**3.7 Neonatal conjunctivitis**

Infants with neonatal conjunctivitis (ophthalmia neonatorum) present with eyes that are red, swollen and accompanied by discharge ("sticky eyes"). *Chlamydia trachomatis* and *N. gonorrhoeae* are the most significant pathogens which cause ophthalmia neonatorum in developing countries although infections from *Staphylococcus aureus*, *Streptococcus pneumoniae*, *Haemophilus* spp., and *Pseudomonas* spp. occur. The oropharynx, urogenital tract, and rectum of neonates may also be affected in *Chlamydia trachomatis* or *N. gonorrhoeae* infection. *Neisseria* conjunctivitis develops within a few days of birth whereas *C. trachomatis* conjunctivitis develops slower, 5-14 days after birth. Neonatal conjunctivitis caused by *N. gonorrhoeae* can lead to blindness when untreated. Coverage should be provided for both of these STIs in settings where definitive diagnosis is not possible, especially where there is evidence of a maternal STI. Treatment should include a single dose therapy for gonorrhea and multiple dose therapy for chlamydia. For gonorrhea a single intramuscular injection of ceftriaxone, 50 mg/kg to a maximum of 125 mg total, should be administered. If ceftriaxone is unavailable, single injections of kanamycin or spectinomycin at 25 mg/kg to a maximum dose of 75 mg total may be used. For chlamydia treatment, erythromycin syrup, 50 mg/kg per day orally, in 4 divided doses for 14 days or trimethoprim, 40 mg with sulfamethoxazole, 200 mg orally twice daily for 14 days are recommended. Gonococcal ophthalmia neonatorum is preventable if a 1% silver nitrate solution or 1% tetracycline ointment is applied at birth as a prophylactic measure.
