Imole Agunbiade and Favour Solomon-Uwakwe (Lead writers)
When Emeka (not his real name) began showing symptoms of a sexually transmitted infection (STI), specifically a burning sensation during urination, he felt embarrassed and, like many others, sought a quick remedy from a patent medicine vendor who gave him a broad-spectrum antibiotic.
However, the treatment did not work and the infection persisted. When he finally visited a hospital, the doctor struggled to manage his condition as the antibiotics that should have been effective no longer worked. The doctor suspected a resistant strain of gonorrhoea.
Emeka’s experience is far from unique, the 2023–2024 Nigeria Demographic and Health Survey (NDHS) reported that 14% of men and 16% of women age 15–49 have had an STI or STI-related symptoms within 12 months preceding the survey.
Despite this high prevalence, fear of stigma often drives many people to self-medicate when treating STIs. Without proper medical guidance, they may take antibiotics incorrectly, either the wrong dosage or for the wrong duration, reducing effectiveness and fuelling antimicrobial resistance (AMR).
A Nigeria Health Watch community listening survey, conducted between April and May 2025 across six states, explored how households access antibiotics. The findings revealed that nearly half of the 4,137 respondents obtain antibiotics through informal sources or self-prescription. Another 35.6% purchased them from chemists or patent medicine vendors, while 5.9% turned to traditional healers for treatment. A key factor compounding AMR is the poorly regulated drug supply chain, with studies showing that 72.4% of community pharmacies and 89.3% of patent medicine vendors typically sell antibiotics without a prescription.
This has worsened AMR in the treatment of STIs, according to a recent report titled “Irresistible” published on Impact Global Health. The report revealed that globally, over one million people are newly infected daily with the four most curable STIs: syphilis, gonorrhea, trichomoniasis, and chlamydia. If left inadequately treated, these infections can lead to severe health consequences, including pelvic inflammatory disease, infertility and even death.
Data that demands action
For gonorrhea, the report noted that the lack of an approved vaccine and the limited availability of effective treatments have made drug-resistant gonorrhoea an escalating global concern. AMR has been documented against nearly all recommended therapies.
For instance, 96% of samples tested under the Enhanced Gonococcal AMR Surveillance Programme (EGASP) showed resistance to ciprofloxacin– a type of antibiotic used in treating gonorrhea. Even ceftriaxone, the current mainstay of gonorrhoea treatment, has recorded resistance rates above 15% in countries such as Cambodia and Vietnam, far exceeding the World Health Organization’s (WHO) 5% threshold for discontinuing a drug as first-line therapy.
Only three approved diagnostics for gonorrhoea can be used at point of care, while most require advanced laboratory facilities. Notably, there is still no commercially available rapid diagnostic test to detect gonorrhoea, posing a major barrier to timely and appropriate treatment.
In the case of trichomoniasis, a common sexually transmitted infection caused by the parasite Trichomonas vaginalis, the report revealed that current treatments rely entirely on a single class of drugs, the nitroimidazoles, with metronidazole being the most commonly used. While widespread resistance has not yet emerged, there are growing reports of treatment failures and signs of AMR linked to metronidazole use. This is particularly troubling because all the available second-line options belong to the same drug family, meaning resistance to one could easily affect them all.
Adding to the challenge, metronidazole requires patients to complete a seven-day treatment course, which can be difficult to stick to. Missed doses or incomplete treatment increase the risk of the infection evolving into strains that are even harder to treat.
For Mycoplasma genitalium (Mgen), a sexually transmitted bacterium that infects the urinary and genital tracts, the two main drugs used to treat it, macrolides and fluoroquinolones, are already facing high levels of resistance. Because of this, the WHO advises doctors to adjust treatment based on a patient’s resistance profile, switching between the two drugs depending on which is more likely to work.
However, in many low- and middle-income countries, the diagnostic tests required to identify resistance are not easily available. As a result, health workers often have to rely on local surveillance data or past treatment trends to estimate the best option for their patients.
According to the report, there are currently 164 products being developed globally to tackle STIs that carry the risk of AMR, and 52 products have already been approved. Of these, 129 target gonorrhoea, 58 focus on trichomoniasis, and 29 address Mycoplasma genitalium (Mgen).
Call to action and the way forward
Nigeria has taken steps to address AMR through its One Health AMR National Action Plan (AMR NAP) 2.0, launched in 2024 and through its preparedness to host the 5th Global High-Level Ministerial Conference on Antimicrobial Resistance in 2026. However, more targeted action is still needed to address the growing challenge of AMR in STIs specifically.
According to the report “Irresistible”, the following actions can help combat AMR in STIs:
- Strengthen antimicrobial stewardship: Updated national treatment guidelines must be widely disseminated, and health workers, including pharmacists must be trained
- to prescribe responsibly. Incorporating STI-specific goals into stewardship programmes can curb misuse and preserve drug effectiveness.
- Improve surveillance and diagnostics: Establish specialised laboratories, ensuring affordable diagnostic testing and collect timely data to guide treatment and policy. Without better diagnostics, new antibiotics will quickly lose effectiveness.
- Ensure sustainable funding: Governments must create dedicated budget lines for STI–AMR initiatives, covering education, surveillance and treatment. Donor support is helpful, but domestic investment ensures ownership and long-term impact.
- Regulate antibiotic sales: Enforce stricter controls on over-the-counter access to antibiotics. Train community pharmacists as partners in referral and awareness to promote appropriate care.
- Engage communities: Public education campaigns should address stigma, promote safer sexual practices, and encourage timely medical consultation.
AMR in STIs is a silent emergency-spreading quietly but dangerously. Every misuse of antibiotics today endangers the effectiveness of tomorrow’s treatments. Nigeria stands at a critical juncture: with the right policies, investment, and community engagement, it can lead in safeguarding antimicrobials and saving lives.