These U.S. Cities Have the Highest STD Rates

The COVID-19 pandemic has understandably dominated the news cycle for almost three years now. As we gradually transition out of this public health emergency and continue down paths to better management and recovery, 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 6th annual study of STD rates, Innerbody Research 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 Memphis, TN, overtaking Jackson, MS, 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 Centers for Disease Control and Prevention (CDC) data; examine correlations between infection rates and local health spending levels; and address what this data means in the context of the COVID-19 pandemic.

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. While reported cases of chlamydia dropped by just over a percent since 2016, cases of gonorrhea and syphilis rose by 45% and 52%, respectively.
• The South continues to be disproportionately represented among the hardest-hit cities. Of the Top 25, 14 are Southern cities.
• Three of the Top 25 cities are located in Florida, which is actually an improvement from last year when the Sunshine State accounted for four of them. However, Jacksonville and Miami both saw their rankings worsen from 23rd and 24th to 16th and 17th, respectively.
• Meanwhile, across the continent, major California cities saw some significant movement in rankings. San Francisco improved rather dramatically from 3rd to 15th. Los Angeles and San Diego both saw more modest ranking improvements and now sit at 33rd and 48th rather than 37th and 55th, respectively. Sacramento improved from 51st to 66th.
• California contributed 13 cities to our rankings this year — the most from any state. In 2022, it shared this distinction with Texas, but only seven cities from the Lone Star State made our list this year.

The biggest downward movements in this year’s rankings included:

• Norfolk, VA, rose 19 spots from 29 → 10
• Columbia, SC, rose 15 spots from 18 → 3
• Cleveland, OH, rose 14 spots from 25 → 11
• Memphis, TN, rose 11 spots from 12 → 1
• Little Rock, AR, rose 11 spots from 19 → 8

And the biggest positive improvements in rankings are:

• Atlanta, GA, improved 20 spots from 22 → 42
• New York, NY, improved 19 spots from 7 → 26
• Denver, CO, improved 19 spots from 32 → 51
• Cincinnati, OH, improved 16 spots from 30 → 46
• San Francisco, CA, improved 12 spots from 3 → 15

With an aim to better understand why some cities ranked higher than others in our report, we took a deep look into healthcare expenditures per capita using data from the Centers for Medicare and Medicaid Services (CMS). We were curious to see whether there was any correlation between healthcare spending and STD rates. Here is what we found:

• 17 of the Top 25 cities with the highest STD rates are located in states with healthcare spending below the national average of $10,191 per capita.
• States that are among the lowest in healthcare spending per capita — Mississippi, Tennessee, and South Carolina — account for the three highest STD rates.
• The top 15 states with the highest per capita healthcare spending only contribute two cities (Baltimore, MD and Rochester, NY) to our list of the Top 25 cities with the highest STD rates.
• A correlation between healthcare spending and STD rates is not perfect, however. For example, although the District of Columbia has the highest healthcare spending per capita at $14,381 — more than $4,000 above the national average — the city nonetheless ranks 9th worst for STD infection rates in our city-focused study.

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 witness increases in STD infection 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.

When comparing infection rates of White people to those of some minority racial and ethnic groups, the CDC data shows that dramatic disparities remain. Though non-hispanic Black people comprise approximately 12% of the total population of the country, they account for a disproportionate 32% of chlamydia, syphilis, and gonorrhea infections.

Differences in sexual behavior aren't the explanation for these differences in rates of infection. 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 healthcare and testing and, consequently, 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.”

In previous years after releasing our annual study, our readers and members of the press often asked us whether there is any correlation between political party governance and city STD rankings. Given this considerable interest, here is a summary of what we’ve found this year.

Out of the Top 20 cities with the highest STD rates in our rankings, 16 of them are led by Democratic mayors.

However, since a significant percentage of health spending happens at the state level, we also took a look at the political party membership of governors in the states where those cities are located. Through this lens, a murkier picture emerges: among the Top 20 cities with the highest STD infection rates, 12 are located in states led by Republican governors.

But not so fast — the political picture gets more complicated when you consider that budgetary decisions at the state level are a result of either a yearly or two-year process involving state legislative and executive branches reaching an agreement. A governor proposes the budget, but a state's legislature (made up of two chambers — a House and a Senate) must agree to it or propose modifications; the legislature holds a lot of budgetary power in this equation. This year, Democrats fully control the state legislature in two of the 15 states that contribute our Top 20 cities with the highest STD rates, while Republicans control the state legislature in 11 out of 15 states.

Some political observers pay particular attention to states where one party has what is called a governing "trifecta." A state government trifecta occurs when one party controls the governor's office as well as both the state House and Senate. Given what we described above, one party subsequently has complete control over the budgeting decisions for that state. Looking at those same 15 states that account for our Top 20 cities with the worst STD rates, there is a Republican state trifecta in eight of them, while Democrats have a trifecta in two states.

What does all of this mean? Above, we provided a concise snapshot of the political landscape in those geographic areas of particular interest in our study. But it is only a snapshot — rather than a summary of pertinent local political history over the course of a decade or more — and correlation and causation are not the same. We are a health research company, not a political one. We will let you make your own inferences.

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 underreported due to insufficient pandemic-era testing? During March and April of 2020, reported new cases of STDs declined dramatically, but they had been increasing in the months prior to our nation's first lockdowns.

During the pandemic, many testing labs have dealt with insufficient personnel or a shift in focus entirely to COVID-19 as our country attempted to keep up during the deadly surges. The pandemic ushered in a refocusing not only of lab personnel but also testing equipment and materials in attempts to stem the tide of COVID-19 cases. Additional resources that help control the spread of STDs in our communities were also diverted. This shift in focus led to serious under-testing and lack of typically available resources at what amounted to a high-water mark in STD infections nationwide.

Understanding that people did not stop having sex during these past several years, 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. In 2021, for instance, a survey revealed that over a third of staff in STD testing programs at the state and local levels remained focused on COVID-19. For its part, the CDC has stated that it believes the drop in reported chlamydia cases to be more about pandemic-era underreporting than an actual drop in infections.

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

• Partner with pharmacies and clinics to increase easy local access to STD testing and treatment.
• Establish express clinics where people can access walk-in testing and treatment without full exams.
• Harness 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 8th and 9th 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. Syphilis data includes only primary and secondary syphilis cases and does not include congenital and early latent syphilis cases. HIV cases are not reported in 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 U.S. Census Bureau.

For our rankings, we chose to include only city metro areas with an estimated population of 500,000 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/2020/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/nchhstp/newsroom/2021/2019-std-surveillance-report-press-release.html
• 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
• Innerbody: Ways to Protect Yourself from STDs

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
• Hims Review

Support Resources:

• Online Therapy Guide | BetterHelp Review
• Talkspace Review | BetterHelp vs. Talkspace
• Herpes Dating Sites | Positive Singles Review

Innerbody Research is committed to preventing the rapid spread of STDs. The reason why we invest the time and effort into creating this and other STD-related research and guides is to raise STD prevention awareness by making this information widely available. We hope to reach as many people as possible. As such, please feel free to share our content for educational, editorial, or discussion purposes. We only ask that you link back to this page and credit the author as Innerbody.com. https://www.innerbody.com/std-testing/std-statistics

Since its founding in 1998, Innerbody Research has provided objective, science-based research and advice to help our readers make more informed choices about home health products and services. Each month, we help over 2 million visitors lead healthier lives.

Our researchers and expert writers have advanced degrees in relevant scientific fields. All content that contains medical-related information is thoroughly reviewed by members of Innerbody Research’s Medical Review Board, which consists of board-certified physicians and medical experts from across the country.

If you have any questions or feedback regarding this research or any other material on our website, or if you would like to interview one of this study’s authors, please email us at media@innerbody.com.