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:
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 is defined as an absence of reported sexual contact during the post-treatment period AND one of the following:
In the event of cephalosporin treatment failure, consultation with an infectious disease specialist is recommended.
Repeat gonorrhea screening is recommended six months post-treatment for all individuals with N. gonorrhoeae infection given risks of reinfection.
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.
August 2024
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.
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:
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.
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.
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.
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:
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.