Background: Syndromic management of bacterial sexually transmitted infections (STIs) in women misses 50-80% of genital Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG). Women engaging in transactional sex in sub-Saharan Africa are likely to be exposed to STIs. Nucleic acid amplification testing (NAAT) is recommended for CT/NG diagnostics but has limited availability and is expensive. We compared the performance characteristics of the less expensive Atila iAMP-4STI NAAT to the Cepheid Xpert CT/NG NAAT for diagnosing genital CT and NG in women engaged in transactional sex in Cameroon. Methods: We conducted a cross-sectional comparison study using a convenience sample of women in a health clinic in urban Cameroon. Patient demographics, behaviors, and symptoms were captured. Providers collected vaginal swabs for testing on both platforms. We calculated positive and negative percent agreement, Cohen's K-score, and used McNemar's χ2 test as a statistical comparator between assays. Results: Between September 7 and September 11, 2020, we tested samples from 277 women (median age: 37, IQR 31-42). Thirty-one (11.2%) had a syndromic diagnosis of cervicitis or pelvic inflammatory disease. Atila iAMP-4STI was positive for CT in 32/277 (11.6%) women and NG in 20/277 (7.2%). Cepheid Xpert CT/GC was positive for CT in 33/277 (11.9%) women and NG in 17/277 (6.1%). Positive and negative percent agreements for CT were 75.8% and 97.1% (p=0.8, K-score 0.74), respectively. Positive and negative percent agreements for NG were 52.9% and 95.8% (p=0.49, K-score 0.45), respectively. Conclusions: Our findings suggest a limited utility for the Atila iAMP-4STI assay to diagnose female genital CT and less for NG. Unfortunately, providers cannot use this assay to supplement or replace syndromic management. [ABSTRACT FROM AUTHOR]