Introduction: A Growing STI Crisis in Nigeria and Beyond
From a worsening trend in antimicrobial resistance (AMR) to gaps in diagnosis and regulation, sexually transmitted infections (STIs) are increasingly difficult to treat. A recent synthesis of global data, including the 2023–2024 Nigeria Demographic and Health Survey (NDHS) and the Impact Global Health report “Irresistible,” paints a concerning picture: high STI prevalence, widespread antibiotic misuse, and a mounting resistance to the drugs we have relied on for decades.
The Real-World Toll: How AMR Fuels Untreatable STIs
Stories like Emeka’s—where a patient turns to a patent medicine vendor for a broad-spectrum antibiotic and finds no relief—highlight systemic problems. Self-medication, stigma, and weak drug regulation drive improper antibiotic use, which accelerates AMR and undermines treatment effectiveness for infections such as gonorrhoea, chlamydia, trichomoniasis, and syphilis.
NDHS data from 2023–2024 show that roughly 14% of men and 16% of women aged 15–49 reported an STI or related symptoms within the last year. When people delay proper care or rely on over-the-counter fixes, infections persist and can progress to complications like pelvic inflammatory disease and infertility.
Global and Local Signals: What the Data Tell Us
The “Irresistible” report reveals a global surge in new STI infections and underscores AMR as a critical barrier to effective treatment. In gonorrhoea, resistance to ciprofloxacin is staggering—about 96% of samples in surveillance programs show resistance. Even ceftriaxone, long a frontline therapy, faces resistance above 15% in some settings, surpassing WHO’s thresholds for changing first-line treatment.
Diagnostics compound the problem. Only a handful of point-of-care tests exist for gonorrhoea, and there is no widely available rapid test, delaying accurate treatment. Trichomoniasis likewise depends largely on a single drug class, nitroimidazoles, with rising concerns about resistance and limited second-line options. For Mycoplasma genitalium (Mgen), resistance to macrolides and fluoroquinolones is already reducing the reliability of standard therapies. In many low- and middle-income countries, limited access to resistance testing forces clinicians to rely on imperfect data and past trends.
What This Means for Nigeria
Even as Nigeria strengthens its AMR National Action Plan (NAP) and prepares to host global discussions on AMR, the STI-specific challenge remains acute. The country faces regulatory gaps that allow antibiotic sales without prescriptions, and many communities turn to informal sources for treatment. This reality speeds up resistance and leaves many patients undertreated or inadequately treated.
Actions That Can Turn the Tide
Experts advocate a multi-pronged strategy to curb AMR in STIs and safeguard treatment effectiveness:
- Strengthen antimicrobial stewardship. Update national treatment guidelines, train health workers and pharmacists to prescribe responsibly, and incorporate STI goals into stewardship programs.
- Improve surveillance and diagnostics. Build affordable, accessible diagnostics and invest in laboratories that can guide timely, evidence-based decisions.
- Ensure sustainable funding. Create dedicated budgets for STI-AMR initiatives that cover education, surveillance, and treatment.
- Regulate antibiotic sales. Enforce prescription-only sales and empower pharmacists to refer and educate customers on appropriate care.
- Engage communities. Launch stigma-reducing campaigns and promote safer sexual practices and prompt medical consultation.
With the right investments and coordinated action, Nigeria can lead in protecting antimicrobial effectiveness and reducing the human cost of untreatable STIs.
