Gonorrhea

Reporting Obligations

Individuals with suspect or confirmed cases must be reported to the Thunder Bay District Health Unit by the next working day by fax, phone or mail.

  • Fax: (807) 625-4866
  • Phone: 625-5976 or toll-free at 1-888-294-6630, ext. 5976
  • Mail: 999 Balmoral Street, Thunder Bay, ON P7B 6E7

 

Epidemiology

Aetiologic Agent:

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

Clinical Presentation:

Many cases are asymptomatic. 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.

Females present with initial urethritis, Bartholinitis, 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.

Pharyngeal and anorectal gonorrhea infections are more likely to be asymptomatic and can occur in those that are engaging in oral and anal sex.

Complications and sequelae: Pelvic Inflammatory Disease (PID), infertility, ectopic pregnancy, chronic pelvic ain, reactive arthritis, disseminated gonococcal infection, and epididymo-orchitis.

Modes of transmission:

Sexual contact via oral, vaginal, cervical, urethral or anal routes. In children, transmission can occur if exposed to infected genitals (consider the possibility of sexual abuse).

Newborns can be infected during delivery from an infected woman.

Incubation Period:

In individuals who display symptoms, the incubation period is usually 2-7 days.

Period of Communicability:

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

 

Risk Factors/Susceptibility

Transmission is more effective male to female than female to male. Risk factors include:

  • Individuals who have had sexual contact with a person with a confirmed or suspected gonococcal infection
  • Sexually active youth < 25 years of age
  • Individuals who have had sex with multiple partners
  • Men who have unprotected sex with men
  • Vulnerable populations (e.g., sex trade workers, street-involved youth, etc.)
  • Individuals with a history of other sexually transmitted infections, including HIV.

 

Diagnosis & Laboratory Testing

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

See Additional Resources (links below) and the Summary of Recommendations: Ontario Gonorrhea Testing and Treatment Guide, 2nd Edition, 2018. (PDF)

Testing Information & Requisition

 

Treatment & Case Management

Treatment is under the direction of the attending health care provider. Provide education about and promote safer sex practices. Regardless of test results, sex partners are recommended to receive empiric treatment as per the treatment recommendations as soon as possible. A test of cure is recommended when first-line therapy is not used, in pregnancy, or for pharyngeal gonorrhea. See Additional Resources (links below) and the Summary of Recommendations: Ontario Gonorrhea Testing and Treatment Guide, 2nd Edition, 2018. (PDF)

 

Patient Information

Patient Fact Sheet

 

References

  1. Ministry of Health and Long Term Care, Infectious Diseases Protocol, 2018.  Appendix A (2019) and Appendix B (2019)

 

Additional Resources

Public Health Ontario. (2018). Guidelines fo Testing and Treatment of Gonorrhea in Ontario, 2nd edition (Full Text).

Public Health Ontario. (2019). Bacterial STI Testing: Quick Reference. (PDF)

Public Health Ontario. (2019). Gonorrhea Treatment Quick Reference. (PDF)

Heymann, D.L. Control of Communicable Disease Manual (20th Ed.). Washington, American Public Health Association, 2015.

Public Health Agency of Canada. “Canadian Guidelines on Sexually Transmitted Infections, evergreen edition: Gonococcal Infections"

Last Updated: 30/07/2019