**3. Peculiarities of bacterial STI treatment in resource-limited settings**

The above treatment recommendations for bacterial sexually transmitted infections are mostly practicable in developed societies. Some health facilities in the resource-limited settings are able to promptly carry out etiologic diagnosis of bacterial STIs and as such the above guidelines may be very beneficial in the management of patients who seek care in such centers. Nevertheless, there is predominantly a paucity of trained personnel, equipment, hospitals, and even access road to go to the existing health facilities in most parts of these resource-limited countries. The functional tertiary and secondary health facilities in most developing countries are situated in a

few cities in such countries. The communities are thus left without adequate coverage by skilled personnel. The diagnosis of STIs in such areas is clinical (based on symptoms and signs) and mostly inaccurate due to a lack of trained personnel and equipment. Consequently, the treatment for bacterial STIs is mostly based on WHO syndromic case management. This entails treatment with a combination of broadspectrum antibiotics without etiologic diagnosis. Usually, a combination of antibiotics from different classes is employed in the treatment of suspected cases of bacterial STIs [20]. These antibiotics are mostly gotten over the counter in these resource-limited settings. Even so, these disease conditions are treated by patent medicine dealers (who do not have conventional training in health and medicine-related matters) and other health personnel who are not trained and/or licensed for drug prescription/patient treatment. These treatments in resource-limited communities are usually inadequate due to inappropriate choice of drugs, under-dosing, and poor compliance to the prescribed drug regimen occasioned by poverty and ignorance. This results in bacterial antibiotic resistance, immediate and long-term avoidable sequelae of the infections, transmission to other sex partners, and endemicity of such infections in the affected communities.
