Limitations and common pitfalls

The most important limitation is the interpretation and validity of the reported symptoms. Some studies have demonstrated considerable discrepancies between reported and observed symptoms (1) and there might well be recall bias, leading to underreporting. More importantly, the presence of asymptomatic gonococcal or chlamydial infection in males seriously limits the usefulness of this indicator, even as a proxy for STI prevalence or incidence (2). Therefore, self-reported symptoms should be used with caution in assessing the impact of preventive and treatment services.

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