The syndromic approach has been the cornerstone of management of sexually transmitted infections (STIs) in developing countries. This strategy has had a considerable impact in decreasing the burden of STI in society. It offers the advantages of treating the infection at the first visit itself, reducing the risk of complications, non-reliance on laboratory diagnostics, and easy integration into the primary healthcare system. Nonetheless, it is not without limitations, most often criticized for its inability to treat asymptomatic cases. Syndromic management has been found to be satisfactory for genital ulcer disease and urethral discharge in several settings. However, its performance is not as good in the treatment of vaginal discharge syndrome, as it does not allow a distinction between cervicitis and vaginitis. Diagnostic validation and a review of its performance should be done periodically to keep abreast of the changing aetiology of various syndromes and patterns of drug susceptibility. Supplementing the syndromic approach with point-of-care tests and simple laboratory tests where available can improve its results. Further, healthcare professionals should be imparted training for optimum patient care. This narrative review critically appraises the syndromic approach to STIs, discusses the challenges that it faces, and offers suggestions to improve its performance.