These U.S. Cities Have the Highest STD Rates

For our 7th annual study of STD rates, based on 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 cities with the highest STD rates. In this year's report, the city with the highest STD rate was Philadelphia, PA, overtaking Memphis, TN, which moved to 2nd. This, in turn, pushed Jackson, MS from 2nd to 3rd in our rankings.

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 data; scrutinize a notable omission in data; and explore why this year's data is somewhat unique from recent years' studies.

• The South continues to suffer — but even more so — relative to other regions of the country.
• This is the first post-lockdown STD data that the CDC has released in the Covid era, and it isn't reassuring.
• Syphilis rates are on a disturbing and deadly rise, with tragic consequences for newborns.
• Where is the STD case data from the Baltimore, MD metropolitan area?
• Want to settle in a city with consistently low STD infection rates relative to other urban areas? Our study would suggest Provo, UT.

Last year, our study found that Philadelphia, PA, was suffering from the 5th worst STD infection rates among U.S. metro areas. Even so, its rates worsened relative to other cities in this year's study. As a result, it now leads all major metropolitan areas with the highest infection rates.

Meanwhile on the West Coast, as San Francisco, CA, has faced its share of well-documented challenges, it experienced a decline in our rankings assessment as well. In our previous study a year ago, available CDC data led the city to improve by three ranks, yet this year, it deteriorated from 15th to 8th — leapfrogging metropolitan areas like the District of Columbia, Little Rock, AR, and Norfolk, VA, which moved very little.

There's one city that hasn't moved much in our rankings — but in a positive way. Coming in at 99th last year, Provo, Utah, narrowly improved on its relatively stellar standing to secure 100th this year — the best among the 100 metro areas in our study.

Southern cities face challenges

In past years, we've made the worrisome observation that the South, as defined by the Census Bureau, contributes a disproportionate number of metro areas to the upper portions of our rankings in our annual study. Last year, for instance, 14 of the 25 U.S. cities with the highest STD infection rates were in the South. That means a region with roughly 39% of our nation's population contributes over half of the 25 cities with the worst STD infection rates.

But this year, the number of southern cities has risen to 17 of that top 25, or just over two-thirds. This overrepresentation in our study is disturbing. Two of last year's top 5 cities find themselves in nearly the same unenviable position in our latest study:

• Memphis, TN (was 1st, now 2nd)
• Jackson, MS (was 2nd, now 3rd)

One capital city, however, appears to be bucking this trend: Columbia, SC, which ranked 3rd highest in our study last year but has since improved to 21st this year.

Charlotte, NC, has also improved dramatically in our rankings; in our prior study, it had the 13th worst STD infection rates, but that ranking improved to 28th this year.

New cases of gonorrhea (over 710,000 of them) and chlamydia (over 1.6 million) signal to the CDC that chlamydia rates have risen back to pre-2020 levels, while gonorrhea rates continue to increase across our cities; unlike chlamydia, confirmed cases of gonorrhea never slowed in 2020.

Meanwhile, syphilis rates have risen by a massive 28.6% since the last study. But the rise in the congenital syphilis rate nationally is even more staggering (30.5%), constituting a tenfold increase in newborn syphilis cases over the span of a decade. These numbers mean that, since 2001, syphilis cases in our nation have increased 781%. Cases of congenital syphilis during that 20-year span rose by 464%.

Tragically, there were 220 cases of stillbirth or infant death in the U.S. due to the disease over the course of the most recent year for which the CDC provides its data. The thousands of infants who survive face lifelong health issues due to the infection.

Every city and state is feeling the effects of the surge in congenital syphilis, but communities in California, Texas, Florida, Arizona, and Louisiana feel it most profoundly — at this time, those five states collectively account for nearly 60% of reported cases.

Though growing infection rates affect nearly all communities, the STD burden within our cities hits 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 that dramatic disparities remain.

A closer look at the rise in syphilis rates illuminates these racial disparities.

Alaska Native or American Indian people account for only 0.7% of live births during this year of the study, yet those newborns account for nearly 4% of the congenital syphilis cases. Meanwhile, non-Hispanic Black people make up about 12% of the U.S. population but suffer 31% of the cases of chlamydia, gonorrhea, and primary and secondary syphilis.

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 these cases of newborn syphilis were 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.

"While newborn syphilis cases are increasing nationwide and across every racial and ethnic group, some communities, including those of people who are Black, Hispanic, and American Indian or Alaskan Natives, are experiencing the brunt of the newborn syphilis epidemic," says Laura Bachmann, MD, MPH, FIDSA, FACP, the chief medical officer in the CDC's Division of STD Prevention.

When the CDC examined data from 2020 a couple of years ago, it had been significantly impacted by socially disruptive lockdowns. And yet, nonetheless, infection rates rose year over year. In other words, we were not socializing more, yet we were spreading STDs at higher rates.

This trend only underscores what CDC officials have said about the vital importance of public health infrastructure to the prevention of the spread of STDs. It's not enough that we see one another less. Reliable and relatively easy access to testing and treatment for STDs is of paramount importance if our goal is to lower STD rates.

While the socially disrupted year 2020 still produced increases in STD infection rates compared to the year prior, the latest CDC data shows that what followed yielded infection rates that were worse still. 2021 was unaffected by various lockdowns or shelter-in-place mandates, yet public health infrastructure remained significantly frayed and has yet to recover. Effectively, what has happened is that normal patterns of life returned but without the easy ability to access sexual health testing and subsequent treatment. For these reasons, with such disruption to routine community healthcare access, the CDC anticipates that its latest data (upon which this study relies) likely underreports infection counts and underestimates infection rates.

It's been widely reported that STD infection rates in Baltimore, MD, were among the highest in the country in recent years. In our most recent study that was released last year, data indicated that Baltimore had one of the worst overall STD infection rates (4th on our list of U.S. metropolitan areas).

To help reduce the spread of STIs in Maryland in 2022, the CDC dedicated nearly $8 million in funds, with close to a million dollars of it going directly to Baltimore. Unfortunately, it appears that county health officials in Maryland did not disclose data about infection rates for the CDC's latest annual report.

Why the data sharing did not occur is unclear. It could be a casualty of the fraying of public health infrastructure that the CDC has lamented. We always find it very disturbing when officials do not or cannot share important public health data, whether it pertains to STDs or any other public health crisis. It's in the public interest for this data to be available; as funds are allocated to Maryland in order to stem the rising tide of infections, we hope that these counties will also once again find the resources to share vitally important data with the public.

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.)

These proposals aim to improve public health infrastructure and, in so doing, provide much-needed help to populations that are statistically at higher risk. Health experts say that access to timely testing and treatment is essential to reducing infection rates nationwide. The CDC's Dr. Bachmann observes that it's no coincidence that the rise in STD rates has happened concurrently with the decline in public health infrastructure. The Covid-19 pandemic took an already flawed infrastructure and weakened it.

"In terms of having a long-term impact," she says, "it is going to be important to have more investment in public health and also the public health workforce."

As part of the American Rescue Plan Act of 2021, the CDC has received a five-year, billion-dollar investment in its Disease Intervention Specialist (DIS) Workforce, which will contribute trained public health personnel who can respond to outbreaks and improve the response capabilities of local public health professionals, as well as help recruit and train additional staff.

But this is only part of the solution. To meet the public health challenges posed by STDs in our cities and across the countryside, the CDC urges a full-court press from local health practitioners, state and local health departments, and the federal government to invest in ongoing research and form innovative partnerships (like those proposed in the STI National Strategic Plan) that improve access to timely testing and treatment.

What can we do as citizens?

As individuals, we can help stem the tide of STD infections by educating ourselves and doing our very best to test for common STDs 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, it's up to all of us to decide whether reports next year and the year after reveal the 9th and 10th 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.

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/chlamydia/about/index.html
• 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
• BetterHelp vs. Talkspace | Best Testosterone Booster
• 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.

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