Chlamydial versus gonococcal conjunctivitis in neonates

[amestramgram]

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Hi, I have a couple questions about chlamydial versus gonococcal conjunctivitis in babies:

- why does USMLEWorld split up the two? In adults I was taught that they usually occur together.

- UWorld keeps saying that Gonococcal conjunctivitis is much more purulent than chlamydial conjunctivitis, however without a comparison (within a question stem) how am I supposed to judge that "wow this is really purulent" and "eeeehhh this is not so purulent"?

- what characteristics of these two kinds of conjunctivitis will let me absolutely tell the difference every time?

thanks for your help!

 

[classof2011]

To distinguish the two on the boards, you can expect Gonococcal conjunctivitis to present before Chlamydial will present (5-7 days compared to 2 weeks respectively). It is true that Gonococcal is generally more purulent (just as in the genital infection) but I wouldnt bank on this fact to get the question right.

if conjunctivitis occurs in the first 24hours, think Chemical Conjunctivitis (from prophylactic silver nitrate drops). after that (up to 5-7 days) Gonococcal. After that (up to 2 weeks) Chlamydial (takes longer to manifest due to its obligate intracellular growth pattern).

 

[Mr Cookie Pants]

Just answer the question based on timing of presentation. That's the key to peds and about 75% of adult questions.

 

[jeesapeesa]

gonococcal 2-5 days after birth
chlamydial 5-14 days after birth (also watch for PNA)