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Background  Over one billion people are infected with soil-transmitted helminths (STH), i.e.  Ascaris lumbricoides , hookworm and  Trichuris trichiura . For estimating drug efficacy and monitoring anthelminthic drug resistance, accurate diagnostic methods are critical. FECPAK G2  is a new remote-diagnostic tool used in veterinary medicine, which produces an image of the stool sample that can be stored on an internet cloud. We compared for the first time FECPAK G2  with the recommended Kato-Katz method.    Methodology/Principal findings  Two stool samples were collected from adolescent participants (age 15–18 years) at baseline and 14 to 21 days after treatment in the framework of a randomized clinical trial on Pemba Island, Tanzania. Stool samples were analyzed with different diagnostic efforts: i) one or ii) two Kato-Katz thick smears from the first sample, iii) two Kato-Katz thick smears from two samples and iv) FECPAK G2  from the first sample. Parameters were calculated based on a hierarchical Bayesian egg count model.  Complete data for all diagnostic efforts were available from 615 participants at baseline and 231 hookworm-positive participants at follow-up. At baseline FECPAK G2  revealed a sensitivity of 75.6% (72.0–77.7) for detecting  A .  lumbricoides , 71.5% (67.4–95.3) for hookworm and 65.8% (64.9–66.2) for  T .  trichiura , which was significantly lower (all p<0.05) than any of the Kato-Katz methods and highly dependent on infection intensity. Despite that the egg counts based on FECPAK G2  were relatively lower compared to Kato-Katz by a ratio of 0.38 (0.32–0.43) for  A .  lumbricoides , 0.36 (0.33–0.40) for hookworm and 0.08 (0.07–0.09) for  T .  trichiura , the egg reduction rates (ERR) were correctly estimated with FECPAK G2 .    Conclusions/Significance  The sensitivity to identify any STH infection was considerably lower for FECPAK G2  compared to Kato-Katz. Following rigorous development, FECPAK G2  might be an interesting tool with unique features for epidemiological and clinical studies.

Diagnostic comparison between FECPAKG2 and the Kato-Katz method for analyzing soil-transmitted helminth eggs in stool