Gonorrhea guide: Key information and resources

On this page

• Key Information
  • Public health importance
  • Screening
  • Diagnostic testing
  • Treatment
  • Follow-up
  • Partner notification
• Resources

Key Information

Public health importance

Overall rates of gonococcal infection are increasing in Canada and it is more prevalent among adolescents and young adults. Its causative agent, Neisseria gonorrhoeae (N. gonorrhoeae), develops antimicrobial resistance (AMR) rapidly and has developed resistance to several classes of antimicrobials.

Screening

Screening for gonococcal infections is recommended in asymptomatic sexually active people under 25 years, all pregnant people during their first trimester (or at their first antenatal visit) and third trimester, neonates born to mothers with gonorrhea and any other people with risk factors for sexually transmitted and blood-borne infection (STBBI). Screening is critical for case finding because the infection is frequently asymptomatic.

Diagnostic testing

Nucleic acid amplification tests (NAATs) are the most sensitive tests for detecting N. gonorrhoeae. NAATs can be done on first-void urine samples or vaginal, cervical and urethral swabs. For extra-genital specimens, check with local laboratory about the availability of NAAT.

Culture provides antimicrobial susceptibility information, which is important for optimizing treatment and public health monitoring of antimicrobial resistance trends. Where clinical manifestations suggest a sexually transmitted infection (STI), obtain swabs for culture in addition to samples for NAAT.

Treatment

Due to potential N. gonorrhoeae AMR and high rates of concomitant infection with chlamydia, treat uncomplicated gonococcal infections with combination therapy. Avoid monotherapy.

Note: Consult your provincial/territorial guidelines as recommendations may differ based on regional and population differences in AMR of N. gonorrhoeae.

• The preferred therapy for uncomplicated infection is ceftriaxone 250 milligrams intramuscularly (IM) PLUS azithromycin 1 gram orally in a single dose

Other adults, including pregnant and lactating people and youth nine years and over:

• The preferred therapy for uncomplicated anogenital and pharyngeal infection is ceftriaxone 250 milligrams intramuscularly PLUS azithromycin 1 gram orally in a single dose.
• For uncomplicated anogenital infection only, cefixime 800 milligrams orally PLUS azithromycin 1 gram orally in a single dose is also a preferred therapy

Follow-up

For all positive sites, obtain cultures for test of cure (TOC) three to seven days after treatment is complete. If culture is not available and NAAT is used as a TOC, it should be performed two to three weeks after completion of treatment.

Repeat screening is recommended six months post-treatment for all people with N. gonorrhoeae infection.

Partner notification

Test and provide empiric treatment to all sexual partners of the index case within 60 days prior to symptom onset or date of specimen collection (if the index case is asymptomatic).

Resources

Awareness Resources

• Factsheets
  • Summary of Recommendations for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Syphilis
  • Canadians are still reluctant to get tested for STBBIs

Surveillance

For the most up-to-date surveillance information on gonorrhea and other STBBI, consult the Sexually transmitted and blood-borne infections surveillance page.

Journal Articles

• Addressing the rising rates of gonorrhea and drug-resistant gonorrhea: There is no time like the present
• Resources to address stigma related to sexuality, substance use and sexually transmitted and blood-borne infections

Other Guidance

• PHAC's STBBI Guideline Main Page