STBBI prevention guide: STBBI management

Last partial content update: November 2025

Content about vaccination and HIV pre- and post-exposure prophylaxis (HIV PrEP and HIV PEP) were moved to the new biomedical prevention page of the STBBI prevention guide.

U=U messaging was edited to align with the content in other Canada.ca pages.

Linked resources were updated.

This information is captured in the table of updates to the guides.

On this page

• Management of STI syndromes
• Treatment of diagnosed STBBI
  • Suppressive therapy
  • Antimicrobial resistance
  • Co-infections
  • Partner treatment
• Follow-up
• Reporting and partner notification
• References

Management of STI syndromes

A syndromic approach refers to the management of an individual based on signs and symptoms, prior to laboratory confirmation of the etiologic agent(s). Some syndromes are commonly associated with sexually transmitted infections (STI) and the determination of the most likely etiologic agent(s) should be based on the evaluation of the likelihood that the individual acquired an STI.

Laboratory testing should be done to confirm infection when there are signs and symptoms that are consistent with an STI or the individual has a sexual partner who has been diagnosed with an STI. Refer to the STI-associated Syndromes guide for an overview of the management of the following STI-associated syndromes: anogenital ulcers, cervicitis, epididymitis, pelvic inflammatory disease (PID), proctitis, urethritis and vaginitis.

Individuals who require advanced diagnostics or hospitalization should be cared for in consultation with an experienced colleague or referred to a specialist.

Treatment of diagnosed STBBI

Treatment objectives depend on the specific pathogen and whether the infection is curable (e.g. bacterial, HCV) or chronic and manageable (e.g. HSV, HBV, HIV).

For confirmed cases of sexually transmitted and blood-borne infections (STBBI), refer to the etiology-specific guide(s) for guidance on:

• Management and treatment
• Test of cure (TOC) and follow-up
• Reporting requirements
• Notification and treatment of partners

Suppressive therapy

Suppressive therapies are available for some viral STBBI.

Encourage individuals taking suppressive therapies to adhere to these therapies as prescribed and to use barriers (e.g., condoms and dental dams) consistently and correctly to reduce the risk of acquiring or transmitting STBBI.

HIV treatment as prevention

Early diagnosis and treatment can lead to reduced morbidity and mortality associated with HIV infection and disease progression. The goal of antiretroviral therapy (ART) is to achieve and maintain a suppressed viral load to improve the overall health of people living with HIV. Another advantage of effective ART is the prevention of HIV transmission, including vertical transmission.

HIV treatment is a rapidly evolving and complex area, with changes in recommended regimens occurring as new research and evidence becomes available. Consider consulting a colleague experienced in HIV/AIDS care or an infectious diseases specialist for guidance on treatment. Consult Canadian, provincial or territorial guidelines for prescribing information and indications for HIV treatment. Consult your provincial or territorial drug formulary regarding coverage.

U=U

Undetectable = Untransmittable (U = U)^{Footnote 1Footnote 2Footnote 3} communicates the scientific consensus that HIV cannot be sexually transmitted when a person living with HIV takes and adheres to ART and maintains a suppressed viral load of less than 200 copies per millilitre of blood.

To confirm that a person has achieved and maintains a suppressed viral load, the viral load is usually measured every 4-6 months as part of clinical care.

U=U applies only to sexual transmission of HIV. It does not apply to sharing drug use equipment, or during pregnancy, breastfeeding or chestfeeding.

Health professionals can increase the uptake of HIV treatment, prevent new infections, and reduce HIV-related stigma by communicating the benefits of HIV treatment as part of general sexual health messaging.

Suppressive therapy for genital herpes

Refer to the Genital herpes guide for indications and recommendations for treatment and suppressive therapy.

Daily suppressive antiviral therapy reduces the length, frequency and severity of genital herpes recurrences^{Footnote 4Footnote 5Footnote 6Footnote 7} and decreases asymptomatic viral shedding and transmission, but does not eradicate the virus.

Antimicrobial resistance (AMR)

AMR is a global public health challenge. Practice antimicrobial stewardship when treating STBBI. The following practices can limit the development and spread of AMR infections:

• Promote safer practices
• Normalize and increase screening
• Increase detection by testing all affected sites (genital and extra-genital)
• Treat individuals and their sex partner(s) according to current guidelines
• Consider testing and waiting for test results, in order to provide etiology-guided treatment, when the person's clinical condition allows, they are willing to abstain from sex, they are likely to return for follow up and/or test turnaround time is rapid
• Follow up with a TOC, as appropriate (Refer to etiology-specific guides)
• Conduct pre-travel counselling and take a travel history

Neisseria gonorrhoeae and Mycoplasma genitalium have demonstrated resistance to multiple classes of antibiotics. In Canada, an accurate picture of drug resistance is difficult because of a shift towards testing using nucleic acid amplification tests (NAAT) rather than culture; as a result, fewer samples are tested for antimicrobial susceptibility^{Footnote 8}. Refer to the Gonorrhea guide and Mycoplasma genitalium guide for recommendations on diagnostic testing and treatment.

Co-infections

Transmission routes are similar for many STBBI; co-infection is common and can have treatment and follow-up implications.

In people living with HIV, co-infection with HBV, HCV or syphilis may impact the course of disease. As well, there may be special considerations for treatment and monitoring to ensure treatment effectiveness and to prevent long-term complications^{Footnote 9}.

Partner treatment

For sexual contacts of those with a confirmed bacterial STI, consider providing empiric treatment as a public health preventive measure, to prevent the development of an infection. If empiric treatment is provided, advise the person to abstain from sex until their test results have been received.

If testing confirms an STBBI, consult etiology specific guides for treatment and follow-up recommendations of sexual partners.

Expedited partner treatment

Some jurisdictions offer expedited partner treatment (EPT). Check with provincial or territorial health authority and professional association(s) regarding policies and guidelines for EPT. EPT could involve providing:

• A prescription or medications for partner(s) without requiring assessment by a healthcare provider
• Test kits for sexual partner(s) to mail back
• Information sheets, referral instructions
• Telemedicine consultations

Potential advantages of EPT include:

• Increased proportion of treated partners, particularly among priority populations
• Timely treatment of partners
• Reduced transmission
• Reduced reinfections
• Treatment of undiagnosed STBBI
• Prevention of morbidity and complications

Challenges related to EPT include:

• A therapeutic relationship is not established
• Difficulty verifying treatment completion
• Potential for negative partner reaction
• Partners not seeking testing and care
• Loss of counselling opportunity
• Possible allergic or adverse drug reactions^{Footnote 10Footnote 11}

Follow-up

Ideally, follow-up should be conducted by the healthcare provider who diagnosed and treated the person, to ensure:

• Resolution of symptoms
• Follow-up testing
• Follow-through on partner notification and treatment

If the same healthcare provider is not available, individuals should be directed to appropriate resources, counselled on when to follow up and on symptoms that may indicate treatment failure.

Follow-up testing is needed if baseline testing might have occurred during the window period.

A TOC may be recommended depending on the pathogen and treatment regimen. For some pathogens a TOC is always recommended and for others, a TOC is recommended only in specific situations. In syphilis cases, post-treatment serologic testing is needed to assess treatment response and should be performed at the recommended intervals for stage of infection.

Offer repeat screening for STBBI based on ongoing risk factors and continued potential for exposure. Repeat screening is generally recommended 3 to 6 months after treatment for a bacterial STI, due to the potential for reinfection.

Refer to etiology-specific guides for information on follow-up.

Reporting and partner notification

STBBI reporting requirements and confidentiality

STBBI reporting requirements vary by province and territory. Inform individuals that provincial or territorial public health acts and the Child Protection Act supersede healthcare provider-client confidentiality and require the release of personal information without consent of the individual for all reportable STBBI and in suspected child abuse.

Assure the person that the information will be reported to authorities only as required by law and will otherwise remain confidential. Advise the person that those who receive and process this personal information are bound by ethical, legal and professional obligations to protect confidentiality.

Partner notification

Healthcare providers are required to maintain confidentiality related to the person: no information related to the person can be released to the partner(s) without consent.

Partner notification is a secondary prevention process through which sexual partners and other contacts potentially exposed to an STBBI are identified, located, assessed, counselled, screened and treated. Partner notification has public health benefits (e.g. disease surveillance and control) and for many STBBI it reduces the potential of reinfection. Partner notification can be an effective means of finding persons with an STBBI or at risk of acquiring an STBBI^{Footnote 12Footnote 13}.

While partner notification is sometimes seen as a conflict between societal and individual rights, its aim is to assist in honouring the rights of the sex partners to know whether they have been exposed to an STBBI and to make informed decisions about their health.

Partner notification practices vary by province and territory. More than one strategy can be used to notify different partners. Partner notification strategies include:

• Self-referral: The person accepts full responsibility for informing their partners of the possibility of exposure to an STBBI and for referring them to appropriate services.
• Healthcare provider or public health referral: With the consent of the person, the healthcare provider or public health professional takes responsibility for confidentially notifying partners of the possibility of their exposure to an STBBI. In general, healthcare provider referral ensures more partners are notified, counselled and assessed^{Footnote 12Footnote 13}.
• Contract referral: The healthcare provider negotiates a time frame with the person (usually 24–48 hours) to inform their partner(s) of their exposure and to refer them to appropriate services, after which time, if not done, the healthcare provider or public health professional will notify the partner(s)^{Footnote 13}.

Barriers to partner notification

If the person does not wish to notify partners or if partners have not come forward, consider the following partner notification barriers. If needed, report to public health authorities.

Potential partner notification barriers

Potential barrier	Barrier reduction strategies
Actual or fear of physical or emotional abuse	Healthcare provider or public health referral may be the best option in these cases to protect the person If there is a safety threat, public health officials should be notified of this so that proper safety precautions are taken to protect the person Prioritize safety over the notification process
Fear of losing a partner due to an STBBI diagnosis (blame or guilt)	Discuss the asymptomatic nature of STBBI and the benefits of asymptomatic partner(s) knowing they can have an infection
Fear of legal procedures	Assure the person the information will be reported to authorities only as required by law but will otherwise remain confidential Provide counselling on risk reduction and prevention measures, refer person to appropriate and relevant support services The consistent and correct use of condoms and the use of ART to achieve and maintain an undetectable viral load are highly effective strategies to help prevent the sexual transmission of HIV There is no evidence of HIV transmission to sexual partners when a person living with HIV takes and adheres to ART and maintains a suppressed viral load of less than 200 copies per millilitre of bloodFootnote 2 Health professionals should not provide legal advice; provide appropriate referrals for additional information, such as the HIV Legal Network In Canada, criminal law imposes a duty to disclose HV positive status before sexual activities that pose a "realistic possibility of transmission"Footnote 14
Fear of re-victimization (victims of sexual assault or sexual abuse)	Healthcare provider or public health referral may be the best option for notification of partners
Anonymous partnering	Wherever possible, encourage notification of partners (e.g., self-referral strategy)