Canadian Guidelines on Sexually Transmitted Infections - Gonococcal Infections



- NAAT recommended for both Chlamydia trachomatis and Neisseria gonorrhoeae.  Urine specimens are acceptable for screening in females. In females undergoing speculum examination, vaginal (preferred) or endocervical swabs can be collected.

- Vaginal (preferred) or endocervical swab for N. gonorrhoeae culture should also be submitted for:

  • sexual assault (see Prophylaxis, Sexual Assault)

  • evaluation of PID

  • treatment failure

  • infection acquired abroad by patient or sexual contact.

- Test and treat, regardless of clinical signs/symptoms, all recent (60 days) sexual contacts. Patients should abstain from sexual intercourse during, and for 7 days after therapy, and until all their sexual partners are treated. Repeat treatment if re-exposed to untreated partner.


Test of cure:

- Test of cure by NAAT 2-3 weeks after completion of therapy should ideally be done in all cases and is especially recommended if:

  • regimen other than recommended has been used

  • antimicrobial resistant organism identified on culture

  • case is linked to another case with antimicrobial resistance or treatment failure

  • previous treatment failure in the individual

  • re-exposure to an untreated partner

  • persistent signs or symptoms post-therapy
  • concomitant infection at non-genital site (e.g. eye, rectum, pharynx)

  • PID or disseminated gonococcal infection

  • uncertain compliance

  • pregnancy

  • therapeutic abortion.

- Repeat screening for individuals with a gonococcal infection is recommended 6 months post-treatment.

- Quinolones no longer recommended due to significant resistance. Ciprofloxacin 500mg PO + azithromycin 2g PO each x 1 dose may be considered if cephalosporin allergy AND known ciprofloxacin susceptibility. Test of cure recommended.

Usual Pathogens

Neisseria gonorrhoeae


Empiric Therapy Dose Duration
[Ceftriaxone 250mg IM 1 dose
Cefixime] 800mg PO 1 dose
Azithromycin  1g PO 1 dose
[Ceftriaxone 250mg IM 1 dose
Cefixime]  800mg PO 1 dose
Doxycycline 100mg PO bid 7 days

Cephalosporin-resistant N. gonorrhoeae or severe ceftriaxone and cefixime allergy

Empiric Therapy Dose Duration
Gentamicin 240mg IM/IV 1 dose
[Azithromycin 2g PO 1 dose
Doxycycline] 100mg PO bid 7 days