Gonococcal infection, caused by Neisseria gonorrhoeae (NG), represents a global public health concern as NG rates continue to increase. The number of people with gonorrhea infection is on the rise in Canada and has nearly doubled in the past 10 years, which has increased antimicrobial resistance in NG which impacted treatment guidelines. It is the second most common bacterial sexually transmitted infection (STI) and often occurs as a co-infection with chlamydia.
The National Advisory Committee on Sexually Transmitted and Blood-Borne Infections (NAC-STBBI) has released their interim guidance for the treatment of uncomplicated gonococcal infections (i.e., urethral, endocervical, vaginal, rectal, and pharyngeal) for adults and adolescents 10 years of age and older1.
Summary of Recommendations
- Treatment of all Uncomplicated NG infection in adults and adolescents 10 years of age and older1
- Monotherapy of 500mg of ceftriaxone IM as a single dose, which is a change from the previous preferred treatment of combined therapy of 250mg of ceftriaxone IM + 1g of azithromycin PO.
- As 500mg vials of ceftriaxone are not available in Canada, clinicians should continue to use 250mg vials. Whether two doses of 250mg or one dose of 500mg are administered is a decision left to the clinicians’ discretion.
- If chlamydia trachomatis (CT) infection has not been excluded by a negative test, concurrent treatment for chlamydia continues to be recommended. Refer to the treatment recommendations in the PHAC Chlamydia and LGV Guide: Treatment and follow-up.
- Alternative Treatment for Uncomplicated NG infection in adults and adolescents 10 years of age and older1
- The alternative treatment options below are required if access to IM injection is not available, if the individual refuses the injection, or if the individual is severely allergic to cephalosporins or has a history of severe non-IgE-mediated reactions to penicillin.
- Cefixime 800 mg PO in a single dose plus doxycycline 100 mg PO BID x 7 days.
- Cefixime 800 mg PO in a single dose plus azithromycin 1g PO in a single dose.
- Azithromycin 2 g PO in a single dose PLUS gentamicin 240 mg IM in a single dose.
- Gentamicin 240 mg IM in a single dose PLUS doxycycline 100 mg PO twice daily for 7 days.
- Doxycycline is contraindicated in pregnant and lactating individuals. The combination therapy containing gentamicin is not recommended in pregnancy.
- As previous alternative treatment regimens have been removed, please refer to the PHAC Gonorrhea Guide: Treatment and follow-up for further details for each alternative treatment regimen.
- The alternative treatment options below are required if access to IM injection is not available, if the individual refuses the injection, or if the individual is severely allergic to cephalosporins or has a history of severe non-IgE-mediated reactions to penicillin.
- Choice of Test and timing of Test of Cure (TOC)2
- Test of Cure (TOC) is recommended for all positive NG sites in all cases, especially when regimens other than ceftriaxone 500mg IM are used.
- Repeat screening of people with NG infection is recommended 6 months post-treatment because of the risk for reinfection.
- Refer to the Test of Cure section in the Gonorrhea Guide for more information on the timing for TOC and Table 3 for recommendations on NG culture.
ADDITIONAL READING AND RESOURCES
- NAC-STBBI’s Advisory Committee Statement (ACS)
- NAC-STBBI’s Gonorrhea Guide: Treatment and Follow-Up
- Public Health Ontario: (CT/NG) – Nucleic Acid Amplification Testing (NAAT)
For questions or concerns, please contact us at:
Infection Disease Prevention Department
Windsor-Essex County Health Unit
519-258-2146, ext. 1420
Fx. 226-783-2132