Enhanced Surveillance of Antimicrobial-Resistant Gonorrhea System (ESAG): Resources and references
This page presents resources related to ESAG work as well as a list of references used throughout this dashboard.
- Last updated: 2025-07-04
Provincial/ territorial treatment guidelines
- Alberta (external link)
- Manitoba (external link)
- New Brunswick (external link)
- Northwest Territories (external link)
- Nova Scotia (external link)
PHAC gonorrhea treatment guidelines
National gonorrhea treatment guidelines published December 23, 2024
Treatment guidelines in effect during the analysis period (2018–2023)
Table 1 summarizes PHAC’s treatment guidelines for uncomplicated anogenital and pharyngeal gonorrhea in effect during this dashboard’s analysis period (2018–2023).
These were replaced by the national guidelines published December 23, 2024, linked above.
Table 1. PHAC treatment recommendations for gonorrhea (2018–2023)
| - | Anogenital Infections | Pharyngeal Infections | ||
|---|---|---|---|---|
| Group | Preferred Therapy | Alternative Therapy | Preferred Therapy | Alternative Therapy |
| GBMSM | Ceftriaxone 250 mg IMa + Azithromycin 1 g POa | Cefixime 800 mg POa+ Azithromycin 1 g POa OR Cefixime 800 mg POa + Doxycycline 100 mg POb OR Ceftriaxone 250 mg IMa+ Doxycycline 100 mg POb OR Azithromycin 2 g POa+ Gentamicin 240 mg IM/IVd OR Gentamicin 240 mg IMc + Doxycycline 100 mg POb, e OR Azithromycin 2 g POa + Ciprofloxacin 500 mg POa, f OR Azithromycin 2 g POa+ Gemifloxacin 320 mg POa, f | Ceftriaxone 250 mg IMa+ Azithromycin 1 g POa | Cefixime 800 mg POa+ Azithromycin 1 g POa |
| Other Adults | Ceftriaxone 250 mg IMa+ Azithromycin 1 g POa OR Cefixime 800 mg POa + Azithromycin 1g POa | Cefixime 800 mg POa+ Doxycycline 100 mg POb OR Ceftriaxone 250 mg IMa + Doxycycline 100 mg POb OR Azithromycin 2g POa + Gentamicin 240 mg IMc, d OR Gentamicin 240 mg IMc + Doxycycline 100 mg POb, e OR Azithromycin 2 g POa+ Ciprofloxacin 500 mg POa, f OR Azithromycin 2 g PO+ Gemifloxacin 320 mga, f | Ceftriaxone 250 mg IMa+ Azithromycin 1 g POa | Cefixime 800 mg POa + Azithromycin 1g POa |
Table notes
Note: GBMSM = gay, bisexual and other men-who-have-sex-with-men
Other adults includes heterosexual males and all females but excludes males with unknown sexual behaviour
PO=taken orally
IM=intramuscular
IV=intravenous
Anogenital infections include both rectal and genital infections
Pharyngeal infections refer to those affecting the throat
a single dose
b twice daily (BID) for 7 days
c Patients with cephalosporin-resistant N. gonorrhoeae or a history of anaphylactic reaction to penicillin or allergy to cephalosporins. The gentamicin 240 mg IM is administered in 2 separate 3-mL injections of 40 mg/mL solution.
d Gentamicin 240 mg IV infused over 30 minutes may be considered as an alternative route of administration when the IM route is not feasible.
e Patients with macrolide-resistant N. gonorrhoeae or a history of anaphylactic reaction to macrolides, and with contraindications to cephalosporins. Where azithromycin is not used, doxycycline 100 mg orally twice daily for 7 days should be provided unless contraindicated or there is documented tetracycline resistance. Patients should be treated with combination therapy whenever possible.
f Quinolone treatment regimens. This combination therapy/ regimen should only be used if quinolone susceptibility is demonstrated or regional/ local quinolone resistance rated are under 5%. At the time of publication, Gemifloxacin was not available on the Canadian or US market. In the future, Gemifloxacin is expected to be marketed in the US, at which time it will be made accessible through Health Canada's Special Access Program.
Antimicrobial-resistant gonorrhea national surveillance data
National gonorrhea and STBBI surveillance data
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