Context: Most of the sexually transmitted infections (STIs), both ulcerative and non-ulcerative are prevalent in India. However, due to lack of adequate laboratory infrastructure in the country, information regarding STIs lies essentially on syndromic basis. Hence, there is very limited data of laboratory proven STIs. Aims: The aim of this study is to determine the prevalent STI and reproductive tract infection (RTI) in the region and comparison of etiological diagnosis with syndromic approach. Settings and Design: Cross-sectional study. Materials and Methods: A total of 1120 patients attending STI/RTI clinic were included in the study with one or more complaints as enunciated by World Health Organization in its syndromic approach. Depending on syndromic presentation, different samples such as ulcer swabs, genital swabs and blood samples were collected. These samples were processed by the standard guidelines of National AIDS Control Organization. Warts, Molluscum contagiosum and genital scabies were diagnosed clinically. Results: Age of acquiring STI in females (20-24 years) was lower than males (25-44 and more). Vaginal discharge syndrome (90.3%) was most common followed by cervical discharge syndrome (20%). The highest incidence of herpes (14.3%) seen in genital ulcerative diseases but clinically human papilloma virus (16.5%) was common. Overall, Candida was the most common isolates. Bacterial STIs like chancroid (0%) and gonorrhea (0.54%) are showing a declining trend. Laboratory confirmation of syndromic diagnosis was seen in only 409/1120 (36.5%). Conclusions: Viral STIs/RTIs are getting the upper hand over bacterial. Syndromic algorithms have some shortcomings and they need to be periodically reviewed and adapted to the epidemiological patterns of STIs in a given setting.