Analysis of Neisseria gonorrhoeae and Mycoplasma genitalium from nucleic acid amplification test specimens, Nunavut region of Inuit Nunangat, Canada, 2020-2023.

This study analyzed Neisseria gonorrhoeae (GC) and Mycoplasma genitalium (Mgen) from remnant nucleic acid amplification test (NAAT) specimens in Nunavut, Canada (2020-2023) to assess strain distribution, antimicrobial resistance (AMR), and co-infection rates. Among 2,221 GC-positive specimens, no cephalosporin resistance was detected, but intermediate-to-decreased susceptibility increased in 2023. Predicted ciprofloxacin resistance was 45%, and azithromycin resistance remained stable at 9.6%. Of 778 tested specimens, 31.4% were co-infected with Mgen, with 49.2% associated with azithromycin resistance, but none with moxifloxacin resistance. These findings highlight emerging AMR trends and support reassessment of current treatment guidelines. Remnant urine specimens submitted for nucleic acid amplification testing identified differences in the prevalence and AMR patterns in GC and Mgen in a large Canadian Arctic territory.IMPORTANCENunavut has the highest gonorrhea rates in Canada, yet antimicrobial resistance (AMR) surveillance is limited to culture-based testing. This study bridges that gap by using molecular assays to predict AMR directly from remnant nucleic acid amplification test specimens, providing data for remote regions that lack the resources to culture and transport Neisseria gonorrhoeae cultures. Findings highlight relevant AMR trends for gonorrhea treatment. Mgen, despite increasing clinical prevalence and high co-infection rates with other sexually transmitted infections, is not included in national surveillance programs, furthering the need for extended monitoring.