heart failure may be observed, the fall in bloodpressure, intestinal paresis. There may come a death.
Congestion in the pelvic organs that develop during pregnancy,determine the identity of gonorrhea in pregnant women. Despite thelack of complaints, the majority of patients can bedetected very pronounced inflammation in theurethra, cervix, rectum, etc.The cervix is affected gonococcus in all pregnant women, theurethra - in 74%, the uterus - in 20.5%, the rectum -at 16.35%,Bartholin gland - at 7.45%.Gonorrhea in 6.5-10% of pregnant women leads to spontaneousabortions and in 6.3 - 12% is a cause of preterm birth.Treatment:Drugs of choice during pregnancy are some ofthe cephalosporins,macrolides,spectinomycin, benzylpenicillin. Tetracyclines are contraindicated,fluoroquinolones, aminoglycosides.The criteria for cure are:-the absence of subjective and objective symptoms-negative results of microscopy and culture studies
In girls, due to age-related anatomicaland physiological features theclinical pictureof gonorrheal process is other thanthose in women.Sources of infection:-are most often parents or otherpersons who are caring for a child.- Rarely become infected throughsex with an attempt to rape.- Rarely can betransmitted gonococcal infection tothe fetus by hematogenous way orthrough placenta.Incubation period is up to 3 days.Gonorrhea among girls, as well as inwomen, is a multifocal disease.
Clinical picture:manifestationsof gonorrhea depend on the stateof the organism and the virulenceof gonococci. Inacute vulvovaginitis, the skin ofthe labia minora and majora, thevestibule mucous membraneare swollen, hyperemic and arecovered by purulent mucoussecretions , the clitoris andthe hymen is swollen. Purulentdischarge collects in the posteriorfornix of vagina. Mainly the frontthird of the urethra is affected.Chronic gonorrhea in girls is rareand is only 6%.
Gonococci fall into the rectum with purulent secretion from thegender gap in women and girls, or after perverted sexualact with homosexual male. Only the distal part of rectum and theregion of external sphincter of the anus are affected,where gonococci have favorable conditions forexistence. Gonorrheal proctitis rarely occurs acutely.The clinical picture of acute suppurative proctitis:- Pain with bowel movements or itching in the anus, in the formationof cracks and erosions in the external anal sphincter may be anadmixture of blood to feces;-circumference of the anus is hyperemic.In chronic and fresh torpid forms of proctitis there are nocomplaints from patients .
Gonococcal pharyngitis is caused by oral-genital sex, thus there is infection of the throat andother organs of the mouth: the tonsils, gums,tongue, palatine arches with the tongue.Clinical picture:-often asymptomatic.Sometimes, patients can be confusing by dryness inthe throat, pain, aggravatedby swallowing, "tickle" in the throat.On examination congestion and swelling of themucous membrane of the oropharynx maybe detected .Sometimes individual follicles, anincrease of regional lymph nodes and low-gradefever can be found . Sometimes thereis hoarseness. The inflammatory process mayspread to other parts of the oral mucosa, soft palate,gums. Gonococcal gingivitis may be accompaniedby bleeding gums and the appearance of halitosis.
This is a common manifestation of gonococcal infection ofnewborns(gonococcal conjunctivitis, iridocyclitis, gonococcalophthalmia neonatorum), but also meet in adults. Newborns are infected duringpassage through the birth canal, but maybe in utero infection of theamniotic fluid.The incubation period ranges from 2 to 5 days. The disease mayoccur on the first day of life.
The clinical picture of eye gonorrhea :-swelling of both eyelids, photophobia, mitigation age 3-4days, the appearance of copious purulent discharge,which accumulates at the edges of the eyelids.The period of the flow of pus has a duration of twoto three weeks. After this period, a periodof papillary hypertrophy, there is a decrease in theamount of pus and its liquefaction, edema andhyperemia of the conjunctiva is also reduced, andpapillary growths appear .Neonatal ophthalmia develops after the deep penetrationof the inflammation to the eye, it affects theinner shell. This may be result in thesubsequent scarring and vision loss.
Gonococci penetrate into the bloodstream in most cases of gonorrhea. But in theblood gonococci are killed immediately by the influence of factors of naturalimmunity. Only in relatively rare cases the hematogenous dissemination ofgonococci occurs, when they are multiplying in the blood (gonokokkemiya),recorded in various organs and tissues, causing destruction of the joints,endocardium, meninges, liver (abscess, perihepatitis), and skin.Disseminated gonorrheal infection occurs in two main forms.1) A heavy, sometimes fulminant sepsis.- high fever, tachycardia, chills and heavy sweats, and various skin rashes.2) Easy process- The phenomenon of toxemia expressed slightly, febrile reaction is moderate orshort-term, and the clinical picture is dominated by joint destruction.
The main methods of laboratory diagnosis of gonorrhea - smear andbacteriological, are aimed at detecting the pathogen. The identification is carriedout in three gonorrhea signs: diplococcus, intracellular location, gram-negativemicroorganisms. Due to the high potential for variation under the influence ofadverse environmental effects is not always possible gonococci detected bymicroscopy, the sensitivity and specificity of which consists of 45-80% and 38%respectively.Bacteriological method is more suitable . Planting material produced in aspecially created artificial culture media. The sensitivity of bacteriologicalmethods - 90-100%, specificity - 98%.The men take swabs from the urethra and rectum in women - from the urethra,vagina and rectum.Other methods of laboratory diagnosis of gonorrhea (immunofluorescence,ELISA, DNKdiagnosis),they are rarely used.
A. Bacterioscopy (in acute form of gonorrheapathogen is largely confined to leukocytes, and in chronic form -extracellularly).N - neutrophilic leukocytes.Gn - gonococci, filling the inside white blood cells/
2 .Bacteriological examination, the definition of sensitivity toantibiotics.3. Immunofluorescence assay (IFA).4. Immunofluorescenceassay (IFA). With this diagnosticmethod can identify the gonococcus in the early stages of the disease,it is important incases where there is a combination of gonorrhea andother microorganisms, such as pale treponema (syphilis).5. Molecular methods: polymerase chain reaction and ligase chainreaction (PCR, LCR).PCR is a DNA analysis for gonorrhea - a method of geneticidentification of gonorrhea. This method has the highest sensitivityand specificity.
Treatment of uncomplicated gonococcal infection:Suggested modes are:Ceftriaxone (Rocephin) / m 250mg onceCiprofloxacin 500 mg orally onceCefixime per os a single dose of 400 mgAlternative modes:Ofloxacin 400 mg per os onceSpektomitsetin (macrolide) 2.0 V / m for single men, 4.0 V / m forwomen.The drug is indicated for intolerance of quinolones and cephalosporins.It is also used:Tseftizoktsim-500 mg / m onceCefotaxime (klaforan) 500 mg / m onceTsefotetan 1.0 / m onceCefoxitin 2.0 V / m onceCefuroxime aksetil 1,0 per os onceProkstil cefpodoxime 200 mg per os onceEnoksatsin 400 mg per os onceNorfofloksatsin 800 mg per os once
Treatment of complicated gonorrheaRecommended modeCeftriaxone is 1.0 V / m or / once a dayalternative modes ofCefotaxime or Tseftizoksim 1.0 in / in 8 hoursIf intolerance B-lactam ntibiotics, Spectinomycin 2.0 V/ m after 12 hours.Treatment is carried out before clinical signsof improvement, and24-48 hours after that,then, before the expiration of a full week since thebeginning of treatment, it is used thefollowing modes: Cefixime 400 mg orciprofloxacin 500 mg per os twice a day
Treatment of gonococcal infections of the eye:Ceftriaxone--1.0 g / m once.Local treatment: 1% - th solution of silver nitrate,1% tetracycline eye ointment th,0.5% eritromitsinovaya eye ointment.Treatment of gonococcal meningitisand endocarditis:-I / O high-dose Ceftriaxone: 1-2,0 in 12 hours. Thetreatment lasts10-14 days, meningitis, endocarditis, upto 4 weeks.
Treatment of neonatal ophthalmiaOphthalmia neonatorum requires isolation of thesick child for 24 hours of starting treatment.-Ceftriaxone at a dose of 25-50 mg / kg / d / or/ m in a single dosefor 7 days.Cefotaxime--25-50 mg / kg / m every 12hours. (With disseminated gonococcal infection inneonates).locally:to hourly rinsing with saline until the terminationof discharge.-solution of Na Cl 0,9%
Prophylaxis of ophthalmia neonatorum:Prevention is for all of preterm infants. It is doneimmediately after birth.Silver nitrate, 1% aqueous solution of a singledose of 2-3 drops in each eye.Erythromycin 0.5%, 1% eye ointment onceTetracycline 1% eye ointment
Ceftriaxone (Rocephin) / m single 125 mg (bodyweight less than 45kg)Alternative modes:Spektomitsetin 40 mg / kg dose.And children weighing over 45 kg, aretreated like an adult.