Research Article Syndromic versus Laboratory Diagnosis of Sexually Transmitted Infections in Men in Moshi District of Tanzania Yuwei Cheng, 1 Elijah Paintsil , 2 and Musie Ghebremichael 3 1 Department of Mathematical and Computer Sciences, College of the Holy Cross, Worcester, MA, USA 2 Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA 3 Harvard Medical School, Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA Correspondence should be addressed to Musie Ghebremichael; musie_ghebremichael@dfci.harvard.edu Received 31 October 2019; Accepted 26 December 2019; Published 7 February 2020 Academic Editor: Seble Kassaye Copyright © 2020 uwei Cheng et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. e syndromic diagnosis of sexually transmitted infections (STIs) is widely recognized as the most practical, feasible, and cost- effective diagnostic tool in resource-limited settings. is study assessed the diagnostic accuracy of syndromic versus laboratory testing of STIs among 794 men randomly selected from the Moshi district of Tanzania. Participants were interviewed with a questionnaire that included questions on history of STIs symptoms. Blood and urine samples were taken from the participants for laboratory testing. Only 7.9% of the men reported any symptoms of STI; however, 46% of them tested positive for at least one STI. ere was little agreement between syndromic and laboratory-confirmed diagnoses, with low sensitivity (0.4%–7.4%) and high specificity (96%–100%) observed for each individual symptom. e area under the receiver-operating curve was 0.528 (95% CI: 0.505–0.550), indicating that the syndromic approach has a 52.8% probability of correctly identifying STIs in study participants. In conclusion, whenever possible, laboratory diagnosis of STI should be favored over syndromic diagnosis. 1. Introduction AIDS continues to be one of the leading causes of death in sub-Saharan Africa [1]. Among the 36.9 million people living with HIV globally , 53% lived in sub-Saharan Africa [2]. Sexually transmitted infections (STIs) facilitate the transmission, disease progression, and treatment outcomes of HIV [3–5]. Moreover, people living with HIV (PLWH) have an increased prevalence of other STIs [6]. In sub- Saharan Africa, high incidence of untreated STIs has been associated with an increased rate of HIV transmission [7]. e World Health Organization (WHO) reported that other STIs such as syphilis and HSV-2 increase a person’s risk of acquiring HIV infection by more than three-fold [8]. us, timely recognition, management, and prevention of STIs are critical for prevention of HIV acquisition. Although superior in terms of reliability, laboratory di- agnosis of STIs is time-consuming, cost-prohibitive, and re- quires technology and capacity, which makes its routine use difficult in resource-limited countries. Most of these countries have a high burden of STIs; however, they lack the technical expertise, specialist physicians, and laboratory setup for the diagnosis of these STIs [9]. Furthermore, in situations where laboratory capacity exist, testing may be outsourced to regional facilities and obtaining test results may take up to several weeks. By contrast, syndromic case management algorithms provide an immediate result, allowing for on-site counseling and point-of-care treatment. Furthermore, syndromic diag- nosis is feasible and economical in resource-limited countries; it costs less than a fifth of the cost of laboratory-based testing [10]. In 2001, the WHO introduced an updated algorithm for syndromic case management that uses decision trees for the most common signs and symptoms of STIs [11]. Based on the patient’s symptoms and gender, different decision-tree dia- grams are used. However, these symptoms may be subjective, variable among patients, and a patient with an STI may not manifest overt symptoms. us, syndromic diagnosis may miss individuals with asymptomatic STIs [12]. Hindawi AIDS Research and Treatment Volume 2020, Article ID 7607834, 7 pages https://doi.org/10.1155/2020/7607834