Objective: To analyze the epidemiological characteristics and temporal trends of pulmonary tuberculosis (PTB) in Nanjing from 2005 to 2020 and provide scientific evidence for tuberculosis prevention strategy. Method: Data of registered PTB in Nanjing from 2005 to 2020 was collected through the National Tuberculosis Information Management System. The Joinpoint regression model was used to estimate the annual percent change (APC) as well as the average annual percent change (AAPC) and the 95% CI respectively. Result: A total of 51 624 PTB were reported with the reported incidence dropped from 71.86/100 000 to 26.45/100 000 and presented overall declining trend, with an average annual decline of 6.47% (AAPC= -6.47, 95%CI: -9.84 ~ -2.97, P< 0.001). The reported incidence and the proportion of smear-positive PTB annually decreased by 8.72% (AAPC= -8.72, 95%CI:-14 .71 ~ -2.32, P= 0.008) and 3.37% (AAPC= -3.37, 95%CI: -4.60 ~ -2.12, P< 0.001) respectively. There was no significant change in reported incidence of bacteriological-positive PTB (AAPC= -6.37, 95%CI: -15.21~3.41, P= 0.194), however, the proportion of bacteriological-positive PTB showed an annual decrease of 4.18% (APC2005—2016= -4.18, 95%CI: -6.59 ~ -1.71, P= 0.004) between 2005 to 2016 while increased by13.12% (APC2016—2020= 13.12, 95%CI: 0.38 ~ 27.48, P= 0.044) annually since 2016. The reported incidence of PTB in the males and females both presented significant declining trend (AAPC[= -6.80, 95%CI: -10.13 ~ -3.35, P< 0.001 and AAPC= -6.88, 95%CI: -8.54 ~ -5.18, P< 0.001) and there was no significant difference in the decline rate between the sexes (P= 0.968). The proportion of the male cases decreased by 0.42% (AAPC= -0.42, 95%CI: -0.73 ~ -0.10, P= 0.013) annually, while female showed an annual increasing trend of 0.99% (AAPC= 0.99, 95%CI: 0.31 ~ 1.67, P= 0.008). The reported incidence of PTB of all the age groups showed significant downward trend except for the 0~14 and 15~29 years old age groups. In addition, the proportion of 15~29 years old age group showed an increasing trend (AAPC= 1.66, 95%CI: 0.28 ~ 3.07, P= 0.019) while there was no significant change trend of all the other age groups. The PTB reported incidence in the main urban districts and the suburban districts all showed decreasing trend (AAPC=-8.42, 95%CI:-15.60 ~ -0.62, P= 0.035 and AAPC= -5.37, 95%CI: -9.13 ~ -1.46, P< 0.008) and there was no significant difference with respect to the decline rate (P= 0.478), however, the proportion of the suburban districts increased annually (APC2009—2020= 3.29, 95%CI: 1.84 ~ 4.75, P< 0.001) since 2019 while the main urban districts showed opposite trend (APC2009—2020= -3.47, 95%CI: -4.92 ~ -1.99, P< 0.001). Conclusion: The overall reported incidence of tuberculosis in Nanjing showed a downward trend from 2005 to 2020 and the pathogen positive rate increased annually since 2016. More effort should be paid to the 15~29 years old age group population, meanwhile the females and the suburban districts should be neglected.