Why we should move away – not towards – symptom-based terminology and policy in tuberculosis

For over a century, tuberculosis (TB) has referred to the disease caused by Mycobacterium tuberculosis-an infection that can take many forms and exist without symptoms. Recently, WHO introduced the term 'asymptomatic tuberculosis' (aTB) for cases without reported symptoms during screening. While intended to highlight the importance of aTB and limitations of symptom-based screening, this Viewpoint questions whether the term helps or hinders these aims. aTB relies on ill-defined 'symptom report', leading to variable interpretation, misunderstanding, and paradoxically reinforcing symptom-screening. Terminologically splitting TB has also led to aTB being misunderstood as a distinct, milder 'condition', prompting speculation its treatment may be unnecessary-contrary to WHO's intent. Rather than reframing TB to highlight the inaccuracy of symptom-based screening, this Viewpoint calls for removing symptom-based screening from guidelines and the promotion of evidence-based methods and terminology. TB remains the most accurate, programmatically relevant and compelling term for all forms of the disease.