Do I need eye ointment if I tested negative for STIs during pregnancy?

The ointment prevents an eye infection passed from gonorrhea or chlamydia during vaginal birth. If you received prenatal care, were screened for both, and tested negative, your baby’s risk of those infections is essentially zero, so the ointment is preventing something that is very unlikely to happen for you. That is why many parents in this situation consider declining or delaying. It is also why the standard recommendation still exists as a safety net: no screening system is perfect. Both readings are honest.

Can I legally decline eye ointment?

It depends on your state. Nearly all US states mandate newborn eye prophylaxis by law, and not administering it is typically a misdemeanor for providers. Some states, including California and Tennessee, let parents decline after signing a waiver, and West Virginia repealed its mandate entirely in 2025. Others are strict: in Texas providers can face criminal charges even if you sign a waiver, and New York provides no explicit way for parents to refuse. Ask your hospital or birth center directly what their policy is on parental refusal before your due date.

Does the ointment work against both gonorrhea and chlamydia?

Not equally. Erythromycin is about 80% effective at preventing gonococcal eye infections. Research shows it does not effectively prevent chlamydial eye infections, even though chlamydia is now more common than gonorrhea in the US. So the ointment works best against the less common of the two infections it is meant to cover. If chlamydia exposure is a concern, oral antibiotics for the baby are the more effective route.

What if I have a planned cesarean?

The standard recommendation includes eye ointment regardless of delivery method. But with a planned cesarean, your baby does not pass through the birth canal, which is where these infections are transmitted, so the actual risk is essentially eliminated. Some hospitals still apply it just in case. This is a good thing to ask your provider about ahead of time.

How long can we delay the eye ointment?

The AAP says routine procedures can be delayed until the first feeding is complete or at least one hour after delivery. Waiting that long still keeps the medication within its effective window, so you do not have to trade the ointment for your first hour together. Many hospitals now delay it until the golden hour is finished for exactly this reason: it protects uninterrupted bonding, skin-to-skin, and starting breastfeeding while still giving the medication.

If I tested negative for gonorrhea and chlamydia, does my baby still need it?

The ointment prevents an infection passed only from a mother who carries gonorrhea or chlamydia during a vaginal birth. If you received prenatal care, were screened for both, tested negative, and are in a monogamous relationship with a tested partner, your baby's infection risk is essentially zero, so the ointment is preventing something that cannot happen for you. It is still applied to every baby as a catch-all to cover the rare cases screening can miss: a false-negative test, an exposure after testing, or a mother who was never screened at all. Both the low-risk reading and the universal safety-net reading are honest.

Why erythromycin and not another option?

The US used silver nitrate drops for about a century, but they irritated most babies' eyes, so by the 1980s erythromycin ointment replaced it: it works better against gonorrhea, offers some protection against chlamydia, and causes fewer side effects. Erythromycin is now the standard agent used in the US. Several other countries have moved in a different direction entirely, no longer requiring routine treatment for all newborns: the UK, Canada, Denmark, Norway, and Sweden concluded that prenatal screening and treatment is enough for low-risk babies.

Newborn Eye Ointment (Erythromycin): The Real Trade-Off

Q: Can I delay the ointment so it does not interfere with bonding?

Often yes. The ointment blurs your baby’s vision for about 15 to 30 minutes, which some parents feel intrudes on the first eye-to-eye moments. The AAP says routine procedures can be delayed until the first feeding is complete or at least one hour after delivery. That lets you protect the golden hour while still giving the medication within its effective window. Ask whether your hospital will wait until after skin-to-skin.

Q: Does the ointment interfere with breastfeeding or eye contact?

It blurs your baby's vision for about 15 to 30 minutes while it is present, which some parents feel intrudes on the first clear eye-to-eye moments. Newborns can tell direct from indirect eye contact and prefer mutual gazing, and the golden hour after birth is established as important for bonding, skin-to-skin, and starting breastfeeding. Whether the brief blur meaningfully interferes with bonding is not definitively proven, since bonding involves far more than clear vision in the first 30 minutes. If it concerns you, delaying the ointment until after the first feeding or the golden hour lets you keep that window intact.

In the first moments after birth, a nurse will likely apply antibiotic ointment to your baby's eyes. It is erythromycin, and it is meant to prevent a serious eye infection called ophthalmia neonatorum, passed from gonorrhea or chlamydia during a vaginal birth. That infection was once a leading cause of childhood blindness. Today, thanks to prenatal STI screening, it is rare, and for a mother who tested negative the risk is essentially zero.

No one can make this call but you, and you are the one who lives with it either way. Many well-informed parents accept the ointment. Many well-informed parents, especially those who screened negative, choose to delay it or decline where the law allows. Here is both sides, honestly, so you can make an informed choice, not a default.

Why Informed Parents Decide Differently

Before the details, here is the heart of this decision and the honest case for each path. You already know the standard recommendation; the more useful question is why thoughtful, well-read parents still land in different places.

Why an informed parent might accept the ointment

The US Preventive Services Task Force gives erythromycin prophylaxis a Grade A recommendation, the strongest level, for all newborns, and concluded it is not associated with serious harms. Applied to every baby, it works as a safety net for the cases screening can miss: a falsely negative test, an exposure that came after testing, or an STI status that is simply unknown at delivery. For a parent who prioritizes covering the rare but fast-moving danger, and values a quick, low-harm step that follows the standard exactly, accepting it is the straightforward call.

Why an informed parent might delay it past the golden hour

The ointment blurs a baby’s vision for about 15 to 30 minutes, and newborns can tell direct from indirect eye contact and prefer mutual gazing, so some parents want the first hour protected for eye contact, skin-to-skin, and starting breastfeeding. The AAP says routine procedures can be delayed until the first feeding is complete or at least one hour after delivery. A parent choosing this path keeps the bonding window intact while still getting the medication in within its effective window: they do not have to trade one for the other.

Why an informed parent might decline it

If you received prenatal care, were screened for gonorrhea and chlamydia, tested negative, and are in a monogamous relationship with a tested partner, your baby essentially cannot catch the infection this prevents, so the specific risk is close to zero. Some parents also weigh that erythromycin does not effectively prevent chlamydia, now the more common of the two infections. A parent who declines is prioritizing fewer interventions on a healthy newborn where the danger does not apply to them, paired with a plan to watch for eye symptoms and reach care quickly.

These are not the choices of parents who did not do their homework. Equally informed parents, looking at the exact same evidence, reasonably arrive at different conclusions, because they are weighing different priorities. That is the whole point: there is a version of this decision that is right for your family.

Required by law, but usually still your choice

Most US states require eye ointment for newborns, but "required" rarely means you cannot decline. In most states parents can still opt out, often just by signing a declination form for the hospital's records. A few states are stricter (New York, for example, does not provide an explicit way to refuse). The mandate is on the provider to offer it; in most places it does not erase your ability to decline.

Laws change and vary by state, so confirm two things before your due date: your state's current rule and your specific hospital's refusal policy. For a well-sourced overview of the state-law landscape and your right to refuse, see Evidence Based Birth's guide to erythromycin eye ointment.

If you screened negative, the risk is astronomically small

The ointment prevents an infection passed only from a mother who carries gonorrhea or chlamydia. If you had prenatal care, were screened for both, and tested negative, your baby essentially cannot catch it from you. The ointment is applied to every baby as a preventative catch-all, to cover the rare cases of a false-negative, an exposure after testing, or no screening at all.

What It Is, and What It Prevents

Erythromycin ointment is applied as a small ribbon along each of your baby's lower eyelids, usually within the first hour after birth. It targets ophthalmia neonatorum, a serious eye infection a baby can catch passing through the birth canal if the mother carries gonorrhea or chlamydia. Untreated, gonococcal infection can cause blindness within 24 hours of birth.

This practice began over 140 years ago for good reason. In the 1880s, about 10% of babies born in hospital maternity wards developed these eye infections, and many went blind. In 1880, German doctor Carl Crede introduced silver nitrate drops right after birth, and infection rates dropped from 10% to less than 1%. It became one of the great successes of preventive medicine and was mandated by law across the United States. Silver nitrate irritated most babies' eyes, so by the 1980s erythromycin replaced it: it works better against gonorrhea, offers some protection against chlamydia, and causes fewer side effects.

Here is what changed. Today, standard prenatal care includes STI screening. If you tested negative for gonorrhea and chlamydia, your baby cannot catch from you an infection you do not have. Gonococcal eye infections are now rare in the United States, and many pediatricians practicing today have never seen a case. That is the tension at the center of this decision: a real and once-devastating danger, now made rare for most families by screening.

What Hospitals Tell You

In most US states, eye ointment is required by law, and it is applied routinely to all newborns regardless of the mother's STI status or mode of delivery. The case for it is genuine. The US Preventive Services Task Force gives erythromycin prophylaxis a Grade A recommendation, the strongest level, meaning they recommend it universally for all newborns. They concluded that it is "not associated with serious harms." If a mother has untreated gonorrhea and delivers vaginally, about 30 to 50% of babies develop the infection, and erythromycin is about 80% effective at preventing it.

The procedure itself is quick, and likely not harmful. That is why it has been standard for over a century, and why it protects even in the rare case where a screening was falsely negative or an exposure came after testing.

What often gets lost is that this is presented as routine rather than as a choice, and applied identically to every baby whether the mother screened negative or was never screened at all. You are usually allowed to ask questions about your own situation. You may have more options than the default suggests.

The Full Picture

Two things are true at once, and most sources tell you only one. The infection this prevents is genuinely serious when it happens. And for a screened, low-risk mother it is genuinely unlikely to happen, which is why thoughtful parents land in different places. Here is the honest case on both sides.

Why the Standard Case Is Real

Untreated gonococcal eye infection can cause blindness within 24 hours of birth. When it happens, it moves fast.
If a mother has untreated gonorrhea and delivers vaginally, about 30 to 50% of babies develop the infection.
Erythromycin is about 80% effective at preventing gonococcal eye infections, and the USPSTF found it is not associated with serious harms.
It offers a safety net when a screening was falsely negative, an exposure came after testing, or STI status is simply unknown at delivery.

Why Some Parents Decline or Wait

The risk may not exist for them. If you screened negative for gonorrhea and chlamydia and are in a monogamous relationship with a tested partner, your baby's infection risk is essentially zero. Applying medication to prevent something that cannot happen provides no benefit, only side effects.
It does not prevent chlamydia well. Research shows erythromycin does not effectively prevent chlamydial eye infections, even though chlamydia is now more common than gonorrhea in the US.
Resistance is rising. Gonorrhea is becoming more resistant to erythromycin, with resistance rates averaging around 21% globally and as high as 72% in some regions. The 80% effectiveness studies were done decades ago, before that resistance emerged.
Major bodies are re-examining it. In 2024 the AAP called for "ongoing re-evaluation" of universal mandates, and the UK, Canada, Denmark, Norway, and Sweden no longer require routine treatment for all newborns.

Effects on Your Baby

Temporary blurred vision and mild irritation

Erythromycin causes blurred or cloudy vision for about 15 to 30 minutes while it is present. For parents hoping for those first clear eye-to-eye moments, that matters. About 13% of newborns who receive it develop mild "chemical pink eye": redness and irritation with no actual infection. It is generally mild and clears quickly, but it can worry parents who wonder if something is wrong.

Bonding and the golden hour

Newborns can tell the difference between direct and indirect eye contact and prefer mutual gazing with their parents, and the golden hour after birth is established as important for bonding, skin-to-skin, and starting breastfeeding. Whether the brief blur meaningfully interferes with bonding is not definitively proven: bonding involves far more than clear vision in the first 30 minutes, and the USPSTF does not count it as a serious harm. It is a real consideration for some parents and a minor one for others.

A microbiome question, still unsettled

This is an emerging concern, and we want to be careful about how far the evidence goes. Erythromycin can be absorbed into the bloodstream even when applied to the eyes, and early antibiotic exposure in newborns is linked to disruption of the gut bacteria that seed the immune system, which happens during the same first hours after birth. But there is not extensive research specifically on how eye ointment affects the infant microbiome. The studies we have are mostly on oral or IV antibiotics, not topical ointment. So this is worth including in your decision, not a settled fact to decide it.

Your Options

Delay it past the golden hour: the middle path

You do not have to choose between the ointment and uninterrupted bonding. Many hospitals now delay eye ointment until the golden hour is complete. The AAP says routine procedures can be delayed until the first feeding is finished or at least one hour after delivery. That gives you bonding time first while still applying the medication within its effective window. If you want the protection but not the blur during your first hour, this is often the simplest ask.

Accept it as recommended

Applying it routinely follows the current standard of care and the USPSTF Grade A recommendation. It is quick, likely not harmful, and covers the rare cases screening can miss. Parents who prefer not to weigh a small residual risk, or who value following the standard exactly, reasonably choose this. It matters most if you have any actual risk factors.

Decline where the law allows

If you received prenatal care, were screened for gonorrhea and chlamydia, tested negative, and are in a monogamous relationship with a tested partner, your infection risk is essentially zero, and declining is a legitimate, informed choice that many thoughtful parents make. Declining is legal in some states and commonly done. It is not a risk-free decision if your circumstances change, so make it deliberately.

If you decline, replace the prophylaxis with a plan: watch your baby's eyes closely (red, swollen, or draining eyes in the first weeks warrant immediate medical attention), know how to reach your pediatrician and urgent care quickly, tell your pediatrician you declined so they can monitor, and be honest about any actual risk factors, because if you have them, prophylaxis is genuinely safer.

When It Clearly Makes Sense

Eye ointment is genuinely important in certain situations. It provides real protection and is worth accepting if any of these apply to you:

You tested positive for gonorrhea or chlamydia and were not treated before delivery.
You received little or no prenatal care and your STI status is unknown at delivery.
You have risk factors: age under 25, multiple sexual partners, a history of prior STI, symptoms suggesting infection at delivery, or a partner with a known STI.

The Legal Landscape

Your options depend heavily on your state, so find this out before your due date. Nearly all US states mandate newborn eye prophylaxis by law, and not administering it is typically a misdemeanor for providers.

Some states allow refusal. California, Tennessee, and others let parents decline after signing a waiver or informed refusal form. West Virginia repealed its mandate entirely in 2025.
Some states are strict. In Texas, providers can face criminal charges for not administering the ointment even if parents sign a waiver. New York provides no explicit way for parents to refuse.

Contact your hospital or birthing center and ask directly: "What is your policy on parental refusal of eye prophylaxis?" Find out whether it is mandatory in your state, whether parents can refuse, and whether a waiver process is available.

Our Take

This is a real trade-off, and we are not going to flatten it into a warning or a shrug. Eye ointment matters for babies whose mothers have untreated infections or unknown status, and the procedure itself is quick and likely not harmful. At the same time, for a low-risk pregnancy with prenatal care and negative STI testing, it prevents a risk that does not exist for that baby. Several developed countries have recognized this and moved away from mandatory universal treatment, and the AAP now calls for reconsideration of US mandates. Both the acceptance case and the decline case are honest.

So the choice really turns on your situation. If you have any risk factors, the ointment provides genuine protection and is worth accepting. If you are low-risk with negative testing, consider whether your state allows refusal; if it does, declining is reasonable, and if it does not, delayed administration after bonding time is a good compromise. Whatever you choose, asking for it after the golden hour lets you have uninterrupted bonding first. The key is understanding your actual risk, knowing your legal options, and making a choice that aligns with your values. You are the one who takes this baby home.

Make it an informed choice, not a default. Your birth. Your body. Your baby. Your choice.

Questions to Ask Your Provider

Is eye prophylaxis mandatory in our state, and can parents legally decline? Is a waiver process available?
Have my gonorrhea and chlamydia test results been communicated to the delivery team?
Can we delay the ointment until after our first feeding or the golden hour?
Given my negative STI screening, what medical indication would my baby have for the ointment?
Will you still apply it for a planned cesarean, where the baby does not pass through the birth canal?
If we decline, what eye symptoms should we watch for, and how do we reach you quickly if they appear?

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Sources

This article is drawn from our research guide. The sources below are the peer-reviewed studies and clinical guidance behind the key facts on this page.

StatPearls. Ophthalmia Neonatorum. National Library of Medicine. www.ncbi.nlm.nih.gov/books/NBK551572/
U.S. Preventive Services Task Force. (2019). Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: Preventive Medication. JAMA, 321(4), 394-398. DOI: 10.1001/jama.2018.21443 doi.org/10.1001/jama.2018.21443
Smith-Norowitz TA, et al. (2021). Neonatal prophylaxis with antibiotic containing ointments does not reduce incidence of chlamydial conjunctivitis in newborns. BMC Infectious Diseases, 21, 244. DOI: 10.1186/s12879-021-05974-3 doi.org/10.1186/s12879-021-05974-3
CDC. (2024). STI Surveillance Data and Statistics. Centers for Disease Control and Prevention. www.cdc.gov/sti-statistics/annual/index.html
American Academy of Pediatrics. (2024). Gonococcal Ophthalmia Neonatorum Prevention. In: Red Book: 2024-2027 Report of the Committee on Infectious Diseases. publications.aap.org/redbook/book/755/chapter-abstract/14084142/
USPSTF Evidence Review. Countries including the UK, Denmark, Norway, and Sweden no longer require universal prophylaxis. www.ncbi.nlm.nih.gov/books/NBK537599/
Moore DL, MacDonald NE; Canadian Paediatric Society. (2015). Preventing ophthalmia neonatorum. Paediatrics & Child Health, 20(2), 93-96. DOI: 10.1093/pch/20.2.93 doi.org/10.1093/pch/20.2.93
PMC. (2022). Global status of Azithromycin and Erythromycin Resistance Rates in Neisseria gonorrhoeae: A systematic review and meta-analysis. pmc.ncbi.nlm.nih.gov/articles/PMC9765340/
Bell TA, et al. (1993). Randomized Trial of Silver Nitrate, Erythromycin, and No Eye Prophylaxis for the Prevention of Conjunctivitis Among Newborns Not at Risk for Gonococcal Ophthalmitis. Pediatrics, 92(6), 755-760. DOI: 10.1542/peds.92.6.755 doi.org/10.1542/peds.92.6.755
Farroni T, Menon E, Johnson MH. (2006). Factors influencing newborns' preference for faces with eye contact. Journal of Experimental Child Psychology, 95(4), 298-308. DOI: 10.1016/j.jecp.2006.08.001 doi.org/10.1016/j.jecp.2006.08.001
FIGO. Harnessing the golden hour: breastfeeding recommended within first hour of life. www.figo.org/resources/figo-statements/harnessing-golden-hour-breastfeeding-recommended-within-first-hour-life

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Medical Disclaimer: This information is for educational purposes only and does not constitute medical advice. We are not doctors. Eye prophylaxis is recommended by the US Preventive Services Task Force, ophthalmia neonatorum is a serious infection, and prophylaxis laws vary by state. Always discuss your specific situation, test results, and state laws with your healthcare provider before making decisions about your baby's care.

Last reviewed July 21, 2026.