Sexual Health Information for Health Professionals

Toronto Public Health (TPH) promotes and celebrates healthy sexuality. Our Sexual Health programs and services follow the Ontario Public Health Standards.

In December 2024 The National Advisory Committee on Sexually Transmitted and Blood-Borne Infections released interim guidance for the preferred treatment of uncomplicated gonorrhea infections. As a result, PHO’s 2018 Ontario Gonorrhea Testing and Treatment Guide is no longer available. Health care professionals should refer to the Sexually Transmitted and Blood Borne Infections: Guides for Health Professionals for recommendations on screening, testing, treatment, and follow-up of gonorrhea and other bacterial sexually transmitted infections (STI):

Summary of updated guidance:

  • Preferred treatment:
    • Ceftriaxone 500 mg IM as a single dose (monotherapy) for all uncomplicated infections (urethral, endocervical, vaginal, rectal and pharyngeal)*
  • Test of Cure (TOC) – recommended for all positive NG sites in all cases, particularly when treatments other than ceftriaxone 500 mg IM are used:
    • 3 to 21 Days After Treatment: Culture is recommended, regardless of the patient’s symptom status.
    • >21 Days After Treatment:
      • Asymptomatic patients: Nucleic acid amplification testing (NAAT) is recommended.
      • Symptomatic patients: Both culture and NAAT are recommended.
  • Specimen Collection – recommend culture (to assess drug sensitivity) along with NAAT for greater sensitivity, particularly in the following scenarios:
    • Suspected treatment failure;
    • Symptoms of cervicitis, urethritis, pelvic inflammatory disease (PID), epididymo-orchitis, proctitis or pharyngitis;
    • Pregnancy;
    • Asymptomatic contact of an NG infected case;
    • When sexual abuse/sexual assault is suspected
    • Infections acquired in countries or areas with high rates of antimicrobial resistance (AMR) (NG resistant strains have been reported in Canada, Japan, Europe and Australia; many were associated with travel to South-East Asia).
  • When NG infection is confirmed by NAAT only, a culture is recommended (if it doesn’t delay treatment)

 *For patients for whom chlamydia infection has not been ruled out with a negative test, concurrent treatment for chlamydia should also be offered as per PHAC’s Chlamydia and LGV Guidance.

Treatment Failure

Treatment failure is defined as an absence of reported sexual contact during the post-treatment period AND one of the following:

  • Presence of intracellular Gram-negative diplococci on microscopy in specimens taken at least 72 hours after treatment completion treatment (for penile urethral swabs only);
  • Positive N. gonorrhoeae on culture taken at least 72 hours after treatment completion;
  • Positive N. gonorrhoeae NAAT taken at least 3-4 weeks post-treatment.

In the event of cephalosporin treatment failure, consultation with an infectious disease specialist is recommended.

Clinical Follow-up

Repeat gonorrhea screening is recommended six months post-treatment for all individuals with N. gonorrhoeae infection given risks of reinfection.

Education and Counselling

To avoid reinfection, individuals should be instructed to abstain from sex for seven days after they (and their sexual partners) have completed treatment and symptoms have resolved.

January 2025

TPH recommends the use of Expedited Partner Therapy (EPT), also known as Patient Delivered Partner Therapy (PDPT), for the treatment of partners of patients with chlamydia who may not otherwise receive treatment. EPT can also help to ensure partners are treated at the same time as the patient to avoid re-infection. This recommendation is in accordance with CPSO Policy Prescribing Drugs: Relying on an Assessment Undertaken by Someone Else / Prescribing with no Prior Assessment .

  • If no prior assessment of the patient has been undertaken, physicians must only prescribe:
  • For the sexual partner of a patient with a sexually transmitted infection (STI) who would not otherwise receive treatment and where there is a risk of further transmission.

When dispensing medication as EPT, provide your patient and their partner the EPT Information for Sexual Partners Fact Sheet for Chlamydia  and Azithromycin Medication Information Sheet .

Note: EPT is only recommended for partners of patients with chlamydia.

EPT is NOT recommended for:

Toronto Public Health provides free condoms and lubricant to non-profit community agencies, programs and services. Please email cdp@toronto.ca‎ for more information.

Toronto Public Health provides free STI medications to all City of Toronto health care providers and medical clinics for the treatment of chlamydia, gonorrhea, and syphilis. All patients diagnosed with a reportable STI and their contacts, regardless of OHIP status, are eligible for the following free STI medications:

  • Azithromycin
  • Ceftriaxone
  • Doxycycline
  • Penicillin G Benzathine (Bicillin)

To order the above medications, send the completed STI Medication Order form as an email attachment to STIDrugOrders@toronto.ca.

Follow directions on the bottom of the form to submit using the “Submit STI Drug Order” button. Please ensure all the fields in the ordering health care information section is completed, as only forms with complete information will be processed.

Note: Fillable PDF forms are not supported by Firefox. Please use a different browser to submit the form or save the form to your computer before completing. Attach the completed saved form to an email and send to STIDrugOrders@toronto.ca.