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Gonorrhea

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Reporting Obligations

Individuals who have or may have gonorrhea shall be reported to the local Health Unit. For community health professionals testing and treating chlamydia and gonorrhea infections, please review the following memo.

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Epidemiology

Aetiologic Agent

The causative agent for gonorrhea is a gram-negative diplococcus, Neisseria gonorrhoeae.

Clinical Presentation

Many cases are asymptomatic. If symptoms do occur, they usually appear two to seven days after infection. Presentation and severity differs in males and females. In males, the most common presenting symptom is a painful, purulent urethral discharge usually with dysuria and increased frequency of urination as well as redness, itching and urethral swelling. Up to 10% of urogenital infections in men are asymptomatic.

Females present with initial urethritis or cervicitis which is frequently mild and can go unnoticed. Abnormal vaginal discharge and post-coital bleeding may occur and infection can progress to pelvic inflammatory disease. Up to 50% of urogenital infections in women are asymptomatic.

Pharyngeal and rectal infections can occur among those engaging in oral and anal sex. Most rectal and pharyngeal gonococcal infections are asymptomatic.

Modes of Transmission

Sexual contact via oral, vaginal, cervical, urethral or anal routes; in children, consider the possibility of sexual abuse; newborns: during delivery from infected mother.

Incubation Period

In individuals who display symptoms, the incubation period is usually 1–14 days.

Period of Communicability

Can extend for months if untreated. Effective treatment usually ends communicability within hours.

Risk Factors/Susceptibility

General susceptibility.  Risk factors for transmission include:

  • Sexually active youth under 25 years of age
  • Men who have sex with men
  • Those who have had contact with a person with proven gonorrhea infection or a compatible syndrome
  • Sex workers and their sexual partners
  • Street-involved youth
  • Individuals with a history of gonorrhea or other STI infection

Diagnosis and Laboratory Testing

Neisseria gonorrhoeae is confirmed when detected in an appropriate clinical specimen (e.g., urogenital, rectal or throat (pharyngeal) swab, urine).

See Bacterial STI Testing: Quick Reference, March 2019 and additional resources (below).

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Treatment and Case Management

Treatment is under the direction of the attending health care provider. See Gonorrhea Treatment Quick Reference for Adolescents and Adults, June 2019 and additional resources (below).

Regardless of test results, sex partners of a case should receive empiric treatment as soon as possible, as per the above treatment recommendations.

Patients and their sexual contacts can be referred to a Sexual Health walk-in clinic to receive first-line treatment at no cost.

First-Line Gonorrhea Treatment Kit

Publicly funded, first-line treatment kits are available through the following First-Line Gonorrhea Treatment Kit online order form. Refer to the product monographs for Azithromycin and Ceftriaxone Sodium, and Reconstitution of Ceftriaxone Sodium resource for treatment information. For patient information, see the Azithromycin and Ceftriaxone Sodium fact sheets, or the Gonorrhea fact sheet listed below.

Patient Information

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Additional Resources

Public Health Ontario. “Bacterial STI Testing: Quick Reference, March 2019.”

Public Health Ontario. “Gonorrhea Treatment Quick Reference for Adolescents and Adults, June 2019.”

Government of Canada. “Canadian Guidelines on Sexually Transmitted Infections, Gonococcal Infections, revised 2016.”

References

Ministry of Health and Long-Term Care, Infectious Diseases Protocol, 2019.