Sexually transmitted infections
Follow-up now has the INSPQ 2026 expedited partner therapy (TAP) rules.
Do not build Pap/HPV cervical screening here; those are cancer pages. Acute HIV on differential for new STI; 4th-generation Ag/Ab.
Don't miss
- INESSS Institut national d'excellence en santé et services sociaux
| Decision | Guideline |
|---|---|
| Pelvic inflammatory disease (PID) | Clinical diagnosis
|
| Acute HIV on differential | 4th-generation Ag/Ab now New STI, acute retroviral syndrome symptoms. not next annual screen. |
Screening
Earned- MSSS Ministère de la Santé et des Services sociaux
| Decision | Guideline |
|---|---|
| Chlamydia/gonorrhea screening | ≤25 sexually active:
recommend chlamydia;
gonorrhea for women;
for men only Terres-Cries / Nunavik.
|
| Syphilis screening | Risk-based Sexual history risk factors, pregnancy, at-risk populations.
|
| Men who have sex with men | Chlamydia, Gonorrhea, Syphilis, HIV, Hepatitis B Man who has sex with other men. |
ITSS à rechercher selon les facteurs de risque décelés opens in a new tab
How often to screen opens in a new tab
| Decision | Guideline |
|---|---|
| Adults aged 18 and over | An annual assessment of STBBI risk factors is among the recommended measures. When risk factors are present, screen according to the risk factors found. |
| People for whom screening is indicated | Offer a test at least once a year.
|
| Settings that serve people vulnerable to STBBI | Offer screening at least once a year to people who:
|
| More frequent offer | Screening may be offered more often when the risk assessment finds one of these characteristics.
|
| Continuous or repeated risk factors | When risk factors are present continuously or repeatedly, offer screening every three to six months. |
| Person receiving HIV pre-exposure prophylaxis | HIV test one month after PPrE starts, then every three months. Other STBBI according to the risk factors. |
Specimen sites opens in a new tab
| Decision | Guideline |
|---|---|
| Chlamydia trachomatis infection and gonococcal infection | Possible sites: vagina, cervix, urethra, rectum, or pharynx. The site is chosen from sexual practices and the tests the laboratory offers. A urine specimen is also acceptable. |
| Syphilis, HBV, HCV, and HIV | These tests use a blood specimen. |
Diagnose
SyndromicINESSS ITSS GUOs use syndromic approach. Open official GUO for complete decision trees.
- INESSS Institut national d'excellence en santé et services sociaux
| Decision | Guideline |
|---|---|
| Urethritis | Discharge, dysuria in men
|
| Cervicitis | Mucopurulent discharge or bleeding Test for chlamydia and gonorrhea. |
| Genital ulcer | Test syphilis, herpes INESSS genital herpes GUO, p. 2 opens in a new tabINESSS syphilis GUO, p. 3, 7 opens in a new tab |
Treat
First-line regimensINESSS CT/GC Sept 2024 and syphilis GUO. Prefer ceftriaxone for pharyngeal gonorrhea. Treat chlamydia too unless all exposed sites are negative. Open the GUO for allergy algorithms. To reassess a penicillin label, see Penicillin allergy. Confirmed trichomoniasis: see Vaginitis.
| Drug | Dose | Duration |
|---|---|---|
| Not pregnant | ||
| Doxycycline | 100 mg PO BID | 7 days |
| Azithromycin (2nd choice) | 1 g PO | 1 dose |
| LGV genotype | ||
| Doxycycline | 100 mg PO BID | 21 consecutive days |
| Pregnancy | ||
| Azithromycin | 1 g PO | 1 dose |
| Amoxicillin (2nd choice) | 500 mg PO TID | 7 days |
| Drug | Dose | Duration |
|---|---|---|
| First choice | ||
| Ceftriaxone | 500 mg IM (lidocaine 1% without epinephrine) | 1 dose |
| Second choice | ||
| Cefixime plus azithromycin | Cefixime 800 mg PO + azithromycin 2 g PO | 1 dose each |
| Cephalosporin allergy | ||
| Gentamicin plus azithromycin | Gentamicin 240 mg IM (two 3 mL injections) + azithromycin 2 g PO | 1 dose each |
| Drug | Dose | Early | Late or unknown duration |
|---|---|---|---|
| First-line | |||
| Benzathine Penicillin G | 2.4 million units IM | 1 dose | 1×/sem × 3 |
| Penicillin allergy | |||
| Doxycycline | 100 mg PO BID | 14 days | 28 days |
| Drug | Dose | Duration |
|---|---|---|
| Ceftriaxone | 500 mg IM (lidocaine 1% without epinephrine) | 1 dose |
| Doxycycline | 100 mg PO BID | 14 days |
| Metronidazole | 500 mg PO BID | 14 days |
Follow-up
- INESSS Institut national d'excellence en santé et services sociaux
- INSPQ Institut national de santé publique du Québec
| Decision | Guideline |
|---|---|
| Pelvic inflammatory disease | Follow closely and re-examine 3 days after treatment starts to check clinical improvement.
|
| Gonorrhea, test of cure | Test of cure in every case.
|
| Chlamydia, test of cure | Test of cure if signs persist or appear, in pregnancy, if adherence is uncertain, if the regimen is not a recommended one, for rectal infection treated without Doxycycline, or for LGV genotype L1-3.
|
| Reinfection | To detect possible reinfection, recommend screening 3 to 6 months after treatment of the initial infection for everyone infected with C. trachomatis or N. gonorrhoeae.
|
| Partners, chlamydia or gonorrhea | Contact partners who had sex in the 60 days before the first symptoms or the specimen, while the person had symptoms, or before the end of multi-dose treatment or less than 7 days after a single-dose treatment.
|
| Expedited partner therapy (TAP) | Only for partners 14 and older, without symptoms, who are unlikely to consult. MSM and pregnant partners: last resort only.
|
| Syphilis serology | Clinical and serological follow-up (nontreponemal titre) to judge treatment response and to read later titres.
|
| Syphilis partners | Offer immediate empirical treatment for early syphilis to partners who had sex with a person with early or unknown-duration syphilis in the 90 days before diagnosis, especially if their follow-up cannot be assured, whatever the serology shows.
|
Reviewed 31 August 2026 against the official sources below.
Sources
Blue square: Québec. The code names the body; each section's key gives its full name.