Background
Antimicrobial resistance (AMR) in gonorrhoea is a growing global public health threat, with
increasing resistance to first-line therapies, including extended-spectrum cephalosporins. In low- and middle-income countries such as Nigeria, unregulated access to antibiotics and reliance on informal healthcare providers may accelerate resistance. Beyond its immediate effects, untreated or poorly treated gonorrhoea contributes to infertility, adverse pregnancy outcomes, and neonatal infections. This study explores community perceptions and treatment practices contributing to inappropriate antibiotic use in an urban Nigerian setting.
Methods
A qualitative exploratory study was conducted in an urban community in Ebonyi State, Southeast Nigeria. Participants were purposively selected to capture diverse perspectives on gonorrhoea and antibiotic use. Data were collected through 8 in-depth interviews with young adults (aged 18-35 years) and patent medicine vendors respectively, and 2 focus group discussions with sexually active male and female community members.
Semi-structured interview guides were used to explore perceptions of gonorrhoea, treatment-seeking pathways, and antibiotic use practices. Interviews and discussions were conducted in English and the local language, audio-recorded with consent, and transcribed verbatim. Data were analysed using thematic analysis, following an inductive approach. Coding was conducted independently by two researchers, and discrepancies were resolved through discussion to ensure analytical rigor.
Results
Gonorrhoea was widely perceived as a mild and easily treatable infection, which normalized self-medication and reliance on informal drug vendors. Participants reported frequent use of non-prescribed antibiotics, incomplete treatment courses, and switching medications without professional guidance. Awareness of AMR was minimal, and treatment failure was often attributed to disease severity rather than drug resistance. Stigma surrounding sexually transmitted infections contributed to delayed healthcare seeking and concealment of symptoms. Patent medicine vendors played a central role in antibiotic access, often dispensing medications without adherence to treatment guidelines.
Conclusion
Community perceptions, stigma, and informal treatment practices are key drivers of inappropriate antibiotic use, accelerating AMR in Neisseria gonorrhoeae. Addressing these challenges requires integrated interventions, including community-based health education, stigma reduction, and strengthened regulation of informal drug vendors. Such strategies are critical for improving reproductive health outcomes and mitigating the growing threat of AMR in Nigeria and similar settings.