Which organism causes hyperacute conjunctivitis with copious purulent discharge requiring urgent systemic antibiotics?

• A. Neisseria gonorrhoeae
• B. Streptococcus pneumoniae
• C. Haemophilus aegyptius
• D. Chlamydia trachomatis

Answer: (A)

Hyperacute purulent conjunctivitis points to Neisseria gonorrhoeae because this organism can invade the conjunctival mucosa rapidly, producing a dramatic, thick, purulent discharge that progresses quickly and can threaten the cornea. The urgency comes from the risk of rapid corneal involvement and potential perforation, so systemic antibiotics are required rather than relying on topical drops alone. This pattern—sudden onset with copious purulent discharge and a need for systemic therapy—is the classic clue to gonococcal conjunctivitis.

Haemophilus aegyptius can cause acute purulent conjunctivitis, but it typically doesn’t present as hyperacute with such copious discharge or carry the same risk of rapid corneal damage requiring systemic antibiotics. Chlamydia trachomatis tends to cause inclusion conjunctivitis, which is subacute to chronic with follicles on the conjunctiva and doesn’t present with the sudden, heavy purulence seen in gonococcal infection. Streptococcus pneumoniae can cause conjunctivitis as well, but the discharge is usually less explosive and the presentation isn’t the same hyperacute, rapidly progressive pattern.