Gonorrhea guide: Key information and resources

Key information and additional resources for Neisseria gonorrhoeae infections. The following treatment, testing and follow-up recommendations consist of an interim guidance from the National Advisory Committee on Sexually Transmitted and Blood-Borne Infections. Final recommendations will be available after the completion of a review currently underway.

Key Information

Public health importance

Gonorrhea is the second most commonly reported sexually transmitted infection (STI) in Canada. Increasing rates of gonococcal infection represent a significant public health concern globally due to its causative agent's, Neisseria gonorrhoeae (N. gonorrehoeae) ability to rapidly develop antimicrobial resistance (AMR) to several classes of antimicrobials. When left undiagnosed and untreated, gonococcal infections can lead to serious complications.

Screening

Screening is critical for case finding because the infection is frequently asymptomatic.

Universal annual screening is recommended in all sexually active adults and adolescents under the age of 30 years. For persons with multiple sexual partners or a new partner since last tested, offer screening every three to six months.

Consider implementing an opt-out approach to gonorrhea screening as frequently as every 3 months in populations or communities experiencing high prevalence of gonorrhea (and other STBBI).

Screen neonates exposed to gonorrhea during pregnancy, labour, or delivery. Screen all pregnant people during the first trimester or at the first prenatal visit. Rescreen during the third trimester.

Screen pregnant people at the time of labour in any of the following situations:

No prenatal screening has occurred (no valid results are available at the time of labour)
Third trimester screening has not occurred
A positive test result was obtained for N. gonorrhoeae or C. trachomatis during pregnancy without appropriate follow-up, including treatment and a test-of-cure

Diagnostic testing

Nucleic acid amplification tests (NAAT) are the most sensitive tests for detecting N. gonorrhoeae. NAAT 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.

Although culture is less sensitive than NAAT, it provides antimicrobial susceptibility information, which is important for optimizing treatment and public health monitoring of antimicrobial resistance trends. Consult the Screening and diagnostic testing tab of the Gonorrhea Guide for more information of when to collect swabs for culture in addition to NAAT.

Treatment

In the context of changing patterns of N. gonorrhoeae resistance to azithromycin and cefixime, and considering therapeutic efficacy and the importance of antimicrobial stewardship, treat all uncomplicated gonococcal infections with ceftriaxone monotherapy.

Preferred treatment for uncomplicated gonococcal infections in adults and adolescents 10 years or older (including pregnant people): Ceftriaxone 500mg IM as a single dose

Note: Uncomplicated gonococcal infections include urethral, endocervical, rectal and pharyngeal infections. Consult your provincial/territorial guidelines as recommendations may differ based on regional and population differences in AMR of N.gonorrhoeae.

Refer to the Treatment section of the Gonorrhea Guide for alternative treatment options.

Follow-up

For all positive sites in all cases, test of cure (TOC) samples should ideally be taken both for culture and NAAT within the following time frames:

For asymptomatic individuals: Obtain NAAT three to four weeks after the completion of treatment
When TOC is performed within three weeks after treatment: Obtain culture at least three days after completion of treatment
When treatment failure is suspected more than three weeks after treatment: Obtain both NAAT and culture

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
- Screening recommendations for chlamydia and gonorrhea in pregnancy in Canada, 2023
- Enhanced Surveillance of Antimicrobial-Resistant Gonorrhea in Canada (infographic)

Surveillance

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

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