Organisms that produce a membranes such as C. diptheriae, and adenovirus can also lend some confusion, but they typically are less purulent and less aggressive in onset. Prompt and effective management of gonococcal ophthalmia greatly affects the prognosis of the affected eye. Parenteral antibiotics are the cornerstone of disease therapy. They are used because of the virulence of the organism and the high risk of perforation and loss of the eye if lesser modalities are used. Dosing regimens have been more of a source of controversy than the antibiotics in use.
Ceftriaxone has very good penetration in the aqueous humor.
Some physicians in the past have advocated single dose IM ceftriaxone in this disease if no corneal involvement is present, while others contend that IV dosing is the most beneficial. Penicillin allergic patients may use Spectinomycin, a relative of the aminoglycosides, as an alternative. Concomitant treatment of other sexually transmitted diseases is important. Neither Ceftriaxone nor Spectinomycin is active against C. trachomatis. Doxycycline or tetracycline is the drug of choice for this organism.