<i>Neisseria gonorrhoeae</i> infection and antimicrobial resistance in Alberta, Saskatchewan, and Manitoba compared to Canada between 1980 and 2022

We aimed to describe the evolution of gonorrhea infection and its antimicrobial resistance patterns in the Prairie provinces compared to Canada between 1980 and 2022. Data was collected from publicly available sexually transmitted infection reports in Canada, Alberta, Saskatchewan, and Manitoba. We extracted the number and rates of gonorrhea cases; percentage of cases by sex, age, ethnicity, sexual orientation; and data on cases diagnosed by culture and antimicrobial resistance. Descriptive statistics and age-period-cohort effect analysis were used. Gonorrhea cases in Canada rose from 32.4 per 100 000 in 1992 to 92.3 in 2022. In 2020, 36.9% of gonorrhea cases in Canada were females, compared to 42.8% in Alberta, 55.3% in Saskatchewan and 56% in Manitoba. People aged ≥30 years represented 22.5% of cases in 1980, and 54.1% in 2022. By 2022, the proportion of Canadian cases detected by culture declined to less than 10%, and azithromycin resistance of <i>N. gonorrhoeae</i> isolates was 8.1%. Alberta, Manitoba, and Saskatchewan reported higher rates of gonorrhea compared to Canada, with a higher proportion of female cases in Manitoba and Saskatchewan. Rising antimicrobial resistance rates and decreased culture testing present significant concerns for gonorrhea control and surveillance.