By: Eric Rodriguez and Tim Barclay, PhD

Last Updated: Sep 28, 2021

After a 6-month, Covid-related delay, the Centers for Disease Control and Prevention (CDC) finally released its latest Sexually Transmitted Disease Surveillance Report last month, and the numbers are disturbing. For the 6th consecutive year, the STD rate in the United States hit a record high.

Covid-19 has understandably dominated the news over the past 14 months. As we head into recovery and our economy begins to open up in the summer, it’s important not to lose sight of the viruses that predated the pandemic and currently infect over 110 million Americans, with over 20 million new infections each year.

For our 4th annual study of STD rates, the Innerbody Research team analyzed the latest statistics on a city-by-city basis and developed our list of the Top 100 cities with the highest STD rates. In this year’s report, the city with the highest STD rate was Jackson, MS, overtaking Baltimore, MD, which moved to 2nd.

In addition to ranking the 100 cities with the highest STD rates, below we’ll provide some takeaways from our report; spotlight cities whose STD rates have significantly improved or declined; highlight racial disparities that emerge from the CDC’s data; and address what this data means in the context of the Covid-19 pandemic.

Quick takeaways
Cities show movement in our rankings
Data illuminates racial inequities
The Rankings: Top 25 U.S. cities with the highest STD rates
Rounding out our Top 100
Covid-19 and underreporting STD rates
Proposed actions to improve the national outlook
How we collected data for this report
Sources
About Innerbody Research

Before we get to the full rankings, here are some findings and trends that we observed:

• Chlamydia, gonorrhea, and syphilis top the list of most commonly reported new STD infections. Taken together, infections from these three reportable diseases increased almost 30% from 2015 to 2019.
• The South continues to be disproportionately represented among the hardest-hit cities. Of the Top 25, 17 are southern cities (or 19, if you use the Census Bureau’s definition to include Baltimore and the District of Columbia).
• Four of the Top 25 cities are located in Florida, which is a worrisome development for the Sunshine State. Miami, for instance, spiked upward five spots to the 24th highest rate.
• Meanwhile, across the continent, major California cities saw an increase in STD rates. San Francisco swapped positions with Philadelphia, PA to rank 3rd highest (up from 4th). Los Angeles, San Diego, and Sacramento all rose over ten spots to rank 37th, 55th, and 51st, respectively.
• California and Texas tie for the state with the most cities in our rankings, at 14 apiece, though these are after all two of the largest states in our country. But Alabama – at around two percent of our national population – is one of the more overrepresented states, with six cities in our report.
• We noted that three of the Top 10 cities are relatively small (Augusta, GA, Montgomery, AL, and Fayetteville, NC) but share one thing in common: they are home to relatively large military bases.

Numerous cities saw significant movement upward with higher infection rates, including:

• Washington, DC rose 12 spots from 17 → 5
• Knoxville, TN rose 17 spots from 26 → 9
• New Orleans, LA rose 13 spots from 24 → 11
• Jacksonville, FL rose 15 spots from 38 → 23
• Albany, NY rose 15 spots from 68 → 53

It wasn’t all bad news; some cities bucked the national trend with improved STD rates. For instance, Milwaukee, WI and Indianapolis, IN both moved out of the Top 10, though they remain among the Top 25 cities.

Other cities’ infection rates improved dramatically, such as:

• Shreveport, LA improved 12 spots from 9 → 21
• Denver, CO improved 13 spots from 19 → 32
• Richmond, VA improved 12 spots from 32 → 44
• Portland, OR improved 15 spots from 73 → 88
• Omaha, NE improved 13 spots from 79 → 92

The CDC’s data this year highlights an ongoing trend that appears to worsen each year: the STD burden is not equal within our cities. While we are seeing increases in STDs overall across many groups, the STD burden continued to hit minority racial and ethnic groups the hardest. The fact that many of the highest-ranking cities in our study have a higher percentage of minority residents also appears to reflect this trend.

Based on CDC data, STD rates were:

• 5-8 times higher for African Americans or Black people than for non-Hispanic White people
• 3-5 times higher for American Indians, Native Alaskans, and Native Hawaiians than for non-Hispanic White people
• 1-2 times higher for Hispanic or Latino people than for non-Hispanic white people

Experts such as the CDC’s Jo Valentine, Director of the Office of Health Equity, point to systemic inequalities that lead to lower access to health and testing and subsequently poorer health outcomes.

“Focusing on hard-hit populations is critical to reducing disparities,” said Valentine. “To effectively reduce these disparities, the social, cultural, and economic conditions that make it more difficult for some populations to stay healthy must be addressed. These include poverty, unstable housing, drug use, lack of medical insurance or regular medical provider, and high burden of STDs in some communities.”

#1

Jackson, MS

• STD Cases / 100K Population

  4,281

• HIV Cases

  2,541

• Chlamydia Cases

  3,984

• Gonorrhea Cases

  2,081

• Syphilis Cases

  100

#2

Baltimore, MD

• STD Cases / 100K Population

  3,707

• HIV Cases

  9,441

• Chlamydia Cases

  8,602

• Gonorrhea Cases

  3,982

• Syphilis Cases

  312

#3

San Francisco, CA

• STD Cases / 100K Population

  3,150

• HIV Cases

  12,149

• Chlamydia Cases

  9,505

• Gonorrhea Cases

  5,593

• Syphilis Cases

  579

#4

Philadelphia, PA

• STD Cases / 100K Population

  2,827

• HIV Cases

  16,917

• Chlamydia Cases

  20,354

• Gonorrhea Cases

  7,043

• Syphilis Cases

  470

#5

Washington DC

• STD Cases / 100K Population

  2,771

• HIV Cases

  62

• Chlamydia Cases

  17,589

• Gonorrhea Cases

  2,236

• Syphilis Cases

  865

#6

Augusta, GA

• STD Cases / 100K Population

  2,596

• HIV Cases

  1,400

• Chlamydia Cases

  2,636

• Gonorrhea Cases

  1,100

• Syphilis Cases

  97

#7

New York, NY

• STD Cases / 100K Population

  2,544

• HIV Cases

  97,206

• Chlamydia Cases

  74,014

• Gonorrhea Cases

  28,394

• Syphilis Cases

  1,952

#8

Montgomery, AL

• STD Cases / 100K Population

  2,365

• HIV Cases

  1,470

• Chlamydia Cases

  2,569

• Gonorrhea Cases

  1,226

• Syphilis Cases

  75

#9

Knoxville, TN

• STD Cases / 100K Population

  2,314

• HIV Cases

  960

• Chlamydia Cases

  3,710

• Gonorrhea Cases

  1,626

• Syphilis Cases

  34

#10

Fayetteville, NC

• STD Cases / 100K Population

  2,255

• HIV Cases

  1,368

• Chlamydia Cases

  4,337

• Gonorrhea Cases

  1,741

• Syphilis Cases

  49

#11

New Orleans, LA

• STD Cases / 100K Population

  2,213

• HIV Cases

  6,911

• Chlamydia Cases

  8,190

• Gonorrhea Cases

  3,004

• Syphilis Cases

  153

#12

Memphis, TN

• STD Cases / 100K Population

  2,045

• HIV Cases

  6,601

• Chlamydia Cases

  11,407

• Gonorrhea Cases

  4,620

• Syphilis Cases

  226

#13

Milwaukee, WI

• STD Cases / 100K Population

  2,007

• HIV Cases

  2,144

• Chlamydia Cases

  11,703

• Gonorrhea Cases

  5,083

• Syphilis Cases

  101

#14

Tallahassee, FL

• STD Cases / 100K Population

  1,990

• HIV Cases

  1,257

• Chlamydia Cases

  3,379

• Gonorrhea Cases

  1,083

• Syphilis Cases

  101

#15

Indianapolis, IN

• STD Cases / 100K Population

  1,905

• HIV Cases

  4,736

• Chlamydia Cases

  10,503

• Gonorrhea Cases

  4,073

• Syphilis Cases

  154

#16

Baton Rouge, LA

• STD Cases / 100K Population

  1,893

• HIV Cases

  4,173

• Chlamydia Cases

  4,781

• Gonorrhea Cases

  1,635

• Syphilis Cases

  118

#17

Fort Lauderdale, FL

• STD Cases / 100K Population

  1,871

• HIV Cases

  19,483

• Chlamydia Cases

  12,167

• Gonorrhea Cases

  4,436

• Syphilis Cases

  426

#18

Columbia, SC

• STD Cases / 100K Population

  1,817

• HIV Cases

  3,879

• Chlamydia Cases

  6,405

• Gonorrhea Cases

  2,505

• Syphilis Cases

  105

#19

Little Rock, AR

• STD Cases / 100K Population

  1,791

• HIV Cases

  1,940

• Chlamydia Cases

  3,419

• Gonorrhea Cases

  1,513

• Syphilis Cases

  160

#20

Savannah, GA

• STD Cases / 100K Population

  1,783

• HIV Cases

  1,696

• Chlamydia Cases

  2,633

• Gonorrhea Cases

  765

• Syphilis Cases

  62

#21

Shreveport, LA

• STD Cases / 100K Population

  1,758

• HIV Cases

  1,437

• Chlamydia Cases

  3,543

• Gonorrhea Cases

  1,447

• Syphilis Cases

  78

#22

Atlanta, GA

• STD Cases / 100K Population

  1,714

• HIV Cases

  31,833

• Chlamydia Cases

  23,724

• Gonorrhea Cases

  8,136

• Syphilis Cases

  1,100

#23

Jacksonville, FL

• STD Cases / 100K Population

  1,694

• HIV Cases

  6,450

• Chlamydia Cases

  8,810

• Gonorrhea Cases

  4,259

• Syphilis Cases

  239

#24

Miami, FL

• STD Cases / 100K Population

  1,686

• HIV Cases

  26,316

• Chlamydia Cases

  14,680

• Gonorrhea Cases

  4,971

• Syphilis Cases

  581

#25

Cleveland, OH

• STD Cases / 100K Population

  1,681

• HIV Cases

  4,617

• Chlamydia Cases

  11,051

• Gonorrhea Cases

  5,146

• Syphilis Cases

  92

Last year, many cities outside of the Top 100 asked us for their ranking. So this year, we decided to expand our report to include the next 50 cities with the highest STD rates by rank.

One urgent question is unique to our current moment: do the CDC’s numbers paint an accurate picture of the extent of our problems today or are STD infections now underreported due to insufficient pandemic-era testing?

During the pandemic, many testing labs lacked sufficient personnel or had to shift focus entirely to Covid-19 in an attempt to keep up during the deadly surges. This led to serious under-testing at what amounted to a high-water mark in STD infections nationwide.

Understanding that people did not stop having sex during the past year, experts fear that the lack of normal access to STD testing and treatment likely means our infection rates are, if anything, higher than they appear in this latest report. As recently as January 2021, a survey revealed that over a third of staff in STD testing programs at the state and local levels have needed to remain focused on Covid-19.

We’re often asked how metropolitan areas can take actions to improve STD rates. For this, we’re inclined to turn to the STI National Strategic Plan released by the HHS. It provides recommended approaches and enhancements aimed at turning our trends in a positive direction. Among its proposals are:

• Partnering with pharmacies and clinics to increase easy local access to STD testing and treatment.
• Establishing express clinics, where people could access walk-in testing and treatment without full exams.
• Harnessing the potential of telehealth/telemedicine as a convenient method of testing and consultation for people across the country, including in rural areas. (If you live in such an area, 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.)

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 you have an open and honest conversation about your sexual history and STD testing with your doctor…”

Our STD testing and treatment infrastructure had been strained prior to the pandemic, contributing to increased STD rates each year. It’s up to all of us to decide whether reports next year and the year after reveal the 7th and 8th consecutive years of record-high infections or we instead make this tide turn, addressing budget shortfalls and improving public education and access to testing and treatment in our communities.

All of the STD data found in our report – including case statistics for HIV, syphilis, gonorrhea, and chlamydia – are from the CDC’s latest data release from April 2021. Syphilis data includes only primary and secondary syphilis cases and does not include congenital and early latent syphilis cases. HIV cases are not reported for some cities. 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.

All estimated metro area and state population data is from the CDC and the US Census Bureau. For our interactive map, our research team decided to use counties as visual proxies for most metro areas. The CDC does not have STD data for all US counties.

For our rankings, we chose to include only city metro areas with an estimated population of 200,000 or more. Though Washington, DC is technically a district, we chose to include it as a city. No statistical testing was used during the production of this research.

https://www.cdc.gov/std/statistics/2019/default.htm
https://www.ncsddc.org/resource/covid-19-and-the-state-of-the-std-field-phase-iii
https://www.cdc.gov/std/chlamydia/default.htm
https://www.cdc.gov/std/gonorrhea/default.htm
https://www.cdc.gov/std/syphilis/default.htm
https://www.cdc.gov/std/hiv/default.htm
https://www.countyhealthrankings.org/explore-health-rankings
https://www.cdc.gov/hiv/library/reports/surveillance-data-tables/vol-1-no-3/index.html
https://www.cdc.gov/std/stats18/default.htm
https://gis.cdc.gov/grasp/nchhstpatlas/tables.html
https://www.census.gov/data/datasets/time-series/demo/popest/2010s-counties-total.html

STD Information:
STD Symptoms & Causes from the Mayo Clinic
STD Guide from Planned Parenthood
STD Awareness for Teens from KidsHealth
STD Testing Resources:
Mayo Clinic: STD Testing Guide
Planned Parenthood: STD Testing
Innerbody: STD Testing At-Home Guide
STD Testing Companies:
LetsGetChecked Review | MyLAB Box Review
STDcheck Review | Everlywell Review
BlueChew Review | BlueChew Free Trial
Support Resources:
BetterHelp | Talkspace

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