The design of new antimalarial combinations to treat Plasmodium falciparum infections requires drugs that, in addition to resolving disease symptoms caused by asexual blood stage parasites, can also interrupt transmission to the mosquito vector. Gametocytes, which are essential for transmission, develop as sexual blood stage parasites in the human host over 8 to 12 days and are the most accessible developmental stage for transmission-blocking drugs. Considerable effort is currently being devoted to identifying compounds active against mature gametocytes. However, investigations on the drug sensitivity of developing gametocytes, as well as screening methods for identifying inhibitors of early gametocytogenesis, remain scarce. We have developed a luciferase-based high-throughput screening (HTS) assay using tightly synchronous stage I to III gametocytes from a recombinant P. falciparum line expressing green fluorescent protein (GFP)-luciferase. The assay has been used to evaluate the earlystage gametocytocidal activity of the MMV Malaria Box, a collection of 400 compounds with known antimalarial (asexual blood stage) activity. Screening this collection against early-stage (I to III) gametocytes yielded 64 gametocytocidal compounds with 50% inhibitory concentrations (IC 50 s) below 2.5 M. This assay is reproducible and suitable for the screening of large compound libraries, with an average percent coefficient of variance (%CV) of <5%, an average signal-to-noise ratio (S:N) of >30, and a Z= of ϳ0.8. Our findings highlight the need for screening efforts directed specifically against early gametocytogenesis and indicate the importance of experimental verification of early-stage gametocytocidal activity in the development of new antimalarial candidates for combination therapy. P lasmodium falciparum malaria remains a primary global cause of death and disability from infectious disease, particularly in infants and pregnant women (1). Malaria treatment currently relies on artemisinin-based combination therapy (ACT); however, emerging resistance to artemisinins in the field (2, 3) underscores the need to progress new antimalarial candidates through the drug development pipeline. Recent in vitro high-throughput screening (HTS) campaigns against P. falciparum asexual blood stages, the forms responsible for the clinical manifestations of the disease, have identified a wealth of active chemical classes, representing a promising starting point for the discovery of new therapeutic agents (4-7). The current malaria elimination strategy has also highlighted the need for all new antimalarial combination therapies to include components capable of interrupting the transmission of sexual-stage gametocytes to Anopheles mosquitoes (8, 9). Methods to enable prioritization of inhibitors of the asexual parasite stages based on their additional transmission-blocking activity are therefore urgently required.P. falciparum gametocytes develop through five morphologically distinct stages in the human blood over 8 to 12 days (10) and thereafter ...