Abstract
BACKGROUND: Neisseria gonorrhoeae (NG) infection remains a concern due to its morbidity and increasing antimicrobial resistance. This study synthesized evidence on NG prevalence in Canada, examining epidemiological patterns across populations and anatomical sites, temporal trends, and key associations. METHODS: A systematic review of NG prevalence studies published up to August 7, 2025, was conducted following the Cochrane framework and reported in accordance with PRISMA guidelines. Random-effects meta-analyses generated pooled prevalence estimates, while random-effects meta-regression analyses identified associations and sources of heterogeneity. RESULTS: A total of 136 publications contributed 226 prevalence measures spanning 1969–2025. In the general population, the pooled mean prevalence of urogenital infection was 1.0% (95% CI: 0.5–1.5%). Among men who have sex with men, pooled prevalence was 0.9% (95% CI: 0.2–1.9%) for urogenital, 2.6% (95% CI: 0.9–4.9%) for anorectal, and 1.6% (95% CI: 0.2–3.8%) for oropharyngeal infection. Among STI clinic attendees, prevalence was 7.5% (95% CI: 4.2–11.6%) for urogenital, 2.5% (95% CI: 0.7–5.3%) for anorectal, and 5.0% (95% CI: 1.8–9.6%) for oropharyngeal infection. Prevalence was high among symptomatic populations—15.9% (95% CI: 4.0–33.2%) in women and 37.4% (95% CI: 11.1–68.6%) in men. Meta-regression analyses explained over half of the variation in prevalence, showing a long-term decline, a gradient by population type, and a small-study effect, but no differences by age, sex, or province. CONCLUSIONS: NG prevalence in Canada mirrors global levels and patterns. The persistence of infection underscores the need for sustained prevention, enhanced surveillance—including extragenital screening—and continued research to inform policy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-026-26579-y.