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Appropriate <jats:styled-content style=\"fixed-case\">STI<\/jats:styled-content> diagnosis is crucial to prevent the transmission and sequelae of untreated infection. We reviewed the diagnostic accuracy of syndromic case management and existing point\u2010of\u2010care tests (<jats:styled-content style=\"fixed-case\">POCT<\/jats:styled-content>s), including those in the pipeline, to diagnose <jats:styled-content style=\"fixed-case\">STI<\/jats:styled-content>s in resource\u2010constrained settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prioritized updating the systematic review and meta\u2010analysis of the diagnostic accuracy of vaginal discharge from 2001 to 2015 to include studies until 2018. We calculated the absolute effects of different vaginal flowcharts and the diagnostic performance of <jats:styled-content style=\"fixed-case\">POCT<\/jats:styled-content>s on important outcomes. We searched the peer\u2010reviewed literature for previously conducted systematic reviews and articles from 1990 to 2018 on the diagnostic accuracy of syndromic management of vaginal and urethral discharge, genital ulcer and anorectal infections. We conducted literature reviews from 2000 to 2018 on the existing <jats:styled-content style=\"fixed-case\">POCT<\/jats:styled-content>s and those in the pipeline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and discussions<\/jats:title><jats:p>The diagnostic accuracy of urethral discharge and genital ulcer disease syndromes is relatively adequate. Asymptomatic <jats:italic>Chlamydia trachomatis<\/jats:italic> (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>) and <jats:italic>Neisseria gonorrhoeae<\/jats:italic> (<jats:styled-content style=\"fixed-case\">NG<\/jats:styled-content>) infections limit the use of vaginal discharge and anorectal syndromes. The pooled diagnostic accuracy of vaginal syndromic case management for <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">NG<\/jats:styled-content> is low, resulting in high numbers of overtreatment and missed treatment. The absolute effect of <jats:styled-content style=\"fixed-case\">POCT<\/jats:styled-content>s was reduced overtreatment and missed treatment. Findings of the reviews on syndromic case management underscored the need for low\u2010cost and accurate <jats:styled-content style=\"fixed-case\">POCT<\/jats:styled-content>s for the identification, first, of <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">NG<\/jats:styled-content>, and, second, of <jats:italic>Mycoplasma genitalium<\/jats:italic> (<jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content>) and <jats:italic>Trichomonas vaginalis<\/jats:italic> (<jats:styled-content style=\"fixed-case\">TV<\/jats:styled-content>) and <jats:styled-content style=\"fixed-case\">NG<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content> resistance\/susceptibility testing. Near\u2010patient <jats:styled-content style=\"fixed-case\">POCT<\/jats:styled-content> molecular assays for <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">NG<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">TV<\/jats:styled-content> are commercially available. The prices of these <jats:styled-content style=\"fixed-case\">POCT<\/jats:styled-content>s remain the barrier for uptake in resource\u2010constrained settings. This is driving the development of lower cost solutions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content> syndromic case management guidelines should be updated to raise the quality of <jats:styled-content style=\"fixed-case\">STI<\/jats:styled-content> management through the integration of laboratory tests. <jats:styled-content style=\"fixed-case\">STI<\/jats:styled-content> screening strategies are needed to address asymptomatic <jats:styled-content style=\"fixed-case\">STI<\/jats:styled-content>s. <jats:styled-content style=\"fixed-case\">POCT<\/jats:styled-content>s that are accurate, rapid, simple and affordable are urgently needed in resource\u2010constrained settings to support the uptake of aetiological diagnosis and treatment.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25343","type":"journal-article","created":{"date-parts":[[2019,8,30]],"date-time":"2019-08-30T07:02:26Z","timestamp":1567148546000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":128,"title":["Diagnosing sexually transmitted infections in resource\u2010constrained settings: challenges and ways forward"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7640-9166","authenticated-orcid":false,"given":"Teodora EC","family":"Wi","sequence":"first","affiliation":[{"name":"Department of Reproductive Health and Research World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2162-4237","authenticated-orcid":false,"given":"Francis J","family":"Ndowa","sequence":"additional","affiliation":[{"name":"Skin &amp; Genito\u2010Urinary Medicine Clinic Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5480-7940","authenticated-orcid":false,"given":"Cecilia","family":"Ferreyra","sequence":"additional","affiliation":[{"name":"Department of Emerging Threat and AMR FIND Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4526-8487","authenticated-orcid":false,"given":"Cassandra","family":"Kelly\u2010Cirino","sequence":"additional","affiliation":[{"name":"Department of Emerging Threat and AMR FIND Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1786-6295","authenticated-orcid":false,"given":"Melanie M","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Reproductive Health and Research World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Toskin","sequence":"additional","affiliation":[{"name":"Department of Reproductive Health and Research World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4180-7858","authenticated-orcid":false,"given":"James","family":"Kiarie","sequence":"additional","affiliation":[{"name":"Department of Reproductive Health and Research World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Santesso","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Biostatistics McMaster University Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"Unemo","sequence":"additional","affiliation":[{"name":"World Health Organization Collaborating Centre for Gonorrhoea and other STIs Department of Laboratory Medicine Faculty of Medicine and Health \u00d6rebro University \u00d6rebro Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8,30]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"World Health Organization (WHO).Report on global sexually transmitted infection surveillance.Geneva:WHO;2018[cited 2019 Jan 8]. 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