Demographic information of study participants

More than 80% of the participants (n = 16) were aged between 21 and 30 years. There was an equal number of females and males (n = 9). 10 participants (> 50%) were dispensing assistants, 6 were community pharmacists, and the remaining 2 were pharmacy technicians. The majority of the participants had 2 to 3 years of working experience in community pharmacy practice (Table 1).

Table 1 Demographic characteristics of the participantsSTIs management practices

The themes derived from the study were knowledge of Standard Treatment guidelines (STGs) and STI management, attitude and perception towards the use of STGs and practice of the respondents in STIs management (Table 2).

Table 2 Thematic table on STIs management practicesKnowledge of STGs and the management of STIs

Most of the participants had adequate knowledge of STGs for managing STIs. Some participants explained what STGs are about and how they are used in managing STIs. They noted that STGs contained conditions, signs and symptoms and possible prescriptions or medications for treating them. Some, however argued that the recommendations from the STGs are not exhaustive as sometimes laboratory tests are necessary before treatment and that some medications not included in the STGs may be more effective. The following quotes present their views:

The STG recommendations are okay, with uncomplicated STIs but is only complicated ones that is not okay. Mmm, for the uncomplicated ones I will say, syndromic management is the best, but for the complicated ones the person would have to go to the hospital for further investigations like the laboratory tests and stuff hence syndromic approach is not the best for that side. —Dispensing assistant (R9)

So, we usually use syndromic approach. And for gonorrhoea, usually I treat with Cefixime 400mg, a start dose. And with chlamydia usually Doxycycline because is cheap. Syphilis, errh, I usually go for Azithromycin because we cannot give injection here, so. —Community pharmacist (R6)

“Yes, we have a protocol, we follow the standard treatment guidelines. Depending on the symptoms too, we let the patient sometimes go for laboratory test.” —Dispensing assistant (R14)

“Yes, we have – we have a protocol. We use erh erh – STGs – the Standard Treatment Guidelines

Erh, we often go with the antibiotics, mostly the broad spectrums: azithromycin, doxycycline, erm metronidazole. Those – those are the ones we use.”—Pharmacy technician (R5)

Few participants, nevertheless, were not aware of STGs for STI management. This was more typical of the dispensing assistants. They claimed to be ignorant about STGs and that they were not aware that STGs should be used to guide the diagnosis and treatment of illnesses, including STIs. A dispensing assistant stated, “I have not heard of STGs.”

Attitude and perspectives of respondents towards use of Standard Treatment Guidelines

Participants expressed their views and perception towards the use of Standard Treatment Guidelines in STI management. This section explored the perception of the participants on STGs use in STIs management and found two main opinions, namely; STGs are very important and recommendations from the STGs are not effective sometimes. Some participants noted that STG is an essential tool in the management of STIs as it guides treatment choices and decisions based on accepted standards. They noted that without the guidelines, practitioners would have to practice trial and error, which can have detrimental effects on the patients’ health.

Nevertheless, some participants argued that in some cases, the treatment in the guidelines is not effective in treating STIs. They intimated that sometimes they gave a particular medication as indicated by the STG but after that the patient returned without their signs and symptoms being resolved. The poor management recommended by the guidelines has resulted in poor perception of the guide’s effectiveness in treating STIs among some of the participants. A community pharmacist (R5), stated;

I think the STG should be reviewed often because there are cases of STIs when we refer to the STG, we give the medications to the people and then they come back. And then sometimes, you don’t know the duration for which the person has been carrying the STI so if you give the STG recommended treatment and then the person goes and come back with the same condition, it’s a problem. So, I think it needs to be reviewed often so that we can have an update of what is going on. —Community pharmacist (R5)

Another community pharmacist (R4) opined;

Personally, I have a lot of issues with the STG recommendations on the management of STIs, especially because of the syndromic approach being used. You see, personally I don’t like that approach but I mean so far as it works; patients are also relieved of their symptoms. —Community pharmacist (R4)

“But I wish the STG will be updated every six months, because people who are resistant to antibiotics, you give the drugs to them and they wouldn’t even recover.”—Dispensing assistant (R15).

More so, some participants, argued that syndromic treatment is not good. They argued that it is important for the causative organism to be confirmed before initiating treatment, as a poor choice of antibiotics may contribute to antimicrobial resistance or treatment failure. They further noted that on this basis, they believed that syndromic treatment is not the best practice in STI management. Their views are presented below:

Erh, syndromic management – erh, I think that that’s where the problem is because we are just using symptoms to manage the cases and um, organisms are like that, they change. So, I think if we should do the test – run the tests for the various infections before we start treatment. That will be the best.—Pharmacy technician (R5)

Personally, I have an issue because I am a firm believer of antimicrobial resistance, so I mean going by the syndromic approach, we are definitely going to increase, ehh... we are going to have increase in the antibiotic resistance but sometimes you are not sure, though we could see that anytime someone come with gonorrhea, there is a likelihood the person is having gonorrhea but not 100%. So therefore, if you introduce the person to another antibiotic, you turn to increase the risk of antimicrobial resistance. Personally, am not a believer of syndromic approach but I still practice it anyways due to the absence of lab or testing. —Community pharmacist (R4)

Practices of STIs management

Practice of STIs management was also explored. Three subthemes (two positive and one negative) on the practice of STIs management among community pharmacy staff emerged. The two positive practices were consistent use of STGs in conjunction with the recommended tests and antibiotics for treatment and comfortable in discussing STIs related topics with clients. The third, a negative practice was not considering multiple infections in treatment practice.

The majority adhered closely to the STGs proposed antibiotic regimen, while a few incorporated the recommended STG laboratory tests in conjunction with antibiotic treatment. Regarding participants’ strict use of STG, many of the participants explained that they always followed the guidelines. They explained that they diagnosed the symptoms as stated in the guidelines and conclude on a diagnosis based on the signs and symptoms, then prescribe the recommended antibiotics. They, thus, confirmed syndromic treatment. Their quotes are presented as follows:

We usually use the STG and most of our workers believe that if someone comes with the normal STI, we do the syndromic management. So, they give Ciprofloxacin tablets, Metronidazole or Doxycycline, but then sometimes, they also give Azithromycin and then Ciprofloxacin, it depends on who is serving the person and they try to cover all basis. I think the STG is good, I think it is fine. —Community pharmacist (R1)

So, as I said we follow the STGs, so for gonorrhea and chlamydia, we just go with, emmm… we just go with either Ciprofloxacin 500mg stat or we can also go with Cefixime 400gram stat and Azithromycin 1 g stat. Syphilis we don’t usually manage them here, we usually inform them to go, for them to have their shot (Benzathine penicillin). —Community pharmacist (R4)

Consequently, some participants relied on the results of the laboratory tests before providing the drug therapy recommended by the STG. They noted that sometimes they requested for some laboratory tests to be carried out before prescribing the recommended treatment.

“Yeah, that’s why we use the multiple treatment. Sometimes when they come to you, they haven’t done the test. So, we run the tests to see which of the infection it actually is.” —Pharmacy technician (R5)

Furthermore, most of the participants also felt comfortable in discussing STI-related issues with their clients however, some of the clients were very shy and failed to open up to the pharmacy staff for informed decisions to be made on the therapy.

“Yes I am comfortable discussing STI related matters with my patients, why not we do it paa (a lot).”—Dispensing assistant (R16)

Yes, but they won't tell you what you want to know so you won't force further. There is different form of communication uh-huh, personal and stuff. So, if the person does not allow you to know them personally, you wouldn't force further.—Pharmacy technician (R8)

“Oh yes, I am very comfortable, the clients are sometimes not comfortable but for me, I am very comfortable.”—Community pharmacist(R4)

A major treatment practice among the participants was not considering multiple infections. The participants always provided treatment for the suspected STI condition based on the symptoms and did not consider the presence of other infections. They noted that they only prescribed treatment for the most probable STI based on the signs and symptoms given by the client/patient. Consequently, after deciding the most likely condition based on these symptoms, they give the recommended antibiotics.

Emm… Usually, I usually treat them based on the symptoms that they came with and the impressions that has been able to form so far, just manage them for and then you try to advise him/her on all the risky behaviours, multiple partners and if possible, we encourage them to come with their partners so that they are also treated. —Community pharmacist (R4)

When we investigate them and they are able to give us the real symptoms, and also tell us what they are going through, we can know the particular infection we are treating. So, I can say no to your question, we don't treat it as multiple infection, yeah. —Dispensing assistant (R9)