In suspected gonococcal conjunctivitis, which diagnostic evaluation is recommended?

• A. Giemsa stain
• B. Gram stain and culture
• C. Tzanck smear
• D. Direct fluorescent antibody testing

Answer: (B)

When gonococcal conjunctivitis is suspected, the best approach is to obtain a sample of the conjunctival discharge for Gram staining and culture. The Gram stain typically shows Gram-negative diplococci inside neutrophils, which is a strong clue for Neisseria gonorrhoeae. Culture on a selective medium (such as Thayer-Martin) confirms the organism and provides antibiotic susceptibility data, which is crucial because gonorrhea can be resistant to multiple drugs and treatment needs to be guided by susceptibility results.

Other tests like Giemsa stain, Tzanck smear, or direct fluorescent antibody testing are oriented toward different pathogens (for example, Chlamydia or viruses like HSV) and are not as reliable or definitive for gonococcal conjunctivitis. The combination of Gram stain plus culture gives both a rapid presumptive clue and definitive identification with resistance information.