Gonorrhea guide: Key information and resources

Key information and additional resources for Neisseria gonorrhoeae infections.

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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, 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.

Other adults, including pregnant and breastfeeding women and youth nine years and over:

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

Surveillance

Journal Articles

Other Guidance

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