Case Presentation

A case of cervicitis in suspected gonococcal

blepharokeratoconjuctivitis in adults

Irene Darmawan
Division of Sexually Transmitted Infection
Department of Dermatology and Venereology

May 9th 2023

Identity

Initial : Mrs. S
MR : 46633XX
Gender : Female
Date of birth/age : March 8th 1976 / 47 years
Address : Mampang Prapatan, Jakarta Selatan
Religion : Islam
Marrital status : Married
Insurance : BPJS

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 The patient was consulted to our division on May 2 nd 2023.
(Autoanamnesis)

Chief Complaint Redness and purulent discharge on the left eye since 3 days
ago.
(Patient was consulted for STI screening)

3

• Redness in left eye, accompanied
by burning sensation.
• She washed the left eye using tap
water and Eyerins.
• No symptoms on the right eye.
History of Disease
• Admitted to ophthalmic emergency
ward. Eye assessment:
• She has leftside headache. No fever. Blepharokeratoconjunctivitis suspected gonococcal
• On Gram staining, purulent or other bacterial infection.
discharged showed intracellular and
extracellular diplococcus.
• Ceftriaxone 1 gram IM was given.

3 days ago 1 day ago

2 days ago The day consulted

• Redness in left eye increased followed by • Consulted for STI screening.

eyelid swelling and purulent discharge
from left eye.
• Vision was slight reduced on the left eye.
• She washed her left eye using betel
water.
• Eye irrigation with urine was denied.
• Purulent eye discharge and ocular pain was
slightly decreased.
• Redness and swelling were still the same.
• Vaginal discharge was denied. No pain or
pruritus on genital area. No urination
symptoms. No lower abdominal pain. No sore
throat.
• Habits of eye rubbing was denied. 4
History of present illness
No history of painful blister, warts, painless ulcer on the genital area.
No history of rash on the palms, soles, and other skin area.
No history of lower abdominal pain.

Past medical history

No history of previous STI. No routine medication.

Socioeconomic Aspect
Works in golf club canteen as a food seller.
She is married (first marriage since 2001). Second marriage for her husband.
Sexual contact other than with her husband was denied.
Last sexual contact in 2021 (genito-genital, without condom) as her husband has been ill.
Her husband has no STI symptoms.

Recent sexual contact was denied. Masturbation or using sextoys were denied .
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Obstetric history: P2A0
o 2003, male, spontaneous vaginal delivery
o 2010, male, spontaneous vaginal delivery

Menstrual cycle:
o Regular cycle, 5 days, no dysmenorrhea
o Regularly changes her menstrual pad around 3 times a day or when the pad is full
o Menarche: 13 years old
o Last menstruation: 2 weeks ago

No history of blood transfusion, alcohol consumption, nor drug abuse.

The patient lives with her husband, 2 children, and 2 sisters (unmarried). Using sharing towels and other personal items
were denied.

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Physical Examination

Awake and alert

Blood pressure : 102/73 mmHg
Heart rate : 76x/minute
Respiratory rate : 17x/minute
Temperature: 36,5oC
Height : 163 cm
Weight : 60 kg
BMI : 25,6 kg/m2 (Obesity grade 1)

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 May 2nd 2023

Left eye: eyelid edema, conjunctival injection, ciliary injection, slight mucopurulent discharge

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 May 1st 2023

Documentation from ophthalmology

department
 May 2nd 2023

Venereology status
- Mons pubis, labia majora: no erythema, no edema, no warts
- Labia minora, vaginal opening: erythema, moderate mucopurulent discharge, no bleeding, no warts

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 May 2nd 2023

Speculum examination (last urination 6 hours ago):

1. Cervix: slight erythema, no ecteropion, no bleeding, moderate
mucopurulent discharge
2. Posterior fornix: moderate mucopurulent discharge, no bleeding
3. Vaginal wall: no erythema, no warts, no bleeding

No regional lymph node enlargement

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Laboratory Result
May 1st 2023 Result Reference
Hemoglobin 12,7 g/dL 12,0 – 15,0
Hematocrite 38,2 % 36,0 – 46,0
Leukosit 13.270 /µL 4.000 – 10.000
Trombosit 389.000 /µL 150.000 – 400.000
SGOT 14 U/L 5,00 – 34,00
SGPT 12 U/L 0,00 – 55,00
Ureum 17,1 mg/dL 21 – 43
Kreatinin 0,60 mg/dL 0,55 – 1,02
eGFR 108,9 mL/min/1,73 m2 39 - 90
Sodium 135 mEq/L 136 – 145
Potassium 3,6 mEq/L 3,5 – 5,1
Chloride 103,9 mEq/L 98,0 – 107,0
Random blood glucose 98 mg/dL < 100
HS CRP 62,79 mg/L >3.0 High risk
PCT 0,04 ng/mL <0,05
HBsAg Non reactive Non reactive
Anti HCV Non reactive Non reactive
HIV Non reactive Non reactive
RPR Non reactive Non reactive
TPHA Non reactive Non reactive
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Laboratory Result - Inspeculo
May 2nd 2023 Cervix Vagina Urethra

PMN >30 7-8 3-4

Diplococcus
- Intracellular Negative Negative Negative
- Extracellular Negative Negative Negative
Candida albicans
- Pseudohyphae Negative Negative Negative
- Blastospore Negative Negative Negative
Clue cells Negative Negative Negative

Gram positive rod +2 +2 +1

Trichomonas vaginalis Negative

Epitel 7-8 5-6 3-4

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Laboratory Result – Corneal swab

May 1st 2023 May 2nd 2023

PMN 25-30/LPK 15-20/LPK

Diplococcus moderate sparse

- Intracellular
- Extracellular
Gram positive
coccus

Epitel 10-15/LPK 4-5/LPK

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Gram staining from corneal swab - May 1st 2023

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Diagnosis 1. Blepharokeratoconjunctivitis suspected gonococcal
dd other bacterial infection
2. Nonspecific cervicitis dd gonococcal cervicitis

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 Non-medicament:
Treatment - Counselling on the diagnosis, transmission, and therapy.
- Counselling on abstinence until cured, hand hygiene,

(DV) and partner notification

- Keep good hygiene on genital area

Medicament:
• Azythromycin 1 gram oral single dose
• Ceftriaxone IM 1 gram for 3 days (or as treatment from
ophtalmologists)

Follow up on May 9th 2023.

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  Ceftriaxone 1 gr IM day 1, followed by ceftriaxone 1 gr
IV day 2-3
 LFX per hour for left eye
Treatment 

Cenfresh per hour for left eye
Gentamicin eye oinment tid for left eye
(Opthalmology  Eye irrigation per hour for left eye

department) Discharged on day-4:

 Cefixime 200 mg bid
 LFX per hour for left eye
 Cenfresh per hour for left eye
 Gentamicin eye oinment tid for left eye
 Eye irrigation per hour for left eye

Follow up on May 9th 2023

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Prognosis Quo ad vitam
Quo ad functionam : Ad bonam
: Ad bonam

Quo ad sanationam : Dubia ad bonam

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Follow up
May 8th 2023 (Teleconsultation)

• Redness on the left eye has reduced. No more mucopurulent discharge from left eye.
• No vaginal discharge, no pain or pruritus on genital area. No urination symptoms. No
lower abdominal pain.
• After discharged, the patient routinely consumed cefixime 2x200 mg (day-5) and using
eye drops as suggested.
• She was scheduled for follow up on May 9 th 2023.

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Laboratory Result Follow Up – Corneal swab
May 1st 2023 May 2nd 2023 May 3rd 2023 May 4th 2023

PMN 25-30/LPK 15-20/LPK 8-10/LPK 0-1/LPK

Diplococcus moderate sparse

- Intracellular
- Extracellular
Gram positive slight
coccus

Epitel 10-15/LPK 4-5/LPK 2-3/LPK 1-2/LPK

Ceftriaxone Ceftriaxone Ceftriaxone Discharged

1 gram day 1 1 gram day 2 1 gram day 3
+ Azythromycin 1
gram single dose
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Laboratory Result Follow Up – Corneal swab culture
May 1st 2023 May 2nd 2023

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 DISCUSSION
Demonstration of rare case.

What are other possible etiology and source of

transmission?
THANK YOU