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TRAINER’S NOTES
CONGENITAL STI SYNDROMES
Infection of babies in utero or during delivery is one of the leading complications of
untreated STIs among mothers. This can result in congenital STIs among newborns.
Among the most serious congenital infections are infections with syphilis, HIV
gonococcal and chlamydial organisms and herpes simplex.
1. Neonatal Conjunctivitis:
This refers to conjunctival infection of neonates by STI organisms in the infected
mother’s birth canal. Neonates acquire this infection during passage through an infected
birth canal during delivery. It is a very serious condition that can lead to corneal
ulceration and ultimately to blindness. Blindness in children is associated with high infant
morbidity and mortality.
Main clinical Presentation:
This disease begins during the initial thirty days after birth. It is often characterized by
bilateral purulent eye discharge. The conjunctiva is inflamed and eyelids swollen. If
untreated, the cornea may be affected giving rise to corneal ulceration that can lead to
perforation and blindness. Corneal scarring may occur if treatment is delayed.
Case definition: A purulent conjunctivitis with at least one polymorphonuclear leucocyte
per high power field on a Gram stain of a smear of the eye discharge of an infant less
than 30 days old.
Aetiology: Opthalmia neonatorum may be caused by a number of organisms but the most
common are N.gonorrhoea and C. trachomatis. However, there are other non STI causes
of neonatal conjunctivitis predisposed by difficulty labour such as early rupture of
membranes, vaccum extraction or other assisted vaginal delivery.
Antibiotic treatment of choice:
Treatment should be given to cover both STI causative organisms. Attempts to
differentiate between the two based on clinical grounds can be counter productive.
Systemic treatment is recommended as well as irrigation of the eyes. Staff should use
gloves and wash their hands thoroughly after handling the eyelids. The recommended
treatment is Ceftriaxone injection, 125 mg single dose intramuscularly
Alternative treatment to cover gonococcal infections is Spectinomycin 25 mg per kg to a
maximum of 75 mg as a single IM injection, Kanamycin 25mg per kg to a maximum of
75 mg as single IM injection may also be used. This treatment will also cover Chlamydia.
Topical Tetracycline eye ointment has been shown to have no added benefit. However,
local irrigation of the eye with saline or sterile water should be carried. Staff should cover
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