Sexually 

Transmitted 

Disease 

Surveillance 

2013

Division of STD Prevention 

December 2014

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention 

Division of STD Prevention 

Atlanta, Georgia 30333
ii STD Surveillance 2013

Acknowledgments

Publication of this report would not have been possible without the contributions of the state and territorial 

health departments, sexually transmitted disease control programs, and public health laboratories that provided 

surveillance data to CDC.

This report was prepared by the following CDC staff: 

Jim Braxton, Delicia Carey, Darlene Davis, Elaine Flagg, Alison Footman, LaZetta Grier, Alesia Harvey, Sarah 

Kidd, Robert Kirkcaldy, Eloisa Llata, Rob Nelson, Fred Rivers, Mark Stenger, John Su, Elizabeth Torrone, 

Hillard Weinstock, the Surveillance and Data Management Branch of the Division of STD Prevention, 

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. We would also like to acknowledge 

contributions from Jo Valentine, in the Office of Health Equity, Division of STD Prevention, National Center 

for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
STD Surveillance 2013 iii

Copyright Information

All material contained in this report is in the public domain and may be used and reprinted without special 

permission; however, citation as to source is appreciated.

Suggested Citation

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2013. Atlanta: U.S. Department of 

Health and Human Services; 2014.

Web Site

The online version of this report is available at http://www.cdc.gov/std/stats.

Selected STD Surveillance and Prevention References and Web Sites

STD Surveillance Reports 1993–2012 

http://www.cdc.gov/std/stats/

STD Data in the NCHHSTP Atlas 

http://www.cdc.gov/nchhstp/atlas/

STD Data on Wonder 

http://wonder.cdc.gov/std.html

STD Data Management & Information Technology 

http://www.cdc.gov/std/Program/data-mgmt.htm 

STD Fact Sheets 

http://www.cdc.gov/std/healthcomm/fact_sheets.htm

STD Treatment Guidelines 

http://www.cdc.gov/STD/treatment/

STD Program Evaluation Guidelines 

http://www.cdc.gov/std/program/pupestd.htm

STD Program Operation Guidelines 

http://www.cdc.gov/std/program/GL-2001.htm

Recommendations for Public Health Surveillance of Syphilis in the United States 

http://www.cdc.gov/std/SyphSurvReco.pdf

Behavioral Surveillance 

Youth Risk Behavior Surveillance System: http://www.cdc.gov/HealthyYouth/yrbs/index.htm

National Survey of Family Growth 

http://www.cdc.gov/nchs/nsfg.htm

STD Surveillance 2013 v

Foreword

“STDs are hidden epidemics of enormous health and 

economic consequence in the United States. They are 

hidden because many Americans are reluctant to address 

sexual health issues in an open way and because of 

the biologic and social characteristics of these diseases. 

All Americans have an interest in STD prevention 

because all communities are impacted by STDs and all 

individuals directly or indirectly pay for the costs of these 

diseases. STDs are public health problems that lack easy 

solutions because they are rooted in human behavior and 

fundamental societal problems. Many of the strongest 

predictors of health, including sexual health, are social, 

economic, and environmental. Providing information 

about personal health and health services can empower 

people to make healthier choices to protect their health. 

Indeed, there are many obstacles to effective prevention 

efforts. The first hurdle will be to confront the reluctance 

of American society to openly confront issues surrounding 

sexuality and STDs. Despite the barriers, there are existing 

individual- and community-based interventions that are 

effective and can be implemented immediately. That is why 

a multifaceted approach is necessary at both the individual 

and community levels.

To successfully prevent STDs, many stakeholders need 

to redefine their mission, refocus their efforts, modify 

how they deliver services, and accept new responsibilities. 

In this process, strong leadership, innovative thinking, 

partnerships, and adequate resources will be required. The 

additional investment required to effectively prevent STDs 

may be considerable, but it is negligible when compared 

with the likely return on the investment. The process of 

preventing STDs must be a collaborative one. No one 

agency, organization, or sector can effectively do it alone; all 

members of the community must do their part. A successful 

national initiative to confront and prevent STDs requires 

widespread public awareness and participation and bold 

national leadership from the highest levels.”1

1 Eng TR, Butler WT, editors; Institute of Medicine (US). Summary: The hidden epidemic: confronting sexually transmitted diseases.

Washington (DC): National Academy Press; 1997. p. 43.
vi STD Surveillance 2013

Preface

Sexually Transmitted Disease Surveillance 2013 presents 

statistics and trends for sexually transmitted diseases (STDs) 

in the United States through 2013. This annual publication 

is intended as a reference document for policy makers, 

program managers, health planners, researchers, and others 

who are concerned with the public health implications 

of these diseases. The figures and tables in this edition 

supersede those in earlier publications of these data. 

The surveillance information in this report is based 

on the following sources of data: (1) notifiable disease 

reporting from state and local STD programs; (2) projects 

that monitor STD positivity and prevalence in various 

settings, including the National Job Training Program, 

the STD Surveillance Network, and the Gonococcal 

Isolate Surveillance Project; and (3) other national surveys 

implemented by federal and private organizations.

The STD surveillance systems operated by state and local 

STD control programs, which provide the case report 

data for chlamydia, gonorrhea, syphilis, and chancroid, 

are the data sources of many of the figures and most of the 

statistical tables in this publication. These systems are an 

integral part of program management at all levels of STD 

prevention and control in the United States. Because of 

incomplete diagnosis and reporting, the number of STD 

cases reported to the Centers for Disease Control and 

Prevention is less than the actual number of cases occurring 

in the U.S. population. National summary data of case 

reports for other STDs are not available because they are 

not nationally notifiable diseases.

Beginning with the publication of Sexually Transmitted 

Disease Surveillance 2010, redistribution methodology is 

no longer applied to any of the data to account for cases 

missing race, sex or age. The counts presented in this report 

are summations of all valid data reported in reporting year 

2013. Because missing data are excluded from calculations 

of rates by age group, race/ethnicity, and sex, incidence rates 

by these characteristics, particularly by race/ethnicity for 

chlamydia and gonorrhea, appear somewhat lower than in 

reports released for data prior to 2010. 

The collection of information on race/ethnicity has been 

standardized since 1997 in the United States from the 

Office of Management and Budget (OMB). Following a 

revision in the National Electronic Telecommunication 

System for Surveillance (NETSS) implementation guide in 

April 2008, jurisdictions reporting STD data were to collect 

race according to the OMB standard categories: American 

Indian or Alaska Native, Asian, black or African American, 

Hispanic or Latino, Native Hawaiian/Other Pacific Islander, 

white and multirace. While 48 jurisdictions (47 states and 

the District of Columbia) collect and report data for at 

least one STD in formats compliant with these standards 

as of 2013, some jurisdictions only recently adopted this 

standard and used previous standards to report their case 

data to CDC in past years. In 2013, one jurisdiction 

reported data for syphilis cases in compliance with OMB 

standards but reported chlamydia and gonorrhea using an 

outdated standard. Consequently, historical trend and rate 

data by race/ethnicity displayed in figures and interpreted in 

this report for 2009–2013 include only those jurisdictions 

reporting in the current standard consistently for 2009 

through 2013 .

Sexually Transmitted Disease Surveillance 2013 consists 

of four sections: the National Profile, the Special Focus 

Profiles, the Tables, and the Appendix. The National Profile 

section contains figures that provide an overview of STD 

morbidity in the United States. The accompanying text 

identifies major findings and trends for selected STDs. 

The Special Focus Profiles section contains figures and 

text that describe STDs in selected populations that are a 

focus of national and state prevention efforts. The Tables 

section provides statistical information about STDs at 

county, metropolitan statistical area, regional, state, and 

national levels. The Appendix includes information on how 

to interpret the STD surveillance data used to produce 

this report, as well as information about Healthy People 

2020 STD objectives and progress toward meeting these 

objectives, Government Performance and Results Act 

goals and progress toward meeting these goals, and STD 

surveillance case definitions.

Any comments and suggestions that would improve future 

publications are appreciated and should be sent to

Director, Division of STD Prevention 

National Center for HIV/AIDS, Viral Hepatitis, STD, and 

TB Prevention 

Centers for Disease Control and Prevention 

1600 Clifton Road, Mailstop E-02 

Atlanta, Georgia 30333
STD Surveillance 2013 vii

Guide to Acronyms

CDC Centers for Disease Control and Prevention

CSF cerebrospinal fluid

DSTDP Division of STD Prevention

GISP Gonococcal Isolate Surveillance Project 

HEDIS Healthcare Effectiveness Data and Information Set

HHS U.S. Department of Health and Human Services

HMOs health maintenance organizations

HIV human immunodeficiency virus

HP2020 Healthy People 2020 

HPV human papillomavirus

HSV herpes simplex virus

MICs minimum inhibitory concentrations

MPC mucopurulent cervicitis 

MSA metropolitan statistical area

MSM men who have sex with men

MSW men who have sex with women only

NAATs nucleic acid amplification tests

NDTI National Disease and Therapeutic Index

NGU nongonococcal urethritis

NHANES National Health and Nutrition Examination Survey

NJTP National Job Training Program

OMB Office of Management and Budget

P&S primary and secondary

PID pelvic inflammatory disease

QRNG quinolone-resistant Neisseria gonorrhoeae

RPR rapid plasma reagin

SSuN STD Surveillance Network 

STD sexually transmitted disease

VDRL Venereal Disease Research Laboratory
viii STD Surveillance 2013
STD Surveillance 2013 ix

Contents

Acknowledgements ......................................................................................................................................... ii

Foreword .........................................................................................................................................................v

Preface ............................................................................................................................................................vi

Guide to Acronyms .......................................................................................................................................vii

Figures in the National Profile .........................................................................................................................x

Figures in the Special Focus Profiles ..............................................................................................................xiii

Tables in the National Profile ........................................................................................................................ xv

Census Regions of the United States ............................................................................................................. xix

National Overview of Sexually Transmitted Diseases (STDs), 2013 .................................................................1

National Profile .................................................................................................................... 3

Chlamydia ...............................................................................................................................................4

Gonorrhea .............................................................................................................................................13

Syphilis ..................................................................................................................................................28

Other Sexually Transmitted Diseases ......................................................................................................40

Special Focus Profiles ........................................................................................................ 49

STDs in Women and Infants .................................................................................................................50

STDs in Adolescents and Young Adults .................................................................................................58

STDs in Racial and Ethnic Minorities ...................................................................................................63

STDs in Men Who Have Sex with Men ................................................................................................71

Tables

National Summary ................................................................................................................................77

Chlamydia .............................................................................................................................................79

Gonorrhea .............................................................................................................................................91

Syphilis ................................................................................................................................................103

Chancroid ...........................................................................................................................................125

Selected STDs .....................................................................................................................................126

Appendix

Interpreting STD Surveillance Data.....................................................................................................127

Table A1. Selected STDs—Percentage of Unknown, Missing, or Invalid Values for 

Selected Variables by State and by Nationally Notifiable STD, 2013 .............................. 134

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2013 .................. 135

Table A3. Healthy People 2020 (HP2020) Sexually Transmitted Diseases Objectives ....................... 136

Table A4. Government Performance and Results Act (GPRA) Sexually Transmitted 

Disease Goals, Measures, and Target ............................................................................... 137

STD Surveillance Case Definitions ......................................................................................................138

Contributors ........................................................................................................................................148
x STD Surveillance 2013

Figures in the National Profile

Chlamydia

Figure 1. Chlamydia — Rates of Reported Cases by Sex, United States, 1993–2013 ......................... 8

Figure 2. Chlamydia — Rates of Reported Cases by Region, United States, 2004–2013 ................... 8

Figure 3. Chlamydia — Rates of Reported Cases by State, United States and Outlying 

Areas 2013 ......................................................................................................................... 9

Figure 4. Chlamydia — Rates of Reported Cases by County, United States, 2013 ............................ 9

Figure 5. Chlamydia — Rates of Reported Cases by Age and Sex, United States, 2013 ................... 10

Figure 6. Chlamydia — Rates of Reported Cases by Race/Ethnicity, United States, 2009–2013 ..... 10

Figure 7. Chlamydia — Reported Cases by Reporting Source and Sex, United States, 

2004–2013....................................................................................................................... 11

Figure 8. Chlamydia — Percentage of Reported Cases by Sex and Reporting 

Source, United States, 2013.............................................................................................. 11

Figure 9. Chlamydia — Proportion of STD Clinic Patients Testing Positive by Age, Sex, 

and Sexual Behavior, STD Surveillance Network (SSuN), 2013 ....................................... 12

Figure 10. Chlamydia — Prevalence Among Persons Aged14–39 Years by Sex, Race/Ethnicity, 

or Age Group, National Health and Nutrition Examination Survey, 2005–2008 .............. 12

Gonorrhea

Figure 11. Gonorrhea — Rates of Reported Cases by Year, United States, 1941–2013 ...................... 18

Figure 12. Gonorrhea — Rates of Reported Cases by Sex, United States, 1993–2013 ....................... 18

Figure 13. Gonorrhea — Rates of Reported Cases by Region, United States, 2004–2013 ................. 19

Figure 14. Gonorrhea — Rates of Reported Cases by State, United States and 

Outlying Areas, 2013 ....................................................................................................... 19

Figure 15. Gonorrhea — Rates of Reported Cases by County, United States, 2013........................... 20

Figure 16. Gonorrhea — Rates of Reported Cases by Age and Sex, United States, 2013 ................... 20

Figure 17. Gonorrhea — Rates of Reported Cases Among Women Aged 15–44 

Years by Age, United States, 2004–2013 ........................................................................... 21

Figure 18. Gonorrhea — Rates of Reported Cases Among Men Aged 15–44 Years 

by Age, United States, 2004–2013 ................................................................................... 21

Figure 19. Gonorrhea — Rates of Reported Cases by Race/Ethnicity, United States, 2009–2013 ..... 22

Figure 20. Gonorrhea — Reported Cases by Reporting Source and Sex, United States, 

2004–2013....................................................................................................................... 22

Figure 21. Gonorrhea — Percentage of Reported Cases by Sex and Reporting 

Source, United States, 2013.............................................................................................. 23

Figure 22. Estimated Proportion of MSM, MSW, and Women Among Gonorrhea 

Cases by Site, STD Surveillance Network (SSuN), 2013 .................................................. 23

Figure 23. Gonorrhea — Proportion of STD Clinic Patients Testing Positive by Age, Sex, 

and Sexual Behavior, STD Surveillance Network (SSuN), 2013 ....................................... 24

Figure 24. Location of Participating Sentinel Sites and Regional Laboratories, 

Gonoccoccal Isolate Surveillance Project (GISP), United States, 2013 .............................. 24

Figure 25. Neisseria gonorrhoeae — Percentage of Isolates with Elevated Ceftriaxone 

Minimum Inhibitory Concentrations (MICs) (≥0.125 μg/ml), Gonococcal Isolate 

Surveillance Project (GISP), 2006–2013 .......................................................................... 25
STD Surveillance 2013 xi

Figure 26. Neisseria gonorrhoeae — Percentage of Isolates with Elevated Cefixime 

Minimum Inhibitory Concentrations (MICs) (≥0.25 μg/ml), Gonococcal Isolate 

Surveillance Project (GISP), 2006–2013 .......................................................................... 25

Figure 27. Neisseria gonorrhoeae — Distribution of Azithromycin Minimum Inhibitory 

Concentrations (MICs), Gonococcal Isolate Surveillance Project (GISP), 

2009–2013....................................................................................................................... 26

Figure 28. Neisseria gonorrhoeae — Percentage of Isolates with Penicillin, Tetracycline, 

and/or Ciprofloxacin Resistance, Gonococcal Isolate Surveillance Project 

(GISP), 2013 ................................................................................................................... 26

Figure 29. Primary Antimicrobial Drugs Used to Treat Gonorrhea Among Participants, 

Gonococcal Isolate Surveillance Project (GISP), 1988–2013 ............................................ 27

Syphilis

Figure 30. Syphilis — Reported Cases by Stage of Infection, United States, 1941–2013 ................... 32

Figure 31. Primary and Secondary Syphilis — Reported Cases by Sex and Sexual 

Behavior, 33 areas, 2007–2013 ......................................................................................... 32

Figure 32. Primary and Secondary Syphilis — Rates of Reported Cases by Sex and 

Male-to-Female Rate Ratios, United States, 1990–2013 ................................................... 33

Figure 33. Primary and Secondary Syphilis — Rates of Reported Cases by Region, 

United States, 2004–2013 ................................................................................................ 33

Figure 34. Primary and Secondary Syphilis — Rates of Reported Cases by State, 

 United States and Outlying Areas, 2013 .......................................................................... 34

Figure 35. Primary and Secondary Syphilis — Rates of Reported Cases by County, 

United States, 2013 .......................................................................................................... 34

Figure 36. Primary and Secondary Syphilis — Rates of Reported Cases by Age 

 and Sex, United States, 2013 ........................................................................................... 35

Figure 37. Primary and Secondary Syphilis — Rates of Reported Cases Among 

Women Aged 15–44 Years, by Age, United States, 2004–2013 ........................................ 35

Figure 38. Primary and Secondary Syphilis — Rates of Reported Cases Among 

Men Aged 15–44 Years, by Age, United States, 2004–2013 ............................................. 36

Figure 39. Primary and Secondary Syphilis — Rates of Reported Cases by 

Race/Ethnicity, United States, 2009–2013 ....................................................................... 36

Figure 40. Primary and Secondary Syphilis — Reported Cases by Stage, Sex, 

and Sexual Behavior, 2013 ............................................................................................... 37

Figure 41. Primary and Secondary Syphilis — Reported Cases by Sex, Sexual 

Behavior, and Race/Ethnicity, United States, 2013 ........................................................... 37

Figure 42. Primary and Secondary Syphilis — Reported Cases by Sex, Sexual 

Behavior, and HIV Status (Positive or Negative), 31 areas, 2013 ...................................... 38

Figure 43. Primary and Secondary Syphilis — Reported Cases by Reporting Source 

and Sex, United States, 2004–2013 .................................................................................. 38

Figure 44. Primary and Secondary Syphilis — Percentage of Reported Cases by Sex, 

Sexual Behavior, and Selected Reporting Sources, 2013 .................................................... 39

Figure 45. Congenital Syphilis — Reported Cases Among Infants by Year of Birth and Rates 

of Primary and Secondary Syphilis Among Women, United States, 2004–2013 ............... 39
xii STD Surveillance 2013

Other Sexually Transmitted Diseases

Figure 46. Chancroid — Reported Cases by Year, United States, 1981–2013 .................................... 43

Figure 47. Human Papillomavirus — Cervicovaginal Prevalence of High-risk and 

Low-risk Types Among Women Aged 14–59 Years by Age Group, 

National Health and Nutrition Examination Survey, 2003–2006 ..................................... 43

Figure 48. Human Papillomavirus — Cervicovaginal Prevalence of Types 6, 11, 16, and 18 

Among Women Aged 14–59 Years by Age Group and Time Period, National Health 

and Nutrition Examination Survey, 2003–2006 and 2007–2010 ..................................... 44

Figure 49. Genital Warts — Initial Visits to Physicians’ Offices, United States, 1966–2013 .............. 44

Figure 50. Genital Warts — Prevalence per 1000 Person-Years Among Participants In Private 

Health Plans Aged 10–39 Years by Sex, Age Group, and Year, 2003–2010 ....................... 45

Figure 51. Genital Warts — Prevalence Among STD Clinic Patients by Sex, 

Sex of Partners, and Year, STD Surveillance Network (SSuN), 2010–2013 ...................... 45

Figure 52. Genital Warts — Prevalence Among STD Clinic Patients by Sex, Sex 

of Partners, and Site, STD Surveillance Network (SSuN), 2013 ....................................... 46

Figure 53. Genital Herpes — Initial Visits to Physicians’ Offices, United States, 

1966–2013....................................................................................................................... 46

Figure 54. Herpes Simplex Virus Type 2 — Seroprevalence Among Non-Hispanic Whites 

and Non-Hispanic Blacks by Sex and Age Group, National Health and Nutrition 

Examination Surveys, 1988–1994, 1999–2002, 2003–2006, and 2007–2010 ................. 47

Figure 55. Trichomoniasis and Other Vaginal Infections Among Women — Initial 

Visits to Physicians’ Offices, United States, 1966–2013 .................................................... 47
STD Surveillance 2013 xiii

Figures in the Special Focus Profiles

STDs in Women and Infants

Figure A. Chlamydia — Rates of Reported Cases Among Women by State, United 

States and Outlying Areas, 2013 ....................................................................................... 54

Figure B. Gonorrhea — Rates of Reported Cases Among Women by State, United 

States and Outlying Areas, 2013 ....................................................................................... 54

Figure C. Primary and Secondary Syphilis — Rates of Reported Cases Among 

Women by State, United States and Outlying Areas, 2013 ............................................... 55

Figure D. Congenital Syphilis — Rates of Reported Cases Among Infants by Year 

of Birth and State, United States and Outlying Areas, 2013 ............................................. 55

Figure E. Pelvic Inflammatory Disease — Trends in lifetime prevalence of treatment 

Among Sexually Experienced Women Aged 15-44 Years by Race/Ethnicity, 

National Family Growth Survey, 1995, 2002, 2006–2010 ............................................... 56

Figure F. Pelvic Inflammatory Disease — Initial Visits to Physicians’ Offices 

Among Women Aged15–44 Years, United States, 2004–2013 .......................................... 56

Figure G. Ectopic Pregnancy — Rates Among Commercially Insured Pregnant 

Women Aged15–44 Years by Age, 2002–2012 ................................................................. 57

STDs in Adolescents and Young Adults

Figure H. Chlamydia — Rates of Reported Cases Among Women 15–24 Years 

of Age By State, United States and Outlying Areas, 2013 ................................................. 60

Figure I. Gonorrhea — Rates of Reported Cases Among Women 15–24 Years 

of Age By State, United States and Outlying Areas, 2013 ................................................. 60

Figure J. Chlamydia — Prevalence Among Women Aged 16–24 Years Entering 

the National Job Training Program by State of Residence, United States 

and Outlying Areas, 2013 ................................................................................................ 61

Figure K. Chlamydia — Prevalence Among Men Aged 16–24 Years Entering 

the National Job Training Program by State of Residence, United States 

and Outlying Areas, 2013 ................................................................................................ 61

Figure L. Gonorrhea — Prevalence Among Women Aged 16–24 Years Entering 

the National Job Training Program by State of Residence, United States 

and Outlying Areas, 2013 ................................................................................................ 62

Figure M. Gonorrhea — Prevalence Among Men Aged 16–24 Years Entering 

the National Job Training Program by State of Residence, United States 

and Outlying Areas, 2013 ................................................................................................ 62

STDs in Racial and Ethnic Minorities

Figure N. Chlamydia — Rates of Reported Cases by Race/Ethnicity and Sex, 

United States, 2013 .......................................................................................................... 67

Figure O. Gonorrhea —Rate Ratios by Race/Ethnicity, United States, 2009–2013 .......................... 67

Figure P. Gonorrhea — Rates of Reported Cases by Race/Ethnicity and Sex, 

United States, 2013 .......................................................................................................... 68

Figure Q. Gonorrhea — Rate Ratios by Race/Ethnicity and Region, United States, 2013 ................ 68

Figure R. Primary and Secondary Syphilis — Rates of Reported Cases by Race/ 

Ethnicity and Sex, United States, 2013 ............................................................................. 69

Figure S. Primary and Secondary — Rates of Reported Cases Syphilis Among 

Females Aged 15–19 Years, by Race/Ethnicity, United States, 2009–2013 ........................ 69
xiv STD Surveillance 2013

Figure T. Primary and Secondary Syphilis — Rates of Reported Cases Among 

Males Aged 15–19 Years, by Race/Ethnicity, United States, 2009–2013 ........................... 70

Figure U. Congenital Syphilis — Rates of Reported Cases Among Infants, by Year 

of Birth and Mother’s Race/Ethnicity, United States, 2004–2013 ..................................... 70

STDs in Men Who Have Sex with Men

Figure V. Gonorrhea and Chlamydia — Proportion of MSM Attending STD Clinics Testing 

Positive for Gonorrhea and Chlamydia, STD Surveillance Network (SSuN), 2013 .......... 73

Figure W. Primary and Secondary Syphilis and HIV — Proportion of MSM Attending STD 

Clinics with Primary and Secondary Syphilis Who Are Co-infected with HIV, STD 

Surveillance Network (SSuN), 2013 ................................................................................. 73

Figure X. Proportion of MSM Attending STD Clinics with Primary and Secondary 

Syphilis, Gonorrhea or Chlamydia by HIV Status, STD Surveillance Network 

(SSuN), 2013 ................................................................................................................... 74

Figure Y. Neisseria gonorrhoeae — Percentage of Urethral Isolates Obtained from 

MSM Attending STD Clinics, Gonococcal Isolate Surveillance 

(GISP), 1990–2013 ......................................................................................................... 74

Figure Z. Neisseria gonorrhoeae — Percentage of Urethral Isolates with Elevated 

Ceftriaxone Minimum Inhibitory Concentrations (MICs) (≥0.125 μg/ml) by 

Reported Sex of Sex Partner, Gonococcal Isolate Surveillance Project (GISP), 

2006–2013....................................................................................................................... 75
STD Surveillance 2013 xv

Tables in the National Profile

National Summary

Table 1. Sexually Transmitted Diseases — Reported Cases and Rates of Reported 

Cases per 100,000 Population, United States, 1941–2013 ............................................... 77

Chlamydia

Table 2. Chlamydia — Reported Cases and Rates of Reported Cases by State, Ranked 

by Rates, United States, 2013 ........................................................................................... 79

Table 3. Chlamydia — Reported Cases and Rates of Reported Cases by State by State/ 

Area and Region in Alphabetical Order, United States and Outlying Areas, 

2009–2013....................................................................................................................... 80

Table 4. Chlamydia Among Women — Reported Cases and Rates of Reported Cases 

by State/Area and Region in Alphabetical Order, United States and Outlying Areas, 

2009–2013....................................................................................................................... 81

Table 5. Chlamydia Among Men—Reported Cases and Rates of Reported Cases by 

State/Area and Region in Alphabetical Order, United States and Outlying 

Areas, 2009–2013 ............................................................................................................ 82

Table 6. Chlamydia—Reported Cases and Rates in Selected Metropolitan Statistical Areas 

(MSAs) in Alphabetical Order, United States, 2009–2013 ............................................... 83

Table 7. Chlamydia Among Women — Reported Cases and Rates of Reported Cases 

in Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2009–2013 ................................................................................................ 84

Table 8. Chlamydia Among Men — Reported Cases and Rates of Reported 

in Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2009–2013 ................................................................................................ 85

Table 9. Chlamydia — Reported Cases and Rates of Reported Cases in Counties and 

Independent Cities Ranked by Number of Reported Cases, United States, 2013 .............. 86

Table 10. Chlamydia — Reported Cases and Rates of Reported Cases by Age Group 

and Sex, United States, 2009–2013 .................................................................................. 87

Table 11A. Chlamydia — Reported Cases by Race/Ethnicity, Age Group, and Sex, 

United States, 2013 .......................................................................................................... 88

Table 11B. Chlamydia — Rates of Reported Cases per 100,000 Population by Race/ 

Ethnicity, Age Group, and Sex, United States, 2013 ......................................................... 89

Table 12. Chlamydia Among Women 15–25 Years of Age — Reported Cases and Rates 

of Reported Cases by Age, United States, 2009–2013 ...................................................... 90

Gonorrhea

Table 13. Gonorrhea — Reported Cases and Rates of Reported Cases by State, 

Ranked by Rates, United States, 2013 .............................................................................. 91

Table 14. Gonorrhea — Reported Cases and Rates of Reported Cases by State/Area 

and Region in Alphabetical Order, United States and Outlying Areas, 2009–2013 ........... 92

Table 15. Gonorrhea Among Women — Reported Cases and Rates of Reported Cases 

by State/Area and Region in Alphabetical Order, United States and Outlying 

Areas, 2009–2013 ............................................................................................................ 93

Table 16. Gonorrhea Among Men — Reported Cases and Rates of Reported Cases State/Area 

and Region in Alphabetical Order, United States and Outlying Areas, 2009–2013 ........... 94

Table 17. Gonorrhea — Reported Cases and Rates of Reported Cases in Selected Metropolitan 

Statistical Areas (MSAs) in Alphabetical Order, United States, 2009–2013 ...................... 95
xvi STD Surveillance 2013

Table 18. Gonorrhea Among Women — Reported Cases and Rates of Reported Cases 

in Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2009–2013 ................................................................................................ 96

Table 19. Gonorrhea Among Men — Reported Cases and Rates of Reported Cases in 

Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, United 

States, 2009–2013 ............................................................................................................ 97

Table 20. Gonorrhea — Reported Cases and Rates of Reported Cases in Counties and 

Independent Cities, Ranked by Number of Reported Cases, United States, 2013 ............. 98

Table 21. Gonorrhea — Reported Cases and Rates of Reported Cases by Age Group 

and Sex, United States, 2009–2013 .................................................................................. 99

Table 22A. Gonorrhea — Reported Cases by Race/Ethnicity, Age Group, and Sex, 

United States, 2013 ........................................................................................................ 100

Table 22B. Gonorrhea — Rates of Reported Cases per 100,000 Population by Race/ 

 Ethnicity, Age Group, and Sex, United States, 2013 ...................................................... 101

Table 23. Gonorrhea Among Women 15–25 Years of Age — Reported Cases and Rates 

of Reported Cases by Age, United States, 2009–2013 .................................................... 102

Syphilis

Table 24. All Stages of Syphilis — Reported Cases and Rates of Reported Cases by 

State/Area and Region in Alphabetical Order, United States and Outlying Areas, 

2009–2013..................................................................................................................... 103

Table 25. All Stages of Syphilis — Reported Cases and Rates of Reported Cases 

in Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2009–2013 .............................................................................................. 104

Table 26. Primary and Secondary Syphilis — Reported Cases and Rates of Reported 

Cases by State, Ranked by Rates, United States, 2013 .................................................... 105

Table 27. Primary and Secondary Syphilis — Reported Cases and Rates of Reported 

Cases by State/Area and Region in Alphabetical Order, United States and 

Outlying Areas, 2009–2013 ........................................................................................... 106

Table 28. Primary and Secondary Syphilis Among Women — Reported Cases and Rates 

of Reported Cases by State/Area and Region in Alphabetical Order, United 

States and Outlying Areas, 2009–2013 ........................................................................... 107

Table 29. Primary and Secondary Syphilis Among Men — Reported Cases and Rates of 

Reported Cases by State/Area and Region in Alphabetical Order, United States 

and Outlying Areas, 2009–2013 .................................................................................... 108

Table 30. Primary and Secondary Syphilis — Reported Cases and Rates of Reported 

Cases in Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2009–2013 .............................................................................................. 109

Table 31. Primary and Secondary Syphilis Among Women — Reported Cases and 

Rates of Reported Cases in Selected Metropolitan Statistical Areas (MSAs) in 

Alphabetical Order, United States, 2009–2013 ............................................................... 110

Table 32. Primary and Secondary Syphilis Among Men — Reported Cases and Rates 

of Reported Cases in Selected Metropolitan Statistical Areas (MSAs) in 

Order, United States, 2009–2013 ................................................................................... 111

Table 33. Primary and Secondary Syphilis — Reported Cases and Rates of Reported 

Cases in Counties and Independent Cities Ranked by Number of Reported 

Cases, United States, 2013 ............................................................................................. 112
STD Surveillance 2013 xvii

Table 34. Primary and Secondary Syphilis — Reported Cases and Rates of Reported 

Cases Among Men and Women per 100,000 population, and Male-To-Female 

Rate Ratios in the Counties and Independent Cities Ranked in the Top 30 for 

Cases in 2013, United States, 2012–2013 ...................................................................... 113

Table 35. Primary and Secondary Syphilis — Reported Cases and Rates of Reported 

Cases by Age Group and Sex, United States, 2009–2013 ................................................ 114

Table 36A. Primary and Secondary Syphilis — Reported Cases by Race/Ethnicity, Age 

Group, and Sex, United States, 2013 .............................................................................. 116

Table 36B. Primary and Secondary Syphilis — Rates of Reported Cases per 100,000 

Population by Race/Ethnicity, Age Group, and Sex, United States, 2013 ........................ 117

Table 37. Early Latent Syphilis — Reported Cases and Rates of Reported Cases by 

State/Area and Region in Alphabetical Order, United States and Outlying Areas, 

2009–2013..................................................................................................................... 118

Table 38. Early Latent Syphilis — Reported Cases and Rates of Reported Cases 

in Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2009–2013 .............................................................................................. 119

Table 39. Late and Late Latent Syphilis — Reported Cases and Rates of 

Cases by State/Area and Region in Alphabetical Order, United States and 

Outlying Areas, 2009–2013 ........................................................................................... 120

Table 40. Late and Late Latent Syphilis — Reported Cases and Rates of Reported Cases 

Selected Metropolitan Areas (MSAs) in Alphabetical Order, United States, 

2009–2013..................................................................................................................... 121

Table 41. Congenital Syphilis — Reported Cases and Rates of Reported Cases in Infants 

by State, Ranked by Rates, United States, 2013 .............................................................. 122

Table 42. Congenital Syphilis — Reported Cases and Rates of Reported Cases in Infants 

by Year of Birth, by State/Area and Region in Alphabetical Order, United States, 

2009–2013..................................................................................................................... 123

Table 43. Congenital Syphilis — Reported Cases and Rates of Reported Cases per 

100,000 Live Births in Infants by Year of Birth and Race/Ethnicity of Mother, 

United States, 2009–2013 .............................................................................................. 124

Chancroid

Table 44. Chancroid — Reported Cases and Rates of Reported Cases by State/Area 

in Alphabetical Order, United States and Outlying Areas, 2009–2013 ........................... 125

Selected STDs

Table 45. Selected STDs and Complications — Initial Visits to Physicians’ Offices, 

National Disease and Therapeutic Index, United States, 1966–2013 .............................. 126

Interpreting STD Surveillance Data

Table A1. Selected STDs—Percentage of Unknown, Missing, or Invalid Values for 

Selected Variables by State and by Nationally Notifiable STD, 2013 .............................. 134

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2013 .................. 135

Table A3. Healthy People 2020 (HP2020) Sexually Transmitted Diseases Objectives ....................... 136

Table A4. Government Performance and Results Act (GPRA) Sexually Transmitted 

Diseases Goals, Measures, and Target ............................................................................. 137
xviii STD Surveillance 2013
STD Surveillance 2013 xix

Census Regions of the United States

West Midwest Northeast

South

West Midwest South Northeast

Alaska Illinois Alabama Connecticut

Arizona Indiana Arkansas Maine

California Iowa Delaware Massachusetts

Colorado Kansas District of Columbia New Hampshire

Hawaii Michigan Florida New Jersey

Idaho Minnesota Georgia New York

Montana Missouri Kentucky Pennsylvania

Nevada Nebraska Louisiana Rhode Island

New Mexico North Dakota Maryland Vermont

Oregon Ohio Mississippi

Utah South Dakota North Carolina

Washington Wisconsin Oklahoma

Wyoming South Carolina

Tennessee

Texas

Virginia

West Virginia
xx STD Surveillance 2013
STD Surveillance 2013 Overview 1

National Overview of Sexually 

Transmitted Diseases (STDs), 2013

All Americans should have the opportunity to make choices 

that lead to health and wellness. An approach to improve 

health equity can address what the health providers can 

do with other partners working together.1

 Interested 

committed public and private organizations, communities, 

and individuals can take action to prevent sexually 

transmitted diseases (STDs) and their related health 

burdens. In addition to federal, state, and local public 

support for STD prevention, local community leaders can 

promote STD prevention education. Health providers 

can assess their patients’ risks and talk to them about 

testing. Parents can better educate their children about 

STDs and sexual health. Individuals can use condoms 

consistently and correctly, and openly discuss ways to 

protect their health with partners and providers. As noted 

in the Institute of Medicine report, The Hidden Epidemic: 

Confronting Sexually Transmitted Diseases, surveillance is 

a key component of all our efforts to prevent and control 

these diseases.2

This overview summarizes national surveillance data for 

2013 on the three notifiable diseases for which there are 

federally funded control programs: chlamydia, gonorrhea, 

and syphilis. The data presented here by race and ethnicity 

are categorized according to the Office of Management 

and Budget standards. However, data for all jurisdictions 

by race/ethnicity using these categories are not available; 

consequently, absolute rates by race/ethnicity and 

comparisons among racial/ethnic groups may not match 

those provided in previous reports. 

Chlamydia

In 2013, a total of 1,401,906 cases of Chlamydia 

trachomatis infection were reported to the CDC (Table 1). 

This case count corresponds to a rate of 446.6 cases per 

100,000 population, a decrease of 1.5% compared with 

the rate in 2012. This is the first time since nationwide 

reporting for chlamydia began that the overall rate of 

reported cases of chlamydia has decreased. The rate in 

women decreased 2.4% while rate in men increased 0.8%. 

In 2013, the overall rate of chlamydial infection in the 

United States among women (623.1 cases per 100,000 

females) was over two times the rate among men (262.6 

cases per 100,000 males), reflecting the larger number 

of women screened for this infection (Tables 4 and 5). 

However, with the increased availability of urine testing, 

men are increasingly being tested for chlamydial infection. 

During 2009–2013, the chlamydia rate in men increased 

21%, compared with an 6.2% increase in women during 

this period. Rates also varied among different racial and 

ethnic minority populations. For example, in 2013, the 

chlamydia rate in blacks was 6.4 times the rate in whites 

and the rate among American Indians/Alaska Natives was 

almost 4 times that rate among whites.

Gonorrhea

Following a 74% decline in the rate of reported gonorrhea 

during 1975–1997, overall gonorrhea rates plateaued for 10 

years. After the decline halted for several years, gonorrhea 

rates decreased further to 98.1 cases per 100,000 population 

in 2009, the lowest rate since recording of gonorrhea 

rates began. Between 2009 and 2012, the gonorrhea rate 

increased slightly each year to 106.7 cases per 100,000 

population in 2012. In 2013, there were 333,004 cases 

of gonorrhea reported and the national gonorrhea rate 

decreased slightly to 106.1 cases per 100,000 population. In 

2013, rates decreased among all persons aged 15–19 years 

and in women 20–24 years; rates increased in other age 

groups. 

In 2013, for the first time since 2000, the rate of reported 

gonorrhea cases among men was higher than the rate 

among women. During 2012–2013, the gonorrhea rate 

among men increased 4.3% and the rate among women 

decreased 5.1%. The increase among men compared 

with a decrease among women suggests either increased 

transmission or increased case ascertainment (e.g., through 

increased extra-genital screening) among gay, bisexual and 

other men who have sex with men. 

In 2013, the gonorrhea rate in blacks was 12.4 times 

the rate in whites (Table 22B); while rates among blacks 

have been declining, even greater increases in whites have 

contributed to lessening of the apparent disparities in 

rates between blacks and whites. As with chlamydia, data 

on gonorrhea prevalence in defined populations were 

available from several sources in 2013. These data showed a 

continuing high burden of disease in some adolescents and 

young adults in parts of the United States.
2 Overview STD Surveillance 2013

In 2013, 1,708 more cases were reported than in 2012. 

This increase was almost solely among men (Figure 31). 

In 2013, men accounted for 91% of all P&S cases; in 

the 49 states and the District of Columbia that provided 

information about sex of sex partners of patients with 

syphilis, MSM accounted for 75% of all P&S cases. In 

areas where information for both sex of partner and HIV 

status was relatively complete (70% or greater for all cases), 

52% of MSM with P&S syphilis were also co-infected with 

HIV; co-infection in MSW and women was 9.9% and 

5.2%, respectively (Figure 42). 

Rates in women remained unchanged between 2011 and 

2013. In 2013, 1,500 cases of P&S syphilis were reported 

in women. The 2013 rate of congenital syphilis (8.7 

cases per 100,000 live births) marks the first increase in 

congenital syphilis since 2008 and was largely driven by 

increases in the West, coinciding with increases in P&S 

syphilis among women in the West. There were 348 cases 

of congenital syphilis reported in 2013.

Significant racial and ethnic disparities in STD rates 

persist. In 2013, the P&S syphilis rate among blacks 

was almost six times the rate among whites (Figure 39). 

In some subgroups, however, these disparities are much 

higher. The 2013 rate among blacks aged 15–19 years 

was approximately 13 times the rate for whites in that age 

group (Table 36B). While rates in congenital syphilis have 

decreased in recent years, the rates are still 10 times higher 

in blacks than in whites and almost 3.5 times higher in 

Hispanics than in whites (Table 43). 

1 Sadana R, Blas E. What can public programs do to improve health 

equity? Public Health Reports. 2013;Vol 128:12-20.

2 Eng TR, Butler WT, editors; Institute of Medicine (US). The 

hidden epidemic: confronting sexually transmitted diseases. 

Washington (DC): National Academy Press; 1997. p 43. 

3 Centers for Disease Control and Prevention. CDC’s sexually 

transmitted diseases treatment guidelines, 2014. MMWR Morb 

Mortal Wkly Rep. 2014 (in press). 

4 Centers for Disease Control and Prevention. The national plan 

to eliminate syphilis from the United States. Atlanta: U.S. 

Department of Health and Human Services; 2006. 

Antimicrobial resistance remains an important 

consideration in the treatment of gonorrhea. With 

increased resistance to the fluoroquinolones and declining 

susceptibility to cefixime, dual therapy with ceftriaxone 

and azithromycin is now the only CDC recommended 

treatment for gonorrhea.3

 In 2013, decreases in minimum 

inhibitory concentrations (MICs) of cephalosporins 

(cefixime and ceftriaxone) were observed. Continued 

monitoring of susceptibility patterns to these antibiotics is 

critical. (Figures 25 and 26). 

Syphilis

The rate of primary and secondary (P&S) syphilis reported 

in the United States decreased during the 1990s, and in 

2000, it was the lowest since reporting began in 1941. The 

low rate of syphilis and the concentration of most syphilis 

cases in a small number of geographic areas led to the 

development of the National Plan to Eliminate Syphilis from 

the United States, which was announced by the Surgeon 

General in 1999 and updated in 2006.4

 The overall rate of 

P&S syphilis in the United States declined 89.7% during 

1990–2000, then increased each year from 2001 through 

2009. In 2010, the overall rate decreased for the first time 

in 10 years. While the rate remained unchanged in 2011, 

the rate increased 22% during 2011–2013. 
NATIONAL PROFILE
NATIONAL PROFILE
STD Surveillance 2013 National Profile 3

National Profile

The National Profile section contains figures that show trends and the distribution of nationally reportable STDs 

(chlamydia, gonorrhea, syphilis, and chancroid) by age, sex, race/ethnicity, and location for the United States.
4 National Profile: Chlamydia STD Surveillance 2013

Chlamydia

Background

C. trachomatis infection is the most commonly reported 

notifiable disease in the United States. It is among the most 

prevalent of all STDs, and since 1994, has comprised the 

largest proportion of all STDs reported to CDC (Table 1). 

Studies also demonstrate the high prevalence of chlamydial 

infections in the general U.S. population, particularly 

among young women.1,2

Chlamydial infections in women are usually asymptomatic. 

However, untreated infection can result in pelvic 

inflammatory disease (PID), which is a major cause of 

infertility, ectopic pregnancy, and chronic pelvic pain. Data 

from randomized controlled trials of chlamydia screening 

suggested that screening programs can lead to a reduction in 

the incidence of PID.3,4 As with other inflammatory STDs, 

chlamydial infection might facilitate the transmission 

of human immunodeficiency virus (HIV) infection.5

 In 

addition, pregnant women infected with chlamydia can pass 

the infection to their infants during delivery, potentially 

resulting in neonatal ophthalmia and pneumonia. Because 

of the large burden of disease and risks associated with 

infection, CDC recommends that all sexually active women 

younger than age 26 years receive annual chlamydia 

screening.6

The Healthcare Effectiveness Data and Information Set 

(HEDIS) contains a measure which assesses chlamydia 

screening coverage of sexually active young women who 

receive medical care through commercial or Medicaid 

managed care organizations.Among sexually-active 

women aged 16–24 years in commercial plans, chlamydia 

screening increased from 23.1% in 2001 to 45.1% in 

2012. During the same time period, the screening rate 

among sexually-active women aged 16–24 years covered 

by Medicaid increased from 40.4% to 57.1%.7

 Although 

chlamydia screening is expanding, many women who are at 

risk are still not being tested—reflecting, in part, the lack 

of awareness among some health care providers and the 

limited resources available to support these screenings.

Interpreting Rates of Reported Cases of 

Chlamydia

Trends in rates of reported cases of chlamydia are 

influenced by changes in incidence of infection, as well as 

changes in diagnostic, screening, and reporting practices. 

As chlamydial infections are usually asymptomatic, the 

number of infections identified and reported can increase 

as more people are screened even when incidence is flat or 

decreasing. Expanded use of more sensitive diagnostics tests 

(e.g., nucleic acid amplification tests) can also increase the 

number of infections identified and reported independent 

of increases in incidence. Although chlamydia has been 

a nationally notifiable condition since 1994, it was not 

until 2000 that all 50 states and the District of Columbia 

required reporting of chlamydia cases. National case rates 

prior to 2000 reflect incomplete reporting. Additionally, 

increasing use of electronic laboratory reporting has 

likely increased the proportion of diagnosed cases that are 

reported. Consequently, an increasing chlamydia case rate 

may reflect increases in incidence of infection, screening 

coverage, and use of more sensitive tests, as well as more 

complete reporting. Likewise, decreases in chlamydia case 

rates may suggest decreases in incidence of infection or 

screening coverage.

Chlamydia—United States

In 2013, a total of 1,401,906 chlamydial infections were 

reported to CDC in 50 states and the District of Columbia 

(Table 1). This case count corresponds to a rate of 446.6 

cases per 100,000 population. During 1993–2011, the 

rate of reported chlamydial infection increased from 178.0 

to 453.4 cases per 100,000 population (Figure 1, Table 

1). During 2011–2012, the national rate of reported cases 

remained stable (453.4 to 453.3 cases per 100,000). During 

2012–2013, the rate decreased 1.5% to 446.6 cases per 

100,000. This is the first time since national reporting 

began that the rate of reported cases of chlamydia has 

decreased.

Chlamydia by Region

In 2013, rates of reported chlamydia were highest in the 

South (485.1 per 100,000 population), followed by the 

Midwest (439.0), the West (424.9), and the Northeast 

(403.3) (Table 3). Between 2004–2012, rates of reported 

cases of chlamydia increased in all regions (Figure 2). 

During 2012–2013, the rate decreased in the Northeast by 

3.1%, in the Midwest by 2.7%, and in the South by 1.4% 

and increased in the West by 0.6% (Table 3).
STD Surveillance 2013 National Profile: Chlamydia 5

Chlamydia by State

In 2013, rates of reported cases of chlamydia by state 

ranged from 236.2 cases per 100,000 population in New 

Hampshire to 789.4 cases in Alaska (Figure 3, Table 2); 

the rate in the District of Columbia was 1,104.4 cases per 

100,000 (Table 3). During 2012–2013, rates of reported 

chlamydia decreased in 26 states and in the District of 

Columbia.

Chlamydia by Metropolitan 

Statistical Area 

In 2013, the rate of reported cases of chlamydia per 

100,000 population in the 50 most populous metropolitan 

statistical areas (MSAs) decreased 2.4% from the rate in 

2012 (462.7 and 474.2 cases per 100,000, respectively) 

(Table 6). In 2013, 56.5% of chlamydia cases were reported 

by these MSAs. Among women in these MSAs, the rate 

decreased 3.6% during 2012–2013 (653.1 to 629.6 cases 

per 100,000) (Table 7). Among men, the 2013 rate (286.7 

per 100,000 males) was similar to the 2012 rate (286.5 

cases per 100,000 males) (Table 8). 

Chlamydia by County

Counties in the United States with the highest rates of 

reported cases of chlamydia were located primarily in the 

Southeast and West, including Alaska (Figure 4). In 2013, 

866 (27.6%) of 3,142 counties had rates higher than 

400.0 cases per 100,000 population. Seventy counties and 

independent cities reported 43% of all chlamydia cases in 

2013 (Table 9). 

Chlamydia by Sex

In 2013, 993,348 cases of chlamydia were reported among 

females for a case rate of 623.1 per 100,000 females. During 

1995–2011, the rate among females increased each year 

(Figure 1). During 2011–2012 the rate decreased slightly 

(0.7%) from 643.4 to 638.7 cases per 100,000 and during 

2012–2013 decreased 2.4% from 638.7 to 623.1 cases per 

100,000 (Table 4). 

The overall case rate among males increased slightly (0.8%) 

during 2012–2013 (260.6 to 262.6 cases per 100,000 

males). As in previous years, the reported case rate among 

females was about two times the case rate among males in 

2013, likely reflecting a larger number of women screened 

for this infection (Figure 1, Tables 4 and 5). The lower rate 

among men also suggests that many of the sex partners of 

women with chlamydia are not receiving a diagnosis of 

chlamydia or being reported as having chlamydia. 

However, with the advent of highly sensitive nucleic acid 

amplification tests (NAATs) that can be performed on 

urine, chlamydial infection is increasingly being diagnosed 

in symptomatic and asymptomatic men. During 2009–

2013, the rate of reported cases among men increased 

21.0% (from 217.1 to 262.6 cases per 100,000 males) 

compared with a 6.2% increase among women during 

the same period (from 586.7 to 623.1 cases per 100,000 

females).

Chlamydia by Age

Rates of reported cases of chlamydia are highest among 

adolescents and young adults aged 15–24 years (Table 

10). In 2013, the rate among 15–19 year olds was 1,852.1 

cases per 100,000 and the rate among 20–24 year olds was 

2,451.6 cases per 100,000. 

Among women, the highest age-specific rates of reported 

chlamydia in 2013 were among those aged 15–19 years 

(3,043.3 cases per 100,000 females) and 20–24 years 

(3,621.1 cases per 100,000 females) (Figure 5, Table 10). 

Within these age ranges, reported rates were highest among 

women aged 19 years (4,767.2 cases per 100,000 females) 

and aged 20 years (4,507.3 cases per 100,000 females) 

(Table 12). After increasing steadily during 2000–2011, 

the rate among women aged 15–19 years decreased 5.6% 

during 2011–2012 and decreased 8.7% during 2012–2013. 

The rate increased slightly (1.8%) among women aged 

20–24 years during 2011–2012 and was stable during 

2012–2013.

Age-specific rates among men, although substantially lower 

than the rates among women, were highest in those aged 

20–24 years (1,325.6 cases per 100,000 males) (Figure 5, 

Table 10). Similar to trends in women, after increasing for 

the last decade, reported case rate among men aged 15–19 

years decreased 5.1% during 2011–2012 and decreased 

9.0% during 2012–2013. Among men aged 20–24 years, 

the reported case rate was similar in 2012 and 2013 

(1,322.8 and 1,325.6 cases per 100,000 males).

Chlamydia by Race/Ethnicity

Among the 47 jurisdictions (46 states and the District of 

Columbia) that submitted data in the race and ethnicity 

categories in 2013 according to Office of Management 

and Budget (OMB) standards, rates of reported cases of 

chlamydia were highest among black men and women 

(Figure L, Table 11B). The rate of chlamydia among blacks 

was 6.4 times the rate among whites (1,147.2 and 180.3 
6 National Profile: Chlamydia STD Surveillance 2013

cases per 100,000 population, respectively). The rate among 

American Indians/Alaska Natives (697.9 cases per 100,000) 

was 3.9 times the rate among whites. The rate among 

Hispanics (377.0 cases per 100,000) was 2.1 times the rate 

among whites. The rate among Native Hawaiians/Other 

Pacific Islanders (633.3 cases per 100,000) was 3.5 times 

the rate among whites. The rate among Asians was lower 

than the rate among whites (111.5 cases and 180.3 cases per 

100,000, respectively).

During 2009–2013, 40 jurisdictions (39 states and the 

District of Columbia) submitted chlamydia case report data 

in the race and ethnicity categories according to the OMB 

standards. Between 2009–2012, rates increased among 

all races and ethnicities (Figure 6). During 2012–2013, 

rates decreased among American Indians/Alaska Natives 

(5.0%), among blacks (6.8%), and among whites (0.8%), 

were stable among Hispanics, and increased 10.0% among 

Native Hawaiians/Other Pacific Islanders (Figure 6). 

Chlamydia by Reporting Source

Most chlamydia cases reported in 2013 were from venues 

outside of STD clinics (Figure 8 and Table A2). Over 

time, the proportion of cases reported from non-STD 

clinic sites has continued to increase (Figure 7). In 2013, 

among women, only 5.5% of chlamydia cases were reported 

through an STD clinic (Figure 8). Most cases among 

women were reported from private physicians/health 

maintenance organizations (HMOs) (33.2%). Among 

men, 17.2% of chlamydia cases were reported from an 

STD clinic in 2013 and 24.3% were reported from private 

physicians/HMOs.

Chlamydia Prevalence in the 

Population

The National Health and Nutrition Examination Survey 

(NHANES) is a nationally representative survey of the 

U.S. civilian, non-institutionalized population aged 14–39 

years that provides an important measure of chlamydia 

disease burden. From 1999–2000 to 2007–08, there was an 

estimated 40% reduction (95% Confidence Interval [CI]: 

8%, 61%) in prevalence among persons aged 14–39 years.1

During 2005–2008, the overall prevalence of chlamydia 

among persons aged 14–39 years was 1.5% (95% CI: 1.2%, 

1.9%). Prevalence was highest among non-Hispanic blacks 

(5.9%, 95% CI: 4.5%, 7.7%) (Figure 10). 

Chlamydia Positivity in Selected 

Populations

In 2005, the STD Surveillance Network (SSuN) was 

established to improve the capacity of national, state, and 

local STD programs to detect, monitor, and respond to 

trends in STDs. In 2013, a total of 42 STD clinics at 12 

sites collected enhanced behavioral information on patients 

who presented for care to these clinics. More detailed 

information about SSuN methodology can be found in 

the STD Surveillance Network section of the Appendix, 

Interpreting STD Surveillance Data.

In 2013, the proportion of STD clinic patients testing 

positive for chlamydia varied by age, sex, and sexual 

behavior. Adolescent men who have sex with women 

(MSW) had the highest prevalence (31.7%), likely 

reflecting targeted testing of partners of females diagnosed 

with chlamydia. Among MSW and women, prevalence 

among those tested decreased with age. The variation in 

prevalence by age was not as pronounced for gay, bisexual, 

and other men who have sex with men (MSM) (Figure 9). 

Chlamydia Among Special Populations

More information on chlamydia among women of 

reproductive age, adolescents and young adults, MSM, 

and minority populations is presented in the Special Focus 

Profiles.

Chlamydia Summary

Chlamydia continues to be the most commonly reported 

nationally notifiable disease with 1,401,906 cases reported 

in 2013. For the first time since national reporting began, 

the rate of reported cases of chlamydia decreased. Decreases 

in the overall rate were driven by decreases among women; 

in particular, decreases among women aged 15-19 years. 

However, both test positivity and the number of reported 

cases of C. trachomatis infections remain high among most 

age groups, racial/ethnic groups, geographic areas, and 

both sexes. Racial differences also persist; reported case 

rates and prevalence estimates among blacks continue to be 

substantially higher than among other racial/ethnic groups.
STD Surveillance 2013 National Profile: Chlamydia 7

1 Datta SD, Torrone E, Kruszon-Moran D, Berman S, Johnson 

R, Satterwhite CL, et al. Chlamydia trachomatis trends in 

the United States among persons 14 to 39 years of age, 1999-

2008. Sex Transm Dis. 2012;39(2):92-6. doi: 10.1097/

OLQ.0b013e31823e2ff7.

2 Miller WC, Ford CA, Morris M, Handcock MS, Schmitz JL, 

Hobbs MM, et al. Prevalence of chlamydial and gonococcal 

infections among young adults in the United States. JAMA. 2004 

12;291(18):2229-36.

3 Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes 

KK, Stamm WE. Prevention of pelvic inflammatory disease 

by screening for cervical chlamydial infection. N Engl J Med.

1996;34(21):1362-6.

4 Oakeshott P, Kerry S, Aghaizu A, Atherton H, Hay S, TaylorRobinson D, et al. Randomised controlled trial of screening for 

Chlamydia trachomatis to prevent pelvic inflammatory disease: the 

POPI (prevention of pelvic infection) trial. BMJ. 2010;340:c1642. 

doi: 10.1136/bmj.c1642.

5 Fleming DT, Wasserheit JN. From epidemiological synergy 

to public health policy and practice: the contribution of other 

sexually transmitted diseases to sexual transmission of HIV 

infection. Sex Transm Infect. 1999;75:3-17.

6 Centers for Disease Control and Prevention. Sexually transmitted 

diseases treatment guidelines, MMWR Morb Mortal Wkly Rep. 

2010; No.59(RR-12):1-110. Erratum in: MMWR Recomm Rep. 

2011;60(1):18.

7 National Committee for Quality Assurance. The state of 

healthcare quality 2013. Washington (DC): National Committee 

for Quality Assurance; 2013. p. 79-81.
8 National Profile: Chlamydia STD Surveillance 2013

 0

150

300

450

600

750

Year

1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

Rate (per 100,000 population)

Men

Women

Total

 0

100

200

300

400

500

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Rate (per 100,000 population)

West

Midwest

Northeast

South

Figure 2. Chlamydia — Rates of Reported Cases by Region, United States, 2004–2013

Figure 1. Chlamydia — Rates of Reported Cases by Sex, United States, 1993–2013

NOTE: As of January 2000, all 50 states and the District of Columbia have regulations that require the reporting of chlamydia cases.
STD Surveillance 2013 National Profile: Chlamydia 9

Virgin Islands 736 

Rate per 100,000

population

Guam 586 

Puerto Rico 163 

<=300.0

300.1-400.0

>400.0

(n= 6)

(n= 14)

(n= 34)

VT 294

NH 236

MA 349

RI 411

CT 356

NJ 320

DE 568

MD 454

DC 1014

611

789

466 524

440 393

415

515

477

340

496 429

356

382 391

625

259

454

348

585

454

380

394 427

587

490

497

419

460

479

364

408

542

471

470

498

264

407

362

277

412

348

Rate per 100,000

population

<=300.0 (n= 1,755)

300.1-400.0 (n= 521)

>400.0 (n= 866)

Figure 4. Chlamydia — Rates of Reported Cases by County, United States, 2013

Figure 3. Chlamydia — Rates of Reported Cases by State, United States and Outlying Areas, 2013

NOTE: The total rate of reported cases of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 443.5 per 100,000 

population.
10 National Profile: Chlamydia STD Surveillance 2013

Men Rate (per 100,000 population) Women

4000 3200 2400 1600 800 0 Age 0 800 1600 2400 3200 4000

14.7 10-14 108.9

715.2 15-19 3043.3

1325.6 20-24 3621.1

757.9 25-29 1428.3

390.9 30-34 599.2

207.5 35-39 273.4

116.6 40-44 118.3

55.9 45-54 41.4

17.0 55-64 11.3

4.0 65+ 2.5

262.6 Total 623.1

 0

 300

 600

 900

1200

1500

Year

2009 2010 2011 2012 2013

Rate (per 100,000 population) AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

Figure 6. Chlamydia — Rates of Reported Cases by Race/Ethnicity, United States, 2009–2013

Figure 5. Chlamydia — Rates of Reported Cases by Age and Sex, United States, 2013

* AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders.

NOTE: Includes 39 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats during 

2009–2013 (see Reporting of Data for Race/Ethnicity in the Appendix).
STD Surveillance 2013 National Profile: Chlamydia 11

 0

 200

 400

 600

 800

1,000

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Cases (in thousands)

Non-STD Clinic, Men

Non-STD Clinic, Women

STD Clinic, Men

STD Clinic, Women

Percentage

Private Physician/HMO*

STD Clinic

Other HD* Clinic

Family Planning Clinic

Emergency Room

Other

Missing/Unknown

 0

 10

 20

 30

 40

Men Women

Figure 8. Chlamydia — Percentage of Reported Cases by Sex and Reporting Source, 

United States, 2013

Figure 7. Chlamydia — Reported Cases by Reporting Source and Sex, United States, 2004–2013

* HMO = health maintenance organization; HD = health department.

NOTE: Other includes: Drug Treatment, Tuberculosis Clinic, Correctional Facility, Laboratory, Blood Bank, Labor and Delivery, Prenatal Care, National Job 

Training Program, School-based Clinic, Mental Health Provider, Other Hospital, Indian Health Service, Military, and HIV Counseling and Testing Site 
12 National Profile: Chlamydia STD Surveillance 2013

Figure 10. Chlamydia — Prevalence Among Persons Aged 14–39 Years by Sex, Race/Ethnicity, or Age 

Group, National Health and Nutrition Examination Survey, 2005–2008

Figure 9. Chlamydia — Proportion of STD Clinic Patients* Testing Positive by Age, Sex, and Sexual 

Behavior, STD Surveillance Network (SSuN), 2013

* Only includes patients tested for chlamydia

†

 MSM = men who have sex with men; MSW = men who have sex with women only.

NOTE: Six jurisdictions (Birmingham, Chicago, Denver, Hartford/New Haven, New Orleans, and Richmond) contributed data from January through June 2013 and 

the remaining jurisdictions (Baltimore, Los Angeles, New York City, Philadelphia, San Francisco and Seattle) contributed data for all of 2013.

NOTE: Error bars indicate 95% confidence intervals.

Prevalence, %

0

2

4

6

8

Overall Men

 Sex

Women NonHispanic

Whites

NonHispanic

Blacks

Race/Ethnicity

Mexican

Americans 14-25

 Age

26-39 Men

14-25

Women

14-25

Age and Sex 

Percentage

Age

MSM

MSW

Women

0

10

20

30

40

<=19 20-24 25-29 30-39 >=40

†

†
STD Surveillance 2013 National Profile: Gonorrhea 13

Gonorrhea

Background

Gonorrhea is the second most commonly reported 

notifiable disease in the United States. Infections due to 

Neisseria gonorrhoeae, like those resulting from Chlamydia 

trachomatis, are a major cause of pelvic inflammatory 

disease (PID) in the United States. PID can lead to 

serious outcomes in women, such as tubal infertility, 

ectopic pregnancy, and chronic pelvic pain. In addition, 

epidemiologic and biologic studies provide evidence that 

gonococcal infections facilitate the transmission of HIV 

infection.1

 Although an individual’s sexual behavior can 

increase the risk of acquiring gonorrhea, social determinants 

of health, such as socioeconomic status, may contribute to 

the burden of gonorrhea in a community.2

In 2009, the national rate of reported gonorrhea cases 

reached an historic low of 98.1 cases per 100,000 

population (Figure 11 and Table 1). However, during 

2009–2012, the rate increased slightly each year, to 106.7 

cases per 100,000 population in 2012. In 2013, a total of 

333,004 gonorrhea cases were reported, and the national 

gonorrhea rate decreased slightly to 106.1 cases per 100,000 

population. 

The decrease in gonorrhea rate during 2012–2013 was 

observed primarily among women (Figure 12). Although 

trends by sex varied by region, nationwide, the gonorrhea 

rate decreased among women, but increased among men. 

Overall, the gonorrhea rate decreased in the Northeast, 

Midwest, and South, but increased in the West (Figure 13). 

The rate decreased among persons aged 15–19 years and 

20–24 years, but increased among those aged 25 years or 

older (Table 21). 

N. gonorrhoeae has progressively developed resistance to 

each of the antimicrobials used for treatment of gonorrhea. 

Most recently, declining susceptibility to cefixime resulted 

in a change to the CDC treatment guidelines, so that 

dual therapy with ceftriaxone and either azithromycin 

or doxycycline is now the only CDC-recommended 

treatment regimen for gonorrhea.3

 The emerging threat of 

cephalosporin resistance highlights the need for continued 

surveillance of N. gonorrhoeae antimicrobial susceptibility. 

The combination of persistently high gonorrhea morbidity 

in some populations and the threat of cephalosporinresistant gonorrhea reinforces the need to better understand 

the epidemiology of gonorrhea. 

Interpreting Rates of Reported Cases of 

Gonorrhea

Although gonorrhea case reporting is useful for monitoring 

disease trends, the number of gonorrhea cases reported 

to CDC is affected by many factors in addition to the 

actual occurrence of the infection within the population. 

Changes in the burden of gonorrhea may be masked by 

changes in screening practices (e.g., screening for chlamydia 

with tests that also detect N. gonorrhoeae infections or 

increased screening at extra-genital anatomic sites), the use 

of diagnostic tests with different test performance (e.g., the 

broader use of nucleic acid amplification tests [NAATs]), 

and changes in reporting practices. As with other STDs, the 

reporting of gonorrhea cases to CDC is incomplete.4

 For 

these reasons, supplemental data on gonorrhea prevalence 

in persons screened in a variety of settings are useful in 

assessing the burden of disease in selected populations. 

Gonorrhea—United States

In 2013, a total of 333,004 cases of gonorrhea were 

reported in the United States, yielding a rate of 106.1 cases 

per 100,000 population (Table 1). The rate decreased 0.6% 

since 2012; however, the rate increased 8.2% overall during 

2009–2013.

Gonorrhea by Region

In 2013, as in previous years, the South had the highest 

rate of reported gonorrhea cases (128.6 cases per 100,000 

population) among the four regions of the United States, 

followed by the Midwest (108.6 cases per 100,000 

population), Northeast (85.5 cases per 100,000 population), 

and West (83.5 cases per 100,000 population) (Table 14). 

During 2012–2013, the gonorrhea rate decreased 7.3% in 

the Northeast, 5.0% in the Midwest, and 1.5% in the South, 

but increased 15.0% in the West (Figure 13, Table 14). 

Gonorrhea by State

In 2013, rates of reported gonorrhea cases per 100,000 

population ranged by state from 9.2 in New Hampshire 

to 188.4 in Louisiana; the gonorrhea rate in the District of 

Columbia was 391.9 per 100,000 population (Figure 14, 

Table 13). During 2012–2013, gonorrhea rates increased 

in 50% (25/50) of states and in the District of Columbia, 

decreased in 48% (24/50) of states, and did not change in 

one state (Table 14).
14 National Profile: Gonorrhea STD Surveillance 2013

Gonorrhea by Metropolitan Statistical 

Area (MSA)

The overall rate of reported gonorrhea cases in the 50 most 

populous MSAs was 118.1 cases per 100,000 population in 

2013 (Table 17), representing a 1.6% decrease compared 

with 2012 (120.0 cases per 100,000 population). In 2013, 

60.7% of reported gonorrhea cases were reported by these 

MSAs. Since 2010, the gonorrhea rate among women in 

the 50 most populous MSAs has been lower than the rate 

among men (Tables 18 and 19). In 2013, the rate among 

women was 105.4 cases per 100,000 population, while the 

rate among men was 130.8 cases per 100,000 population.

Gonorrhea by County

In 2013, 51% of reported gonorrhea cases occurred in just 

70 counties or independent cities (Table 20). In 2013, 

1,108 counties (35.3%) in the United States had a rate 

less than or equal to 19 cases per 100,000 population 

(Figure 15). The rate ranged from 19.1 to 100 per 100,000 

population in 1,424 counties (45.3%), and was more than 

100 cases per 100,000 population in 610 counties (19.4%). 

As in previous years, most counties with more than 100 

cases per 100,000 population were located in the South. 

Gonorrhea by Sex

In 2013, for the first time since 2000, the rate of reported 

gonorrhea cases among men (109.5 cases per 100,000 

population) was higher than the rate among women (102.4 

cases per 100,000 population) (Figure 12, Tables 15 and 

16). During 2012–2013, the gonorrhea rate among men 

increased 4.3%, and the rate among women decreased 

5.1% During 2009–2013, the rate among men increased 

20.3%, while the rate among women decreased 2.0%. 

The magnitude of the increase among men compared 

with a decrease among women suggests either increased 

transmission or increased case ascertainment (e.g., through 

increased extra-genital screening) among gay, bisexual, and 

other men who have sex with men (collectively referred to 

as MSM). However, most jurisdictions do not routinely 

report sex of sex partner or site of infection for gonorrhea 

cases, so trends in gonorrhea rates among MSM over time 

cannot be assessed.

Gonorrhea by Region and Sex

During 2012–2013 in the West, the rate of reported 

gonorrhea cases increased among men (17.3%) and among 

women (11.8%) (Tables 15 and 16). In contrast, in the 

Midwest and the South, the gonorrhea rate increased 

among men (increased 0.6% in the Midwest, 2.4% in the 

South), but decreased among women (decreased 9.2% in 

the Midwest, 5.0% in the South). In the Northeast, the 

gonorrhea rate decreased among men (1.9%) and among 

women (13.2%).

Gonorrhea by Age

In 2013, rates of reported gonorrhea cases were highest 

among adolescents and young adults. In 2013, the highest 

rates among women were observed among those aged 20–

24 years (541.6 cases per 100,000 population) and 15–19 

years (459.2 cases per 100,000 population). Among men, 

the rate was highest among those aged 20–24 years (459.4 

cases per 100,000 population) (Figure 16, Table 21). 

In 2013, persons aged 15–44 years accounted for 93.6% 

of reported gonorrhea cases with known age. During 

2012–2013, the gonorrhea rate decreased 11.6% among 

those aged 15–19 years, and decreased 1.9% among those 

aged 20–24 years (Table 21). However, the gonorrhea 

rate increased 6.3% among those aged 25–29 years, 8.4% 

among those aged 30–34 years, 11.3% among those aged 

35–39 years, and 7.9% among those aged 40–44 years.

Among women aged 15–44, the rate decreased among those 

aged 15–19 years and 20–24 years, but increased in older 

age groups (Figure 17). Among men aged 15–44, the rate 

decreased among those aged 15–19 years, but increased in 

those aged 20–24 years and in older age groups (Figure 18). 

Gonorrhea by Race/Ethnicity 

In 2013, among the 47 jurisdictions (46 states and the 

District of Columbia) that submitted data in the race and 

ethnicity categories according to Office of Management 

and Budget (OMB) standards, the rate of reported 

gonorrhea cases remained highest among blacks (426.6 

cases per 100,000 population) (Table 22B). The rate 

among blacks was 12.4 times the rate among whites (34.5 

cases per 100,000 population). The gonorrhea rate among 

American Indians/Alaska Natives (137.4 cases per 100,000 

population) was 4.0 times that of whites, the rate among 

Native Hawaiians/Other Pacific Islanders (94.0 cases per 

100,000 population) was 2.7 times that of whites, the rate 

among Hispanics (65.8 cases per 100,000 population) was 

1.9 times that of whites, and the rate among Asians (17.1 

cases per 100,000 population) was 0.5 times that of whites 

(Table 22B).

During 2009–2013, among the 40 jurisdictions (39 states 

and the District of Columbia) that submitted data in the 

OMB-compliant race and ethnicity categories for all five 
STD Surveillance 2013 National Profile: Gonorrhea 15

years during that period, the gonorrhea rate increased 

among American Indians/Alaska Natives (87.4%), Native 

Hawaiians/Other Pacific Islanders (79.1%), whites (54.4%), 

Hispanics (50.2%), and Asians (29.4%) (Figure 19). 

During this same time period, the gonorrhea rate decreased 

9.1% among blacks.

More information on gonorrhea rates among racial/

ethnicity groups can be found in the Special Focus Profiles.

Gonorrhea by Reporting Source

The number of gonorrhea cases reported by STD clinics 

declined during 2004–2013 (Figure 20). In 2013, 16.3% 

of gonorrhea cases with known reporting source were 

reported by STD clinics (Table A2). This is a decrease from 

2012, when 17.3% of gonorrhea cases were reported by 

STD clinics. In 2013, among women, private physicians 

or health maintenance organizations (HMOs) (25.5%) 

were the most common reporting source, followed by 

family planning clinics (9.4%), STD clinics (8.6%), other 

health department clinics (6.6%), and emergency rooms 

(5.2%) (Figure 21). Among men, private physicians/HMOs 

(20.1%) and STD clinics (19.8%) were the most common 

reporting sources. Other reporting sources for men included 

other health department clinics (8.5%), emergency rooms 

(5.5%), and family planning clinics (5.2%). 

STD Surveillance Network

The STD Surveillance Network (SSuN) is a network of 12 

states and independently funded cities that collect enhanced 

information on a representative sample of gonorrhea cases 

reported to the state or city health department from all 

reporting sources. This project provides more complete 

estimates of case characteristics often missing on routine 

case reports—such as gender of sex partners—which 

is essential for better targeting of gonorrhea control 

efforts. Between January 1st and June 30th, 2013, 

SSuN collaborators interviewed 3,121 gonorrhea cases 

representing 8.1% of total morbidity reported from 

participating jurisdictions during that time period. Based 

on these enhanced interviews, the burden of disease 

represented by MSM, men who have sex with women 

only (MSW), and women varied substantially across 

collaborating sites (Figure 22). San Francisco County had 

the highest proportion of estimated MSM cases (82.6%), 

while the lowest proportion of morbidity estimated to be 

attributed to MSM was found in Virginia at 13.0%. Across 

all SSuN jurisdictions in 2013, 27.4% of gonorrhea cases 

were estimated to be among MSM, 30.5% among MSW, 

and 42.1% among women. 

In addition, a total of 42 STD clinics in the 12 SSuN 

jurisdictions collected enhanced behavioral information 

from patients who presented for care at these clinics during 

2013. In 2013, the proportion of STD clinic patients who 

tested positive for gonorrhea varied by age, sex, and sex 

of sex partner (Figure 23). Among those attending these 

clinics, adolescent MSW ≤19 years of age had the highest 

gonorrhea positivity (32.4%). Within older age groups, 

MSM had a higher gonorrhea positivity than MSW or 

women.

Additional information about SSuN methodology can be 

found in the STD Surveillance Network section of the 

Appendix, Interpreting STD Surveillance Data.

Gonococcal Isolate Surveillance Project 

Antimicrobial resistance remains an important 

consideration in the treatment of gonorrhea.3, 5–9 In 1986, 

the Gonococcal Isolate Surveillance Project (GISP), a 

national sentinel surveillance system, was established to 

monitor trends in antimicrobial susceptibilities of urethral 

N. gonorrhoeae strains in the United States.10 Data are 

collected from selected STD clinic sentinel sites and from 

regional laboratories (Figure 24).

Information on the antimicrobial susceptibility criteria 

used in GISP can be found in the Gonococcal Isolate 

Surveillance Project section of the Appendix, Interpreting 

STD Surveillance Data. More information about GISP and 

additional data can be found at http://www.cdc.gov/std/

GISP.

Susceptibility to Ceftriaxone

Susceptibility testing for ceftriaxone began in 1987. 

The percentage of GISP isolates that exhibited elevated 

ceftriaxone minimum inhibitory concentrations (MICs), 

defined as ≥0.125 μg/ml, increased from 0.1% in 2008 to 

0.4% in 2011, and decreased to 0.05% in 2013 (Figure 25).

Five isolates with decreased susceptibility to ceftriaxone 

(MIC = 0.5 μg/ml) have been previously identified in 

GISP: one from San Diego, California (1987), two from 

Cincinnati, Ohio (1992 and 1993), one from Philadelphia, 

Pennsylvania (1997), and one from Oklahoma City, 

Oklahoma (2012). 
16 National Profile: Gonorrhea STD Surveillance 2013

Susceptibility to Cefixime

Susceptibility testing for cefixime began in 1992, was 

discontinued in 2007, and was restarted in 2009. The 

percentage of isolates with elevated cefixime MICs (≥0.25 

μg/ml) increased from 0.1% in 2006 to 1.4% in 2010 and 

2011, and declined to 0.4% in 2013 (Figure 26). In 2013, 

no isolates had cefixime MICs of ≥0.5 μg/ml.

Susceptibility to Azithromycin

Susceptibility testing for azithromycin began in 1992. 

Figure 27 displays the distribution of azithromycin MICs 

among GISP isolates collected during 2009–2013. Most 

isolates had MICs of 0.125–0.25 μg/ml. The proportion of 

GISP isolates with azithromycin MICs of ≥2.0 μg/ml varied 

by year between 0.2% and 0.6%. 

Susceptibility to Spectinomycin

All isolates were susceptible to spectinomycin in 2013. A 

spectinomycin-resistant isolate was last identified in GISP 

in 1994 (West Palm Beach, Florida).

Susceptibility to Ciprofloxacin

The proportion of GISP isolates with ciprofloxacin 

resistance (MIC ≥1 μg/ml) peaked in 2007 at 14.8%. 

Following a decline in 2008 and 2009, the proportion 

increased from 9.6% in 2009 to 16.1% in 2013. In 2013, 

27.7% of isolates from MSM and 9.8% of isolates from 

MSW exhibited ciprofloxacin resistance.

Other Antimicrobial Susceptibility Testing

In 2013, 33.9% of isolates collected from GISP sites were 

resistant to penicillin, tetracycline, ciprofloxacin, or some 

combination of those antimicrobials (Figure 28). Although 

these antimicrobials are no longer recommended for 

treatment of gonorrhea, the resistance phenotypes remain 

common. Conversely, 66.1% of isolates were susceptible to 

all three of these antimicrobials.

Antimicrobial Treatments Given for 

Gonorrhea

The antimicrobial agents given to GISP patients for 

gonorrhea therapy are shown in Figure 29. The proportion 

of patients treated with ceftriaxone 250 mg increased from 

84.0% in 2011 to 96.9% in 2013. The proportion treated 

with cefixime decreased from 5.3% in 2011 to 0.02% 

in 2013. In 2013, 1.7% of patients were treated with 

azithromycin 2 grams as monotherapy.

Among patients treated with ceftriaxone 250 mg in 2013, 

95.4% were also treated with azithromycin one gram, 

4.0% were also treated with doxycycline, and 0.5% did not 

receive a second antimicrobial.

Gonorrhea Among Special Populations

More information about gonorrhea in racial/ethnic groups, 

women of reproductive age, adolescents, MSM, and other 

populations at higher risk can be found in the Special Focus 

Profiles.

Gonorrhea Summary

The national rate of reported gonorrhea cases reached 

an historic low in 2009, but increased each year during 

2009–2012. In 2013, the gonorrhea rate decreased slightly. 

This decrease was largely attributable to a decrease among 

women. The gonorrhea rate among men increased in every 

region except the Northeast, while the gonorrhea rate 

among women decreased in every region except the West. 

High gonorrhea rates persist in some geographic areas, 

among adolescents and young adults, and in some racial/

ethnic groups.

GISP continues to monitor for the emergence of decreased 

susceptibility and resistance to cephalosporins and 

azithromycin.
STD Surveillance 2013 National Profile: Gonorrhea 17

1 Fleming DT, Wasserheit JN. From epidemiological synergy 

to public health policy and practice: the contribution of other 

sexually transmitted diseases to sexual transmission of HIV 

infection. Sex Transm Infect. 1999;75(1):3–17.

2 Sullivan AB, Gesink DC, Brown P, Zhou L, Kaufman JS, Fitch 

M, et al. Are neighborhood sociocultural factors influencing the 

spatial pattern of gonorrhea in North Carolina? Ann Epidemiol. 

2011; 21:245–252.

3 Centers for Disease Control and Prevention. Update to CDC’s 

sexually transmitted diseases treatment guidelines, 2010: 

Oral cephalosporins no longer a recommended treatment 

for gonococcal infections. MMWR Morb Mortal Wkly Rep. 

2012;61(31):590–594.

4 Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, 

Ocfemia MC et al. Sexually transmitted infections among US 

women and men: prevalence and incidence estimates, 2008. Sex 

Transm Dis. 2013; 40(3):187–193.

5 Centers for Disease Control and Prevention. Update to CDC’s 

sexually transmitted diseases treatment guidelines, 2006: 

fluoroquinolones no longer recommended for treatment of 

gonococcal infections. MMWR Morb Mortal Wkly Rep. 

2007;56:332–6.

6 Centers for Disease Control and Prevention. Sexually 

transmitted diseases treatment guidelines, 2010. MMWR 

Recomm Rep. 2010;59(No.RR-12).

7

 Centers for Disease Control and Prevention. Neisseria 

gonorrhoeae with reduced susceptibility to azithromycin — San 

Diego County, California, 2009. MMWR Morb Mortal Wkly 

Rep. 2011;60:579–81.

8 Centers for Disease Control and Prevention. Cephalosporin 

susceptibility among Neisseria gonorrhoeae isolates—United 

States, 2000–2010. MMWR Morb Mortal Wkly Rep. 

2011;60:873–7.

9 Kirkcaldy RD, Ballard RC, Dowell D. Gonococcal resistance: 

Are cephalosporins next? Curr Infect Dis Rep. 2011;13: 

196–204.

10 Schwarcz S, Zenilman J, Schnell D, Knapp JS, Hook EW 

3rd, Thompson S, et al. National surveillance of antimicrobial 

resistance in Neisseria gonorrhoeae. JAMA. 1990;264:1413–7.
18 National Profile: Gonorrhea STD Surveillance 2013

 0

 50

100

150

200

250

Year

1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

Rate (per 100,000 population)

Men

Women

Total

 0

100

200

300

400

500

Year

1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Rate (per 100,000 population)

Figure 12. Gonorrhea — Rates of Reported Cases by Sex, United States, 1993–2013

Figure 11. Gonorrhea — Rates of Reported Cases by Year, United States, 1941–2013
STD Surveillance 2013 National Profile: Gonorrhea 19

Rate per 100,000

population

Guam 57.5 

Puerto Rico 9.7 

Virgin Islands 55.1 

<=19.0

19.1-100.0

>100.0

(n= 6)

(n= 25)

(n= 23)

VT 15.5

NH 9.2

MA 46.7

RI 43.2

CT 79.7

NJ 79.1

DE 151.6

MD 101.8

DC 391.9

173.7

154.2

97.8 135.9

100.3 54.4

107.8

143.7

51.6

13.2

127.9 109.3

47.9

74.9 98.5

188.4

18.4

106.9

72.0

170.7

125.3

22.3

74.6 98.4

92.0

101.8

140.1

70.3

144.0

139.0

44.3

108.7

152.3

94.1

114.2

129.8

33.3

84.9

63.3

57.3

80.3

11.5

 0

 50

100

150

200

250

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Rate (per 100,000 population)

West

Midwest

Northeast

South

Figure 14. Gonorrhea — Rates of Reported Cases by State, United States and Outlying Areas, 2013

Figure 13. Gonorrhea — Rates of Reported Cases by Region, United States, 2004–2013

NOTE: The total rate of reported cases of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 104.9 per 100,000 

population.
20 National Profile: Gonorrhea STD Surveillance 2013

Rate per 100,000

population

<=19.0 (n= 1,108)

19.1-100.0 (n= 1,424)

>100.0 (n= 610)

Figure 15. Gonorrhea — Rates of Reported Cases by County, United States, 2013

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 Age 0 150 300 450 600 750

4.8 10-14 21.0

220.9 15-19 459.2

459.4 20-24 541.6

320.1 25-29 258.4

198.7 30-34 126.2

122.0 35-39 62.9

82.1 40-44 30.2

50.8 45-54 12.1

17.1 55-64 3.1

3.7 65+ 0.5

109.5 Total 102.4

Figure 16. Gonorrhea — Rates of Reported Cases by Age and Sex, United States, 2013
STD Surveillance 2013 National Profile: Gonorrhea 21

 0

 150

 300

 450

 600

 750

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Rate (per 100,000 population) Age Group

15-19

20-24

25-29

30-34

35-39

40-44

Figure 17. Gonorrhea — Rates of Reported Cases Among Women Aged 15–44 Years by Age, United 

States, 2004–2013

 0

 120

 240

 360

 480

 600

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Rate (per 100,000 population)

Age Group

15-19

20-24

25-29

30-34

35-39

40-44

Figure 18. Gonorrhea — Rates of Reported Cases Among Men Aged 15–44 Years by Age, United 

States, 2004–2013
22 National Profile: Gonorrhea STD Surveillance 2013

 0

100

200

300

400

500

Year

2009 2010 2011 2012 2013

Rate (per 100,000 population)

AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

Figure 19. Gonorrhea — Rates of Reported Cases by Race/Ethnicity, United States, 2009–2013

* AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders.

NOTE: Includes 39 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats during 

2009–2013 (see Reporting of Data for Race/Ethnicity in the Appendix).

 0

 40

 80

120

160

200

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Cases (in thousands)

Non-STD Clinic, Men

Non-STD Clinic, Women

STD Clinic, Men

STD Clinic, Women

Figure 20. Gonorrhea — Reported Cases by Reporting Source and Sex, United States, 2004–2013
STD Surveillance 2013 National Profile: Gonorrhea 23

Percentage

Private Physician/HMO*

STD Clinic

Other HD* Clinic

Family Planning Clinic

Emergency Room

Other

Missing/Unknown

 0

 10

 20

 30

 40

Men Women

Figure 21. Gonorrhea — Percentage of Reported Cases by Sex and Reporting Source, 

United States, 2013

* HMO = health maintenance organization; HD = health department.

NOTE: Other includes: Drug Treatment, Tuberculosis Clinic, Correctional Facility, Laboratory, Blood Bank, Labor and Delivery, Prenatal Care, National Job 

Training Program, School-based Clinic, Mental Health Provider, Other Hospital, Indian Health Service, Military, and HIV Counseling and Testing Site 

Percentage

MSM*

MSW*

Women

 0

 20

 40

 60

 80

100

San

Francisco

New York

City ColoradoWashingtonChicago

California‡

BaltimorePhiladelphiaConnecticut

Louisiana

Alabama Virginia

Figure 22. Estimated Proportion of MSM* , MSW*, and Women Among Gonorrhea Cases† by Site, 

STD Surveillance Network (SSuN), 2013

* MSM = men who have sex with men; MSW = men who have sex with women only.

†

 Estimate based on weighted analysis of data obtained from interviews (n=3,121) conducted among a random sample of reported gonorrhea cases during January to June 2013. 

‡ California data excludes San Francisco County (shown separately).

NOTE: See STD Surveillance Network (SSuN) in the Appendix for SSuN methods and jurisdictions included in each project area.
24 National Profile: Gonorrhea STD Surveillance 2013

Percentage

Age

MSM

MSW

Women

0

10

20

30

40

<=19 20-24 25-29 30-39 >=40

†

†

Figure 23. Gonorrhea — Proportion of STD Clinic Patients* Testing Positive by Age, Sex, and Sexual 

Behavior, STD Surveillance Network (SSuN), 2013

* Only includes patients tested for gonorrhea.

†

 MSM = men who have sex with men; MSW = men who have sex with women only.

NOTE: Six jurisdictions (Birmingham, Chicago, Denver, Hartford/New Haven, New Orleans, and Richmond) contributed data from January through June 

2013 and the remaining jurisdictions (Baltimore, Los Angeles, New York City, Philadelphia, San Francisco and Seattle) contributed data for all of 2013.

Sentinel Sites

Sites and Regional

Labs

 Birmingham Phoenix

 Los Angeles

 Orange Co.

 San Diego

 San Francisco Denver

 Miami

 Atlanta

 Honolulu

 Tripler AMC

 Chicago

 Indianapolis

 New Orleans

 Baltimore

 Pontiac Minneapolis

 Kansas City

 Las Vegas

 Albuquerque

 New York City

 Greensboro

 Cleveland

 Columbus

 Oklahoma City

 Portland

 Philadelphia

 Austin

 Dallas

 Richmond

 Seattle

Figure 24. Location of Participating Sentinel Sites and Regional Laboratories, Gonococcal Isolate 

Surveillance Project (GISP), United States, 2013

NOTE: Austin is a regional laboratory only.
STD Surveillance 2013 National Profile: Gonorrhea 25

Percentage

Year

 0.0

 0.1

 0.2

 0.3

 0.4

 0.5

2006 2007 2008 2009 2010 2011 2012 2013

Figure 25. Neisseria gonorrhoeae — Percentage of Isolates with Elevated Ceftriaxone Minimum 

Inhibitory Concentrations (MICs) (≥0.125 μg/ml), Gonococcal Isolate Surveillance Project 

(GISP), 2006–2013

Percentage

Year

 0.0

 0.3

 0.6

 0.9

 1.2

 1.5

2006 2007* 2008* 2009 2010 2011 2012 2013

Figure 26. Neisseria gonorrhoeae — Percentage of Isolates with Elevated Cefixime Minimum 

Inhibitory Concentrations (MICs) (≥0.25 μg/ml), Gonococcal Isolate Surveillance Project 

(GISP), 2006–2013

* Isolates not tested for cefixime susceptibility in 2007 and 2008.
26 National Profile: Gonorrhea STD Surveillance 2013

Percentage

MICs (μg/ml)

2009

2010

2011

2012

2013

 0

 10

 20

 30

 40

 50

≤0.03 0.06 0.125 0.25 0.5 1 2 4 8 ≥16

Figure 27. Neisseria gonorrhoeae — Distribution of Azithromycin Minimum Inhibitory 

Concentrations (MICs), Gonococcal Isolate Surveillance Project (GISP), 2009–2013

Susceptible

PenR

TetR

QRNG

PenR/TetR

PenR/QRNG

TetR/QRNG

PenR/TetR/QRNG

66.1%

4.5%

11.7%

4.7%

1.7%

1.1%

5.4%

4.9%

Figure 28. Neisseria gonorrhoeae — Percentage of Isolates with Penicillin, Tetracycline, and/or 

Ciprofloxacin Resistance, Gonococcal Isolate Surveillance Project (GISP), 2013

NOTE: PenR=penicillinase-producing Neisseria gonorrhoeae and chromosomally-mediated penicillin-resistant N. gonorrhoeae; TetR=chromosomally- and 

plasmid-mediated tetracycline-resistant N. gonorrhoeae; and QRNG=quinolone-resistant N. gonorrhoeae.
STD Surveillance 2013 National Profile: Gonorrhea 27

0

20

40

60

80

100

Year

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Other Cephalosporins

Ceftriaxone 125 mg Spectinomycin

Ceftriaxone 250 mg

Cefixime

Penicillins

Ciprofloxacin

Tetracyclines

Ofloxacin

Other

Percentage

Figure 29. Primary Antimicrobial Drugs Used to Treat Gonorrhea Among Participants, Gonococcal 

Isolate Surveillance Project (GISP), 1988–2013

NOTE: For 2013, “Other” includes no therapy (0.9%), azithromycin 2g (1.7%), and other less frequently used drugs (<0.1%).
28 National Profile: Syphilis STD Surveillance 2013

Syphilis

Background

Syphilis, a genital ulcerative disease, causes significant 

complications if untreated and facilitates the transmission 

of HIV infection. Untreated early syphilis in pregnant 

women results in perinatal death in up to 40% of cases 

and, if acquired during the 4 years before pregnancy, can 

lead to infection of the fetus in 80% of cases.1

The rate of primary and secondary (P&S) syphilis reported 

in the United States decreased during the 1990s; in 

2000, the rate was the lowest since reporting began in 

1941 (Figure 30). The low rate of P&S syphilis and the 

concentration of the majority of syphilis cases in a small 

number of geographic areas in the United States led to the 

development of CDC’s National Plan to Eliminate Syphilis, 

which was announced by the Surgeon General in October 

1999 and revised in May 2006.2

Syphilis remains a major health problem, with increased 

cases occurring among gay, bisexual and other men who 

have sex with men (MSM). Cases among MSM have been 

characterized by high rates of HIV co-infection and highrisk sexual behaviors.3–7The estimated proportion of P&S 

syphilis cases attributable to MSM increased from 7% in 

2000 to 64% in 2004.8,9 In 2005, CDC requested that 

all state health departments report the sex of sex partners 

for persons with syphilis. Of reported male cases with 

P&S syphilis, sex of sex partner information in 2013 was 

available for 83%. In 2013, 49 states and the District of 

Columbia provided information about sex of sex partners. 

Among cases of P&S syphilis for whom sex of partner was 

known, MSM accounted for 75% of P&S syphilis cases.

Interpreting rates of reported cases of 

syphilis

Left untreated, infection with syphilis can span decades. 

Primary and secondary syphilis are the earliest stages of 

infection, reflect symptomatic disease, and are indicators 

of incident infection.10For these reasons, trend analyses of 

syphilis focus upon cases and rates of reported cases of P&S 

syphilis. (When referred to as “P&S syphilis”, case counts 

are the sum of both primary and secondary cases, while 

the “rate of P&S syphilis” is this sum per unit population.) 

However, changes in reporting and screening practices can 

complicate interpretation of these trends. To minimize the 

effect of changes in reporting over time, trend data in this 

report are restricted to jurisdictions that consistently report 

data of interest (e.g., sex of sex partner) for each year of a 

given time period. Details of these restrictions are provided 

in the text and footnotes of the pertinent text and figures. 

Syphilis — All Stages (P&S, Early Latent, 

Late, Late Latent, and Congenital)

Total case counts and rates for syphilis were the highest 

recorded since 1996. The total number of cases of syphilis 

(P&S, early latent, late, late latent, and congenital) reported 

to CDC increased 13.1% during 2012–2013 (from 49,915 

cases to 56,471 cases) (Table 1). The number of cases of 

early latent syphilis reported to CDC increased 16.7% 

(from 14,503 cases to 16,929 cases), and the number of 

cases of late and late latent syphilis increased 12.4% (from 

19,411 cases to 21,819 cases) (Tables 1, 37, and 39).

P&S Syphilis — United States

Although the rate of P&S syphilis in the United States 

declined 89.7% during 1990–2000, the rate increased 

annually during 2001–2009 before decreasing in 2010 and 

remaining unchanged during 2011. The rate again increased 

during 2012 and 2013.

The case count and rate for P&S syphilis in 2013 was the 

highest recorded since 1995. The number of P&S syphilis 

cases reported to CDC increased from 15,667 in 2012 to 

17,375 in 2013, an increase of 10.9%. The rate of P&S 

syphilis in the United States increased from 5.0 to 5.5 cases 

per 100,000 population (a 10.0% increase) during 2012–

2013 (Table 1). 

P&S Syphilis by Region

Each year since 2009, the rate of P&S syphilis has increased 

in the West. In 2013, for the first time in at least 50 years,11

the rate in the West (6.8 cases per 100,000 population) 

exceeded the rate in the South (6.0 cases) (Figure 33). 

During 2012–2013, the rate of P&S syphilis increased 

24.2% in the Midwest (from 3.3 to 4.1 cases), 19.3% in the 

West (from 5.7 to 6.8 cases), 11.6% in the Northeast (from 

4.3 to 4.8 cases), and 3.4% in the South (from 5.8 to 6.0 

cases per 100,000 population) (Figure 33, Table 27). The 

South continued to comprise the largest proportion of cases 

of P&S syphilis in 2013 (40%). 

P&S Syphilis by State

In 2013, the 15 states and areas (including the District of 

Columbia) with the highest rates of P&S syphilis accounted 

for 70% of all U.S. cases of P&S syphilis. The rate of P&S 

syphilis in 14 of these 15 states and areas (including the 

District of Columbia) exceeded the national rate of 5.5 

cases per 100,000 population; 9 of these 15 states and areas 

(including the District of Columbia) were in the South 

(Figure 34, Table 26). 
STD Surveillance 2013 National Profile: Syphilis 29

P&S Syphilis by Metropolitan Statistical 

Area 

The rate of P&S syphilis in 2013 for the 50 most populous 

MSAs (7.8 cases per 100,000 population) (Table 30) 

exceeded the overall rate for the United States (5.5 cases) 

(Table 27). The rate increased in 31 of these 50 MSAs 

(62%) during 2012–2013. 

P&S Syphilis by County

Of 3,142 counties in the United States, counties reporting 

no cases of P&S syphilis decreased during 2012–2013, from 

2,123 counties (67.6%) in 2012 to 2,029 counties (64.6%) 

in 2013 (Figure 35). In 2013, half of the total number of 

P&S syphilis cases was reported from 29 counties and two 

cities (Table 33).

P&S Syphilis by Sex

The rate of P&S syphilis increased 12.0% among men 

(from 9.2 to 10.3 cases per 100,000 men) during 2012–

2013 (Figure 32, Table 29). During this same period, the 

rate among women remained unchanged (0.9 cases per 

100,000 women) (Figure 32, Table 28).

P&S Syphilis by Age Group

In 2013, the rate of P&S syphilis was highest among 

persons aged 20–24 years and 25–29 years (16.1 and 15.6 

cases per 100,000 population, respectively) (Table 35).

The rate of P&S syphilis decreased among women aged 

15–19 years and 45–54 years (from 2.3 to 1.9 and from 

0.6 to 0.5 cases per 100,000 population, respectively). The 

rate remained the same or increased for women of all other 

age groups. The rate remained highest among women aged 

20–24 years (Figures 36 and 37, Table 35).

The rate of P&S syphilis was highest among men 20–29 

years, increasing 11.7% (from 24.8 to 27.7 cases) among 

men 20–24 years and 14.8% (from 24.4 to 28.0 cases) 

among men 25–29 years during 2012–2013 (Figures 36 

and 38, Table 35). This marks the sixth consecutive year 

(2008–2013) that the rate of P&S syphilis among men 

has been highest among men aged 20–29 years (Table 35). 

During 2008–2013, the rate has increased among men aged 

20–24 years by 60.1% (from 17.3 to 27.7 cases) and among 

men aged 25–29 years by 65.7% (from 16.9 to 28.0 cases). 

These data indicate a shift since 2006, when the rate was 

highest in men aged 35–39 years. 

P&S Syphilis by Race/Ethnicity

In 2013, among the 48 jurisdictions (47 states and the 

District of Columbia) that submitted data in race and 

ethnicity categories according to the current Office of 

Management and Budget (OMB) standards, rates of P&S 

syphilis remained highest among blacks (16.8 cases per 

100,000 population) (Table 36B). The rate among blacks 

was 5.6 times the rate among whites (3.0 cases per 100,000 

population). The rate among American Indians/Alaska 

Natives (4.6) was 1.5 times that of whites, the rate among 

Native Hawaiians/Other Pacific Islanders (8.6) was 2.9 

times that of whites, the rate among Hispanics (6.3) was 2.1 

times that of whites, and the rate among Asians (2.5) was 

0.8 times that of whites (Table 36B).

During 2009–2013, among the 40 jurisdictions (39 states 

and the District of Columbia) that submitted data in 

race and ethnic categories according to the current OMB 

standards for all five years during that period, the rate of 

P&S syphilis increased 65.3% among Hispanics (from 

3.9 to 6.5 cases per 100,000 population), 42.5% among 

non-Hispanic whites (from 2.2 to 3.1 cases per 100,000 

population), 77.2% among American Indians/Alaska 

Natives (from 2.8 to 5.0 cases per 100,000 population), 

83.5% among Asians (from 1.4 to 2.7 cases per 100,000 

population), 102.3% among Native Hawaiians/Other 

Pacific Islanders (from 4.8 to 9.6 cases per 100,000 

population), and 113.8% among multirace individuals 

(from 0.9 to 1.8 cases per 100,000 population) (Figure 39). 

The rate decreased 7.4% among non-Hispanic blacks (from 

18.7 to 17.3 cases per 100,000 population). Non-Hispanic 

blacks, non-Hispanic whites, and Hispanics comprised 

95.0% of reported cases in 2009 and 92.3% of reported 

cases in 2013.

P&S Syphilis by Race/Ethnicity and Sex

In 2013, among the 48 jurisdictions (47 states and the 

District of Columbia) that submitted data in the race 

and ethnic categories according to OMB standards, rates 

of P&S syphilis among men were highest among nonHispanic black men (30.2 cases per 100,000 population), 

followed by Native Hawaiian/Other Pacific Islander (15.8 

cases per 100,000 population), Hispanic (11.6 cases per 

100,000 population), American Indian/Alaska Native 

(7.1 cases per 100,000 population), non-Hispanic white 

(5.7 cases per 100,000 population), Asian (4.9 cases per 

100,000 population) and multirace (3.4 cases per 100,000 

population) men (Figure R, Table 36B).

Rates of P&S syphilis among women were highest among 

non-Hispanic black women (4.5 cases per 100,000 

population), followed by American Indian/Alaska Native 

(2.1 cases per 100,000 population), Native Hawaiian/

Other Pacific Islander (1.2 cases per 100,000 population), 

Hispanic (0.8 cases per 100,000 population), non-Hispanic 

white (0.3 cases per 100,000 population), multirace (0.3 

cases per 100,000 population) and Asian (0.2 cases per 

100,000 population) women (Figure R, Table 36B).
30 National Profile: Syphilis STD Surveillance 2013

P&S Syphilis by Sex, Sex Behavior, and 

Race/Ethnicity

The male-to-female rate ratio for P&S syphilis rates rose 

steeply during 2000–2003 (from 1.5 to 5.3), and again 

during 2008–2013 (from 5.0 to 11.3), reflecting higher 

rates in men than women (Figure 32). In 2013, this ratio 

was more than double the ratio of 2003, and 7.5 times the 

ratio of 2000.

In 2005, CDC began collecting information on the sex of 

sex partners of patients with P&S syphilis. In 2013, this 

information was available for 83% of male cases. A higher 

proportion of MSW were reported with primary syphilis 

(39.3%) compared to women (20.7%) and MSM (29.4%) 

(Figure 40).

In 2013, most women with P&S syphilis were black 

(57.9%), while others were white (20.2%), Hispanic 

(14.0%), or of other races/ethnicities (4.1%). Most MSW 

were also black (52.6%), while others were white (20.9%), 

Hispanic (20.2%), or of other races/ethnicities (3.2%). 

MSM with P&S syphilis were of greater racial and ethnic 

diversity: 38.2% were white, 32.8% were black, 21.2% 

were Hispanic, and 4.9% were of other races/ethnicities 

(Figure 41).

During 2007–2013, 33 areas (32 states and Washington, 

D.C.) reported sex of partner data for at least 70% of cases 

each year during this time period (Figure 31). In these 

areas, increases in cases of P&S syphilis occurred among 

all individuals (women, men having sex with women 

only (MSW), and MSM) during 2007–2008. Among 

heterosexual individuals, cases decreased during 2008–2011 

(18.4% among women and 25.9% among MSW), but 

increased during 2011–2013 (2.9% among women and 

14.4% among MSW). Among MSM, cases increased 

annually during 2007–2013 (75%). 

In 2013, 31 areas (30 states and District of Columbia) 

reported both sex of partner and human immunodeficiency 

virus (HIV) status (HIV-positive or HIV-negative) for 

70% or more of reported cases of P&S syphilis. Among 

individuals with P&S syphilis, a higher proportion of MSM 

were HIV-positive (51.6%) compared to MSW (9.9%) or 

women (5.2%) (Figure 42).

P&S Syphilis by Race/Ethnicity, Age, 

and Sex 

In 2013, among the 48 jurisdictions (47 states and the 

District of Columbia) that submitted data in the new race 

and ethnicity categories according to OMB standards, the 

rate of P&S syphilis among non-Hispanic blacks remained 

highest among women aged 20–24 years (17.0 cases per 

100,000 women) and among men aged 20–24 years 

and 25–29 years (96.4 and 97.2 cases per 100,000 men, 

respectively). For Hispanics, the rate was highest among 

women aged 20–24 years and 25–29 years (2.5 and 2.1 

cases per 100,000 women, respectively), and among men 

aged 20–24 years and 25–29 years (27.2 and 28.4 cases per 

100,000 men, respectively). For non-Hispanic whites, the 

rate was highest among women aged 20–24 years (1.2 cases 

per 100,000 women) and among men aged 25–29 years 

and 30–34 years (12.6 and 11.8 cases per 100,000 men, 

respectively) (Table 36B).

For Asians, the rate was highest among women aged 20–24 

years (1.0 cases per 100,000 women) and among men aged 

20–24 years (13.1 cases per 100,000 men). For American 

Indians/Alaska Natives, the rate was highest among women 

aged 20–24 years (9.0 cases per 100,000 women) and 

among men aged 20–24 years and 25–29 years (18.3 and 

16.7 cases per 100,000 men, respectively). For Native 

Hawaiians/Other Pacific Islanders, the rate was highest 

among women aged 15–19 and 35–39 years (5.3 cases and 

5.6 cases per 100,000 women, respectively) and among 

men aged 25–29 years (59.7 cases per 100,000 men). For 

multirace individuals, rates were highest among women 

aged 30–34 years (1.2 cases per 100,000 women) and 

among men aged 25–29 years (10.4 cases per 100,000 men) 

(Table 36B).

In some age groups, particularly young men aged 20–24 

years and 25–29 years, wide racial and ethnic disparities in 

rates of P&S syphilis have occurred in recent years.9,12 In 

2013, rates among men aged 20–24 years and 25–29 years 

remained highest among blacks (96.4 cases and 97.2 cases 

per 100,000 population, respectively). These rates were 

8.9 and 7.7 times (respectively) the rates of white men of 

the same age groups. Large disparities were also seen with 

Native Hawaiian/Other Pacific Islander and Hispanic men, 

compared to white men. The 2013 rates among Native 

Hawaiian/Other Pacific Islander men aged 20–24 years 

and 25–29 years were 3.0 and 4.7 times the rates of white 

men of the same age groups. Likewise, 2013 rates among 

Hispanic men aged 20–24 years and 25–29 years were 2.5 

and 2.3 times, respectively, the rates of white men of the 

same age group. 
STD Surveillance 2013 National Profile: Syphilis 31

1 Ingraham NR. The value of penicillin alone in the prevention 

and treatment of congenital syphilis. Acta Derm Venereol. 

1951:31(Suppl 24):60-88.

2 Centers for Disease Control and Prevention. The national plan 

to eliminate syphilis from the United States. Atlanta: U.S. 

Department of Health and Human Services; 2006.

3 Centers for Disease Control and Prevention. Resurgent bacterial 

sexually transmitted disease among men who have sex with 

men — King County, Washington, 1997–1999. MMWR Morb 

Mortal Wkly Rep. 1999;48:773-7.

4 Centers for Disease Control and Prevention. Outbreak of syphilis 

among men who have sex with men — Southern California, 

2000. MMWR Morb Mortal Wkly Rep. 2001;50(7):117-20.

5 Centers for Disease Control and Prevention. Primary and 

secondary syphilis among men who have sex with men — New 

York City, 2001. MMWR Morb Mortal Wkly Rep. 2002;51: 

853-6.

6 Chen SY, Gibson S, Katz MH, Klausner JD, Dilley JW, Schwarcz 

SK, et al. Continuing increases in sexual risk behavior and sexually 

transmitted diseases among men who have sex with men: San 

Francisco, California, 1999–2001 [Letter] Am J Public Health. 

2002;92:1387-8.

7 D’Souza G, Lee JH, Paffel JM. Outbreak of syphilis among men 

who have sex with men in Houston, Texas. Sex Transm Dis. 

2003;30:872-3.

8 Centers for Disease Control and Prevention. Primary and 

secondary syphilis — United States, 2003–2004. MMWR Morb 

Mortal Wkly Rep. 2006;55:269-73.

9 Heffelfinger JD, Swint EB, Berman SM, Weinstock HS. Trends 

in primary and secondary syphilis among men who have sex with 

men in the United States. Am J Public Health. 2007;97:1076-83.

10 Peterman TA, Kahn RH, Ciesielski CA, Ortiz-Rios E, Furness 

BW, Blank S, et al. Misclassification of the stages of syphilis: 

implications for surveillance. Sex Transm Dis. 2005;32(3):144-9.

11 Centers for Disease Control and Prevention. Primary and 

secondary syphilis--United States, 2005–2013. MMWR Morb 

Mortal Wkly Rep. 2014 May 9;63(18):402-6.

12 Su JR, Beltrami JF, Zaidi AA, Weinstock HS. Primary and 

secondary syphilis among black and Hispanic men who have 

sex with men: case report data from 27 States. Ann Intern Med. 

2011;155(3):145-51.

13 Centers for Disease Control and Prevention. Estimated HIV 

incidence in the United States, 2007–2010. HIV Surveillance 

Supplemental Report 2012;17(No. 4). Published December 2012. 

Racial and ethnic disparities in rates among men and 

women 15–19 years were also present in 2013. Rates 

among black men aged 15–19 years were 11.7 times the 

rate for white men and 3.2 times the rate for Hispanic 

men of the same age, and 2013 rates for black women aged 

15–19 years were 18.2 times and 8.3 times the rate for 

white and Hispanic women of the same ages, respectively 

(Table 36B). The disparities in rates of P&S syphilis among 

young men are of particular concern given data indicating 

increasing HIV incidence among young MSM.13

P&S Syphilis by Reporting Source

In 1990, 25.6% of P&S syphilis cases were reported from 

sources other than STD clinics; this figure increased to 

39.2% in 1998. During 1998–2013, the proportion 

of cases reported from sources other than STD clinics 

increased from 39.2% to 73.6% (Figure 43, Table A2). 

During 2004–2013, the number of cases among males 

reported from non-STD clinic sources increased steadily, 

while the number reported from STD clinics increased only 

slightly by comparison (Figure 43).

In 2013, patients with P&S syphilis were usually diagnosed 

by private physicians or STD clinics. Similar proportions of 

cases among MSM were reported from private physicians 

and STD clinics, while more cases among MSW were 

reported from STD clinics than from private physicians, 

and more cases among women were reported from private 

physicians than STD clinics (Figure 44). 

Congenital Syphilis—United States and 

by Region

For the first time since 2008, the rate of congenital syphilis 

increased, from 8.4 (in 2012) to 8.7 (in 2013) cases per 

100,000 live births (4%) (Table 1 and Table 42). This 

recent increase in the rate of congenital syphilis was largely 

driven by rate increases in the West (Table 42). This increase 

coincided with the increased rate of P&S syphilis in the 

West among females during 2010–2013 (Table 28). 

Syphilis among Special Populations

More information about syphilis and congenital syphilis in 

racial and ethnic minority populations, adolescents, MSM, 

and other populations at higher risk can be found in the 

Special Focus Profiles.

Syphilis Summary

In recent years, the highest rates of P&S syphilis have 

occurred among young men. According to information 

reported from 49 states and the District of Columbia, 

75% of P&S syphilis cases are among MSM. Although the 

majority of U.S. syphilis cases have occurred among MSM, 

transmission among MSW and women continues to occur 

in certain jurisdictions.
32 National Profile: Syphilis STD Surveillance 2013

 0

120

240

360

480

600

Year

1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Cases (in thousands)

Primary and Secondary

Early Latent

Total Syphilis

Figure 30. Syphilis — Reported Cases by Stage of Infection, United States, 1941–2013

 0

 2,000

 4,000

 6,000

 8,000

10,000

Year

2007 2008 2009 2010 2011 2012 2013

Cases

†

†

MSM

MSW

Women

Figure 31. Primary and Secondary Syphilis — Reported Cases by Sex and Sexual Behavior, 33 areas*, 

2007–2013

* 32 states and Washington, DC reported sex of partner data for ≥70% of reported cases of P&S syphilis for each year during 2007–2013. †

 MSM = men who have sex with men; MSW = men who have sex with women only.
STD Surveillance 2013 National Profile: Syphilis 33

 0

 5

 10

 15

 20

 25

Year

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012

1:1

2:1

4:1

8:1

16:1

Rate (per 100,000 population) Rate Ratio (log scale)

Male Rate

Female Rate

Total Rate

Male-to-Female Rate Ratio

Figure 32. Primary and Secondary Syphilis — Rates of Reported Cases by Sex and Male-to-Female 

Rate Ratios, United States, 1990–2013

 0

 2

 4

 6

 8

10

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Rate (per 100,000 population)

West

Midwest

Northeast

South

Figure 33. Primary and Secondary Syphilis — Rates of Reported Cases by Region, United States, 

2004–2013
34 National Profile: Syphilis STD Surveillance 2013

Rate per 100,000

population

Guam 3.8 

Puerto Rico 10.5 

Virgin Islands 1.9 

<=0.2

0.21-2.2

>2.2

(n= 1)

(n= 12)

(n= 41)

VT 0.5

NH 2.1

MA 5.4

RI 4.3

CT 1.6

NJ 2.6

DE 5.7

MD 7.7

DC 26.6

3.8

3.1

4.4 6.0

9.3 3.1

7.8

10.3

3.3

0.9

6.2 3.3

3.4

1.8 2.8

9.2

0.8

4.9

3.6

2.6

4.2

0.5

2.2 7.4

3.7

7.5

4.1

1.7

3.8

3.1

6.8

3.7

5.7

5.3

3.3

5.7

2.6

3.8

4.1

0.8

1.7

0.2

Figure 34. Primary and Secondary Syphilis — Rates of Reported Cases by State, United States and 

Outlying Areas, 2013

NOTE: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 5.6 per 100,000 

population.

Rate per 100,000

population

<=0.2 (n= 2,031)

0.21-2.2 (n= 363)

>2.2 (n= 748)

Figure 35. Primary and Secondary Syphilis — Rates of Reported Cases by County, United States, 

2013

NOTE: In 2013, 2,029 (64.6%) of 3,142 counties in the United States reported no cases of primary and secondary syphilis.
STD Surveillance 2013 National Profile: Syphilis 35

g

Men Rate (per 100,000 population) Women

25 20 15 10 5 0 0 5 10 15 20 25 Age

0.1 10-14 0.1

6.4 15-19 1.9

27.7 20-24 3.9

28.0 25-29 2.7

21.7 30-34 1.7

17.2 35-39 1.3

15.2 40-44 1.0

11.4 45-54 0.5

3.8 55-64 0.2

0.8 65+ 0.0

10.3 Total 0.9

Figure 36. Primary and Secondary Syphilis — Rates of Reported Cases by Age and Sex, United 

States, 2013

 0

 2

 4

 6

 8

 10

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Rate (per 100,000 population)

Age Group

15-19

20-24

25-29

30-34

35-39

40-44

Figure 37. Primary and Secondary Syphilis — Rates of Reported Cases Among Women Aged 15–44 

Years, by Age, United States, 2004–2013
36 National Profile: Syphilis STD Surveillance 2013

 0

 4

 8

 12

 16

 20

Year

2009 2010 2011 2012 2013

Rate (per 100,000 population)

AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

Figure 39. Primary and Secondary Syphilis — Rates of Reported Cases by Race/Ethnicity, United 

States, 2009–2013

* AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders.

NOTE: Includes 39 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats during 

2009–2013 (see Reporting of Data for Race/Ethnicity in the Appendix).

 0

 6

 12

 18

 24

 30

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Rate (per 100,000 population)

Age Group

15-19

20-24

25-29

30-34

35-39

40-44

Figure 38. Primary and Secondary Syphilis — Rates of Reported Cases Among Men Aged 15–44 

Years, by Age, United States, 2004–2013
STD Surveillance 2013 National Profile: Syphilis 37

Cases

†

Primary

Secondary

 0

 1600

 3200

 4800

 6400

MSW Women MSM†

Figure 40. Primary and Secondary Syphilis — Reported Cases* by Stage, Sex, and Sexual Behavior, 

2013

* Of the reported male cases of primary and secondary syphilis, 16.9% were missing sex of sex partner information.

†

 MSW = men who have sex with women only; MSM = men who have sex with men.

Cases

†

Whites

Blacks

Hispanics

Other

 0

 750

 1500

 2250

 3000

 3750

MSW Women MSM†

Figure 41. Primary and Secondary Syphilis — Reported Cases* by Sex, Sexual Behavior, and Race/

Ethnicity, United States, 2013

* Of the reported male cases of primary and secondary syphilis, 16.9% were missing sex of sex partner information; 2.9% of reported male cases with sex of sex

partner data were missing race/ethnicity data.

†

 MSW = men who have sex with women only; MSM = men who have sex with men. 
38 National Profile: Syphilis STD Surveillance 2013

 0

 3

 6

 9

 12

 15

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Cases (in thousands)

Non-STD Clinic, Men

Non-STD Clinic, Women

STD Clinic, Men

STD Clinic, Women

Figure 43. Primary and Secondary Syphilis — Reported Cases by Reporting Source and Sex, United 

States, 2004–2013

Cases

†

HIVHIV+

 0

 1000

 2000

 3000

 4000

MSW Women MSM†

Figure 42. Primary and Secondary Syphilis — Reported Cases by Sex, Sexual Behavior, and HIV 

status (positive or negative), 31 areas* , 2013

* 30 states and Washington, D.C. reported both sex of partner and HIV status for 70% or more cases during 2013.

†

 MSW = men who have sex with women only; MSM = men who have sex with men.
STD Surveillance 2013 National Profile: Syphilis 39

Percentage, %

†

Correctional Facility

HIV Counseling and Testing Site

Private Physician/HMO

STD Clinic

 0

 10

 20

 30

 40

MSW Women MSM†

†

CS* Cases (in thousands) P&S* Rate (per 100,000 women)

P&S Rate

CS Cases

0.0

0.2

0.4

0.6

0.8

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

0

1

2

3

4

Figure 44. Primary and Secondary Syphilis — Percentage of Reported Cases* by Sex, Sexual 

Behavior, and Selected Reporting Sources, 2013

* Of all cases, 5.6% had a missing or unknown reporting source. Among cases with a known reporting source the categories presented represent 74.0% of 

cases; 26.0% were reported from sources other than those shown.

†

 HMO = health maintenance organization; MSM = men who have sex with men; MSW = men who have sex with women only.

Figure 45. Congenital Syphilis — Reported Cases Among Infants by Year of Birth and Rates of 

Primary and Secondary Syphilis Among Women, United States, 2004–2013

* CS = congenital syphilis; P&S = primary and secondary syphilis.
40 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2013

Other Sexually Transmitted Diseases 

Chancroid

Reported cases of chancroid declined steadily between 

1987 and 2001. Since then, the number of reported cases 

has fluctuated (Figure 46, Table 1). In 2013, a total of 10 

cases of chancroid were reported in the United States. Only 

4 states reported one or more cases of chancroid in 2013 

(Table 44). 

Although the overall decline in reported chancroid cases 

most likely reflects a decline in the incidence of this disease, 

these data should be interpreted with caution because 

Haemophilus ducreyi, the causative organism of chancroid, 

is difficult to culture; as a result, this condition may be 

substantially underdiagnosed.1,2

Human Papillomavirus 

Human papillomavirus (HPV) is the most common 

sexually transmitted infection.3

 Over 40 distinct types 

can infect the genital tract;4

 about 90% of infections are 

asymptomatic and resolve spontaneously within 2 years.5

However, persistent infection with some HPV types can 

cause cancer and other benign diseases. Of the 13 HPV 

types designated as human carcinogens, types 16 and 

18 account for 70% of cervical cancers worldwide.6,7

Among non-carcinogenic types, types, HPV 6 and 11 are 

responsible for 90% of genital warts.8,9

A quadrivalent HPV vaccine that targets HPV 6, 11, 16 

and 18 has been licensed in the United States for use in 

females aged 9–26 years since June 2006,10 and in males 

aged 9–26 years since October 2009.11 In October 2009, a 

bivalent HPV vaccine against HPV 16 and 18 was licensed 

for use in females aged 10–25 years.12 Routine vaccination 

with either vaccine is recommended for females aged 11 or 

12 years, and through age 26 years for those not previously 

vaccinated.12 The quadrivalent vaccine is recommended for 

routine use in males aged 11 or 12 years and through age 21 

years for those not previously vaccinated.13

HPV vaccine uptake in the U.S. remains lower than the 

Healthy People 2020 goal of 80% coverage.14 In 2013, a 

national survey found that 57% of girls aged 13–17 years 

had received at least 1 dose of the HPV vaccine series, but 

only 38% had received all 3 doses in the series.15 Vaccine 

uptake is much lower among boys.15

National population-based data were obtained from the 

National Health and Nutrition Examination Survey 

(NHANES) to examine the prevalence of HPV vaccine 

types in the civilian, non-institutionalized female 

population during 2003–2006. HPV detection and 

typing were performed on self-collected cervicovaginal 

swab samples using the Research Use Only Linear Array 

genotyping assay (Roche Diagnostics). In the pre-vaccine 

era (2003–2006), the overall prevalence of any HPV was 

42.5% (95% CI: 40.3–44.7) among females aged 14–59 

years.16 Prevalence varied significantly by age, peaking in 

young women 20–24 years of age (Figure 47). 

Despite low vaccine coverage in the U.S., prevalence of 

quadrivalent HPV vaccine types 6, 11, 16, and/or 18 in 

cervicovaginal specimens decreased from 11.5% (95% CI: 

9.2–14.4) in the prevaccine era (2003–2006) to 5.1% (95% 

CI: 3.8–6.6) in the vaccine era (2007–2010) among females 

aged 14–19 years, the age group most likely to benefit from 

HPV vaccination (Figure 48). Among other age groups, 

vaccine-type HPV prevalence did not differ significantly 

between the 2 time periods.17

Data from the National Disease and Therapeutic Index 

(NDTI) suggest that cases of genital warts (Figure 49, 

Table 45), as measured by initial visits to physicians’ offices, 

may have increased during the late 1990s through 2011. 

Although the number of cases appears to have decreased 

in 2012 and 2013, compared to 2011, more years of data 

are needed to discern whether genital warts are declining, 

particularly since 2013 cases exceed those reported in 

2012. Prevalence of genital warts in a large U.S. cohort 

of individuals with private health insurance significantly 

declined in 2007 through 2010 among girls aged 15–19 

years. 18 Among women aged 20–24 years, genital wart 

prevalence, which had been increasing from 2003 through 

2007, was stable from 2007 to 2009 and then decreased in 

2010. Prevalence in women aged 25–29 increased through 

2009, but decreases in genital warts were also observed for 

this group in 2010 (Figure 50).18 These declines are what 

would be expected several years after initiating routine HPV 

vaccination for girls aged 11 to 12 years, with catch-up 

vaccination through age 26 years. Although genital wart 

prevalence in women aged 30–34 and 35–39 years did not 

continue to increase between 2009 and 2010, more years 

of data are needed to interpret these observations, as well 

as the observed decline in prevalence in 2010 for men aged 

20–24 years. NHANES data for 1999–2004 indicated that 

5.6% (95% CI: 4.9–6.4) of sexually active adults aged 18–

59 years self-reported a history of a genital wart diagnosis.19

For data reported in Figures 51 and 52, enhanced 
STD Surveillance 2013 National Profile: Other Sexually Transmitted Diseases 41

behavioral and demographic information on patients who 

presented for care in 2013 at the 42 clinics participating 

in the STD Surveillance Network (SSuN) was used. 

Genital warts were identified by provider diagnosis 

or by documentation from the physical examination. 

Gay, bisexual, and other men who have sex with men 

(collectively referred to as MSM) and men who have sex 

with women only (MSW) were defined by self-report or by 

sex of reported sex partners. For more detailed information 

about SSuN methodology, see the Appendix. Between 

2010 and 2013, 57,974 (4.6%) patients aged 12–82 years 

in the SSuN clinics were diagnosed with genital warts; 

among those patients, 17.0% were women, 20.5% were 

MSM and 62.5% were MSW. In 2013, the prevalence 

of diagnosed genital warts among MSM was 3.0 times 

that of women and the prevalence among MSW was 4.0 

times that of women, with similar male:female ratios for all 

years (Figure 51). MSW had a higher prevalence of genital 

warts compared to MSM across all years; during this time 

period, prevalence among MSW increased (6.8% to 7.4%), 

while prevalence among MSM decreased (6.3% to 5.5%). 

The proportion of women diagnosed with genital warts 

decreased slightly over time, from 1.9% in 2010 to 1.6% in 

2013 (Figure 51). The prevalence of genital warts in 2013 is 

presented separately for MSM, MSW, and women by SSuN 

site in Figure 52. Among women the median prevalence of 

genital warts was 1.4% (range 0.4 to 2.7) across all sites, 

compared to 3.8% (range 1.2 to 5.8) for MSM and 5.0% 

(range 1.9 to 8.5) for MSW.

Pelvic Inflammatory Disease 

For data on pelvic inflammatory disease, see Special Focus 

Profiles, STDs in Women and Infants. 

Herpes Simplex Virus 

Case reporting data for genital herpes simplex virus (HSV) 

are not available. Data on initial visits to physicians’ offices 

for this condition are available from NDTI (Figure 53, 

Table 45).

National trend data on the gender-specific seroprevalence 

of HSV-2 among those aged 14–49 years from NHANES 

were compared across survey years 1988–1994, 1999–2002, 

2003–2006, and 2007–2010 (Figure 54). Overall, HSV2 seroprevalence decreased between 1988–1994 and 

2007–2010, from 21.2% to 15.5%.20 Among non-Hispanic 

white females, HSV-2 seroprevalence decreased from 19.5% 

(1988–1994) to 15.3% (2007–2010; P<0.001); HSV2 seroprevalence remained stable among non-Hispanic 

black or African American (hereinafter referred to as black) 

females, from 52.5% (1988–1994) to 49.9% (2007–2010; 

P=0.1). These data, along with data from NHANES 

survey years 1976–1980,21 indicate that blacks had higher 

seroprevalence than whites for each survey period and age 

group. 

Although HSV-2 seroprevalence is decreasing, most persons 

with HSV-2 have not received a diagnosis. The overall 

percentage of HSV-2 seropositive NHANES participants 

who reported never being told by a doctor or health care 

professional that they had genital herpes did not change 

significantly between 1988–1994 and 2007–2010, and 

remained high (90.7% and 87.4%, respectively).20 However, 

an overall increase in the number of visits for genital 

herpes over time, as suggested by NDTI data, may indicate 

increased recognition of infection.

Neonatal HSV Infections, although relatively rare, cause 

significant morbidity and mortality. An examination of 

inpatient records of infants aged 60 days or younger at 

admission using the Healthcare Cost and Utilization Project 

Kid’s Inpatient Database showed an overall incidence of 9.6 

cases per 100,000 live births in 2006.22 Rates did not vary 

significantly by region or race/ethnicity, however prevalence 

was significantly higher among cases for which the expected 

primary payer was Medicaid (15.1 per 100,000; 95% CI: 

12.1–18.1) compared with private insurance or managed 

health care (5.4 per 100,000; 95% CI: 4.0-6.8).

Trichomoniasis

Trend data for this infection are limited to estimates of 

initial physician office visits from the NDTI (Figure 55, 

Table 45). NHANES data from 2001–2004 indicated 

an overall trichomoniasis prevalence of 3.1% (95% CI: 

2.3–4.3), with the highest prevalence observed among 

blacks (13.3%; 95% CI: 10.0-17.7).23
42 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2013

1 Schulte JM, Martich FA, Schmid GP. Chancroid in the United 

States, 1981–1990: evidence for underreporting of cases. MMWR 

Morb Mortal Wkly Rep. 1992;41(SS-3):57–61.

2 Mertz KJ, Trees D, Levine WC, Lewis JS, Litchfield B, Pettus 

KS, et al. Etiology of genital ulcers and prevalence of human 

immunodeficiency virus coinfection in 10 US cities. J Infect Dis. 

1998;178(6):1795–8.

3 Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, 

Banez Ocefemia MC, et al. Sexually transmitted infections among 

US women and men: prevalence and incidence estimates, 2008. 

Sex Transm Dis. 2013;40(3):187–93.

4

 Bouvard V, Baan R, Straif K, Grosse Y, Secretan B, El Ghissassi F, 

et al. A review of human carcinogens — part B: biological agents. 

Lancet Oncol. 2009;10:321–2.

5

 Ho GYF, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural 

history of cervicovaginal papillomavirus infection in young 

women. N Engl J Med. 1998;338(7);423–8.

6 Clifford GM, Smith JS, Plummer M, Munoz N, Franceschi 

S. Human papillomavirus types in invasive cervical cancer 

worldwide: a meta-analysis. Br J Cancer. 2003;88(1):63–73.

7 Bosch FX, Manos MM, Munoz N, Sherman M, Jansen AM, Peto 

J, et al. Prevalence of human papillomavirus in cervical cancer: a 

worldwide perspective. J Natl Cancer Inst. 1995;87(11):796–802.

8 Garland SM, Steben M, Sings HL, James M, Lu S, Railkar R, 

et al. Natural history of genital warts: analysis of the placebo 

arm of 2 randomized phase III trials of a quadrivalent human 

papillomavirus (types 6, 11, 16, and 18) vaccine. J Infect Dis. 

2009;199(6):805–14.

9 Gissmann L, Wolnik L, Ikenberg H, Koldovsky U, Schnurch 

HG, zur Hausen H. Human papillomavirus types 6 and 11 DNA 

sequences in genital and laryngeal papillomas and in some cervical 

cancers. Proc Natl Acad Sci USA. 1983;80(2):560–3.

10 Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson 

H, Unger ER. Quadrivalent human papillomavirus vaccine. 

Recommendations of the Advisory Committee on Immunization 

Practices (ACIP). MMWR Morb Mortal Wkly Rep. 

2007;56(RR02):1–24.

11 Centers for Disease Control and Prevention. FDA licensure of 

quadrivalent human papillomavirus vaccine (HPV4, Gardasil) 

for use in males and guidance from the Advisory Committee on 

Immunization Practices (ACIP). MMWR Morb Mortal Wkly 

Rep. 2010;59(20):630–2.

12 Centers for Disease Control and Prevention. FDA licensure of 

bivalent human papillomavirus vaccine (HPV2, Cervarix) for use 

in females and updated HPV vaccination recommendations from 

the Advisory Committeee on Immunization Practices (ACIP). 

MMWR Morb Mortal Wkly Rep. 2010;59(20):626–9. 

13 Centers for Disease Control and Prevention. Recommendations on 

the use of quadrivalent human papillomavirus vaccine in males — 

Advisory Committee on Immunization Practices (ACIP), 2011. 

MMWR Morb Mortal Wkly Rep. 2011;60(50):1705–8.

14 HealthyPeople.gov. 2020 Topics & Objectives. Immunization and 

Infectious Diseases. Objectives. IID-11.4. Increase the vaccination 

coverage level of 3 doses of human papillomavirus (HPV) vaccine 

for females by age 13 to 15 years. http://www.healthypeople.

gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=23, 

Accessed May 15, 2014 .

15 Stokley S, Jeyarajah J, Yankey D, Cano M, Gee J, Roark J, et al. 

Human papillomavirus vaccination coverage among adolescents, 

2007–2013, and postlicensure vaccine safety monitoring, 

2006–2014 — United States. MMWR Morb Mortal Wkly Rep. 

2014;63(29):620–4. 

16 Hariri S, Unger ER, Sternberg M, Dunne EF, Swan D, Patel S, et 

al. Prevalence of genital human papillomavirus among females in 

the United States, the National Health and Nutrition Examination 

Survey, 2003–2006. J Infect Dis. 2011;204(4):566–73.

17 Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, McQuillan 

G, et al. Reduction in human papillomavirus (HPV) prevalence 

among young women following HPV vaccine introduction in 

the United States, National Health and Nutrition Examination 

Surveys, 2003–2010. J Infect Dis. 2013;208(3):385–93. 

18 Flagg EW, Schwartz R, Weinstock H. Prevalence of anogenital 

warts among participants in private health plans in the United 

States, 2003–2010: potential impact of human papillomavirus 

vaccination. Am J Public Health. 2013;103(8):1428–35. 

19 Dinh TH, Sternberg M, Dunne EF, Markowitz LE. Genital warts 

among 18- to 59-year-olds in the United States, National Health 

and Nutrition Examination Survey, 1999–2004. Sex Transm Dis. 

2008;35(4):357–60.

20 Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz 

L. Trends in seroprevalence of herpes simplex virus type 2 

among non-Hispanic blacks and non-Hispanic whites aged 14 

to 49 years — United States, 1988 to 2010. Sex Transm Dis. 

2013;40(11):860–4.

21 Xu F, Sternberg MR, Kottiri BJ, McQuillan GM, Lee FK, 

Nahmias AJ, et al. Trends in herpes simplex virus type 1 and type 

2 seroprevalence in the United States. JAMA. 2006;296(8):964–

73.

22 Flagg EW, Weinstock H. Incidence of neonatal herpes 

simplex virus infections in the United States, 2006. Pediatrics 

2011;172(1):e1–8.

23 Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman S, 

Markowitz L. The prevalence of Trichomonas vaginalis infection 

among reproductive-age women in the United States, 2001–2004. 

Clin Infect Dis. 2007;45(10):1319–26.
STD Surveillance 2013 National Profile: Other Sexually Transmitted Diseases 43

 0

 1

 2

 3

 4

 5

Year

1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

Cases (in thousands)

Figure 46. Chancroid — Reported Cases by Year, United States, 1981–2013

Prevalence, %

Age Group

Low-risk HPV*

High-risk HPV*

0

10

20

30

40

50

60

14-19 20-24 25-29 30-39 40-49 50-59

Figure 47. Human Papillomavirus — Cervicovaginal Prevalence of High-risk and Low-risk Types 

Among Women Aged 14–59 Years by Age Group, National Health and Nutrition 

Examination Survey, 2003–2006

* HPV = human papillomavirus.

NOTE: Error bars indicate 95% confidence interval. Both high-risk and low-risk HPV types were detected in some females.

SOURCE: Hariri S, Unger ER, Sternberg M, Dunne EF, Swan D, Patel S, et al. Prevalence of genital human papillomavirus among females in the United States, 

the National Health and Nutrition Examination Survey, 2003–2006. J Infect Dis. 2011;204(4):566–73.
44 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2013

 0

100

200

300

400

500

Year

1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Visits (in thousands)

Figure 49. Genital Warts — Initial Visits to Physicians’ Offices, United States, 1966–2013

NOTE: The relative standard errors for genital warts estimates of more than 100,000 range from 18% to 23%. See Other Surveillance Data Sources in the 

Appendix and Table 45.

SOURCE: IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966–2013. 

Prevalence, %

Age Group

2003-2006

2007-2010

0

5

10

15

20

25

30

14-19 20-24 25-29 30-39 40-49 50-59

Figure 48. Human Papillomavirus — Cervicovaginal Prevalence of Types 6, 11, 16, and 18 Among 

Women Aged 14–59 Years by Age Group and Time Period, National Health and Nutrition 

Examination Survey, 2003–2006 and 2007–2010

NOTE: Error bars indicate 95% confidence interval.

SOURCE: Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, McQuillan G, et al. Reduction in human papillomavirus (HPV) prevalence among young women 

following HPV vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003–2010. J Infect Dis. 2013;208(3):385–93.
STD Surveillance 2013 National Profile: Other Sexually Transmitted Diseases 45

 0

 2

 4

 6

 8

 10

Year

2003

2004

2005

2006

2007

2008

2009

2010

Prevalence

Females

 0

 2

 4

 6

 8

 10

Year

2003 2004 2005 2006 2007 2008 2009 2010

Prevalence

Males

10-14

15-19

20-24

25-29

30-34

35-39

Age Group

Figure 50. Genital Warts — Prevalence per 1000 Person-Years Among Participants in Private Health 

Plans Aged 10–39 Years by Sex, Age Group, and Year, 2003–2010

SOURCE: Flagg EW, Schwartz R, Weinstock H. Prevalence of anogenital warts among participants in private health plans in the United States, 2003–2010: 

potential impact of human papillomavirus vaccination. Am J Public Health. 2013;103(8):1428–35.

Prevalence, %

MSM*

MSW*

Women

 0

 3

 6

 9

 12

 15

2010 2011 2012 2013

Figure 51. Genital Warts — Prevalence Among STD Clinic Patients by Sex, Sex of Partners, and Year, 

STD Surveillance Network (SSuN), 2010-2013

* MSM = men who have sex with men; MSW = men who have sex with women only. 

NOTE: In 2013, six jurisdictions (Birmingham, Chicago, Denver, Hartford/New Haven, New Orleans, and Richmond) contributed data from January through 

June 2013 and the remaining jurisdictions (Baltimore, Los Angeles, New York City, Philadelphia, San Francisco and Seattle) contributed data for all of 2013.
46 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2013

Prevalence, %

MSM*

MSW*

Women

 0

 3

 6

 9

 12

 15

Seattle San

Francisco

Los

Angeles

Denver Chicago New

Orleans

Birmingham  

Richmond

Baltimore  

Philadelphia

New York

City

Hartford/

New Haven

Figure 52. Genital Warts — Prevalence Among STD Clinic Patients by Sex, Sex of Partners, and Site, 

STD Surveillance Network (SSuN), 2013

* MSM = men who have sex with men; MSW = men who have sex with women only. 

NOTE: In 2013, six jurisdictions (Birmingham, Chicago, Denver, Hartford/New Haven, New Orleans, and Richmond) contributed data from January through June 

2013 and the remaining jurisdictions (Baltimore, Los Angeles, New York City, Philadelphia, San Francisco and Seattle) contributed data for all of 2013.

 0

 80

160

240

320

400

Year

1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Visits (in thousands)

Figure 53. Genital Herpes — Initial Visits to Physicians’ Offices, United States, 1966–2013

NOTE: The relative standard errors for genital herpes estimates of more than 100,000 range from 19% to 23%. See Other Surveillance Data Sources in the 

Appendix and Table 45.

SOURCE: IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966–2013. 
STD Surveillance 2013 National Profile: Other Sexually Transmitted Diseases 47

NOTE: The relative standard errors for trichomoniasis estimates range from 16% to 21% and for other vaginitis estimates range from 8% to 13%. See Other 

Surveillance Data Sources in the Appendix and Table 45.

SOURCE: IMS Health, Integrated Promotional ServicesTM, IMS Health Report, 1966–2013.

Prevalence, %

1988-1994

1999-2002

2003-2006

2007-2010

0

20

40

60

80

All Ages 14-19 20-29 30-39 40-49

Prevalence, %

0

20

40

60

80

All Ages 14-19 20-29 30-39 40-49

Prevalence, %

0

20

40

60

80

All Ages 14-19 20-29 30-39 40-49

Prevalence, %

0

20

40

60

80

All Ages 14-19 20-29 30-39 40-49

Non-Hispanic Black Males

Non-Hispanic Black Females

Non-Hispanic White Males

Non-Hispanic White Females

Age Group Age Group

Age Group Age Group

 0

 900

1,800

2,700

3,600

4,500

Year

1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Visits (in thousands)

Trichomoniasis

Other Vaginitis

Figure 54. Herpes Simplex Virus Type 2 — Seroprevalence Among Non-Hispanic Whites and NonHispanic Blacks by Sex and Age Group, National Health and Nutrition Examination 

Surveys, 1988–1994, 1999–2002, 2003–2006, and 2007–2010

NOTE: Error bars indicate 95% confidence interval.

SOURCE: Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz L. Trends in seroprevalence of herpes simplex virus type 2 among non-Hispanic blacks 

and non-Hispanic whites aged 14 to 49 years — United States, 1988 to 2010. Sex Transm Dis. 2013;40(11):860–4. 

Figure 55. Trichomoniasis and Other Vaginal Infections Among Women — Initial Visits to 

Physicians’ Offices, United States, 1966–2013
48 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2013
SPECIAL FOCUS PROFILES
SPECIAL FOCUS PROFILES
STD Surveillance 2013 Special Focus Profiles 49

Special Focus Profiles

The Special Focus Profiles highlight trends and distribution of STDs in populations of particular interest to STD and HIV 

prevention programs in state and local health departments: women and infants, adolescents and young adults, racial and 

ethnic minority groups, and gay and bisexual men and other men who have sex with men (MSM). These populations are 

most vulnerable to STDs and their consequences and often lack adequate access to healthcare services. In 2013, in the 

U.S., age was strongly associated with having health insurance. Older adults (65 years and older) and children (19 years and 

under) were most likely to have health insurance. Working adults (19 years to 64 years) had higher uninsured rates. The 

rates of non-insured for whites, blacks, and Hispanics were: 9.8%, 15.9%, and 24.3% respectively.1

 The Patient Protection 

and Affordable Care Act (ACA) aims to increase access to sexual and reproductive health services through reforms based on 

the U.S. Preventive Services Task Force recommendations that include: chlamydia and gonorrhea screening (for sexually 

active women under 25 and all higher risk women), HIV screening (everyone 15–65 years old, pregnant, and higher risk), 

STD counseling (for all sexually active adolescents and higher-risk adults), and syphilis screening (for pregnant women and 

adults at higher risk).2

 However, although health insurance coverage has been expanded for most groups, including both 

men and women, and for most race and ethnic groups, evidence suggests that disparities in health insurance coverage and 

access to STD services remain.3-4

1

 Smith, J and Medalia, Carla. U.S. Census Bureau, Current Population Reports, P60-250, Health Insurance Coverage in the United States: 

2013, U.S. Government Printing Office, Washington, DC, 2014.

2

 Oglesby, WH. Perceptions of and preferences for federally-funded family planning clinics. Reproductive Health 2014; 11(50)1-9. 

http://www.reproductive-health-journal.com/content/11/1/50

3

 O’Hara, B and Brault, MW. The disparate impact of the ACA-dependent expansion across population subgroups. Health Serv Res. 2013 

Oct;48(5):1581-92.

4

 Drainoni, M, Sullivan, M, Sequeira, S, Bacic, J, and Hsu, K. Health reform and shifts in funding for sexually transmitted infection 

services. Sexually Transmitted Diseases 41(7), July 2014, p 455–460.
50 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2013

STDs in Women and Infants

Public Health Impact

Women and infants bear significant long-term consequences 

of STDs. In addition to biological and social factors such 

as poverty and access to quality STD services, a woman’s 

inability to negotiate safer sexual practices, such as condom 

use, can significantly affect her sexual health and subsequently 

the health of her unborn baby.1,2 A woman’s relationship 

status with her male partner, in particular, has been identified 

as an important predictor of her sexual health.3

 For example, 

a perceived shortage of available men in a community 

can cause women to be more accepting of their partners’ 

concurrent sexual relationships, and partner concurrency is a 

factor associated with increased risk for STDs.4

 A number of 

studies have found significant associations between condom 

use and socio-demographic characteristics, including age, 

income, education, and acculturation.5 Because it may be 

the behavior of her male partner, rather than the woman’s 

own behavior that increases a woman’s risk for STDs, even a 

woman who has only one partner may be obliged to practice 

safer sex such as using condoms.6

Women infected with C. trachomatis or N. gonorrhoeae

can develop pelvic inflammatory disease (PID), which, in 

turn, can lead to reproductive morbidity such as ectopic 

pregnancy and tubal factor infertility. An estimated 10%–

20% of women with chlamydia or gonorrhea may develop 

PID if they do not receive adequate treatment.7,8 Among 

women with PID, tubal scarring can cause infertility in 8% 

of women, ectopic pregnancy in 9%, and chronic pelvic 

pain in 18%.9

About 80%–90% of chlamydial infections10 and up to 80% 

of gonococcal infections11 in women are asymptomatic.

These infections are detected primarily through screening. 

Because the symptoms associated with PID can be 

nonspecific, up to 85% of women with PID delay seeking 

medical care, thereby increasing the risk for infertility and 

ectopic pregnancy.12 Data from two randomized controlled 

trials of chlamydia screening suggest that such screening 

programs reduce PID incidence. 13,14

HPV infections are highly prevalent in the United States, 

especially among young sexually active women. Although 

most HPV infections in women resolve within 2 years, 

they are a major concern because persistent infection with 

specific types of the virus are causally related to cervical 

cancer; these types also cause Papanicolaou (Pap) smear 

abnormalities. Other types cause genital warts, low-grade 

Pap smear abnormalities, and, rarely, recurrent respiratory 

papillomatosis in infants born to infected mothers.15

Direct Impact on Pregnancy

Chlamydia and gonorrhea can result in adverse outcomes 

of pregnancy, including neonatal ophthalmia and, in the 

case of chlamydia, neonatal pneumonia. Although topical 

prophylaxis of infants at delivery is effective for prevention 

of gonococcal ophthalmia neonatorum, prevention of 

neonatal pneumonia requires prenatal detection and 

treatment.

Genital infections with HSV are extremely common, can 

cause painful outbreaks, and can have serious consequences 

for pregnant women and their infants.16

When a woman has a syphilis infection during pregnancy, 

she can transmit the infection to the fetus in utero. 

Transmission can result in fetal death or an infant born with 

physical and mental developmental disabilities. Most cases 

of congenital syphilis are easily preventable if women are 

screened for syphilis and treated early during prenatal care.17

Observations

Chlamydia—United States 

Chlamydial infections in women are usually asymptomatic 

and screening is necessary to identify most infections.18

Routine chlamydia screening of sexually-active young 

women has been recommended by CDC since 1993.19 

Rates of reported cases among women increased steadily 

from the early 1990s until 2011, which likely reflect 

expanded screening coverage and use of more sensitive 

diagnostic tests (Figure 1). During 2011–2012, reported 

case rates among women decreased slightly (0.7%) from 

643.4 cases to 638.7 cases per 100,000 females. During 

2012–2013, rates decreased 2.4% to 623.1 cases per 

100,000 females (Table 4).

Chlamydia rates are highest among young women, the 

population targeted for screening (Figure 5, Table 10). 

During 2012–2013, rates of reported chlamydia decreased 

8.7% among females aged 15–19 years and decreased 0.3% 

among females aged 20–24 years. Regionally, chlamydia 

case rates are highest among women in the South, with 

a rate of 690.5 per 100,000 females in 2013 (Table 4). 

During 2012–2013, rates of reported chlamydia among 

women decreased in all regions (Table 4). Rates of reported 

chlamydia exceeded gonorrhea rates among women in all 

regions (Figures A and B, Tables 4 and 15).
STD Surveillance 2013 Special Focus Profiles: STDs in Women and Infants 51

Gonorrhea—United States 

Like chlamydia, gonorrhea is often asymptomatic in 

women. Thus, gonorrhea screening is an important strategy 

for the identification of gonorrhea among women. Largescale screening programs for gonorrhea in women began in 

the 1970s. After an initial increase in cases detected through 

screening, rates of reported gonorrhea cases for both women 

and men declined steadily throughout the 1980s and early 

1990s and then declined more gradually in the late 1990s 

and the 2000s (Figure 11). After reaching a 40-year low in 

2009 (104.5 cases per 100,000 females), the gonorrhea rate 

for women increased slightly each year during 2009–2011, 

and plateaued at 107.9 cases per 100,000 females in 2012. 

In 2013, the gonorrhea rate among women decreased to 

102.4 cases per 100,000 females (Figure 12, Table 15).

The gonorrhea rate among women was slightly higher than 

the rate among men during 2001–2012, but the rate among 

men surpassed the rate among women in 2013 (Figure 

12, Tables 15 and 16). Gonorrhea rates are highest among 

young women (Figure 16, Table 21). Among young women 

and adolescents, rates were highest in 2013 among 19-year 

old females (685.6 per 100,000 females) (Table 23). 

Positivity in Selected Populations

During the mid-1990s to 2011, chlamydia and gonorrhea 

positivity among young women screened in prenatal care 

clinics participating in infertility prevention activities were 

reported to CDC to monitor chlamydia and gonorrhea 

prevalence in women. As the national infertility prevention 

program expanded, these data became difficult to interpret 

as trends were influenced by changes in screening coverage, 

screening criteria, and test technologies, as well as 

demographic changes in patients attending clinics reporting 

data to CDC. These issues could not be addressed with the 

limited variables that were collected at the national level. 

Positivity data continue to be useful locally to inform clinicbased screening recommendations and to identify at-risk 

populations in need of prevention interventions, but are no 

longer collected to monitor national trends in chlamydia 

and gonorrhea.

Congenital Syphilis

Trends in congenital syphilis usually follow trends in 

primary and secondary syphilis among women, with a 

lag of 1–2 years (Figure 45). The rate of P&S syphilis 

among women declined 95.4% (from 17.3 to 0.8 cases 

per 100,000 females) during 1990–2004 (Figure 32). The 

rate of congenital syphilis declined by 92.4% (from a peak 

of 107.6 cases to 8.2 cases per 100,000 live births) during 

1991–2005 (Table 1). Rates of both female P&S and 

congenital syphilis increased during 2005–2008. During 

2008–2012, rates of both female P&S and congenital 

syphilis declined (from 1.5 to 0.9 cases per 100,000 

population and from 10.5 to 8.4 cases per 100,000 live 

births, respectively). Rates of female P&S remained 

unchanged (0.9 cases) but rates of congenital syphilis 

increased (to 8.7 cases) during 2013 (Tables 28 and 42). 

The highest rates of P&S syphilis among women and 

congenital syphilis were observed in the South (Figures C 

and D, Table 42). However, the West was the only region 

with increased rates of congenital syphilis in 2013, and rates 

of P&S syphilis among women in the West have increased 

each year during 2010–2013.

Although most cases of congenital syphilis occur among 

infants whose mothers have had some prenatal care, 

late or limited prenatal care has been associated with 

congenital syphilis. Failure of health care providers to 

adhere to maternal syphilis screening recommendations also 

contributes to the occurrence of congenital syphilis.20

Pelvic Inflammatory Disease 

Accurate estimates of PID and tubal factor infertility 

resulting from chlamydial and gonococcal infections are 

difficult to obtain, in part because definitive diagnoses of 

these conditions can be complex. Published data suggest 

overall declining rates of women diagnosed with PID in the 

United States in both hospital and ambulatory settings.21-23

The National Disease and Therapeutic Index (NDTI) 

provides estimates of initial visits to office-based, private 

physicians for PID. NDTI estimated that from 2003–2012 

the number of visits to such physicians for PID among 

women aged 15–44 decreased (39.8%) from 123,000 

to 88,000 visits (Figure F). Several suggestions have 

been put forth as factors that could influence PID rates, 

including increases in chlamydia and gonorrhea screening 

coverage, more sensitive diagnostic technologies, and 

availability of single-dose therapies that increase adherence 

to treatment.22-24 While PID is declining nationally, it still 

causes an enormous amount of unnecessary and expensive 

morbidity.

Differences in PID diagnoses or treatment by race/ethnicity 

have been observed in earlier research.21 Using data from the 

National Survey of Family Growth, the overall proportion 

of sexually experienced women who have been treated for 

PID declined from 8.6% in 1995 to 5.7% in 2002 and 

leveled off to 5.0% in 2006–2010 (Figure E).25 While this 

pattern was observed across all racial/ethnic groups, the 

proportion who had received PID treatment was higher 

among non-Hispanic blacks than those among Hispanics 

or non-Hispanic whites. These disparities are consistent 
52 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2013

with the marked racial disparities observed for chlamydia 

and gonorrhea. However, because of the subjective methods 

by which PID is diagnosed, racial disparity data should be 

interpreted with caution.

Ectopic Pregnancy

Ectopic pregnancy (EP) is a potentially life-threatening 

adverse pregnancy outcome that requires prompt evaluation 

and treatment, and an important cause of pregnancy related 

mortality. Past studies have found that it affects 1–2% of 

all pregnancies.26-27 Fallopian tube pathology is the most 

common etiology of EP.28 Tubal damage can result from 

tubal surgery, previous EP, untreated STDs and PID, in 

utero diethylstilbestrol exposure, and other conditions. 29–33

In the past, the National Hospital Discharge Survey, which 

collects information on discharged hospital inpatients in the 

United States, was used to estimate trends in the rate of EP. 

However, medical and surgical treatment of EP is currently 

provided in both inpatient and outpatient settings, making 

the task of tracking reliable estimates at the national level 

difficult.34 More recent attempts to estimate EP incidence 

use data from surveys or administrative databases of public 

and private insurance and managed care systems.35 Data 

from a large administrative claims database suggests the 

rate of EP increases with age among pregnancies in girls 

and women aged 15–44 years during the period of 2002 

to 2012 (Figure G). In 2012, EP rates were highest among 

women aged 35–44 years. During 2002–2012, the EP 

rate increased slightly in certain age groups: the EP rate 

increased 5.7% among those aged 20–24, 11.3% among 

those aged 25–29 years, 4.3% among those aged 35–39 

years, and 6.4% among those aged 40–44 years. Rates 

remained the same for women of all other age groups.

1 Pulerwitz J, Amaro H, De Jong W, Gortmaker SL, Rudd R. 

Relationship power, condom use and HIV risk among women in 

the USA. AIDS Care. 2002;14(6):789-800.

2 McCree DH, Rompalo A. Biological and behavioral risk factors 

associated with STDs/HIV in women: implications for behavioral 

interventions, In: Aral SO, Douglas JM,Lipshutz JA (editors). 

Behavioral Interventions for Prevention and Control of Sexually 

Transmitted Diseases (p. 310-324). New York, NY: Springer. 

3 El-Bassel N, Gilbert L, Krishnan S, Schilling R, Gaeta T, Purpura 

S, et al. Partner violence and sexual HIV-Risk behaviors among 

women in an inner-city emergency department. Violence Vict. 

1998;13(4):377-393.

4 Hogben M, Leichliter JS. Social determinants and sexually 

transmitted disease disparities. Sex Transm Dis. 35(12) S13 S18.

5 Manderson L, Chang T, Tye LC, Rajanayagam K. Condom use in 

heterosexual sex: a review of research, 1985–1994. In: Catalan J, 

Sherr L, Hedge B (editors). The impact of AIDS: psychological and 

social aspects of HIV Infection. p. 1-26. The Netherlands: Harwood 

Academic Publishers.

6 O’Leary A. A woman’s risk for HIV from a primary partner: 

balancing risk and intimacy. Annu Rev Sex Res. 2000; 11:191 234. 

7 Paavonen J, Westrom L, Eschenbach. Pelvic Inflammatory 

Disease. In: Holmes KK, Sparling PF, Stamm WE, Piot P, 

Wasserheit JN, Corey L, Cohen, MS, Watts DH, (editors). Sex 

Transm Dis. 4th ed. New York: McGraw-Hill; 2008:1017-1050. 

8 Hook EW III, Handsfield HH. Gonococcal infections in the 

adult. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit 

JN, Corey L, et al, (editors). Sex Transm Dis. 4th ed. New York: 

McGraw-Hill; 2008:627-45.

9 Westrom L, Joesoef R, Reynolds G, Hagdu A, Thompson SE. 

Pelvic inflammatory disease and fertility: a cohort study of 1,844 

women with laparoscopically verified disease and 657 control 

women with normal laparoscopy. Sex Transm Dis. 1992;9:185-92.

10 Stamm WE. Chlamydia trachomatis infections in the adult. In: 

Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, 

Corey L, et al, (editors). Sex Transm Dis. 4th ed. New York: 

McGraw-Hill; 2008:575-93.

11 Marrazzo JM, Handsfield HH, Sparling PF. Neisseria gonorrhoeae

In: Mandell GL, Bennett JE, Dolin R (editors). Principles and 

practice of Infectious Diseases, 7th ed. Philadelphia, PA: Churchill 

Livingstone; 2010: 2753-2770.

12 Hillis SD, Joesoef R, Marchbanks PA, Wasserheit JN, Cates 

W Jr, Westrom L. Delayed care of pelvic inflammatory disease 

as a risk factor for impaired fertility. Am J Obstet Gynecol. 

1993;168:1503-9.

13 Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes 

KK, Stamm WE. Prevention of pelvic inflammatory disease 

by screening for cervical chlamydial infection. N Engl J Med. 

1996;34(21):1362-6.

14 Oakeschott, P, Kerry S, Aghaizu A, Atherton H, Hay S, et 

al. Randomised controlled trial of screening for Chlamydia 

trachomatis to prevent pelvic inflammatory disease: the POPI 

(prevention of pelvic infection) trial. BMJ. 2010;340:c1642.

15 Centers for Disease Control and Prevention. Prevention of genital 

HPV infection and sequelae: report of an external consultants’ 

meeting. Atlanta: U.S. Department of Health and Human 

Services; 1999.

16 Kimberlin DW. Herpes simplex virus infections of the newborn. 

Semin Perinatol. 2007;31(1):19-25.

17 Centers for Disease Control and Prevention. Guidelines for 

prevention and control of congenital syphilis. MMWR Morb 

Mortal Wkly Rep. 1988;37(No. SS-1).

18 Farley TA, Cohen DA, Elkins W. Asymptomatic sexually 

transmitted diseases: the case for screening. preventive medicine. 

2003;36:502-9. 
STD Surveillance 2013 Special Focus Profiles: STDs in Women and Infants 53

27 Van Den Eeden SK, Shan J, Bruce C, Glasser M. Ectopic 

pregnancy rate and treatment utilization in a large managed care 

organization. Obstet Gynecol 2005;105:1052–7.

28 Medical management of ectopic pregnancy. ACOG Practice 

Bulletin No. 94. American College of Obstetricians and 

Gynecologists.Obstet Gynecol 2008;111:1479–85.

29 Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors 

for ectopic pregnancy: a meta-analysis. Fertil Steril 1996;65:1093–9.

30 Barnhart KT, Sammel MD, Gracia CR, Chittams J, Hummel 

AC, Shaunik A. Risk factors for ectopic pregnancy in women with 

symptomatic first-trimester pregnancies. Fertil Steril 2006;86:36–

43.

31 Marchbanks PA, Annegers JF, Coulam CB, Strathy JH, Kurland 

LT. Risk factors for ectopic pregnancy. A population-based study. 

JAMA 1988;259:1823–7.

32 Centers for Disease Control and Prevention. DES update home. 

Available at http://www.cdc.gov/DES/. Retrieved August 5, 2014.

33 Clayton HB, Schieve LA, Peterson HB, Jamieson DJ, Reynolds 

MA, Wright VC. Ectopic pregnancy risk with assisted 

reproductive technology procedures. Obstet Gynecol 2006;107: 

595–604.

34 Zane SB, Kieke BA Jr, Kendrick JS, Bruce C. Surveillance in 

a time of changing health care practices: estimating ectopic 

pregnancy incidence in the United States. Matern Child Health J 

2002;6:227–36..

35 Hoover KW, Tao G, Kent CK. Trends in the diagnosis and 

treatment of ectopic pregnancy in the United States. Obstet 

Gynecol. 2010;3(115):495-502.

19 Centers for Disease Control and Prevention. Recommendations 

for the prevention and management of Chlamydia trachomatis

infections. 1993 Aug 6;42(RR-12):1-39. 

20 Centers for Disease Control and Prevention. Congenital syphilis 

— United States, 2003–2008. MMWR Morb Mortal Wkly Rep. 

2010;59:413-17.

21 Sutton MY, Sternberg M, Zaidi A, St. Louis ME, Markowitz LE. 

Trends in pelvic inflammatory disease hospital discharges and 

ambulatory visits, United States, 1985–2001. Sex Transm Dis. 

2005;32(12)778-84.

22 Bohm MK, Newman L, Satterwhite CL, et al. Pelvic 

inflammatory disease among privately insured women, United 

States, 2001–2005. Sex Transm Dis 2010;37:131–136.

23 Whiteman MK, Kuklina E, Jamieson DJ, et al. Inpatient 

hospitalization for gynecologic disorders in the United States. Am 

J Obstet Gynecol 2010;202:541 e1–6. 

24 Owusu-Edusei, Kwame Jr. Bohm, Michele K. Chesson, Harrell W. 

Kent, Charlotte K. Chlamydia screening and pelvic inflammatory 

disease: Insights from exploratory time-series analyses. Am J Prev 

Med. 2010;38(6):652-7.

25 Leichliter JS. Chandra A. Aral SO. Correlates of self-reported 

pelvic inflammatory disease treatment in sexually experienced 

reproductive-aged women in the United States, 1995 and 2006-

2010. Sex Transm Dis. 2013;40(5):413-8.

26 Ectopic pregnancy–United States, 1990–1992. MMWR Morb 

Mortal Wkly Rep 1995;44:46–8.
54 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2013

Rate per 100,000

population

Guam 889 

Puerto Rico 250 

Virgin Islands 1034 

<=400.0

400.1-600.0

>600.0

(n= 5)

(n= 23)

(n= 26)

VT 416

NH 327

MA 463

RI 562

CT 500

NJ 457

DE 786

MD 628

DC 1198

850

1113

666 755

588 555

574

721

673

487

698 612

510

574 544

905

354

637

478

826

629

540

530 598

858

639

743

559

649

679

505

546

787

673

637

739

356

556

505

386

571

492

Rate per 100,000

population

Guam 54.6 

Puerto Rico 6.3 

Virgin Islands 73.2 

<=19.0

19.1-100.0

>100.0

(n= 6)

(n= 27)

(n= 21)

VT 14.5

NH 7.8

MA 34.1

RI 35.4

CT 77.1

NJ 76.7

DE 161.4

MD 93.6

DC 285.9

188.0

168.2

94.1 143.9

74.6 48.1

98.5

139.3

38.2

10.9

130.8 114.4

52.4

84.2 104.9

209.7

17.5

116.5

75.3

177.5

128.4

25.4

74.4 88.0

78.2

79.6

151.0

87.5

155.5

155.8

28.8

110.3

166.9

111.8

109.4

131.2

26.3

88.3

49.3

57.3

85.1

13.8

Figure B. Gonorrhea — Rates of Reported Cases Among Women by State, United States and 

Outlying Areas, 2013

Figure A. Chlamydia — Rates of Reported Cases Among Women by State, United States and 

Outlying Areas, 2013

NOTE: The total rate of reported cases of chlamydia among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 

618.9 per100,000 female population.

NOTE: The total rate of reported cases of gonorrhea among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 

101.2 per 100,000 female population.
STD Surveillance 2013 Special Focus Profiles: STDs in Women and Infants 55

Rate per 100,000

population

Guam 6.3 

Puerto Rico 1.8 

Virgin Islands 1.8 

<=0.2

0.21-4.0

>4.0

(n= 10)

(n= 41)

(n= 3)

VT 0.0

NH 0.1

MA 0.5

RI 0.2

CT 0.4

NJ 0.3

DE 0.6

MD 2.0

DC 5.7

0.9

0.6

0.8 2.9

1.1 0.2

1.4

1.7

0.0

0.0

1.0 0.5

0.6

0.3 0.8

4.9

0.1

0.6

0.4

1.2

0.6

0.2

0.4 1.0

1.9

0.4

0.7

0.3

1.1

0.7

0.6

0.4

1.6

3.6

0.7

1.4

0.1

0.4

0.4

0.4

0.3

0.0

Rate per 100,000

live births

Guam 29.3 

Puerto Rico 2.4 

Virgin Islands 0.0 

<=1.0

1.1-10.0

>10.0

(n= 27)

(n= 15)

(n= 12)

VT 0.0

NH 0.0

MA 5.5

RI 0.0

CT 0.0

NJ 0.0

DE 8.8

MD 19.0

DC 21.8

3.3

8.7

14.9 31.1

11.0 0.0

17.2

14.9

0.0

0.0

13.9 0.0

0.0

0.0 7.2

51.3

0.0

7.9

0.0

0.0

3.9

0.0

0.0 5.6

7.2

4.5

0.8

0.0

12.2

0.0

0.0

1.4

1.7

0.0

2.5

19.4

0.0

1.9

0.0

0.0

0.0

0.0

Figure D. Congenital Syphilis — Rates of Reported Cases Among Infants by Year of Birth and State, 

United States and Outlying Areas, 2013

Figure C. Primary and Secondary Syphilis — Rates of Reported Cases Among Women by State, 

United States and Outlying Areas, 2013

NOTE: The total rate of primary and secondary syphilis among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 

1.0 per 100,000 females.

NOTE: The total rate of congenital syphilis for infants by year of birth for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 

8.6 per 100,000 live births.
56 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2013

 0

 40

 80

120

160

200

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Visits (in thousands)

Prevalence, %

1995

2002

2006-2010

 0

 5

 10

 15

 20

Hispanic Non Hispanic

Whites

Non Hispanic

Blacks

Total

Figure F. Pelvic Inflammatory Disease — Initial Visits to Physicians’ Offices Among Women Aged 

15–44 Years, United States, 2004–2013

Figure E. Pelvic Inflammatory Disease — Trends in Lifetime Prevalence of Treatment Among 

Sexually Experienced Women Aged 15-44 Years by Race/Ethnicity, National Survey of 

Family Growth, 1995, 2002, 2006–2010

SOURCE: Leichliter, Jami, Chandra Anjani, Aral SO. Correlates of Self-Reported Pelvic Inflammatory Disease Treatment in Sexually Experienced Reproductive-Aged Women in the United States, 1995, 2002, 2006–2010. Sex Transm Dis. 2013;40(5):413-418. 

NOTE: The relative standard errors for these estimates are 16%–23%. See Other Data Sources in the Appendix and Table 45.

SOURCE: IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966 – 2013. 
STD Surveillance 2013 Special Focus Profiles: STDs in Women and Infants 57

0.0

0.4

0.8

1.2

1.6

2.0

Year

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Rate

Age Group

15-19

20-24

25-29

30-34

35-39

40-44

Figure G. Ectopic Pregnancy — Rates Among Commercially Insured Pregnant Women Aged 15-44 

years by Age, 2002-2012

SOURCE: MarketScan Commercial Claims and Encounters Database, Truven Health Analytics, Ann Arbor, MI, 2002-2012.
58 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2013

STDs in Adolescents and Young Adults

Public Health Impact

Prevalence estimates suggest that young people aged 15–24 

years acquire half of all new STDs1

 and that 1 in 4 sexually 

active adolescent females have an STD, such as chlamydia 

or human papillomavirus (HPV).2 Compared with older 

adults, sexually active adolescents aged 15–19 years 

and young adults aged 20–24 years are at higher risk of 

acquiring STDs for a combination of behavioral, biological, 

and cultural reasons. For some STDs, such as chlamydia, 

adolescent females may have increased susceptibility to 

infection because of increased cervical ectopy. The higher 

prevalence of STDs among adolescents also may reflect 

multiple barriers to accessing quality STD prevention 

services, including ability to pay, lack of transportation, 

discomfort with facilities and services designed for 

adults, and concerns about confidentiality. Traditionally, 

intervention efforts have targeted individual-level factors 

associated with STD risk which do not address higher-level 

factors (e.g., peer norms and media influences) that may also 

influence behaviors.3

 Interventions for at-risk adolescents 

and young adults that address underlying aspects of the 

social and cultural conditions that affect sexual risk-taking 

behaviors are needed, as are strategies designed to improve 

the underlying social conditions themselves.4,5

Observations

Chlamydia

In 2013, 949,270 cases of chlamydial infection were 

reported among persons aged 15–24 years of age, 

representing 68% of all reported chlamydia cases. Among 

those aged 15–19 years, the rate of reported cases of 

chlamydia increased 6.4% during 2009–2011, decreased 

4.4% during 2011–2012, and decreased 8.7% during 

2012–2013 (Table 10). Among those aged 20–24 years, 

the rate increased 16.1% during 2009–2011 and remained 

stable during 2011–2013 (Table 10).

Among women aged 15–24 years of age, the population 

targeted for chlamydia screening, the overall rate of reported 

cases of chlamydia was 3,340.8 per 100,000 females. Rates 

varied by state, with highest reported case rates in the South 

(Figure H).

15- to 19-Year Old Women—In 2013, the chlamydia case 

rate among women aged 15–19 years was 3,043.3 cases per 

100,000 females, a 8.7% decrease from the 2012 rate of 

3,331.7 cases per 100,000 females (Table 10). Decreases in 

rates of reported cases were largest among 15-, 16-, and 17- 

year old females (Table 12). 

20- to 24-Year Old Women—In 2013, women aged 20–24 

years had the highest rate of chlamydia (3,621.1 cases per 

100,000 females) compared with any other age and sex 

group (Figure 5). The overall chlamydia case rate among 

women in this age group remained stable during 2012–

2013 (Table 10); however, rates of reported chlamydia 

increased among 23- and 24- year old females (Table 12).

15- to 19-Year Old Men—The chlamydia case rate for men 

aged 15–19 years decreased 9.0% from 785.8 cases per 

100,000 males in 2011 to 715.2 cases per 100,000 males in 

2013 (Table 10). 

20- to 24-Year Old Men—In 2013, as in previous years, 

men aged 20–24 years had the highest rate of chlamydia 

among men (1,325.6 cases per 100,000 males). The 

chlamydia rate for men in this age group remained stable 

during 2012–2013 (Table 10).

Gonorrhea

During 2012–2013, the rate of reported gonorrhea 

cases decreased 11.6% for persons aged 15–19 years and 

decreased 1.9% for persons aged 20–24 years. Among 

women aged 15–24 years, the overall rate was 501.6 

per 100,000 females. Rates varied by state, with highest 

reported case rates in the South (Figure I).

15- to 19-Year Old Women—In 2013, women aged 15–19 

years had the second highest rate of gonorrhea (459.2 cases 

per 100,000 females) compared with other females (Figure 

16, Table 21). During 2012–2013, the gonorrhea rate for 

women in this age group decreased 12.9%. 

20- to 24-Year Old Women—In 2013, women aged 20–24 

years had the highest rate of gonorrhea (541.6 cases per 

100,000 females) compared with any other age or sex group 

(Figure 16, Table 21). During 2012–2013, the gonorrhea 

rate for women in this age group decreased 4.7%.

15- to 19-Year Old Men—In 2013, the gonorrhea rate 

among men aged 15–19 years was 220.9 cases per 100,000 

males (Figure 16, Table 21). During 2012–2013, the 

gonorrhea rate for men in this age group decreased 8.9%.

20- to 24-Year Old Men—In 2013, as in previous years, 

men aged 20–24 years had the highest rate of gonorrhea 

(459.4 cases per 100,000 males) compared with other males 
STD Surveillance 2013 Special Focus Profiles: STDs in Adolescents and Young Adults 59

(Figure 16, Table 21). During 2012–2013, the gonorrhea 

rate for men in this age group increased 1.3%.

Primary and Secondary Syphilis 

15- to 19-Year Old Women—The rate of P&S syphilis 

among women aged 15–19 years increased annually during 

2004–2009 (from 1.5 cases to 3.3 cases per 100,000 

females), but decreased every year since 2010 to 1.9 cases in 

2013 (Figures 36 and 37).

20- to 24-Year Old Women—The rate among women aged 

20–24 years increased annually during 2006–2009 (from 

2.9 to 5.5 cases per 100,000 females). The rate decreased 

from 5.5 to 3.7 cases during 2009–2011, then increased 

slightly (from 3.7 to 3.9 cases) during 2011–2013 (Figures 

36 and 37, Table 35).

15- to 19-Year Old Men—The rate among men aged 15–19 

years increased annually during 2002–2009 (from 1.3 to 

6.0 cases per 100,000 males). The rate decreased to 5.5 cases 

in 2010 and 2011, then increased to 5.8 cases (in 2012) and 

6.4 cases (in 2013) (Figures 36 and 38, Table 35). In 2013, 

the rate among men aged 15–19 years was the highest 

reported since 1995.

20- to 24-Year Old Men—The rate among men aged 20–24 

years increased annually during 2000–2013 (from 4.3 to 

27.7 cases per 100,000 males) (Figures 36 and 38, Table 

35). Men aged 20–24 years had the highest rate of P&S 

syphilis among men of any age group during 2008–2012, 

barely surpassed by men 25–29 years in 2013 (28.0 cases) 

(Figure 38, Table 35). In 2013, the rate among men aged 

20–24 years was the highest reported since 1992.

Positivity in Selected Populations

During the mid-1990s to 2011, chlamydia and gonorrhea 

positivity among young women screened in clinics and 

juvenile correctional facilities participating in infertility 

prevention activities were reported to CDC to monitor 

chlamydia prevalence. As the national infertility prevention 

program expanded, these data became difficult to 

interpret as trends were influenced by changes in screening 

coverage, screening criteria, and test technologies, as well 

as demographic changes in patients attending clinics 

reporting data to CDC. Variables available at the national 

level limited the ability to address these issues. Positivity 

data continue to be useful locally to inform clinic-based 

screening recommendations and to identify at-risk 

populations in need of prevention interventions, but are no 

longer collected to monitor national trends in chlamydia 

and gonorrhea.

National Job Training Program 

The National Job Training Program (NJTP) is an 

educational program for socioeconomically disadvantaged 

youth aged 16–24 years and is administered at more than 

100 sites throughout the country. The NJTP screens 

participants for chlamydia and gonorrhea within two days 

of entry to the program. All of NJTP’s chlamydia screening 

tests and the majority of gonorrhea screening tests are 

conducted by a single national contract laboratory*, which 

provides these data to CDC. To increase the stability of 

the estimates, chlamydia or gonorrhea prevalence data are 

presented when valid test results for 100 or more students 

per year are available for the population subgroup and state.

Among women entering the program in 40 states, the 

District of Columbia, and Puerto Rico, the median statespecific chlamydia prevalence in 2013 was 11.7% (range: 

4.1% to 19.0%) (Figure J). Among men entering the 

program in 47 states, the District of Columbia, and Puerto 

Rico, the median state-specific chlamydia prevalence was 

7.4% (range: 1.8% to 14.6%) (Figure K).

Among women entering the program in 39 states and 

Puerto Rico, the median state-specific gonorrhea prevalence 

in 2013 was 2.1% (range: 0.0% to 5.6%) (Figure L). 

Among men entering the program in 36 states and Puerto 

Rico, the median state-specific gonorrhea prevalence was 

0.7% (range: 0.0% to 2.6%) (Figure M).

* Laboratory data are provided by the Center for Disease Detection,

LLC San Antonio, Texas.

1 Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, 

Ocfemia MC, et al. Sexually transmitted infections among US 

women and men: prevalence and incidence estimates, 2008. Sex 

Transm Dis. 2013;40(3):187-93.

2 Forhan SE, Gottlieb SL, Sternberg MR, Xu F, Datta SD, 

McQuillan GM, et al. Prevalence of sexually transmitted 

infections among female adolescents aged 14 to 19 in the United 

States. Pediatrics. 2009;124(6):1505-12 doi: 10.1542/peds.2009-

0674. Epub 2009 Nov 23.

3 DiClemente RJ, Salazar LF, Crosby RA. A review of STD/HIV 

preventive interventions for adolescents: sustaining effects using an 

ecological approach. J. Pediatr. Psychol. 2007;32 (8): 888-906. 

4 Sieving RE, Bernat DH, Resnick MD, Oliphant J, Pettingell S, 

Plowman S, et al. A clinic-based youth development program to 

reduce sexual risk behaviors among adolescent girls: prime time 

pilot study. Health Promot Pract. 2012;13(4):462-71. 

5 Upchurch DM, Mason W, Kusunoki Y, Kriechbaum MJ. Social 

and behavioral determinants of self-reported STD among 

adolescents. Perspect Sex Reprod Health. 2004;36(6):276-287.
60 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2013

Rate per 100,000

population

Guam 40 

Puerto Rico 29 

Virgin Islands 372 

<=400.0

400.1-600.0

>600.0

(n= 25)

(n= 15)

(n= 14)

VT 58

NH 34

MA 150

RI 152

CT 350

NJ 413

DE 775

MD 494

DC 1289

999

523

402 780

287 234

514

717

147

36

717 558

232

370 513

1103

73

598

403

892

643

114

351 401

327

369

783

370

795

720

111

569

861

486

586

637

73

453

197

297

423

63

Figure I. Gonorrhea — Rates of Reported Cases Among Women 15–24 Years of Age by State, 

United States and Outlying Areas, 2013

NOTE: Rates for Guam and the Virgin Islands were calculated by using the 2010 population estimates (see Population Denominators and Rate Calculations 

in the Appendix).

Rate per 100,000

population

Guam 2936 

Puerto Rico 1254 

Virgin Islands 5711 

<=3000.0

3000.1-4000.0

>4000.0

(n= 21)

(n= 22)

(n= 11)

VT 2341

NH 1922

MA 2361

RI 2759

CT 2779

NJ 2580

DE 4215

MD 3545

DC 5384

4868

5045

3399 4333

2747 2996

3309

3894

3458

2601

3927 3327

2786

3092 3127

4891

2174

3582

2706

4494

3583

3026

2793 3145

4229

3255

4228

2751

3726

3702

2827

3110

4399

3512

3657

3719

1575

3062

2677

2440

3158

2771

Figure H. Chlamydia — Rates of Reported Cases Among Women 15–24 Years of Age by State, 

United States and Outlying Areas, 2013

NOTE: Rates for Guam and the Virgin Islands were calculated by using the 2010 population estimates (see Population Denominators and Rate Calculations 

in the Appendix).
STD Surveillance 2013 Special Focus Profiles: STDs in Adolescents and Young Adults 61

Prevalence, %

Puerto Rico 10.8 

Virgin Islands 

*

<10.0

10.0-14.9

>=15.0

(n= 11)

(n= 16)

(n= 20)

(n= 6)

VT

NH

MA 5.0

RI

CT 12.1

NJ 14.8

DE 13.3

MD 12.7

DC 7.6

14.8

8.0 17.1

6.5

14.4

19.0

6.8

12.7 14.5

9.1

11.2 9.9

18.2

8.7

12.5

5.7

15.3

11.0

9.6

9.5

15.5

9.3

11.3

13.5

12.5

13.4

5.9

9.1

10.7

16.3

8.5

12.5

4.1

12.2

14.8

Prevalence, %

Puerto Rico 5.3 

Virgin Islands 

*

<10.0

>=10.0

(n= 4)

(n= 38)

(n= 11)

VT 3.0

NH

MA 4.5

RI

CT 4.5

NJ 8.3

DE 8.3

MD 6.7

DC 8.5

11.6

3.5

4.0 14.6

4.3 4.4

7.5

11.6

5.4

4.0

12.2 8.8

7.7

10.6 8.8

13.3

4.8

11.0

2.0

10.8

8.6

6.0

2.8 7.2

8.1

6.2

10.6

5.2

10.7

8.9

2.6

7.2

10.5

1.8

7.6

9.4

3.0

7.4

3.9

5.8

7.7

Figure K. Chlamydia — Prevalence Among Men Aged 16–24 Years Entering the National Job 

Training Program by State of Residence, United States and Outlying Areas, 2013

Figure J. Chlamydia — Prevalence Among Women Aged 16–24 Years Entering the National Job 

Training Program by State of Residence, United States and Outlying Areas, 2013

* Fewer than 100 women who resided in these states/areas and entered the National Job Training Program were screened for chlamydia in 2013.

* Fewer than 100 men who resided in these states/areas and entered the National Job Training Program were screened for chlamydia in 2013.
62 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2013

Figure L. Gonorrhea — Prevalence Among Women Aged 16–24 Years Entering the National Job 

Training Program by State of Residence, United States and Outlying Areas, 2013

Prevalence, %

Puerto Rico 1.1 

Virgin Islands 

*

<2.0

>=2.0

(n= 13)

(n= 19)

(n= 21)

VT

NH

MA 0.2

RI

CT 3.0

NJ 4.3

DE 1.6

MD 0.9

DC

2.6

1.3 3.0

0.5

2.0

4.4

3.0 3.6

0.9

2.7 1.7

2.8

0.9

2.2

0.0

3.6

4.2

0.6

1.8

0.0

1.2

2.8

2.4

5.6

3.2

0.4

2.1

2.5

3.1

0.0

1.2

0.0

3.4

0.5

Prevalence, %

Puerto Rico 0.0 

Virgin Islands 

*

<2.0

>=2.0

(n= 16)

(n= 34)

(n= 3)

VT 0.0

NH

MA 0.0

RI

CT 0.8

NJ 0.0

DE

MD 1.0

DC

1.3

0.0

0.6 2.6

0.0

0.7

1.5

1.2

0.0

1.2

0.5

0.0

1.3

0.0

2.1

1.3

0.6

0.0 0.7

0.9

0.7

0.9

0.6

0.7

1.9

0.7

2.4

1.4

0.4

0.3

0.0

* Fewer than 100 women who resided in these states/areas and entered the National Job Training Program were screened for gonorrhea in 2013.

NOTE: Many training centers use local laboratories to test female students for gonorrhea; these results are not available to CDC. For this map, gonorrhea 

test results for students at centers that submitted specimens to the national contract laboratory were included if the numbers of gonorrhea tests submitted was greater than the 90% of the number of chlamydia tests submitted.

Figure M. Gonorrhea — Prevalence Among Men Aged 16–24 Years Entering the National Job 

Training Program by State of Residence, United States and Outlying Areas, 2013

* Fewer than 100 men who resided in these states/areas and entered the National Job Training Program were screened for gonorrhea in 2013.

NOTE: Many training centers use local laboratories to test male students for gonorrhea; these results are not available to CDC. For this map, gonorrhea test 

results for students at centers that submitted specimens to the national contract laboratory were included if the number of gonorrhea tests submitted was 

greater than 90% of the number of chlamydia tests submitted.
STD Surveillance 2013 Special Focus Profiles: STDs in Racial and Ethnic Minorities 63

STDs in Racial and Ethnic Minorities

Public Health Impact

Surveillance data show higher rates of reported STDs 

among some racial or ethnic minority groups when 

compared with rates among whites.1,2 Race and ethnicity 

in the United States are population characteristics that are 

correlated with other fundamental determinants of health 

status such as high rates of poverty, income inequality, 

unemployment and low educational attainment.3-5

People who struggle financially are often experiencing life 

circumstances that potentially increase their risk for STDs.6

Those who cannot afford basic necessities may have 

trouble accessing and affording quality sexual health 

services.7

 Despite a decline in the overall U.S. poverty 

rate in 2013, from 15.0 in 2012 to 14.5 in 2013, many 

Americans continue to face economic challenges. For 

example, the poverty rate for whites was 9.6%, for blacks 

it was 27.2%, and for Hispanics it was 23.5%.3,8 Access to 

health insurance is often related to employment. People of 

Hispanic ethnicity may face additional barriers accessing 

care arising from immigration or undocumented status.9

Even when health care is available, fear and distrust of 

health care institutions can negatively affect the health 

care-seeking experience for many racial/ethnic minorities 

when there is social discrimination, provider bias, or the 

perception that these may exist.10 Moreover, the quality of 

care may differ substantially for minority patients.11These 

inequities in social and economic conditions are reflected 

in the profound disparities observed in the incidence of 

STDs among some racial and ethnic minorities. 

In communities where STD prevalence is higher, 

individuals may have a more difficult time reducing their 

risk for infection. With each sexual encounter, they face a 

greater chance of encountering an infected partner than 

those in lower prevalence settings.2 Acknowledging the 

inequity in STD rates by race or ethnicity is one of the first 

steps in empowering affected communities to organize and 

focus on this problem. 

STD Reporting Practices

Surveillance data are based on cases of STDs reported to 

state and local health departments (see Interpreting STD 

Surveillance Data in the Appendix). In many state and local 

health jurisdictions, reporting from public sources (e.g., 

STD clinics) is thought to be more complete than reporting 

from private sources. Because minority populations may use 

public clinics more than whites, differences in rates between 

minorities and whites may be increased by this reporting 

bias.12 However, prevalence data from population-based 

surveys, such as NHANES and the National Longitudinal 

Study of Adolescent Health, confirm the existence of 

marked STD disparities in some minority populations.13,14

Method of Classifying Race & Hispanic 

Ethnicity

Interpretation of racial and ethnic disparities among persons 

with STDs is influenced by data collection methods, and 

by the categories by which these data are displayed. Data 

on race and Hispanic ethnicity are displayed in this report 

in compliance with the 1997 Office of Management and 

Budget (OMB) standards.15 Forty-seven jurisdictions (46 

states and the District of Columbia) collect and report 

data in formats compliant with these standards as of 2013. 

One additional jurisdiction reported cases of primary 

& secondary syphilis by the appropriate standard, but 

did not report chlamydia and gonorrhea cases by this 

standard. Many jurisdictions only recently adopted OMB 

standards and used previous categories to report their case 

data to CDC in past years. Historical trend and rate data 

by race and Hispanic ethnicity displayed in figures and 

interpreted in this report for 2009–2013 include only 

those jurisdictions (39 states plus the District of Columbia) 

reporting in the current standard consistently for years 2009 

through 2013. Please refer to Interpreting STD Surveillance 

Data in the Appendix for a complete listing of these 

jurisdictions.

Completeness of Race/Ethnicity Data

Chlamydia—In 2013, 26.0% of chlamydia case reports 

were missing race or ethnicity data, ranging by state from 

0.4% to 63.5% (Table A1).

Gonorrhea—In 2013, 19.4% of gonorrhea case reports 

were missing information on race or ethnicity, ranging by 

state from 0.0% to 46.2% (Table A1).

Syphilis—In 2013, 3.8% of P&S syphilis case reports were 

missing information on race or ethnicity, ranging from 

0.0% to 20.1% among states with 10 or more cases of P&S 

syphilis (Table A1).
64 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2013

Observations

Chlamydia

Among the 40 jurisdictions (39 states and the District 

of Columbia) that submitted data on race and Hispanic 

ethnicity for each year during 2009–2013 according to 

the OMB standards, rates of reported cases of chlamydia 

increased during 2009–2013 among all racial and ethnic 

groups except among Blacks (Figure 6). During 2009–

2013, chlamydia rates increased by 23.9% among American 

Indians/Alaska Natives, 6.4% among Hispanics, 6.6% 

among Asians, 39.8% among Native Hawaiians/Other 

Pacific Islanders, and 32.7% among whites. During 2009–

2013, rates of reported cases of chlamydia decreased 5.2% 

among blacks.

In 2013, 47 jurisdictions (46 states and the District of 

Columbia) submitted data on race and Hispanic ethnicity 

in 2013 according to the OMB standards. The following 

data pertain to those jurisdictions:

Blacks—In 2013, the overall rate among blacks in the 

United States was 1,147.2 cases per 100,000 population 

(Table 11B). The rate of reported cases of chlamydia among 

black women was 5.8 times the rate among white women 

(1,491.7 and 258.5 per 100,000 females, respectively) 

(Table 11B and Figure N). The chlamydia rate among black 

men was almost eight times the rate among white men 

(771.1 and 99.4 cases per 100,000 males, respectively).

Rates of reported cases of chlamydia were highest for blacks 

aged 15–19 and 20–24 years in 2013 (Table 11B). The 

chlamydia rate among black females aged 15–19 years was 

6,907.6 cases per 100,000 females, which was five times the 

rate among white females in the same age group (1,383.3 

per 100,000 females). The rate among black women aged 

20–24 years was 4.1 times the rate among white women in 

the same age group (Table 11B).

Similar racial disparities in reported chlamydia rates exist 

among men. Among males aged 15–19 years, the rate 

among blacks was 9.5 times the rate among whites (Table 

11B). The chlamydia rate among black men aged 20–24 

years was 5.5 times the rate among white men of the same 

age group (3,282.5 and 594.0 cases per 100,000 males, 

respectively).

American Indians/Alaska Natives— In 2013, the 

chlamydia rate among American Indians/Alaska Natives was 

697.9 cases per 100,000 population (Table 11B). Overall, 

the rate of chlamydia among American Indians/Alaska 

Natives in the United States was 3.9 times the rate among 

whites.

Native Hawaiians/Other Pacific Islanders— In 2013, 

the chlamydia rate among Native Hawaiians/Other Pacific 

Islanders was 633.3 cases per 100,000 population (Table 

11B). The overall rate among Native Hawaiians/Other 

Pacific Islanders was 3.5 times the rate among whites and 

5.7 times the rate among Asians.

Hispanics— In 2013, the chlamydia rate among Hispanics 

was 377.0 cases per 100,000 population (Table 11B) which 

is 2.1 times the rate among whites.

Asians— In 2013, the chlamydia rate among Asians was 

111.5 cases per 100,000 population (Table 11B). The overall 

rate among whites is 1.6 times the rate among Asians. 

Gonorrhea

During 2009–2013, among the 40 jurisdictions (39 states 

and the District of Columbia) that submitted data for each 

year according to the OMB standards, rates of reported 

gonorrhea cases increased 87.5% among American Indians/

Alaska Natives (76.6 to 143.6), 79.3% among Native 

Hawaiians/Other Pacific Islanders (56.4 to 101.1), 54.8% 

among whites (23.0 to 35.6), 50.1% among Hispanics 

(45.5 to 68.3), and 29.4% among Asians (13.6 to 17.6) 

(Figure 19). The gonorrhea rate decreased 9.1% among 

blacks (471.6 to 428.5).

In 2013, 47 jurisdictions (46 states and the District of 

Columbia) submitted data in race and ethnic categories 

according to the OMB standards. The following data 

pertain to those jurisdictions:

Blacks—In 2013, 58.4% of reported gonorrhea cases with 

known race/ethnicity occurred among blacks (excluding 

cases with missing information on race or ethnicity, and 

cases whose reported race or ethnicity was other) (Table 

22A). The rate of gonorrhea among blacks in 2013 was 

426.6 cases per 100,000 population, which was 12.4 times 

the rate among whites (34.5 per 100,000) (Table 22B). This 

disparity has decreased slightly in recent years (Figure O). 

This disparity was similar for black men (12.7 times the rate 

among white men) and black women (12.0 times the rate 

among white women) (Figure P, Table 22B). 

As in previous years, the disparity in gonorrhea rates for 

blacks in 2013 was larger in the Midwest and Northeast 

than in the West or the South (Figure Q).

Considering all racial/ethnic and age categories, gonorrhea 

rates were highest for blacks aged 20–24 and 15–19 years 

in 2013 (Table 22B). Black women aged 20–24 had a 

gonorrhea rate of 1,949.1 cases per 100,000 women. This 

rate was 10.2 times the rate among white women in the 

same age group (190.3 per 100,000). Black women aged 
STD Surveillance 2013 Special Focus Profiles: STDs in Racial and Ethnic Minorities 65

15–19 years had a gonorrhea rate of 1,768.5 cases per 

100,000 women, which was 13.6 times the rate among 

white women in the same age group (130.1 per 100,000).

Black men aged 20–24 years had a gonorrhea rate of 

1,734.5 cases per 100,000 men, which was 13.0 times the 

rate among white men in the same age group (133.7 per 

100,000). Black men aged 25–29 years had a gonorrhea rate 

of 1,207.2 cases per 100,000 men, which was 10.4 times 

the rate among white men in the same age group (116.5 per 

100,000).

American Indians/Alaska Natives—In 2013, the 

gonorrhea rate among American Indians/Alaska Natives 

was 137.4 cases per 100,000 population, which was 4.0 

times the rate among whites (Table 22B). The disparity 

between gonorrhea rates for American Indians/Alaska 

Natives and whites was larger for American Indian/Alaska 

Native women (5.2 times the rate among white women) 

than for American Indian/Alaska Native men (2.7 times 

the rate among white men) (Figure P, Table 22 B). The 

disparity in gonorrhea rates for American Indians/Alaska 

Natives in 2013 was larger in the Midwest than in the West, 

Northeast, and South (Figure Q).

Native Hawaiians/Other Pacific Islanders—In 2013, 

the gonorrhea rate among Native Hawaiians/Other Pacific 

Islanders was 94.0 cases per 100,00 population, which 

was 2.7 times the rate among whites (Table 22B). The 

disparity between gonorrhea rates for Native Hawaiians/

Other Pacific Islanders and whites was the similar for 

Native Hawaiian/Other Pacific Islander women (2.7 times 

the rate among white women) and Native Hawaiian/Other 

Pacific Islander men (2.8 times the rate among white men) 

(Figure P, Table 22B). The disparity in gonorrhea rates 

for Native Hawaiians/Other Pacific Islanders in 2013 was 

lower in the West than in the Midwest, Northeast, and 

South (Figure Q).

Hispanics—In 2013, the gonorrhea rate among Hispanics 

was 65.8 cases per 100,000 population, which was 1.9 

times the rate among whites (Table 22B). This disparity 

was similar for Hispanic women (1.8 times the rate among 

white women) and Hispanic men (2.0 times) (Figure P, 

Table 22B). The disparity in gonorrhea rates for Hispanics 

was highest in the Northeast and lowest in the West and 

Midwest (Figure Q).

Asians—In 2013, the gonorrhea rate among Asians was 

17.1 cases per 100,000 population, which was lower 

than (0.5 times) the rate among whites (Table 22B). This 

difference is larger for Asian women than for Asian men 

(Figure P, Table 22B). In 2013, rates among Asians were 

lower than rates among whites in all four regions of the 

United States (Figure Q).

Primary and Secondary Syphilis

The syphilis epidemic in the late 1980s occurred primarily 

among men who have sex with women only (MSW), 

women, and minority populations.16,17 While the rate of 

primary and secondary (P&S) syphilis declined among all 

racial and ethnic groups during the 1990s, rates again began 

increasing in the early 2000s among gay, bisexual and other 

men who have sex with men (MSM) in their 30s and 40s 

of varied racial and ethnic groups.17 During 2009–2013, 

40 jurisdictions (39 states and the District of Columbia) 

submitted data on race and Hispanic ethnicity for each 

year according to the OMB standards. Among these areas, 

rates of reported cases increased among non-Hispanic 

whites, non-Hispanic blacks, Hispanics, Asians, American 

Indians/Alaska Natives, and Native Hawaiians/Other 

Pacific Islanders, and decreased slightly among multirace 

individuals, during 2013 (Figure 39).

In 2013, 48 jurisdictions (47 states and the District of 

Columbia) submitted syphilis data by race and Hispanic 

ethnicity according to the OMB standards. The following 

data pertain to those jurisdictions:

Blacks — In 2013, 37.3% of all cases reported to CDC 

were among blacks. The overall 2013 rate for blacks was 5.6 

times the rate for whites. In 2013, the rate of P&S syphilis 

among black men was 5.3 times the rate among white men; 

the rate among black women was 15 times the rate among 

white women (Table 36B).

In 2013, rates among both men and women aged 25–29 

years remained highest among blacks (97.2 cases and 12.9 

cases per 100,000 population, respectively). Rates among 

both men and women aged 20–24 years remained highest 

among blacks (96.4 cases and 17.0 cases per 100,000 

population, respectively). 

American Indians/Alaska Natives — In 2013, 0.6% 

of all cases reported to CDC were among American 

Indians/Alaska Natives. The 2013 rate of P&S syphilis for 

American Indians/Alaska Natives was 4.6 cases per 100,000 

population, 1.5 times the rate for whites (Table 36B).

Native Hawaiians/Other Pacific Islanders — In 2013, 

0.3% of all cases reported to CDC were among Native 

Hawaiians/Other Pacific Islanders. The 2013 rate of P&S 

syphilis for Native Hawaiians/Other Pacific Islanders was 

8.6 cases per 100,000 population, which was 2.9 times the 

rate for whites (Table 36B).
66 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2013

1 Newman LM, Berman SM. Epidemiology of STD Disparities 

in African American Communities. Sex Transm Dis. 

2008;35(12):S4-S12.

2

 Hogben M, Leichliter JS. Social determinants and sexually 

transmitted disease disparities. Sex Transm Dis. 2008;35(12 

Suppl):S13-8.

3 DeNavas-Walt, Carmen and Bernadette D. Proctor, U.S. Census 

bureau, Current Population Reports, P60-249, Income and Poverty 

in the United States: 2013, U. S. Government Printing Office, 

Washington, DC, 2014.

4

 Harling G, Subramanian SV, Barnighausen T, Kawachi I. 

Socioeconomic disparities in sexually transmitted infections 

among young adults in the United States: Examining the 

interaction between Income and race/ethnicity. Sex Transm Dis. 

2013;40(7):575-581. 

5 Centers for Disease Control and Prevention. CDC Health 

Disparities and Inequalities Report - United States 2013 MMWR 

Morb Mortal Wkly. Rep. 2013;62(Suppl 3).

6 Laumann EO, Youm Y. Racial/ethinic group differences in the 

prevalence of sexually transmitted diseases in the United States: a 

network explanation. Sex Transm Dis. 1999;26(5):250-61. 

7 Institute of Medicine. The Hidden Epidemic: Confronting 

Sexually Transmitted Diseases. Washington, DC: National 

Academy Press; 1997. 

8 Bureau of Labor Statistics Report, August 2014 

http://www.bls.gov.

9 Pérez-Escamilla R. Health care access among Latinos: Implications 

for social and health care r5eform. J Hispanic High Educ. 

2010:9(1):43-60.

Hispanics — In 2013, 19.9% of all cases reported to CDC 

were among Hispanics. The 2013 rate of P&S syphilis for 

Hispanics was 6.3 cases per 100,000 population, which was 

2.1 times the rate for whites (Table 36B).

Asians — In 2013, 2.2% of all cases reported to CDC were 

among Asians. The 2013 rate of P&S syphilis for Asians was 

2.5 cases per 100,000 population, which was 0.8 times the 

rate for whites (Table 36B).

Congenital Syphilis

Race/ethnicity for cases of congenital syphilis is based on 

the mother’s race/ethnicity. In 2013, the rate of congenital 

syphilis was 29.0 cases per 100,000 live births among blacks 

and 9.7 cases per 100,000 live births among Hispanics. 

These rates were 10.4 and 3.5 times, respectively, the rate 

among whites (2.8 cases per 100,000 live births) (Table 43, 

Figure U). 

10 Berk ML, Schur CL. The effect of fear on access to care 

among undocumented Latino immigrants. J Immigr Health. 

2001;3(3):151-156. 

11 Institute of Medicine. Unequal Treatment: Confronting Racial 

and Ethnic Disparities in Health Care. Washington, DC: National 

Academies Press; 2002.

12 Miller WC. Epidemiology of chlamydial infection: are we losing 

ground? Sex Transm Infect. 2008;84:82-6. 

13 Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, 

McQuillan G, et al. Gonorrhea and chlamydia in the United 

States among persons 14 to 39 years of age, 1999 to 2002. Ann 

Intern Med. 2007;147(2):89-96.

14 Miller WC, Ford CA, Morris M, Handcock MS, Schmitz JL, 

Hobbs MM, et al. Prevalence of chlamydial and gonococcal 

infections among young adults in the United States. JAMA. 

2004;291(18):2229-36.

15 Office of Management and Budget. Provisional guidance on the 

implementation of the 1997 standards for federal data on race 

and ethnicity. 1999. [Accessed July 29, 2013]. Available at: http://

www.whitehouse.gov/omb/fedreg_1997standards/. 

16 Nakashima AK, Rolfs RT, Flock ML, Kilmarx P, Greenspan JR. 

Epidemiology of syphilis in the United States, 1941 through 

1993. Sex Transm Dis. 1996;23:16-23.

17 Peterman TA, Heffelfinger JD, Swint EB, Groseclose SL. 

The changing epidemiology of syphilis. Sex Transm Dis. 

2005;32(Suppl 10):S4-10.
STD Surveillance 2013 Special Focus Profiles: STDs in Racial and Ethnic Minorities 67

1:4

1:2

1:1

2:1

4:1

8:1

16:1

32:1

Year

2009 2010 2011 2012 2013

Rate Ratio†

‡

‡

AI/AN

Asians

Blacks

Hispanics

NHOPI

Men Rate (per 100,000 population) Women

2250 1800 1350 900 450 0 Race/Ethnicity 0 450 900 1350 1800 2250

304.0 AI/AN* 1079.2

63.5 Asians 154.6

771.1 Blacks 1491.7

195.2 Hispanics 564.2

284.3 NHOPI* 989.6

99.4 Whites 258.5

61.9 Multirace 163.0

262.6 623.1 Total

Figure O. Gonorrhea — Rate Ratios* by Race/Ethnicity, United States, 2009–2013

Figure N. Chlamydia — Rates of Reported Cases by Race/Ethnicity and Sex, United States, 2013

* AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders. 

NOTE: Includes 46 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats in 2013 (see 

Reporting of Data for Race/Ethnicity in the Appendix ).

* Rate ratios are calculated as the rate of reported gonorrhea cases per 100,000 population for a given racial or ethnic minority population divided by the 

rate of reported gonorrhea cases per100,000 population for non-Hispanic whites. Any population with a lower rate of reported cases of gonorrhea than 

the non-Hispanic white population will have a rate ratio of less than 1:1.

†

 Y-axis is log scale.

‡ AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders.

NOTE: Includes 39 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats during 

2009–2013 (see Reporting of Data for Race/Ethnicity in the Appendix).
68 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2013

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 Race/Ethnicity 0 150 300 450 600 750

94.6 AI/AN* 178.7

22.8 Asians 11.8

444.9 Blacks 409.2

70.4 Hispanics 60.8

96.4 NHOPI* 91.5

34.9 Whites 34.1

28.7 Multirace 33.2

109.5 102.4 Total

Figure P. Gonorrhea — Rates of Reported Cases by Race/Ethnicity and Sex, United States, 2013

* AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders.

NOTE: Includes 46 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats in 2013 (see 

Reporting of Data for Race/Ethnicity in the Appendix).

Rate Ratio†

‡

West

Midwest

Northeast

South

1:4

1:2

1:1

2:1

4:1

8:1

16:1

32:1

AI/AN Asians Blacks Hispanics NHOPI ‡

Figure Q. Gonorrhea — Rate Ratios* by Race/Ethnicity and Region, United States, 2013

* Rate ratios are calculated as the rate of reported gonorrhea cases per 100,000 population for a given racial or ethnic minority population divided by the 

rate of reported gonorrhea cases per 100,000 population for non-Hispanic whites. Any population with a lower rate of reported cases of gonorrhea than 

the non-Hispanic white population will have a rate ratio of less than 1:1.

†

 Y-axis is log scale.

‡ AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders.

NOTE: Includes 46 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats in 2013 (see 

Reporting of Data for Race/Ethnicity in the Appendix).
STD Surveillance 2013 Special Focus Profiles: STDs in Racial and Ethnic Minorities 69

Men Rate (per 100,000 population) Women

30 24 18 12 6 0 Race/Ethnicity 0 6 12 18 24 30

7.1 AI/AN* 2.1

4.9 Asians 0.2

30.2 Blacks 4.5

11.6 Hispanics 0.8

15.8 NHOPI* 1.2

5.7 Whites 0.3

3.4 Multirace 0.3

10.3 Total 0.9

Figure R. Primary and Secondary Syphilis — Rates of Reported Cases by Race/Ethnicity and Sex, 

United States, 2013

* AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders.

NOTE: Includes 47 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats in 2013 (see 

Reporting of Data for Race/Ethnicity in the Appendix).

 0

 4

 8

 12

 16

 20

Year

2009 2010 2011 2012 2013

Rate (per 100,000 population) AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

Figure S. Primary and Secondary Syphilis — Rates of Reported Cases Among Females Aged 15–19 

Years, by Race/Ethnicity, United States, 2009–2013

* AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders.

NOTE: Includes 39 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats during 

2009–2013 (see Reporting of Data for Race/Ethnicity in the Appendix).
70 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2013

 0

 10

 20

 30

 40

 50

Year

2009 2010 2011 2012 2013

Rate (per 100,000 population)

AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

Figure T. Primary and Secondary Syphilis — Rates of Reported Cases Among Males Aged 15–19 

Years, by Race/Ethnicity, United States, 2009–2013

* AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders.

NOTE: Includes 39 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats during 

2009–2013 (see Reporting of Data for Race/Ethnicity in the Appendix). 

 0

 10

 20

 30

 40

 50

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Rate (per 100,000 live births) AI/AN*

Asians/Pacific Islanders

Blacks

Hispanics

Whites

Figure U. Congenital Syphilis — Rates of Reported Cases Among Infants, by Year of Birth and 

Mother’s Race/Ethnicity, United States, 2004–2013

* AI/AN = American Indians/Alaska Natives.

NOTE: National Center for Health Statistics bridged race categories are presented to allow the display of data across several years. Cases missing maternal 

race/ethnicity information were excluded (< 1% of cases).
STD Surveillance 2013 Special Focus Profiles: STDs in Men Who Have Sex with Men 71

STDs in Men Who Have Sex with Men

Public Health Impact

Compared to women and men who have sex with women 

only, gay, bisexual, and other men who have sex with men 

(collectively known as MSM) are at increased risk for 

STDs and antimicrobial resistance.1–4 Because STDs and 

the behaviors associated with acquiring them increase the 

likelihood of acquiring and transmitting HIV infection,5

STDs among MSM may be associated with an increase in 

HIV diagnoses.6

Although a number of individual-level risk behaviors (e.g., 

higher numbers of lifetime sex partners, higher rates of 

partner change and partner acquisition rates, and unprotected 

sex) significantly contribute to the ongoing disparities in the 

sexual health of MSM, other interpersonal and societal-level 

factors have also been associated with higher rates of sexually 

transmitted infections, including HIV among MSM.7

 MSM 

who have lower economic status are particularly vulnerable 

to poorer health outcomes, especially if they belong to racial 

and ethnic minority populations.8, 9 For example, studies 

show that for black MSM, factors such as emotional and 

social support can drive sexual risk-taking and, in addition, 

broader societal factors such as power, privilege, and position 

in society also play a significant role.10 Similarly, for Hispanic 

men, the relationship between individual experiences of 

oppression (e.g., social discrimination and financial hardship) 

and risk for sexually transmitted infections in the United 

States has been documented.11

With the exception of reported syphilis cases, most nationally 

notifiable STD surveillance data do not include information 

on sexual behaviors; therefore, trends in STDs among MSM 

in the United States are based on findings from sentinel 

surveillance systems. Furthermore, testing strategies are 

often suboptimal for detecting STDs in MSM. Testing 

for gonorrhea and chlamydia in MSM largely focuses on 

detecting urethral infections, which are more likely to be 

symptomatic than pharyngeal or rectal infections.12 Data 

from enhanced surveillance projects are presented in this 

section to provide information on STDs in MSM.

STD Surveillance Network (SSuN) — 

Monitoring Trends in Prevalence of 

STDs Among MSM Who Visit STD 

Clinics, 2012

In 2005, SSuN was established to improve the capacity 

of national, state, and local STD programs to detect, 

monitor, and respond rapidly to trends in STDs through 

enhanced collection, reporting, analysis, visualization, and 

interpretation of disease information.13 SSuN is a sentinel 

surveillance system comprised of 42 STD clinics within 12 

collaborating jurisdictions that follow common protocols 

for data collection and management.14 For data reported 

in this section, MSM were defined as men who either 

reported having a male sex partner or who self-reported as 

gay/homosexual or bisexual. MSW were defined as men 

who reported having sex with women only or who did 

not report the sex of their sex partner, but reported that 

they considered themselves straight/heterosexual. For more 

detailed information about SSuN methodology see the 

STD Surveillance Network (SSuN) in the Appendix. 

Gonorrhea and Chlamydial Infection

In 2013, the proportion of MSM who tested positive for 

gonorrhea and chlamydia at STD clinics varied by SSuN 

site (Figure V). A larger proportion of MSM who visited 

SSuN STD clinics tested positive for gonorrhea than tested 

positive for chlamydia in all cities except Birmingham, 

Denver, and Hartford/New Haven (where the proportion 

for chlamydia was higher). 

Across the participating sites, 20,955 MSM were tested for 

gonorrhea and 20,710 MSM were tested for chlamydia. The 

median site-specific gonorrhea prevalence was 16.9% (range 

by site: 10.4%–28.1%). The median site-specific chlamydia 

prevalence was 15.2% (range by site: 7.4%–30.7%). For 

this report, a person who tested positive for gonorrhea or 

chlamydia more than one time in a year was counted only 

once for each infection.

Co-infection of Primary and Secondary 

(P&S) Syphilis and HIV

Among MSM who presented to seven SSuN clinics with 

P&S syphilis infection in 2013, the proportion who were 

also infected with HIV ranged from 15.8% in Los Angeles 

to 47.4% in Philadelphia (Figure W). The median sitespecific proportion of MSM co-infected with HIV (45.5%) 

was comparable to the proportion of co-infection in MSM 

observed in 2013 case report data (51.6%). P&S syphilis 

was identified by provider diagnosis, and HIV was identified 

by laboratory report, self-report, or provider diagnosis. 
72 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2013

HIV status and STDs

Among MSM visiting SSuN STD clinics, prevalence of 

STDs was higher among HIV-positive MSM than among 

HIV-negative MSM (Figure X). The prevalence of P&S 

syphilis was 9.0% among HIV-positive MSM and 2.6% 

among HIV-negative MSM. Among HIV-positive MSM, 

urethral gonorrhea positivity was 15.0%, pharyngeal 

gonorrhea positivity was 10.0%, and rectal gonorrhea 

positivity was 16.4% (compared to 10.1%, 7.4%, and 

8.9%, respectively, among HIV-negative MSM). Among 

HIV-positive MSM, urethral chlamydia positivity was 7.6% 

and rectal chlamydia positivity was 22.2% (compared to 

7.1% and 11.4%, respectively, among HIV-negative MSM). 

Nationally Notifiable Syphilis 

Surveillance Data

P&S syphilis among MSM has been increasing since at least 

2000.3,15 In 33 areas reporting sex of partner data for 70% or 

more of cases of P&S syphilis each year during 2007–2013, 

cases among MSM increased 7% during 2012–2013 (Figure 

31). In 2013, MSM accounted for 75% of all P&S syphilis 

cases in 49 states and the District of Columbia that provided 

information about sex of sex partners. MSM accounted for 

more cases than MSW or women in all racial and ethnic 

groups (Figure 41). More information about syphilis can be 

found in the Syphilis section of the National Profile.

Gonococcal Isolate Surveillance Project

GISP is a national sentinel surveillance system designed 

to monitor trends in antimicrobial susceptibilities of N. 

gonorrhoeae strains in the United States.16 Overall, the 

proportion of isolates from MSM in selected STD clinics 

from GISP sentinel sites has increased steadily, from 

4.6% in 1990 to 35.1% in 2013 (Figure Y). The reason 

for this increase is unclear, but might reflect changes in 

the epidemiology of gonorrhea or changes in healthcare 

seeking behaviors of men infected with gonorrhea. GISP 

has demonstrated that gonococcal isolates from MSM are 

more likely to exhibit antimicrobial resistance than isolates 

from MSW.4

 During 2007–2013, the prevalence of elevated 

ceftriaxone MICs (≥0.125 μg/ml) was higher in isolates 

from MSM than from MSW. (Figure Z).

More information on GISP can be found in the Gonorrhea 

section of the National Profile.

1 Brewer TH, Schillinger J, Lewis FM, Blank S, Pathela P, Jordahl L, 

et al. Infectious syphilis among adolescent and young adult men: 

implications for human immunodeficiency virus transmission and 

public health interventions. Sex Transm Dis. 2011;38(5):367-71.

2 Centers for Disease Control and Prevention. Trends in HIV/AIDS 

diagnoses among men who have sex with men — 33 States, 2000–

2006. MMWR Morb Mortal Wkly Rep. 2008; 57:681–686.

3 Su JR, Beltrami JF, Zaidi AA, Weinstock HS. Primary and 

secondary syphilis among black and Hispanic men who have sex 

with men: case report data from 27 States. Ann Intern Med. 2011; 

155(3):145-51.

4 Kirkcaldy RD, Zaidi A, Hook EW 3rd, Holmes KK, Soge O, del 

Rio C, et al. Neisseria gonorrhoeae antimicrobial resistance among 

men who have sex with men and men who have sex exclusively 

with women: The Gonococcal Isolate Surveillance Project, 

2005–2010. Ann Intern Med. 2013; 158(5 Pt 1):321–8.

5 Fleming DT, Wasserheit JN. From epidemiologic synergy to 

public health policy and practice: the contribution of other 

sexually transmitted diseases to sexual transmission of HIV 

infection. Sex Transm Infect. 1999;75:3-17.

6 Hall HI, Song R, Rhodes P, Prejean J, An Q, Lee LM, et al, for the 

HIV Incidence Surveillance Group. Estimation of HIV incidence 

in the United States. JAMA. 2008;6;300(5):520-9.

7 Koblin BA, Husnik MJ, Marla JB, Colfax GC, Huang Y, Madison 

ME, et al. Risk factors for HIV infection among men who have 

sex with men. AIDS. 2006;20(5):731-739.

8

 Alvy LM , McKirnan DJ, Du Bois SN , Jones K, Ritchie N, 

Fingerhut D. Health Care Disparities and Behavioral Health 

Among Men Who Have Sex with Men. J Gay Lesbian Soc Serv. 

2011;23(4): 507-522.

9

 McKirnan DJ, Du Bois SN, Alvy LM, Jones K. Health Care 

Access and Health Behaviors Among Men Who Have Sex With 

Men: The Cost of Health Disparities. Health Educ Behav. 

2013;40(1):32-41.

10 Mays VM, Cochran SD, Zamudio A. HIV prevention research: 

are we meeting the needs of African American men who have sex 

with men? J Black Psychol. 2004;30:78.

11 Díaz RM, Ayala G, Bein E. Sexual risk as an outcome of social 

oppression: data from a probability sample of Latino gay men 

in three U.S. cities. Cultur Divers Ethnic Minor Psychol. 

2004;10(3):255-267. 

12 Patton ME, Kidd S, Llata E, Stenger M, Braxton J, et al. 

Extragenital gonorrhea and chlamydia testing and infection 

among men who have sex with men--STD Surveillance Network, 

United States, 2010-2012. Clin Infect Dis. 2014;58(11):1564-70.

13 Rietmeijer K, Donnelly J, Bernstein K, Bissette J, Martins S, 

Pathela P, et al. Here comes the SSuN—early experiences with the 

STD Surveillance Network. Pub Health Rep. 2009;124(Suppl 

2):72-77.

14 Centers for Disease Control and Prevention. Sexually Transmitted 

Disease Surveillance 2011. Atlanta: U.S. Department of Health 

and Human Services; 2012.

15 Heffelfinger JD, Swint EB, Berman SM, Weinstock HS. Trends 

in primary and secondary syphilis among men who have sex 

with men in the United States. Am J Public Health. 2007 

Jun;97(6):1076-83.

16 Schwarcz S, Zenilman J, Schnell D, Knapp JS, Hook EW 

III, Thompson S, et al. National surveillance of antimicrobial 

resistance in Neisseria gonorrhoeae. JAMA. 1990;264(11):1413-7. 
STD Surveillance 2013 Special Focus Profiles: STDs in Men Who Have Sex with Men 73

Percentage

Gonorrhea

Chlamydia

 0

 7

 14

 21

 28

 35

Seattle San

Francisco

Los

Angeles Denver Chicago New Orleans Birmingham

Baltimore

Philadelphia

New York

City

Hartford/

New Haven

Figure V. Gonorrhea and Chlamydia — Proportion of MSM* Attending STD Clinics Testing Positive 

for Gonorrhea and Chlamydia, STD Surveillance Network (SSuN), 2013

* Among men who have sex with men who were tested for gonorrhea and/or chlamydia

NOTE: Includes jurisdictions that reported data on at least 50 MSM tested for gonorrhea or chlamydia in 2013. Five jurisdictions (Birmingham, Chicago, 

Denver, Hartford/New Haven, and New Orleans) contributed data from January through June 2013 and the remaining 6 jurisdictions contributed data for 

all of 2013.

Percentage

 0

 20

 40

 60

 80

100

Seattle San

Francisco

Los

Angeles Chicago Baltimore Philadelphia

New York

City

Figure W. Primary and Secondary Syphilis and HIV — Proportion of MSM* Attending STD Clinics 

with Primary and Secondary Syphilis Who Are Co-infected with HIV, STD Surveillance 

Network (SSuN), 2013

* MSM = men who have sex with men. 

NOTE: Includes jurisdictions that reported data on at least 25 MSM with primary and secondary syphilis in 2013. One jurisdiction (Chicago) contributed 

data from January through June 2013 and the remaining 6 jurisdictions contributed data for all of 2013.
74 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2013

Percentage

‡

HIVHIV+

 0

 4

 8

 12

 16

 20

P&S 

syphilis

GC 

urethral

GC 

pharyngeal

GC 

rectal

CT 

urethral

CT 

rectal ‡

Figure X. Proportion of MSM* Attending STD Clinics with Primary and Secondary Syphilis, 

Gonorrhea or Chlamydia by HIV Status†

, STD Surveillance Network (SSuN), 2013

* MSM = men who have sex with men.

†

 Excludes all persons for whom there was no laboratory documentation or self-report of HIV status.

‡ GC urethral and CT urethral include results from both urethral and urine specimens.

NOTE: Six jurisdictions (Birmingham, Chicago, Denver, Hartford/New Haven, New Orleans, and Richmond) contributed data from January through June 

2013 and the remaining jurisdictions (Baltimore, Los Angeles, New York City, Philadelphia, San Francisco and Seattle) contributed data for all of 2013.

 0

 8

 16

 24

 32

 40

Year

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012

Percentage

Figure Y. Neisseria gonorrhoeae — Percentage of Urethral Isolates Obtained from MSM* Attending 

STD Clinics, Gonococcal Isolate Surveillance Project (GISP), 1990–2013

* MSM = men who have sex with men.
STD Surveillance 2013 Special Focus Profiles: STDs in Men Who Have Sex with Men 75

Percentage

MSM*

MSW*

0.0

0.5

1.0

1.5

2.0

2006 2007 2008 2009 2010 2011 2012 2013

Figure Z. Neisseria gonorrhoeae — Percentage of Urethral Isolates with Elevated Ceftriaxone 

Minimum Inhibitory Concentrations (MICs) (≥0.125 μg/ml) by Reported Sex of Sex 

Partner, Gonococcal Isolate Surveillance Project (GISP), 2006–2013

* MSM = men who have sex with men; MSW = men who have sex with women only.
76 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2013
TABLES
TABLES
STD Surveillance 2013 National Summary Tables 77

Table 1. Sexually Transmitted Diseases — Reported Cases and Rates of Reported Cases per 

100,000 Population, United States, 1941–2013

Syphilis

Year*

All Stages†

Primary and 

Secondary Early Latent

Late and Late 

Latent‡ Congenital Chlamydia Gonorrhea Chancroid

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

1941 485,560 368.2 68,231 51.7 109,018 82.6 202,984 153.9 17,600 651.1 NR — 193,468 146.7 3,384 2.5

1942 479,601 363.4 75,312 57.0 116,245 88.0 202,064 153.1 16,918 566.0 NR — 212,403 160.9 5,477 4.1

1943 575,593 447.0 82,204 63.8 149,390 116.0 251,958 195.7 16,164 520.7 NR — 275,070 213.6 8,354 6.4

1944 467,755 367.9 78,443 61.6 123,038 96.7 202,848 159.6 13,578 462.0 NR — 300,676 236.5 7,878 6.1

1945 359,114 282.3 77,007 60.5 101,719 79.9 142,187 111.8 12,339 431.7 NR — 287,181 225.8 5,515 4.3

1946 363,647 271.7 94,957 70.9 107,924 80.6 125,248 93.6 12,106 354.9 NR — 368,020 275.0 7,091 5.2

1947 355,592 252.3 93,545 66.4 104,124 73.9 122,089 86.6 12,200 319.6 NR — 380,666 270.0 9,515 6.7

1948 314,313 218.2 68,174 47.3 90,598 62.9 123,312 85.6 13,931 383.0 NR — 345,501 239.8 7,661 5.3

1949 256,463 175.3 41,942 28.7 75,045 51.3 116,397 79.5 13,952 382.4 NR — 317,950 217.3 6,707 4.6

1950 217,558 146.0 23,939 16.7 59,256 39.7 113,569 70.2 13,377 368.3 NR — 286,746 192.5 4,977 3.3

1951 174,924 116.1 14,485 9.6 43,316 28.7 98,311 65.2 11,094 290.4 NR — 254,470 168.9 4,233 2.8

1952 167,762 110.2 10,449 6.9 36,454 24.0 105,238 69.1 8,553 218.8 NR — 244,957 160.8 3,738 2.5

1953 148,573 95.9 8,637 5.6 28,295 18.3 98,870 63.8 7,675 193.9 NR — 238,340 153.9 3,338 2.2

1954 130,687 82.9 7,147 4.5 23,861 15.1 89,123 56.5 6,676 164.0 NR — 242,050 153.5 3,003 1.9

1955 122,392 76.2 6,454 4.0 20,054 12.5 86,526 53.8 5,354 130.7 NR — 236,197 147.0 2,649 1.7

1956 130,201 78.7 6,392 3.9 19,783 12.0 95,097 57.5 5,491 130.4 NR — 224,346 135.7 2,135 1.3

1957 123,758 73.5 6,576 3.9 17,796 10.6 91,309 54.2 5,288 123.0 NR — 214,496 127.4 1,637 1.0

1958 113,884 66.4 7,176 4.2 16,556 9.7 83,027 48.4 4,866 114.6 NR — 232,386 135.6 1,595 0.9

1959 120,824 69.2 9,799 5.6 17,025 9.8 86,740 49.7 5,130 119.7 NR — 240,254 137.6 1,537 0.9

1960 122,538 68.8 16,145 9.1 18,017 10.1 81,798 45.9 4,416 103.7 NR — 258,933 145.4 1,680 0.9

1961 124,658 68.8 19,851 11.0 19,486 10.8 79,304 43.8 4,163 97.5 NR — 264,158 145.8 1,438 0.8

1962 126,245 68.7 21,067 11.5 19,585 10.7 79,533 43.3 4,070 97.7 NR — 263,714 143.6 1,344 0.7

1963 124,137 66.5 22,251 11.9 18,235 9.8 78,076 41.8 4,031 98.4 NR — 278,289 149.0 1,220 0.7

1964 114,325 60.4 22,969 12.1 17,781 9.4 68,629 36.3 3,516 87.3 NR — 300,666 158.9 1,247 0.7

1965 112,842 58.9 23,338 12.2 17,458 9.1 67,317 35.1 3,564 94.8 NR — 324,925 169.5 982 0.5

1966 105,159 54.2 21,414 11.0 15,950 8.2 63,541 32.7 3,170 87.9 NR — 351,738 181.2 838 0.4

1967 102,581 52.2 21,053 10.7 15,554 7.9 61,975 31.5 2,894 82.2 NR — 404,836 205.9 784 0.4

1968 96,271 48.4 19,019 9.6 15,150 7.6 58,564 29.4 2,381 68.0 NR — 464,543 233.4 845 0.4

1969 92,162 45.7 19,130 9.5 15,402 7.6 54,587 27.1 2,074 57.6 NR — 534,872 265.4 1,104 0.5

1970 91,382 44.8 21,982 10.8 16,311 8.0 50,348 24.7 1,953 52.3 NR — 600,072 294.2 1,416 0.7

1971 95,997 46.4 23,783 11.5 19,417 9.4 49,993 24.2 2,052 57.7 NR — 670,268 324.1 1,320 0.6

1972 91,149 43.6 24,429 11.7 20,784 9.9 43,456 20.8 1,758 54.0 NR — 767,215 366.6 1,414 0.7

1973 87,469 41.4 24,825 11.7 23,584 11.2 37,054 17.5 1,527 48.7 NR — 842,621 398.7 1,165 0.6

1974 83,771 39.3 25,385 11.9 25,124 11.8 31,854 14.9 1,138 36.0 NR — 906,121 424.7 945 0.4

1975 80,356 37.3 25,561 11.9 26,569 12.3 27,096 12.6 916 29.1 NR — 999,937 464.1 700 0.3

1976 71,761 33.0 23,731 10.9 25,363 11.7 21,905 10.1 626 19.8 NR — 1,001,994 460.6 628 0.3

1977 64,621 29.4 20,399 9.3 21,329 9.7 22,313 10.2 463 13.9 NR — 1,002,219 456.0 455 0.2

1978 64,875 29.2 21,656 9.8 19,628 8.8 23,038 10.4 434 13.0 NR — 1,013,436 456.3 521 0.2

1979 67,049 29.9 24,874 11.1 20,459 9.1 21,301 9.5 332 9.5 NR — 1,004,058 447.1 840 0.4

1980 68,832 30.3 27,204 12.0 20,297 8.9 20,979 9.2 277 7.7 NR — 1,004,029 442.1 788 0.3

1981 72,799 31.7 31,266 13.6 21,033 9.2 20,168 8.8 287 7.9 NR — 990,864 431.8 850 0.4

1982 75,579 32.6 33,613 14.5 21,894 9.5 19,799 8.5 259 7.0 NR — 960,633 414.7 1,392 0.6

1983 74,637 31.9 32,698 14.0 23,738 10.2 17,896 7.7 239 6.6 NR — 900,435 385.1 847 0.4

1984 69,872 29.6 28,607 12.1 23,131 9.8 17,829 7.6 305 8.3 7,594 6.5 878,556 372.5 665 0.3

1985 67,563 28.4 27,131 11.4 21,689 9.1 18,414 7.7 329 8.7 25,848 17.4 911,419 383.0 2,067 0.9

1986 67,779 28.2 27,667 11.5 21,656 9.0 18,046 7.5 410 10.9 58,001 35.2 892,229 371.5 3,045 1.3

1987 87,286 36.0 35,585 14.7 28,233 11.7 22,988 9.5 480 12.6 91,913 50.8 787,532 325.0 4,986 2.1

1988 104,546 42.8 40,474 16.6 35,968 14.7 27,363 11.2 741 19.0 157,854 87.1 738,160 301.9 4,891 2.0

1989 115,089 46.6 45,826 18.6 45,394 18.4 22,032 8.9 1,837 45.5 200,904 102.5 733,294 297.1 4,697 1.9
78 National Summary Tables STD Surveillance 2013

Table 1. Sexually Transmitted Diseases — Reported Cases and Rates of Reported Cases per 

100,000 Population, United States, 1941–2013 (continued)

Syphilis

Year*

All Stages†

Primary and 

Secondary Early Latent

Late and Late 

Latent‡ Congenital Chlamydia Gonorrhea Chancroid

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

1990 135,590 54.3 50,578 20.3 55,397 22.2 25,750 10.3 3,865 92.9 323,663 160.2 690,042 276.4 4,212 1.7

1991 128,719 50.9 42,950 17.0 53,855 21.3 27,490 10.9 4,424 107.6 381,228 179.7 621,918 245.8 3,476 1.4

1992 114,730 44.7 34,009 13.3 49,929 19.5 26,725 10.4 4,067 100.0 409,694 182.3 502,858 196.0 1,906 0.7

1993 102,612 39.5 26,527 10.2 41,919 16.1 30,746 11.8 3,420 85.5 405,332 178.0 444,649 171.1 1,292 0.5

1994 82,713 31.4 20,641 7.8 32,017 12.2 27,603 10.5 2,452 62.0 451,785 192.5 419,602 163.9 782 0.3

1995 69,359 26.0 16,543 6.2 26,657 10.0 24,296 9.1 1,863 47.8 478,577 187.8 392,651 147.5 607 0.2

1996 53,240 19.8 11,405 4.2 20,187 7.5 20,366 7.6 1,282 32.9 492,631 190.6 328,169 121.8 386 0.1

1997 46,716 17.1 8,556 3.1 16,631 6.1 20,447 7.5 1,082 27.9 537,904 205.5 327,665 120.2 246 0.1

1998 38,289 13.9 7,007 2.5 12,696 4.6 17,743 6.4 843 21.4 614,250 231.8 356,492 129.2 189 0.1

1999 35,386 12.7 6,617 2.4 11,534 4.1 16,655 6.0 580 14.6 662,647 247.2 360,813 129.3 110 0.0

2000 31,618 11.2 5,979 2.1 9,465 3.4 15,594 5.5 580 14.3 709,452 251.4 363,136 128.7 78 0.0

2001 32,286 11.3 6,103 2.1 8,701 3.0 16,976 5.9 506 12.6 783,242 274.5 361,705 126.8 38 0.0

2002 32,919 11.4 6,862 2.4 8,429 2.9 17,168 6.0 460 11.4 834,555 289.4 351,852 122.0 48 0.0

2003 34,289 11.8 7,177 2.5 8,361 2.9 18,319 6.3 432 10.6 877,478 301.7 335,104 115.2 54 0.0

2004 33,423 11.4 7,980 2.7 7,768 2.6 17,300 5.9 375 9.1 929,462 316.5 330,132 112.4 30 0.0

2005 33,288 11.2 8,724 2.9 8,176 2.8 16,049 5.4 339 8.2 976,445 329.4 339,593 114.6 17 0.0

2006 36,958 12.3 9,756 3.3 9,186 3.1 17,644 5.9 372 8.7 1,030,911 344.3 358,366 119.7 19 0.0

2007 40,925 13.6 11,466 3.8 10,768 3.6 18,256 6.1 435 10.1 1,108,374 367.5 355,991 118.0 23 0.0

2008 46,292 15.2 13,500 4.4 12,401 4.1 19,945 6.6 446 10.5 1,210,523 398.1 336,742 110.7 25 0.0

2009 44,832 14.6 13,997 4.6 13,066 4.3 17,338 5.6 431 10.4 1,244,180 405.3 301,174 98.1 28 0.0

2010 45,844 14.8 13,774 4.5 13,604 4.4 18,079 5.9 387 9.4 1,307,893 423.6 309,341 100.2 24 0.0

2011 46,040 14.8 13,970 4.5 13,136 4.2 18,576 6.0 358 8.7 1,412,791 453.4 321,849 103.3 8 0.0

2012 49,915 15.9 15,667 5.0 14,503 4.6 19,411 6.2 334 8.4 1,422,976 453.3 334,826 106.7 15 0.0

2013 56,471 18.0 17,375 5.5 16,929 5.4 21,819 7.0 348 8.7 1,401,906 446.6 333,004 106.1 10 0.0

* For 1941–1946, data were reported for the federal fiscal year ending June 30 of the year indicated. From 1947 to the present, data were reported for the calendar 

year ending December 31. For 1941–1958, data for Alaska and Hawaii were not included.

† Includes stage of syphilis not stated.

‡ Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other than 

neurosyphilis.

§ Rates include all cases of congenitally acquired syphilis per 100,000 live births. As of 1995, cases of congenital syphilis are obtained in hardcopy and electronic 

format on the basis of case reporting form CDC 73.126.

NR = No report.

Note: Adjustments to the number of cases reported from state health departments were made for hardcopy forms and for electronic data submissions through 

June 4, 2014 (see Appendix). The number of cases and the rates shown here supersede those published in previous reports. For more information regarding 

reporting, reporting, see Interpreting STD Surveillance Data in the Appendix. Cases and rates shown in this table exclude the outlying areas of Guam, Puerto Rico, 

and Virgin Islands.
STD Surveillance 2013 Chlamydia Tables 79

Table 2. Chlamydia — Reported Cases and Rates of Reported Cases by State, Ranked by Rates, 

United States, 2013

Rank* State Cases Rate per 100,000 Population

1 Alaska 5,774 789.4

2 Louisiana 28,739 624.5

3 Alabama 29,464 611.0

4 New Mexico 12,249 587.3

5 Mississippi 17,464 585.1

6 Delaware 5,213 568.4

7 South Carolina 25,594 541.8

8 Arkansas 15,447 523.8

9 Georgia 51,070 514.8

10 Texas 129,861 498.3

11 North Carolina 48,416 496.5

12 Illinois 63,797 495.5

13 New York 95,803 489.5

14 Oklahoma 18,278 479.1

15 Hawaii 6,640 476.9

16 South Dakota 3,927 471.2

17 Tennessee 30,370 470.4

18 Arizona 30,564 466.4

19 Ohio 53,121 460.2

20 Maryland 26,723 454.1

21 Missouri 27,328 453.8

22 Michigan 44,835 453.6

U.S. TOTAL† 1,401,906 446.6

23 California 167,346 439.9

24 Indiana 28,023 428.7

25 Nevada 11,781 427.0

26 North Dakota 2,932 419.1

27 Florida 80,182 415.1

28 Wisconsin 23,572 411.6

29 Rhode Island 4,312 410.6

30 Pennsylvania 52,056 407.8

31 Virginia 33,316 407.0

32 Nebraska 7,301 393.5

33 Colorado 20,386 393.0

34 Kentucky 17,134 391.2

35 Kansas 11,012 381.6

36 Montana 3,818 379.8

37 Oregon 14,181 363.7

38 Washington 24,950 361.8

39 Iowa 10,953 356.3

40 Connecticut 12,775 355.8

41 Massachusetts 23,210 349.2

42 Minnesota 18,742 348.4

43 Wyoming 2,005 347.8

44 Idaho 5,428 340.2

45 New Jersey 28,327 319.6

46 Vermont 1,842 294.2

47 West Virginia 5,139 277.0

48 Utah 7,535 263.9

49 Maine 3,438 258.7

50 New Hampshire 3,119 236.2

* States were ranked by rate, then by case count, then in alphabetical order, with rates shown rounded to the nearest tenth.

† Total includes cases reported by the District of Columbia with 6,414 cases and a rate of 1,014.4, but excludes outlying areas (Guam with 937 cases and rate of 

585.9, Puerto Rico with 5,969 cases and rate of 162.8, and Virgin Islands with 775 cases and rate of 736.2).
80 Chlamydia Tables STD Surveillance 2013

Table 3. Chlamydia — Reported Cases and Rates of Reported Cases by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2009–2013

Cases Rates per 100,000 Population

State/Area 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Alabama 25,929 27,041 29,626 30,621 29,464 550.7 565.7 616.9 635.0 611.0

Alaska 5,166 6,019 5,739 5,462 5,774 739.6 847.5 794.1 746.7 789.4

Arizona 26,002 26,861 29,251 30,444 30,564 394.2 420.2 451.2 464.6 466.4

Arkansas 14,354 15,424 16,052 16,611 15,447 496.8 529.0 546.4 563.3 523.8

California 146,796 150,443 166,773 167,695 167,346 397.2 403.8 442.5 440.8 439.9

Colorado 19,998 19,447 21,811 21,631 20,386 398.0 386.7 426.3 417.0 393.0

Connecticut 12,127 12,649 13,649 13,065 12,775 344.7 353.9 381.2 363.9 355.8

Delaware 4,718 4,464 4,508 4,438 5,213 533.0 497.1 496.9 483.9 568.4

District of Columbia 6,549 5,589 6,585 6,808 6,414 1,092.1 928.8 1,065.5 1,076.7 1,014.4

Florida 72,931 74,744 76,033 77,644 80,182 393.4 397.5 399.0 401.9 415.1

Georgia 39,828 45,147 54,403 52,418 51,070 405.2 466.0 554.3 528.4 514.8

Hawaii 6,026 6,015 6,001 6,340 6,640 465.3 442.2 436.5 455.4 476.9

Idaho 3,842 4,208 4,699 4,550 5,428 248.5 268.4 296.5 285.1 340.2

Illinois 60,542 60,672 64,939 67,701 63,797 468.9 472.9 504.6 525.8 495.5

Indiana 21,732 22,825 27,801 29,505 28,023 338.3 352.0 426.6 451.3 428.7

Iowa 9,406 10,542 10,705 11,377 10,953 312.7 346.1 349.6 370.1 356.3

Kansas 10,510 9,601 10,598 11,135 11,012 372.9 336.5 369.1 385.8 381.6

Kentucky 13,293 16,376 16,629 17,273 17,134 308.1 377.4 380.6 394.3 391.2

Louisiana 27,628 29,151 31,614 27,353 28,739 615.0 643.0 691.0 594.4 624.5

Maine 2,431 2,586 3,094 3,413 3,438 184.4 194.7 232.9 256.8 258.7

Maryland 23,747 26,192 27,212 26,534 26,723 416.7 453.7 466.9 450.9 454.1

Massachusetts 19,315 21,080 22,764 23,550 23,210 292.9 321.9 345.6 354.3 349.2

Michigan 45,714 49,478 49,568 47,566 44,835 458.5 500.6 501.9 481.3 453.6

Minnesota 14,197 15,294 16,902 18,056 18,742 269.6 288.4 316.2 335.7 348.4

Mississippi 23,589 21,417 21,216 23,054 17,464 799.1 721.8 712.3 772.3 585.1

Missouri 25,868 26,049 27,887 27,835 27,328 432.0 435.0 464.0 462.2 453.8

Montana 2,988 3,082 3,406 3,827 3,818 306.5 311.5 341.2 380.7 379.8

Nebraska 5,443 5,114 6,780 6,748 7,301 303.0 280.0 368.0 363.7 393.5

Nevada 10,045 9,666 10,507 11,137 11,781 380.0 357.9 385.8 403.7 427.0

New Hampshire 2,102 2,462 3,010 3,072 3,119 158.7 187.0 228.3 232.6 236.2

New Jersey 23,974 26,142 26,209 27,271 28,327 275.3 297.3 297.1 307.6 319.6

New Mexico 9,493 11,706 11,374 11,898 12,249 472.4 568.5 546.2 570.5 587.3

New York 92,069 99,920 102,763 100,546 95,803 471.1 515.6 527.9 513.8 489.5

North Carolina 41,045 42,048 54,819 50,596 48,416 437.5 441.0 567.7 518.8 496.5

North Dakota 1,957 2,404 2,445 2,908 2,932 302.5 357.4 357.5 415.6 419.1

Ohio 48,239 51,150 52,653 53,141 53,121 417.9 443.4 456.1 460.3 460.2

Oklahoma 15,023 14,302 14,596 16,843 18,278 407.5 381.2 385.0 441.5 479.1

Oregon 11,497 12,352 13,643 13,454 14,181 300.5 322.4 352.4 345.0 363.7

Pennsylvania 43,068 47,518 52,884 54,993 52,056 341.7 374.1 415.0 430.9 407.8

Rhode Island 3,615 3,480 4,146 4,313 4,312 343.2 330.6 394.4 410.6 410.6

South Carolina 26,654 26,525 28,932 27,149 25,594 584.4 573.5 618.3 574.7 541.8

South Dakota 3,015 3,192 3,409 3,924 3,927 371.1 392.1 413.7 470.9 471.2

Tennessee 29,711 28,327 31,105 32,525 30,370 471.9 446.4 485.8 503.8 470.4

Texas 105,910 119,872 124,882 127,036 129,861 427.4 476.7 486.4 487.5 498.3

Utah 6,145 6,690 7,086 7,615 7,535 220.7 242.1 251.5 266.7 263.9

Vermont 1,186 1,257 1,483 1,724 1,842 190.7 200.9 236.7 275.4 294.2

Virginia 30,903 30,797 36,314 34,963 33,316 392.0 384.9 448.5 427.1 407.0

Washington 21,387 21,348 23,280 24,596 24,950 320.9 317.5 340.8 356.6 361.8

West Virginia 3,604 3,876 4,295 4,790 5,139 198.0 209.2 231.5 258.2 277.0

Wisconsin 20,906 23,236 24,619 23,726 23,572 369.7 408.6 431.0 414.3 411.6

Wyoming 1,963 2,113 2,092 2,102 2,005 360.7 374.9 368.2 364.7 347.8

U.S. TOTAL 1,244,180 1,307,893 1,412,791 1,422,976 1,401,906 405.3 423.6 453.4 453.3 446.6

Northeast 199,887 217,094 230,002 231,947 224,882 361.6 392.5 414.3 416.0 403.3

Midwest 267,529 279,557 298,306 303,622 295,543 400.3 417.7 444.2 451.0 439.0

South 505,416 531,292 578,821 576,656 568,824 446.0 463.8 498.8 491.8 485.1

West 271,348 279,950 305,662 310,751 312,657 379.1 389.1 419.5 422.3 424.9

Guam 620 899 1,071 1,031 937 347.5 563.9 671.1 644.7 585.9

Puerto Rico 7,302 5,960 5,634 6,227 5,969 184.1 160.0 152.0 169.8 162.8

Virgin Islands 488 609 820 802 775 444.4 573.1 775.2 761.8 736.2

OUTLYING AREAS 8,410 7,468 7,525 8,060 7,681 197.6 187.1 189.4 205.0 195.3

TOTAL 1,252,590 1,315,361 1,420,316 1,431,036 1,409,587 402.4 420.6 450.1 450.2 443.5
STD Surveillance 2013 Chlamydia Tables 81

Table 4. Chlamydia Among Women — Reported Cases and Rates of Reported Cases by State/

Area and Region in Alphabetical Order, United States and Outlying Areas, 2009–2013

Cases Rates per 100,000 Population

State/Area 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Alabama 19,413 20,030 21,217 22,099 21,096 799.8 814.4 857.9 889.8 849.5

Alaska 3,364 3,960 3,801 3,670 3,899 1,000.5 1,162.6 1,093.7 1,047.9 1,113.3

Arizona 19,097 19,529 21,196 22,087 21,950 580.6 607.2 650.5 670.4 666.2

Arkansas 10,689 11,303 11,921 12,247 11,334 725.2 761.5 797.3 816.1 755.3

California 101,716 102,645 114,657 114,396 112,460 551.1 547.8 605.3 598.2 588.1

Colorado 14,765 14,188 15,751 15,476 14,336 592.1 565.6 617.8 598.9 554.8

Connecticut 8,937 9,223 9,824 9,464 9,210 496.3 502.8 535.1 514.2 500.4

Delaware 3,573 3,296 3,191 3,181 3,714 784.5 711.9 682.9 672.9 785.6

District of Columbia 4,153 3,782 4,357 4,426 3,992 1,311.8 1,191.2 1,337.4 1,328.0 1,197.8

Florida 52,747 53,318 54,262 55,628 56,688 560.3 554.7 557.3 563.6 574.4

Georgia 29,074 32,863 39,829 37,456 36,559 582.2 662.8 794.6 738.9 721.2

Hawaii 4,399 4,340 4,314 4,452 4,646 686.5 639.1 629.8 644.9 673.0

Idaho 2,768 3,014 3,345 3,206 3,885 359.5 385.3 422.7 402.2 487.4

Illinois 44,560 44,598 46,728 48,575 45,764 680.2 682.1 712.9 740.9 698.1

Indiana 16,150 16,344 20,065 21,633 20,307 495.6 496.2 606.2 651.8 611.8

Iowa 6,785 7,612 7,647 8,194 7,895 445.7 494.9 495.0 528.7 509.5

Kansas 8,209 7,449 8,158 8,440 8,323 578.5 518.1 564.4 581.8 573.8

Kentucky 9,621 11,859 11,990 12,366 12,086 438.0 538.0 540.2 556.3 543.8

Louisiana 20,719 20,564 23,390 20,507 21,258 898.1 888.6 1,001.1 872.7 904.7

Maine 1,705 1,814 2,149 2,420 2,404 252.7 267.4 316.9 356.5 354.1

Maryland 18,782 19,827 20,004 19,295 19,049 639.8 664.9 665.1 635.9 627.8

Massachusetts 13,786 14,753 15,744 16,319 15,851 406.8 436.4 463.3 476.4 462.7

Michigan 33,860 36,431 36,367 34,510 32,056 668.3 723.5 723.0 685.7 636.9

Minnesota 10,204 10,965 11,827 12,568 12,950 385.7 410.4 439.7 464.3 478.4

Mississippi 17,829 15,958 15,697 16,771 12,676 1,172.2 1,045.7 1,024.6 1,092.1 825.5

Missouri 18,825 18,867 20,097 19,745 19,303 614.9 617.5 655.4 643.0 628.6

Montana 2,134 2,194 2,390 2,655 2,701 438.2 445.3 480.9 530.8 540.0

Nebraska 3,884 3,561 4,783 4,628 4,945 429.2 387.0 515.7 495.9 529.9

Nevada 7,112 6,897 7,215 7,628 8,183 548.3 515.9 534.9 557.7 598.3

New Hampshire 1,542 1,808 2,184 2,150 2,187 229.6 271.0 327.3 321.6 327.2

New Jersey 18,757 20,128 19,886 20,231 20,771 422.5 446.1 439.9 445.5 457.4

New Mexico 6,987 8,718 8,309 8,724 9,033 688.3 836.9 789.7 828.6 858.0

New York 63,882 68,693 70,466 68,337 64,454 636.1 686.9 702.3 677.9 639.4

North Carolina 33,002 33,836 42,992 39,140 37,146 688.9 691.9 868.1 782.9 743.0

North Dakota 1,297 1,577 1,603 1,898 1,923 403.0 474.0 474.7 551.9 559.2

Ohio 36,724 38,636 38,914 38,879 38,293 621.5 654.4 658.9 658.8 648.9

Oklahoma 11,101 10,297 10,349 12,341 13,065 595.2 543.6 540.8 641.1 678.7

Oregon 8,136 8,565 9,489 9,425 9,932 421.9 442.6 485.3 478.8 504.5

Pennsylvania 30,335 33,175 36,463 37,569 35,657 469.1 509.4 558.5 575.0 545.8

Rhode Island 2,603 2,478 2,984 3,091 3,044 480.5 455.4 549.5 570.3 561.6

South Carolina 21,124 20,842 22,278 20,497 19,103 902.7 877.5 927.2 844.7 787.3

South Dakota 2,214 2,300 2,491 2,801 2,793 544.7 565.4 606.2 674.9 673.0

Tennessee 21,655 20,559 22,200 22,732 21,057 671.1 632.1 676.3 687.3 636.6

Texas 82,551 92,847 95,326 96,405 96,923 665.5 732.6 737.1 735.3 739.2

Utah 4,019 4,473 4,821 5,149 5,050 290.5 325.2 343.9 362.8 355.8

Vermont 889 910 1,106 1,296 1,319 281.6 286.6 348.3 408.5 415.8

Virginia 22,390 22,348 26,283 24,670 23,167 558.7 548.4 637.9 592.4 556.3

Washington 15,741 15,634 16,641 17,271 17,452 472.0 463.3 486.5 499.8 505.1

West Virginia 2,684 2,832 3,092 3,405 3,624 289.3 301.5 328.8 362.2 385.5

Wisconsin 15,038 16,657 17,402 16,727 16,448 528.4 581.5 605.1 580.1 570.5

Wyoming 1,187 1,305 1,357 1,492 1,387 444.2 472.5 487.4 528.8 491.6

U.S. TOTAL 912,718 949,802 1,018,552 1,018,272 993,348 586.7 605.1 643.4 638.7 623.1

Northeast 142,436 152,982 160,806 160,877 154,897 502.6 537.8 563.8 562.0 541.1

Midwest 197,750 204,997 216,082 218,598 211,000 583.1 602.9 633.7 639.9 617.6

South 381,107 396,361 428,378 423,166 412,537 661.6 678.5 724.2 708.3 690.5

West 191,425 195,462 213,286 215,631 214,914 536.2 541.5 583.9 584.6 582.7

Guam 512 664 783 726 700 583.9 846.8 996.9 921.9 888.9

Puerto Rico 6,336 4,878 4,528 5,102 4,766 307.0 251.4 234.3 267.1 249.6

Virgin Islands 435 427 591 592 579 752.2 757.7 1,051.7 1,056.8 1,033.6

OUTLYING AREAS 7,283 5,969 5,902 6,420 6,045 329.6 287.6 285.5 314.0 295.7

TOTAL 920,001 955,771 1,024,454 1,024,692 999,393 583.1 601.0 638.8 634.6 618.9

Note: Cases reported with unknown sex are not included in this table.
82 Chlamydia Tables STD Surveillance 2013

Table 5. Chlamydia Among Men — Reported Cases and Rates of Reported Cases by State/Area 

and Region in Alphabetical Order, United States and Outlying Areas, 2009–2013

Cases Rates per 100,000 Population

State/Area 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Alabama 6,508 6,877 7,648 8,295 8,201 285.2 296.4 328.3 354.7 350.7

Alaska 1,802 2,058 1,938 1,792 1,875 497.5 556.8 516.5 470.0 491.8

Arizona 6,904 7,331 8,052 8,354 8,610 208.8 230.8 249.8 256.4 264.2

Arkansas 3,664 4,112 4,125 4,360 4,104 258.8 287.2 285.9 301.0 283.3

California 44,592 47,239 51,554 52,983 54,679 241.0 255.1 275.0 280.1 289.0

Colorado 5,228 5,259 6,057 6,155 6,050 206.6 208.6 235.9 236.4 232.4

Connecticut 3,190 3,426 3,825 3,524 3,481 185.7 196.9 219.2 201.4 198.9

Delaware 1,145 1,168 1,317 1,257 1,499 266.5 268.5 299.4 282.9 337.3

District of Columbia 2,390 1,789 2,225 2,345 2,400 844.3 629.4 761.4 784.2 802.6

Florida 20,069 21,362 21,685 22,009 23,300 220.0 232.5 232.6 233.0 246.6

Georgia 10,513 11,965 13,978 14,521 14,063 217.4 253.0 291.0 299.3 289.9

Hawaii 1,626 1,675 1,687 1,888 1,994 248.5 245.9 244.6 269.0 284.1

Idaho 1,051 1,183 1,347 1,344 1,528 135.5 150.6 169.7 168.3 191.3

Illinois 15,964 15,957 18,083 18,977 17,943 251.0 253.6 286.4 300.3 283.9

Indiana 5,502 6,451 7,681 7,850 7,708 173.9 202.2 239.5 243.9 239.5

Iowa 2,621 2,930 3,058 3,183 3,058 176.4 194.3 201.5 208.8 200.6

Kansas 2,301 2,152 2,440 2,695 2,689 164.4 152.0 171.1 187.8 187.4

Kentucky 3,647 4,488 4,577 4,851 4,989 172.2 210.2 212.9 224.8 231.2

Louisiana 6,841 6,658 7,568 6,846 7,481 313.1 300.0 338.1 304.0 332.2

Maine 726 768 944 990 1,031 112.8 118.1 145.2 152.2 158.5

Maryland 4,885 6,336 7,197 7,193 7,654 176.7 227.0 255.2 252.4 268.5

Massachusetts 5,490 6,302 7,000 7,193 7,341 171.3 199.0 219.5 223.4 228.0

Michigan 11,675 12,926 13,095 12,962 12,683 238.1 266.6 270.2 267.2 261.5

Minnesota 3,993 4,329 5,075 5,430 5,791 152.4 164.5 191.2 203.2 216.7

Mississippi 5,760 5,459 5,519 6,281 4,788 402.5 378.8 381.5 433.4 330.4

Missouri 7,043 7,182 7,790 8,090 8,025 240.7 244.8 264.6 274.1 271.9

Montana 851 888 1,016 1,172 1,116 174.4 178.8 202.7 232.1 221.0

Nebraska 1,549 1,548 1,987 2,093 2,196 173.7 170.8 217.1 226.9 238.1

Nevada 2,931 2,768 3,290 3,508 3,590 217.7 203.0 239.3 252.2 258.0

New Hampshire 560 654 826 922 932 85.8 100.7 126.9 141.4 142.9

New Jersey 5,200 5,874 6,231 6,958 7,476 121.8 137.3 144.9 160.9 172.9

New Mexico 2,500 2,986 3,054 3,170 3,209 251.3 293.5 296.5 307.0 310.7

New York 28,171 31,224 32,126 32,147 31,273 296.6 333.0 340.6 338.8 329.6

North Carolina 7,798 8,030 11,585 11,354 11,254 169.9 172.9 246.3 238.9 236.8

North Dakota 654 822 841 1,010 1,009 201.2 241.9 242.9 283.9 283.6

Ohio 10,978 12,320 13,731 14,262 14,828 194.9 218.7 243.5 252.8 262.8

Oklahoma 3,879 3,997 3,851 4,498 5,213 212.9 215.2 205.1 238.0 275.8

Oregon 3,361 3,786 4,154 4,028 4,243 177.2 199.7 216.7 208.6 219.8

Pennsylvania 12,700 14,297 16,364 17,388 16,360 206.9 231.0 263.3 279.1 262.6

Rhode Island 1,012 1,002 1,162 1,222 1,268 197.9 197.1 228.6 240.4 249.5

South Carolina 5,418 5,653 6,585 6,588 6,432 243.9 251.2 289.2 286.8 280.0

South Dakota 788 883 914 1,123 1,134 194.1 216.8 221.2 268.5 271.1

Tennessee 8,055 7,748 8,905 9,754 9,311 262.4 250.5 285.3 309.8 295.7

Texas 23,302 26,966 29,533 30,532 31,980 188.3 216.2 231.8 235.8 247.0

Utah 2,126 2,215 2,265 2,466 2,485 151.8 159.5 160.0 171.7 173.1

Vermont 297 347 377 428 523 97.1 112.6 122.1 138.6 169.4

Virginia 8,442 8,397 9,929 10,247 10,112 217.9 213.9 249.7 254.8 251.4

Washington 5,645 5,711 6,639 7,325 7,498 169.6 170.5 194.7 212.8 217.9

West Virginia 920 1,044 1,203 1,385 1,514 103.1 114.3 131.5 151.3 165.4

Wisconsin 5,740 6,573 7,203 6,999 7,114 204.3 232.9 254.0 246.2 250.2

Wyoming 776 808 734 610 617 280.1 281.1 253.3 207.3 209.7

U.S. TOTAL 328,783 353,923 389,970 402,557 405,652 217.1 233.2 254.4 260.6 262.6

Northeast 57,346 63,894 68,855 70,772 69,685 212.8 237.8 255.0 260.8 256.8

Midwest 68,808 74,073 81,898 84,674 84,178 209.0 225.0 247.7 255.4 253.9

South 123,236 132,049 147,430 152,316 154,295 221.2 235.2 259.1 264.8 268.3

West 79,393 83,907 91,787 94,795 97,494 221.3 234.1 252.6 258.3 265.7

Guam 108 235 288 305 234 119.0 290.1 355.3 375.8 288.3

Puerto Rico 957 1,076 1,106 1,125 1,203 50.3 60.3 62.3 64.0 68.5

Virgin Islands 53 182 229 210 196 102.0 364.7 461.8 426.3 397.9

OUTLYING AREAS 1,118 1,493 1,623 1,640 1,633 54.6 77.9 85.2 86.9 86.5

TOTAL 329,901 355,416 391,593 404,197 407,285 214.9 231.2 252.3 258.5 260.4

Note: Cases reported with unknown sex are not included in this table.
STD Surveillance 2013 Chlamydia Tables 83

Table 6. Chlamydia — Reported Cases and Rates of Reported Cases in Selected Metropolitan 

Statistical Areas (MSAs)* in Alphabetical Order, United States, 2009–2013

Cases Rates per 100,000 Population

MSAs 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Atlanta-Sandy Springs-Roswell, GA 20,337 22,203 27,372 26,470 16,429 370.2 420.0 509.0 485.0 301.0

Austin-Round Rock, TX 8,456 8,511 9,360 9,810 10,138 495.9 495.9 524.8 534.8 552.7

Baltimore-Columbia-Towson, MD 12,883 13,988 14,399 13,578 13,749 478.8 516.1 527.6 493.2 499.4

Birmingham-Hoover, AL 6,120 6,126 6,834 6,868 6,552 541.1 543.1 603.6 604.2 576.4

Boston-Cambridge-Newton, MA-NH 13,285 14,291 15,703 16,339 16,127 289.5 313.9 342.0 352.1 347.5

Buffalo-Cheektowaga-Niagara Falls, NY 5,769 5,938 5,965 6,010 5,724 513.3 522.9 526.0 529.9 504.7

Charlotte-Concord-Gastonia, NC-SC 10,474 9,060 13,257 11,548 11,418 474.9 408.7 587.2 502.8 497.2

Chicago-Naperville-Elgin, IL-IN-WI 46,505 45,726 49,590 51,329 47,837 485.4 483.3 521.7 539.0 502.4

Cincinnati, OH-KY-IN 8,868 9,791 10,044 10,234 10,207 411.4 463.0 473.2 480.8 479.5

Cleveland-Elyria, OH 10,439 11,608 12,348 12,339 12,126 499.2 558.8 597.0 598.0 587.6

Columbus, OH 9,095 9,625 9,031 8,946 9,734 487.4 506.1 469.3 460.2 500.7

Dallas-Fort Worth-Arlington, TX 27,239 29,430 32,002 31,697 30,684 419.0 458.0 486.2 473.0 457.9

Denver-Aurora-Lakewood, CO 11,803 14,320 12,710 12,764 12,131 462.5 563.0 488.9 482.5 458.6

Detroit-Warren-Dearborn, MI 25,347 27,751 26,237 24,229 22,567 575.6 645.9 612.2 564.5 525.8

Hartford-West Hartford-East Hartford, CT 4,467 4,616 4,837 4,562 4,311 373.5 380.7 398.7 375.7 355.0

Houston-The Woodlands-Sugar Land, TX 20,999 27,462 26,508 26,807 29,120 359.4 463.9 437.4 434.0 471.4

Indianapolis-Carmel-Anderson, IN 8,258 8,797 11,117 12,714 11,835 440.4 466.0 582.1 659.1 613.5

Jacksonville, FL 6,745 7,093 7,264 6,813 7,138 507.9 527.1 534.0 494.5 518.1

Kansas City, MO-KS 9,822 9,372 10,038 10,152 9,513 481.2 466.4 495.3 498.0 466.6

Las Vegas-Henderson-Paradise, NV 8,177 7,614 8,337 8,587 9,286 429.7 390.2 423.2 429.2 464.1

Los Angeles-Long Beach-Anaheim, CA 54,892 56,033 58,552 60,231 59,386 426.4 436.8 452.3 461.4 455.0

Louisville/Jefferson County, KY-IN 5,165 6,157 6,483 6,658 6,384 426.1 498.3 520.6 532.1 510.2

Memphis, TN-MS-AR 13,405 12,486 11,720 12,744 10,763 1,021.0 942.5 878.3 949.8 802.2

Miami-Fort Lauderdale-West Palm Beach, FL 19,101 19,095 19,561 20,933 22,821 344.3 343.1 345.0 363.2 396.0

Milwaukee-Waukesha-West Allis, WI 10,588 11,512 11,712 10,929 10,754 678.9 739.9 749.7 697.5 686.3

Minneapolis-St. Paul-Bloomington, MN-WI 10,018 10,975 12,143 12,144 12,227 300.0 327.7 358.5 354.9 357.3

Nashville-Davidson--Murfreesboro--Franklin, TN 6,135 6,026 6,990 7,151 7,356 368.1 360.6 411.5 414.1 426.0

New Orleans-Metairie, LA 6,812 7,050 8,124 7,118 8,134 562.5 592.5 669.8 580.1 662.9

New York-Newark-Jersey City, NY-NJ-PA 85,579 92,464 95,088 92,763 89,211 433.4 472.5 483.0 467.7 449.8

Oklahoma City, OK 5,475 4,704 5,087 5,640 6,190 446.1 375.4 398.0 435.0 477.4

Orlando-Kissimmee-Sanford, FL 9,199 9,491 9,545 9,928 10,230 441.7 444.7 439.6 446.5 460.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 30,449 33,050 34,799 35,513 34,741 510.2 554.0 580.7 590.0 577.2

Phoenix-Mesa-Scottsdale, AZ 15,615 16,519 17,746 20,358 20,164 357.8 394.0 416.3 470.2 465.7

Pittsburgh, PA 6,597 7,096 8,436 8,994 8,605 280.1 301.2 357.5 381.0 364.5

Portland-Vancouver-Hillsboro, OR-WA 7,215 7,415 8,509 7,797 8,536 321.8 333.1 376.1 340.5 372.8

Providence-Warwick, RI-MA 4,865 4,759 5,559 5,941 5,828 303.9 297.3 347.4 371.0 363.9

Raleigh, NC 3,941 5,122 5,693 5,373 4,966 350.1 453.1 489.3 452.1 417.8

Richmond, VA 6,543 6,911 7,698 7,224 6,817 550.5 572.1 631.5 586.4 553.3

Riverside-San Bernardino-Ontario, CA 16,934 12,263 20,749 20,994 19,819 408.7 290.3 482.0 482.6 455.6

Sacramento--Roseville--Arden-Arcade, CA 6,320 8,084 10,866 9,852 9,771 297.1 376.2 499.3 448.5 444.8

Salt Lake City, UT 3,375 3,653 3,767 4,041 3,947 308.7 335.8 339.9 359.6 351.2

San Antonio-New Braunfels, TX 11,555 12,430 13,066 13,023 13,335 557.6 580.2 595.3 582.9 596.9

San Diego-Carlsbad, CA 14,169 15,341 15,346 16,524 14,706 464.0 495.6 488.7 520.1 462.9

San Francisco-Oakland-Hayward, CA 16,642 17,686 18,745 17,171 18,254 385.4 407.9 426.9 385.4 409.7

San Jose-Sunnyvale-Santa Clara, CA 5,537 5,691 5,965 4,676 6,717 301.0 309.8 319.8 246.8 354.6

Seattle-Tacoma-Bellevue, WA 11,533 11,510 12,329 12,965 12,971 338.4 334.6 352.3 365.0 365.2

St. Louis, MO-IL 14,519 14,660 15,517 14,843 14,783 517.7 525.9 555.7 530.9 528.8

Tampa-St. Petersburg-Clearwater, FL 11,835 12,158 12,595 12,274 12,752 430.8 436.8 445.9 431.7 448.6

Virginia Beach-Norfolk-Newport News, VA-NC 11,961 11,387 13,674 12,409 11,852 712.3 679.1 811.5 730.0 697.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 20,276 20,027 22,839 23,872 23,531 366.7 355.3 396.6 407.3 401.5

SELECTED MSAs TOTAL 721,338 755,077 811,856 811,879 792,177 430.1 450.9 479.2 474.2 462.7

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.
84 Chlamydia Tables STD Surveillance 2013

Table 7. Chlamydia Among Women — Reported Cases and Rates of Reported Cases in Selected 

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2009–2013

Cases Rates per 100,000 Population

MSAs 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Atlanta-Sandy Springs-Roswell, GA 14,241 15,556 19,507 18,298 11,221 512.1 573.1 707.7 652.7 400.2

Austin-Round Rock, TX 6,020 6,212 6,644 6,909 6,691 721.0 725.5 746.6 755.2 731.4

Baltimore-Columbia-Towson, MD 10,187 10,744 10,668 9,933 9,848 730.8 764.4 754.3 696.7 690.7

Birmingham-Hoover, AL 4,530 4,525 4,834 4,866 4,486 774.5 775.0 824.1 826.1 761.6

Boston-Cambridge-Newton, MA-NH 9,369 9,937 10,747 11,234 10,791 398.0 422.9 454.1 469.9 451.4

Buffalo-Cheektowaga-Niagara Falls, NY 4,254 4,386 4,370 4,317 4,024 731.7 746.5 745.7 737.4 687.3

Charlotte-Concord-Gastonia, NC-SC 8,112 7,101 10,024 8,731 8,605 721.5 624.2 864.7 740.1 729.4

Chicago-Naperville-Elgin, IL-IN-WI 34,202 33,360 35,360 36,701 34,216 702.6 689.5 728.0 754.3 703.2

Cincinnati, OH-KY-IN 7,238 7,740 7,763 7,750 7,527 656.4 716.1 715.9 713.0 692.5

Cleveland-Elyria, OH 7,755 8,556 9,065 8,877 8,550 714.7 793.1 844.7 829.5 798.9

Columbus, OH 6,688 6,947 6,266 6,280 6,749 707.7 717.8 640.2 635.3 682.8

Dallas-Fort Worth-Arlington, TX 21,314 22,979 24,221 24,018 22,744 659.7 705.4 726.5 707.6 670.0

Denver-Aurora-Lakewood, CO 8,617 10,458 9,143 9,117 8,447 677.3 817.7 700.4 686.4 636.0

Detroit-Warren-Dearborn, MI 18,870 20,530 19,161 17,460 16,152 836.7 927.2 867.8 789.8 730.6

Hartford-West Hartford-East Hartford, CT 3,250 3,324 3,470 3,301 3,109 530.6 534.2 557.6 529.8 499.0

Houston-The Woodlands-Sugar Land, TX 16,710 21,875 20,956 20,858 22,027 573.5 735.0 688.2 672.3 710.0

Indianapolis-Carmel-Anderson, IN 5,844 5,976 7,579 8,899 8,149 613.0 619.1 776.3 902.5 826.4

Jacksonville, FL 4,874 5,191 5,213 4,812 5,131 716.5 752.4 746.9 680.7 725.8

Kansas City, MO-KS 7,219 6,800 7,278 7,295 6,795 694.9 662.8 703.8 701.5 653.4

Las Vegas-Henderson-Paradise, NV 5,874 5,537 5,777 5,942 6,571 628.5 571.4 590.2 597.1 660.3

Los Angeles-Long Beach-Anaheim, CA 36,965 37,486 38,802 39,470 38,456 571.1 576.7 592.0 597.1 581.8

Louisville/Jefferson County, KY-IN 3,760 4,545 4,745 4,884 4,574 605.9 718.4 744.1 762.7 714.3

Memphis, TN-MS-AR 10,195 9,542 8,767 9,367 7,717 1,496.0 1,385.5 1,263.3 1,342.7 1,106.2

Miami-Fort Lauderdale-West Palm Beach, FL 13,788 13,566 13,815 14,692 15,645 485.5 472.5 473.5 495.4 527.5

Milwaukee-Waukesha-West Allis, WI 7,747 8,376 8,397 7,760 7,463 970.2 1,048.2 1,047.4 964.7 927.8

Minneapolis-St. Paul-Bloomington, MN-WI 7,103 7,788 8,371 8,326 8,293 422.7 459.4 488.7 481.1 479.2

Nashville-Davidson--Murfreesboro--Franklin, TN 4,359 4,250 4,942 4,928 5,084 514.3 497.5 568.7 557.8 575.5

New Orleans-Metairie, LA 4,953 5,134 6,056 5,326 6,062 788.2 840.7 972.3 843.9 960.5

New York-Newark-Jersey City, NY-NJ-PA 60,491 64,520 65,988 63,588 60,539 595.3 636.7 648.2 620.5 590.7

Oklahoma City, OK 3,912 3,292 3,518 3,951 4,430 627.6 517.9 543.3 601.6 674.6

Orlando-Kissimmee-Sanford, FL 6,740 6,777 6,993 7,373 7,503 640.8 621.9 631.1 649.6 661.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 21,297 22,863 23,928 24,166 23,532 690.9 740.7 772.0 776.5 756.1

Phoenix-Mesa-Scottsdale, AZ 11,405 11,892 12,696 14,396 14,206 529.1 564.3 592.8 661.6 652.8

Pittsburgh, PA 4,884 5,146 5,963 6,325 6,046 400.3 422.5 489.5 519.7 496.7

Portland-Vancouver-Hillsboro, OR-WA 5,069 5,091 5,824 5,359 5,809 450.0 451.8 508.8 462.8 501.6

Providence-Warwick, RI-MA 3,503 3,433 4,022 4,256 4,124 425.1 415.1 486.9 515.3 499.3

Raleigh, NC 2,918 3,525 3,951 3,691 3,490 513.4 609.5 663.4 606.8 573.8

Richmond, VA 4,736 5,161 5,599 5,083 4,792 774.3 826.7 889.1 798.4 752.7

Riverside-San Bernardino-Ontario, CA 12,305 8,810 15,241 15,296 14,536 595.5 414.8 704.9 700.5 665.7

Sacramento--Roseville--Arden-Arcade, CA 4,589 5,754 7,874 7,122 6,915 425.7 525.2 709.9 635.9 617.4

Salt Lake City, UT 2,137 2,386 2,517 2,679 2,541 395.2 441.3 457.0 479.6 454.9

San Antonio-New Braunfels, TX 8,566 8,972 9,286 9,436 9,576 811.6 823.1 832.0 832.1 844.5

San Diego-Carlsbad, CA 10,050 10,538 10,395 11,102 9,684 660.5 683.6 664.9 702.5 612.8

San Francisco-Oakland-Hayward, CA 10,618 10,940 11,733 10,391 10,845 489.6 497.8 527.7 460.5 480.6

San Jose-Sunnyvale-Santa Clara, CA 3,989 3,951 4,187 3,260 4,530 443.2 431.6 450.7 345.9 480.7

Seattle-Tacoma-Bellevue, WA 8,062 8,000 8,259 8,460 8,411 473.1 463.0 470.9 474.8 472.1

St. Louis, MO-IL 10,460 10,468 11,077 10,351 10,364 722.8 727.9 769.0 717.8 718.7

Tampa-St. Petersburg-Clearwater, FL 8,323 8,527 8,913 8,738 8,948 590.9 593.9 612.5 596.5 610.8

Virginia Beach-Norfolk-Newport News, VA-NC 8,512 8,106 9,798 8,771 8,259 991.1 948.5 1,141.0 1,015.2 956.0

Washington-Arlington-Alexandria, DC-VA-MD-WV 14,552 14,263 15,946 16,349 15,768 515.6 493.1 540.4 544.5 525.2

SELECTED MSAs TOTAL 521,156 540,836 575,649 570,494 549,975 612.3 632.3 665.7 653.1 629.6

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

Note: Cases reported with unknown sex are not included in this table.
STD Surveillance 2013 Chlamydia Tables 85

Table 8. Chlamydia Among Men — Reported Cases and Rates of Reported Cases in Selected 

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2009–2013

Cases Rates per 100,000 Population

MSAs 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Atlanta-Sandy Springs-Roswell, GA 5,934 6,482 7,563 7,917 5,061 218.7 252.0 288.6 298.3 190.7

Austin-Round Rock, TX 2,430 2,290 2,710 2,890 2,592 279.3 266.2 303.2 314.3 281.9

Baltimore-Columbia-Towson, MD 2,665 3,231 3,723 3,608 3,889 205.5 247.6 283.2 271.8 293.0

Birmingham-Hoover, AL 1,588 1,545 1,852 1,985 2,031 290.7 283.9 339.4 362.5 370.9

Boston-Cambridge-Newton, MA-NH 3,891 4,334 4,946 5,086 5,328 174.1 196.7 222.4 226.0 236.8

Buffalo-Cheektowaga-Niagara Falls, NY 1,515 1,552 1,595 1,693 1,700 279.3 283.2 291.1 308.5 309.8

Charlotte-Concord-Gastonia, NC-SC 2,341 1,948 3,191 2,794 2,804 216.5 180.5 290.5 250.2 251.1

Chicago-Naperville-Elgin, IL-IN-WI 12,273 12,250 14,110 14,518 13,553 260.4 265.0 303.6 311.8 291.1

Cincinnati, OH-KY-IN 1,566 2,017 2,279 2,482 2,676 148.7 195.1 219.5 238.3 256.9

Cleveland-Elyria, OH 2,579 3,016 3,283 3,462 3,576 256.3 302.1 329.9 348.5 360.0

Columbus, OH 2,330 2,646 2,762 2,666 2,985 253.0 283.2 292.2 279.0 312.4

Dallas-Fort Worth-Arlington, TX 5,921 6,445 7,778 7,669 7,916 181.0 203.4 239.5 231.9 239.4

Denver-Aurora-Lakewood, CO 3,184 3,862 3,564 3,647 3,684 248.8 305.4 275.4 276.9 279.7

Detroit-Warren-Dearborn, MI 6,329 7,134 7,011 6,718 6,350 294.6 342.6 337.4 322.8 305.1

Hartford-West Hartford-East Hartford, CT 1,217 1,292 1,367 1,245 1,181 208.6 219.0 231.3 210.5 199.7

Houston-The Woodlands-Sugar Land, TX 4,253 5,550 5,550 5,944 7,078 145.2 188.5 184.1 193.3 230.2

Indianapolis-Carmel-Anderson, IN 2,394 2,814 3,513 3,802 3,681 259.7 305.0 376.3 403.2 390.4

Jacksonville, FL 1,868 1,893 2,047 2,001 1,989 288.3 288.7 309.1 298.2 296.5

Kansas City, MO-KS 2,603 2,572 2,760 2,857 2,718 259.7 261.5 278.1 286.1 272.1

Las Vegas-Henderson-Paradise, NV 2,301 2,076 2,558 2,644 2,708 237.7 211.4 258.1 262.9 269.3

Los Angeles-Long Beach-Anaheim, CA 17,728 18,343 19,577 20,633 20,831 276.9 289.9 306.3 320.3 323.3

Louisville/Jefferson County, KY-IN 1,392 1,601 1,710 1,744 1,781 235.3 265.5 281.4 285.4 291.5

Memphis, TN-MS-AR 3,209 2,938 2,953 3,377 3,046 508.2 461.8 461.1 524.3 472.9

Miami-Fort Lauderdale-West Palm Beach, FL 5,304 5,523 5,721 6,238 7,134 195.9 205.0 207.8 223.0 255.0

Milwaukee-Waukesha-West Allis, WI 2,767 3,134 3,312 3,169 3,284 363.5 414.1 435.5 415.5 430.6

Minneapolis-St. Paul-Bloomington, MN-WI 2,915 3,187 3,772 3,813 3,933 175.7 192.7 225.3 225.4 232.5

Nashville-Davidson--Murfreesboro--Franklin, TN 1,776 1,767 2,048 2,185 2,271 216.9 216.4 246.8 259.1 269.3

New Orleans-Metairie, LA 1,836 1,714 2,043 1,792 2,072 315.1 295.9 346.3 300.7 347.7

New York-Newark-Jersey City, NY-NJ-PA 25,060 27,844 28,877 29,065 28,546 261.4 295.2 303.7 303.3 297.9

Oklahoma City, OK 1,536 1,410 1,457 1,688 1,760 254.3 228.4 231.1 263.8 275.1

Orlando-Kissimmee-Sanford, FL 2,452 2,705 2,539 2,555 2,708 237.9 258.9 238.8 234.7 248.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 9,129 10,146 10,817 11,314 11,178 316.4 352.4 373.9 389.2 384.6

Phoenix-Mesa-Scottsdale, AZ 4,210 4,626 5,047 5,960 5,957 190.6 221.8 237.9 276.8 276.6

Pittsburgh, PA 1,712 1,947 2,471 2,668 2,550 150.8 171.1 216.5 233.3 223.0

Portland-Vancouver-Hillsboro, OR-WA 2,146 2,323 2,685 2,437 2,723 192.4 211.4 240.2 215.3 240.6

Providence-Warwick, RI-MA 1,360 1,325 1,536 1,683 1,702 175.1 171.2 198.4 217.1 219.5

Raleigh, NC 999 1,577 1,723 1,673 1,474 179.2 285.6 303.4 288.3 254.0

Richmond, VA 1,786 1,727 2,053 2,129 2,011 309.6 295.8 348.4 357.6 337.8

Riverside-San Bernardino-Ontario, CA 4,622 3,437 5,412 5,683 5,271 222.5 163.6 252.6 262.3 243.3

Sacramento--Roseville--Arden-Arcade, CA 1,682 2,287 2,960 2,712 2,846 160.3 217.1 277.4 251.9 264.4

Salt Lake City, UT 1,238 1,267 1,250 1,362 1,406 224.1 231.5 224.2 241.0 248.8

San Antonio-New Braunfels, TX 2,986 3,458 3,780 3,587 3,757 293.7 328.6 350.4 326.1 341.5

San Diego-Carlsbad, CA 4,097 4,785 4,925 5,418 5,013 267.4 308.0 312.3 339.3 313.9

San Francisco-Oakland-Hayward, CA 5,909 6,645 6,948 6,739 7,370 274.9 310.8 320.5 306.5 335.2

San Jose-Sunnyvale-Santa Clara, CA 1,513 1,649 1,667 1,353 2,186 161.0 179.0 178.0 142.1 229.6

Seattle-Tacoma-Bellevue, WA 3,471 3,509 4,070 4,505 4,560 203.7 205.0 233.1 254.5 257.6

St. Louis, MO-IL 4,059 4,190 4,436 4,474 4,411 299.0 310.5 328.1 330.5 325.8

Tampa-St. Petersburg-Clearwater, FL 3,441 3,601 3,657 3,532 3,752 257.0 267.2 267.0 256.3 272.3

Virginia Beach-Norfolk-Newport News, VA-NC 3,420 3,275 3,857 3,631 3,584 416.9 398.3 466.8 434.3 428.7

Washington-Arlington-Alexandria, DC-VA-MD-WV 5,660 5,720 6,867 7,461 7,725 209.0 208.5 244.6 261.1 270.3

SELECTED MSAs TOTAL 198,597 212,609 234,332 240,208 240,342 240.4 259.6 282.5 286.5 286.7

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

Note: Cases reported with unknown sex are not included in this table.
86 Chlamydia Tables STD Surveillance 2013

Table 9. Chlamydia — Reported Cases and Rates of Reported Cases in Counties and 

Independent Cities Ranked by Number of Reported Cases, United States, 2013

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percentage

1 Los Angeles County, CA 50,775 509.6 3

2 Cook County, IL 34,589 661.2 6

3 Harris County, TX 23,698 557.1 7

4 Philadelphia County, PA 19,570 1,264.5 9

5 Maricopa County, AZ 18,940 480.4 10

6 Kings County, NY 17,808 694.1 11

7 Bronx County, NY 16,116 1,144.2 12

8 Wayne County, MI 15,723 877.2 14

9 San Diego County, CA 14,706 462.9 15

10 Dallas County, TX 14,691 598.7 16

11 Bexar County, TX 11,826 662.3 17

12 New York County, NY 11,426 705.7 17

13 Queens County, NY 11,092 488.0 18

14 San Bernardino County, CA 10,966 526.9 19

15 Miami-Dade County, FL 10,287 397.0 20

16 Cuyahoga County, OH 10,025 792.4 20

17 Milwaukee County, WI 9,734 1,019.0 21

18 Clark County, NV 9,286 464.1 22

19 Marion County, IN 9,282 1,010.0 22

20 Riverside County, CA 8,853 390.2 23

21 Tarrant County, TX 8,774 466.7 24

22 Orange County, CA 8,611 278.7 24

23 Shelby County, TN 8,471 900.4 25

24 Broward County, FL 8,048 443.4 25

25 Sacramento County, CA 7,965 549.3 26

26 Franklin County, OH 7,825 654.5 27

27 Baltimore (City), MD 7,765 1,249.7 27

28 Hillsborough County, FL 7,167 560.9 28

29 Travis County, TX 6,839 624.2 28

30 Orange County, FL 6,803 565.9 29

31 King County, WA 6,792 338.3 29

32 Hamilton County, OH 6,584 820.9 30

33 Santa Clara County, CA 6,517 354.7 30

34 Kern County, CA 6,508 760.1 30

35 Alameda County, CA 6,479 416.7 31

36 Washington, D.C. 6,414 1,014.4 31

37 Fresno County, CA 6,390 674.1 32

38 Prince George's County, MD 6,163 699.4 32

39 Allegheny County, PA 6,095 495.8 33

40 Mecklenburg County, NC 6,087 628.2 33

41 Suffolk County, MA 5,785 777.1 34

42 Hennepin County, MN 5,766 486.8 34

43 Duval County, FL 5,720 650.3 34

44 El Paso County, TX 5,583 674.8 35

45 Denver County, CO 5,380 848.2 35

46 Jefferson County, AL 5,290 801.5 36

47 Essex County, NJ 5,221 662.8 36

48 St. Louis County, MO 5,211 520.9 36

49 Pima County, AZ 5,192 523.2 37

50 Honolulu County, HI 5,185 531.0 37

51 San Francisco County, CA 5,112 619.0 37

52 Jackson County, MO 5,078 749.7 38

53 Jefferson County, KY 4,944 658.5 38

54 Erie County, NY 4,892 532.3 38

55 Bernalillo County, NM 4,604 683.6 39

56 Monroe County, NY 4,582 612.7 39

57 Palm Beach County, FL 4,486 330.7 39

58 Contra Costa County, CA 4,443 411.5 40

59 Fulton County, GA 4,416 451.6 40

60 Oklahoma County, OK 4,300 579.7 40

61 Pierce County, WA 4,294 529.0 41

62 Wake County, NC 4,210 442.2 41

63 St. Louis (City), MO 4,128 1,297.4 41

64 Pinellas County, FL 4,080 442.8 42

65 Orleans Parish, LA 4,064 1,100.6 42

66 Davidson County, TN 3,965 611.6 42

67 Multnomah County, OR 3,933 518.0 42

68 Salt Lake County, UT 3,806 357.8 43

69 New Haven County, CT 3,799 440.3 43

70 Hartford County, CT 3,759 418.9 43

* Accounting for 43% of reported chlamydia cases.

† Counties and independent cities were ranked in descending order by number of cases reported then by rate in 2013.
STD Surveillance 2013 Chlamydia Tables 87

Table 10. Chlamydia — Reported Cases and Rates of Reported Cases by Age Group and Sex, 

United States, 2009–2013 

Age

Group

Cases Rates*

Total Male Female Unknown Sex Total Male Female

0–4 1,022 339 676 7 4.8 3.1 6.5

2009

5–9 187 33 154 0 0.9 0.3 1.5

10–14 13,899 1,405 12,447 47 69.6 13.7 127.6

15–19 429,173 80,725 347,597 851 1,992.6 730.5 3,314.7

20–24 454,760 120,975 332,946 839 2,111.3 1,090.5 3,187.3

25–29 190,481 62,437 127,708 336 878.7 561.7 1,209.1

30–34 77,606 28,344 49,103 159 390.2 280.4 502.0

35–39 36,286 14,859 21,354 73 176.7 143.5 209.7

40–44 18,263 8,750 9,467 46 87.0 83.3 90.3

45–54 15,033 7,818 7,183 32 33.7 35.6 31.8

55–64 3,365 1,787 1,573 5 9.7 10.6 8.7

65+ 946 472 471 3 2.4 2.8 2.1

Unknown Age 3,159 839 2,039 281

TOTAL 1,244,180 328,783 912,718 2,679 405.3 217.1 586.7

0–4 964 327 619 18 4.8 3.2 6.3

2010

5–9 188 26 158 4 0.9 0.3 1.6

10–14 14,531 1,590 12,860 81 70.3 15.0 127.4

15–19 441,342 85,570 354,252 1,520 2,002.4 757.0 3,299.5

20–24 488,996 131,686 355,994 1,316 2,265.3 1,195.6 3,367.4

25–29 197,525 66,470 130,561 494 936.1 625.0 1,247.4

30–34 83,408 31,230 51,925 253 417.8 312.4 521.0

35–39 38,384 15,861 22,421 102 190.2 157.9 221.2

40–44 19,614 9,594 9,931 89 93.9 92.3 94.6

45–54 16,106 8,635 7,423 48 35.8 39.0 32.5

55–64 3,523 1,834 1,674 15 9.7 10.4 8.9

65+ 954 464 481 9 2.4 2.7 2.1

Unknown Age 2,358 636 1,503 219

TOTAL 1,307,893 353,923 949,802 4,168 423.6 233.2 605.1

0–4 747 284 458 5 3.7 2.8 4.6

2011

5–9 143 24 118 1 0.7 0.2 1.2

10–14 15,405 1,743 13,588 74 74.4 16.5 134.3

15–19 459,029 90,764 366,818 1,447 2,120.8 816.3 3,485.2

20–24 542,947 147,948 393,534 1,465 2,450.8 1,307.8 3,630.0

25–29 214,534 73,357 140,628 549 1,008.2 681.7 1,337.0

30–34 91,787 34,971 56,562 254 447.5 340.1 553.0

35–39 40,734 16,911 23,711 112 207.9 173.2 241.1

40–44 21,654 10,460 11,120 74 102.9 100.0 105.2

45–54 18,136 9,910 8,182 44 40.6 45.0 36.0

55–64 4,210 2,300 1,903 7 11.1 12.5 9.7

65+ 1,064 569 486 9 2.6 3.2 2.1

Unknown Age 2,401 729 1,444 228

TOTAL 1,412,791 389,970 1,018,552 4,269 453.4 254.4 643.4

0–4 774 272 495 7 3.9 2.7 5.1

2012

5–9 151 17 134 0 0.7 0.2 1.3

10–14 14,355 1,655 12,673 27 69.5 15.7 125.5

15–19 433,239 86,150 346,430 659 2,028.2 785.8 3,331.7

20–24 554,173 152,772 400,629 772 2,453.9 1,322.8 3,630.9

25–29 224,014 77,666 146,037 311 1,046.9 716.2 1,383.8

30–34 97,736 38,011 59,594 131 467.4 362.2 572.1

35–39 43,660 18,274 25,313 73 224.0 188.1 259.0

40–44 23,882 11,596 12,245 41 113.6 110.9 115.9

45–54 20,321 11,332 8,961 28 45.9 52.0 39.9

55–64 4,950 2,783 2,161 6 12.8 15.0 10.8

65+ 1,134 602 525 7 2.6 3.2 2.2

Unknown Age 4,587 1,427 3,075 85

TOTAL 1,422,976 402,557 1,018,272 2,147 453.3 260.6 638.7

0–4 681 266 402 13 3.4 2.6 4.1

2013

5–9 145 20 123 2 0.7 0.2 1.2

10–14 12,585 1,554 11,001 30 60.9 14.7 108.9

15–19 395,612 78,404 316,438 770 1,852.1 715.2 3,043.3

20–24 553,658 153,102 399,545 1,011 2,451.6 1,325.6 3,621.1

25–29 233,429 82,190 150,733 506 1,090.9 757.9 1,428.3

30–34 103,675 41,017 62,414 244 495.8 390.9 599.2

35–39 46,991 20,157 26,720 114 241.1 207.5 273.4

40–44 24,774 12,200 12,501 73 117.8 116.6 118.3

45–54 21,511 12,180 9,299 32 48.6 55.9 41.4

55–64 5,424 3,154 2,259 11 14.1 17.0 11.3

65+ 1,377 750 616 11 3.2 4.0 2.5

Unknown Age 2,044 658 1,297 89

TOTAL 1,401,906 405,652 993,348 2,906 446.6 262.6 623.1

* No population data are available for unknown sex and age; therefore, rates are not calculated.

Note: This table should be used only for age comparisons. Cases in the 0–4 age group may include cases due to perinatal transmission.
88 Chlamydia Tables STD Surveillance 2013

Table 11A. Chlamydia — Reported Cases by Race/Ethnicity, Age Group, and Sex, 

United States*, 2013

Age

Group

American Indians/ 

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 1 0 1 8 2 6 139 52 87

5–9 1 1 0 1 0 1 40 4 36

10–14 189 14 175 46 2 44 4,415 654 3,750

15–19 4,022 739 3,282 2,313 296 2,013 119,385 28,712 90,577

20–24 5,267 1,135 4,130 5,634 1,248 4,380 149,739 46,479 103,170

25–29 2,714 628 2,084 3,264 998 2,261 57,402 22,563 34,804

30–34 1,250 306 943 1,685 615 1,066 23,876 10,841 13,022

35–39 524 129 395 879 350 528 10,207 5,269 4,930

40–44 254 68 186 513 227 286 4,977 2,962 2,008

45–54 209 67 141 467 227 240 4,137 2,613 1,519

55–64 44 11 33 138 67 70 1,049 660 388

65+ 8 4 4 31 14 17 154 96 58

Unknown Age 15 8 7 20 9 11 245 99 143

TOTAL 14,498 3,110 11,381 14,999 4,055 10,923 375,765 121,004 254,492

Age

Group

Native Hawaiians/ 

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 3 0 3 128 55 71 3 1 2

5–9 0 0 0 21 1 20 1 0 1

10–14 20 1 19 1,849 101 1,746 79 4 75

15–19 699 97 602 82,131 11,894 70,185 2,036 333 1,703

20–24 1,263 262 1,001 132,378 34,140 98,148 2,412 664 1,748

25–29 679 181 498 54,838 19,036 35,758 907 331 576

30–34 294 90 204 22,993 9,115 13,853 353 148 205

35–39 103 36 67 9,578 4,242 5,325 124 59 64

40–44 58 29 29 5,324 2,787 2,532 63 37 26

45–54 31 15 16 5,011 3,272 1,738 61 39 22

55–64 5 5 0 1,222 887 335 5 3 2

65+ 1 0 1 260 189 71 2 2 0

Unknown Age 5 1 4 307 98 205 6 1 5

TOTAL 3,161 717 2,444 316,040 85,817 229,987 6,052 1,622 4,429

Age

Group

Hispanics Other/Unknown

Total† Male Female Total† Male Female

0–4 87 30 56 211 84 118

5–9 27 5 22 34 5 27

10–14 1,319 148 1,171 2,640 333 2,291

15–19 47,557 8,565 38,951 86,597 16,561 69,506

20–24 70,663 17,742 52,830 120,508 31,880 87,946

25–29 33,276 10,657 22,575 52,251 17,296 34,607

30–34 15,620 5,411 10,184 24,810 9,143 15,510

35–39 7,431 2,660 4,761 12,060 4,732 7,254

40–44 3,489 1,396 2,085 6,668 2,979 3,644

45–54 2,439 1,166 1,270 5,824 3,009 2,797

55–64 441 205 236 1,654 911 734

65+ 102 54 48 540 270 266

Unknown Age 228 73 150 733 270 405

TOTAL 182,679 48,112 134,339 314,530 87,473 225,105

* Includes 46 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2013. † Total includes cases reported with unknown sex.

Note: These tables should be used only for race/ethnicity comparisons. See Table 10 for age–specific cases and rates and Tables 3–5 for total and sex–specific 

cases and rates.

Cases in the 0–4 age group may include cases due to perinatal transmission.
STD Surveillance 2013 Chlamydia Tables 89

Table 11B. Chlamydia — Rates of Reported Cases per 100,000 Population by Race/Ethnicity, 

Age Group, and Sex, United States*, 2013

Age

Group

American Indians/ 

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 0.6 0.0 1.3 1.0 0.5 1.5 5.9 4.3 7.5

5–9 0.6 1.2 0.0 0.1 0.0 0.2 1.7 0.3 3.1

10–14 116.4 16.9 219.5 5.8 0.5 11.1 178.0 51.9 307.6

15–19 2,376.9 855.1 3,964.1 284.1 71.5 503.2 4,467.5 2,109.6 6,907.6

20–24 2,977.2 1,255.8 4,772.6 564.5 246.4 890.8 5,308.0 3,282.5 7,342.7

25–29 1,784.9 824.0 2,747.9 294.3 185.4 396.0 2,428.5 1,957.6 2,873.6

30–34 889.7 437.3 1,337.1 147.6 115.4 175.2 1,045.7 993.3 1,092.6

35–39 405.9 202.5 604.0 77.1 65.3 87.3 489.2 533.6 448.6

40–44 189.3 102.9 273.2 46.2 43.7 48.4 226.3 284.1 173.6

45–54 72.5 48.4 94.2 25.3 26.4 24.3 91.3 122.1 63.6

55–64 19.4 10.2 27.6 9.4 10.2 8.6 29.7 40.7 20.2

65+ 4.3 4.8 3.9 2.2 2.3 2.1 5.1 7.9 3.2

Unknown Age

TOTAL 697.9 304.0 1,079.2 111.5 63.5 154.6 1,147.2 771.1 1,491.7

Age

Group

Native Hawaiians/ 

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 7.9 0.0 16.2 1.4 1.2 1.6 0.4 0.2 0.5

5–9 0.0 0.0 0.0 0.2 0.0 0.4 0.1 0.0 0.3

10–14 54.0 5.2 106.3 18.6 2.0 36.1 12.5 1.2 24.0

15–19 1,806.3 488.9 3,192.6 786.1 221.3 1,383.3 367.6 119.4 619.6

20–24 2,709.0 1,084.9 4,454.2 1,173.6 594.0 1,774.2 528.4 297.9 748.4

25–29 1,495.0 775.2 2,256.6 502.3 344.3 663.6 256.8 196.9 311.1

30–34 700.6 417.9 998.4 214.7 168.6 261.3 113.8 100.9 125.3

35–39 285.4 194.8 380.4 95.6 84.1 107.1 48.8 49.2 47.7

40–44 170.7 169.4 172.1 46.2 48.1 44.1 26.7 33.1 21.0

45–54 48.7 47.3 50.0 18.9 24.9 13.0 14.6 19.5 10.0

55–64 11.1 22.7 0.0 4.9 7.2 2.6 1.6 2.1 1.3

65+ 2.9 0.0 5.3 0.9 1.4 0.4 0.8 1.8 0.0

Unknown Age

TOTAL 633.3 284.3 989.6 180.3 99.4 258.5 113.4 61.9 163.0

Age

Group

Hispanics

Total† Male Female

0–4 1.8 1.2 2.4

5–9 0.6 0.2 1.0

10–14 30.4 6.7 55.1

15–19 1,128.8 394.0 1,910.3

20–24 1,689.6 803.1 2,677.5

25–29 836.5 502.7 1,214.9

30–34 398.8 263.6 546.5

35–39 204.2 142.2 269.0

40–44 104.4 81.6 127.7

45–54 45.6 43.1 48.1

55–64 13.5 12.9 13.9

65+ 3.6 4.4 3.0

Unknown Age

TOTAL 377.0 195.2 564.2

* Includes 46 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2013. † Total includes cases reported with unknown sex.

Note: These tables should be used only for race/ethnicity comparisons. See Table 10 for age–specific cases and rates and Tables 3–5 for total and sex–specific 

cases and rates.

Cases in the 0–4 age group may include cases due to perinatal transmission.

No population data exist for unknown sex, unknown age, or unknown race; therefore rates are not calculated.
90 Chlamydia Tables STD Surveillance 2013

Table 12. Chlamydia Among Women 15–25 Years of Age — Reported Cases and Rates of 

Reported Cases by Age, United States, 2009–2013

Age Cases Rate per 100,000 Population

2009

15 25,118 1,246.0

16 47,662 2,316.9

17 72,782 3,466.4

18 98,822 4,626.6

19 103,213 4,738.9

20 92,398 4,384.4

21 78,650 3,775.1

22 64,631 3,122.6

23 53,362 2,558.1

24 43,905 2,091.4

25 35,465 1,720.0

2010

15 25,432 1,231.1

16 48,233 2,296.7

17 73,089 3,428.0

18 100,399 4,573.2

19 107,099 4,774.3

20 99,175 4,485.9

21 84,674 3,973.3

22 69,755 3,342.6

23 56,264 2,734.2

24 46,126 2,212.0

25 37,155 1,768.4

2011

15 25,792 1,272.2

16 48,942 2,368.5

17 75,143 3,569.5

18 104,501 4,902.9

19 112,440 5,122.9

20 107,958 4,804.7

21 95,195 4,236.2

22 77,799 3,605.2

23 62,339 2,953.3

24 50,243 2,417.5

25 40,711 1,943.9

2012

15 24,453 1,207.2

16 45,041 2,212.8

17 69,465 3,346.4

18 99,459 4,699.5

19 108,012 5,036.6

20 104,425 4,727.7

21 96,456 4,266.0

22 81,292 3,593.9

23 65,473 3,011.7

24 52,983 2,489.8

25 41,911 1,999.6

2013

15 21,680 1,070.3

16 40,528 1,991.1

17 61,666 2,970.7

18 90,330 4,268.2

19 102,234 4,767.2

20 99,556 4,507.3

21 93,713 4,144.7

22 81,884 3,620.0

23 68,600 3,155.5

24 55,792 2,621.8

25 44,330 2,115.0

Note: This table should be used only for age comparisons. Cases reported with unknown sex are not included in this table.
STD Surveillance 2013 Gonorrhea Tables 91

Table 13. Gonorrhea — Reported Cases and Rates of Reported Cases by State, Ranked by Rates, 

United States, 2013

Rank* State Cases Rate per 100,000 Population

1 Louisiana 8,669 188.4

2 Alabama 8,377 173.7

3 Mississippi 5,096 170.7

4 Alaska 1,128 154.2

5 South Carolina 7,194 152.3

6 Delaware 1,390 151.6

7 Ohio 16,619 144.0

8 Georgia 14,252 143.7

9 North Carolina 13,666 140.1

10 Oklahoma 5,303 139.0

11 Arkansas 4,007 135.9

12 Texas 33,835 129.8

13 Illinois 16,464 127.9

14 Missouri 7,546 125.3

15 Tennessee 7,376 114.2

16 Indiana 7,144 109.3

17 Pennsylvania 13,874 108.7

18 Florida 20,818 107.8

19 Michigan 10,569 106.9

U.S. TOTAL† 333,004 106.1

20 New York 19,919 101.8

21 Maryland 5,989 101.8

22 California 38,166 100.3

23 Kentucky 4,315 98.5

24 Nevada 2,714 98.4

25 Arizona 6,412 97.8

26 South Dakota 784 94.1

27 New Mexico 1,918 92.0

28 Virginia 6,952 84.9

29 Wisconsin 4,599 80.3

30 Connecticut 2,860 79.7

31 New Jersey 7,014 79.1

32 Kansas 2,161 74.9

33 Nebraska 1,385 74.6

34 Minnesota 3,873 72.0

35 North Dakota 492 70.3

36 Washington 4,369 63.3

37 West Virginia 1,063 57.3

38 Colorado 2,820 54.4

39 Hawaii 718 51.6

40 Iowa 1,472 47.9

41 Massachusetts 3,106 46.7

42 Oregon 1,729 44.3

43 Rhode Island 454 43.2

44 Utah 951 33.3

45 Montana 224 22.3

46 Maine 245 18.4

47 Vermont 97 15.5

48 Idaho 211 13.2

49 Wyoming 66 11.5

50 New Hampshire 121 9.2

* States were ranked by rate, then case count, then in alphabetical order, with rates shown rounded to the nearest tenth.

†

 Total includes cases reported by the District of Columbia with 2,478 cases and a rate of 391.9, but excludes outlying areas (Guam with 92 cases and rate of 57.5, 

Puerto Rico with 356 cases and rate of 9.7, and Virgin Islands with 58 cases and rate of 55.1).
92 Gonorrhea Tables STD Surveillance 2013

Table 14. Gonorrhea — Reported Cases and Rates of Reported Cases by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2009–2013

Cases Rates per 100,000 Population

State/Area 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Alabama 7,498 7,933 9,132 9,270 8,377 159.2 166.0 190.1 192.2 173.7

Alaska 990 1,273 984 726 1,128 141.7 179.2 136.2 99.3 154.2

Arizona 3,250 3,249 4,564 5,809 6,412 49.3 50.8 70.4 88.6 97.8

Arkansas 4,460 4,769 4,687 4,307 4,007 154.4 163.6 159.5 146.0 135.9

California 23,228 26,441 27,516 33,579 38,166 62.8 71.0 73.0 88.3 100.3

Colorado 2,823 2,787 2,363 2,822 2,820 56.2 55.4 46.2 54.4 54.4

Connecticut 2,558 2,569 2,449 2,133 2,860 72.7 71.9 68.4 59.4 79.7

Delaware 971 1,010 827 899 1,390 109.7 112.5 91.2 98.0 151.6

District of Columbia 2,561 2,104 2,569 2,402 2,478 427.1 349.7 415.7 379.9 391.9

Florida 20,878 20,163 19,689 19,462 20,818 112.6 107.2 103.3 100.7 107.8

Georgia 13,687 15,852 16,428 15,326 14,252 139.2 163.6 167.4 154.5 143.7

Hawaii 631 759 685 815 718 48.7 55.8 49.8 58.5 51.6

Idaho 110 147 162 167 211 7.1 9.4 10.2 10.5 13.2

Illinois 19,962 15,777 17,037 18,149 16,464 154.6 123.0 132.4 141.0 127.9

Indiana 6,835 6,496 6,569 7,338 7,144 106.4 100.2 100.8 112.2 109.3

Iowa 1,658 1,803 1,920 2,006 1,472 55.1 59.2 62.7 65.3 47.9

Kansas 2,505 2,084 2,209 2,228 2,161 88.9 73.0 76.9 77.2 74.9

Kentucky 3,827 4,345 4,521 4,283 4,315 88.7 100.1 103.5 97.8 98.5

Louisiana 8,996 8,912 9,169 8,873 8,669 200.3 196.6 200.4 192.8 188.4

Maine 143 162 272 456 245 10.8 12.2 20.5 34.3 18.4

Maryland 6,395 7,413 6,458 5,686 5,989 112.2 128.4 110.8 96.6 101.8

Massachusetts 1,976 2,483 2,353 2,628 3,106 30.0 37.9 35.7 39.5 46.7

Michigan 14,704 13,627 12,901 12,584 10,569 147.5 137.9 130.6 127.3 106.9

Minnesota 2,303 2,119 2,284 3,082 3,873 43.7 40.0 42.7 57.3 72.0

Mississippi 7,241 6,195 5,814 6,875 5,096 245.3 208.8 195.2 230.3 170.7

Missouri 6,488 7,159 7,802 7,889 7,546 108.4 119.5 129.8 131.0 125.3

Montana 80 102 85 108 224 8.2 10.3 8.5 10.7 22.3

Nebraska 1,376 1,187 1,352 1,429 1,385 76.6 65.0 73.4 77.0 74.6

Nevada 1,726 1,728 2,000 2,264 2,714 65.3 64.0 73.4 82.1 98.4

New Hampshire 113 151 130 147 121 8.5 11.5 9.9 11.1 9.2

New Jersey 4,762 5,872 7,348 7,486 7,014 54.7 66.8 83.3 84.4 79.1

New Mexico 1,082 1,229 1,839 1,883 1,918 53.8 59.7 88.3 90.3 92.0

New York 17,004 18,320 20,706 22,571 19,919 87.0 94.5 106.4 115.3 101.8

North Carolina 13,870 14,111 17,454 14,318 13,666 147.9 148.0 180.8 146.8 140.1

North Dakota 151 204 251 335 492 23.3 30.3 36.7 47.9 70.3

Ohio 15,988 16,496 16,726 16,493 16,619 138.5 143.0 144.9 142.9 144.0

Oklahoma 4,673 4,369 4,215 4,441 5,303 126.7 116.5 111.2 116.4 139.0

Oregon 1,113 1,076 1,489 1,464 1,729 29.1 28.1 38.5 37.5 44.3

Pennsylvania 10,138 12,883 13,770 15,390 13,874 80.4 101.4 108.1 120.6 108.7

Rhode Island 322 291 360 507 454 30.6 27.6 34.2 48.3 43.2

South Carolina 8,318 7,970 8,350 7,638 7,194 182.4 172.3 178.4 161.7 152.3

South Dakota 344 468 602 707 784 42.3 57.5 73.1 84.8 94.1

Tennessee 7,926 7,121 7,667 9,098 7,376 125.9 112.2 119.7 140.9 114.2

Texas 29,295 31,788 30,930 32,473 33,835 118.2 126.4 120.5 124.6 129.8

Utah 341 310 277 479 951 12.2 11.2 9.8 16.8 33.3

Vermont 50 58 48 99 97 8.0 9.3 7.7 15.8 15.5

Virginia 7,789 7,402 6,518 6,885 6,952 98.8 92.5 80.5 84.1 84.9

Washington 2,285 2,864 2,737 3,238 4,369 34.3 42.6 40.1 46.9 63.3

West Virginia 475 579 796 831 1,063 26.1 31.2 42.9 44.8 57.3

Wisconsin 5,201 5,091 4,789 4,704 4,599 92.0 89.5 83.8 82.1 80.3

Wyoming 74 40 46 44 66 13.6 7.1 8.1 7.6 11.5

U.S. TOTAL 301,174 309,341 321,849 334,826 333,004 98.1 100.2 103.3 106.7 106.1

Northeast 37,066 42,789 47,436 51,417 47,690 67.0 77.4 85.4 92.2 85.5

Midwest 77,515 72,511 74,442 76,944 73,108 116.0 108.3 110.8 114.3 108.6

South 148,860 152,036 155,224 153,067 150,780 131.4 132.7 133.8 130.5 128.6

West 37,733 42,005 44,747 53,398 61,426 52.7 58.4 61.4 72.6 83.5

Guam 59 97 96 92 92 33.1 60.8 60.2 57.5 57.5

Puerto Rico 230 312 341 345 356 5.8 8.4 9.2 9.4 9.7

Virgin Islands 115 151 139 136 58 104.7 142.1 131.4 129.2 55.1

OUTLYING AREAS 404 560 576 573 506 9.5 14.0 14.5 14.6 12.9

TOTAL 301,578 309,901 322,425 335,399 333,510 96.9 99.1 102.2 105.5 104.9
STD Surveillance 2013 Gonorrhea Tables 93

Table 15. Gonorrhea Among Women — Reported Cases and Rates of Reported Cases by State/

Area and Region in Alphabetical Order, United States and Outlying Areas, 2009–2013

Cases Rates per 100,000 Population

State/Area 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Alabama 4,240 4,432 5,103 5,187 4,668 174.7 180.2 206.3 208.9 188.0

Alaska 516 698 515 385 589 153.5 204.9 148.2 109.9 168.2

Arizona 1,475 1,553 2,212 2,827 3,102 44.8 48.3 67.9 85.8 94.1

Arkansas 2,562 2,729 2,687 2,432 2,160 173.8 183.9 179.7 162.1 143.9

California 9,430 10,546 10,811 13,045 14,258 51.1 56.3 57.1 68.2 74.6

Colorado 1,502 1,514 1,285 1,362 1,243 60.2 60.4 50.4 52.7 48.1

Connecticut 1,491 1,449 1,378 1,153 1,419 82.8 79.0 75.1 62.6 77.1

Delaware 564 621 471 496 763 123.8 134.1 100.8 104.9 161.4

District of Columbia 1,233 1,073 1,209 1,006 953 389.5 338.0 371.1 301.8 285.9

Florida 10,745 10,240 9,999 9,570 9,718 114.1 106.5 102.7 97.0 98.5

Georgia 7,253 8,297 8,589 7,921 7,060 145.2 167.3 171.4 156.3 139.3

Hawaii 264 314 273 299 264 41.2 46.2 39.9 43.3 38.2

Idaho 51 68 79 63 87 6.6 8.7 10.0 7.9 10.9

Illinois 11,248 8,924 9,500 9,837 8,574 171.7 136.5 144.9 150.1 130.8

Indiana 3,985 3,598 3,690 4,139 3,796 122.3 109.2 111.5 124.7 114.4

Iowa 1,049 1,179 1,217 1,170 812 68.9 76.7 78.8 75.5 52.4

Kansas 1,541 1,235 1,360 1,339 1,222 108.6 85.9 94.1 92.3 84.2

Kentucky 2,132 2,487 2,596 2,328 2,331 97.1 112.8 117.0 104.7 104.9

Louisiana 5,125 4,824 5,263 5,080 4,927 222.2 208.5 225.3 216.2 209.7

Maine 62 75 122 240 119 9.2 11.1 18.0 35.4 17.5

Maryland 3,457 4,028 3,461 2,878 2,841 117.8 135.1 115.1 94.9 93.6

Massachusetts 976 1,004 1,083 1,076 1,168 28.8 29.7 31.9 31.4 34.1

Michigan 8,536 7,971 7,599 7,194 5,865 168.5 158.3 151.1 142.9 116.5

Minnesota 1,270 1,248 1,294 1,676 2,037 48.0 46.7 48.1 61.9 75.3

Mississippi 4,335 3,602 3,344 3,834 2,726 285.0 236.0 218.3 249.7 177.5

Missouri 3,585 3,951 4,195 4,209 3,944 117.1 129.3 136.8 137.1 128.4

Montana 46 56 51 58 127 9.4 11.4 10.3 11.6 25.4

Nebraska 821 675 823 784 694 90.7 73.4 88.7 84.0 74.4

Nevada 826 830 879 982 1,203 63.7 62.1 65.2 71.8 88.0

New Hampshire 54 59 59 61 52 8.0 8.8 8.8 9.1 7.8

New Jersey 2,435 3,115 3,916 3,798 3,484 54.8 69.0 86.6 83.6 76.7

New Mexico 570 610 925 857 823 56.2 58.6 87.9 81.4 78.2

New York 7,927 8,718 9,716 10,021 8,020 78.9 87.2 96.8 99.4 79.6

North Carolina 7,868 8,314 10,076 8,093 7,547 164.2 170.0 203.4 161.9 151.0

North Dakota 88 140 149 207 301 27.3 42.1 44.1 60.2 87.5

Ohio 9,766 10,034 10,009 9,706 9,176 165.3 169.9 169.5 164.5 155.5

Oklahoma 2,809 2,493 2,395 2,652 3,000 150.6 131.6 125.1 137.8 155.8

Oregon 505 477 602 528 566 26.2 24.7 30.8 26.8 28.8

Pennsylvania 5,650 7,268 7,687 8,360 7,206 87.4 111.6 117.7 128.0 110.3

Rhode Island 146 121 167 232 192 27.0 22.2 30.8 42.8 35.4

South Carolina 5,004 4,905 4,981 4,416 4,050 213.8 206.5 207.3 182.0 166.9

South Dakota 190 290 399 446 464 46.7 71.3 97.1 107.5 111.8

Tennessee 4,365 3,884 4,112 4,721 3,617 135.3 119.4 125.3 142.7 109.4

Texas 16,071 17,246 16,476 17,151 17,206 129.6 136.1 127.4 130.8 131.2

Utah 70 75 66 132 373 5.1 5.5 4.7 9.3 26.3

Vermont 29 24 24 54 46 9.2 7.6 7.6 17.0 14.5

Virginia 4,314 4,146 3,693 3,734 3,678 107.6 101.7 89.6 89.7 88.3

Washington 949 1,044 1,066 1,230 1,704 28.5 30.9 31.2 35.6 49.3

West Virginia 281 326 467 438 539 30.3 34.7 49.7 46.6 57.3

Wisconsin 3,113 3,164 2,907 2,640 2,455 109.4 110.5 101.1 91.6 85.1

Wyoming 44 19 25 19 39 16.5 6.9 9.0 6.7 13.8

U.S. TOTAL 162,568 165,693 171,005 172,066 163,208 104.5 105.6 108.0 107.9 102.4

Northeast 18,770 21,833 24,152 24,995 21,706 66.2 76.7 84.7 87.3 75.8

Midwest 45,192 42,409 43,142 43,347 39,340 133.3 124.7 126.5 126.9 115.2

South 82,358 83,647 84,922 81,937 77,784 143.0 143.2 143.6 137.1 130.2

West 16,248 17,804 18,789 21,787 24,378 45.5 49.3 51.4 59.1 66.1

Guam 32 45 44 46 43 36.5 57.4 56.0 58.4 54.6

Puerto Rico 126 141 140 157 120 6.1 7.3 7.2 8.2 6.3

Virgin Islands 90 96 94 92 41 155.6 170.3 167.3 164.2 73.2

OUTLYING AREAS 248 282 278 295 204 11.2 13.6 13.4 14.4 10.0

TOTAL 162,816 165,975 171,283 172,361 163,412 103.2 104.4 106.8 106.7 101.2

Note: Cases reported with unknown sex are not included in this table.
94 Gonorrhea Tables STD Surveillance 2013

Table 16. Gonorrhea Among Men — Reported Cases and Rates of Reported Cases by State/Area 

and Region in Alphabetical Order, United States and Outlying Areas, 2009–2013

Cases Rates per 100,000 Population

State/Area 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Alabama 3,250 3,430 3,825 4,034 3,680 142.4 147.8 164.2 172.5 157.4

Alaska 474 575 469 341 539 130.9 155.6 125.0 89.4 141.4

Arizona 1,775 1,696 2,350 2,981 3,310 53.7 53.4 72.9 91.5 101.6

Arkansas 1,898 2,038 1,996 1,873 1,843 134.1 142.4 138.3 129.3 127.2

California 13,705 15,773 16,598 20,431 23,849 74.1 85.2 88.5 108.0 126.1

Colorado 1,319 1,273 1,078 1,460 1,577 52.1 50.5 42.0 56.1 60.6

Connecticut 1,067 1,120 1,071 978 1,440 62.1 64.4 61.4 55.9 82.3

Delaware 407 389 356 403 627 94.7 89.4 80.9 90.7 141.1

District of Columbia 1,328 1,028 1,360 1,386 1,519 469.2 361.7 465.4 463.5 508.0

Florida 10,099 9,906 9,675 9,892 11,049 110.7 107.8 103.8 104.7 116.9

Georgia 6,368 7,421 7,684 7,301 7,075 131.7 156.9 160.0 150.5 145.8

Hawaii 367 445 412 516 454 56.1 65.3 59.7 73.5 64.7

Idaho 58 78 83 104 124 7.5 9.9 10.5 13.0 15.5

Illinois 8,710 6,824 7,513 8,283 7,872 137.0 108.5 119.0 131.1 124.6

Indiana 2,831 2,884 2,867 3,188 3,347 89.5 90.4 89.4 99.1 104.0

Iowa 609 624 703 836 660 41.0 41.4 46.3 54.8 43.3

Kansas 964 849 849 889 939 68.9 60.0 59.5 61.9 65.4

Kentucky 1,690 1,854 1,913 1,948 1,966 79.8 86.8 89.0 90.3 91.1

Louisiana 3,849 3,540 3,739 3,793 3,742 176.1 159.5 167.0 168.4 166.2

Maine 81 86 150 216 126 12.6 13.2 23.1 33.2 19.4

Maryland 2,922 3,377 2,992 2,806 3,145 105.7 121.0 106.1 98.4 110.3

Massachusetts 996 1,479 1,269 1,551 1,932 31.1 46.7 39.8 48.2 60.0

Michigan 6,004 5,634 5,281 5,372 4,694 122.5 116.2 109.0 110.8 96.8

Minnesota 1,033 871 990 1,395 1,835 39.4 33.1 37.3 52.2 68.7

Mississippi 2,906 2,593 2,470 3,039 2,370 203.1 179.9 170.8 209.7 163.5

Missouri 2,903 3,208 3,607 3,680 3,602 99.2 109.4 122.5 124.7 122.1

Montana 34 46 34 50 97 7.0 9.3 6.8 9.9 19.2

Nebraska 553 512 528 641 674 62.0 56.5 57.7 69.5 73.1

Nevada 900 898 1,121 1,280 1,509 66.9 65.9 81.6 92.0 108.5

New Hampshire 59 92 71 86 69 9.0 14.2 10.9 13.2 10.6

New Jersey 2,326 2,727 3,400 3,673 3,514 54.5 63.7 79.1 85.0 81.3

New Mexico 512 619 914 1,025 1,095 51.5 60.8 88.7 99.3 106.0

New York 9,072 9,601 10,977 12,529 11,844 95.5 102.4 116.4 132.0 124.8

North Carolina 5,902 5,712 7,300 6,180 6,113 128.6 123.0 155.2 130.0 128.6

North Dakota 62 64 101 127 191 19.1 18.8 29.2 35.7 53.7

Ohio 6,068 6,421 6,717 6,787 7,443 107.7 114.0 119.1 120.3 131.9

Oklahoma 1,857 1,873 1,708 1,789 2,303 101.9 100.9 91.0 94.7 121.9

Oregon 608 599 887 936 1,163 32.0 31.6 46.3 48.5 60.2

Pennsylvania 4,484 5,615 6,078 7,025 6,659 73.0 90.7 97.8 112.8 106.9

Rhode Island 176 170 193 275 262 34.4 33.4 38.0 54.1 51.5

South Carolina 3,289 3,056 3,351 3,196 3,133 148.1 135.8 147.2 139.1 136.4

South Dakota 153 177 202 259 320 37.7 43.4 48.9 61.9 76.5

Tennessee 3,560 3,235 3,555 4,368 3,758 116.0 104.6 113.9 138.7 119.3

Texas 13,215 14,524 14,448 15,286 16,410 106.8 116.5 113.4 118.1 126.7

Utah 271 235 211 347 578 19.3 16.9 14.9 24.2 40.3

Vermont 21 33 24 45 51 6.9 10.7 7.8 14.6 16.5

Virginia 3,465 3,248 2,814 3,145 3,272 89.4 82.7 70.8 78.2 81.4

Washington 1,334 1,818 1,671 2,008 2,665 40.1 54.3 49.0 58.3 77.4

West Virginia 194 253 329 393 524 21.7 27.7 36.0 42.9 57.2

Wisconsin 2,061 1,926 1,880 2,064 2,140 73.4 68.2 66.3 72.6 75.3

Wyoming 30 21 21 25 27 10.8 7.3 7.2 8.5 9.2

U.S. TOTAL 137,819 142,470 149,835 162,235 169,130 91.0 93.9 97.7 105.0 109.5

Northeast 18,282 20,923 23,233 26,378 25,897 67.9 77.9 86.1 97.2 95.4

Midwest 31,951 29,994 31,238 33,521 33,717 97.0 91.1 94.5 101.1 101.7

South 66,199 67,477 69,515 70,832 72,529 118.8 120.2 122.2 123.2 126.1

West 21,387 24,076 25,849 31,504 36,987 59.6 67.2 71.1 85.9 100.8

Guam 27 52 52 46 49 29.8 64.2 64.2 56.7 60.4

Puerto Rico 104 171 201 188 236 5.5 9.6 11.3 10.7 13.4

Virgin Islands 25 55 45 44 17 48.1 110.2 90.7 89.3 34.5

OUTLYING AREAS 156 278 298 278 302 7.6 14.5 15.6 14.7 16.0

TOTAL 137,975 142,748 150,133 162,513 169,432 89.9 92.9 96.7 103.9 108.3

Note: Cases reported with unknown sex are not included in this table.
STD Surveillance 2013 Gonorrhea Tables 95

Table 17. Gonorrhea — Reported Cases and Rates of Reported Cases in Selected Metropolitan 

Statistical Areas (MSAs)* in Alphabetical Order, United States, 2009–2013

MSAs

Cases Rates per 100,000 Population

2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Atlanta-Sandy Springs-Roswell, GA 7,484 8,351 8,577 8,299 5,452 136.2 158.0 159.5 152.1 99.9

Austin-Round Rock, TX 1,973 1,932 2,009 2,204 2,570 115.7 112.6 112.6 120.2 140.1

Baltimore-Columbia-Towson, MD 3,869 4,369 3,634 2,974 3,233 143.8 161.2 133.2 108.0 117.4

Birmingham-Hoover, AL 1,970 2,363 2,550 2,340 2,130 174.2 209.5 225.2 205.9 187.4

Boston-Cambridge-Newton, MA-NH 1,352 1,881 1,671 1,995 2,372 29.5 41.3 36.4 43.0 51.1

Buffalo-Cheektowaga-Niagara Falls, NY 1,574 1,227 1,543 2,172 1,232 140.1 108.1 136.1 191.5 108.6

Charlotte-Concord-Gastonia, NC-SC 3,689 3,060 3,832 3,172 3,058 167.3 138.0 169.7 138.1 133.2

Chicago-Naperville-Elgin, IL-IN-WI 15,864 12,380 13,188 14,304 12,793 165.6 130.9 138.8 150.2 134.3

Cincinnati, OH-KY-IN 3,220 3,378 3,515 3,227 3,229 149.4 159.7 165.6 151.6 151.7

Cleveland-Elyria, OH 3,089 3,608 3,930 4,203 4,155 147.7 173.7 190.0 203.7 201.4

Columbus, OH 3,197 3,354 3,038 2,859 3,220 171.3 176.3 157.9 147.1 165.6

Dallas-Fort Worth-Arlington, TX 7,935 8,771 8,743 7,842 8,354 122.0 136.5 132.8 117.0 124.7

Denver-Aurora-Lakewood, CO 1,995 2,344 1,662 2,055 1,828 78.2 92.2 63.9 77.7 69.1

Detroit-Warren-Dearborn, MI 9,366 9,160 8,924 8,062 6,564 212.7 213.2 208.2 187.8 152.9

Hartford-West Hartford-East Hartford, CT 961 1,126 1,036 744 1,065 80.4 92.9 85.4 61.3 87.7

Houston-The Woodlands-Sugar Land, TX 6,225 7,645 6,861 7,582 7,783 106.5 129.1 113.2 122.7 126.0

Indianapolis-Carmel-Anderson, IN 3,110 3,140 3,128 3,738 3,616 165.9 166.3 163.8 193.8 187.5

Jacksonville, FL 2,015 2,128 2,040 1,948 2,321 151.7 158.1 150.0 141.4 168.5

Kansas City, MO-KS 3,186 3,202 2,913 2,919 2,696 156.1 159.4 143.7 143.2 132.2

Las Vegas-Henderson-Paradise, NV 1,553 1,604 1,740 1,968 2,256 81.6 82.2 88.3 98.4 112.8

Los Angeles-Long Beach-Anaheim, CA 9,774 11,156 11,105 13,102 14,449 75.9 87.0 85.8 100.4 110.7

Louisville/Jefferson County, KY-IN 2,099 2,243 2,400 2,040 2,063 173.2 181.5 192.7 163.0 164.9

Memphis, TN-MS-AR 4,542 4,094 3,852 4,498 3,086 345.9 309.0 288.7 335.2 230.0

Miami-Fort Lauderdale-West Palm Beach, FL 5,239 5,506 5,352 5,291 5,801 94.4 98.9 94.4 91.8 100.7

Milwaukee-Waukesha-West Allis, WI 3,588 3,425 3,349 3,277 3,179 230.0 220.1 214.4 209.1 202.9

Minneapolis-St. Paul-Bloomington, MN-WI 1,805 1,670 1,889 2,534 3,188 54.1 49.9 55.8 74.0 93.2

Nashville-Davidson--Murfreesboro--Franklin, TN 1,318 1,362 1,681 1,900 1,806 79.1 81.5 99.0 110.0 104.6

New Orleans-Metairie, LA 2,116 2,022 2,099 2,198 2,448 174.7 169.9 173.1 179.1 199.5

New York-Newark-Jersey City, NY-NJ-PA 15,543 17,724 21,153 21,310 19,319 78.7 90.6 107.4 107.5 97.4

Oklahoma City, OK 2,066 1,700 1,845 1,947 2,352 168.3 135.7 144.4 150.2 181.4

Orlando-Kissimmee-Sanford, FL 2,663 2,495 2,277 2,328 2,514 127.9 116.9 104.9 104.7 113.1

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 7,407 9,694 10,123 11,026 10,557 124.1 162.5 168.9 183.2 175.4

Phoenix-Mesa-Scottsdale, AZ 2,317 2,335 3,340 4,526 4,918 53.1 55.7 78.3 104.5 113.6

Pittsburgh, PA 1,866 2,069 2,473 3,048 2,827 79.2 87.8 104.8 129.1 119.8

Portland-Vancouver-Hillsboro, OR-WA 826 926 1,318 1,183 1,199 36.8 41.6 58.3 51.7 52.4

Providence-Warwick, RI-MA 427 382 475 643 593 26.7 23.9 29.7 40.2 37.0

Raleigh, NC 1,141 1,388 1,606 1,532 1,384 101.3 122.8 138.0 128.9 116.4

Richmond, VA 1,866 1,701 1,419 1,671 1,658 157.0 140.8 116.4 135.6 134.6

Riverside-San Bernardino-Ontario, CA 1,921 1,924 2,330 3,031 3,273 46.4 45.5 54.1 69.7 75.2

Sacramento--Roseville--Arden-Arcade, CA 1,124 1,676 1,913 2,324 2,597 52.8 78.0 87.9 105.8 118.2

Salt Lake City, UT 242 202 197 342 690 22.1 18.6 17.8 30.4 61.4

San Antonio-New Braunfels, TX 3,697 3,729 3,731 3,672 3,352 178.4 174.0 170.0 164.4 150.0

San Diego-Carlsbad, CA 1,829 2,021 2,173 2,620 2,825 59.9 65.3 69.2 82.5 88.9

San Francisco-Oakland-Hayward, CA 4,375 4,867 5,009 5,263 5,681 101.3 112.3 114.1 118.1 127.5

San Jose-Sunnyvale-Santa Clara, CA 563 586 680 1,020 1,145 30.6 31.9 36.5 53.8 60.4

Seattle-Tacoma-Bellevue, WA 1,700 2,189 1,971 2,323 2,990 49.9 63.6 56.3 65.4 84.2

St. Louis, MO-IL 3,617 4,136 5,014 4,810 4,492 129.0 148.4 179.6 172.0 160.7

Tampa-St. Petersburg-Clearwater, FL 3,818 3,516 3,655 3,422 3,660 139.0 126.3 129.4 120.4 128.7

Virginia Beach-Norfolk-Newport News, VA-NC 3,651 3,431 2,813 2,630 2,581 217.4 204.6 166.9 154.7 151.8

Washington-Arlington-Alexandria, DC-VA-MD-WV 5,334 5,250 5,503 5,369 5,616 96.5 93.1 95.6 91.6 95.8

SELECTED MSAs TOTAL 182,101 190,442 197,279 205,487 202,170 108.6 113.7 116.4 120.0 118.1

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.
96 Gonorrhea Tables STD Surveillance 2013

Table 18. Gonorrhea Among Women — Reported Cases and Rates of Reported Cases in Selected 

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2009–2013

Cases Rates per 100,000 Population

MSAs 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Atlanta-Sandy Springs-Roswell, GA 3,639 3,964 4,141 3,907 2,458 130.9 146.0 150.2 139.4 87.7

Austin-Round Rock, TX 980 910 935 993 1,078 117.4 106.3 105.1 108.5 117.8

Baltimore-Columbia-Towson, MD 2,181 2,397 1,941 1,527 1,542 156.5 170.5 137.2 107.1 108.2

Birmingham-Hoover, AL 1,056 1,323 1,417 1,280 1,099 180.6 226.6 241.6 217.3 186.6

Boston-Cambridge-Newton, MA-NH 624 708 730 738 828 26.5 30.1 30.8 30.9 34.6

Buffalo-Cheektowaga-Niagara Falls, NY 878 669 828 1,173 594 151.0 113.9 141.3 200.4 101.5

Charlotte-Concord-Gastonia, NC-SC 2,103 1,754 2,117 1,778 1,700 187.1 154.2 182.6 150.7 144.1

Chicago-Naperville-Elgin, IL-IN-WI 8,712 6,741 7,015 7,464 6,374 179.0 139.3 144.4 153.4 131.0

Cincinnati, OH-KY-IN 2,182 2,331 2,264 2,051 1,932 197.9 215.7 208.8 188.7 177.8

Cleveland-Elyria, OH 1,808 2,082 2,371 2,426 2,328 166.6 193.0 220.9 226.7 217.5

Columbus, OH 1,876 1,919 1,561 1,514 1,500 198.5 198.3 159.5 153.2 151.8

Dallas-Fort Worth-Arlington, TX 4,557 4,791 4,653 4,157 3,921 141.0 147.1 139.6 122.5 115.5

Denver-Aurora-Lakewood, CO 1,035 1,261 885 965 724 81.4 98.6 67.8 72.7 54.5

Detroit-Warren-Dearborn, MI 5,204 5,217 5,114 4,406 3,614 230.8 235.6 231.6 199.3 163.5

Hartford-West Hartford-East Hartford, CT 551 633 596 422 543 90.0 101.7 95.8 67.7 87.1

Houston-The Woodlands-Sugar Land, TX 3,299 4,170 3,803 4,039 4,033 113.2 140.1 124.9 130.2 130.0

Indianapolis-Carmel-Anderson, IN 1,701 1,638 1,674 1,957 1,761 178.4 169.7 171.5 198.5 178.6

Jacksonville, FL 1,048 1,152 1,121 983 1,121 154.1 167.0 160.6 139.1 158.6

Kansas City, MO-KS 1,816 1,804 1,592 1,585 1,424 174.8 175.8 153.9 152.4 136.9

Las Vegas-Henderson-Paradise, NV 746 779 742 847 1,015 79.8 80.4 75.8 85.1 102.0

Los Angeles-Long Beach-Anaheim, CA 3,641 3,947 3,944 4,359 4,578 56.2 60.7 60.2 65.9 69.3

Louisville/Jefferson County, KY-IN 1,121 1,246 1,375 1,096 1,079 180.6 196.9 215.6 171.2 168.5

Memphis, TN-MS-AR 2,540 2,288 2,192 2,418 1,550 372.7 332.2 315.9 346.6 222.2

Miami-Fort Lauderdale-West Palm Beach, FL 2,439 2,480 2,361 2,198 2,225 85.9 86.4 80.9 74.1 75.0

Milwaukee-Waukesha-West Allis, WI 2,098 2,070 1,980 1,814 1,655 262.8 259.0 247.0 225.5 205.8

Minneapolis-St. Paul-Bloomington, MN-WI 931 953 1,035 1,322 1,641 55.4 56.2 60.4 76.4 94.8

Nashville-Davidson--Murfreesboro--Franklin, TN 676 642 776 858 838 79.8 75.2 89.3 97.1 94.9

New Orleans-Metairie, LA 1,118 1,027 1,131 1,186 1,317 177.9 168.2 181.6 187.9 208.7

New York-Newark-Jersey City, NY-NJ-PA 7,047 8,248 9,826 9,157 7,615 69.4 81.4 96.5 89.3 74.3

Oklahoma City, OK 1,188 962 1,034 1,081 1,305 190.6 151.3 159.7 164.6 198.7

Orlando-Kissimmee-Sanford, FL 1,364 1,171 1,090 1,087 1,114 129.7 107.5 98.4 95.8 98.1

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 3,811 5,125 5,361 5,581 5,052 123.6 166.0 173.0 179.3 162.3

Phoenix-Mesa-Scottsdale, AZ 1,022 1,071 1,568 2,118 2,318 47.4 50.8 73.2 97.3 106.5

Pittsburgh, PA 1,161 1,274 1,501 1,857 1,715 95.2 104.6 123.2 152.6 140.9

Portland-Vancouver-Hillsboro, OR-WA 322 371 482 393 325 28.6 32.9 42.1 33.9 28.1

Providence-Warwick, RI-MA 196 159 232 294 261 23.8 19.2 28.1 35.6 31.6

Raleigh, NC 619 738 868 807 677 108.9 127.6 145.7 132.7 111.3

Richmond, VA 991 967 797 908 957 162.0 154.9 126.6 142.6 150.3

Riverside-San Bernardino-Ontario, CA 1,024 976 1,196 1,562 1,576 49.6 46.0 55.3 71.5 72.2

Sacramento--Roseville--Arden-Arcade, CA 557 907 990 1,212 1,323 51.7 82.8 89.3 108.2 118.1

Salt Lake City, UT 37 40 41 88 263 6.8 7.4 7.4 15.8 47.1

San Antonio-New Braunfels, TX 1,921 1,886 1,835 1,865 1,624 182.0 173.0 164.4 164.5 143.2

San Diego-Carlsbad, CA 620 535 609 847 827 40.7 34.7 39.0 53.6 52.3

San Francisco-Oakland-Hayward, CA 1,421 1,710 1,531 1,493 1,491 65.5 77.8 68.9 66.2 66.1

San Jose-Sunnyvale-Santa Clara, CA 248 249 243 372 446 27.6 27.2 26.2 39.5 47.3

Seattle-Tacoma-Bellevue, WA 604 686 649 732 988 35.4 39.7 37.0 41.1 55.5

St. Louis, MO-IL 1,906 2,187 2,699 2,467 2,313 131.7 152.1 187.4 171.1 160.4

Tampa-St. Petersburg-Clearwater, FL 1,907 1,834 1,887 1,701 1,774 135.4 127.7 129.7 116.1 121.1

Virginia Beach-Norfolk-Newport News, VA-NC 2,009 1,856 1,563 1,402 1,341 233.9 217.2 182.0 162.3 155.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,646 2,685 2,709 2,355 2,278 93.8 92.8 91.8 78.4 75.9

SELECTED MSAs TOTAL 93,181 96,533 99,005 98,842 92,055 109.5 112.9 114.5 113.1 105.4

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

Note: Cases reported with unknown sex are not included in this table.
STD Surveillance 2013 Gonorrhea Tables 97

Table 19. Gonorrhea Among Men — Reported Cases and Rates of Reported Cases by State/Area 

and Region in Alphabetical Order, United States and Outlying Areas, 2009–2013

 Cases Rates per 100,000 Population

MSAs 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Atlanta-Sandy Springs-Roswell, GA 3,798 4,310 4,343 4,329 2,952 140.0 167.5 165.7 163.1 111.2

Austin-Round Rock, TX 991 1,022 1,073 1,196 1,295 113.9 118.8 120.1 130.1 140.8

Baltimore-Columbia-Towson, MD 1,675 1,968 1,690 1,447 1,690 129.2 150.8 128.5 109.0 127.3

Birmingham-Hoover, AL 913 1,024 1,094 1,057 1,029 167.2 188.2 200.5 193.0 187.9

Boston-Cambridge-Newton, MA-NH 726 1,173 940 1,257 1,541 32.5 53.2 42.3 55.9 68.5

Buffalo-Cheektowaga-Niagara Falls, NY 696 558 715 999 638 128.3 101.8 130.5 182.1 116.3

Charlotte-Concord-Gastonia, NC-SC 1,574 1,299 1,704 1,384 1,356 145.6 120.3 155.1 123.9 121.4

Chicago-Naperville-Elgin, IL-IN-WI 7,141 5,610 6,150 6,819 6,407 151.5 121.4 132.3 146.4 137.6

Cincinnati, OH-KY-IN 1,019 1,041 1,250 1,176 1,297 96.8 100.7 120.4 112.9 124.5

Cleveland-Elyria, OH 1,254 1,517 1,559 1,777 1,827 124.6 151.9 156.7 178.9 183.9

Columbus, OH 1,291 1,432 1,477 1,345 1,720 140.2 153.3 156.2 140.8 180.0

Dallas-Fort Worth-Arlington, TX 3,378 3,977 4,089 3,682 4,426 103.3 125.5 125.9 111.4 133.9

Denver-Aurora-Lakewood, CO 958 1,083 777 1,090 1,104 74.8 85.6 60.0 82.8 83.8

Detroit-Warren-Dearborn, MI 4,005 3,924 3,794 3,642 2,942 186.4 188.5 182.6 175.0 141.4

Hartford-West Hartford-East Hartford, CT 410 493 440 322 522 70.3 83.5 74.5 54.5 88.3

Houston-The Woodlands-Sugar Land, TX 2,922 3,462 3,055 3,543 3,749 99.8 117.6 101.3 115.2 121.9

Indianapolis-Carmel-Anderson, IN 1,404 1,499 1,447 1,772 1,854 152.3 162.5 155.0 187.9 196.6

Jacksonville, FL 966 973 919 965 1,198 149.1 148.4 138.8 143.8 178.6

Kansas City, MO-KS 1,370 1,398 1,321 1,334 1,272 136.7 142.2 133.1 133.6 127.4

Las Vegas-Henderson-Paradise, NV 807 825 998 1,119 1,239 83.3 84.0 100.7 111.3 123.2

Los Angeles-Long Beach-Anaheim, CA 6,081 7,156 7,124 8,712 9,849 95.0 113.1 111.5 135.2 152.9

Louisville/Jefferson County, KY-IN 976 995 1,020 940 969 165.0 165.0 167.9 153.8 158.6

Memphis, TN-MS-AR 2,001 1,805 1,660 2,080 1,536 316.9 283.7 259.2 323.0 238.5

Miami-Fort Lauderdale-West Palm Beach, FL 2,799 3,024 2,987 3,093 3,564 103.4 112.3 108.5 110.6 127.4

Milwaukee-Waukesha-West Allis, WI 1,470 1,354 1,368 1,463 1,521 193.1 178.9 179.9 191.8 199.4

Minneapolis-St. Paul-Bloomington, MN-WI 874 717 854 1,209 1,546 52.7 43.4 51.0 71.5 91.4

Nashville-Davidson--Murfreesboro--Franklin, TN 642 719 905 1,034 968 78.4 88.0 109.1 122.6 114.8

New Orleans-Metairie, LA 990 937 962 1,012 1,131 169.9 161.8 163.0 169.8 189.8

New York-Newark-Jersey City, NY-NJ-PA 8,491 9,451 11,291 12,124 11,639 88.6 100.2 118.7 126.5 121.5

Oklahoma City, OK 876 736 775 866 1,047 145.0 119.2 122.9 135.3 163.6

Orlando-Kissimmee-Sanford, FL 1,297 1,320 1,186 1,241 1,399 125.8 126.4 111.5 114.0 128.5

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 3,593 4,565 4,756 5,439 5,501 124.5 158.6 164.4 187.1 189.3

Phoenix-Mesa-Scottsdale, AZ 1,295 1,264 1,770 2,407 2,600 58.6 60.6 83.4 111.8 120.7

Pittsburgh, PA 704 795 971 1,191 1,110 62.0 69.8 85.1 104.1 97.1

Portland-Vancouver-Hillsboro, OR-WA 504 555 836 790 874 45.2 50.5 74.8 69.8 77.2

Providence-Warwick, RI-MA 231 223 243 349 331 29.7 28.8 31.4 45.0 42.7

Raleigh, NC 513 648 735 724 707 92.0 117.4 129.4 124.8 121.8

Richmond, VA 871 732 617 761 701 151.0 125.4 104.7 127.8 117.7

Riverside-San Bernardino-Ontario, CA 895 944 1,126 1,467 1,695 43.1 44.9 52.5 67.7 78.2

Sacramento--Roseville--Arden-Arcade, CA 558 756 917 1,104 1,271 53.2 71.8 85.9 102.6 118.1

Salt Lake City, UT 205 162 156 254 427 37.1 29.6 28.0 44.9 75.6

San Antonio-New Braunfels, TX 1,775 1,843 1,896 1,807 1,728 174.6 175.1 175.8 164.3 157.1

San Diego-Carlsbad, CA 1,206 1,482 1,552 1,766 1,995 78.7 95.4 98.4 110.6 124.9

San Francisco-Oakland-Hayward, CA 2,933 3,127 3,454 3,746 4,167 136.5 146.3 159.4 170.4 189.5

San Jose-Sunnyvale-Santa Clara, CA 314 333 430 626 699 33.4 36.1 45.9 65.8 73.4

Seattle-Tacoma-Bellevue, WA 1,094 1,501 1,322 1,591 2,002 64.2 87.7 75.7 89.9 113.1

St. Louis, MO-IL 1,711 1,949 2,315 2,340 2,178 126.0 144.4 171.2 172.8 160.9

Tampa-St. Petersburg-Clearwater, FL 1,887 1,678 1,761 1,721 1,871 141.0 124.5 128.6 124.9 135.8

Virginia Beach-Norfolk-Newport News, VA-NC 1,634 1,572 1,248 1,226 1,239 199.2 191.2 151.0 146.7 148.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,685 2,558 2,791 3,001 3,330 99.2 93.2 99.4 105.0 116.5

SELECTED MSAs TOTAL 88,403 93,489 97,863 106,339 109,653 107.0 114.1 118.0 126.8 130.8

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

Note: Cases reported with unknown sex are not included in this table.
98 Gonorrhea Tables STD Surveillance 2013

Table 20. Gonorrhea — Reported Cases and Rates of Reported Cases in Counties and 

Independent Cities* Ranked by Number of Reported Cases, United States, 2013

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percentage

1 Los Angeles County, CA 12,997 130.5 3

2 Cook County, IL 10,551 201.7 7

3 Harris County, TX 6,561 154.2 9

4 Philadelphia County, PA 6,303 407.3 10

5 Wayne County, MI 5,047 281.6 12

6 Dallas County, TX 4,803 195.7 13

7 Maricopa County, AZ 4,657 118.1 15

8 Kings County, NY 3,892 151.7 16

9 New York County, NY 3,796 234.5 17

10 Cuyahoga County, OH 3,679 290.8 18

11 Bronx County, NY 3,496 248.2 19

12 Marion County, IN 3,191 347.2 20

13 Bexar County, TX 3,074 172.1 21

14 Milwaukee County, WI 3,048 319.1 22

15 Franklin County, OH 2,935 245.5 23

16 San Diego County, CA 2,825 88.9 24

17 San Francisco County, CA 2,526 305.9 25

18 Shelby County, TN 2,508 266.6 25

19 Washington, D.C. 2,478 391.9 26

20 Miami-Dade County, FL 2,391 92.3 27

21 Hamilton County, OH 2,361 294.4 27

22 Broward County, FL 2,356 129.8 28

23 Sacramento County, CA 2,314 159.6 29

24 Tarrant County, TX 2,258 120.1 30

25 Clark County, NV 2,256 112.8 30

26 Allegheny County, PA 2,170 176.5 31

27 Baltimore (City), MD 2,158 347.3 32

28 Fulton County, GA 2,122 217.0 32

29 Duval County, FL 2,057 233.9 33

30 Hillsborough County, FL 2,018 157.9 33

31 Hennepin County, MN 1,983 167.4 34

32 Queens County, NY 1,964 86.4 35

33 Jefferson County, AL 1,925 291.7 35

34 Travis County, TX 1,905 173.9 36

35 Orange County, FL 1,898 157.9 36

36 San Bernardino County, CA 1,875 90.1 37

37 Oklahoma County, OK 1,862 251.0 37

38 Jackson County, MO 1,860 274.6 38

39 Alameda County, CA 1,849 118.9 39

40 Jefferson County, KY 1,835 244.4 39

41 Fresno County, CA 1,780 187.8 40

42 King County, WA 1,776 88.5 40

43 Mecklenburg County, NC 1,775 183.2 41

44 St. Louis (City), MO 1,754 551.3 41

45 St. Louis County, MO 1,734 173.3 42

46 Kern County, CA 1,594 186.2 42

47 Orleans Parish, LA 1,485 402.2 43

48 Prince George's County, MD 1,482 168.2 43

49 Orange County, CA 1,452 47.0 44

50 Essex County, NJ 1,435 182.2 44

51 Riverside County, CA 1,398 61.6 44

52 Pinellas County, FL 1,394 151.3 45

53 Bell County, TX 1,361 421.3 45

54 Guilford County, NC 1,344 268.3 46

55 Suffolk County, MA 1,325 178.0 46

56 Montgomery County, AL 1,309 568.8 46

57 Davidson County, TN 1,282 197.7 47

58 Tulsa County, OK 1,248 203.3 47

59 Camden County, NJ 1,218 237.2 48

60 Wake County, NC 1,205 126.6 48

61 Cumberland County, NC 1,197 369.4 48

62 Montgomery County, OH 1,163 217.7 49

63 Santa Clara County, CA 1,120 61.0 49

64 DeKalb County, GA 1,087 153.7 49

65 New Haven County, CT 1,063 123.2 50

66 Erie County, NY 1,057 115.0 50

67 Palm Beach County, FL 1,054 77.7 50

68 Hinds County, MS 1,042 419.1 51

69 Monroe County, NY 1,019 136.3 51

70 Bernalillo County, NM 1,011 150.1 51

* Accounting for 51% of reported gonorrhea cases.

† Counties and independent cities were ranked in descending order by number of cases reported then by rate in 2013.
STD Surveillance 2013 Gonorrhea Tables 99

Table 21. Gonorrhea — Reported Cases and Rates of Reported Cases by Age Group and 

Sex, United States, 2009–2013

Age

Group

Cases Rates*

Total Male Female Unknown Sex Total Male Female

0–4 226 83 141 2 1.1 0.8 1.4

2009

5–9 90 13 77 0 0.4 0.1 0.8

10–14 2,983 507 2,471 5 14.9 5.0 25.3

15–19 86,996 27,444 59,353 199 403.9 248.3 566.0

20–24 100,645 43,986 56,436 223 467.3 396.5 540.3

25–29 49,855 26,016 23,719 120 230.0 234.1 224.6

30–34 24,607 14,364 10,178 65 123.7 142.1 104.1

35–39 13,971 8,997 4,928 46 68.0 86.9 48.4

40–44 8,975 6,504 2,446 25 42.8 61.9 23.3

45–54 9,294 7,311 1,954 29 20.8 33.3 8.6

55–64 2,212 1,848 363 1 6.4 11.0 2.0

65+ 554 446 108 0 1.4 2.7 0.5

Unknown Age 766 300 394 72

TOTAL 301,174 137,819 162,568 787 98.1 91.0 104.5

0–4 247 70 167 10 1.2 0.7 1.7

2010

5–9 64 10 53 1 0.3 0.1 0.5

10–14 3,016 486 2,498 32 14.6 4.6 24.7

15–19 88,250 28,002 59,867 381 400.4 247.7 557.6

20–24 105,619 46,708 58,574 337 489.3 424.1 554.1

25–29 50,890 26,818 23,907 165 241.2 252.2 228.4

30–34 25,401 14,809 10,510 82 127.2 148.1 105.5

35–39 13,769 8,812 4,907 50 68.2 87.8 48.4

40–44 9,262 6,745 2,495 22 44.3 64.9 23.8

45–54 9,555 7,490 2,043 22 21.2 33.8 8.9

55–64 2,194 1,852 338 4 6.0 10.5 1.8

65+ 520 411 105 4 1.3 2.4 0.5

Unknown Age 554 257 229 68

TOTAL 309,341 142,470 165,693 1,178 100.2 93.9 105.6

0–4 182 43 136 3 0.9 0.4 1.4

2011

5–9 82 15 66 1 0.4 0.1 0.7

10–14 3,223 548 2,648 27 15.6 5.2 26.2

15–19 88,139 28,102 59,747 290 407.2 252.7 567.7

20–24 111,730 49,633 61,756 341 504.3 438.7 569.6

25–29 53,245 28,288 24,821 136 250.2 262.9 236.0

30–34 27,157 16,044 11,044 69 132.4 156.0 108.0

35–39 14,109 8,972 5,096 41 72.0 91.9 51.8

40–44 9,686 6,955 2,708 23 46.1 66.5 25.6

45–54 10,473 8,222 2,222 29 23.4 37.3 9.8

55–64 2,747 2,270 471 6 7.2 12.4 2.4

65+ 587 485 99 3 1.4 2.7 0.4

Unknown Age 489 258 191 40

TOTAL 321,849 149,835 171,005 1,009 103.3 97.7 108.0

0–4 198 72 122 4 1.0 0.7 1.2

2012

5–9 68 16 52 0 0.3 0.2 0.5

10–14 3,136 573 2,559 4 15.2 5.4 25.3

15–19 81,548 26,578 54,852 118 381.8 242.4 527.5

20–24 115,224 52,351 62,711 162 510.2 453.3 568.4

25–29 58,441 31,631 26,722 88 273.1 291.7 253.2

30–34 31,420 18,936 12,436 48 150.3 180.4 119.4

35–39 16,193 10,493 5,670 30 83.1 108.0 58.0

40–44 10,965 7,858 3,089 18 52.1 75.1 29.2

45–54 12,383 9,773 2,594 16 28.0 44.8 11.5

55–64 3,230 2,642 586 2 8.4 14.2 2.9

65+ 644 537 105 2 1.5 2.9 0.4

Unknown Age 1,376 775 568 33

TOTAL 334,826 162,235 172,066 525 106.7 105.0 107.9

0–4 172 60 111 1 0.9 0.6 1.1

2013

5–9 75 11 64 0 0.4 0.1 0.6

10–14 2,637 508 2,122 7 12.8 4.8 21.0

15–19 72,092 24,212 47,749 131 337.5 220.9 459.2

20–24 113,035 53,055 59,760 220 500.5 459.4 541.6

25–29 62,102 34,718 27,266 118 290.2 320.1 258.4

30–34 34,065 20,855 13,143 67 162.9 198.7 126.2

35–39 18,034 11,850 6,145 39 92.5 122.0 62.9

40–44 11,817 8,590 3,192 35 56.2 82.1 30.2

45–54 13,823 11,087 2,714 22 31.2 50.8 12.1

55–64 3,802 3,176 621 5 9.9 17.1 3.1

65+ 825 696 128 1 1.9 3.7 0.5

Unknown Age 525 312 193 20

TOTAL 333,004 169,130 163,208 666 106.1 109.5 102.4

* No population data are available for unknown sex and age; therefore, rates are not calculated.

Note: This table should be used only for age comparisons.

Cases in the 0–4 age group may include cases due to perinatal transmission.
100 Gonorrhea Tables STD Surveillance 2013

Table 22A. Gonorrhea —Reported Cases by Race/Ethnicity, Age Group, and Sex, United States*, 

2013

Age

Group

American Indians/ 

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 0 0 0 3 1 2 51 15 36

5–9 1 0 1 0 0 0 26 4 22

10–14 23 2 21 4 0 4 1,303 266 1,035

15–19 541 140 401 252 90 161 35,653 12,438 23,189

20–24 941 311 630 666 390 272 51,980 24,560 27,386

25–29 636 242 392 481 314 167 24,381 13,914 10,455

30–34 341 121 220 338 247 90 11,906 7,534 4,367

35–39 161 51 110 229 165 63 5,872 4,127 1,742

40–44 87 35 52 142 114 28 3,397 2,613 779

45–54 100 52 48 135 102 32 3,844 3,221 622

55–64 14 6 8 38 25 13 1,058 929 126

65+ 8 8 0 11 8 3 176 152 24

Unknown Age 2 0 2 2 2 0 83 46 37

TOTAL 2,855 968 1,885 2,301 1,458 835 139,730 69,819 69,820

Age

Group

Native Hawaiians/ 

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 0 0 0 34 9 25 1 1 0

5–9 1 0 1 9 0 9 2 1 1

10–14 1 0 1 256 28 228 16 0 16

15–19 56 16 40 8,888 2,279 6,600 410 104 306

20–24 166 84 82 18,231 7,687 10,529 595 237 358

25–29 109 58 51 12,671 6,439 6,215 299 167 132

30–34 67 43 24 7,734 4,360 3,364 168 120 48

35–39 34 18 16 4,043 2,465 1,574 62 41 21

40–44 18 10 8 3,172 2,287 881 37 27 10

45–54 14 11 3 4,036 3,332 698 47 40 7

55–64 2 2 0 1,120 967 153 14 12 2

65+ 0 0 0 233 212 21 0 0 0

Unknown Age 1 1 0 55 32 23 2 1 1

TOTAL 469 243 226 60,482 30,097 30,320 1,653 751 902

Age

Group

Hispanics Other/Unknown

Total† Male Female Total† Male Female

0–4 12 4 8 48 19 28

5–9 11 1 10 19 5 14

10–14 174 42 132 496 111 381

15–19 5,969 2,123 3,835 12,357 4,302 7,982

20–24 10,520 5,399 5,097 17,619 8,262 9,240

25–29 6,727 4,003 2,708 9,555 5,180 4,313

30–34 3,809 2,450 1,351 5,775 3,360 2,381

35–39 2,077 1,402 670 3,365 2,079 1,263

40–44 1,223 871 344 2,341 1,615 713

45–54 1,076 818 257 2,827 2,129 687

55–64 223 170 53 906 722 182

65+ 44 36 8 234 192 41

Unknown Age 45 28 15 253 162 75

TOTAL 31,910 17,347 14,488 55,795 28,138 27,300

* Includes 46 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2013. † Total includes cases reported with unknown sex.

Note: These tables should be used only for race/ethnicity comparisons. See Table 21 for age–specific cases and rates and Tables 14–16 for total and sex–specific 

cases and rates.

Cases in the 0–4 age group may include cases due to perinatal transmission.
STD Surveillance 2013 Gonorrhea Tables 101

Table 22B. Gonorrhea — Rates of Reported Cases per 100,000 Population by Race/Ethnicity, Age 

Group, and Sex, United States*, 2013

Age

Group

American Indians/ 

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 0.0 0.0 0.0 0.4 0.2 0.5 2.2 1.2 3.1

5–9 0.6 0.0 1.3 0.0 0.0 0.0 1.1 0.3 1.9

10–14 14.2 2.4 26.3 0.5 0.0 1.0 52.5 21.1 84.9

15–19 319.7 162.0 484.3 30.9 21.7 40.2 1,334.2 913.9 1,768.5

20–24 531.9 344.1 728.0 66.7 77.0 55.3 1,842.6 1,734.5 1,949.1

25–29 418.3 317.5 516.9 43.4 58.3 29.3 1,031.5 1,207.2 863.2

30–34 242.7 172.9 311.9 29.6 46.3 14.8 521.4 690.3 366.4

35–39 124.7 80.1 168.2 20.1 30.8 10.4 281.5 418.0 158.5

40–44 64.9 53.0 76.4 12.8 22.0 4.7 154.5 250.6 67.4

45–54 34.7 37.5 32.1 7.3 11.9 3.2 84.9 150.5 26.0

55–64 6.2 5.6 6.7 2.6 3.8 1.6 29.9 57.3 6.6

65+ 4.3 9.6 0.0 0.8 1.3 0.4 5.8 12.5 1.3

Unknown Age

TOTAL 137.4 94.6 178.7 17.1 22.8 11.8 426.6 444.9 409.2

Age

Group

Native Hawaiians/ 

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 0.0 0.0 0.0 0.4 0.2 0.6 0.1 0.2 0.0

5–9 2.6 0.0 5.4 0.1 0.0 0.2 0.3 0.3 0.3

10–14 2.7 0.0 5.6 2.6 0.5 4.7 2.5 0.0 5.1

15–19 144.7 80.6 212.1 85.1 42.4 130.1 74.0 37.3 111.3

20–24 356.0 347.8 364.9 161.6 133.7 190.3 130.3 106.3 153.3

25–29 240.0 248.4 231.1 116.1 116.5 115.3 84.6 99.3 71.3

30–34 159.6 199.7 117.5 72.2 80.6 63.4 54.2 81.8 29.3

35–39 94.2 97.4 90.8 40.4 48.9 31.7 24.4 34.2 15.6

40–44 53.0 58.4 47.5 27.5 39.5 15.4 15.7 24.1 8.1

45–54 22.0 34.7 9.4 15.2 25.3 5.2 11.2 20.0 3.2

55–64 4.4 9.1 0.0 4.5 7.9 1.2 4.6 8.2 1.3

65+ 0.0 0.0 0.0 0.8 1.6 0.1 0.0 0.0 0.0

Unknown Age

TOTAL 94.0 96.4 91.5 34.5 34.9 34.1 31.0 28.7 33.2

Age

Group

Hispanics

Total† Male Female

0–4 0.3 0.2 0.3

5–9 0.2 0.0 0.4

10–14 4.0 1.9 6.2

15–19 141.7 97.7 188.1

20–24 251.5 244.4 258.3

25–29 169.1 188.8 145.7

30–34 97.3 119.3 72.5

35–39 57.1 75.0 37.9

40–44 36.6 50.9 21.1

45–54 20.1 30.3 9.7

55–64 6.8 10.7 3.1

65+ 1.6 3.0 0.5

Unknown Age

TOTAL 65.8 70.4 60.8

* Includes 46 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2013. † Total includes cases reported with unknown sex.

Note: These tables should be used only for race/ethnicity comparisons. See Table 21 for age–specific cases and rates and Tables 14–16 for total and sex–specific 

cases and rates.

Cases in the 0–4 age group may include cases due to perinatal transmission.

No population data exist for unknown sex, unknown age, or unknown race; therefore rates are not calculated.
102 Gonorrhea Tables STD Surveillance 2013

Table 23. Gonorrhea Among Women 15–25 Years of Age — Reported Cases and Rates of 

Reported Cases by Age, United States, 2009–2013

Age Cases Rate per 100,000 Population

2009

15 4,458 221.1

16 8,150 396.2

17 12,226 582.3

18 16,770 785.1

19 17,749 814.9

20 15,433 732.3

21 13,321 639.4

22 10,933 528.2

23 9,151 438.7

24 7,598 361.9

25 6,429 311.8

2010

15 4,502 217.9

16 8,286 394.6

17 12,397 581.4

18 16,743 762.6

19 17,939 799.7

20 16,320 738.2

21 14,015 657.6

22 11,087 531.3

23 9,329 453.4

24 7,823 375.1

25 6,546 311.6

2011

15 4,466 220.3

16 8,128 393.4

17 12,308 584.7

18 16,973 796.3

19 17,872 814.3

20 16,865 750.6

21 14,559 647.9

22 12,202 565.4

23 9,861 467.2

24 8,269 397.9

25 6,804 324.9

2012

15 4,241 209.4

16 7,316 359.4

17 11,006 530.2

18 15,580 736.2

19 16,709 779.1

20 15,849 717.5

21 15,029 664.7

22 12,800 565.9

23 10,449 480.6

24 8,584 403.4

25 7,343 350.3

2013

15 3,776 186.4

16 6,503 319.5

17 9,374 451.6

18 13,393 632.8

19 14,703 685.6

20 14,420 652.8

21 13,394 592.4

22 12,272 542.5

23 10,819 497.7

24 8,855 416.1

25 7,446 355.3

Note: This table should be used only for age comparisons. Cases reported with unknown sex are not included in this table.
STD Surveillance 2013 Syphilis Tables 103

Table 24. All Stages of Syphilis* — Reported Cases and Rates of Reported Cases by State/Area and 

Region in Alphabetical Order, United States and Outlying Areas, 2009–2013

Cases Rates per 100,000 Population

State/Area 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Alabama 1,138 781 758 705 679 24.2 16.3 15.8 14.6 14.1

Alaska 4 15 11 34 35 0.6 2.1 1.5 4.6 4.8

Arizona 1,084 905 907 787 962 16.4 14.2 14.0 12.0 14.7

Arkansas 552 534 464 468 527 19.1 18.3 15.8 15.9 17.9

California 6,033 6,115 6,782 8,016 9,971 16.3 16.4 18.0 21.1 26.2

Colorado 269 342 367 503 475 5.4 6.8 7.2 9.7 9.2

Connecticut 179 234 189 121 133 5.1 6.5 5.3 3.4 3.7

Delaware 87 44 124 106 146 9.8 4.9 13.7 11.6 15.9

District of Columbia 431 495 552 589 609 71.9 82.3 89.3 93.1 96.3

Florida 3,860 4,070 4,143 4,483 5,024 20.8 21.6 21.7 23.2 26.0

Georgia 2,717 2,347 1,895 2,434 2,990 27.6 24.2 19.3 24.5 30.1

Hawaii 88 73 32 43 87 6.8 5.4 2.3 3.1 6.2

Idaho 31 20 42 54 42 2.0 1.3 2.6 3.4 2.6

Illinois 1,915 2,236 2,426 2,424 2,661 14.8 17.4 18.9 18.8 20.7

Indiana 324 412 468 531 543 5.0 6.4 7.2 8.1 8.3

Iowa 65 68 70 143 226 2.2 2.2 2.3 4.7 7.4

Kansas 151 110 76 129 196 5.4 3.9 2.6 4.5 6.8

Kentucky 239 311 335 390 395 5.5 7.2 7.7 8.9 9.0

Louisiana 1,964 2,484 2,043 1,780 1,998 43.7 54.8 44.7 38.7 43.4

Maine 15 41 24 22 21 1.1 3.1 1.8 1.7 1.6

Maryland 993 1,015 1,278 1,243 1,361 17.4 17.6 21.9 21.1 23.1

Massachusetts 473 639 770 806 990 7.2 9.8 11.7 12.1 14.9

Michigan 636 683 764 786 1,068 6.4 6.9 7.7 8.0 10.8

Minnesota 217 350 367 335 541 4.1 6.6 6.9 6.2 10.1

Mississippi 745 823 748 456 293 25.2 27.7 25.1 15.3 9.8

Missouri 514 512 414 426 609 8.6 8.5 6.9 7.1 10.1

Montana 5 5 9 3 8 0.5 0.5 0.9 0.3 0.8

Nebraska 45 33 36 35 95 2.5 1.8 2.0 1.9 5.1

Nevada 306 412 430 445 523 11.6 15.3 15.8 16.1 19.0

New Hampshire 37 43 33 65 79 2.8 3.3 2.5 4.9 6.0

New Jersey 890 947 971 883 968 10.2 10.8 11.0 10.0 10.9

New Mexico 208 151 212 234 247 10.3 7.3 10.2 11.2 11.8

New York 4,623 4,860 4,786 5,312 6,173 23.7 25.1 24.6 27.1 31.5

North Carolina 1,524 1,233 1,255 1,037 1,150 16.2 12.9 13.0 10.6 11.8

North Dakota 8 6 5 14 25 1.2 0.9 0.7 2.0 3.6

Ohio 795 1,076 954 1,141 1,095 6.9 9.3 8.3 9.9 9.5

Oklahoma 296 272 270 256 383 8.0 7.3 7.1 6.7 10.0

Oregon 132 173 252 424 527 3.5 4.5 6.5 10.9 13.5

Pennsylvania 1,028 1,007 1,125 1,349 1,485 8.2 7.9 8.8 10.6 11.6

Rhode Island 64 79 84 93 94 6.1 7.5 8.0 8.9 8.9

South Carolina 507 580 639 624 753 11.1 12.5 13.7 13.2 15.9

South Dakota 10 12 14 29 61 1.2 1.5 1.7 3.5 7.3

Tennessee 1,317 1,193 1,025 1,068 980 20.9 18.8 16.0 16.5 15.2

Texas 6,975 6,413 6,161 7,057 7,045 28.1 25.5 24.0 27.1 27.0

Utah 55 133 64 101 172 2.0 4.8 2.3 3.5 6.0

Vermont 1 4 10 12 10 0.2 0.6 1.6 1.9 1.6

Virginia 755 800 726 906 1,000 9.6 10.0 9.0 11.1 12.2

Washington 322 535 712 709 711 4.8 8.0 10.4 10.3 10.3

West Virginia 32 26 9 24 39 1.8 1.4 0.5 1.3 2.1

Wisconsin 166 186 203 268 257 2.9 3.3 3.6 4.7 4.5

Wyoming 7 6 6 12 9 1.3 1.1 1.1 2.1 1.6

U.S. TOTAL 44,832 45,844 46,040 49,915 56,471 14.6 14.8 14.8 15.9 18.0

Northeast 7,310 7,854 7,992 8,663 9,953 13.2 14.2 14.4 15.5 17.8

Midwest 4,846 5,684 5,797 6,261 7,377 7.3 8.5 8.6 9.3 11.0

South 24,132 23,421 22,425 23,626 25,372 21.3 20.4 19.3 20.1 21.6

West 8,544 8,885 9,826 11,365 13,769 11.9 12.3 13.5 15.4 18.7

Guam 12 11 26 27 24 6.7 6.9 16.3 16.9 15.0

Puerto Rico 725 723 671 704 810 18.3 19.4 18.1 19.2 22.1

Virgin Islands 2 4 7 2 9 1.8 3.8 6.6 1.9 8.5

OUTLYING AREAS 739 738 704 733 843 17.4 18.5 17.7 18.6 21.4

TOTAL 45,571 46,582 46,744 50,648 57,314 14.6 14.9 14.8 15.9 18.0

* See Syphilis Morbidity Reporting in the Appendix for definition.
104 Syphilis Tables STD Surveillance 2013

Table 25. All Stages of Syphilis* — Reported Cases and Rates of Reported Cases in Selected 

Metropolitan Statistical Areas (MSAs)†

 in Alphabetical Order, United States, 2009–2013

MSAs

Cases Rates per 100,000 Population

2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Atlanta-Sandy Springs-Roswell, GA 2,188 1,916 1,549 1,822 2,257 39.8 36.2 28.8 33.4 41.4

Austin-Round Rock, TX 352 362 425 478 501 20.6 21.1 23.8 26.1 27.3

Baltimore-Columbia-Towson, MD 567 531 710 726 732 21.1 19.6 26.0 26.4 26.6

Birmingham-Hoover, AL 412 234 276 226 236 36.4 20.7 24.4 19.9 20.8

Boston-Cambridge-Newton, MA-NH 411 544 607 570 758 9.0 11.9 13.2 12.3 16.3

Buffalo-Cheektowaga-Niagara Falls, NY 40 43 48 70 115 3.6 3.8 4.2 6.2 10.1

Charlotte-Concord-Gastonia, NC-SC 380 314 372 310 360 17.2 14.2 16.5 13.5 15.7

Chicago-Naperville-Elgin, IL-IN-WI 1,797 2,085 2,266 2,269 2,499 18.8 22.0 23.8 23.8 26.2

Cincinnati, OH-KY-IN 227 483 436 529 437 10.5 22.8 20.5 24.9 20.5

Cleveland-Elyria, OH 170 182 151 140 111 8.1 8.8 7.3 6.8 5.4

Columbus, OH 253 248 237 316 341 13.6 13.0 12.3 16.3 17.5

Dallas-Fort Worth-Arlington, TX 2,152 1,958 1,816 2,141 2,093 33.1 30.5 27.6 32.0 31.2

Denver-Aurora-Lakewood, CO 223 293 319 434 382 8.7 11.5 12.3 16.4 14.4

Detroit-Warren-Dearborn, MI 412 459 522 607 830 9.4 10.7 12.2 14.1 19.3

Hartford-West Hartford-East Hartford, CT 67 85 55 21 43 5.6 7.0 4.5 1.7 3.5

Houston-The Woodlands-Sugar Land, TX 2,037 1,891 1,870 2,246 1,891 34.9 31.9 30.9 36.4 30.6

Indianapolis-Carmel-Anderson, IN 162 236 270 336 340 8.6 12.5 14.1 17.4 17.6

Jacksonville, FL 235 228 188 177 189 17.7 16.9 13.8 12.8 13.7

Kansas City, MO-KS 220 145 141 164 320 10.8 7.2 7.0 8.0 15.7

Las Vegas-Henderson-Paradise, NV 273 389 402 403 438 14.3 19.9 20.4 20.1 21.9

Los Angeles-Long Beach-Anaheim, CA 3,278 3,003 3,247 3,540 4,536 25.5 23.4 25.1 27.1 34.8

Louisville/Jefferson County, KY-IN 123 196 186 201 210 10.1 15.9 14.9 16.1 16.8

Memphis, TN-MS-AR 777 760 587 591 578 59.2 57.4 44.0 44.0 43.1

Miami-Fort Lauderdale-West Palm Beach, FL 1,969 2,259 2,315 2,591 2,740 35.5 40.6 40.8 45.0 47.5

Milwaukee-Waukesha-West Allis, WI 117 121 117 159 153 7.5 7.8 7.5 10.1 9.8

Minneapolis-St. Paul-Bloomington, MN-WI 183 309 326 313 487 5.5 9.2 9.6 9.1 14.2

Nashville-Davidson--Murfreesboro--Franklin, TN 306 267 229 271 239 18.4 16.0 13.5 15.7 13.8

New Orleans-Metairie, LA 464 688 668 547 634 38.3 57.8 55.1 44.6 51.7

New York-Newark-Jersey City, NY-NJ-PA 5,135 5,379 5,303 5,670 6,506 26.0 27.5 26.9 28.6 32.8

Oklahoma City, OK 210 148 114 148 213 17.1 11.8 8.9 11.4 16.4

Orlando-Kissimmee-Sanford, FL 408 391 485 499 632 19.6 18.3 22.3 22.4 28.4

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 959 930 1,029 1,119 1,333 16.1 15.6 17.2 18.6 22.1

Phoenix-Mesa-Scottsdale, AZ 682 645 676 624 713 15.6 15.4 15.9 14.4 16.5

Pittsburgh, PA 70 72 92 128 95 3.0 3.1 3.9 5.4 4.0

Portland-Vancouver-Hillsboro, OR-WA 114 153 220 410 475 5.1 6.9 9.7 17.9 20.7

Providence-Warwick, RI-MA 76 95 111 125 138 4.7 5.9 6.9 7.8 8.6

Raleigh, NC 199 154 151 150 179 17.7 13.6 13.0 12.6 15.1

Richmond, VA 205 210 154 194 204 17.2 17.4 12.6 15.7 16.6

Riverside-San Bernardino-Ontario, CA 416 428 527 775 803 10.0 10.1 12.2 17.8 18.5

Sacramento--Roseville--Arden-Arcade, CA 212 183 258 249 289 10.0 8.5 11.9 11.3 13.2

Salt Lake City, UT 40 94 48 74 136 3.7 8.6 4.3 6.6 12.1

San Antonio-New Braunfels, TX 739 730 736 983 1,167 35.7 34.1 33.5 44.0 52.2

San Diego-Carlsbad, CA 495 607 609 717 791 16.2 19.6 19.4 22.6 24.9

San Francisco-Oakland-Hayward, CA 932 1,150 1,271 1,595 1,892 21.6 26.5 28.9 35.8 42.5

San Jose-Sunnyvale-Santa Clara, CA 141 183 159 233 276 7.7 10.0 8.5 12.3 14.6

Seattle-Tacoma-Bellevue, WA 256 439 589 559 539 7.5 12.8 16.8 15.7 15.2

St. Louis, MO-IL 294 403 271 280 338 10.5 14.5 9.7 10.0 12.1

Tampa-St. Petersburg-Clearwater, FL 631 503 516 582 633 23.0 18.1 18.3 20.5 22.3

Virginia Beach-Norfolk-Newport News, VA-NC 235 237 212 296 301 14.0 14.1 12.6 17.4 17.7

Washington-Arlington-Alexandria, DC-VA-MD-WV 1,004 1,191 1,316 1,374 1,543 18.2 21.1 22.9 23.4 26.3

SELECTED MSAs TOTAL 33,248 34,554 35,182 38,982 43,646 19.8 20.6 20.8 22.8 25.5

* See Syphilis Morbidity Reporting in the Appendix for definition.

† MSAs were selected on the basis of the largest population in the 2010 U.S. Census.
STD Surveillance 2013 Syphilis Tables 105

Table 26. Primary and Secondary Syphilis — Reported Cases and Rates of Reported Cases by 

State, Ranked by Rates, United States, 2013

Rank* State Cases Rate per 100,000 Population

1 Georgia 1,017 10.3

2 California 3,532 9.3

3 Louisiana 423 9.2

4 Florida 1,513 7.8

5 Maryland 456 7.7

6 New York 1,459 7.5

7 Nevada 205 7.4

8 Oregon 267 6.8

9 Illinois 798 6.2

10 Arkansas 177 6.0

11 South Carolina 271 5.7

12 Delaware 52 5.7

13 Texas 1,475 5.7

U.S. TOTAL† 17,375 5.5

14 Massachusetts 360 5.4

15 South Dakota 44 5.3

16 Michigan 487 4.9

17 Arizona 287 4.4

18 Rhode Island 45 4.3

19 Missouri 251 4.2

20 North Carolina 404 4.1

21 Washington 284 4.1

22 Virginia 315 3.8

23 Alabama 183 3.8

24 Ohio 436 3.8

25 New Mexico 78 3.7

26 Pennsylvania 471 3.7

27 Minnesota 193 3.6

28 Iowa 106 3.4

29 Tennessee 214 3.3

30 Hawaii 46 3.3

31 Indiana 215 3.3

32 Alaska 23 3.1

33 Colorado 163 3.1

34 Oklahoma 118 3.1

35 Kentucky 122 2.8

36 New Jersey 233 2.6

37 Mississippi 78 2.6

38 Utah 74 2.6

39 Nebraska 41 2.2

40 New Hampshire 28 2.1

41 Kansas 51 1.8

42 North Dakota 12 1.7

43 Wisconsin 95 1.7

44 Connecticut 56 1.6

45 Idaho 15 0.9

46 West Virginia 15 0.8

47 Maine 10 0.8

48 Montana 5 0.5

49 Vermont 3 0.5

50 Wyoming 1 0.2

* States were ranked by rate, then by case count, then in alphabetical order, with rates shown rounded to the nearest tenth.

† Total includes cases reported by the District of Columbia with 168 cases and a rate of 26.6, but excludes outlying areas (Guam with 6 cases and rate of 3.8, Puerto 

Rico with 385 cases and rate of 10.5, and Virgin Islands with 2 cases and rate of 1.9).
106 Syphilis Tables STD Surveillance 2013

Table 27. Primary and Secondary Syphilis — Reported Cases and Rates of Reported Cases by State/

Area and Region in Alphabetical Order, United States and Outlying Areas, 2009–2013

State/Area

Cases Rates per 100,000 Population

2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Alabama 417 260 228 216 183 8.9 5.4 4.7 4.5 3.8

Alaska 0 3 5 11 23 0.0 0.4 0.7 1.5 3.1

Arizona 231 230 274 202 287 3.5 3.6 4.2 3.1 4.4

Arkansas 275 205 182 173 177 9.5 7.0 6.2 5.9 6.0

California 1,900 2,065 2,443 2,953 3,532 5.1 5.5 6.5 7.8 9.3

Colorado 105 138 133 208 163 2.1 2.7 2.6 4.0 3.1

Connecticut 65 98 65 55 56 1.8 2.7 1.8 1.5 1.6

Delaware 27 9 27 38 52 3.1 1.0 3.0 4.1 5.7

District of Columbia 163 134 165 165 168 27.2 22.3 26.7 26.1 26.6

Florida 1,041 1,184 1,257 1,369 1,513 5.6 6.3 6.6 7.1 7.8

Georgia 953 795 678 937 1,017 9.7 8.2 6.9 9.4 10.3

Hawaii 33 35 14 23 46 2.5 2.6 1.0 1.7 3.3

Idaho 3 6 13 26 15 0.2 0.4 0.8 1.6 0.9

Illinois 750 908 881 804 798 5.8 7.1 6.8 6.2 6.2

Indiana 158 175 173 224 215 2.5 2.7 2.7 3.4 3.3

Iowa 23 19 20 70 106 0.8 0.6 0.7 2.3 3.4

Kansas 32 19 24 24 51 1.1 0.7 0.8 0.8 1.8

Kentucky 92 139 129 150 122 2.1 3.2 3.0 3.4 2.8

Louisiana 741 546 447 339 423 16.5 12.0 9.8 7.4 9.2

Maine 4 32 12 17 10 0.3 2.4 0.9 1.3 0.8

Maryland 314 328 452 431 456 5.5 5.7 7.8 7.3 7.7

Massachusetts 238 285 266 316 360 3.6 4.4 4.0 4.8 5.4

Michigan 230 235 286 295 487 2.3 2.4 2.9 3.0 4.9

Minnesota 71 149 139 118 193 1.3 2.8 2.6 2.2 3.6

Mississippi 237 228 191 150 78 8.0 7.7 6.4 5.0 2.6

Missouri 173 152 136 157 251 2.9 2.5 2.3 2.6 4.2

Montana 4 3 7 2 5 0.4 0.3 0.7 0.2 0.5

Nebraska 5 12 10 8 41 0.3 0.7 0.5 0.4 2.2

Nevada 91 130 136 113 205 3.4 4.8 5.0 4.1 7.4

New Hampshire 14 22 18 36 28 1.1 1.7 1.4 2.7 2.1

New Jersey 212 244 232 229 233 2.4 2.8 2.6 2.6 2.6

New Mexico 61 53 71 101 78 3.0 2.6 3.4 4.8 3.7

New York 1,182 1,098 1,083 1,224 1,459 6.0 5.7 5.6 6.3 7.5

North Carolina 579 396 431 347 404 6.2 4.2 4.5 3.6 4.1

North Dakota 4 3 1 4 12 0.6 0.4 0.1 0.6 1.7

Ohio 360 528 440 425 436 3.1 4.6 3.8 3.7 3.8

Oklahoma 97 92 84 83 118 2.6 2.5 2.2 2.2 3.1

Oregon 57 71 97 212 267 1.5 1.9 2.5 5.4 6.8

Pennsylvania 341 369 373 494 471 2.7 2.9 2.9 3.9 3.7

Rhode Island 20 41 46 44 45 1.9 3.9 4.4 4.2 4.3

South Carolina 123 155 221 225 271 2.7 3.4 4.7 4.8 5.7

South Dakota 0 4 0 18 44 0.0 0.5 0.0 2.2 5.3

Tennessee 403 277 278 266 214 6.4 4.4 4.3 4.1 3.3

Texas 1,644 1,230 1,169 1,627 1,475 6.6 4.9 4.6 6.2 5.7

Utah 31 65 14 42 74 1.1 2.4 0.5 1.5 2.6

Vermont 0 4 9 6 3 0.0 0.6 1.4 1.0 0.5

Virginia 299 279 213 285 315 3.8 3.5 2.6 3.5 3.8

Washington 139 266 328 302 284 2.1 4.0 4.8 4.4 4.1

West Virginia 8 6 4 8 15 0.4 0.3 0.2 0.4 0.8

Wisconsin 44 49 65 91 95 0.8 0.9 1.1 1.6 1.7

Wyoming 3 0 0 4 1 0.6 0.0 0.0 0.7 0.2

U.S. TOTAL 13,997 13,774 13,970 15,667 17,375 4.6 4.5 4.5 5.0 5.5

Northeast 2,076 2,193 2,104 2,421 2,665 3.8 4.0 3.8 4.3 4.8

Midwest 1,850 2,253 2,175 2,238 2,729 2.8 3.4 3.2 3.3 4.1

South 7,413 6,263 6,156 6,809 7,001 6.5 5.5 5.3 5.8 6.0

West 2,658 3,065 3,535 4,199 4,980 3.7 4.3 4.9 5.7 6.8

Guam 2 1 5 6 6 1.1 0.6 3.1 3.8 3.8

Puerto Rico 227 228 254 306 385 5.7 6.1 6.9 8.3 10.5

Virgin Islands 0 0 0 0 2 0.0 0.0 0.0 0.0 1.9

OUTLYING AREAS 229 229 259 312 393 5.4 5.7 6.5 7.9 10.0

TOTAL 14,226 14,003 14,229 15,979 17,768 4.6 4.5 4.5 5.0 5.6
STD Surveillance 2013 Syphilis Tables 107

Table 28. Primary and Secondary Syphilis Among Women — Reported Cases and Rates of 

Reported Cases by State/Area and Region in Alphabetical Order, United States and 

Outlying Areas, 2009–2013

State/Area

Cases Rates per 100,000 Population

2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Alabama 137 75 54 38 22 5.6 3.0 2.2 1.5 0.9

Alaska 0 0 1 1 2 0.0 0.0 0.3 0.3 0.6

Arizona 22 20 15 16 27 0.7 0.6 0.5 0.5 0.8

Arkansas 104 82 76 49 44 7.1 5.5 5.1 3.3 2.9

California 79 74 103 116 210 0.4 0.4 0.5 0.6 1.1

Colorado 6 2 4 3 4 0.2 0.1 0.2 0.1 0.2

Connecticut 1 5 5 9 8 0.1 0.3 0.3 0.5 0.4

Delaware 11 1 1 2 3 2.4 0.2 0.2 0.4 0.6

District of Columbia 10 2 7 6 19 3.2 0.6 2.1 1.8 5.7

Florida 147 147 134 134 137 1.6 1.5 1.4 1.4 1.4

Georgia 101 82 58 66 87 2.0 1.7 1.2 1.3 1.7

Hawaii 6 7 0 2 0 0.9 1.0 0.0 0.3 0.0

Idaho 0 0 1 2 0 0.0 0.0 0.1 0.3 0.0

Illinois 55 108 81 73 66 0.8 1.7 1.2 1.1 1.0

Indiana 13 20 13 22 18 0.4 0.6 0.4 0.7 0.5

Iowa 6 3 5 7 10 0.4 0.2 0.3 0.5 0.6

Kansas 9 1 0 2 4 0.6 0.1 0.0 0.1 0.3

Kentucky 4 8 19 13 17 0.2 0.4 0.9 0.6 0.8

Louisiana 349 251 179 127 115 15.1 10.8 7.7 5.4 4.9

Maine 0 0 0 2 1 0.0 0.0 0.0 0.3 0.1

Maryland 42 26 49 45 61 1.4 0.9 1.6 1.5 2.0

Massachusetts 5 16 23 15 17 0.1 0.5 0.7 0.4 0.5

Michigan 40 23 26 30 29 0.8 0.5 0.5 0.6 0.6

Minnesota 0 9 5 7 12 0.0 0.3 0.2 0.3 0.4

Mississippi 73 69 45 34 19 4.8 4.5 2.9 2.2 1.2

Missouri 15 3 6 12 19 0.5 0.1 0.2 0.4 0.6

Montana 0 0 1 0 1 0.0 0.0 0.2 0.0 0.2

Nebraska 0 3 1 1 4 0.0 0.3 0.1 0.1 0.4

Nevada 7 7 7 4 14 0.5 0.5 0.5 0.3 1.0

New Hampshire 0 1 1 0 1 0.0 0.1 0.1 0.0 0.1

New Jersey 26 16 13 19 13 0.6 0.4 0.3 0.4 0.3

New Mexico 6 3 2 9 20 0.6 0.3 0.2 0.9 1.9

New York 55 47 37 45 44 0.5 0.5 0.4 0.4 0.4

North Carolina 108 55 31 37 36 2.3 1.1 0.6 0.7 0.7

North Dakota 1 1 0 0 1 0.3 0.3 0.0 0.0 0.3

Ohio 63 132 107 85 63 1.1 2.2 1.8 1.4 1.1

Oklahoma 24 16 12 6 13 1.3 0.8 0.6 0.3 0.7

Oregon 1 1 0 6 12 0.1 0.1 0.0 0.3 0.6

Pennsylvania 42 36 34 34 26 0.6 0.6 0.5 0.5 0.4

Rhode Island 1 2 3 1 1 0.2 0.4 0.6 0.2 0.2

South Carolina 10 9 24 34 39 0.4 0.4 1.0 1.4 1.6

South Dakota 0 0 0 1 15 0.0 0.0 0.0 0.2 3.6

Tennessee 122 49 34 31 22 3.8 1.5 1.0 0.9 0.7

Texas 490 333 255 269 179 4.0 2.6 2.0 2.1 1.4

Utah 0 2 0 0 2 0.0 0.1 0.0 0.0 0.1

Vermont 0 2 0 0 0 0.0 0.6 0.0 0.0 0.0

Virginia 22 20 18 21 17 0.5 0.5 0.4 0.5 0.4

Washington 6 5 6 9 13 0.2 0.1 0.2 0.3 0.4

West Virginia 2 0 0 2 4 0.2 0.0 0.0 0.2 0.4

Wisconsin 10 6 5 11 9 0.4 0.2 0.2 0.4 0.3

Wyoming 1 0 0 0 0 0.4 0.0 0.0 0.0 0.0

U.S. TOTAL 2,232 1,780 1,501 1,458 1,500 1.4 1.1 0.9 0.9 0.9

Northeast 130 125 116 125 111 0.5 0.4 0.4 0.4 0.4

Midwest 212 309 249 251 250 0.6 0.9 0.7 0.7 0.7

South 1,756 1,225 996 914 834 3.0 2.1 1.7 1.5 1.4

West 134 121 140 168 305 0.4 0.3 0.4 0.5 0.8

Guam 1 1 2 1 5 1.1 1.3 2.5 1.3 6.3

Puerto Rico 23 18 17 20 35 1.1 0.9 0.9 1.0 1.8

Virgin Islands 0 0 0 0 1 0.0 0.0 0.0 0.0 1.8

OUTLYING AREAS 24 19 19 21 41 1.1 0.9 0.9 1.0 2.0

TOTAL 2,256 1,799 1,520 1,479 1,541 1.4 1.1 0.9 0.9 1.0

Note: Cases reported with unknown sex are not included in this table.
108 Syphilis Tables STD Surveillance 2013

Table 29. Primary and Secondary Syphilis Among Men — Reported Cases and Rates of Reported 

Cases by State/Area and Region in Alphabetical Order, United States and Outlying 

Areas, 2009–2013

State/Area

Cases Rates per 100,000 Population

2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Alabama 280 185 174 178 161 12.3 8.0 7.5 7.6 6.9

Alaska 0 3 4 10 21 0.0 0.8 1.1 2.6 5.5

Arizona 208 210 257 186 260 6.3 6.6 8.0 5.7 8.0

Arkansas 171 123 106 124 133 12.1 8.6 7.3 8.6 9.2

California 1,821 1,990 2,327 2,823 3,319 9.8 10.7 12.4 14.9 17.5

Colorado 99 136 129 205 159 3.9 5.4 5.0 7.9 6.1

Connecticut 64 93 60 46 48 3.7 5.3 3.4 2.6 2.7

Delaware 16 8 26 36 49 3.7 1.8 5.9 8.1 11.0

District of Columbia 153 132 158 159 149 54.1 46.4 54.1 53.2 49.8

Florida 894 1,037 1,123 1,235 1,376 9.8 11.3 12.0 13.1 14.6

Georgia 852 713 620 870 930 17.6 15.1 12.9 17.9 19.2

Hawaii 27 28 14 21 46 4.1 4.1 2.0 3.0 6.6

Idaho 3 6 12 24 15 0.4 0.8 1.5 3.0 1.9

Illinois 695 800 800 731 731 10.9 12.7 12.7 11.6 11.6

Indiana 145 155 160 202 197 4.6 4.9 5.0 6.3 6.1

Iowa 17 16 15 63 96 1.1 1.1 1.0 4.1 6.3

Kansas 23 18 24 22 47 1.6 1.3 1.7 1.5 3.3

Kentucky 88 131 110 137 105 4.2 6.1 5.1 6.3 4.9

Louisiana 392 284 268 212 308 17.9 12.8 12.0 9.4 13.7

Maine 4 32 12 15 9 0.6 4.9 1.8 2.3 1.4

Maryland 272 302 403 386 395 9.8 10.8 14.3 13.5 13.9

Massachusetts 233 269 243 301 343 7.3 8.5 7.6 9.3 10.7

Michigan 190 212 260 265 458 3.9 4.4 5.4 5.5 9.4

Minnesota 71 140 134 111 178 2.7 5.3 5.0 4.2 6.7

Mississippi 164 159 146 116 59 11.5 11.0 10.1 8.0 4.1

Missouri 158 149 130 145 232 5.4 5.1 4.4 4.9 7.9

Montana 4 3 6 2 4 0.8 0.6 1.2 0.4 0.8

Nebraska 5 9 9 7 37 0.6 1.0 1.0 0.8 4.0

Nevada 84 123 129 109 191 6.2 9.0 9.4 7.8 13.7

New Hampshire 14 21 17 36 27 2.1 3.2 2.6 5.5 4.1

New Jersey 186 228 219 210 220 4.4 5.3 5.1 4.9 5.1

New Mexico 55 50 69 92 58 5.5 4.9 6.7 8.9 5.6

New York 1,127 1,051 1,045 1,175 1,408 11.9 11.2 11.1 12.4 14.8

North Carolina 471 341 400 310 368 10.3 7.3 8.5 6.5 7.7

North Dakota 3 2 1 4 11 0.9 0.6 0.3 1.1 3.1

Ohio 297 396 333 340 373 5.3 7.0 5.9 6.0 6.6

Oklahoma 73 76 72 77 105 4.0 4.1 3.8 4.1 5.6

Oregon 56 70 97 206 255 3.0 3.7 5.1 10.7 13.2

Pennsylvania 299 333 339 460 445 4.9 5.4 5.5 7.4 7.1

Rhode Island 19 39 43 43 44 3.7 7.7 8.5 8.5 8.7

South Carolina 113 146 197 191 232 5.1 6.5 8.7 8.3 10.1

South Dakota 0 4 0 17 29 0.0 1.0 0.0 4.1 6.9

Tennessee 281 228 244 235 192 9.2 7.4 7.8 7.5 6.1

Texas 1,154 896 914 1,358 1,296 9.3 7.2 7.2 10.5 10.0

Utah 31 63 14 42 72 2.2 4.5 1.0 2.9 5.0

Vermont 0 2 9 6 3 0.0 0.6 2.9 1.9 1.0

Virginia 277 259 195 264 298 7.1 6.6 4.9 6.6 7.4

Washington 133 261 322 293 271 4.0 7.8 9.4 8.5 7.9

West Virginia 6 6 4 6 11 0.7 0.7 0.4 0.7 1.2

Wisconsin 34 43 60 80 86 1.2 1.5 2.1 2.8 3.0

Wyoming 2 0 0 4 1 0.7 0.0 0.0 1.4 0.3

U.S. TOTAL 11,764 11,981 12,453 14,190 15,861 7.8 7.9 8.1 9.2 10.3

Northeast 1,946 2,068 1,987 2,292 2,547 7.2 7.7 7.4 8.4 9.4

Midwest 1,638 1,944 1,926 1,987 2,475 5.0 5.9 5.8 6.0 7.5

South 5,657 5,026 5,160 5,894 6,167 10.2 9.0 9.1 10.2 10.7

West 2,523 2,943 3,380 4,017 4,672 7.0 8.2 9.3 10.9 12.7

Guam 1 0 3 5 1 1.1 0.0 3.7 6.2 1.2

Puerto Rico 204 210 237 286 350 10.7 11.8 13.4 16.3 19.9

Virgin Islands 0 0 0 0 1 0.0 0.0 0.0 0.0 2.0

OUTLYING AREAS 205 210 240 291 352 10.0 11.0 12.6 15.4 18.6

TOTAL 11,969 12,191 12,693 14,481 16,213 7.8 7.9 8.2 9.3 10.4

Note: Cases reported with unknown sex are not included in this table.
STD Surveillance 2013 Syphilis Tables 109

Table 30. Primary and Secondary Syphilis — Reported Cases and Rates of Reported Cases in 

Selected Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 

2009–2013

Cases Rates per 100,000 Population

MSAs 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Atlanta-Sandy Springs-Roswell, GA 809 651 581 745 789 14.7 12.3 10.8 13.7 14.5

Austin-Round Rock, TX 99 107 114 154 145 5.8 6.2 6.4 8.4 7.9

Baltimore-Columbia-Towson, MD 204 212 308 307 288 7.6 7.8 11.3 11.2 10.5

Birmingham-Hoover, AL 145 82 89 73 69 12.8 7.3 7.9 6.4 6.1

Boston-Cambridge-Newton, MA-NH 203 240 191 204 268 4.4 5.3 4.2 4.4 5.8

Buffalo-Cheektowaga-Niagara Falls, NY 10 11 14 27 38 0.9 1.0 1.2 2.4 3.4

Charlotte-Concord-Gastonia, NC-SC 150 116 152 116 134 6.8 5.2 6.7 5.1 5.8

Chicago-Naperville-Elgin, IL-IN-WI 732 881 853 759 763 7.6 9.3 9.0 8.0 8.0

Cincinnati, OH-KY-IN 124 272 228 166 166 5.8 12.9 10.7 7.8 7.8

Cleveland-Elyria, OH 71 82 55 44 32 3.4 3.9 2.7 2.1 1.6

Columbus, OH 116 123 122 159 167 6.2 6.5 6.3 8.2 8.6

Dallas-Fort Worth-Arlington, TX 502 342 317 391 445 7.7 5.3 4.8 5.8 6.6

Denver-Aurora-Lakewood, CO 92 120 116 183 135 3.6 4.7 4.5 6.9 5.1

Detroit-Warren-Dearborn, MI 151 146 203 235 394 3.4 3.4 4.7 5.5 9.2

Hartford-West Hartford-East Hartford, CT 25 32 15 9 14 2.1 2.6 1.2 0.7 1.2

Houston-The Woodlands-Sugar Land, TX 432 330 322 537 363 7.4 5.6 5.3 8.7 5.9

Indianapolis-Carmel-Anderson, IN 84 109 91 150 146 4.5 5.8 4.8 7.8 7.6

Jacksonville, FL 57 49 47 44 40 4.3 3.6 3.5 3.2 2.9

Kansas City, MO-KS 80 43 57 65 155 3.9 2.1 2.8 3.2 7.6

Las Vegas-Henderson-Paradise, NV 86 125 126 97 164 4.5 6.4 6.4 4.8 8.2

Los Angeles-Long Beach-Anaheim, CA 858 766 876 1,049 1,299 6.7 6.0 6.8 8.0 10.0

Louisville/Jefferson County, KY-IN 58 104 92 81 71 4.8 8.4 7.4 6.5 5.7

Memphis, TN-MS-AR 189 166 120 110 105 14.4 12.5 9.0 8.2 7.8

Miami-Fort Lauderdale-West Palm Beach, FL 518 652 630 705 762 9.3 11.7 11.1 12.2 13.2

Milwaukee-Waukesha-West Allis, WI 28 29 35 43 54 1.8 1.9 2.2 2.7 3.4

Minneapolis-St. Paul-Bloomington, MN-WI 67 140 127 116 181 2.0 4.2 3.7 3.4 5.3

Nashville-Davidson--Murfreesboro--Franklin, TN 93 76 85 88 57 5.6 4.5 5.0 5.1 3.3

New Orleans-Metairie, LA 139 93 101 66 103 11.5 7.8 8.3 5.4 8.4

New York-Newark-Jersey City, NY-NJ-PA 1,308 1,228 1,169 1,315 1,491 6.6 6.3 5.9 6.6 7.5

Oklahoma City, OK 70 55 39 54 78 5.7 4.4 3.1 4.2 6.0

Orlando-Kissimmee-Sanford, FL 109 103 174 168 201 5.2 4.8 8.0 7.6 9.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 289 307 302 369 396 4.8 5.1 5.0 6.1 6.6

Phoenix-Mesa-Scottsdale, AZ 169 161 213 162 219 3.9 3.8 5.0 3.7 5.1

Pittsburgh, PA 29 36 49 61 39 1.2 1.5 2.1 2.6 1.7

Portland-Vancouver-Hillsboro, OR-WA 53 66 90 209 240 2.4 3.0 4.0 9.1 10.5

Providence-Warwick, RI-MA 28 47 55 58 65 1.7 2.9 3.4 3.6 4.1

Raleigh, NC 75 44 47 56 70 6.7 3.9 4.0 4.7 5.9

Richmond, VA 96 88 50 64 70 8.1 7.3 4.1 5.2 5.7

Riverside-San Bernardino-Ontario, CA 115 157 182 166 203 2.8 3.7 4.2 3.8 4.7

Sacramento--Roseville--Arden-Arcade, CA 73 57 131 151 147 3.4 2.7 6.0 6.9 6.7

Salt Lake City, UT 28 54 9 34 65 2.6 5.0 0.8 3.0 5.8

San Antonio-New Braunfels, TX 216 183 188 329 310 10.4 8.5 8.6 14.7 13.9

San Diego-Carlsbad, CA 190 274 293 331 333 6.2 8.9 9.3 10.4 10.5

San Francisco-Oakland-Hayward, CA 438 543 626 744 814 10.1 12.5 14.3 16.7 18.3

San Jose-Sunnyvale-Santa Clara, CA 59 91 68 105 146 3.2 5.0 3.6 5.5 7.7

Seattle-Tacoma-Bellevue, WA 115 236 276 248 211 3.4 6.9 7.9 7.0 5.9

St. Louis, MO-IL 83 118 92 95 108 3.0 4.2 3.3 3.4 3.9

Tampa-St. Petersburg-Clearwater, FL 180 183 199 230 226 6.6 6.6 7.0 8.1 7.9

Virginia Beach-Norfolk-Newport News, VA-NC 102 92 64 106 102 6.1 5.5 3.8 6.2 6.0

Washington-Arlington-Alexandria, DC-VA-MD-WV 324 311 360 358 418 5.9 5.5 6.3 6.1 7.1

SELECTED MSAs TOTAL 10,271 10,533 10,743 12,136 13,299 6.1 6.3 6.3 7.1 7.8

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.
110 Syphilis Tables STD Surveillance 2013

Table 31. Primary and Secondary Syphilis Among Women — Reported Cases and Rates of 

Reported Cases in Selected Metropolitan Statistical Areas (MSAs)* in Alphabetical 

Order, United States, 2009–2013

MSAs

Cases Rates per 100,000 Population

2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Atlanta-Sandy Springs-Roswell, GA 59 44 40 33 52 2.1 1.6 1.5 1.2 1.9

Austin-Round Rock, TX 14 18 12 8 6 1.7 2.1 1.3 0.9 0.7

Baltimore-Columbia-Towson, MD 33 19 39 39 46 2.4 1.4 2.8 2.7 3.2

Birmingham-Hoover, AL 44 21 10 7 5 7.5 3.6 1.7 1.2 0.8

Boston-Cambridge-Newton, MA-NH 3 12 14 5 10 0.1 0.5 0.6 0.2 0.4

Buffalo-Cheektowaga-Niagara Falls, NY 0 0 2 1 2 0.0 0.0 0.3 0.2 0.3

Charlotte-Concord-Gastonia, NC-SC 18 6 14 15 6 1.6 0.5 1.2 1.3 0.5

Chicago-Naperville-Elgin, IL-IN-WI 46 107 77 77 65 0.9 2.2 1.6 1.6 1.3

Cincinnati, OH-KY-IN 26 107 99 63 31 2.4 9.9 9.1 5.8 2.9

Cleveland-Elyria, OH 14 6 3 5 2 1.3 0.6 0.3 0.5 0.2

Columbus, OH 15 13 10 14 18 1.6 1.3 1.0 1.4 1.8

Dallas-Fort Worth-Arlington, TX 153 103 63 56 41 4.7 3.2 1.9 1.6 1.2

Denver-Aurora-Lakewood, CO 3 0 1 3 3 0.2 0.0 0.1 0.2 0.2

Detroit-Warren-Dearborn, MI 26 9 20 27 25 1.2 0.4 0.9 1.2 1.1

Hartford-West Hartford-East Hartford, CT 0 3 2 3 0 0.0 0.5 0.3 0.5 0.0

Houston-The Woodlands-Sugar Land, TX 113 77 69 97 59 3.9 2.6 2.3 3.1 1.9

Indianapolis-Carmel-Anderson, IN 7 12 5 10 9 0.7 1.2 0.5 1.0 0.9

Jacksonville, FL 11 11 11 4 5 1.6 1.6 1.6 0.6 0.7

Kansas City, MO-KS 8 1 4 1 9 0.8 0.1 0.4 0.1 0.9

Las Vegas-Henderson-Paradise, NV 7 6 4 2 6 0.7 0.6 0.4 0.2 0.6

Los Angeles-Long Beach-Anaheim, CA 22 17 16 26 50 0.3 0.3 0.2 0.4 0.8

Louisville/Jefferson County, KY-IN 1 4 7 9 11 0.2 0.6 1.1 1.4 1.7

Memphis, TN-MS-AR 67 33 22 22 17 9.8 4.8 3.2 3.2 2.4

Miami-Fort Lauderdale-West Palm Beach, FL 54 55 47 63 65 1.9 1.9 1.6 2.1 2.2

Milwaukee-Waukesha-West Allis, WI 9 5 5 5 5 1.1 0.6 0.6 0.6 0.6

Minneapolis-St. Paul-Bloomington, MN-WI 0 5 5 7 9 0.0 0.3 0.3 0.4 0.5

Nashville-Davidson--Murfreesboro--Franklin, TN 24 11 3 1 4 2.8 1.3 0.3 0.1 0.5

New Orleans-Metairie, LA 37 31 17 9 10 5.9 5.1 2.7 1.4 1.6

New York-Newark-Jersey City, NY-NJ-PA 70 53 39 57 46 0.7 0.5 0.4 0.6 0.4

Oklahoma City, OK 16 12 6 1 5 2.6 1.9 0.9 0.2 0.8

Orlando-Kissimmee-Sanford, FL 19 7 10 15 9 1.8 0.6 0.9 1.3 0.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 37 33 28 30 24 1.2 1.1 0.9 1.0 0.8

Phoenix-Mesa-Scottsdale, AZ 8 12 9 14 22 0.4 0.6 0.4 0.6 1.0

Pittsburgh, PA 4 2 4 5 2 0.3 0.2 0.3 0.4 0.2

Portland-Vancouver-Hillsboro, OR-WA 0 2 0 9 9 0.0 0.2 0.0 0.8 0.8

Providence-Warwick, RI-MA 1 3 3 1 3 0.1 0.4 0.4 0.1 0.4

Raleigh, NC 6 5 1 5 9 1.1 0.9 0.2 0.8 1.5

Richmond, VA 3 6 10 10 4 0.5 1.0 1.6 1.6 0.6

Riverside-San Bernardino-Ontario, CA 5 1 8 3 7 0.2 0.0 0.4 0.1 0.3

Sacramento--Roseville--Arden-Arcade, CA 16 12 7 5 10 1.5 1.1 0.6 0.4 0.9

Salt Lake City, UT 0 0 0 0 1 0.0 0.0 0.0 0.0 0.2

San Antonio-New Braunfels, TX 42 28 39 59 44 4.0 2.6 3.5 5.2 3.9

San Diego-Carlsbad, CA 6 3 13 12 10 0.4 0.2 0.8 0.8 0.6

San Francisco-Oakland-Hayward, CA 9 20 27 28 40 0.4 0.9 1.2 1.2 1.8

San Jose-Sunnyvale-Santa Clara, CA 5 3 4 3 9 0.6 0.3 0.4 0.3 1.0

Seattle-Tacoma-Bellevue, WA 4 2 3 6 10 0.2 0.1 0.2 0.3 0.6

St. Louis, MO-IL 9 3 3 9 6 0.6 0.2 0.2 0.6 0.4

Tampa-St. Petersburg-Clearwater, FL 29 33 26 29 31 2.1 2.3 1.8 2.0 2.1

Virginia Beach-Norfolk-Newport News, VA-NC 11 3 7 5 5 1.3 0.4 0.8 0.6 0.6

Washington-Arlington-Alexandria, DC-VA-MD-WV 19 13 16 15 35 0.7 0.4 0.5 0.5 1.2

SELECTED MSAs TOTAL 1,133 992 884 933 912 1.3 1.2 1.0 1.1 1.0

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

Note: Cases reported with unknown sex are not included in this table.
STD Surveillance 2013 Syphilis Tables 111

Table 32. Primary and Secondary Syphilis Among Men — Reported Cases and Rates of Reported 

Cases in Selected Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United 

States, 2009–2013

MSAs

Cases Rates per 100,000 Population

2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Atlanta-Sandy Springs-Roswell, GA 750 607 541 712 737 27.6 23.6 20.6 26.8 27.8

Austin-Round Rock, TX 85 89 102 146 139 9.8 10.3 11.4 15.9 15.1

Baltimore-Columbia-Towson, MD 171 193 269 268 242 13.2 14.8 20.5 20.2 18.2

Birmingham-Hoover, AL 101 61 79 66 64 18.5 11.2 14.5 12.1 11.7

Boston-Cambridge-Newton, MA-NH 200 228 177 199 258 8.9 10.4 8.0 8.8 11.5

Buffalo-Cheektowaga-Niagara Falls, NY 10 11 12 26 36 1.8 2.0 2.2 4.7 6.6

Charlotte-Concord-Gastonia, NC-SC 132 110 138 101 128 12.2 10.2 12.6 9.0 11.5

Chicago-Naperville-Elgin, IL-IN-WI 686 774 776 682 697 14.6 16.7 16.7 14.6 15.0

Cincinnati, OH-KY-IN 98 165 129 103 135 9.3 16.0 12.4 9.9 13.0

Cleveland-Elyria, OH 57 76 52 39 30 5.7 7.6 5.2 3.9 3.0

Columbus, OH 101 110 112 145 149 11.0 11.8 11.8 15.2 15.6

Dallas-Fort Worth-Arlington, TX 349 239 254 335 404 10.7 7.5 7.8 10.1 12.2

Denver-Aurora-Lakewood, CO 89 120 115 180 132 7.0 9.5 8.9 13.7 10.0

Detroit-Warren-Dearborn, MI 125 137 183 208 369 5.8 6.6 8.8 10.0 17.7

Hartford-West Hartford-East Hartford, CT 25 29 13 6 14 4.3 4.9 2.2 1.0 2.4

Houston-The Woodlands-Sugar Land, TX 319 253 253 440 304 10.9 8.6 8.4 14.3 9.9

Indianapolis-Carmel-Anderson, IN 77 97 86 140 137 8.4 10.5 9.2 14.8 14.5

Jacksonville, FL 46 38 36 40 35 7.1 5.8 5.4 6.0 5.2

Kansas City, MO-KS 72 42 53 64 146 7.2 4.3 5.3 6.4 14.6

Las Vegas-Henderson-Paradise, NV 79 119 122 95 158 8.2 12.1 12.3 9.4 15.7

Los Angeles-Long Beach-Anaheim, CA 836 749 858 1,019 1,248 13.1 11.8 13.4 15.8 19.4

Louisville/Jefferson County, KY-IN 57 100 85 72 60 9.6 16.6 14.0 11.8 9.8

Memphis, TN-MS-AR 122 133 98 88 88 19.3 20.9 15.3 13.7 13.7

Miami-Fort Lauderdale-West Palm Beach, FL 464 597 583 642 697 17.1 22.2 21.2 23.0 24.9

Milwaukee-Waukesha-West Allis, WI 19 24 30 38 49 2.5 3.2 3.9 5.0 6.4

Minneapolis-St. Paul-Bloomington, MN-WI 67 135 122 109 169 4.0 8.2 7.3 6.4 10.0

Nashville-Davidson--Murfreesboro--Franklin, TN 69 65 82 87 53 8.4 8.0 9.9 10.3 6.3

New Orleans-Metairie, LA 102 55 84 57 93 17.5 9.5 14.2 9.6 15.6

New York-Newark-Jersey City, NY-NJ-PA 1,238 1,175 1,129 1,254 1,438 12.9 12.5 11.9 13.1 15.0

Oklahoma City, OK 54 43 33 53 73 8.9 7.0 5.2 8.3 11.4

Orlando-Kissimmee-Sanford, FL 90 96 164 153 192 8.7 9.2 15.4 14.1 17.6

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 252 274 274 339 372 8.7 9.5 9.5 11.7 12.8

Phoenix-Mesa-Scottsdale, AZ 161 149 202 148 197 7.3 7.1 9.5 6.9 9.1

Pittsburgh, PA 25 34 45 56 37 2.2 3.0 3.9 4.9 3.2

Portland-Vancouver-Hillsboro, OR-WA 53 64 90 200 231 4.8 5.8 8.0 17.7 20.4

Providence-Warwick, RI-MA 27 44 52 57 62 3.5 5.7 6.7 7.4 8.0

Raleigh, NC 69 39 46 51 61 12.4 7.1 8.1 8.8 10.5

Richmond, VA 93 82 40 54 66 16.1 14.0 6.8 9.1 11.1

Riverside-San Bernardino-Ontario, CA 110 156 171 163 196 5.3 7.4 8.0 7.5 9.0

Sacramento--Roseville--Arden-Arcade, CA 57 45 122 144 137 5.4 4.3 11.4 13.4 12.7

Salt Lake City, UT 28 54 9 34 64 5.1 9.9 1.6 6.0 11.3

San Antonio-New Braunfels, TX 174 155 149 270 266 17.1 14.7 13.8 24.5 24.2

San Diego-Carlsbad, CA 184 271 279 318 323 12.0 17.4 17.7 19.9 20.2

San Francisco-Oakland-Hayward, CA 429 523 596 713 773 20.0 24.5 27.5 32.4 35.2

San Jose-Sunnyvale-Santa Clara, CA 54 88 64 102 137 5.7 9.5 6.8 10.7 14.4

Seattle-Tacoma-Bellevue, WA 111 234 273 242 201 6.5 13.7 15.6 13.7 11.4

St. Louis, MO-IL 74 115 89 86 102 5.5 8.5 6.6 6.4 7.5

Tampa-St. Petersburg-Clearwater, FL 151 150 173 201 195 11.3 11.1 12.6 14.6 14.2

Virginia Beach-Norfolk-Newport News, VA-NC 91 89 57 101 97 11.1 10.8 6.9 12.1 11.6

Washington-Arlington-Alexandria, DC-VA-MD-WV 305 298 344 343 383 11.3 10.9 12.3 12.0 13.4

SELECTED MSAs TOTAL 9,138 9,534 9,845 11,189 12,374 11.1 11.6 11.9 13.3 14.8

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census. 

Note: Cases reported with unknown sex are not included in this table.
112 Syphilis Tables STD Surveillance 2013

Table 33. Primary and Secondary Syphilis — Reported Cases and Rates of Reported Cases in 

Counties and Independent Cities* Ranked by Number of Reported Cases, United 

States, 2013

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percentage

1 Los Angeles County, CA 1,095 11.0 6

2 Cook County, IL 694 13.3 10

3 San Francisco County, CA 503 60.9 13

4 New York County, NY 484 29.9 15

5 Miami-Dade County, FL 413 15.9 18

6 Fulton County, GA 379 38.8 20

7 San Diego County, CA 333 10.5 22

8 Harris County, TX 319 7.5 24

9 Bexar County, TX 293 16.4 25

10 Kings County, NY 287 11.2 27

11 Wayne County, MI 286 16.0 29

12 Philadelphia County, PA 278 18.0 30

13 Broward County, FL 265 14.6 32

14 Dallas County, TX 244 9.9 33

15 Bronx County, NY 235 16.7 35

16 Maricopa County, AZ 212 5.4 36

17 Baltimore (City), MD 211 34.0 37

18 Orange County, CA 204 6.6 38

19 DeKalb County, GA 198 28.0 39

20 King County, WA 171 8.5 40

21 Washington, D.C. 168 26.6 41

22 Clark County, NV 164 8.2 42

23 Hillsborough County, FL 163 12.8 43

24 Multnomah County, OR 160 21.1 44

25 Franklin County, OH 156 13.0 45

26 Alameda County, CA 156 10.0 46

27 Tarrant County, TX 153 8.1 47

28 Orange County, FL 147 12.2 48

29 Queens County, NY 147 6.5 49

30 Santa Clara County, CA 145 7.9 49

31 Suffolk County, MA 136 18.3 50

32 Marion County, IN 135 14.7 51

33 Hennepin County, MN 134 11.3 52

34 Hamilton County, OH 131 16.3 52

35 Travis County, TX 128 11.7 53

36 Riverside County, CA 128 5.6 54

37 Kern County, CA 122 14.2 55

38 Prince George's County, MD 122 13.8 55

39 Sacramento County, CA 117 8.1 56

40 Jackson County, MO 112 16.5 57

41 Mecklenburg County, NC 108 11.1 57

42 Caddo Parish, LA 99 38.5 58

43 Denver County, CO 89 14.0 58

44 Shelby County, TN 89 9.5 59

45 Fresno County, CA 87 9.2 59

46 Palm Beach County, FL 84 6.2 60

47 Contra Costa County, CA 79 7.3 60

48 San Joaquin County, CA 75 10.7 61

49 San Bernardino County, CA 75 3.6 61

50 Oklahoma County, OK 69 9.3 62

51 Oakland County, MI 69 5.7 62

52 Wake County, NC 66 6.9 62

53 Orleans Parish, LA 65 17.6 63

54 Middlesex County, MA 65 4.2 63

55 Richland County, SC 64 16.3 63

56 Salt Lake County, UT 64 6.0 64

57 Jefferson County, KY 63 8.4 64

58 St. Louis (City), MO 60 18.9 65

59 Cobb County, GA 59 8.3 65

60 San Mateo County, CA 58 7.8 65

61 Stanislaus County, CA 57 10.9 66

62 Pulaski County, AR 55 14.1 66

63 Pima County, AZ 53 5.3 66

64 Hudson County, NJ 52 8.0 66

65 Jefferson County, AL 52 7.9 67

66 Pinellas County, FL 52 5.6 67

67 Clayton County, GA 50 18.8 67

68 Gwinnett County, GA 50 5.9 68

69 Milwaukee County, WI 50 5.2 68

70 East Baton Rouge Parish, LA 48 10.8 68

* Accounting for 68% of reported primary and secondary syphilis cases.

† Counties and independent cities were ranked in descending order by number of cases reported then by rate in 2013.
STD Surveillance 2013 Syphilis Tables 113

Table 34. Primary and Secondary Syphilis Among Men and Women — Reported Cases and Rates 

of Reported Cases per 100,000 population, and Male–To–Female Rate Ratios in the 

Counties and Independent Cities Ranked in the Top 30 for Cases in 2013, United States, 

2012–2013

Male Female Male-to-Female

2012 2013 2012 2013 Rate Ratio

County/Independent City* Cases Rates Cases Rates Cases Rates Cases Rates 2012 2013

Maricopa County, AZ 147 7.5 191 9.8 12 0.6 21 1.1 12.5 8.9

Alameda County, CA 126 16.5 138 18.1 9 1.1 18 2.3 15.0 7.9

Los Angeles County, CA 918 18.7 1,055 21.5 23 0.5 40 0.8 37.4 26.9

Orange County, CA 101 6.6 193 12.6 3 0.2 10 0.6 33.0 21.0

San Diego County, CA 318 19.9 323 20.2 12 0.8 10 0.6 24.9 33.7

San Francisco County, CA 483 115 489 116 11 2.7 13 3.2 42.6 36.4

Santa Clara County, CA 101 10.9 136 14.7 3 0.3 9 1.0 36.3 14.7

Washington, D.C. 159 53.2 149 49.8 6 1.8 19 5.7 29.6 8.7

Broward County, FL 255 28.9 242 27.4 26 2.8 23 2.5 10.3 11.0

Hillsborough County, FL 136 21.8 137 22.0 19 2.9 26 4.0 7.5 5.5

Miami-Dade County, FL 325 25.8 382 30.4 21 1.6 31 2.3 16.1 13.2

Orange County, FL 126 21.3 141 23.8 11 1.8 6 1.0 11.8 23.8

DeKalb County, GA 163 48.2 186 54.9 4 1.1 12 3.3 43.8 16.6

Fulton County, GA 376 78.8 358 75.0 18 3.6 21 4.2 21.9 17.9

Cook County, IL 615 24.3 635 25.0 64 2.4 58 2.2 10.1 11.4

Baltimore (City), MD 221 75.5 177 60.5 30 9.1 34 10.3 8.3 5.9

Wayne County, MI 148 17.2 267 31.0 23 2.5 19 2.0 6.9 15.5

Clark County, NV 95 9.4 158 15.7 2 0.2 6 0.6 47.0 26.2

Bronx County, NY 170 25.6 226 34.1 7 0.9 8 1.1 28.4 31.0

Kings County, NY 257 21.2 278 22.9 10 0.7 5 0.4 30.3 57.3

New York County, NY 373 48.8 477 62.4 4 0.5 7 0.8 97.6 78.0

Queens County, NY 152 13.8 139 12.6 7 0.6 6 0.5 23.0 25.2

Franklin County, OH 139 23.9 141 24.2 12 2.0 15 2.4 12.0 10.1

Multnomah County, OR 131 34.9 158 42.1 3 0.8 2 0.5 43.6 84.2

Philadelphia County, PA 247 33.8 262 35.9 22 2.7 16 2.0 12.5 18.0

Bexar County, TX 265 30.2 251 28.6 56 6.2 42 4.6 4.9 6.2

Dallas County, TX 168 13.8 222 18.3 21 1.7 22 1.8 8.1 10.2

Harris County, TX 405 19.1 269 12.7 84 3.9 50 2.3 4.9 5.5

Tarrant County, TX 135 14.6 137 14.9 28 2.9 16 1.7 5.0 8.8

King County, WA 208 20.8 165 16.5 5 0.5 6 0.6 41.6 27.5

* Counties and independent cities are in alphabetical order by state.
114 Syphilis Tables STD Surveillance 2013

Table 35. Primary and Secondary Syphilis — Reported Cases and Rates of Reported 

Cases by Age Group and Sex, United States, 2009–2013

Age

Group

Cases Rates*

Total Male Female Unknown Sex Total Male Female

2009

0–4 1 0 1 0 0.0 0.0 0.0

5–9 1 0 1 0 0.0 0.0 0.0

10–14 19 4 15 0 0.1 0.0 0.2

15–19 1,005 661 344 0 4.7 6.0 3.3

20–24 2,812 2,242 570 0 13.1 20.2 5.5

25–29 2,405 2,027 377 1 11.1 18.2 3.6

30–34 1,857 1,571 286 0 9.3 15.5 2.9

35–39 1,612 1,409 203 0 7.8 13.6 2.0

40–44 1,643 1,476 167 0 7.8 14.1 1.6

45–54 2,033 1,815 218 0 4.6 8.3 1.0

55–64 517 475 42 0 1.5 2.8 0.2

65+ 90 83 7 0 0.2 0.5 0.0

Unknown Age 2 1 1 0

TOTAL 13,997 11,764 2,232 1 4.6 7.8 1.4

2010

0–4 1 0 1 0 0.0 0.0 0.0

5–9 0 0 0 0 0.0 0.0 0.0

10–14 18 7 11 0 0.1 0.1 0.1

15–19 932 617 313 2 4.2 5.5 2.9

20–24 2,907 2,429 474 4 13.5 22.1 4.5

25–29 2,455 2,131 322 2 11.6 20.0 3.1

30–34 1,794 1,597 197 0 9.0 16.0 2.0

35–39 1,454 1,313 140 1 7.2 13.1 1.4

40–44 1,553 1,448 104 1 7.4 13.9 1.0

45–54 2,056 1,877 176 3 4.6 8.5 0.8

55–64 493 457 36 0 1.4 2.6 0.2

65+ 107 102 5 0 0.3 0.6 0.0

Unknown Age 4 3 1 0

TOTAL 13,774 11,981 1,780 13 4.5 7.9 1.1

2011

0–4 9 5 4 0 0.0 0.0 0.0

5–9 1 1 0 0 0.0 0.0 0.0

10–14 15 6 9 0 0.1 0.1 0.1

15–19 864 606 258 0 4.0 5.5 2.5

20–24 2,987 2,582 403 2 13.5 22.8 3.7

25–29 2,546 2,277 268 1 12.0 21.2 2.5

30–34 1,846 1,657 187 2 9.0 16.1 1.8

35–39 1,382 1,265 115 2 7.1 13.0 1.2

40–44 1,503 1,408 91 4 7.1 13.5 0.9

45–54 2,123 1,999 120 4 4.7 9.1 0.5

55–64 554 510 43 1 1.5 2.8 0.2

65+ 138 135 3 0 0.3 0.8 0.0

Unknown Age 2 2 0 0

TOTAL 13,970 12,453 1,501 16 4.5 8.1 0.9

2012

0–4 1 1 0 0 0.0 0.0 0.0

5–9 0 0 0 0 0.0 0.0 0.0

10–14 9 5 4 0 0.0 0.0 0.0

15–19 880 640 238 2 4.1 5.8 2.3

20–24 3,280 2,859 418 3 14.5 24.8 3.8

25–29 2,911 2,641 266 4 13.6 24.4 2.5

30–34 2,209 2,023 182 4 10.6 19.3 1.7

35–39 1,563 1,443 120 0 8.0 14.9 1.2

40–44 1,618 1,544 70 4 7.7 14.8 0.7

45–54 2,439 2,310 128 1 5.5 10.6 0.6

55–64 614 586 27 1 1.6 3.2 0.1

65+ 123 121 2 0 0.3 0.6 0.0

Unknown Age 20 17 3 0

TOTAL 15,667 14,190 1,458 19 5.0 9.2 0.9

2013

0–4 5 2 3 0 0.0 0.0 0.0

5–9 0 0 0 0 0.0 0.0 0.0

10–14 23 14 9 0 0.1 0.1 0.1

15–19 900 700 200 0 4.2 6.4 1.9

20–24 3,642 3,204 435 3 16.1 27.7 3.9

25–29 3,329 3,037 286 6 15.6 28.0 2.7

30–34 2,447 2,272 172 3 11.7 21.7 1.7

35–39 1,800 1,674 125 1 9.2 17.2 1.3

40–44 1,693 1,587 105 1 8.1 15.2 1.0

45–54 2,614 2,495 119 0 5.9 11.4 0.5

55–64 750 716 34 0 1.9 3.8 0.2

65+ 162 152 10 0 0.4 0.8 0.0

Unknown Age 10 8 2 0

TOTAL 17,375 15,861 1,500 14 5.5 10.3 0.9

* No population data are available for unknown sex and age; therefore, rates are not calculated.

Cases in the 0–4 and 5–9 age groups may include cases due to congenital transmission.

Note: This table should be used only for age comparisons.
STD Surveillance 2013 Syphilis Tables 115

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116 Syphilis Tables STD Surveillance 2013

Table 36A. Primary and Secondary Syphilis — Reported Cases by Race/Ethnicity, Age Group, and 

Sex, United States*, 2013

Age

Group

American Indians/ 

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 0 0 0 0 0 0 2 0 2

5–9 0 0 0 0 0 0 0 0 0

10–14 1 0 1 0 0 0 11 6 5

15–19 6 3 3 13 11 2 441 316 125

20–24 25 17 8 73 68 5 1,674 1,425 249

25–29 16 13 3 57 54 3 1,328 1,162 162

30–34 11 11 0 50 49 1 784 697 87

35–39 9 6 3 53 51 2 485 424 61

40–44 13 10 3 32 32 0 369 323 46

45–54 12 10 2 46 44 2 503 454 49

55–64 5 5 0 12 11 1 128 111 17

65+ 0 0 0 0 0 0 24 22 2

Unknown Age 0 0 0 0 0 0 1 0 1

TOTAL 98 75 23 336 320 16 5,750 4,940 806

Age

Group

Native Hawaiians/ 

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 0 0 0 1 1 0 0 0 0

5–9 0 0 0 0 0 0 0 0 0

10–14 1 1 0 1 0 1 0 0 0

15–19 5 4 1 133 108 25 7 5 2

20–24 8 8 0 718 650 68 23 21 2

25–29 15 14 1 778 724 53 19 18 1

30–34 3 3 0 699 661 38 17 15 2

35–39 5 4 1 589 557 31 10 9 1

40–44 0 0 0 695 659 36 8 8 0

45–54 5 5 0 1,272 1,245 27 10 10 0

55–64 1 1 0 424 415 9 5 5 0

65+ 0 0 0 98 93 5 0 0 0

Unknown Age 0 0 0 4 3 1 0 0 0

TOTAL 43 40 3 5,412 5,116 294 99 91 8

Age

Group

Hispanics Other/Unknown

Total† Male Female Total† Male Female

0–4 0 0 0 2 1 1

5–9 0 0 0 0 0 0

10–14 6 5 1 1 1 0

15–19 177 154 23 33 27 6

20–24 656 607 49 107 85 22

25–29 646 606 40 83 78 5

30–34 469 447 22 91 82 9

35–39 354 337 17 68 65 3

40–44 311 298 13 70 68 1

45–54 356 337 19 125 119 6

55–64 79 77 2 31 29 2

65+ 20 18 2 8 8 0

Unknown Age 3 3 0 1 1 0

TOTAL 3,077 2,889 188 620 564 55

* Includes 47 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2013. † Total includes cases reported with unknown sex.

Note: These tables should be used only for race/ethnicity comparisons. See Table 35 for age–specific cases and rates and Tables 27–29 for total and sex–specific 

cases and rates.

Cases in the 0–4 and 5–9 age groups may include cases due to congenital transmission.

No population data exist for unknown sex, unknown age, or unknown race; therefore rates are not calculated.
STD Surveillance 2013 Syphilis Tables 117

Table 36B. Primary and Secondary Syphilis — Rates of Reported Cases per 100,000 Population by 

Race/Ethnicity, Age Group, and Sex, United States*, 2013

Age

Group

American Indians/ 

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.2

5–9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

10–14 0.6 0.0 1.2 0.0 0.0 0.0 0.4 0.5 0.4

15–19 3.5 3.4 3.5 1.6 2.6 0.5 15.8 22.2 9.1

20–24 13.8 18.3 9.0 7.1 13.1 1.0 56.8 96.4 17.0

25–29 10.3 16.7 3.9 5.0 9.9 0.5 54.2 97.2 12.9

30–34 7.6 15.3 0.0 4.3 9.0 0.2 33.1 61.6 7.0

35–39 6.8 9.2 4.5 4.6 9.3 0.3 22.3 41.2 5.3

40–44 9.4 14.7 4.3 2.8 6.0 0.0 16.1 29.7 3.8

45–54 4.0 7.0 1.3 2.4 5.0 0.2 10.7 20.4 2.0

55–64 2.1 4.5 0.0 0.8 1.7 0.1 3.5 6.6 0.8

65+ 0.0 0.0 0.0 0.0 0.0 0.0 0.8 1.7 0.1

Unknown Age

TOTAL 4.6 7.1 2.1 2.5 4.9 0.2 16.8 30.2 4.5

Age

Group

Native Hawaiians/ 

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

5–9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

10–14 2.7 5.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0

15–19 12.9 20.1 5.3 1.2 1.9 0.5 1.2 1.7 0.7

20–24 17.1 32.9 0.0 6.1 10.8 1.2 4.9 9.1 0.8

25–29 32.9 59.7 4.5 6.9 12.6 0.9 5.2 10.4 0.5

30–34 7.1 13.9 0.0 6.3 11.8 0.7 5.3 9.9 1.2

35–39 13.8 21.6 5.6 5.6 10.6 0.6 3.8 7.3 0.7

40–44 0.0 0.0 0.0 5.8 10.9 0.6 3.3 6.9 0.0

45–54 7.8 15.7 0.0 4.6 9.1 0.2 2.3 4.8 0.0

55–64 2.2 4.5 0.0 1.6 3.2 0.1 1.6 3.3 0.0

65+ 0.0 0.0 0.0 0.3 0.7 0.0 0.0 0.0 0.0

Unknown Age

TOTAL 8.6 15.8 1.2 3.0 5.7 0.3 1.8 3.4 0.3

Age

Group

Hispanics

Total† Male Female

0–4 0.0 0.0 0.0

5–9 0.0 0.0 0.0

10–14 0.1 0.2 0.0

15–19 4.2 7.0 1.1

20–24 15.5 27.2 2.5

25–29 16.1 28.4 2.1

30–34 11.9 21.6 1.2

35–39 9.6 17.9 1.0

40–44 9.2 17.3 0.8

45–54 6.6 12.4 0.7

55–64 2.4 4.8 0.1

65+ 0.7 1.5 0.1

Unknown Age

TOTAL 6.3 11.6 0.8

* Includes 47 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2013. † Total includes cases reported with unknown sex.

Note: These tables should be used only for race/ethnicity comparisons. See Table 35 for age–specific cases and rates and Tables 27–29 for total and sex–specific 

cases and rates.

Cases in the 0–4 and 5–9 age groups may include cases due to congenital transmission.

No population data exist for unknown sex, unknown age, or unknown race; therefore rates are not calculated.
118 Syphilis Tables STD Surveillance 2013

Table 37. Early Latent Syphilis — Reported Cases and Rates of Reported Cases by State/Area and 

Region in Alphabetical Order, United States and Outlying Areas, 2009–2013

Cases Rates per 100,000 Population

State/Area 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Alabama 419 277 268 237 202 8.9 5.8 5.6 4.9 4.2

Alaska 0 5 3 8 8 0.0 0.7 0.4 1.1 1.1

Arizona 196 166 187 147 207 3.0 2.6 2.9 2.2 3.2

Arkansas 172 202 167 152 163 6.0 6.9 5.7 5.2 5.5

California 1,621 1,788 2,030 2,519 2,844 4.4 4.8 5.4 6.6 7.5

Colorado 63 129 154 194 195 1.3 2.6 3.0 3.7 3.8

Connecticut 40 51 57 52 55 1.1 1.4 1.6 1.4 1.5

Delaware 23 14 49 38 30 2.6 1.6 5.4 4.1 3.3

District of Columbia 158 239 222 244 243 26.3 39.7 35.9 38.6 38.4

Florida 1,254 1,294 1,212 1,384 1,540 6.8 6.9 6.4 7.2 8.0

Georgia 768 636 436 639 863 7.8 6.6 4.4 6.4 8.7

Hawaii 15 15 5 9 22 1.2 1.1 0.4 0.6 1.6

Idaho 3 4 11 21 6 0.2 0.3 0.7 1.3 0.4

Illinois 344 502 581 690 809 2.7 3.9 4.5 5.4 6.3

Indiana 55 103 95 148 157 0.9 1.6 1.5 2.3 2.4

Iowa 9 4 11 15 63 0.3 0.1 0.4 0.5 2.0

Kansas 58 63 34 54 84 2.1 2.2 1.2 1.9 2.9

Kentucky 64 88 109 139 167 1.5 2.0 2.5 3.2 3.8

Louisiana 799 742 488 343 276 17.8 16.4 10.7 7.5 6.0

Maine 10 6 8 2 6 0.8 0.5 0.6 0.2 0.5

Maryland 261 279 332 361 387 4.6 4.8 5.7 6.1 6.6

Massachusetts 135 195 233 231 350 2.0 3.0 3.5 3.5 5.3

Michigan 155 121 132 150 204 1.6 1.2 1.3 1.5 2.1

Minnesota 46 73 121 96 139 0.9 1.4 2.3 1.8 2.6

Mississippi 312 386 313 253 184 10.6 13.0 10.5 8.5 6.2

Missouri 146 133 124 135 220 2.4 2.2 2.1 2.2 3.7

Montana 0 2 1 0 2 0.0 0.2 0.1 0.0 0.2

Nebraska 6 1 3 8 14 0.3 0.1 0.2 0.4 0.8

Nevada 137 178 166 214 232 5.2 6.6 6.1 7.8 8.4

New Hampshire 6 5 5 9 21 0.5 0.4 0.4 0.7 1.6

New Jersey 401 386 452 410 539 4.6 4.4 5.1 4.6 6.1

New Mexico 40 41 56 68 67 2.0 2.0 2.7 3.3 3.2

New York 1,266 1,358 1,254 1,413 1,945 6.5 7.0 6.4 7.2 9.9

North Carolina 357 328 333 244 236 3.8 3.4 3.4 2.5 2.4

North Dakota 0 0 1 0 2 0.0 0.0 0.1 0.0 0.3

Ohio 221 189 160 171 211 1.9 1.6 1.4 1.5 1.8

Oklahoma 172 149 145 146 237 4.7 4.0 3.8 3.8 6.2

Oregon 29 33 63 94 127 0.8 0.9 1.6 2.4 3.3

Pennsylvania 361 355 412 484 581 2.9 2.8 3.2 3.8 4.6

Rhode Island 14 20 20 24 22 1.3 1.9 1.9 2.3 2.1

South Carolina 284 344 345 336 415 6.2 7.4 7.4 7.1 8.8

South Dakota 2 0 0 3 5 0.2 0.0 0.0 0.4 0.6

Tennessee 333 363 256 255 267 5.3 5.7 4.0 3.9 4.1

Texas 1,932 1,874 1,581 1,767 1,902 7.8 7.5 6.2 6.8 7.3

Utah 7 20 8 8 47 0.3 0.7 0.3 0.3 1.6

Vermont 1 0 1 6 2 0.2 0.0 0.2 1.0 0.3

Virginia 233 275 289 303 354 3.0 3.4 3.6 3.7 4.3

Washington 64 109 146 181 204 1.0 1.6 2.1 2.6 3.0

West Virginia 8 4 0 10 10 0.4 0.2 0.0 0.5 0.5

Wisconsin 66 52 57 86 62 1.2 0.9 1.0 1.5 1.1

Wyoming 0 3 0 2 1 0.0 0.5 0.0 0.3 0.2

U.S. TOTAL 13,066 13,604 13,136 14,503 16,929 4.3 4.4 4.2 4.6 5.4

Northeast 2,234 2,376 2,442 2,631 3,521 4.0 4.3 4.4 4.7 6.3

Midwest 1,108 1,241 1,319 1,556 1,970 1.7 1.9 2.0 2.3 2.9

South 7,549 7,494 6,545 6,851 7,476 6.7 6.5 5.6 5.8 6.4

West 2,175 2,493 2,830 3,465 3,962 3.0 3.5 3.9 4.7 5.4

Guam 1 0 4 1 3 0.6 0.0 2.5 0.6 1.9

Puerto Rico 164 191 211 222 270 4.1 5.1 5.7 6.1 7.4

Virgin Islands 0 3 0 0 2 0.0 2.8 0.0 0.0 1.9

OUTLYING AREAS 165 194 215 223 275 3.9 4.9 5.4 5.7 7.0

TOTAL 13,231 13,798 13,351 14,726 17,204 4.3 4.4 4.2 4.6 5.4
STD Surveillance 2013 Syphilis Tables 119

Table 38. Early Latent Syphilis — Reported Cases and Rates of Reported Cases in Selected 

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2009–2013

Cases Rates per 100,000 Population

MSAs 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Atlanta-Sandy Springs-Roswell, GA 613 529 352 491 672 11.2 10.0 6.5 9.0 12.3

Austin-Round Rock, TX 135 137 137 170 220 7.9 8.0 7.7 9.3 12.0

Baltimore-Columbia-Towson, MD 153 148 198 206 216 5.7 5.5 7.3 7.5 7.8

Birmingham-Hoover, AL 150 67 90 74 71 13.3 5.9 7.9 6.5 6.2

Boston-Cambridge-Newton, MA-NH 116 161 176 158 278 2.5 3.5 3.8 3.4 6.0

Buffalo-Cheektowaga-Niagara Falls, NY 3 0 7 11 15 0.3 0.0 0.6 1.0 1.3

Charlotte-Concord-Gastonia, NC-SC 86 101 103 70 74 3.9 4.6 4.6 3.0 3.2

Chicago-Naperville-Elgin, IL-IN-WI 324 476 531 630 751 3.4 5.0 5.6 6.6 7.9

Cincinnati, OH-KY-IN 42 87 67 78 70 1.9 4.1 3.2 3.7 3.3

Cleveland-Elyria, OH 70 20 25 13 14 3.3 1.0 1.2 0.6 0.7

Columbus, OH 64 42 37 49 71 3.4 2.2 1.9 2.5 3.7

Dallas-Fort Worth-Arlington, TX 592 647 500 604 550 9.1 10.1 7.6 9.0 8.2

Denver-Aurora-Lakewood, CO 57 109 139 177 166 2.2 4.3 5.3 6.7 6.3

Detroit-Warren-Dearborn, MI 88 76 82 113 152 2.0 1.8 1.9 2.6 3.5

Hartford-West Hartford-East Hartford, CT 13 18 18 9 19 1.1 1.5 1.5 0.7 1.6

Houston-The Woodlands-Sugar Land, TX 420 370 351 419 348 7.2 6.2 5.8 6.8 5.6

Indianapolis-Carmel-Anderson, IN 27 70 66 102 104 1.4 3.7 3.5 5.3 5.4

Jacksonville, FL 82 91 50 57 73 6.2 6.8 3.7 4.1 5.3

Kansas City, MO-KS 64 59 40 61 111 3.1 2.9 2.0 3.0 5.4

Las Vegas-Henderson-Paradise, NV 135 174 162 207 218 7.1 8.9 8.2 10.3 10.9

Los Angeles-Long Beach-Anaheim, CA 1,070 991 1,132 1,393 1,520 8.3 7.7 8.7 10.7 11.6

Louisville/Jefferson County, KY-IN 17 46 41 72 85 1.4 3.7 3.3 5.8 6.8

Memphis, TN-MS-AR 259 257 180 188 188 19.7 19.4 13.5 14.0 14.0

Miami-Fort Lauderdale-West Palm Beach, FL 644 749 682 831 885 11.6 13.5 12.0 14.4 15.4

Milwaukee-Waukesha-West Allis, WI 46 35 33 57 43 2.9 2.2 2.1 3.6 2.7

Minneapolis-St. Paul-Bloomington, MN-WI 45 68 112 91 131 1.3 2.0 3.3 2.7 3.8

Nashville-Davidson--Murfreesboro--Franklin, TN 65 72 37 50 62 3.9 4.3 2.2 2.9 3.6

New Orleans-Metairie, LA 244 195 109 90 81 20.1 16.4 9.0 7.3 6.6

New York-Newark-Jersey City, NY-NJ-PA 1,537 1,605 1,569 1,668 2,299 7.8 8.2 8.0 8.4 11.6

Oklahoma City, OK 123 76 65 79 124 10.0 6.1 5.1 6.1 9.6

Orlando-Kissimmee-Sanford, FL 132 138 142 136 175 6.3 6.5 6.5 6.1 7.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 362 348 398 408 497 6.1 5.8 6.6 6.8 8.3

Phoenix-Mesa-Scottsdale, AZ 131 126 153 120 150 3.0 3.0 3.6 2.8 3.5

Pittsburgh, PA 25 27 30 46 45 1.1 1.1 1.3 1.9 1.9

Portland-Vancouver-Hillsboro, OR-WA 22 33 58 101 117 1.0 1.5 2.6 4.4 5.1

Providence-Warwick, RI-MA 16 26 26 35 28 1.0 1.6 1.6 2.2 1.7

Raleigh, NC 47 44 35 31 41 4.2 3.9 3.0 2.6 3.4

Richmond, VA 58 76 68 78 75 4.9 6.3 5.6 6.3 6.1

Riverside-San Bernardino-Ontario, CA 88 86 144 138 159 2.1 2.0 3.3 3.2 3.7

Sacramento--Roseville--Arden-Arcade, CA 38 43 51 38 33 1.8 2.0 2.3 1.7 1.5

Salt Lake City, UT 4 12 7 7 37 0.4 1.1 0.6 0.6 3.3

San Antonio-New Braunfels, TX 290 305 252 269 381 14.0 14.2 11.5 12.0 17.1

San Diego-Carlsbad, CA 80 177 162 236 211 2.6 5.7 5.2 7.4 6.6

San Francisco-Oakland-Hayward, CA 253 373 396 528 656 5.9 8.6 9.0 11.9 14.7

San Jose-Sunnyvale-Santa Clara, CA 22 29 35 44 60 1.2 1.6 1.9 2.3 3.2

Seattle-Tacoma-Bellevue, WA 56 91 134 142 167 1.6 2.6 3.8 4.0 4.7

St. Louis, MO-IL 90 106 84 89 125 3.2 3.8 3.0 3.2 4.5

Tampa-St. Petersburg-Clearwater, FL 225 117 139 176 176 8.2 4.2 4.9 6.2 6.2

Virginia Beach-Norfolk-Newport News, VA-NC 77 84 108 90 112 4.6 5.0 6.4 5.3 6.6

Washington-Arlington-Alexandria, DC-VA-MD-WV 306 441 403 497 520 5.5 7.8 7.0 8.5 8.9

SELECTED MSAs TOTAL 9,606 10,158 9,916 11,427 13,376 5.7 6.1 5.9 6.7 7.8

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.
120 Syphilis Tables STD Surveillance 2013

Table 39. Late and Late Latent Syphilis* — Reported Cases and Rates of Reported Cases by State/

Area and Region in Alphabetical Order, United States and Outlying Areas, 2009–2013

Cases Rates per 100,000 Population

State/Area 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Alabama 289 235 252 248 292 6.1 4.9 5.2 5.1 6.1

Alaska 4 7 3 14 3 0.6 1.0 0.4 1.9 0.4

Arizona 629 493 431 424 455 9.5 7.7 6.6 6.5 6.9

Arkansas 95 116 100 132 175 3.3 4.0 3.4 4.5 5.9

California 2,449 2,223 2,269 2,509 3,539 6.6 6.0 6.0 6.6 9.3

Colorado 101 75 80 101 117 2.0 1.5 1.6 1.9 2.3

Connecticut 72 83 67 14 22 2.0 2.3 1.9 0.4 0.6

Delaware 36 19 48 29 63 4.1 2.1 5.3 3.2 6.9

District of Columbia 110 121 164 180 196 18.3 20.1 26.5 28.5 31.0

Florida 1,547 1,572 1,641 1,693 1,934 8.3 8.4 8.6 8.8 10.0

Georgia 982 898 771 842 1,090 10.0 9.3 7.9 8.5 11.0

Hawaii 39 23 13 11 19 3.0 1.7 0.9 0.8 1.4

Idaho 24 9 18 6 21 1.6 0.6 1.1 0.4 1.3

Illinois 805 799 946 902 1,031 6.2 6.2 7.4 7.0 8.0

Indiana 110 134 200 159 171 1.7 2.1 3.1 2.4 2.6

Iowa 33 45 39 58 57 1.1 1.5 1.3 1.9 1.9

Kansas 58 28 18 51 61 2.1 1.0 0.6 1.8 2.1

Kentucky 81 84 95 99 102 1.9 1.9 2.2 2.3 2.3

Louisiana 413 1,163 1,090 1,065 1,267 9.2 25.7 23.8 23.1 27.5

Maine 1 3 4 3 5 0.1 0.2 0.3 0.2 0.4

Maryland 387 386 470 439 504 6.8 6.7 8.1 7.5 8.6

Massachusetts 100 158 271 258 276 1.5 2.4 4.1 3.9 4.2

Michigan 246 322 338 334 368 2.5 3.3 3.4 3.4 3.7

Minnesota 99 128 107 120 209 1.9 2.4 2.0 2.2 3.9

Mississippi 188 200 238 53 31 6.4 6.7 8.0 1.8 1.0

Missouri 189 225 153 133 135 3.2 3.8 2.5 2.2 2.2

Montana 1 0 1 1 1 0.1 0.0 0.1 0.1 0.1

Nebraska 34 20 23 18 40 1.9 1.1 1.2 1.0 2.2

Nevada 75 99 125 117 84 2.8 3.7 4.6 4.2 3.0

New Hampshire 17 16 10 19 30 1.3 1.2 0.8 1.4 2.3

New Jersey 270 314 282 243 196 3.1 3.6 3.2 2.7 2.2

New Mexico 107 57 85 64 100 5.3 2.8 4.1 3.1 4.8

New York 2,160 2,387 2,436 2,667 2,758 11.1 12.3 12.5 13.6 14.1

North Carolina 578 499 485 444 509 6.2 5.2 5.0 4.6 5.2

North Dakota 3 3 3 10 11 0.5 0.4 0.4 1.4 1.6

Ohio 206 349 341 526 431 1.8 3.0 3.0 4.6 3.7

Oklahoma 25 31 39 27 28 0.7 0.8 1.0 0.7 0.7

Oregon 46 69 92 117 133 1.2 1.8 2.4 3.0 3.4

Pennsylvania 321 280 335 365 431 2.5 2.2 2.6 2.9 3.4

Rhode Island 29 18 18 25 27 2.8 1.7 1.7 2.4 2.6

South Carolina 100 80 73 56 66 2.2 1.7 1.6 1.2 1.4

South Dakota 8 8 14 8 12 1.0 1.0 1.7 1.0 1.4

Tennessee 568 542 483 545 497 9.0 8.5 7.5 8.4 7.7

Texas 3,271 3,204 3,312 3,585 3,593 13.2 12.7 12.9 13.8 13.8

Utah 17 47 42 51 51 0.6 1.7 1.5 1.8 1.8

Vermont 0 0 0 0 5 0.0 0.0 0.0 0.0 0.8

Virginia 221 245 224 317 329 2.8 3.1 2.8 3.9 4.0

Washington 118 159 236 226 223 1.8 2.4 3.5 3.3 3.2

West Virginia 16 16 5 6 14 0.9 0.9 0.3 0.3 0.8

Wisconsin 56 84 80 91 100 1.0 1.5 1.4 1.6 1.7

Wyoming 4 3 6 6 7 0.7 0.5 1.1 1.0 1.2

U.S. TOTAL 17,338 18,079 18,576 19,411 21,819 5.6 5.9 6.0 6.2 7.0

Northeast 2,970 3,259 3,423 3,594 3,750 5.4 5.9 6.2 6.4 6.7

Midwest 1,847 2,145 2,262 2,410 2,626 2.8 3.2 3.4 3.6 3.9

South 8,907 9,411 9,490 9,760 10,690 7.9 8.2 8.2 8.3 9.1

West 3,614 3,264 3,401 3,647 4,753 5.0 4.5 4.7 5.0 6.5

Guam 9 10 17 20 14 5.0 6.3 10.7 12.5 8.8

Puerto Rico 328 302 204 175 154 8.3 8.1 5.5 4.8 4.2

Virgin Islands 2 1 7 2 5 1.8 0.9 6.6 1.9 4.7

OUTLYING AREAS 339 313 228 197 173 8.0 7.8 5.7 5.0 4.4

TOTAL 17,677 18,392 18,804 19,608 21,992 5.7 5.9 6.0 6.2 6.9

 * Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other 

than neurosyphilis.
STD Surveillance 2013 Syphilis Tables 121

Table 40. Late and Late Latent Syphilis* — Reported Cases and Rates of Reported Cases in 

Selected Metropolitan Statistical Areas (MSAs)†

 in Alphabetical Order, United States, 

2009–2013

Cases Rates per 100,000 Population

MSAs 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Atlanta-Sandy Springs-Roswell, GA 757 723 611 573 782 13.8 13.7 11.4 10.5 14.3

Austin-Round Rock, TX 116 118 168 154 134 6.8 6.9 9.4 8.4 7.3

Baltimore-Columbia-Towson, MD 193 162 196 203 218 7.2 6.0 7.2 7.4 7.9

Birmingham-Hoover, AL 112 84 95 79 96 9.9 7.4 8.4 7.0 8.4

Boston-Cambridge-Newton, MA-NH 92 142 240 207 211 2.0 3.1 5.2 4.5 4.5

Buffalo-Cheektowaga-Niagara Falls, NY 27 32 27 32 62 2.4 2.8 2.4 2.8 5.5

Charlotte-Concord-Gastonia, NC-SC 142 97 116 122 151 6.4 4.4 5.1 5.3 6.6

Chicago-Naperville-Elgin, IL-IN-WI 727 703 866 853 963 7.6 7.4 9.1 9.0 10.1

Cincinnati, OH-KY-IN 58 117 131 275 191 2.7 5.5 6.2 12.9 9.0

Cleveland-Elyria, OH 29 79 70 82 64 1.4 3.8 3.4 4.0 3.1

Columbus, OH 71 82 76 101 98 3.8 4.3 3.9 5.2 5.0

Dallas-Fort Worth-Arlington, TX 1,024 944 982 1,132 1,081 15.7 14.7 14.9 16.9 16.1

Denver-Aurora-Lakewood, CO 74 64 64 74 81 2.9 2.5 2.5 2.8 3.1

Detroit-Warren-Dearborn, MI 171 232 229 252 277 3.9 5.4 5.3 5.9 6.5

Hartford-West Hartford-East Hartford, CT 29 34 22 3 10 2.4 2.8 1.8 0.2 0.8

Houston-The Woodlands-Sugar Land, TX 1,139 1,149 1,166 1,265 1,154 19.5 19.4 19.2 20.5 18.7

Indianapolis-Carmel-Anderson, IN 51 57 113 84 90 2.7 3.0 5.9 4.4 4.7

Jacksonville, FL 95 87 89 73 75 7.2 6.5 6.5 5.3 5.4

Kansas City, MO-KS 70 43 44 38 54 3.4 2.1 2.2 1.9 2.6

Las Vegas-Henderson-Paradise, NV 49 85 111 98 54 2.6 4.4 5.6 4.9 2.7

Los Angeles-Long Beach-Anaheim, CA 1,332 1,238 1,222 1,091 1,705 10.3 9.7 9.4 8.4 13.1

Louisville/Jefferson County, KY-IN 47 46 51 48 52 3.9 3.7 4.1 3.8 4.2

Memphis, TN-MS-AR 316 326 279 291 283 24.1 24.6 20.9 21.7 21.1

Miami-Fort Lauderdale-West Palm Beach, FL 797 853 984 1,032 1,075 14.4 15.3 17.4 17.9 18.7

Milwaukee-Waukesha-West Allis, WI 43 57 49 59 56 2.8 3.7 3.1 3.8 3.6

Minneapolis-St. Paul-Bloomington, MN-WI 71 101 87 105 175 2.1 3.0 2.6 3.1 5.1

Nashville-Davidson--Murfreesboro--Franklin, TN 147 119 107 133 120 8.8 7.1 6.3 7.7 6.9

New Orleans-Metairie, LA 78 392 457 386 442 6.4 32.9 37.7 31.5 36.0

New York-Newark-Jersey City, NY-NJ-PA 2,271 2,526 2,550 2,679 2,707 11.5 12.9 13.0 13.5 13.6

Oklahoma City, OK 16 17 10 15 11 1.3 1.4 0.8 1.2 0.8

Orlando-Kissimmee-Sanford, FL 165 149 166 192 250 7.9 7.0 7.6 8.6 11.2

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 304 271 325 338 439 5.1 4.5 5.4 5.6 7.3

Phoenix-Mesa-Scottsdale, AZ 368 345 299 332 335 8.4 8.2 7.0 7.7 7.7

Pittsburgh, PA 16 9 13 21 11 0.7 0.4 0.6 0.9 0.5

Portland-Vancouver-Hillsboro, OR-WA 39 54 72 99 118 1.7 2.4 3.2 4.3 5.2

Providence-Warwick, RI-MA 31 22 30 32 45 1.9 1.4 1.9 2.0 2.8

Raleigh, NC 77 65 68 63 68 6.8 5.7 5.8 5.3 5.7

Richmond, VA 50 46 36 51 58 4.2 3.8 3.0 4.1 4.7

Riverside-San Bernardino-Ontario, CA 210 185 201 465 433 5.1 4.4 4.7 10.7 10.0

Sacramento--Roseville--Arden-Arcade, CA 94 81 69 59 107 4.4 3.8 3.2 2.7 4.9

Salt Lake City, UT 8 28 32 33 34 0.7 2.6 2.9 2.9 3.0

San Antonio-New Braunfels, TX 221 232 286 366 457 10.7 10.8 13.0 16.4 20.5

San Diego-Carlsbad, CA 211 148 154 144 245 6.9 4.8 4.9 4.5 7.7

San Francisco-Oakland-Hayward, CA 239 230 244 321 421 5.5 5.3 5.6 7.2 9.4

San Jose-Sunnyvale-Santa Clara, CA 58 62 54 84 69 3.2 3.4 2.9 4.4 3.6

Seattle-Tacoma-Bellevue, WA 84 112 177 169 161 2.5 3.3 5.1 4.8 4.5

St. Louis, MO-IL 120 177 94 95 104 4.3 6.3 3.4 3.4 3.7

Tampa-St. Petersburg-Clearwater, FL 223 195 175 171 227 8.1 7.0 6.2 6.0 8.0

Virginia Beach-Norfolk-Newport News, VA-NC 55 60 40 100 86 3.3 3.6 2.4 5.9 5.1

Washington-Arlington-Alexandria, DC-VA-MD-WV 362 425 536 517 599 6.5 7.5 9.3 8.8 10.2

SELECTED MSAs TOTAL 13,079 13,605 14,283 15,191 16,739 7.8 8.1 8.4 8.9 9.8

* Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other than 

neurosyphilis.

† MSAs were selected on the basis of the largest population in the 2010 U.S. Census.
122 Syphilis Tables STD Surveillance 2013

Table 41. Congenital Syphilis — Reported Cases and Rates of Reported Cases in Infants by 

State, Ranked by Rates, United States, 2013

Rank* State† Cases Rate per 100,000 Live Births

1 Louisiana 32 51.3

2 Arkansas 12 31.1

3 Texas 75 19.4

4 Maryland 14 19.0

5 Florida 37 17.2

6 Georgia 20 14.9

7 Arizona 13 14.9

8 Illinois 23 13.9

9 Ohio 17 12.2

10 California 56 11.0

HP 2020 TARGET 9.1

11 Delaware 1 8.8

12 Alaska 1 8.7

U.S. TOTAL‡ 348 8.7

13 Michigan 9 7.9

14 New Mexico 2 7.2

15 Kentucky 4 7.2

16 Nevada 2 5.6

17 Massachusetts 4 5.5

18 New York 11 4.5

19 Missouri 3 3.9

20 Alabama 2 3.3

21 Tennessee 2 2.5

22 Virginia 2 1.9

23 South Carolina 1 1.7

24 Pennsylvania 2 1.4

25 North Carolina 1 0.8

Colorado 0 0.0

Connecticut 0 0.0

Hawaii 0 0.0

Idaho 0 0.0

Indiana 0 0.0

Iowa 0 0.0

Kansas 0 0.0

Maine 0 0.0

Minnesota 0 0.0

Mississippi 0 0.0

Montana 0 0.0

Nebraska 0 0.0

New Hampshire 0 0.0

New Jersey 0 0.0

North Dakota 0 0.0

Oklahoma 0 0.0

Oregon 0 0.0

Rhode Island 0 0.0

South Dakota 0 0.0

Utah 0 0.0

Vermont 0 0.0

Washington 0 0.0

West Virginia 0 0.0

Wisconsin 0 0.0

Wyoming 0 0.0

* States were ranked by rate, then by case count, then in alphabetical order, with rates shown rounded to the nearest tenth.

†

 Mother’s state of residence was used to assign case.

‡ Total includes cases reported by the District of Columbia, with 2 cases and a rate of 21.8, but excludes outlying areas (Guam with 1 cases, Puerto Rico with 

1 case and rate of 2.4, and Virgin Islands with 0 cases).
STD Surveillance 2013 Syphilis Tables 123

Table 42. Congenital Syphilis — Reported Cases and Rates of Reported Cases in Infants by Year 

of Birth, by State/Area and Region in Alphabetical Order, United States and Outlying 

Areas, 2009–2013

State/Area*

Cases Rates per 100,000 Live Births

2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Alabama 13 9 10 4 2 20.8 15.0 16.7 6.7 3.3

Alaska 0 0 0 1 1 0.0 0.0 0.0 8.7 8.7

Arizona 28 16 15 14 13 30.2 18.3 17.1 16.0 14.9

Arkansas 10 11 15 11 12 25.1 28.5 38.9 28.5 31.1

California 63 39 40 35 56 12.0 7.6 7.8 6.9 11.0

Colorado 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Connecticut 2 2 0 0 0 5.1 5.3 0.0 0.0 0.0

Delaware 1 2 0 1 1 8.7 17.6 0.0 8.8 8.8

District of Columbia 0 1 1 0 2 0.0 10.9 10.9 0.0 21.8

Florida 18 20 33 37 37 8.1 9.3 15.4 17.2 17.2

Georgia 14 18 10 16 20 9.9 13.4 7.5 11.9 14.9

Hawaii 1 0 0 0 0 5.3 0.0 0.0 0.0 0.0

Idaho 1 1 0 1 0 4.2 4.3 0.0 4.3 0.0

Illinois 16 27 18 28 23 9.3 16.3 10.9 16.9 13.9

Indiana 1 0 0 0 0 1.2 0.0 0.0 0.0 0.0

Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kansas 3 0 0 0 0 7.2 0.0 0.0 0.0 0.0

Kentucky 2 0 2 2 4 3.5 0.0 3.6 3.6 7.2

Louisiana 11 33 18 33 32 16.9 52.9 28.9 52.9 51.3

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 31 22 24 12 14 41.3 29.8 32.5 16.3 19.0

Massachusetts 0 1 0 1 4 0.0 1.4 0.0 1.4 5.5

Michigan 5 5 8 7 9 4.3 4.4 7.0 6.1 7.9

Minnesota 1 0 0 1 0 1.4 0.0 0.0 1.5 0.0

Mississippi 89600 18.6 22.5 15.0 0.0 0.0

Missouri 6 2 1 1 3 7.6 2.6 1.3 1.3 3.9

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 0 0 0 1 0 0.0 0.0 0.0 3.9 0.0

Nevada 3 5 3 1 2 8.0 13.9 8.3 2.8 5.6

New Hampshire 0 0 0 1 0 0.0 0.0 0.0 7.8 0.0

New Jersey 7 3 5 1 0 6.3 2.8 4.7 0.9 0.0

New Mexico 0 0 0 1 2 0.0 0.0 0.0 3.6 7.2

New York 15 17 13 8 11 6.0 7.0 5.3 3.3 4.5

North Carolina 10 10 6 2 1 7.9 8.2 4.9 1.6 0.8

North Dakota 10000 11.1 0.0 0.0 0.0 0.0

Ohio 8 10 13 19 17 5.5 7.2 9.3 13.7 12.2

Oklahoma 2 0 2 0 0 3.7 0.0 3.8 0.0 0.0

Oregon 0 0 0 1 0 0.0 0.0 0.0 2.2 0.0

Pennsylvania 5 3 5 6 2 3.4 2.1 3.5 4.2 1.4

Rhode Island 1 0 0 0 0 8.7 0.0 0.0 0.0 0.0

South Carolina 0 1 0 7 1 0.0 1.7 0.0 12.0 1.7

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 13 11822 15.8 13.8 10.1 2.5 2.5

Texas 128 105 99 78 75 31.8 27.2 25.6 20.2 19.4

Utah 0 1 0 0 0 0.0 1.9 0.0 0.0 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 2 1 0 1 2 1.9 1.0 0.0 1.0 1.9

Washington 1 1 2 0 0 1.1 1.2 2.3 0.0 0.0

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wisconsin 0 1 1 0 0 0.0 1.5 1.5 0.0 0.0

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 431 387 358 334 348 10.4 9.7 9.0 8.4 8.7

Northeast 30 26 23 17 17 4.5 4.0 3.5 2.6 2.6

Midwest 41 45 41 57 52 4.7 5.3 4.9 6.8 6.2

South 263 253 234 206 205 16.7 16.6 15.4 13.5 13.5

West 97 63 60 54 74 9.5 6.4 6.1 5.5 7.5

Guam 0 0 0 0 1 0.0 0.0 0.0 0.0 29.3

Puerto Rico 6 2 2 1 1 13.4 4.7 4.7 2.4 2.4

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 62212 12.0 4.2 4.2 2.1 4.2

TOTAL 437 389 360 335 350 10.5 9.6 8.9 8.3 8.6

* Mother’s state of residence was used to assign case.
124 Syphilis Tables STD Surveillance 2013

Table 43. Congenital Syphilis — Reported Cases and Rates of Reported Cases per 100,000 Live 

Births in Infants by Year of Birth and Race/Ethnicity of Mother, United States, 2009–2013

Year of Birth

Whites, Non-Hispanic Blacks, Non-Hispanic Hispanics

Cases Rate Cases Rate Cases Rate

2009 65 2.9 216 35.1 128 12.8

2010 63 2.9 216 36.3 91 9.6

2011 50 2.3 211 35.4 73 7.7

2012 50 2.3 189 31.7 80 8.5

2013 62 2.8 173 29.0 92 9.7

Year of Birth

Asians/Pacific Islanders American Indians/Alaska Natives Multirace

Cases Rate Cases Rate Cases Rate

2009 11 4.6 5 11.8 0 NA

2010 9 3.8 1 2.5 2 NA

2011 14 5.9 2 4.9 0 NA

2012 6 2.5 2 4.9 0 NA

2013 8 3.4 6 14.8 0 NA

Year of Birth

Other Unknown Total

Cases Rate Cases Rate Cases Rate

2009 2 NA 4 NA 431 10.4

2010 1 NA 4 NA 387 9.7

2011 3 NA 5 NA 358 9.0

2012 3 NA 4 NA 334 8.4

2013 2 NA 5 NA 348 8.7

NA = Not applicable.
STD Surveillance 2013 Chancroid 125

Table 44. Chancroid — Reported Cases and Rates of Reported Cases by State/Area in Alphabetical 

Order, United States and Outlying Areas, 2009–2013

Cases Rates per 100,000 Population

State/Area 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Alabama 0 1 0 1 1 0.0 0.0 0.0 0.0 0.0

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 0 0 1 0 0 0.0 0.0 0.0 0.0 0.0

Arkansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

California 1 5 1 7 6 0.0 0.0 0.0 0.0 0.0

Colorado 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Connecticut 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Delaware 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

District of Columbia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Florida 1 1 0 0 0 0.0 0.0 0.0 0.0 0.0

Georgia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Hawaii 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Idaho 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Illinois 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Indiana 1 0 0 1 0 0.0 0.0 0.0 0.0 0.0

Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kentucky 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Louisiana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 0 0 0 1 0 0.0 0.0 0.0 0.0 0.0

Massachusetts 3 1 2 1 2 0.0 0.0 0.0 0.0 0.0

Michigan 0 0 1 2 0 0.0 0.0 0.0 0.0 0.0

Minnesota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Mississippi 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Missouri 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nevada 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Mexico 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New York 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

North Carolina 6 1 0 1 0 0.1 0.0 0.0 0.0 0.0

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Oklahoma 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Oregon 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Pennsylvania 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Rhode Island 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

South Carolina 1 1 2 0 0 0.0 0.0 0.0 0.0 0.0

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 0 1 0 0 0 0.0 0.0 0.0 0.0 0.0

Texas 8 12 1 0 1 0.0 0.0 0.0 0.0 0.0

Utah 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 1 0 0 1 0 0.0 0.0 0.0 0.0 0.0

Washington 0 1 0 0 0 0.0 0.0 0.0 0.0 0.0

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wisconsin 6 0 0 0 0 0.1 0.0 0.0 0.0 0.0

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 28 24 8 15 10 0.0 0.0 0.0 0.0 0.0

Guam 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Puerto Rico 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

TOTAL 28 24 8 15 10 0.0 0.0 0.0 0.0 0.0
126 Selected STDs STD Surveillance 2013

Table 45. Selected STDs and Complications — Initial Visits to Physicians’ Offices, National 

Disease and Therapeutic Index, United States, 1966–2013

Year Genital Herpes Genital Warts

Vaginal 

Trichomoniasis* Other Vaginitis*

Pelvic Inflammatory 

Disease†

1966 19,000 56,000 579,000 1,155,000 NA

1967 15,000 72,000 515,000 1,277,000 NA

1968 16,000 87,000 463,000 1,460,000 NA

1969 15,000 61,000 421,000 1,390,000 NA

1970 17,000 119,000 529,000 1,500,000 NA

1971 49,000 128,000 484,000 1,281,000 NA

1972 26,000 165,000 574,000 1,810,000 NA

1973 51,000 198,000 466,000 1,858,000 NA

1974 75,000 202,000 427,000 1,907,000 NA

1975 36,000 181,000 500,000 1,919,000 NA

1976 57,000 217,000 473,000 1,690,000 NA

1977 116,000 221,000 324,000 1,713,000 NA

1978 76,000 269,000 329,000 2,149,000 NA

1979 83,000 200,000 363,000 1,662,000 NA

1980 57,000 218,000 358,000 1,670,000 423,000

1981 133,000 191,000 369,000 1,742,000 283,000

1982 134,000 256,000 268,000 1,859,000 374,000

1983 106,000 203,000 424,000 1,932,000 424,000

1984 157,000 224,000 381,000 2,450,000 381,000

1985 124,000 263,000 291,000 2,728,000 425,000

1986 136,000 275,000 338,000 3,118,000 457,000

1987 102,000 351,000 293,000 3,087,000 403,000

1988 163,000 290,000 191,000 3,583,000 431,000

1989 148,000 220,000 165,000 3,374,000 413,000

1990 172,000 275,000 213,000 4,474,000 358,000

1991 235,000 282,000 198,000 3,822,000 377,000

1992 139,000 218,000 182,000 3,428,000 335,000

1993 172,000 167,000 207,000 3,755,000 407,000

1994 142,000 239,000 199,000 4,123,000 332,000

1995 160,000 253,000 141,000 3,927,000 262,000

1996 208,000 191,000 245,000 3,472,000 286,000

1997 176,000 145,000 176,000 3,100,000 260,000

1998 188,000 211,000 164,000 3,200,000 233,000

1999 224,000 240,000 171,000 3,077,000 250,000

2000 179,000 220,000 222,000 3,470,000 254,000

2001 157,000 233,000 210,000 3,365,000 244,000

2002 216,000 266,000 150,000 3,315,000 197,000

2003 203,000 264,000 179,000 3,516,000 123,000

2004 269,000 316,000 221,000 3,602,000 132,000

2005 266,000 357,000 165,000 4,071,000 176,000

2006 371,000 422,000 200,000 3,891,000 106,000

2007 317,000 312,000 205,000 3,723,000 146,000

2008 292,000 385,000 204,000 3,571,000 104,000

2009 306,000 357,000 216,000 3,063,000 100,000

2010 232,000 376,000 149,000 3,192,000 113,000

2011 227,000 453,000 168,000 3,102,000 90,000

2012 228,000 353,000 219,000 3,452,000 106,000

2013 306,000 404,000 225,000 3,278,000 88,000

* Women only.

† Women aged 15–44 years only.

NA = Not available.

Note: Standard errors for estimates under 100,000 are not available. The relative standard errors for estimates 100,000-299,999 are from 19% to 23%; 

300,000-599,999 are from 16% to 19%; 600,000-999,999 are from 13% to 16%; and 1,000,000-5,000,000 are from 7% to 13%.

SOURCE: National Disease and Therapeutic Index (IMS Health). See Other Surveillance Data Sources in the Appendix for more information.
APPENDIX
APPENDIX
STD Surveillance 2013 Appendix: Interpreting STD Surveillance Data 127

Interpreting STD Surveillance Data

Sexually Transmitted Disease Surveillance 2013 presents 

surveillance information derived from the official statistics 

for the reported occurrence of nationally notifiable sexually 

transmitted diseases (STDs) in the United States, test 

positivity and prevalence data from numerous prevalence 

monitoring initiatives, sentinel surveillance, and national 

health care services surveys.

Nationally Notifiable STD Surveillance

Nationally notifiable STD surveillance data are collected 

and compiled from reports sent by the STD control 

programs and health departments in all 50 states, the 

District of Columbia, selected cities, U.S. dependencies and 

possessions, and independent nations in free association 

with the United States to the Division of STD Prevention, 

National Center for HIV/AIDS, Viral Hepatitis, STD, and 

TB Prevention, Centers for Disease Control and Prevention 

(CDC). Included among the dependencies, possessions, and 

independent nations are Guam, Puerto Rico, and the Virgin 

Islands. These entities are identified as “outlying areas” of 

the United States in selected figures and tables.

Reporting Formats

STD morbidity data presented in this report are compiled 

from a combination of data reported on standardized hard 

copy reporting forms and electronic data received through 

the National Electronic Telecommunications System for 

Surveillance (NETSS).

Summary Report Forms

The following hard copy forms were used to report national 

STD morbidity data:

1. FORM CDC 73.998: Monthly Surveillance Report of 

Early Syphilis. This monthly hard copy reporting form 

was used during 1984–2002 to report summary data 

for primary and secondary syphilis and early latent 

syphilis by county and state.

2. FORM CDC 73.688: Sexually Transmitted Disease 

Morbidity Report. This quarterly hard copy reporting 

form was used during 1963–2002 to report summary 

data for all stages of syphilis, congenital syphilis, 

gonorrhea, chancroid, chlamydia, and other STDs by 

sex and source of report (private versus public) for all 

50 states, the District of Columbia, 64 selected cities 

(including San Juan, Puerto Rico), and outlying areas 

of the United States. 

Note: Chlamydial infection became a nationally 

notifiable condition in 1996, and the form was 

modified to support reporting of chlamydia that year. 

Congenital syphilis was dropped from this aggregate 

form in 1995 and replaced by the case-specific CDC 

73.126 form described later in this section.

3. FORM CDC 73.2638: Report of Civilian Cases 

of Primary & Secondary Syphilis, Gonorrhea, and 

Chlamydia by Reporting Source, Sex, Race/Ethnicity, 

and Age Group. This annual hard copy form was used 

during 1981–2002 to report summary data for P&S 

syphilis, gonorrhea, and chlamydia by age, race, sex, 

and source (public versus private) for all 50 states, seven 

large cities (Baltimore, Chicago, New York City, Los 

Angeles, Philadelphia, San Francisco, and the District 

of Columbia), and outlying areas of the United States. 

Note: Chlamydial infection became a nationally 

notifiable condition in 1996, and the form was 

modified to support reporting of chlamydia that year.

4. FORM CDC 73.126: Congenital Syphilis (CS) Case 

Investigation and Reporting. This case-specific hard copy 

form was first used in 1983 and continued to be used 

through 2013 to report detailed case-specific data for 

congenital syphilis in some areas.

National Electronic Telecommunications 

System for Surveillance

Notifiable STD data reported electronically through 

NETSS make up the nationally notifiable disease 

information published in CDC’s Morbidity and Mortality 

Weekly Report. 

As of December 31, 2003, all 50 states and the District 

of Columbia had converted from summary hard copy 

reporting to electronic submission of line-listed (i.e., 

case-specific) STD data through NETSS (43 reporting 

areas submit congenital syphilis surveillance data through 

NETSS). Puerto Rico converted to electronic reporting in 

2006 for all STDs excluding congenital syphilis. Guam and 

the Virgin Islands continue to report STD data through 

summary hard copy forms.
128 Appendix: Interpreting STD Surveillance Data STD Surveillance 2013

Surveillance data and updates sent to CDC through 

NETSS and on hard copy forms through June 4, 2014, are 

included in this report. Data received after this date will 

appear in subsequent STD surveillance reports. The data 

presented in the figures and tables in this report supersede 

those in all earlier publications.

Population Denominators and Rate 

Calculations

2000–2013 Rates and Population

CDC’s National Center for Health Statistics (NCHS) 

released bridged-race population counts for the 2000–2012 

U.S. resident populations that are based on counts from 

the 2000 and 2010 U.S. Censuses. These estimates resulted 

from bridging the 31 race categories first used in the 2000 

census, as specified in the 1997 Office of Management and 

Budget (OMB) standards, to the five race/ethnicity groups 

specified in the 1977 OMB standards. This report uses the 

first published population estimate for a given year. The 

latest available year for population estimates at the time 

this report was written was 2012. Thus 2012 population 

estimates were used to calculate 2009-2013 rates. For those 

figures and tables presenting race using The 1997 OMB 

race standards, non-bridged-race data provided directly by 

the U.S. Census Bureau were used to calculate race. Once 

published, the 2013 population estimates will be used to 

calculate rates in the upcoming 2014 STD Surveillance 

Report.

Population estimates for Guam, Puerto Rico, and the Virgin 

Islands were obtained from the U.S. Census Bureau Web 

site at http://www.census.gov/ipc/www/idb/tables.html. The 

2011–2013 rates for outlying areas were calculated by using 

the 2011 population estimates. The 2013 rates by age and 

sex for Guam and the Virgin Islands were calculated using 

2010 population estimates available at: http://factfinder2.

census.gov/faces/nav/jsf/pages/index.xhtml.

Because of the use of the updated population data, rates 

for 2000–2012 may be different from those presented in 

previous STD surveillance reports.

1990–1999 Rates and Population

The population counts for 1990 through 1999 incorporated 

the bridged single-race estimates of the April 1, 2000, U.S. 

resident population. These files were prepared by the U.S. 

Census Bureau with support from the National Cancer 

Institute.

1981–1989 Rates and Population

Rates were calculated by using U.S. Census Bureau 

population estimates for 1981 through 1989.1,2

1941–1980 Rates and Population

Rates for 1941 through 1980 were based on population 

estimates from the U.S. Census Bureau and are currently 

maintained by CDC’s Division of STD Prevention.

1941–2013 Congenital Syphilis Rates and 

Live Births

The congenital syphilis data in Table 1 of this report 

represent the number of congenital syphilis cases per 

100,000 live births for all years during 1941–2013. 

Previous publications presented congenital syphilis rates per 

100,000 population during 1941–1994 and rates for cases 

diagnosed at younger than 1 year of age per 100,000 live 

births during 1995–2005. To allow for trends in congenital 

syphilis rates to be compared for the period 1941 through 

2013, live births now are used as the denominator for 

congenital syphilis, and case counts are no longer limited 

to those diagnosed within the first year of life. Congenital 

syphilis morbidity is assigned by year of birth. Rates of 

congenital syphilis for 1963 through 1988 were calculated 

by using published live birth data.3

 Congenital syphilis rates 

for 1989 through 2012 were calculated by using live birth 

data based on information coded by the states and provided 

to the NCHS through the Vital Statistics Cooperative 

Program. Rates for 2013 were calculated by using live birth 

data for 2010.

Reporting Practices

Although most state and local STD programs generally 

adhere to the national notifiable STD case definitions 

collaboratively developed by the Council of State and 

Territorial Epidemiologists and CDC, differences in policies 

and systems for collecting surveillance data may exist. 

Thus, comparisons of case numbers and rates between 

jurisdictions should be interpreted with caution. 

However, because case definitions and surveillance activities 

within a given area remain relatively stable over time, trends 

should be minimally affected by these differences. 
STD Surveillance 2013 Appendix: Interpreting STD Surveillance Data 129

Reporting of Surveillance Data by 

Metropolitan Statistical Area

Sexually Transmitted Disease Surveillance 2013 continues 

the presentation of STD incidence data and rates for 

the 50 metropolitan statistical areas (MSAs) with the 

largest populations according to 2010 census data. STD 

surveillance reports published before 2005 presented data 

by selected cities; these data were derived from county 

data, which were used to estimate city-specific disease rates. 

Because county data were used to estimate city-specific 

morbidity and because current STD project areas’ reporting 

practices do not support direct identification of city-specific 

morbidity reports, MSAs were chosen as a geographic unit 

smaller than a state or territory for presentation of STD 

morbidity data.

MSAs are defined by the OMB to provide nationally 

consistent definitions for collecting, tabulating, and 

publishing federal statistics for a set of geographic areas.4

An MSA is associated with at least one urbanized area that 

has a population of at least 50,000. The MSA comprises the 

central county or counties containing the central county, 

plus adjacent, outlying counties that have a high degree of 

social and economic integration with the central county as 

measured through commuting. 

The title of an MSA includes the name of the principal 

city with the largest 2010 census population. If there are 

multiple principal cities, the names of the second largest 

and third largest principal cities appear in the title in order 

of descending population size.

The MSA concept has been used as a statistical representation 

of the social and economic links between urban cores and 

outlying, integrated areas. However, MSAs do not equate to 

an urban-rural classification; all counties included in MSAs 

and many other counties contain both urban and rural 

territory and populations. STD programs that treat all parts 

of an MSA as if they were as urban as the densely settled 

core ignore the rural conditions that may exist in some parts 

of the area. In short, MSAs are not intended to be a general 

purpose geographic framework for nonstatistical activities or 

for use in program funding formulas.

For more information on the MSA definitions used in this 

report, go to: http://www.census.gov/population/metro/

data/metrodef.html.

Reporting of Data for Race/Ethnicity

In April 2008, the NETSS record layout was updated to 

conform to the OMB’s current government-wide standard 

for race/ethnicity data.5 The OMB standards were first 

issued in 1997. Beginning with publication of Sexually 

Transmitted Disease Surveillance 2012, the race/ethnicity 

data are presented according to the current standard 

categories: American Indian or Alaska Native, Asian, black 

or African American, Hispanic or Latino, Native Hawaiian/

Other Pacific Islander, white and multirace. As of reporting 

year 2013, there are 46 states (Alabama, Arizona, Arkansas, 

California, Colorado, Connecticut, Delaware, Florida, 

Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, 

Kentucky, Louisiana, Maine, Massachusetts, Minnesota, 

Mississippi, Missouri, Montana, Nebraska, Nevada, New 

Hampshire, New Jersey, New Mexico, North Carolina, 

North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, 

Rhode Island, South Carolina, South Dakota, Tennessee, 

Texas, Utah, Vermont, Virginia, Washington, West Virginia, 

Wisconsin, Wyoming) and the District of Columbia 

compliant with the current OMB race/ethnicity standards 

when reporting chlamydia and gonorrhea. There are 47 

states (Alabama, Arizona, Arkansas, California, Colorado, 

Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, 

Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, 

Massachusetts, Michigan, Minnesota, Mississippi, Missouri, 

Montana, Nebraska, Nevada, New Hampshire, New 

Jersey, New Mexico, North Carolina, North Dakota, Ohio, 

Oklahoma, Oregon, Pennsylvania, Rhode Island, South 

Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, 

Virginia, Washington, West Virginia, Wisconsin, Wyoming) 

and the District of Columbia compliant with the current 

OMB race/ethnicity standards when reporting primary 

and secondary syphilis. In chlamydia and gonorrhea 

figures where trends are shown for 2009-2013, the data 

are presented for 39 states (Alabama, Arizona, Arkansas, 

California, Colorado, Connecticut, Delaware, Florida, 

Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, 

Maine, Massachusetts, Minnesota, Mississippi, Missouri, 

Nebraska, Nevada, New Hampshire, New Mexico, North 

Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, 

South Carolina, South Dakota, Tennessee, Texas, Vermont, 

Virginia, Washington, West Virginia, Wisconsin, Wyoming) 

and the District of Columbia since these areas consistently 

reported race/ethnicity data according to the current 

standard categories for the five consecutive years. In primary 

and secondary syphilis figures where trends are shown for 

2009-2013, the data are presented for 39 states (Alabama, 

Arizona, Arkansas, California, Colorado, Connecticut, 

Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, 

Iowa, Kansas, Kentucky, Maine, Massachusetts, Michigan, 

Minnesota, Mississippi, Missouri, Nebraska, Nevada, New 

Hampshire, New Mexico, North Dakota, Ohio, Oklahoma, 

Pennsylvania, Rhode Island, South Carolina, South Dakota, 

Tennessee, Texas, Vermont, Virginia, Washington, West 

Virginia, Wyoming) and the District of Columbia. 
130 Appendix: Interpreting STD Surveillance Data STD Surveillance 2013

Management of Unknown, Missing, 

or Invalid Data for Age Group, Race/

Ethnicity, and Sex

The percentage of unknown, missing, or invalid data for age 

group, race/ethnicity, and sex varies from year to year, state 

to state, and by disease for reported STDs (Table A1).

Prior to the publication of Sexually Transmitted Disease 

Surveillance 2010, when the percentage of unknown, 

missing, or invalid values for age group, race/ethnicity, 

and sex exceeded 50% for any state, the state’s incidence 

and population data were excluded from the tables that 

presented data stratified by one or more of these variables. 

For the states for which 50% or more of their data were 

valid for age group, race/ethnicity, and sex, the values for 

unknown, missing, or invalid data were redistributed on the 

basis of the state’s distribution of known age group, race/

ethnicity, and sex data. Beginning with the publication 

of Sexually Transmitted Disease Surveillance 2010, 

redistribution methodology is not applied to any of the 

data. The counts presented in this report are summations of 

all valid data reported in reporting year 2013.

As a result, rate data that are stratified by one or more of 

these variables reflect rates based on reported data only.

Classification of STD Morbidity 

Reporting Sources

Before 1996, states classified the source of case reports as 

either private source (including private physicians, hospitals, 

and institutions) or public source (primarily STD clinics). 

As states began reporting morbidity data electronically in 

1996, the classification categories for source of case reports 

expanded to include the following data sources: STD 

clinics, HIV counseling and testing sites, drug treatment 

clinics, family planning clinics, prenatal/obstetrics clinics, 

tuberculosis clinics, private physicians/health maintenance 

organizations, hospitals (inpatient), emergency rooms, 

correctional facilities, laboratories, blood banks, the 

National Job Training Program (NJTP), school-based 

clinics, mental health providers, the military, the Indian 

Health Service, and other unspecified sources.

Analysis of the data reported electronically after 1996 

confirmed that the new STD clinic source of report 

data corresponded to the earlier public source category. 

Therefore, source of case report data during 1984–2013 are 

presented as STD clinic or non-STD clinic only (Table A2).

Interpreting Chlamydia Case Reporting

Trends in rates of reported cases of chlamydia are 

influenced by changes in incidence of infection, as well as 

changes in diagnostic, screening, and reporting practices. 

As chlamydial infections are usually asymptomatic, the 

number of infections identified and reported can increase 

as more people are screened even when incidence is flat or 

decreasing. Expanded use of more sensitive diagnostics tests 

(e.g., nucleic acid amplification tests) can also increase the 

number of infections identified and reported independent 

of increases in incidence. Although chlamydia has been 

a nationally notifiable condition since 1994, it was not 

until 2000 that all 50 states and the District of Columbia 

required reporting of chlamydia cases. National case rates 

prior to 2000 reflect incomplete reporting. Additionally, 

increasing use of electronic laboratory reporting has 

likely increased the proportion of diagnosed cases that are 

reported. Consequently, an increasing chlamydia case rate 

may reflect increases in incidence of infection, screening 

coverage, and use of more sensitive tests, as well as more 

complete reporting. Likewise, decreases in chlamydia case 

rates may suggest decreases in incidence of infection or 

screening coverage.

Syphilis Morbidity Reporting 

The category of “total syphilis” or “all stages of syphilis” 

includes primary, secondary, latent (including early latent, 

late latent, and latent syphilis of unknown duration), 

neurosyphilis, late (including late syphilis with clinical 

manifestations other than neurosyphilis), and congenital 

syphilis.

In 1996, the syphilis stage “late syphilis with clinical 

manifestations other than neurosyphilis (late benign and 

cardiovascular syphilis)” was added to the syphilis case 

definition (see STD Surveillance Case Definitions in the 

Appendix). Although neurosyphilis can occur at almost 

any stage of syphilis, during 1996–2005, it was classified 

and reported as one of several mutually exclusive stages of 

syphilis. Beginning in 2005, neurosyphilis was no longer 

classified or reported as a distinct stage of syphilis.

Congenital Syphilis Morbidity Reporting

In 1988, the surveillance case definition for congenital 

syphilis was changed. This case definition has greater 

sensitivity than the former definition.6 In addition, many 

state and local STD programs have greatly enhanced active 

case finding for congenital syphilis since 1988. For these 

reasons, as well as because of increasing morbidity, the 
STD Surveillance 2013 Appendix: Interpreting STD Surveillance Data 131

number of reported cases increased dramatically during 

1989–1991. All reporting areas had implemented the new 

case definition for reporting congenital syphilis by January 

1, 1992.

In addition to changing the case definition for congenital 

syphilis, CDC introduced a new data collection form 

(CDC 73.126) in 1990 (revised February 2013). Since 

1995, the data collected on this form have been used for 

reporting congenital syphilis cases and associated rates. This 

form is used to collect individual case information, which 

allows more thorough analysis of case characteristics. For 

the purpose of analyzing race/ethnicity, cases are classified 

by the race/ethnicity of the mother. Congenital syphilis 

cases were reported by state and city of residence of the 

mother during 1995–2013.

Congenital syphilis reporting may be delayed as a result of 

case investigation and validation. Cases for previous years 

are added to CDC’s surveillance databases throughout the 

year. Congenital syphilis data reported after publication of 

the current annual STD surveillance report will appear in 

subsequent reports and are assigned by the case patient’s 

year of birth.

Chlamydia and Gonorrhea Positivity and 

Prevalence Monitoring

Chlamydia and gonorrhea prevalence was calculated 

for men and women entering the NJTP. To increase the 

stability of the estimates, chlamydia or gonorrhea prevalence 

data are presented when valid test results for 100 or more 

students per year are available for the population subgroup 

and state. The majority of NJTP’s chlamydia screening 

tests are conducted by a single national contract laboratory, 

which provides these data to CDC. Gonorrhea screening 

tests for male and female students in many training centers 

are conducted by local laboratories; these data are not 

available to CDC. Test results for students at centers that 

submit specimens to the national contract laboratory are 

included only if the number of gonorrhea tests submitted 

is greater than 90% of the number of chlamydia tests 

submitted from the same center for the same period. 

Prevalence data for state-specific figures were published with 

permission from the NJTP.

During the mid-1990s to 2011, chlamydia and gonorrhea 

positivity among women screened in correctional 

facilities, family planning clinics, and prenatal care clinics 

participating in infertility prevention activities were 

reported to CDC to monitor chlamydia and gonorrhea 

prevalence. As the national infertility prevention program 

expanded, these data became difficult to interpret as trends 

were influenced by changes in screening coverage, screening 

criteria, and test technologies, as well as demographic 

changes in patients attending clinics reporting data to 

CDC. These issues could not be addressed with the limited 

variables that were collected at the national level. Positivity 

data continue to be useful locally to inform clinic-based 

screening recommendations and to identify at-risk 

populations in need of prevention interventions, but are no 

longer collected to monitor national trends in chlamydia 

and gonorrhea.

STD Surveillance Network (SSuN)

In 2005, CDC established the STD Surveillance Network 

(SSuN) as a dynamic network comprised of state and 

local STD surveillance units following enhanced STD 

surveillance protocols. The purpose of SSuN is to improve 

the capacity of national, state, and local STD programs 

to detect, monitor, and respond rapidly to trends in 

STDs through enhanced collection, reporting, analysis, 

visualization, and interpretation of disease information.

Twelve collaborating local or state health departments 

contributed data to the network during 2013: Alabama 

Department of Public Health, Baltimore City Health 

Department, Chicago Department of Public Health, 

Colorado Department of Public Health and Environment, 

Connecticut Department of Public Health, County of Los 

Angeles Department of Public Health (in collaboration with 

California State Department of Public Health), Louisiana 

Office of Public Health, New York City Department of 

Health and Mental Hygiene, Philadelphia Department of 

Public Health, San Francisco Department of Public Health, 

Virginia Department of Health, and Washington State 

Department of Health.

The SSuN data contained in this report include 

demographic, behavioral, clinical, and laboratory 

information collected from patients at 42 STD clinics 

within the jurisdictions of SSuN health state and/or 

local health departments. These clinics are located in San 

Francisco, CA (San Francisco City Clinic); Los Angeles, 

CA (12 STD clinics in Los Angeles County); Seattle, 

WA (Seattle-King County Clinic); Denver, CO (Denver 

Metro Health Clinic); Chicago, IL (7 public STD clinics 

in Cook County); New Orleans, LA (Delgado Personal 

Health Center); Birmingham, AL (Jefferson County STD 

Clinic); Richmond, VA (Richmond City, Henrico County 

and Chesterfield County Clinics); Baltimore, MD (Druid 

STD Clinic and Eastern STD Clinic); Philadelphia, PA 

(Philadelphia STD Clinics 1 and 5); New York City, 

NY (9 public STD clinics in 5 boroughs); Hartford, CT 

(Hartford STD Clinic); and New Haven, CT (New Haven 

STD Clinic). However, the STD clinics in 6 jurisdictions 
132 Appendix: Interpreting STD Surveillance Data STD Surveillance 2013

(Birmingham, Chicago, Denver, Hartford/New Haven, 

New Orleans, Richmond) submitted data on all patients 

from January to June 2013. The remaining jurisdictions 

collected data on STD clinic patients for all of 2013. 

In addition to patients presenting for care at STD clinics, 

SSuN jurisdictions also identified a random sample of 

gonorrhea cases reported from all providers for enhanced 

follow-up and administration of a standardized behavioral 

interview including number, gender and demographics of 

recent partners. Gay, bisexual, and other men who have 

sex with men (MSM) were defined as men who either 

reported having sex with another man ever before STD 

testing (asked at all SSuN sites) or who did not report sex 

with men but reported that they considered themselves gay/

homosexual or bisexual (asked at 10 of the 12 sites). Men 

who have sex with women (MSW) were defined as men 

who reported having sex with women only before STD 

testing or who did not report the sex of their sex partner, 

but reported that they considered themselves straight/

heterosexual (asked at 10 of the 12 sites). 

Gonococcal Isolate Surveillance Project

Data on antimicrobial susceptibility in Neisseria gonorrhoeae

were collected through the Gonococcal Isolate Surveillance 

Project (GISP), a sentinel system of selected STD clinics 

located at 25–30 GISP sentinel sites and 4–5 regional 

laboratories in the United States. For more details on 

findings from GISP, go to: http://www.cdc.gov/std/GISP.

For 2013, the antimicrobial agents tested by GISP were 

ceftriaxone, cefixime, azithromycin, spectinomycin, 

ciprofloxacin, penicillin, and tetracycline. 

The antimicrobial susceptibility criteria used in GISP for 

2013 are as follows: 

t Ceftriaxone, minimum inhibitory concentration 

(MIC) ≥0.5 μg/ml (decreased susceptibility)*

t Ceftriaxone, MIC ≥0.125 μg/ml (elevated MICs)*

t Cefixime, MIC ≥0.5 μg/ml (decreased susceptibility)*

t Cefixime, MIC ≥0.25 μg/ml (elevated MICs)*

t Azithromycin, MIC ≥2.0 μg/ml (decreased 

susceptibility)*

t Spectinomycin, MIC ≥128.0 μg/ml (resistance)

t Ciprofloxacin, MIC ≥1.0 μg/ml (resistance)

t Ciprofloxacin, MIC 0.125–0.5 μg/ml (intermediate 

resistance)

t Penicillin, MIC ≥2.0 μg/ml (resistance)

t Tetracycline, MIC ≥2.0 μg/ml (resistance).

The majority of these criteria are also recommended by the 

Clinical and Laboratory Standards Institute (CLSI).7

Other Surveillance Data Sources

National Health and Nutrition 

Examination Survey

The National Health and Nutrition Examination Survey 

(NHANES) is a series of cross-sectional surveys designed 

to provide national statistics on the health and nutritional 

status of the general household population in the United 

States. Data are collected through household interviews, 

standardized physical examinations, and the collection of 

biological samples in special mobile examination centers. 

In 1999, NHANES became a continuous survey with data 

released every 2 years. The sampling plan of the survey 

is a stratified, multistage, probability cluster design that 

selects a sample representative of the U.S. civilian, noninstitutionalized population. For more information, see: 

http://www.cdc.gov/nchs/nhanes.htm.

National Disease and Therapeutic Index

The information on the number of initial visits to private 

physicians’ offices for STDs was based on analysis of data 

from the National Disease and Therapeutic Index (NDTI) 

(machine-readable files or summary statistics for 1966 

through 2013). NDTI is a probability sample survey of 

private physicians’ clinical management practices. For 

more information on this database, contact IMS Health, 

e-mail: ServiceCenter@us.imshealth.com; Telephone: 

(800) 523-5334.

Healthy People 2020 Objectives

For three decades, Healthy People has provided a 

comprehensive set of national 10-year health promotion 

and disease prevention objectives aimed at improving the 

health of all Americans.8

 It is grounded in the principle that 

establishing objectives and providing benchmarks to track 

and monitor progress over time can motivate, guide, and 

focus action.

Healthy People 2020 (HP2020) continues in the tradition 

of its ambitious, yet achievable, 10-year agenda for 

improving the Nation’s health. HP2020 is the result of a 

* The Clinical Laboratory Standards Institute criteria for decreased susceptibility and resistance to ceftriaxone, cefixime, cefpodoxime, and 

azithromycin and for susceptibility to azithromycin have not been established for N. gonorrhoeae.
STD Surveillance 2013 Appendix: Interpreting STD Surveillance Data 133

multiyear process that reflects input from a diverse group of 

individuals and organizations. HP2020 is organized into 42 

topic areas, with more than 1,200 measures designed drive 

action that will support its four overarching goals:

t Attain high-quality, longer lives free of preventable 

disease, disability, injury, and premature death.

t Achieve health equity, eliminate disparities, and 

improve the health of all groups.

t Create social and physical environments that promote 

good health for all.

t Promote quality of life, healthy development, and 

healthy behaviors across all life stages.

The topic area, Sexually Transmitted Diseases, contains 

objectives and measures related to STDs. Baselines, 

HP2020 targets, and annual progress toward the targets are 

reported in Table A3. The year 2020 targets for the diseases 

addressed in this report are as follows: P&S syphilis (males), 

6.8 cases per 100,000 population; P&S syphilis (females), 

1.4 cases per 100,000 population; congenital syphilis, 

9.1 cases per 100,000 live births; gonorrhea (females 

aged 15–44 years), 257.0 cases per 100,000 population 

and gonorrhea (males aged 15–44 years), 198.0 cases per 

100,000 population. 

1 U.S. Census Bureau. United States population estimates by age, 

sex and race: 1980–1988. In: Current population reports [Series 

P-25, No. 1045]. Washington, DC: U.S. Government Printing 

Office; 1990. 

2 U.S. Census Bureau. United States population estimates by age, 

sex and race: 1989. In: Current population reports [Series P-25, 

No. 1057]. Washington, DC: U.S. Government Printing Office; 

1990.

3 Centers for Disease Control and Prevention. Vital statistics of 

the United States 1988. vol.1 - natality. Hyattsville (MD): U.S. 

Department of Health and Human Services; 1990.

4 Office of Management and Budget. Standards for defining 

metropolitan and micropolitan statistical areas. Federal Register. 

2000;65(249):82228-38.

5 Office of Management and Budget. Revisions to the Standards 

for Classification of Federal Data on Race and Ethnicity. Federal 

Register Notice. October 30, 1997.

6 Kaufman RE, Jones OG, Blount JH, Wiesner PJ. Questionnaire 

survey of reported early congenital syphilis: problems in diagnosis, 

prevention, and treatment. Sex Transm Dis. 1977;4:135-9.

7 Clinical and Laboratory Standards Institute. Performance 

standards for antimicrobial susceptibility testing; twentieth 

informational supplement. M100-S23, 33(1). Wayne (PA): 

Clinical and Laboratory Standards Institute; 2013.

8 U.S. Department of Health and Human Services. Healthy People 

2020 Web site. [Accessed on 10/18/2013] http://healthypeople.

gov/2020/default.aspx.

The majority of the STD-related HP2020 targets were set 

using a standard percentage improvement with a standard 

default of a “10 percent improvement over the baseline.”

Government Performance and Results 

Act of 1993

The Government Performance and Results Act (GPRA) 

of 1993 was enacted by Congress to increase confidence 

in the capability of the federal government to increase 

the effectiveness and accountability of federal programs, 

to improve service delivery, to provide federal agencies 

a uniform tool for internal management, and to help 

Congress make decisions. 

GPRA requires each agency to have a performance 

plan with long-term outcomes and annual, measurable 

performance goals and to report on these plans annually, 

comparing results with annual goals. There are two GPRA 

goals for STD: reducing PID and eliminating congenital 

syphilis. Each of these goals has specific measures of 

progress, which are outlined in Table A4.
134 Appendix: Percentage Unknown STD Surveillance 2013

Table A1. Selected STDs — Percentage of Unknown, Missing, or Invalid Values for Selected 

Variables by State and by Nationally Notifiable STD, 2013

State

Primary and Secondary Syphilis Gonorrhea Chlamydia

Percentage 

Unknown 

Race/

Ethnicity

Percentage 

Unknown 

Age

Percentage 

Unknown 

Sex

Percentage 

Unknown 

Sex Partner

Percentage 

Unknown 

Race/

Ethnicity

Percentage 

Unknown 

Age

Percentage 

Unknown 

Sex

Percentage 

Unknown 

Race/

Ethnicity

Percentage 

Unknown 

Age

Percentage 

Unknown 

Sex

Alabama 12.6 0.0 0.0 30.6 29.1 0.1 0.3 32.6 0.2 0.6

Alaska 0.0 0.0 0.0 100.0 0.6 0.0 0.0 0.8 0.0 0.0

Arizona 1.4 0.0 0.0 8.0 15.7 0.0 0.0 19.4 0.0 0.0

Arkansas 1.1 0.0 0.0 7.3 10.0 0.1 0.1 13.3 0.1 0.1

California 6.7 0.2 0.1 12.0 25.7 0.6 0.2 34.9 0.5 0.1

Colorado 8.6 0.0 0.0 1.2 20.2 0.0 0.0 41.1 0.0 0.0

Connecticut 8.9 0.0 0.0 8.9 44.3 0.6 0.0 63.5 0.2 0.7

Delaware 0.0 0.0 0.0 69.2 2.4 0.0 0.0 4.4 0.0 0.0

District of Columbia 5.4 0.0 0.0 20.8 39.8 0.2 0.2 44.1 0.2 0.3

Florida 5.1 0.0 0.0 7.6 16.2 0.0 0.2 22.9 0.0 0.2

Georgia 1.7 0.0 0.0 29.2 32.5 0.1 0.8 42.1 0.2 0.9

Hawaii 4.3 0.0 0.0 17.4 46.2 0.0 0.0 51.1 0.1 0.0

Idaho 0.0 0.0 0.0 6.7 27.5 0.9 0.0 37.6 0.1 0.3

Illinois 1.6 0.0 0.1 20.1 15.0 0.0 0.1 19.0 0.0 0.1

Indiana 1.9 0.0 0.0 6.5 5.8 0.0 0.0 8.4 0.0 0.0

Iowa 2.8 0.0 0.0 9.4 7.0 0.0 0.0 8.2 0.0 0.0

Kansas 0.0 2.0 0.0 9.8 18.3 0.0 0.0 40.8 0.0 0.0

Kentucky 0.0 0.0 0.0 3.3 23.2 0.2 0.4 30.7 0.2 0.3

Louisiana 0.0 0.0 0.0 12.5 0.9 0.0 0.0 1.2 0.0 0.0

Maine 20.0 0.0 0.0 20.0 17.1 0.0 0.0 29.0 0.2 0.1

Maryland 1.8 0.0 0.0 5.0 16.8 0.3 0.1 25.1 0.1 0.1

Massachusetts 5.3 0.0 0.0 21.9 24.0 0.0 0.2 35.3 0.1 0.1

Michigan 0.4 0.0 0.0 9.2 29.5 0.1 0.1 33.0 0.1 0.2

Minnesota 7.8 0.0 1.6 4.1 22.0 0.0 0.0 28.5 0.0 0.0

Mississippi 2.6 0.0 0.0 3.8 15.7 0.0 0.0 19.4 0.1 0.0

Missouri 1.6 0.0 0.0 7.2 8.3 0.0 0.0 14.4 0.0 0.0

Montana* 20.0 0.0 0.0 20.0 11.6 0.0 0.0 6.3 0.8 0.0

Nebraska 12.2 0.0 0.0 31.7 26.1 0.2 1.2 36.9 0.1 2.2

Nevada 4.4 0.0 0.0 5.4 28.4 0.1 0.1 31.9 0.0 0.1

New Hampshire 3.6 0.0 0.0 25.0 5.8 0.0 0.0 10.3 0.0 0.0

New Jersey 1.3 0.0 0.0 21.9 36.6 0.8 0.2 51.7 0.6 0.3

New Mexico 15.4 0.0 0.0 3.8 27.3 0.0 0.0 36.4 0.0 0.1

New York 4.7 0.1 0.5 24.6 31.8 0.3 0.3 40.2 0.4 0.1

North Carolina 0.0 0.0 0.0 15.3 11.6 0.0 0.0 15.0 0.0 0.0

North Dakota 8.3 0.0 0.0 25.0 13.6 0.0 0.0 22.1 0.0 0.0

Ohio 0.0 0.0 0.0 7.1 20.1 0.2 0.0 26.8 0.2 0.0

Oklahoma 0.0 0.0 0.0 5.1 10.1 0.0 0.0 13.3 0.0 0.0

Oregon 2.2 0.0 0.0 24.3 8.2 0.0 0.0 22.5 0.0 0.0

Pennsylvania 5.1 0.0 0.0 18.7 28.4 0.0 0.1 35.3 0.0 0.1

Rhode Island 2.2 0.0 0.0 2.2 14.3 0.0 0.0 18.2 0.0 0.0

South Carolina 0.0 0.4 0.0 2.6 26.7 0.1 0.2 32.3 0.1 0.2

South Dakota 0.0 0.0 0.0 22.7 2.7 0.0 0.0 12.9 0.0 0.0

Tennessee 0.9 0.0 0.0 5.6 1.6 0.0 0.0 2.2 0.0 0.0

Texas 0.5 0.0 0.0 2.4 7.2 0.0 0.6 10.1 0.0 0.7

Utah 0.0 1.4 0.0 23.0 0.0 0.0 0.0 0.4 0.0 0.0

Vermont* 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.9 0.1 0.0

Virginia 0.3 0.0 0.0 7.0 19.9 0.2 0.0 29.8 0.1 0.1

Washington 20.1 0.0 0.0 3.2 17.3 0.0 0.0 21.3 0.1 0.0

West Virginia 0.0 0.0 0.0 20.0 10.1 0.0 0.0 14.4 0.0 0.0

Wisconsin 3.2 0.0 0.0 66.3 20.1 0.0 0.1 20.0 0.0 0.0

Wyoming* 0.0 0.0 0.0 0.0 13.6 0.0 0.0 14.9 0.0 0.0

U.S. TOTAL 3.8 0.1 0.1 13.5 19.4 0.2 0.2 26.0 0.1 0.2

* Percentages for primary and secondary syphilis are based on less than 10 cases.

Note: Unknown includes cases reported with unknown, missing, or invalid data values.
STD Surveillance 2013 Appendix: STD Reporting Source 135

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2013

Disease

Non-STD Clinic STD Clinic Total

Male Female Total* Male Female Total* Male† Female† Total‡

Chlamydia 285,308 814,541 1,102,005 69,680 54,590 124,603 405,652 993,348 1,401,906

Gonorrhea 115,734 128,460 244,630 33,408 14,076 47,615 169,130 163,208 333,004

Primary Syphilis 3,086 216 3,303 1,387 70 1,458 4,891 311 5,204

Secondary Syphilis 7,421 882 8,309 2,507 208 2,721 10,970 1,189 12,171

Early Latent Syphilis 9,983 1,720 11,722 3,248 563 3,812 14,465 2,443 16,929

Late and Late Latent Syphilis§ 10,716 4,665 15,399 2,266 737 3,003 15,540 6,256 21,819

Chancroid 6 4 10 0 0 0 6 4 10

* Total includes cases reported with unknown sex.

† Total includes cases reported with unknown reporting source.

‡ Total includes cases reported with unknown sex and reporting source.

§ Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other than 

neurosyphilis.
136 Appendix: Healthy People 2020 STD Surveillance 2013

Table A3. Healthy People 2020 (HP 2020) Sexually Transmitted Diseases Objectives 

HP2020 Objectives Baseline 

Year Baseline 2011 2012 2013 HP 2020 

Target

1 Reduce the proportion of adolescents and young adults with 

Chlamydia trachomatis infections

a. Among females aged 15 to 24 years attending family planning 

clinics

2008 7.4% 8.3% N/A N/A 6.7%

b. Among females aged 24 years and under enrolled in a National 

Job Training Program

2008 12.8% 10.4% 11.0% 11.7% 11.5%

c. Among males aged 24 years and under enrolled in a National Job 

Training Program

2008 7.0% 8.0% 7.0% 7.4% 6.3%

2 Increase the proportion of sexually active females aged 24 years 

and under enrolled in Medicaid plans who are screened for 

genital Chlamydia infections during the measurement year

a. Females aged 16 to 20 years 2008 52.7% 54.9% 53.5% N/A 70.9%

b. Females aged 21 to 24 years 2008 59.4% 63.4% 63.6% N/A 80.0%

3 Increase the proportion of sexually active females aged 24 

years and under enrolled in commercial health insurance plans 

who are screened for genital Chlamydia infections during the 

measurement year

a. Females aged 16 to 20 years 2008 40.1% 41.5% 41.4% N/A 61.3%

b. Females aged 21 to 24 years 2008 43.5% 48.4% 49.2% N/A 74.6%

4 Reduce the proportion of females aged 15 to 44 who have ever 

required treatment for pelvic inflammatory disease (PID)

2006-2008 4.0% N/A N/A N/A 3.6%

5 Reduce gonorrhea rates (cases per 100,000 population)

a. Females aged 15 to 44 years 2008 285.0 264.8 264.7 250.6 257.0

b. Males aged 15 to 44 years 2008 220.4 217.7 232.1 239.4 198.0

6 Reduce sustained domestic transmission of primary and 

secondary syphilis (cases per 100,000 population)

a. Among females 2008 1.5 0.9 0.9 0.9 1.4

b. Among males 2008 7.5 8.1 9.3 10.3 6.8

7 Reduce congenital syphilis 2008 10.5 8.7 7.8 8.7 9.1

8 Reduce the proportion of females with human papillomavirus 

(HPV) Infection (DEVELOPMENTAL)

a. Females with types 6 and 11 2003-2006 3.2 N/A N/A N/A N/A

b. Females with types 16 and 18 2003-2006 6.2 N/A N/A N/A N/A

c. Females with other types 2003-2006 40.3 N/A N/A N/A N/A

9 Reduce the proportion of young adults with genital herpes 

infection due to herpes simplex type 2

2005-2008 10.5% 8.3%* N/A 9.5%

HP2020 

Objectives Data Source

1 a National Notifiable Disease Surveillance System (NNDSS), NCHHSTP, CDC

1b, 1c National Job Training Program, STD Surveillance System (STDSS), NCHHSTP, CDC

2a, 2b Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)

3a, 3b Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)

4 2006-2010 National Survey of Family Growth (NSFG), NCHS, CDC

5a, 5b STD Surveillance System (STDSS), NCHHSTP, CDC

6a, 6b STD Surveillance System (STDSS), NCHHSTP, CDC

7 STD Surveillance System (STDSS), NCHHSTP, CDC

8a, 8b NHANES, CDC, NCHS and the National Health Interview Survey (NHIS), CDC

8c NHANES, CDC, NCHS

9 NHANES, CDC, NCHS

* The HSV seroprevalence for 20–29 year olds is reported for years 2011–2012. Data from each individual year is not available.
STD Surveillance 2013 Appendix: GPRA Goals 137

Table A4. Government Performance and Results Act (GPRA) Sexually Transmitted Diseases Goals, 

Measures, and Target

GPRA Goals

Actual Target

2011 2012 2013 2014

Goal 1: Reduction in PID (as measured by initial visits to physicians 

in women 15–44 years of age) 90,000 106,000 88,000 98,800

a. Proportion of high-risk women aged 16-20 infected with chlamydia* 13.1† 12.4† 13.3 12.1

b. Proportion of high-risk women aged 21-24 infected with chlamydia* 9.1† 8.9† 9.4 8.6

c. Rate of gonorrhea/100,000 population in women aged 16-20 663 618.5 551.9 587.6

d. Rate of gonorrhea/100,000 population in women aged 21-24 536.9 545.3 513.8 524.2

e. Black: white ratio of gonorrhea in women 16-24 13.6 12.4 11.1 11.2

f. Proportion of sexually active females 16-20 enrolled in Medicaid 

who are screened for chlamydia infections 54.9 53.5 N/A 59.7

g. Proportion of sexually active females 21-24 enrolled in Medicaid 

who are screened for chlamydia infections 63.4 63.6 N/A 70.9

h. Proportion of sexually active females 16-20 enrolled in commercial 

health insurance plans who are screened for chlamydia infections 41.5 41.1 N/A 47.2

i. Proportion of sexually active females 21-24 enrolled in commercial 

health insurance plans who are screened for chlamydia infections 48.4 49.2 N/A 56.7

Goal 2: Elimination of Congenital Syphilis

a. Incidence of P&S syphilis/100,000 population in women aged 15-44 2.1 2.1 2.1 1.8

b. Incidence of congenital syphilis/100,000 live births 8.7 8.4 8.7 7.2

c. Proportion of pregnant women that are screened for syphilis at least 

one month before delivery 83.0 85.0 N/A 81.9

GPRA Goals Data Source

1 National Disease and Therapeutic Index (IMS Health)

1a, 1b National Job Training Program

1c, 1d, 1e STD Surveillance System (STDSS), NCHHSTP, CDC

1f, 1g, 1h, 1i Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)

2a, 2b STD Surveillance System (STDSS), NCHHSTP, CDC

2c Marketscan. Thomson Reuters (Healthcare) Inc.

* Median state-specific chlamydia prevalence/positivity among states with >100 females in this age group entering the National Job Training Program. †

 In FY 2013 CDC improved the calculation of these data to increase the stability of estimate over time. Data for 2010 and later years reflect this improved 

calculation method.

GPRA= Government Performance and Results Act; PID= pelvic inflammatory disease; P&S= primary and secondary.
138 Appendix: STD Surveillance Case Definitions STD Surveillance 2013

STD Surveillance Case Definitions

PART 1. CASE DEFINITIONS1 FOR NATIONALLY NOTIFIABLE 

INFECTIOUS DISEASES

Chancroid (Revised 9/96)

Clinical description

A sexually transmitted disease characterized by painful genital ulceration and inflammatory inguinal adenopathy. The 

disease is caused by infection with Haemophilus ducreyi.

Laboratory criteria for diagnosis

t Isolation of H. ducreyi from a clinical specimen

Case classification

Probable: a clinically compatible case with both a) no evidence of Treponema pallidum infection by darkfield microscopic 

examination of ulcer exudate or by a serologic test for syphilis performed ≥7 days after onset of ulcers and b) either a clinical 

presentation of the ulcer(s) not typical of disease caused by herpes simplex virus (HSV) or a culture negative for HSV.

Confirmed: a clinically compatible case that is laboratory confirmed

Chlamydia trachomatis, Infection (Revised 6/09)

Clinical description

Infection with Chlamydia trachomatis may result in urethritis, epididymitis, cervicitis, acute salpingitis, or other 

syndromes when sexually transmitted; however, the infection is often asymptomatic in women. Perinatal infections 

may result in inclusion conjunctivitis and pneumonia in newborns. Other syndromes caused by C. trachomatis include 

lymphogranuloma venereum (see Lymphogranuloma Venereum) and trachoma.

Laboratory criteria for diagnosis

t Isolation of C. trachomatis by culture or

t Demonstration of C. trachomatis in a clinical specimen by detection of antigen or nucleic acid

Case classification

Confirmed: a case that is laboratory confirmed

Gonorrhea (Revised 9/96)

Clinical description

A sexually transmitted infection commonly manifested by urethritis, cervicitis, or salpingitis. Infection may be asymptomatic.

1 Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance, 1997. MMWR 

Morb Mortal Wkly Rep. 1997;46(No. RR-10).
STD Surveillance 2013 Appendix: STD Surveillance Case Definitions 139

Laboratory criteria for diagnosis

t Isolation of typical gram-negative, oxidase-positive diplococci (presumptive Neisseria gonorrhoeae) from a clinical 

specimen, or

t Demonstration of N. gonorrhoeae in a clinical specimen by detection of antigen or nucleic acid, or

t Observation of gram-negative intracellular diplococci in a urethral smear obtained from a male

Case classification

Probable: a) demonstration of gram-negative intracellular diplococci in an endocervical smear obtained from a female or b) 

a written morbidity report of gonorrhea submitted by a physician

Confirmed: a case that is laboratory confirmed

Syphilis (All Definitions Revised 9/96)

Syphilis is a complex sexually transmitted disease that has a highly variable clinical course. Classification by a clinician with 

expertise in syphilis may take precedence over the following case definitions developed for surveillance purposes.

Syphilis, primary

Clinical description

A stage of infection with Treponema pallidum characterized by one or more chancres (ulcers); chancres might differ 

considerably in clinical appearance.

Laboratory criteria for diagnosis

t Demonstration of T. pallidum in clinical specimens by darkfield microscopy, direct fluorescent antibody (DFA-TP), 

or equivalent methods

Case classification

Probable: a clinically compatible case with one or more ulcers (chancres) consistent with primary syphilis and a reactive 

serologic test (nontreponemal: Venereal Disease Research Laboratory [VDRL] or rapid plasma reagin [RPR]; treponemal: 

fluorescent treponemal antibody absorbed [FTA-ABS] or microhemagglutination assay for antibody to T. pallidum [MHATP])

Confirmed: a clinically compatible case that is laboratory confirmed

Syphilis, secondary

Clinical description

A stage of infection caused by T. pallidum and characterized by localized or diffuse mucocutaneous lesions, often with 

generalized lymphadenopathy. The primary chancre may still be present.

Laboratory criteria for diagnosis

t Demonstration of T. pallidum in clinical specimens by darkfield microscopy, DFA-TP, or equivalent methods

Case classification

Probable: a clinically compatible case with a nontreponemal (VDRL or RPR) titer ≥4

Confirmed: a clinically compatible case that is laboratory confirmed
140 Appendix: STD Surveillance Case Definitions STD Surveillance 2013

Syphilis, latent

Clinical description

A stage of infection caused by T. pallidum in which organisms persist in the body of the infected person without causing 

symptoms or signs. Latent syphilis is subdivided into early, late, and unknown categories based on the duration of 

infection.

Case classification

Probable: no clinical signs or symptoms of syphilis and the presence of one of the following:

No past diagnosis of syphilis, a reactive nontreponemal test (i.e., VDRL or RPR), and a reactive treponemal test (i.e., FTAABS or MHA-TP)

A past history of syphilis therapy and a current nontreponemal test titer demonstrating fourfold or greater increase from 

the last nontreponemal test titer

Syphilis, early latent

Clinical description

A subcategory of latent syphilis. When initial infection has occurred within the previous 12 months, latent syphilis is 

classified as early latent.

Case classification

Probable: latent syphilis (see Syphilis, latent) in a person who has evidence of having acquired the infection within the 

previous 12 months based on one or more of the following criteria:

t Documented seroconversion or fourfold or greater increase in titer of a nontreponemal test during the previous 12 

months

t A history of symptoms consistent with primary or secondary syphilis during the previous 12 months

t A history of sexual exposure to a partner who had confirmed or probable primary or secondary syphilis or probable 

early latent syphilis (documented independently as duration <1 year)

t Reactive nontreponemal and treponemal tests from a person whose only possible exposure occurred within the 

preceding 12 months

Syphilis, late latent

Clinical description

A subcategory of latent syphilis. When initial infection has occurred >1 year previously, latent syphilis is classified as late 

latent.

Case classification

Probable: latent syphilis (see Syphilis, latent) in a patient who has no evidence of having acquired the disease within the 

preceding 12 months (see Syphilis, early latent) and whose age and titer do not meet the criteria specified for latent syphilis 

of unknown duration.
STD Surveillance 2013 Appendix: STD Surveillance Case Definitions 141

Syphilis, latent, of unknown duration

Clinical description

A subcategory of latent syphilis. When the date of initial infection cannot be established as having occurred within the 

previous year and the patient’s age and titer meet criteria described below, latent syphilis is classified as latent syphilis of

unknown duration.

Case classification

Probable: latent syphilis (see Syphilis, latent) that does not meet the criteria for early latent syphilis, and the patient is aged 

13–35 years and has a nontreponemal titer ≥32

Neurosyphilis

Note

Since neurosyphilis can occur at almost any stage of syphilis, it was classified and reported, between 1996 and 2005, as 

one of several mutually exclusive stages of syphilis. In 2005, the Division of STD Prevention requested that STD control 

programs discontinue classifying and reporting neurosyphilis as a distinct stage of syphilis. Since 2005, if the patient has 

confirmed or probably neurosyphilis, the case should be reported as the appropriate state of syphilis and neurological 

manifestations should be noted.

Clinical description

Evidence of central nervous system infection with T. pallidum

Laboratory criteria for diagnosis

A reactive serologic test for syphilis and reactive VDRL in cerebrospinal fluid (CSF) 

Case classification

Probable: syphilis of any stage, a negative VDRL in CSF, and both of the following:

t Elevated CSF protein or leukocyte count in the absence of other known causes of these abnormalities

t Clinical symptoms or signs consistent with neurosyphilis without other known causes for these clinical abnormalities

Confirmed: syphilis of any stage that meets the laboratory criteria for neurosyphilis

Syphilis, late, with clinical manifestations other than Neurosyphilis (late benign syphilis and 

cardiovascular syphilis)

Clinical description

Clinical manifestations of late syphilis other than neurosyphilis may include inflammatory lesions of the cardiovascular 

system, skin, and bone. Rarely, other structures (e.g., the upper and lower respiratory tracts, mouth, eye, abdominal organs, 

reproductive organs, lymph nodes, and skeletal muscle) may be involved. Late syphilis usually becomes clinically manifest 

only after a period of 15–30 years of untreated infection.

Laboratory criteria for diagnosis

t Demonstration of T. pallidum in late lesions by fluorescent antibody or special stains (although organisms are rarely 

visualized in late lesions)
142 Appendix: STD Surveillance Case Definitions STD Surveillance 2013

Case classification

Probable: characteristic abnormalities or lesions of the cardiovascular system, skin, bone, or other structures with a reactive 

treponemal test, in the absence of other known causes of these abnormalities, and without CSF abnormalities and clinical 

symptoms or signs consistent with neurosyphilis

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Analysis of CSF for evidence of neurosyphilis is necessary in the evaluation of late syphilis with clinical manifestations.

Syphilitic Stillbirth

Clinical description

A fetal death that occurs after a 20-week gestation or in which the fetus weighs >500 g and the mother had untreated or 

inadequately* treated syphilis at delivery

Comment

For reporting purposes, syphilitic stillbirths should be reported as cases of congenital syphilis.

Syphilis, Congenital (Revised 9/96)

Clinical description

A condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, and only severe 

cases are clinically apparent at birth. An infant or child (aged <2 years) may have signs such as hepatosplenomegaly, rash, 

condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or 

malnutrition). An older child may have stigmata (e.g., interstitial keratitis, nerve deafness, anterior bowing of shins, frontal 

bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints).

Laboratory criteria for diagnosis

t Demonstration of T. pallidum by darkfield microscopy, fluorescent antibody, or other specific stains in specimens 

from lesions, placenta, umbilical cord, or autopsy material

Case classification

Probable: a condition affecting an infant whose mother had untreated or inadequately treated* syphilis at delivery, regardless 

of signs in the infant, or an infant or child who has a reactive treponemal test for syphilis and any one of the following:

t Any evidence of congenital syphilis on physical examination

t Any evidence of congenital syphilis on radiographs of long bones

t A reactive cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL)

t An elevated CSF cell count or protein (without other cause)

t A reactive fluorescent treponemal antibody absorbed—19S-IgM antibody test or IgM enzyme-linked immunosorbent 

assay

Confirmed: a case that is laboratory confirmed

* Inadequate treatment consists of any nonpenicillin therapy or penicillin administered < 30 days before delivery.
STD Surveillance 2013 Appendix: STD Surveillance Case Definitions 143

Comment

Congenital and acquired syphilis may be difficult to distinguish when a child is seropositive after infancy. Signs of 

congenital syphilis may not be obvious, and stigmata may not yet have developed. Abnormal values for CSF VDRL, 

cell count, and protein, as well as IgM antibodies, may be found in either congenital or acquired syphilis. Findings on 

radiographs of long bones may help because radiographic changes in the metaphysis and epiphysis are considered classic 

signs of congenitally acquired syphilis. The decision may ultimately be based on maternal history and clinical judgment. 

In a young child, the possibility of sexual abuse should be considered as a cause of acquired rather than congenital syphilis, 

depending on the clinical picture. For reporting purposes, congenital syphilis includes cases of congenitally acquired 

syphilis among infants and children as well as syphilitic stillbirths. 
144 Appendix: STD Surveillance Case Definitions STD Surveillance 2013

PART 2. CASE DEFINITIONS1 FOR NON-NOTIFIABLE 

INFECTIOUS DISEASES

Genital Herpes (Herpes Simplex Virus) (Revised 9/96)

Clinical description

A condition characterized by visible, painful genital or anal lesions

Laboratory criteria for diagnosis

t Isolation of herpes simplex virus from cervix, urethra, or anogenital lesion, or

t Demonstration of virus by antigen detection technique in clinical specimens from cervix, urethra, or anogenital 

lesion, or

t Demonstration of multinucleated giant cells on a Tzanck smear of scrapings from an anogenital lesion

Case classification

Probable: a clinically compatible case (in which primary and secondary syphilis have been excluded by appropriate serologic 

tests and darkfield microscopy, when available) with either a diagnosis of genital herpes based on clinical presentation 

(without laboratory confirmation) or a history of one or more previous episodes of similar genital lesions

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Genital herpes should be reported only once per patient. The first diagnosis for a patient with no previous diagnosis should 

be reported.

Genital Warts (Revised 9/96)

Clinical description

An infection characterized by the presence of visible, exophytic (raised) growths on the internal or external genitalia, 

perineum, or perianal region

Laboratory criteria for diagnosis

t Histopathologic changes characteristic of human papillomavirus infection in specimens obtained by biopsy or 

exfoliative cytology or

t Demonstration of virus by antigen or nucleic acid detection in a lesion biopsy

Case classification

Probable: a clinically compatible case without histopathologic diagnosis and without microscopic or serologic evidence that 

the growth is the result of secondary syphilis

Confirmed: a clinically compatible case that is laboratory confirmed

1 Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance, 1997. MMWR 

Morb Mortal Wkly Rep. 1997;46(No. RR-10).
STD Surveillance 2013 Appendix: STD Surveillance Case Definitions 145

Comment

Genital warts should be reported only once per patient. The first diagnosis for a patient with no previous diagnosis should 

be reported.

Granuloma Inguinale

Clinical description

A slowly progressive ulcerative disease of the skin and lymphatics of the genital and perianal area caused by infection with 

Calymmatobacterium granulomatis. A clinically compatible case would have one or more painless or minimally painful 

granulomatous lesions in the anogenital area.

Laboratory criteria for diagnosis

t Demonstration of intracytoplasmic Donovan bodies in Wright or Giemsa-stained smears or biopsies of granulation tissue

Case classification

Confirmed: a clinically compatible case that is laboratory confirmed

Lymphogranuloma Venereum

Clinical description

Infection with L1, L2, or, L3 serovars of Chlamydia trachomatis may result in a disease characterized by genital lesions, 

suppurative regional lymphadenopathy, or hemorrhagic proctitis. The infection is usually sexually transmitted.

Laboratory criteria for diagnosis

t Isolation of C. trachomatis, serotype L1, L2, or L3 from clinical specimen, or

t Demonstration by immunofluorescence of inclusion bodies in leukocytes of an inguinal lymph node (bubo) aspirate, or

t Positive microimmunofluorescent serologic test for a lymphogranuloma venereum strain of C. trachomatis

Case classification

Probable: a clinically compatible case with one or more tender fluctuant inguinal lymph nodes or characteristic 

proctogenital lesions with supportive laboratory findings of a single C. trachomatis complement fixation titer of >64

Confirmed: a clinically compatible case that is laboratory confirmed

Mucopurulent Cervicitis (Revised 9/96)

Clinical description

Cervical inflammation that is not the result of infection with Neisseria gonorrhoeae or Trichomonas vaginalis. Cervical 

inflammation is defined by the presence of one of the following criteria:

t Mucopurulent secretion (from the endocervix) that is yellow or green when viewed on a white, cotton-tipped swab 

(positive swab test)

t Induced endocervical bleeding (bleeding when the first swab is placed in the endocervix)
146 Appendix: STD Surveillance Case Definitions STD Surveillance 2013

Laboratory criteria for diagnosis

No evidence of N. gonorrhoeae by culture, Gram stain, or antigen or nucleic acid detection, and no evidence of T. vaginalis

on wet mount

Case classification

Confirmed: a clinically compatible case in a female who does not have either gonorrhea or trichomoniasis

Comment

Mucopurulent cervicitis (MPC) is a clinical diagnosis of exclusion. The syndrome may result from infection with any of 

several agents (see Chlamydia trachomatis, Genital Infections). If gonorrhea, trichomoniasis, and chlamydia are excluded, a 

clinically compatible illness should be classified as MPC. An illness in a female that meets the case definition of MPC and 

C. trachomatis infection should be classified as chlamydia.

Nongonococcal Urethritis (Revised 9/96)

Clinical description

Urethral inflammation that is not the result of infection with Neisseria gonorrhoeae. Urethral inflammation may be 

diagnosed by the presence of one of the following criteria:

t A visible abnormal urethral discharge, or

t A positive leukocyte esterase test from a male aged <60 years who does not have a history of kidney disease or bladder 

infection, prostate enlargement, urogenital anatomic anomaly, or recent urinary tract instrumentation, or

t Microscopic evidence of urethritis (≥5 white blood cells per high-power field) on a Gram stain of a urethral smear

Laboratory criteria for diagnosis

t No evidence of N. gonorrhoeae infection by culture, Gram stain, or antigen or nucleic acid detection

Case classification

Confirmed: a clinically compatible case in a male in whom gonorrhea is not found, either by culture, Gram stain, or antigen 

or nucleic acid detection

Comment

Nongonococcal urethritis (NGU) is a clinical diagnosis of exclusion. The syndrome may result from infection with any 

of several agents (see Chlamydia trachomatis, Genital Infection). If gonorrhea and chlamydia are excluded, a clinically 

compatible illness should be classified as NGU. An illness in a male that meets the case definition of NGU and C. 

trachomatis infection should be classified as chlamydia.
STD Surveillance 2013 Appendix: STD Surveillance Case Definitions 147

Pelvic Inflammatory Disease (Revised 9/96)

Clinical case definition

A clinical syndrome resulting from the ascending spread of microorganisms from the vagina and endocervix to the 

endometrium, fallopian tubes, and/or contiguous structures. In a female who has lower abdominal pain and who has not 

been diagnosed as having an established cause other than pelvic inflammatory disease (PID) (e.g., ectopic pregnancy, acute 

appendicitis, and functional pain), all the following clinical criteria must be present:

t Lower abdominal tenderness, and

t Tenderness with motion of the cervix, and

t Adnexal tenderness

In addition to the preceding criteria, at least one of the following findings must also be present:

t Meets the surveillance case definition of C. trachomatis infection or gonorrhea

t Temperature >100.4 F (>38.0 C)

t Leukocytosis >10,000 white blood cells/mm3

t Purulent material in the peritoneal cavity obtained by culdocentesis or laparoscopy

t Pelvic abscess or inflammatory complex detected by bimanual examination or by sonography

t Patient is a sexual contact of a person known to have gonorrhea, chlamydia, or nongonococcal urethritis

Case classification

Confirmed: a case that meets the clinical case definition

Comment

For reporting purposes, a clinician’s report of PID should be counted as a case.
148 Appendix: Contributors STD Surveillance 2013

Contributors

We gratefully acknowledge the contributions of state STD project directors, STD program managers, state and territorial 

epidemiologists, and laboratory directors. The persons listed were in the positions shown as of September 10, 2014.

State/City/Outlying Area STD Project Directors STD Program Managers State Epidemiologists Laboratory Directors

Alabama Anthony Merriweather Anthony Merriweather Mary McIntyre Sharon Massingale

Alaska Susan Jones Donna Cecere Joe McLaughlin Bernard Jilly

Arizona Roxanne Ereth Roxanne Ereth Kenneth Komatsu Victor Waddell

Arkansas Miriam Ibrahim Brandi Roberts Dirk Haselow Glen Baker

California Heidi Bauer Romni Neiman Gilberto Chavez Paul Kimsey

Los Angeles Michael Green Vacant Gilberto Chavez Nicole Green (Acting)

San Francisco Trang Nguyen Nora Macias Gilberto Chavez Mark Pandori

Colorado Melanie Mattson Rebecca Jordan-Yehle Lisa Miller Laura Gillim-Ross

Connecticut Lynn Sosa Heidi Jenkins Matthew Cartter John Fontana

Delaware Catherine Mosley Catherine Mosley Tabatha Offutt-Powell (Acting) Christina Pleasanton

District of Columbia Michael Kharfen Michael Kharfen John Davies-Cole Alpha Diallo (Acting)

Florida Adrian Cooksey Kisha Gaines Anna Likos Susanne R. Crowe (Acting)

Georgia Michelle Allen Michelle Allen Cherie Drenzek Elizabeth Franko

Hawaii Peter Whiticar Gerald “Luke” Hasty, Jr. Sarah Park A. Christian Whelen

Idaho Aimee Shipman Aimee Shipman Christine Hahn Christopher Ball

Illinois Rich Zimmerman Rich Zimmerman Craig Conover Tom Johnson

Chicago Nanette Benbow Vacant Craig Conover Susan Gerber

Indiana Andrea Allen Andrea Allen Pamela Pontones Judith Lovchik

Iowa Randy Mayer George Walton Patricia Quinlisk Christopher Atchison

Kansas Jennifer VandeVelde Jennifer VandeVelde Charles Hunt Leo Henning

Kentucky Vacant Chang Lee Kraig Humbaugh Paul Bachner

Louisiana DeAnn Gruber Jeff Hitt Raoult Ratard Stephen Martin

Maine James Markiewicz Sarah Bly Sara Robinson (Acting) Kenneth Pote

Maryland Barbara Conrad Barbara Conrad David Blythe Robert Myers

Baltimore Patrick Chaulk Patrick Chaulk David Blythe Jack DeBoy

Massachusetts Brenda Cole David Goudreau Alfred DeMaria Michael Pentella

Michigan Amna Osman Karen Krzanowski Corrine Miller Sandip Shah

Minnesota Marcie Babcock Marcie Babcock Ruth Lynfield Joanne Bartkus

Mississippi Nicholas Mosca David Peyton Thomas Dobbs Daphne Ware

Missouri Ingrid Denney Ken Palermo George Turabelidze Bill Whitmar

Montana Cara Murolo Cara Murolo Carol Ballew Ron Paul

Nebraska Jeri Weberg-Bryce Jeri Weberg-Bryce Thomas Safranek Steve Hinrichs

Nevada Sandi Larson Jon Basilio Ishan Azzam L. Dee Brown

New Hampshire Donna M. Mombourquette Lindsay Pierce Benjamin Chan Christine Bean

New Jersey Connie F. Calisti-Meyers Patricia Mason Christina Tan Onesia Bishop

New Mexico Andrew Gans Janine Waters Michael Landen David Mills

New York Alison Muse Vacant Debra Blog Jill Taylor (Acting)

New York City Susan Blank Vacant Debra Blog Jennifer Rakeman

North Carolina Jacquelyn Clymore Pete Moore Megan Davies Scott Zimmerman

North Dakota Kirby Kruger Lindsey VanderBusch Tracy Miller Myra Kosse

Ohio Jamie Blair Thomas Joyce Mary DiOrio Rosemarie Gearhart

Oklahoma Jan Fox Kristen Eberly Kristy Bradley S. Terrance Dunn

Oregon Veda Latin Ruth Helsley Katrina Hedberg Michael Skeels

Pennsylvania Beth Butler Faith Blough Maria Moll (Acting) Julia Kiehlbauch

Philadelphia Melinda Salmon Melinda Salmon Maria Moll (Acting) Kerry Buchs

Rhode Island Vacant Jaime Comella Utpala Bandy Ewa King

South Carolina Janice Tapp Bernard Gilliard Linda Bell Shahiedy Shahied

South Dakota Amanda Gill Amanda Gill Lon Kightlinger Michael Smith

Tennessee Brad Beasely Tim Jones James Gibson

Texas Feipe Rocha Shelley Lucas Linda Gaul Grace Kubin

Utah Erin Fratto Lynn Meinor Allyn Nakashima Robyn Atkinson-Dunn

Vermont Daniel Daltry Vacant Patsy Kelso/ Lori Cragin Mary Celotti

Virginia Diana Jordan Oana Vasiliu Laurie Forlano Thomas York

Washington David Kern David Kern Wayne Turnberg/Cathy Wasserman Romesh Gautom

West Virginia Susan Hall Ken Gould Loretta Haddy Sharon Lee Cibrik

Wisconsin Diane Christen Anthony Wade Henry Anderson/Jeffrey Davis Charles Brokopp

Wyoming Vacant Tai Cooper Tracy Murphy Richard Harris

American Samoa Fara M. Utu Fetaui V. Saelua Scott Anesi Mary Matau

Federated States of Micronesia Vita Skilling Mayleen Ekiek Vita Skilling Lisa Barrow

Government of the Marshall Islands Julia Alfred Adela Sibok Daniel Lamar Anne Chang Gum

Northern Marianas (CNMI) John Dax Moreno John Dax Moreno Edward Diaz Philip Dauterman

Guam James W. Gillan Bernadette P. Schumann Robert L. Haddock Vacant

Puerto Rico Greduvel Duran-Guzman Trinidad Garcia-Vargas Brenda Rivera-Garcia Myriam Garcia-Negron (Acting)

Republic of Palau Berrymoon Watson Sherilynn Madraisau Dawn Fitzgibbons Francis Termeteet

Virgin Islands Gritell Martinez Jasper Lettsome Thomas Morris Joseph Mark