By Eric Rodriguez

Our research team dives deep into the CDC’s latest STD Surveillance Statistics and provides our analysis of current trends.

The Centers for Disease Control and Prevention (CDC) recently released its latest Sexual Transmitted Disease Surveillance Report along with new data on the number of reported sexually transmitted disease (STD) cases across the United States.

Innerbody’s research team analyzed and combined the latest statistics to develop our annual state rankings by STD rate from highest to lowest, along with key trends regarding the effects of the COVID-19 pandemic on STDs.

Before moving on to the rankings, let’s explore some key findings and trends we observed.

Key takeaways
- Seven out of the top 10 states with the highest STD rates are in the South
- Mississippi ranks #1 as the state with the highest rate of STD cases
- Vermont has the lowest STD infection rate
- New York ranks #1 as the state with the highest rate of HIV cases
- Southern states are most affected by chlamydia and gonorrhea
- California has the largest amount of total STD cases reported
- Southern states suffering from high infection rates

The three states with the worst STD infection rates are Mississippi, Louisiana, and Georgia, and the South makes up a solid majority of the 10 most affected states. What is going on in the South?

According to Ronald Gray, MD, a professor of epidemiology at John Hopkins, the answer may simply come down to a lack of access to affordable healthcare. “The South has more people living in poverty and in rural areas,” he says, “which may make it harder for them to get tested and treated for STDs.”

If you are sexually active, getting tested for STDs and STIs is highly encouraged. This is especially important for young people aged 15-24, as this group accounts for almost half of all STD cases per year, according to the CDC.

A look into trends for specific STDs and metro areas
Chlamydia and gonorrhea infection rates seemed to mostly affect southern states, whereas syphilis rates varied throughout the country. Compared to our last report, three new states – Alaska, Oklahoma, and New Mexico – have replaced California, Georgia, and Arizona in the Top 5 states with the highest syphilis infection rates. Syphilis cases, in general, have risen since our last report, with those Top 5 states surpassing 20+ cases per 100,000 people.

State rankings by syphilis (primary and secondary) infection rate:
1. Nevada (24.9 cases per 100K population)
2. Mississippi (24.9 cases per 100K population)
3. Alaska (24.1 cases per 100K population)
4. Oklahoma (23.8 cases per 100K population)
5. New Mexico (22.3 cases per 100K population)

Meanwhile, not surprisingly, California and Texas led all states with the largest number of cities with high STD rates, each having 14 cities in the top 150. Florida comes third with 13 cities, followed by Ohio with seven cities. For more information about how individual U.S. cities stack up, check out our recently published City STD Rankings.

Total infections by state
In terms of total STD cases, as one might expect, the largest states have the highest number of reported STD cases.

State rankings by total number of STDs reported:
1. California (399,673 total cases reported)
2. Texas (294,055 total cases reported)
3. New York (268,674 total cases reported)
4. Florida (259,033 total cases reported)
5. Georgia (145,445 total cases reported)

Similar to our previous findings, California remains in the #1 spot for the total number of STD infections reported. This isn’t surprising, as California also has the largest state population with over 39.5 million residents. Texas, New York, and Florida have all stayed in their respective rankings, but there’s a new member in the Top 5: Georgia, which now surpasses Illinois by just over 8,000 cases.

According to the CDC, over 2.4 million combined STD cases are reported across the U.S. each year. These statistics do not even include those who have STDs but may not know it, don’t get tested, etc.

As an aside, the CDC stresses: “If you are sexually active, getting tested for STDs is one of the most important things you can do to protect your health. Make sure to speak with your doctor about your sexual history…” If you are uncomfortable talking with your doctor, or just can’t find the time to go get tested, an increasingly popular option is to take an at-home STD test.

Below are our rankings of each U.S. state based on STD cases (highest to lowest):
Top 10 States with Highest STD Rates

Impact of COVID-19 on STDs
Even in the face of a global pandemic, STDs continue to persist as a significant public health concern. In fact, it is believed that COVID-19 possibly even increased STD transmission during this pandemic. Since the state of STDs have not improved in the U.S., prevention and control efforts remain as important as ever.

In the early months of 2020, before preventive measures were put in place to reduce the spread of COVID-19 in the U.S., the weekly number of diagnosed and reported cases of chlamydia, gonorrhea, and primary and secondary syphilis were all higher than in 2019. However, due to the quarantine and shelter-in-place orders, those numbers unsurprisingly fell in March and April of 2020.

Additionally, the overall number of HIV diagnoses in the U.S. in 2020 was 17% lower than in 2019. Data for the year 2020 should be interpreted with caution due to the impact of COVID-19 on access to testing, materials, and other case surveillance activities. STDs are still heavily affecting the nation and should be taken seriously, despite the rates decreasing due to the pandemic.

Here are some reasons why STD numbers initially decreased:
Reduced screening
Many healthcare clinics and facilities either closed entirely or limited in-person visits to symptomatic patients only. Screening is necessary in order to receive a timely diagnosis and treatments, especially since STDs often do not show symptoms. Other factors of reduced screening include laboratory supply shortages, increased unemployment (and therefore, loss of health insurance), and decreased healthcare visits due to the lockdown.

Limited resources
Many jurisdictions and STD programs redirected their staff and resources to help control the spread of COVID-19. As a result, the focus shifted to stopping COVID-19 rather than STD prevention and surveillance.

Social distancing measures
In order to minimize contact with one another, a social distance of at least 6 feet was implemented and strongly urged. Additionally, because COVID-19 can spread during sexual contact, these social distancing measures may have limited sexual activity or the number of new sexual partners, ultimately reducing the spread of STDs.

STD health equity
According to the CDC, health equity is achieved when everyone has an equal chance to be healthy regardless of race, ethnicity, income, gender, sexual identity, religion, and disability.

Research shows that the higher rates of STDs among some ethnic minority groups, as compared to white adults, are likely caused by factors of poverty, lower education levels, and fewer jobs. These factors can make it more difficult for people to stay sexually healthy.

For example, those who already cannot afford basic necessities may find it much more difficult to access quality sexual health services. Additionally, many ethnic minorities distrust the U.S. health care system, fearing discrimination from doctors and other health care providers. These environments could create negative and apprehensive feelings even about getting tested for STDs.

The first step in empowering STD-affected communities and improving their health status is to learn more about and increase STD awareness, especially among young people. By introducing STD/STI prevention interventions early in life, it is likely that people may engage in safer sex practicies throughout their lifetime.

How We Collected Data for This Report
All of the STD data found in this report, including case statistics for syphilis, gonorrhea, chlamydia, and HIV are from the CDC’s latest data release (covering 2020). Syphilis data includes primary and secondary syphilis cases, as well as congenital syphilis cases. Statistics for other relatively common STDs, such as herpes, are not collected by the CDC at this time and hence are left out of our analysis. For more information about which statistics the CDC does and does not track, see its STD Data & Statistics page.

No statistical testing was used during the production of this research.