What are the symptoms of an STD of the eye?

What Does an STD of the Eye Look Like?

STD-related eye infections present with two distinct clinical pictures: gonococcal conjunctivitis shows severe, rapidly reaccumulating purulent discharge with marked eyelid swelling, while chlamydial conjunctivitis presents with distinctive follicles on the conjunctiva, chemosis, and papillary hypertrophy. 1

Gonococcal Conjunctivitis Appearance

The hallmark features include:

• Marked eyelid edema that is often dramatic and bilateral (though can be unilateral) 1
• Copious purulent discharge that rapidly reaccumulates even after cleaning 2, 1
• Preauricular lymphadenopathy (swollen lymph nodes in front of the ear) 1
• Severe conjunctival injection (redness) 3
• Corneal infiltrates or ulcers may develop rapidly, representing a vision-threatening emergency 1

Critical timing: In neonates, symptoms manifest 1-7 days after birth, but adults can develop symptoms following sexual contact or autoinoculation 3, 2. This is a medical emergency because corneal perforation can occur within 24-48 hours if untreated, potentially leading to blindness 2.

Chlamydial Conjunctivitis Appearance

The distinctive features include:

• Follicular conjunctivitis with characteristic follicles visible on the bulbar conjunctiva and semilunar fold 1
• Chemosis (conjunctival swelling) 1
• Papillary hypertrophy of the conjunctiva 1
• Less severe discharge compared to gonococcal infection, though still present 3
• Can be unilateral or bilateral 1

Critical timing: In neonates, symptoms appear 5-19 days after birth, later than gonococcal infection 2. The presentation is generally less hyperacute than gonococcal conjunctivitis 4.

How Transmission Occurs

Direct contact routes include:

• Autoinoculation from infected genital secretions transferred by hands to eyes 5, 6
• Direct ejaculation into the eye during sexual activity, which is an underrecognized transmission route 5
• Contact with infected bodily fluids from active lesions 4
• Vertical transmission during vaginal delivery in neonates 3, 4

Red Flags Requiring Immediate Ophthalmology Referral

You must seek urgent evaluation if any of these are present:

• Visual loss or changes in vision 2
• Moderate or severe eye pain 3, 2
• Severe purulent discharge that rapidly reaccumulates 2
• Corneal involvement (detected by fluorescein staining showing uptake) 2
• Lack of response to therapy within 3-4 days 2, 1
• Conjunctival scarring 3

Critical Pitfalls to Avoid

Common mistakes that lead to poor outcomes:

• Assuming topical antibiotics alone are sufficient - both gonococcal and chlamydial eye infections require systemic antibiotics, not just eye drops 3, 1
• Delaying evaluation of severe purulent discharge - gonococcal infection can cause corneal perforation and blindness within 24-48 hours 2
• Missing co-infection - patients infected with gonorrhea are often co-infected with chlamydia, requiring treatment for both 3, 1
• Failing to examine and treat sexual partners - this is essential to prevent reinfection and community spread 3, 1
• Not considering sexual abuse in children - any STD-related eye infection in preadolescent children warrants investigation for abuse 3, 1

Associated Systemic Complications

Beyond the eye, these infections can cause:

• Gonococcal: Septicemia, arthritis, meningitis, and disseminated gonococcal infection 3, 1
• Chlamydial: Nasopharyngeal infection, genital infection, and pneumonia (especially in infants with characteristic staccato cough) 1

The key distinguishing feature: Gonococcal conjunctivitis is hyperacute with copious pus and rapid progression, while chlamydial conjunctivitis is more indolent with characteristic follicles and less dramatic discharge. Both require systemic antibiotics and evaluation of sexual partners. 1