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

Due to recent international reports, including from Europe and the USA, of identified multidrug-resistant strain of Neisseria gonorrhoeae, the Province is recommending:

  • For all patients with suspected gonorrhea infection, collect swabs for N. gonorrhoeae culture as well as specimens for NAAT testing for N. gonorrhoeae from all potentially exposed sites (e.g., urethral/cervical, pharyngeal, rectal). It is recommend that you collect both types of specimens for all patients given that NAAT is more sensitive and culture allows assessment for drug sensitivity. Swabs should be received within 48 hours if possible but will be accepted by Public Health Ontario Laboratory up to 72 hours after collection. For additional details on specimen collection and submission, please see the Public Health Ontario Test Information Index.
  • At a minimum, N. gonorrhoeae culture is recommended plus nucleic acid amplification test (NAAT) for the following scenarios:
    • Symptomatic patients, when antimicrobial resistance is suspected
    • Test of cure
    • Pelvic inflammatory disease (PID)
    • Pregnancy
    • Sexual abuse or sexual assault
  • As per the Canadian Guidelines on Sexually Transmitted Infections (CGSTI), test of cure is currently recommended for ALL positive cases of N. gonorrhoeae at all positive sites. Culture is the preferred method for test of cure and should be performed 3-7 days after completion of treatment. If culture is not available, test of cure by NAAT will also be accepted and should be performed at 2-3 weeks post-treatment. For any questions related to testing, please contact Public Health Ontario’s Customer Service Centre by phone: 416-235-6556 or 1-877-604-4567 (Toll Free) or by email:
  • If you identify any patients with multi-drug resistant gonorrhea infection, please contact Toronto Public Health regarding case management and to support notification and follow up of contacts.

Treat suspected or confirmed gonorrhea cases as per the current recommendations in the Ontario Gonorrhea Testing and Treatment Guidelines, 2018.

Please note that Ontario’s guidelines are currently under review. Note that re-treatment is not required for those who are treated as per other evidence-based guidelines (e.g., United States Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines, 2021).

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 2-3 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.

June 5, 2017

TPH is recommending the use of Expedited Partner Therapy (EPT) – also known as Patient-Delivered Partner Therapy – for the treatment of contacts of chlamydia who may not otherwise receive treatment.

Hepatitis A Increase in MSM in Toronto

September 29, 2017

In 2017-to-date, compared to previous years, TPH has noted an increase in reported hepatitis A cases among men who have sex with men (MSM) and who have not reported international travel. TPH’s Communiqué newsletter for additional information.

Infectious Syphilis and Lymphogranuloma Venereum Cases Increase Significantly

Updated August 3, 2017

Toronto is experiencing a significant increase in the number of reported cases of infectious syphilis and lymphogranuloma venereum in men who have sex with men (MSM). Health care providers are reminded about the importance of regularly testing MSM who may be engaging in unprotected anal or oral sex for sexually transmitted infections.

Gonorrhea Rates in Toronto Continue to Rise

From 2014

Toronto Public Health has noted an increase in the incidence of gonorrhea infections in 2014. From January to September 2014, a total of 2,040 cases were reported in Toronto, a 26 per cent increase from the same time period in 2013 (n=1,614)[1]. The number of gonorrhea reports in 2013 (n=2,214) was the highest annual number over the 11-year surveillance period, driven primarily by a 22 per cent increase in reports among males[2].

An increase in the number of gonorrhea infections has also been seen across the province in other parts of Ontario. Rising gonorrhea infection rates, in addition to increasing antimicrobial resistance at the local, national and global level are of great concern at this time; treatment failures have been reported in several jurisdictions across Ontario, associated with the use of oral cefixime[3]. Left untreated, gonorrhea infection can lead to a number of short and long-term complications, including pelvic inflammatory disease, disseminated gonococcal infection and infertility. Moreover, gonorrhea also increases the risk of HIV acquisition and transmission[4].

Due to the increasingly important nature of this infection, site-specific testing of all sexually active individuals is critical in diagnosing gonorrhea infection, particularly as up to 50 per cent of women and 10 per cent of men with urogenital infections are asymptomatic, while rectal and pharyngeal infections are often asymptomatic[5].

Prompt diagnosis of gonorrhea infection facilitates treatment, prevents complications and reduces further transmission. Health care providers in Ontario are encouraged to follow Public Health Ontario’s Guidelines for Testing and Treatment of Gonorrhea in Ontario (2013). This document is informed by provincial resistance data and presents current recommendations for gonorrhea testing and treatment.

  1. Toronto Public Health. Reportable Communicable Diseases Monthly Report September 2014. Retrieved November 27, 2014, from TPH’s Archived Reports
  2. Integrated Public Health Information System (iPHIS). Ontario Ministry of Health and Long-Term Care, iPHIS. Extracted [11/09/2014].
  3. Ontario Agency for Health Protection and Promotion (Public Health Ontario). Guidelines for testing and treatment of gonorrhea in Ontario. Toronto, ON: Queen’s Printer for Ontario; 2013.
  4. Public Health Agency of Canada. Canadian guidelines on sexually transmitted infections. Ottawa, ON: Her Majesty the Queen in Right of Canada; 2008.
  5. Bignell C; IUSTI/WHO. 2009 European (IUSTI/WHO) guideline on the diagnosis and treatment of gonorrhoea

Toronto Public Health provides free condoms and lubricant to non-profit community agencies, programs and services. Please email‎ 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

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.

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Additional Information