These U.S. Cities Have the Highest STI Rates

Our research team dives deep into the CDC’s latest STI Surveillance Statistics and provides our analysis of current trends in 2025.

by Innerbody Research Staff

Last updated: Jan 6th, 2025

For our 8th annual study of STI rates, using the latest data published by the Centers for Disease Control and Prevention (CDC), Innerbody Research analyzed statistics on a city-by-city basis and developed our list of the Top 100 metropolitan areas with the highest STI rates. In this year's report, the metro area with the highest overall STI rate was Detroit, MI, overtaking Philadelphia, PA, which moved to 2nd. Memphis, TN, which had formerly been ranked 2nd, improved to 4th this year, while the metro area that came in 3rd last year — Jackson, MS — improved to 12th in 2025. At the same time, Montgomery, AL (formerly ranked 7th) worsened to 3rd.

In addition to ranking the 100 metro areas with the highest STI rates, below we'll provide some takeaways from our report; spotlight urban communities whose STI rates have significantly improved or declined; highlight racial disparities that emerge from the CDC data; and, for the first time in years, share analysis of some encouraging developments.

Quick takeaways

The South continues to struggle with high infection rates in its metro areas, though there is evidence of positive change.
Topping our annual study for the first time is Detroit, MI.
For the second straight year, Provo, UT, comes in 100th, with 99 metro areas having worse STI rates.
Could the tide be starting to turn in our STI epidemic? Infection rates are near their record-high levels over the past 20 years, but unlike recent years, this year shows a slight decline of nearly 2% in the overall infection rate.
Despite hopeful signs of improvement in overall national figures, STI rates continue to reveal disturbing disparities that deserve reflection and action, and there is significant room for improvement in all respects as our nation continues to confront the epidemic.

Jump to

Notable movement or stability in rankings

Detroit, MI, was ranked 9th worst for STI rates last year, but in this year's study, it has unfortunately earned the distinction of the metro area with the highest infection rates. In our years of conducting these studies, Detroit has never before ranked number one. This also comes during a year in which our nationwide list of the hardest-hit metro areas included almost 30% more places located in Detroit's Census-designated region (East North Central U.S., which includes the states of Michigan, Wisconsin, Illinois, Ohio, and Indiana). Motor City has confronted daunting, highly publicized challenges over the past decade and has exhibited great resilience and spirit; we hope that next year's study shows a Detroit that has rebounded and risen back upward in our rankings.

Other cities joining Detroit in our top 25 are also located in the Great Lakes region. For instance, in neighborhing Ohio, Cleveland finds itself ranked 13th, which reflects a slight worsening of relative infection rates from last year when it ranked 15th. But elsewhere in the Midwest, Minneapolis, MN, which ranked 17th last year, improved its ranking to 21st in our study this year. And Milwaukee, WI, escaped the top 25 altogether to rank 29th among U.S. metro areas.

The South, as defined by the U.S. Census Bureau, remains relatively fraught with high STI rates in its metro areas this year (more on that below).

Meanwhile, out west, our study shows evidence of improvement in metropolitan STI rates. San Francisco, CA, and Portland, OR, remain in the top 25 for the second year in a row, though their ranks have improved by a couple positions. But more broadly, fewer cities in the West are found within the top 50 worst cities for infection rates, and the total number of top 100 cities that are located in the West dropped from 31 to 25.

It's also worthwhile to call out a city for remaining remarkably stable in our study, year after year. For the second straight year, Provo, UT, has ranked 100th. And prior to that, it ranked 99th.

The South fights high infection rates

The U.S. South — a region that is home to roughly 39% of the population — accounts for over 60% of the top 25 metropolitan areas with the highest STI rates in this year's study. But, believe it or not, that's actually a slight improvement over last year's study.

The number of Floridian cities in the top 100 has slightly increased, though Miami has improved relative to other cities, ranking 19th now instead of its previous 16th.

Gulf states, in particular, are heavily represented in our top 25 metro areas, accounting for over a third of them. Louisiana alone is home to three of the 25 cities with the highest STI rates, though Montgomery, AL, has jumped several positions and leapfrogged New Orleans, LA, to become the city with the 3rd highest rates. A look into the state-level data from the CDC reveals similar trends seen in the data for major metropolitan areas: seven of the top 10 states with the highest gonorrhea infection rates are located in the South, and the South contributes eight of the top 10 states with the highest rates of chlamydia infection.

However, some metro areas are bucking regional trends. Jackson, MS, which ranked 3rd worst in last year's study, improved its rank to 12th this year -- a dramatic turnaround for a city that has been plagued by high infection rates for several years in our annual studies. And Little Rock, AR, which had the 11th highest STI rates last year, improved its ranking significantly to 27th.

Is the tide turning in this epidemic?

According to the latest data from the CDC, overall STI rates in the United States actually dropped by 1.8% in 2023 compared to 2022. The national infection rates had trended upward for the better part of two decades leading up to the COVID-19 pandemic. This year's updated data from the CDC gives reason for hope that concerted effort and investment may be helping turn the page at last.

Nationally, the gonorrhea infection rate dropped by 7% compared to the previous year.
The rate of chlamydia infection remained effectively unchanged, which still signifies a 9% drop since 2019.
A 1% increase in overall syphilis infections represents a much slower rate of increase than the staggering 29% increase seen in the previous year-over-year analysis.

Despite the improvement, however, we continue to face an epidemic that requires renewed commitment to maintain improvement and achieve greater momentum (which is what compels us to create our annual study). While a drop of nearly 2% in the national STI rate is something to celebrate, this rate remains 90% higher than it was in 2004. What seems like a scant 1% increase overall in the syphilis infection rate still translates to the highest levels of syphilis infection in our country since 1950.

And hiding beneath that 1% statistic are alarmingly high rates of congenital syphilis. Congenital syphilis cases nationally rose only by about a tenth of the amount they had risen in prior years, yet cases among newborns did rise by 3% since 2022 and by 106% since 2019. Despite the slowing of this surge, these stratospheric rates caused 279 stillbirths and infant deaths over the past year.

And within the overall population, certain groups continue to face disproportionate challenges when it comes to curbing STI rates.

Across racial groups, young people and men who have sex with men (MSM) contend with higher STI rates. A staggering 48% of the total cases of chlamydia, gonorrhea, and primary and secondary syphilis occurred among young people ages 15-24.

But social and racial disparities persist; the STI burden within our cities continues to hit minority racial and ethnic groups the hardest. When comparing infection rates of White people to those of some minority racial and ethnic groups, the CDC data shows dramatic disparities.

Non-Hispanic Black people make up 12.6% of the U.S. population but suffer 32.4% of the cases of chlamydia, gonorrhea, and primary and secondary syphilis.
The rate of chlamydia infection in the Native Hawaiian / Pacific Islander racial group, according to the latest Census data, is over three times higher than that among White people.
The rate of gonorrhea infections among Black / African American males is over eight times the rate among White males.
The rate of congenital syphilis infections within the Hispanic/Latino population is more than double that of White people, and the infection rate among non-Hispanic Black people is higher still — nearly four times higher than the rate among White people.
American Indian / Alaska Native populations face congenital syphilis rates nearly twelve times higher than those of the White population in our country.

Health leaders stress that differences in sexual behavior aren't the explanation for these differences in rates of infection. What can spell the difference between life and death, or illness and health, are timely testing and treatment — but it has to be both. Nearly 90% of newborn syphilis cases are preventable through testing and treatment during pregnancy.

Barriers to timely testing and treatment include lack of health insurance; poverty and housing issues; substance use disorder; and lack of sufficient public health infrastructure. All of these factors continue to affect minority racial and ethnic groups disproportionately.

The Rankings: Top 25 U.S. cities with the highest STI rates

1. Detroit, MI

2. Philadelphia, PA

3. Montgomery, AL

4. Memphis, TN

5. Baltimore, MD

6. New Orleans, LA

7. Washington, DC

8. St. Louis, MO

9. Baton Rouge, LA

10. San Francisco, CA

11. Mobile, AL

12. Jackson, MS

13. Cleveland, OH

14. Columbia, SC

15. Portland, OR

16. Seattle, WA

17. Richmond, VA

18. Shreveport, LA

19. Miami, FL

20. New York, NY

21. Minneapolis, MN

22. San Antonio, TX

23. Savannah, GA

24. Lexington, KY

25. Tampa, FL

Rounding out the Top 100

Proposed actions to improve the national outlook

We're often asked how metropolitan areas can take action to improve STI rates. While it’s true that we are witnessing signs of hope that better days are in front of us, we find ourselves in the midst of an epidemic. Very recent drops in infection rates haven't happened in a vacuum; they're the result of meaningful innovations in testing and treatment and massive investment in infrastructure, which collectively have formed the STI National Strategic Plan and shed light on paths for further improvements.

Continue to research and develop new methods of treatment and prevention.

Doxy PEP — a prophylactic approach using antibiotics to prevent bacterial STI after exposure — is an example of a recent innovation that has proven effective. With investment, our country can improve access among groups known to benefit from it, and further research may identify additional groups who would benefit.

Fully utilize modern, at-home STI testing capabilities.

In announcing the CDC's latest STI Surveillance Report, Dr. Bradley Stoner, MD — director of the Division of STI Prevention — identified at-home self-tests as one of the four major factors that have helped our nation begin to turn the tide.

Improve local access to STI services.

We need to further expand STI testing and treatment capabilities into more local settings in order to build momentum and further reduce infection rates.

Invest heavily in workforces to combat the epidemic.

2021's American Rescue Plan Act (ARPA) might have been aimed at COVID-19, but it funded a massive increase in disease intervention specialists (DIS). It's no coincidence that the recent reduction in STI rates comes on the heels of a multi-year investment of $200 million per year in deploying these specialists across the nation to address the needs of specific communities (often those historically underserved). This DIS program has translated to more robust testing and screening from Georgia to California. It has also enabled unprecedented partnerships with tribal communities and new levels of outreach to historically at-risk groups like MSM. Ultimately, these investments amount to putting our money where our mouth is, demonstrating that we prioritize this epidemic by investing in fighting infection. To avoid losing ground as a nation, we can renew our commitment and prevent those temporary investments from expiring.

Complacency and failure to acknowledge the actions and investments that led us here could send us spiraling back into worsening infection rates. But it’s also up to us all, as individuals, to do what we can to maintain progress.

What can we do as citizens?

As individuals, we can help stem the tide of STIs by educating ourselves and doing our very best to test for common infections routinely and seek treatment when tests indicate an infection.

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."

Ultimately, all of us must decide whether reports next year and the year after bring additional reductions in STI rates through a combination of renewed budget priorities, public education enhancements and community cooperation, or instead show that we have slipped backward in our fight against STIs.

How we collected data for this report

All of the STI 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 STIs, 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 STI Data & Statistics page.

All estimated metro area and state population data is from the CDC and the U.S. Census Bureau.

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.

Sources

Additional STI Resources

STD Information:

STD Testing Resources:

STD Testing Companies:

Support Resources:

Fair use statement

Innerbody Research is committed to preventing the rapid spread of STIs. The reason why we invest the time and effort into creating this and other STI-related research and guides is to raise STI prevention awareness by making this information widely available. We aim 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

About Innerbody Research

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.