Sexual Health and Sexually Transmitted Blood-borne Infections

Canadian STI Guidelines Mobile App

This app for use by health professionals, provides recommendations for screening, diagnosis, management, and treatment of STIs.

Hamilton Public Health Services recommends that practitioners follow the Canadian STI Guidelines for managing all sexually transmitted infections.

Ordering STI Medications & Sexual Health Supplies

STI Medications

Currently, the following STI medications are available through ordering from Hamilton Public Health:
- Amoxicillin (500mg capsules)
- Azithromycin (250mg tablets)
- Cefixime (400mg tablets)
- Ceftriaxone (250mg vials)
- Doxycycline (100mg capsules)
- Bicillin L-A (2.4 million I.U syringes)
To order, please fax the completed STI Medication Ordering Form(PDF, 192.65 KB) to Hamilton Public Health at 905-546-2203
- Delivery of your ordered items is available via vaccine couriers if you have an existing account and shipping will be at your expense. Otherwise, medications will be available for pick-up when ready.

Bicillin® L-A Supply Shortage Notice
There is currently a national shortage of Benzathine Penicillin G (Bicillin® L-A) 1, 200, 000 IU/2mL. Providers are asked to restrict use, follow the Public Health Agency of Canada (PHAC) Interim Syphilis Treatment Guidelines, and order based on immediate need only.
Use of Bicillin® L-A should be reserved for:
- Pregnant individuals and their ongoing sexual contact(s). Please note that infectious syphilis (primary, secondary, and early latent), including during pregnancy, only requires one dose of 2.4 million units of Bicillin® L-A.
- Infectious syphilis (primary, secondary, early latent) cases or contacts of cases where adherence to treatment is uncertain.
- Non-pregnant adults who have already initiated their treatment course with Bicillin® L-A should complete their therapy with Bicillin® L-A.
Note: Oral doxycycline is the preferred alternative treatment for non-pregnant adults with infectious syphilis, late latent syphilis, latent syphilis of unknown duration, and tertiary syphilis (without central nervous system involvement) during the shortage.
We anticipate a return to normal supply by Feb 26 2026.

Condom & Sexual Health Supplies

Condoms and sexual health supplies are available to City of Hamilton agencies who provide targeted services to people at risk of STIs and HIV
- Currently, regular condoms, flavoured condoms, female condoms, & personal lubricants are available as well as Sexual Health Clinic Cards.
To order, please fill out the online form found here: Condom and Sexual Health Supply Ordering Form. Delivery of your ordered items is available via vaccine couriers if you have an existing account and shipping will be at your expense. Otherwise, supplies will be available for pick-up when ready and shipping will be at your expense. Otherwise, supplies will be available for pick-up when ready.
If you have never ordered condoms and sexual health supplies, you will be asked to complete an intake form to ensure your organization meets our eligibility criteria for condom/sexual health supply distribution.

Reporting STIs and Blood Exposure

Blood Exposure

Individuals who have been exposed to someone else’s blood should seek immediate medical attention. Immediate first aid treatment and risk assessment are necessary for people who have had potential exposure to blood borne infections such as HIV, Hepatitis B and Hepatitis C
Refer to St. Michael’s Pocket PEP Guide for blood exposure follow-up

Mandatory Blood Testing Act

The Mandatory Blood Testing Act allows people, who are eligible, to apply to have a person’s blood tested for HIV, Hepatitis B and Hepatitis C.

Who is eligible to submit an application under the Mandatory Blood Testing Act?

Victims of a crime (a police report number is required)
Those providing emergency health services or first aid to someone
Those who are exposed while performing their duties:
- Person employed in a correctional institution, place of open or secured custody
- Police officer, civilian employees or a police service, First Nations Constable or an auxiliary member of a police service
- Firefighter (including volunteer firefighter)
- Paramedic, emergency medical attendant or paramedic student in training
- Member of the College of Nurses of Ontario or a nursing student in training
- Member of the College of Physicians and Surgeons of Ontario or a medical student in training

What are the steps to submit an application?

After the exposed individual has been medically assessed the physician must complete Form 1 - Physician Report .

Note: in the medical assessment, the physician should include a baseline blood test for HIV, Hepatitis B and Hepatitis C, counselling and review the need for vaccination and/or prophylaxis.

The exposed individual needs to complete Form 2 - Applicant Report and submit it to Public Health within 30 days of the exposure to the blood.

Since this is a legal process, it is important that both the physician and applicant reports are completed entirely for the application to be accepted. The applicant will be contacted by Hamilton Public Health Services if either of the forms are incomplete.

*All relevant forms, including the physician and applicant reports and Laboratory Requisition can be accessed through the Central Forms Repository.

Ensure all forms are completed correctly. Fax completed forms to 905-546-4078. If you have any questions about submitting an application under the Mandatory Blood Testing Act, please call Hamilton Public Health Services at 905-546-2063

What is the role of Hamilton Public Health Services in the Mandatory Blood Testing Act process?

Receives and reviews applications made under the Mandatory Blood Testing Act to ensure they meet the requirements of the Act
Attempts to contact the source person to see if they will voluntarily provide a blood sample for testing
Refers applications to the Consent and Capacity Board as required under the Mandatory Blood Testing Act

Links

Timely reporting of STBBIs can help minimize their spread. As outlined in O. Reg. 135/18 Designation of Diseases under the Health Protection and Promotion Act, R.S.O. 1990, c. H.7, suspect and confirmed cases of the following STBBIs need to be reported to the local Medical Officer of Health no later than the next business day by fax (1-844-444-0295).:

Chlamydia
Gonorrhea
Hepatitis C
HIV/AIDS
Syphilis

For more information, please see our Reporting Infectious Diseases webpage

Definitions of Partners/Contacts

Chlamydia & Gonorrhea
- All sexual partners within 60 days of symptom onset or date of specimen collection (if asymptomatic) are considered contacts and should be notified, tested, and treated. If there are no contacts within that 60-day window, then the last sexual contact should be notified.
Syphilis
- Partners/contacts of positive syphilis cases depend on the stage of syphilis infections:
  - Primary: all partners 4 months and 1 week (17 weeks) before development of symptoms
  - Secondary: all partners 8 months before the development of symptoms
  - Early Latent: 1 year before diagnosis
  - Late Latent: assess marital or long-term partners and children, as appropriate

Additional Resources

Sexually Transmitted Infections Case Management and Contact Tracing Best Practice Recommendations (2009)

Current Memos/Medical Advisories

For all current Public Health Memos/Medical Advisories, please see our Medical Advisories.

Please note, that memos/advisories are only posted on the above page for 3 months

Resources for Patients

Online Sexually Transmitted Infections Resources

General Sexual Health Information

Current STI Guidelines

Printed Resources and Materials

Chlamydia

Gonorrhea

Syphilis

HIV & AIDS

Hepatitis

Herpes

HPV

Sexual Health Clinics in Hamilton

Please note, these clinics are for people that:
- Do not have a health care provider
- Do not have a health card
- Cannot access a walk-in clinic
- Are seeking confidential testing
- Are seeking anonymous HIV testing
- Need access to free treatment

Sexual Health Information Line – Hamilton – 905-528-5894

Sexual Health Infoline Ontario & eChat information

Call to speak with a live counsellor from anywhere in Ontario. It’s anonymous and free. Services are available after hours, on weekends, and in various languages

Both Information Lines above are LGBTQ Ally organizations and Safe Zones

General Guidelines

Canadian STI Guidelines
Bacterial STI Testing Options
Public Health Ontario Test Information Index
Rainbow Health Ontario Resource Database: Health resources for LGBT2SQ communities, healthcare providers and others with an interest in LGBT2SQ health.

Labstract: Chlamydia trachomatis and Neisseria gonorrhoeae - Nucleic Acid Amplification Testing

Primary Care Management of Hepatitis B – Quick Reference (HBV-QR)

Herpes Counselling Tool

Ontario Guidelines for Providers Offering HIV Testing
Canadian Guideline on HIV Pre-Exposure Prophylaxis and Non-Occupational Post-Exposure Prophylaxis
British Columbia (BC) Guidelines for the care of HIV positive pregnant women and interventions to reduce perinatal transmission PDF
Treatment and medical care (CATIE): Practical treatment and medical care guides for patients
Treatment Update: CATIE’s resources on HIV cure research

Syphilis

Canadian STI Guidelines – Syphilis Management

Congenital Syphilis

When a pregnant individual has a syphilis infection it can lead to miscarriage, stillbirth, or preterm birth. The infection can also be passed from the pregnant individual to the baby during pregnancy or delivery – this is called congenital syphilis. Without treatment, the baby may develop serious problems, most often in the first few weeks following birth, but sometimes years later.

Congenital syphilis is re-emerging in Hamilton and cases have risen significantly in recent years. Local data indicates that the rate of infectious syphilis has increased 4 times among females from 2019 to 2022. 74% of the female infectious syphilis cases were among those of child-bearing age. This resulted in a rise in the number of infants undergoing investigation for congenital syphilis, due to potential transmission during pregnancy. Between 2018 to 2022, a total of 7 confirmed cases of congenital syphilis were identified, highlighting a need to ensure testing during the prenatal period.

Diagnoses of congenital syphilis in babies can be difficult as antibodies can be transferred from pregnant individual to newborn through the placenta. It is advised that all babies that are suspected congenital syphilis cases should be referred to an infectious diseases or pediatric infectious diseases specialist for a full evaluation.

Recommended Health Care Provider Actions

The Public Health Agency of Canada recommends the following screening during pregnancy:

Universal screening during the first trimester or at first pre-natal visit
Repeat screening at 28-32 weeks and again at time of delivery:
- in areas with outbreaks of syphilis or
- for pregnant individuals at ongoing risk of infection or reinfection
Consider more frequent screening for those at high risk of infection
Screen all people who deliver a stillborn infant after 20 weeks gestation
Individuals at high risk of acquiring syphilis (underhoused, sex workers) may be less likely to receive standard prenatal care, for this reason, screening pregnant individuals in the ER is recommended

Additionally, health care providers can ensure partners of pregnant individuals with syphilis are screened and treated to reduce risk of re-infection. They can also promote the need for safer sex practices, including reducing the number of sexual partners during pregnancy.

For more information on symptoms in babies, prevention measures and the role health care providers can play, screening recommendations, and treatment, please continue to read the information provided below.

Congenital Syphilis Symptoms in Pregnant Individuals & in Babies

A pregnant individual infected with syphilis may have no symptoms. If present, symptoms can include chancres on the genitals or mouth, a rash, fever and swollen glands.

For babies born with congenital syphilis, the infection can cause:

Incorrectly formed bones
Severe anemia
Enlarged liver and spleen
Jaundice
Brain and nerve problems, like blindness or deafness
Meningitis
Skin rashes

Some babies with congenital syphilis may not show any symptoms at birth. How likely a baby contracts the infection and is born with syphilis depends on the pregnant individual’s syphilis stage during pregnancy and the gestational age at the time of treatment.

Syphilis is most likely to pass to the baby if the individual is in the primary or secondary stage of infection when they become pregnant or if they get syphilis while pregnant
Nearly all transmissions to babies are prevented if the pregnant individual receives treatment during the first 28 weeks of pregnancy. The chance of passing syphilis to a baby increased with increasing gestational age – the risk becomes higher if treatment is received later in the pregnancy or if the individual is not treated at all

Preventing Congenital Syphilis

Addressing syphilis among individuals of reproductive age will have a downstream effect of helping to prevent congenital syphilis. Using condoms or dental dams during anal, oral, and vaginal sex helps to prevent the spread of syphilis. However, these measures do not completely eliminate the risk, as syphilis can still pass through skin-to-skin contact if the individual with syphilis has a chancre that’s not covered by a condom or dental dam.

Anyone who may be at risk for syphilis should be tested regularly and treated is necessary. Prompt treatment is important for the individual’s health and prevents syphilis from passing to others, including their baby if the individual is pregnant.

Health Care Providers Role in Preventing Congenital Syphilis

Provide education to your patients about syphilis – how it’s transmitted, the increasing risk of syphilis locally and provincially, how it can be prevented, how it’s diagnosed, and how it’s treated. You can also promote the message that syphilis is easily treated if it’s diagnosed early.

Support access to syphilis prevention, testing, and treatment. This can include direct supports, like the provision of condoms and dental dams as well as information about where individuals can access testing and treatment locally. It can also include offering services or providing referrals to services that address broader issues that impact a person’s health, such as support with housing, food security, substance use services, or mental health services.

Encourage individuals who are pregnant or planning on becoming pregnant to get tested for syphilis and treated if necessary. Educate individuals about the need for retesting during pregnancy if they are at ongoing for syphilis.

Screening Recommendations

The Public Health Agency of Canada recommends the following screening during pregnancy:

Universal screening during the first trimester or at first pre-natal visit
Repeat screening at 28-32 weeks and again at time of delivery:
- in areas with outbreaks of syphilis or
- for pregnant individuals at ongoing risk of infection or reinfection
Consider more frequent screening for those at high risk of infection
Screen all people who deliver a stillborn infant after 20 weeks gestation
Individuals at high risk of acquiring syphilis (underhoused, sex workers) may be less likely to receive standard prenatal care, for this reason, screening pregnant individuals in the ER is recommended

Babies born to individuals who have been diagnosed with syphilis during pregnancy should be assessed for syphilis at birth and followed by an infectious disease or pediatric infectious diseases specialist.

The Public Health Agency of Canada recommends all pregnant individuals get tested for syphilis in their first trimester or their first prenatal visit. For individuals at ongoing risk of syphilis infection and/or those who live in areas where there is a syphilis outbreak among heterosexual individuals, additional screening should take place at 28-32 weeks of pregnancy and again at delivery

For more information visit:

Canadian Guidelines on Sexually Transmitted Infections

Treatment

Syphilis infection in both pregnant individual and baby can be treated and cured with antibiotics. In both cases, treatment needs to be started as soon as possible, which is why testing is so important. Pregnant individuals diagnosed with infectious syphilis and suspect congenital syphilis cases should be managed in consultation with an infectious disease or pediatric infectious disease specialist. It is important to ensure that referral does not delay treatment.

Benzathine penicillin G (Bicillin-LA) is the preferred treatment for pregnant individuals with syphilis. There are no satisfactory alternatives to penicillin for the treatment of syphilis during pregnancy. Bicillin LA can be ordered from Hamilton Public Health Services for pregnant individuals for free at www.hamilton.ca/hcp-sti. Treatment for newborns with congenital syphilis tends to occur in hospitals and is guided by an infectious diseases or pediatric infectious diseases specialist.

Health care providers may want to consider follow-up testing for both the pregnant individual and/or baby to ensure the treatment has worked. Additionally, providers can advise all individuals who are treated to abstain from condomless sexual contact until treatment has been completed and ideally for seven days after completion of treatment.

For more information visit:

Printed resource materials for clients can be ordered from the organizations listed below. Please follow the ordering instructions provided on each organization’s website.

General Sexual Health Information:

CATIE https://orders.catie.ca/
Action Canada – For Sexual Health Rights https://www.actioncanadashr.org/resources
Rainbow Health Ontario – 2SLGBTQ https://www.rainbowhealthontario.ca/rho-shop/

PREP/PEP Resources:

Ontario HIV Treatment Network https://ontarioprep.ca/for-health-care-providers/other-resources/
https://www.ohtn.on.ca/ocn/clinic-resources/

Date modified

February 03, 2026