Why Sexually Transmitted Infections Are Becoming Harder to Treat in Nigeria—and What the New Study Reveals

Key findings: STIs and antimicrobial resistance on the rise

Across Nigeria, sexually transmitted infections (STIs) are not just more common than previously thought—they are becoming harder to treat. A synthesis of recent surveys and a global impact report highlights a worrying trend: improper antibiotic use and weak regulatory controls are accelerating antimicrobial resistance (AMR) in common STIs such as gonorrhoea, syphilis, chlamydia, and trichomoniasis. The result is not only prolonged illness but also a higher risk of complications, including infertility and pelvic inflammatory disease.

The drivers: why treatment is failing more often

Several interconnected factors are fuelling AMR in STIs in Nigeria and beyond:

• <strongSelf-medication and stigma: Fear of stigma leads many to seek remedies from patent medicine vendors or self-prescribe, often without proper guidance on dosage or duration.
• <strongRegulated drug supply gaps: Studies show a large portion of community pharmacies and patent medicine vendors dispense antibiotics without prescriptions, undermining proper treatment.
• <strongLimited diagnostics: The ability to rapidly diagnose STIs and determine resistance is currently constrained, delaying appropriate therapy and increasing misuse of broad-spectrum antibiotics.
• <strongSingle-class drug reliance: For parasites like Trichomonas, treatment depends largely on nitroimidazoles. Emerging resistance and the lack of diverse second-line options raise concerns about future effectiveness.
• <strongResistance across drugs: Gonorrhoea, in particular, has shown resistance to multiple therapies, with some settings recording ceftriaxone resistance above 15% and ciprofloxacin resistance near the top of global figures.

What the data shows: a global and local alarm

Global reports estimate that more than a million new infections daily involve the four most treatable STIs—syphilis, gonorrhoea, trichomoniasis, and chlamydia—when left undertreated. In Nigeria, NDHS data from 2023–2024 indicate that roughly one in six men and women aged 15–49 reported an STI or related symptoms within a 12-month period, underscoring a sizable public health burden.

Furthermore, Nigeria’s AMR landscape for STIs is shaped by a fragile ecosystem: few rapid diagnostics for gonorrhoea exist at point-of-care, and many cases require lab-based confirmation. The consequence is delayed appropriate treatment and a higher chance of resistance building as patients receive suboptimal regimens.

What needs to change: a roadmap for action

The recent report “Irresistible” outlines concrete steps Nigeria and other countries can take to reverse this trend. Key actions include:

• <strongAntimicrobial stewardship: Update and disseminate national treatment guidelines and train health workers and pharmacists to prescribe responsibly. STI-specific stewardship goals can help preserve drug efficacy.
• <strongBetter surveillance and diagnostics: Build specialised laboratories, expand affordable diagnostic testing, and collect timely data to guide treatment policy and practice.
• <strongSustainable funding: Create dedicated government funds for STI–AMR initiatives—covering education, surveillance, and treatment—and leverage donor support for early impact with domestic ownership.
• <strongRegulation of antibiotic sales: Enforce prescription-only antibiotic policies and enlist pharmacists as partners in referral and community education.
• <strongCommunity engagement: Run public campaigns to reduce stigma, promote safer sexual practices, and encourage timely medical consultation.

What Nigeria is doing now—and what more is needed

Nigeria’s One Health AMR National Action Plan 2.0 (2024) and preparations to host a major international anti-AMR conference signal political will. Yet achieving meaningful gains will require expanding access to robust diagnostics, ensuring consistent drug supply, and embedding STI–AMR goals within broader health system reforms. The stakes are high: every inappropriate antibiotic use today risks erasing future gains against curable infections.

Takeaway for individuals

If you suspect an STI, seek medical care rather than self-medicating. Complete prescribed courses, avoid sharing medicines, and use condoms to reduce transmission. For healthcare workers and pharmacists, stringent adherence to guidelines and patient education are essential to preserving antibiotic effectiveness for future generations.