Ike: Why Nigeria Must Intensify Fight Against Drug-Resistant Gonorrhoea

Dr. Ifeanyichukwu Samuel Ike, is a Nigerian-trained physician-epidemiologist and public health specialist based in Illinois, United States. In this interview with Funmi Ogundare, he speaks on the growing threat of antimicrobial resistance, particularly drug-resistant gonorrhoea, and its implications for Nigeria, as well as his experience treating HIV/AIDS and sexually transmitted infections in Nigeria, the importance of data-driven public health interventions, community engagement, antibiotic stewardship and stronger disease surveillance. Excerpts:

You have spent over a decade working at the intersection of infectious disease medicine and public health. What first drew you to HIV/AIDS and sexually transmitted infections specifically?

Honestly, it was unavoidable. When I was a resident physician at the University of Nigeria Teaching Hospital, a 700-bed tertiary facility, HIV/AIDS was not an abstract statistic. It was the patient in front of you every morning. We were operating within a PEPFAR-supported HIV treatment center, so we were seeing patients at every stage of the disease, from early diagnosis to advanced AIDS-defining illness. You learn very quickly that HIV does not exist in isolation. It intersects with tuberculosis, with hepatitis, with sexually transmitted infections, with poverty, with stigma. That clinical reality never left me, and it is what ultimately pushed me toward public health, because I realised that treating one patient at a time, while essential, was never going to move the needle on a population-level crisis. Nigeria shaped everything I now do in this field.

You subsequently completed a postgraduate training in public health with a concentration in infectious disease epidemiology in the United States. How did that training change how you see the problem?

It gave me the language and the tools to see patterns at scale. In clinical medicine, you are trained to focus on the individual, their viral load, their CD4 count, their medication adherence. Public health flips that entirely. You are asking: where is this disease concentrating? Which communities are being left behind by surveillance systems? Where are resistance patterns emerging before clinicians on the ground even notice them? My training gave me proficiency in surveillance platforms and analytical tools. What I discovered is that the data infrastructure exists in high-income countries, but the people who can interpret it with genuine clinical depth are very rare. That gap is dangerous everywhere, but in Nigeria, where the surveillance infrastructure itself remains underfunded, the gap is potentially catastrophic.

Most people associate antimicrobial resistance with hospital superbugs like MRSA. Why are you focused on sexually transmitted infections specifically?

Because Neisseria gonorrhoeae, the bacterium that causes gonorrhea, is now officially a CDC-designated urgent threat. That is the same classification as carbapenem-resistant Enterobacteriaceae. We are running out of antibiotics that work against it. Ceftriaxone is currently our last reliable first-line treatment, and resistance to that is already being documented globally. If we lose ceftriaxone, we will have a sexually transmitted infection with no effective oral treatment option. That is not a distant scenario. It is a trajectory we are already on, and it is one that will hit Nigeria and other low-and-middle-income countries hardest, because the pipeline for new antibiotic development is nearly empty and the burden of STIs in sub-Saharan Africa is among the highest in the world.

That sounds alarming. What does that mean practically for communities on the ground, both in the United States and in Nigeria?

In the United States, it means that populations in rural or medically underserved communities, where access to specialist care is already limited, will be the first and hardest hit. The CDC’s National Antimicrobial Resistance Monitoring System has a 2026 to 2030 strategic plan that explicitly prioritises gonorrhea resistance surveillance as a national priority. But in Nigeria the stakes are even higher. Nigeria has among the highest STI burden in sub-Saharan Africa. Gonorrhea is endemic. Antibiotic misuse and self-medication are widespread, not out of ignorance, but out of necessity, because accessing a physician for every infection is simply not feasible for most Nigerians. That environment accelerates resistance development. If ceftriaxone fails globally, Nigeria will feel it first and feel it most severely.

You implemented a research project on antimicrobial resistance awareness in Illinois. What did you find, and how do those findings speak to the Nigerian context?

The headline finding was sobering. Awareness of antibiotic stewardship principles among university students in Illinois was significantly lower than public health benchmarks require, particularly regarding when antibiotics are and are not appropriate. Now consider that these are educated young adults in a well-resourced university setting in one of the wealthiest countries in the world. If stewardship literacy is this low there, the implications for Nigeria are stark. In a context where antibiotics are sold over the counter without prescription, where patients pressure healthcare workers for antibiotics for viral infections, and where the regulatory environment around antimicrobial dispensing is inconsistently enforced, the conditions for accelerated resistance development are far more severe. My research generated policy recommendations aligned with the CDC CARB Action Plan. Many of those recommendations; community education campaigns, institutional stewardship protocols, data-driven monitoring of prescribing patterns, are directly transferable to the Nigerian setting. The science does not change because the geography does.

Nigeria carries one of the largest HIV burdens in the world. From your vantage point working within the U.S. public health system, what lessons do you believe Nigeria has still not fully applied to its HIV response?

That is a question I think about deeply, because I lived the Nigerian HIV response from the inside as a clinician. The single most important lesson Nigeria has not yet fully applied is the power of data-driven decision making at the community level. The national HIV data exists, NAIIS surveys, PEPFAR program data, NASCOP reporting. But the gap between that data and what actually happens in a primary healthcare center in rural Benue State or a community health post in Zamfara is enormous. The intervention design at the community level is still largely top-down. Programs are designed by policymakers who may never have sat with the communities they are designing for. What I have learned working in public health in the United States, particularly in medically underserved rural communities in Illinois, is that the intervention has to be built from the inside of the problem. Community trust, cultural specificity, and accessibility are not soft considerations. They are the difference between a program that reaches people and one that produces reports nobody acts on.

You led a community health initiative in rural Illinois that reached over 1,500 adults. What did that teach you about reaching underserved communities, and what is the parallel for Nigeria?

That data alone does not save anyone. You can have the most sophisticated surveillance dashboard in the world, but if the community does not trust the messenger, if the outreach is not culturally grounded, if the screening event is not accessible to someone without transportation in a county with no public transit, none of it matters. The Hepatitis B awareness project I led through the Illinois Public Health Association was focused on prevention, screening, vaccination, and linkage to care in a medically underserved rural county. What made it work was designing it from the ground up with the community’s actual barriers in mind, not the barriers we assumed they had. The parallel for Nigeria is direct. In communities where healthcare distrust runs deep, shaped by years of underfunded facilities, drug stockouts, and user fees that turn illness into a financial crisis, you cannot simply deploy a public health program and expect uptake. The program has to earn its way in. Nigeria has community health extension workers, ward development committees, traditional rulers, and religious leaders who have the trust that government programs often lack. Those structures need to be genuinely integrated into HIV and STD intervention design, not just consulted as a checkbox.

The CDC reports approximately 2.2 million cases of chlamydia, gonorrhea, and syphilis annually in the United States. Congenital syphilis has increased 700 per cent over the past decade. How do you make sense of those numbers, and what should Nigerian health authorities learn from them?

The investment in STD control in the United States is real, but the distribution is deeply uneven. When you map STD burden against healthcare access, the overlap with medically underserved communities is almost perfect. Rural counties, communities of color, areas with high poverty rates, these are where surveillance is weakest and where linkage-to-care pathways break down. The congenital syphilis surge is the most painful illustration of this failure. We have had the tools to prevent congenital syphilis for decades. Prenatal screening is standard of care. The fact that cases have risen 700 percent tells you the system is failing at precisely the point where it should connect data to action. For Nigeria, the lesson is urgent. Congenital syphilis remains a significant cause of stillbirth and neonatal death in Nigeria, not because the knowledge to prevent it does not exist, but because antenatal screening coverage is inconsistent and syphilis treatment in pregnancy is not universally available. If the United States, with all its resources, is struggling with congenital syphilis, Nigeria needs to treat this as the emergency it is and invest specifically in antenatal syphilis screening as a national priority.

What would you say to Nigerian policymakers and public health leaders who are setting priorities right now?

I would say: the diseases we are discussing; HIV, drug-resistant gonorrhea, congenital syphilis, do not respect the distinction between high-income and low-income countries. The organisms evolve the same way everywhere. What differs is the capacity to detect, respond, and contain. Nigeria needs to invest urgently in three things. First, a workforce of public health professionals who combine clinical depth with data analytics capability, people who can read a surveillance report and understand what it means for a patient in Kano or Aba or Port Harcourt. Second, community-based intervention models that are built with communities rather than delivered to them. And third, a national antibiotic stewardship framework with real enforcement, because every course of antibiotics used inappropriately in Nigeria today is a contribution to the resistance crisis that will kill Nigerians tomorrow. The United States is learning these lessons expensively and late. Nigeria does not have to repeat that experience. The evidence is already there. The question is whether there is the political will to act on it.

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