Abstract. Plasmodium falciparum gametocytemia and its related infectivity for mosquitoes was studied in 115 patients (median age ϭ 18 years, range ϭ 4-45) with simple malaria attacks who lived in the hypoendemic area of Dakar, Senegal. Patients were included in a 28-day in vivo sensitivity test after treatment with chloroquine (CQ, n ϭ 82) or sulfadoxine plus pyrimethamine (SP, n ϭ 33). The prevalence of resistant infections was 58.5% in those treated with CQ and 0% in those treated with SP. The gametocytemia peaked at day 7 after treatment. The maximal gametocyte prevalence was 38.2% in the CQ-sensitive infection group, 89.6% in the CQ-resistant group, and 97.0% in those treated with SP. The maximal geometric mean gametocytemia was 2.19/l in the CQ-sensitive infection group, 29.12/l in the CQ-resistant group and 85.55/l in those treated with SP. The period between appearance of the first clinical symptom and treatment was positively related to gametocyte prevalence at days 0 and 2. Experimental infection of wild Anopheles arabiensis using membrane feeders was performed at days 0 and 7, and mosquito infectivity was measured by oocyst detection on the midgut. At day 0, 14.1% of the patients had infected at least 1 mosquito, and at day 7, this value was 38.5%. The mean percentage of infected mosquitoes was 3.2% at day 0 and 12.6% at day 7. At day 7 after treatment with CQ, the relative risk for patients with resistant infections of infecting anophelines was 4.07 higher than in those with sensitive infections. No difference was observed in infectivity for mosquitoes between RI-type resistance and the RII ϩ RIII-type resistance. A sporonticidal effect of SP was observed at day 7 after treatment. These data show that P. falciparum gametocytes and their infectivity for mosquitoes were differentiated according to the drug used, its efficacy, and the duration of symptoms before treatment; they were not dependent on the density of asexual stages. Prompt treatment of malaria cases performed at the beginning of symptoms could limit the spread of resistant parasites.The factors that trigger and regulate the switch from asexual to sexual development of the malaria parasite remain largely mysterious, 1,2 but may involve both genetic mechanisms 3 and environmental mechanisms, 4 especially when conditions deteriorate. Completion of Plasmodium falciparum gametocytogenesis (from merozoite to morphologically mature gametocyte) takes 10-12 days in vivo, 5,6 an estimate that is consistent with the 10 days observed in vitro. 7 In the peripheral blood stream, the mature gametocyte has a halflife of 2.4 days and 1 gametocyte generation may persist for up to 3 weeks. 8 In continuous culture, the progeny of a single schizont is either only asexual parasites or only gametocytes, indicating a commitment to 1 or the other path of development prior to the merozoite stage. 9 The passage of the malaria parasite from humans to the mosquito vector is characterized by one word: variability. This intriguing phenomenon has been observed by many inv...