Sexually Transmitted Disease 

Surveillance 2016
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Centers for Disease Control and Prevention: STD Surveillance 2016

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Sexually

Transmitted 

Disease 

Surveillance 

2016

Division of STD Prevention 

September 2017

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, 30329-4027
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Centers for Disease Control and Prevention: STD Surveillance 2016

This report was prepared by

Surveillance and Data Management Branch

Division of STD Prevention

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

Centers for Disease Control and Prevention

Jim Braxton

Darlene Davis 

Elaine Flagg 

Jeremy Grey

LaZetta Grier 

Alesia Harvey 

Sarah Kidd 

Kristen Kreisel 

Eloisa Llata 

Rodney Presley 

Viani Ramirez 

Steven Shapiro

Mark Stenger 

Elizabeth Torrone 

Hillard Weinstock 

Emily Weston

Others contributing to the production and dissemination of this publication

Division of STD Prevention

Diane Ballard 

Gail Bolan 

Keith Davis

Lori Elmore

Suzanne Haecker 

Jaeyoung Hong

Joseph Kang

Rachel Powell 

Raul Romaguera

Salina Smith

Guoyu Tao 

Jo Valentine

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.
Centers for Disease Control and Prevention: STD Surveillance 2016

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 2016. Atlanta: U.S. Department 

of Health and Human Services; 2017.

Web Site

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

Selected STD Surveillance and Prevention References and Web Sites

STD Surveillance Reports 1993–2015

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

STD Data in the NCHHSTP Atlas

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

STD Data on Wonder

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

STD Data Management & Information Technology

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

STD Fact Sheets

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

STD Treatment Guidelines

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

STD Program Evaluation Guidelines

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

STD Program Operation Guidelines

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

Recommendations for Public Health Surveillance of Syphilis in the United States

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

Behavioral Surveillance

Youth Risk Behavior Surveillance System: 

https://www.cdc.gov/healthyyouth/data/yrbs/index.htm

National Survey of Family Growth

https://www.cdc.gov/nchs/nsfg.htm
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Centers for Disease Control and Prevention: STD Surveillance 2016

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Foreword

Sexually transmitted diseases (STDs) have long been an 

underestimated opponent in the public health battle. A 

1997 Institute of Medicine (IOM) report described STDs 

as, “hidden epidemics of tremendous health and economic 

consequence in the United States,” and stated that the 

“scope, impact, and consequences of STDs are underrecognized by the public and healthcare professionals.”1

Since well before this report was published, and nearly 

two decades later, those facts remain unchanged.

It is estimated that there are 20 million new STDs in the 

U.S. each year, and half of these are among young people 

ages 15 to 24 years. Across the nation, at any given time, 

there are more than 110 million total (new and existing) 

infections.2

 These infections can lead to long-term health 

consequences, such as infertility; they can facilitate HIV 

transmission; and they have stigmatized entire subgroups 

of Americans.

Yet not that long ago, gonorrhea rates were at historic 

lows, syphilis was close to elimination, and we were 

able to point to advances in STD prevention, such as 

better chlamydia diagnostic tests and more screening, 

contributing to increases in detection and treatment of 

chlamydial infections. That progress has since unraveled. 

The number of reported syphilis cases is climbing after 

being largely on the decline since 1941, and gonorrhea 

rates are now increasing. This is especially concerning 

given that we are slowly running out of treatment options 

to cure Neisseria gonorrhoeae. Many young women 

continue to have undiagnosed chlamydial infections, 

putting them at risk for infertility.

Beyond the impact on an individual’s health, STDs are 

also an economic drain on the U.S. healthcare system. 

Data suggest the direct cost of treating STDs in the 

U.S. is nearly $16 billion annually.3

 STD public health 

programs are increasingly facing challenges and barriers 

in achieving their mission. In 2012, 52% of state and local 

STD programs experienced budget cuts. This amounts to 

reductions in clinic hours, contact tracing, and screening 

for common STDs. CDC estimates that 21 local health 

department STD clinics closed that year.

It is imperative that federal, state, and local programs 

employ strategies that maximize long-term population 

impact by reducing STD incidence and promoting sexual, 

reproductive, maternal, and infant health. The resurgence 

of syphilis, and particularly congenital syphilis, is not an 

arbitrary event, but rather a symptom of a deteriorating 

public health infrastructure and lack of access to health 

care. It is exposing hidden, fragile populations in need 

that are not getting the health care and preventive services 

they deserve. This points to our need for public health and 

health care action for each of the cases in this report, as 

they represent real people, not just numbers.

We also need to modernize surveillance to move beyond 

counting only those cases in persons who have access to 

diagnosis and treatment, to develop innovative strategies 

to understand the burden of disease in those who may 

not access care, and to improve our surveillance systems 

to collect the information needed to target prevention 

activities. Further, it will be important for us to measure 

and monitor the adverse health consequences of STDs, 

such as ocular and neurosyphilis, pelvic inflammatory 

disease, ectopic pregnancy, infertility, HIV, congenital 

syphilis, and neonatal herpes.

It is my hope that a decade from now, we will be reporting 

on progress, instead of more health inequity in our society. 

This is our challenge and our call to effectively respond to 

the information shared in this report.

Gail Bolan, M.D.

Director, Division of STD Prevention

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

TB Prevention

U.S. Centers for Disease Control and Prevention

References

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.

2. Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections 

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

Transm Dis 2013; 40(3):187–193. DOI: 10.1097/OLQ.0b013e318286bb53. 

Review.

3. Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct 

medical cost of selected sexually transmitted infections in the United 

States, 2008. Sex Transm Dis 2013; 40(3):197–201. DOI: 10.1097/

OLQ.0b013e318285c6d2.
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Preface

Sexually Transmitted Disease Surveillance 2016 presents 

statistics and trends for sexually transmitted diseases 

(STDs) in the United States through 2016. 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 (CDC) 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.

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 

or Other Pacific Islander, White, and Multirace. While all 

states and the District of Columbia collect and report data 

for all STDs in formats compliant with these standards 

as of 2016, some jurisdictions only recently adopted this 

standard and used previous standards to report their case 

data to CDC in past years. Consequently, historical trend 

and rate data by race/ethnicity displayed in figures and 

interpreted in this report for 2012–2016 include only those 

jurisdictions reporting in the current standard consistently 

each year from 2012 through 2016.

Sexually Transmitted Disease Surveillance 2016 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 NE, Mailstop E-02 

Atlanta, Georgia 30329-4027
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Guide to Acronyms

AI/AN American Indians/Alaska Natives

CDC Centers for Disease Control and Prevention

CI confidence interval

CIA chemiluminescence immunoassay

CIN2+ cervical intraepithelial neoplasia grades 2 and 3

CS congenital syphilis

CSF cerebrospinal fluid

CSTE Council of State and Territorial Epidemiologists

EIA enzyme immunoassay

EP ectopic pregnancy

FTA-ABS fluorescent treponemal antibody absorbed 

GISP Gonococcal Isolate Surveillance Project

HD health department

HEDIS Healthcare Effectiveness Data and Information Set 

HMOs health maintenance organizations

HIV human immunodeficiency virus

HP2020 Healthy People 2020

HPV human papillomavirus

HSIL high-grade squamous intraepithelial lesions

HSV herpes simplex virus

IHC immunohistochemistry

LSIL low-grade squamous intraepithelial lesions

MHA-TP microhemagglutination assay for antibody to Treponema pallidum

MICs minimum inhibitory concentrations

MPC mucopurulent cervicitis

MSAs metropolitan statistical areas

MSM gay, bisexual, and other men who have sex with men

MSM-only gay, bisexual, and other men who have sex exclusively with men 

MSMW men who have sex with both men and women

MSW men who have sex with women only

NAATs nucleic acid amplification tests

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

NCHS National Center for Health Statistics

NHOPI Native Hawaiians/Other Pacific Islanders

NDTI National Disease and Therapeutic Index

NETSS National Electronic Telecommunications System for Surveillance

NGU nongonococcal urethritis

NHANES National Health and Nutrition Examination Survey 

NJTP National Job Training Program

NNDSS National Notifiable Diseases Surveillance System 

OMB Office of Management and Budget

P&S primary and secondary

PCR polymerase chain reaction

PID pelvic inflammatory disease

RPR rapid plasma reagin

SSuN STD Surveillance Network

STD sexually transmitted disease

STI sexually transmitted infection

TP-PA T. pallidum particle agglutination

VDRL Venereal Disease Research Laboratory

WBC white blood cell
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Table of Contents

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

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

Preface ....................................................................................................................................................................................vii

Guide to Acronyms.................................................................................................................................................................ix

Figures in the National Profile...............................................................................................................................................xii

Figures in the Special Focus Profiles....................................................................................................................................xiv

Tables in the National Profile................................................................................................................................................xvi

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

National Profile

National Overview of STDs, 2016 ..........................................................................................................................................1

Chlamydia ................................................................................................................................................................................3

Gonorrhea...............................................................................................................................................................................11

Syphilis...................................................................................................................................................................................21

Other STDs.............................................................................................................................................................................29

Special Focus Profiles

STDs in Women and Infants..................................................................................................................................................35

STDs in Adolescents and Young Adults................................................................................................................................43

STDs in Racial and Ethnic Minorities...................................................................................................................................49

STDs in Men Who Have Sex with Men................................................................................................................................55

Tables

National Summary .................................................................................................................................................................62

Chlamydia ..............................................................................................................................................................................64

Gonorrhea...............................................................................................................................................................................76

Syphilis...................................................................................................................................................................................88

Chancroid .............................................................................................................................................................................108

Selected STDs......................................................................................................................................................................109

Appendix

A. Interpreting STD Surveillance Data ...............................................................................................................................111

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

by State and by Nationally Notifiable STD, 2016 ......................................................................................119

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2016 ...........................................121

B. National Objectives and Goals .......................................................................................................................................123

Table B1. Healthy People 2020 (HP2020) Sexually Transmitted Diseases Objectives.............................................124

Table B2. Government Performance and Results Act (GPRA) Sexually Transmitted Diseases Goals, 

Measures, and Target ...................................................................................................................................125

C. STD Surveillance Case Definitions................................................................................................................................127

Contributors..........................................................................................................................................................................137
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Figures in the National Profile

Chlamydia

Figure 1. Chlamydia — Rates of Reported Cases by Sex, United States, 2000–2016 ...................................................4

Figure 2. Chlamydia — Rates of Reported Cases by Region, United States, 2007–2016..............................................4

Figure 3. Chlamydia — Rates of Reported Cases by State, United States and Outlying Areas, 2016...........................5

Figure 4. Chlamydia — Rates of Reported Cases by County, United States, 2016........................................................5

Figure 5. Chlamydia — Rates of Reported Cases by Age Group and Sex, United States, 2016....................................6

Figure 6. Chlamydia — Rates of Reported Cases by Race/Ethnicity, United States, 2012–2016 .................................6

Figure 7. Chlamydia — Percentage of Reported Cases Among Men by Reporting Source, 

United States, 2007–2016..................................................................................................................................7

Figure 8. Chlamydia — Percentage of Reported Cases Among Women by Reporting Source,

United States, 2007–2016..................................................................................................................................7

Figure 9. Chlamydia — Prevalence Among Persons Aged 14–39 Years by Sex, Race/Ethnicity, or Age Group,

National Health and Nutrition Examination Survey (NHANES), 2007–2012................................................8

Figure 10. Chlamydia — Prevalence Among Sexually-Active Women Aged 14–39 Years by Race/Ethnicity 

and Age Group, National Health and Nutrition Examination Survey (NHANES), 2007–2012.....................8

Figure 11. Chlamydia — Proportion of STD Clinic Patients Testing Positive by Age Group, Sex, and Sexual

Behavior, STD Surveillance Network (SSuN), 2016 .......................................................................................9

Gonorrhea 

Figure 12. Gonorrhea — Rates of Reported Cases by Year, United States, 1941–2016........................................... 11

Figure 13. Gonorrhea — Rates of Reported Cases by Sex, United States, 2007–2016............................................ 11

Figure 14. Gonorrhea — Rates of Reported Cases by Region, United States, 2007–2016...................................... 12

Figure 15. Gonorrhea — Rates of Reported Cases by State, United States and Outlying Areas, 2016 ................... 12

Figure 16. Gonorrhea — Rates of Reported Cases by County, United States, 2016 ................................................ 13

Figure 17. Gonorrhea — Rates of Reported Cases by Age Group and Sex, United States, 2016 ............................ 14

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

United States, 2007–2016........................................................................................................................ 14

Figure 19. Gonorrhea — Rates of Reported Cases Among Men Aged 15–44 Years by Age Group, 

United States, 2007–2016........................................................................................................................ 14

Figure 20. Gonorrhea — Rates of Reported Cases by Race/Ethnicity, United States, 2012–2016 .......................... 15

Figure 21. Gonorrhea — Percentage of Reported Cases Among Men by Reporting Source, 

United States, 2007–2016........................................................................................................................ 15

Figure 22. Gonorrhea — Percentage of Reported Cases Among Women by Reporting Source, 

United States, 2007–2016........................................................................................................................ 16

Figure 23. Estimated Proportion of MSM-Only, MSMW, MSW, and Women Among Gonorrhea Cases by 

Jurisdiction, STD Surveillance Network (SSuN), 2016 .......................................................................... 16

Figure 24. Gonorrhea — Proportion of STD Clinic Patients Testing Positive by Age Group, Sex, 

and Sexual Behavior, STD Surveillance Network (SSuN), 2016............................................................ 17

Figure 25. Location of Participating Sentinel Sites and Regional Laboratories, Gonococcal Isolate 

Surveillance Project (GISP), United States, 2016 ................................................................................... 17

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

Concentrations (MICs) (≥0.125 μg/ml) and Elevated Cefixime MICs (≥0.25 μg/ml), Gonococcal 

Isolate Surveillance Project (GISP), 2006–2016..................................................................................... 18

Figure 27. Neisseria gonorrhoeae — Distribution of Azithromycin Minimum Inhibitory Concentrations (MICs) 

by Year, Gonococcal Isolate Surveillance Project (GISP), 2012–2016................................................... 18

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

Resistance, Gonococcal Isolate Surveillance Project (GISP), 2016........................................................ 19

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

Gonococcal Isolate Surveillance Project (GISP), 1988–2016................................................................. 19
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Syphilis

Figure 30. Syphilis — Rates of Reported Cases by Stage of Infection, United States, 1941–2016...............................22

Figure 31. Primary and Secondary Syphilis — Rates of Reported Cases by Region, United States, 

2007–2016........................................................................................................................................................22

Figure 32. Primary and Secondary Syphilis — Rates of Reported Cases by State, United States and

Outlying Areas, 2016.......................................................................................................................................23

Figure 33. Primary and Secondary Syphilis — Rates of Reported Cases by County, United States, 2016 ...................23

Figure 34. Primary and Secondary Syphilis — Rates of Reported Cases by Sex and Male-to-Female 

Rate Ratios, United States, 1990–2016...........................................................................................................24

Figure 35. Primary and Secondary Syphilis — Reported Cases by Sex and Sexual Behavior, 36 States, 

2012–2016........................................................................................................................................................24

Figure 36. Primary and Secondary Syphilis — Distribution of Cases by Sex and Sexual Behavior, 

United States, 2016..........................................................................................................................................24

Figure 37. Primary and Secondary Syphilis — Rates of Reported Cases by Age Group and Sex, 

United States, 2016..........................................................................................................................................25

Figure 38. Primary and Secondary Syphilis — Rates of Reported Cases Among Women Aged 15–44 Years 

by Age Group, United States, 2007–2016.......................................................................................................25

Figure 39. Primary and Secondary Syphilis — Rates of Reported Cases Among Men Aged 15–44 Years 

by Age Group, United States, 2007–2016.......................................................................................................26

Figure 40. Primary and Secondary Syphilis — Rates of Reported Cases by Race/Ethnicity, 

United States, 2012–2016................................................................................................................................26

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

United States, 2016..........................................................................................................................................27

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

United States, 2007–2016................................................................................................................................27

Figure 43. Primary and Secondary Syphilis — Percentage of Reported Cases by Sex, Sexual Behavior, 

and Selected Reporting Sources, United States, 2016....................................................................................28

Figure 44. Congenital Syphilis — Reported Cases by Year of Birth and Rates of Reported Cases of Primary

and Secondary Syphilis Among Women, United States, 2007–2016 ............................................................28

Other STDs

Figure 45. Chancroid — Reported Cases by Year, United States, 1941–2016................................................................29

Figure 46. Human Papillomavirus — Cervicovaginal Prevalence of Types 6, 11, 16 and 18 Among Females 

Aged 14–34 Years by Age Group and Time Period, National Health and Nutrition Examination 

Survey (NHANES), 2003–2006 and 2009–2012 ...........................................................................................30

Figure 47. Cervical Low- and High-Grade Squamous Intraepithelial Lesions and Intraepithelial Neoplasia 

Grades 2 and 3 — Prevalence per 1000 Person-Years Among Female Enrollees in Private Health

Plans Aged 15–39 Years, by Age Group and Year, 2007–2014......................................................................31

Figure 48. Genital Warts — Prevalence per 1000 Person-Years Among Enrollees in Private Health Plans 

Aged 10–39 Years by Sex, Age Group, and Year, 2003–2010.......................................................................32

Figure 49. Herpes Simplex Virus Type 2 — Seroprevalence Among Non-Hispanic Whites and Non-Hispanic 

Blacks by Sex and Age Group, National Health and Nutrition Examination Survey (NHANES), 

1988–1994, 1999–2002, 2003–2006, and 2007–2010 ...................................................................................33

Figure 50. Trichomonas vaginalis and Other Vaginal Infections Among Females — Initial Visits to Physicians’ 

Offices, United States, 1966–2015..................................................................................................................33
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Centers for Disease Control and Prevention: STD Surveillance 2016

Figures in the Special Focus Profiles

STDs in Women and Infants

Figure A. Pelvic Inflammatory Disease — Initial Visits to Physicians’ Offices Among Women 

Aged 15–44 Years, United States, 2006–2015................................................................................................36

Figure B. Pelvic Inflammatory Disease — Lifetime Prevalence Among Sexually Experienced Women

Aged 18–44 Years by Race/Ethnicity and Previous STI Diagnosis, National Health and Nutrition 

Examination Survey (NHANES), 2013–2014................................................................................................37

Figure C. Ectopic Pregnancy — Rates Among Commercially Insured Women with Live Births Aged 15–44 

Years by Age Group, 2004–2015 ....................................................................................................................38

Figure D. Chlamydia — Rates of Reported Cases Among Women by State, United States and

Outlying Areas, 2016.......................................................................................................................................38

Figure E. Gonorrhea — Rates of Reported Cases Among Women by State, United States and

Outlying Areas, 2016.......................................................................................................................................39

Figure F. Chlamydia — Positivity Among Women Aged 14–39 Years by Race/Ethnicity and Age Group in 

Clinics Providing Family Planning and Reproductive Health Services, STD Surveillance 

Network (SSuN), 2016 ....................................................................................................................................39

Figure G. Chlamydia and Gonorrhea — Rates of Reported Cases Among Infants <1 Year of Age by Year and

Specimen Source, United States, 2010–2015 .................................................................................................40

Figure H. Primary and Secondary Syphilis — Rates of Reported Cases Among Women by State,

United States and Outlying Areas, 2016 .........................................................................................................40

Figure I. Congenital Syphilis — Rates of Reported Cases Among Infants by Year of Birth and State,

United States and Outlying Areas, 2016 .........................................................................................................41

STDs in Adolescents and Young Adults 

Figure J. Chlamydia — Rates of Reported Cases Among Women Aged 15–24 Years by State, United States 

and Outlying Areas, 2016................................................................................................................................43

Figure K. Chlamydia — Rates of Reported Cases Among Men Aged 15–24 Years by State, United States 

and Outlying Areas, 2016................................................................................................................................44

Figure L. Gonorrhea — Rates of Reported Cases Among Women Aged 15–24 Years by State, United States 

and Outlying Areas, 2016................................................................................................................................44

Figure M. Gonorrhea — Rates of Reported Cases Among Men Aged 15–24 Years by State, United States 

and Outlying Areas, 2016................................................................................................................................45

Figure N. Chlamydia — Prevalence Among Women Aged 16–24 Years Entering the National Job Training 

Program (NJTP) by State of Residence, United States and Outlying Areas, 2016........................................46

Figure O. Chlamydia — Prevalence Among Men Aged 16–24 Years Entering the National Job Training 

Program (NJTP) by State of Residence, United States and Outlying Areas, 2016........................................46

Figure P. Gonorrhea — Prevalence Among Women Aged 16–24 Years Entering the National Job Training 

Program (NJTP) by State of Residence, United States and Outlying Areas, 2016........................................47

Figure Q. Gonorrhea — Prevalence Among Men Aged 16–24 Years Entering the National Job Training 

Program (NJTP) by State of Residence, United States and Outlying Areas, 2016........................................47

STDs in Racial and Ethnic Minorities

Figure R. Chlamydia — Rates of Reported Cases by Race/Ethnicity and Sex, United States, 2016 ...........................50

Figure S. Gonorrhea — Rate Ratios by Race/Ethnicity, United States, 2012–2016.....................................................51

Figure T. Gonorrhea — Rates of Reported Cases by Race/Ethnicity and Sex, United States, 2016............................51

Figure U. Gonorrhea — Rate Ratios by Race/Ethnicity and Region, United States, 2016 ...........................................52

Figure V. Primary and Secondary Syphilis — Rates of Reported Cases by Race/Ethnicity and Sex, 

United States, 2016..........................................................................................................................................53

Figure W. Congenital Syphilis — Rates of Reported Cases by Year of Birth and Race/Ethnicity of Mother,

United States, 2007–2016................................................................................................................................54
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STDs in Men who Have Sex with Men

Figure X. Primary and Secondary Syphilis — Reported Cases by Sex, Sexual Behavior, and Race/Ethnicity,

United States, 2016 .........................................................................................................................................56

Figure Y. Primary and Secondary Syphilis — Estimated Rates of Reported Cases Among MSM by State, 

United States, 2016..........................................................................................................................................56

Figure Z. Neisseria gonorrhoeae — Percentage of Urethral Isolates Obtained from MSM Attending 

STD Clinics, Gonococcal Isolate Surveillance Project (GISP), 1989–2016 .................................................57

Figure AA. 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), 2006–2016 ............................................................................................57

Figure BB. Gonorrhea — Estimated Rates of Reported Gonorrhea Cases by MSM, MSW, and Women, 

STD Surveillance Network (SSuN), 2010–2015............................................................................................58

Figure CC. Gonorrhea and Chlamydia — Proportion of MSM Attending STD Clinics Testing Positive for 

Urogenital Gonorrhea and Chlamydia by Jurisdiction, STD Surveillance Network (SSuN), 2016.............58

Figure DD. Gonorrhea and Chlamydia — Proportion of MSM Attending STD Clinics Testing Positive for 

Rectal Gonorrhea and Chlamydia by Jurisdiction, STD Surveillance Network (SSuN), 2016....................59

Figure EE. Gonorrhea — Proportion of MSM Attending STD Clinics Testing Positive for Oropharyngeal 

Gonorrhea by Jurisdiction, STD Surveillance Network (SSuN), 2016 .........................................................59

Figure FF. Proportion of MSM Attending STD Clinics with Primary and Secondary Syphilis, Urogenital 

Gonorrhea, or Urogenital Chlamydia by HIV Status, STD Surveillance Network (SSuN), 2016 ...............60
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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, 1941–2016............................................................................................................62

Chlamydia

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

United States, 2016..........................................................................................................................................64

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

Alphabetical Order, United States and Outlying Areas, 2012–2016..............................................................65

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, 2012–2016.............................................66

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, 2012–2016.............................................67

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

Areas (MSAs) in Alphabetical Order, United States, 2012–2016..................................................................68

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

Metropolitan Statistical Areas (MSAs) in Alphabetical Order, United States, 2012–2016...........................69

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

Metropolitan Statistical Areas (MSAs) in Alphabetical Order, United States, 2012–2016...........................70

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

Ranked by Number of Reported Cases, United States, 2016.........................................................................71

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

United States, 2012–2016................................................................................................................................72

Table 11A. Chlamydia — Reported Cases by Race/Ethnicity, Age Group, and Sex, United States, 2016.....................73

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

and Sex, United States, 2016...........................................................................................................................74

Table 12. Chlamydia Among Women Aged 15–24 Years — Reported Cases and Rates of Reported Cases 

by Age, United States, 2012–2016..................................................................................................................75

Gonorrhea

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

United States, 2016..........................................................................................................................................76

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

Alphabetical Order, United States and Outlying Areas, 2012–2016..............................................................77

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, 2012–2016.............................................78

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, 2012–2016.............................................79

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

Areas (MSAs) in Alphabetical Order, United States, 2012–2016..................................................................80

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

Metropolitan Statistical Areas (MSAs) in Alphabetical Order, United States, 2012–2016...........................81

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2012–2016.................................................82

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

Ranked by Number of Reported Cases, United States, 2016.........................................................................83

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

United States, 2012–2016................................................................................................................................84

Table 22A. Gonorrhea — Reported Cases by Race/Ethnicity, Age Group, and Sex, United States, 2016 .....................85
Centers for Disease Control and Prevention: STD Surveillance 2016

xvii

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

and Sex, United States, 2016...........................................................................................................................86

Table 23. Gonorrhea Among Women Aged 15–24 Years — Reported Cases and Rates of Reported Cases 

by Age, United States, 2012–2016..................................................................................................................87

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, 2012–2016.............................................88

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2012–2016.................................................89

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

Ranked by Rates, United States, 2016 ............................................................................................................90

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, 2012–2016......................................91

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, 2012–2016...............92

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, 2012–2016....................93

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

Metropolitan Statistical Areas (MSAs) in Alphabetical Order, United States, 2012–2016...........................94

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, 2012–2016........95

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, 2012–2016........96

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, 2016 .........................................97

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

and Sex, United States, 2012–2016.................................................................................................................98

Table 35A. Primary and Secondary Syphilis — Reported Cases by Race/Ethnicity, Age Group, and Sex,

United States, 2016..........................................................................................................................................99

Table 35B. Primary and Secondary Syphilis — Rates of Reported Cases per 100,000 Population by 

Race/Ethnicity, Age Group, and Sex, United States, 2016...........................................................................100

Table 36. Early Latent Syphilis — Reported Cases and Rates of Reported Cases by State/Area and Region 

in Alphabetical Order, United States and Outlying Areas, 2012–2016........................................................101

Table 37. Early Latent Syphilis — Reported Cases and Rates of Reported Cases in Selected Metropolitan 

Statistical Areas (MSAs) in Alphabetical Order, United States, 2012–2016...............................................102

Table 38. 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, 2012–2016....................................103

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

Metropolitan Statistical Areas (MSAs) in Alphabetical Order, United States, 2012–2016.........................104

Table 40. Congenital Syphilis — Reported Cases and Rates of Reported Cases by State, Ranked by Rates, 

United States, 2016........................................................................................................................................105

Table 41. Congenital Syphilis — Reported Cases and Rates of Reported Cases by Year of Birth,

State/Area, and Region in Alphabetical Order, United States and Outlying Areas, 2012–2016.................106

Table 42. Congenital Syphilis — Reported Cases and Rates of Reported Cases per 100,000 Live Births by 

Year of Birth and Race/Ethnicity of Mother, United States, 2012–2016.....................................................107

Chancroid

Table 43. Chancroid — Reported Cases and Rates of Reported Cases by State/Area in Alphabetical 

Order, United States and Outlying Areas, 2012–2016..................................................................................108
xviii

Centers for Disease Control and Prevention: STD Surveillance 2016

Selected STDs 

Table 44. Selected STDs and Complications — Initial Visits to Physicians’ Offices, National Disease 

and Therapeutic Index, United States, 1966–2015.......................................................................................109

Appendix

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

by State and by Nationally Notifiable STD, 2016 ........................................................................................119

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2016.............................................121

Table B1. Healthy People 2020 (HP 2020) Sexually Transmitted Diseases Objectives..............................................124

Table B2. Government Performance and Results Act (GPRA) Sexually Transmitted Diseases Goals, 

Measures, and Target .....................................................................................................................................125
Centers for Disease Control and Prevention: STD Surveillance 2016

xix

Census Regions of the United States

South

West Midwest Northeast

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

Centers for Disease Control and Prevention: STD Surveillance 2016

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Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

1

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.

National Overview of STDs, 2016

All Americans should have the 

opportunity to make choices that 

lead to health and wellness. Working 

together, interested, committed 

public and private organizations, 

communities, and individuals can 

take action to prevent sexually 

transmitted diseases (STDs) and 

their related health consequences. In 

addition to federal, state, and local 

public support for STD prevention 

activities, local community leaders 

can promote STD prevention 

education. Health care 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.1

This overview summarizes national 

surveillance data for 2016 on the three 

notifiable diseases for which there are 

federally funded control programs: 

chlamydia, gonorrhea, and syphilis.

Chlamydia

In 2016, a total of 1,598,354 cases 

of Chlamydia trachomatis infection 

were reported to the CDC, making it 

the most common notifiable condition 

in the United States. This case count 

corresponds to a rate of 497.3 cases 

per 100,000 population, an increase of 

4.7% compared with the rate in 2015. 

During 2015–2016, rates of reported 

chlamydia increased in all regions of 

the United States. 

Rates of chlamydia are highest 

among adolescent and young adult 

females, the population targeted for 

routine chlamydia screening. Among 

young women attending family 

planning clinics participating in a 

sentinel surveillance program who 

were tested for chlamydia, 9.2% of 

15–19 year olds and 8.0% of 20–24 

year olds were positive. Although 

rates of reported cases among 

men are generally lower than rates 

among women, reflecting the larger 

number of women screened for this 

infection, increased availability of 

urine testing and extragenital testing 

has resulted in an increased number 

of men, including gay, bisexual, and 

other men who have sex with men 

(collectively referred to as MSM) 

being tested and diagnosed with a 

chlamydial infection.
2

National Profile Centers for Disease Control and Prevention: STD Surveillance 2016

Rates of reported chlamydia varied 

among different racial and ethnic 

minority populations. In 2016, rates 

were highest among Blacks and 

American Indians/Alaska Natives. 

However, during 2012–2016, rates 

decreased 3.5% among Blacks and 

6.4% among American Indians/

Alaska Natives and increased among 

Whites, Asians, and Native Hawaiian/

Other Pacific Islanders. 

Gonorrhea

In 2009, the national rate of reported 

gonorrhea cases reached an historic 

low of 98.1 cases per 100,000 

population. During 2009–2012, the 

rate increased slightly each year to 

106.7 cases per 100,000 population 

in 2012 and has increased steadily 

during 2014–2016. In 2016, 468,514 

gonorrhea cases were reported for 

a rate of 145.8 cases per 100,000 

population, an increase of 18.5% 

from 2015.

During 2015–2016, the rate of 

reported gonorrhea increased 

22.2% among men and 13.8% 

among women. The magnitude of 

the increase among men suggests 

either increased transmission or 

increased case ascertainment (e.g., 

through increased extra-genital 

screening) among MSM or both. The 

concurrent increases among cases 

reported among women, suggests 

parallel increases in heterosexual 

transmission, increased screening 

among women, or both.

In 2016, the rate of reported cases of 

gonorrhea remained highest among 

Blacks (481.2 cases per 100,000 

population) and among American 

Indians/Alaska Natives (242.9 cases 

per 100,000 population). During 

2012–2016, rates increased among all 

racial and ethnic groups. 

Antimicrobial resistance remains 

an important consideration in the 

treatment of gonorrhea. Dual therapy 

with ceftriaxone and azithromycin 

is now the only CDC recommended 

treatment for gonorrhea.2

 In 2016, the 

percentage of isolates with elevated 

minimum inhibitory concentrations 

(MICs) of cefixime and ceftriaxone 

remained low (0.3% and 0.3%, 

respectively). During 2013–2016, the 

percentage of isolates with reduced 

azithromycin susceptibility increased 

from 0.6% to 3.6%. Continued 

monitoring of susceptibility patterns 

to these antibiotics is critical.

Syphilis

In 2000 and 2001, the national rate 

of reported primary and secondary 

(P&S) syphilis cases was 2.1 cases 

per 100,000 population, the lowest 

rate since reporting began in 1941. 

However, the P&S syphilis rate has 

increased almost every year since 

2001. In 2016, 27,814 P&S syphilis 

cases were reported, representing a 

national rate of 8.7 cases per 100,000 

population and a 17.6% increase from 

2015. During 2015–2016, the P&S 

syphilis rate increased among both 

men and women in every region of 

the country; overall, the rate increased 

14.7% among men and 35.7% 

among women. 

During 2012–2016, P&S syphilis 

rates were consistently highest 

among persons aged 20–29 years, 

but rates increased in every 5-year 

age group among those aged 15–64 

years. In 2016, rates were highest 

among Blacks (23.3 per 100,000 

population) and Native Hawaiian/

Other Pacific Islanders (13.9 per 

100,000 population); however, rates 

increased among all racial and ethnic 

groups during in 2012–2016.

During 2000–2016, the rise in the 

P&S syphilis rate was primarily 

attributable to increased cases among 

men and, specifically, among MSM. 

In 2016, men accounted for almost 

90% of all cases of P&S syphilis. 

Of those male cases for whom sex 

of sex partner was known, 80.6% 

were MSM. Reported cases of P&S 

syphilis continued to be characterized 

by a high rate of HIV co-infection, 

particularly among MSM. Among 

2016 P&S syphilis cases with known 

HIV-status, 47.0% of MSM were 

HIV-positive, 10.7% of cases among 

MSW and 4.1% of cases among 

women were HIV-positive.

The 2013 rate of congenital syphilis 

(9.2 cases per 100,000 live births) 

marked the first increase in congenital 

syphilis since 2008. During 2013–

2014, the rate increased 27.2%, 

during 2014–2015 the rate increased 

6.0%, and then increased 27.6% 

during 2015–2016. There were 628 

cases of congenital syphilis reported 

in 2016 compared with 492 cases in 

2015. In 2016, rates of congenital 

syphilis were highest among Blacks 

(43.1 cases per 100,000 live births), 

followed by American Indians/Alaska 

Natives (31.6 cases per 100,000 live 

births), and Hispanics (20.5 cases per 

100,000 live births). 

References

1. Eng TR, Butler WT, editors; Institute of 

Medicine. The Hidden Epidemic: Confronting 

Sexually Transmitted Diseases. Washington DC: 

The National Academy Press; 1997.

2. Centers for Disease Control and Prevention. 

Sexually transmitted diseases treatment 

guidelines, 2015. MMWR Morb Mortal Wkly 

Rep 2015; 64(No. RR-3): 1–137.
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

3

Chlamydia

Background

Chlamydia, caused by infection with 

Chlamydia trachomatis, is the most 

common 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

Chlamydial infections in women 

are usually asymptomatic.2

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 could 

facilitate the transmission of HIV 

infection.5

 In addition, pregnant 

women infected with chlamydia can 

pass the infection to their infants 

during delivery, potentially resulting 

in ophthalmia neonatorum, which can 

lead to blindness, and pneumonia. 

Because of the large burden of disease 

and risks associated with infection, 

CDC recommends annual chlamydia 

screening for all sexually active 

women younger than age 25 years and 

women ≥25 years at increased risk for 

infection (e.g., women with new or 

multiple sex partners).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 sexuallyactive women aged 16–24 years 

in commercial health maintenance 

organization (HMO) plans, chlamydia 

screening increased from 23.1% 

in 2001 to 47.4% in 2015. Among 

sexually-active women aged 16–24 

years covered by Medicaid, screening 

rates increased from 40.4% in 2001 

to 58.0% in 2011, then decreased to 

55.2% in 2015.7

 Although chlamydia 

screening has expanded over the 

past two decades, 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. 

During 2000–2011, the expanded 

use of more sensitive diagnostic 

tests (e.g., nucleic acid amplification 

tests [NAATs]) likely increased the 

number of infections identified and 

reported independently of increases in 

incidence. Also, although chlamydia 

has been a nationally notifiable 

condition since 1995, 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. The increased use of 

electronic laboratory reporting over 

the last decade or so also likely 

increased the proportion of diagnosed 

cases reported. Consequently, an 

increasing chlamydia case rate 

over time 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 2016, a total of 1,598,354 

chlamydial infections were reported 

to CDC in 50 states and the District 

of Columbia (Table 1). This case 

count corresponds to a rate of 497.3 

cases per 100,000 population. During 

2000–2011, the rate of reported 

chlamydial infection increased from 

251.4 to 453.4 cases per 100,000 

population (Figure 1, Table 1). During 

2011–2013, the rate of reported cases 

decreased to 443.5 cases per 100,000 

population, followed by an increase in 

the rate of reported cases over each of 

the next 3 years. During 2015–2016, 

the rate increased 4.7%, from 475.0 

to 497.3 cases per 100,000 population 

(Figure 1, Table 1).

Chlamydia by Region

In 2016, rates of reported cases of 

chlamydia were highest in the South 

(529.7 cases per 100,000 population, 

3.0% increase from 2015), followed 

by the Midwest (487.5, 5.1% increase 

from 2015), West (485.9, 5.8% 

increase from 2015), and Northeast 

(454.6, 7.0% increase from 2015) 

(Table 3). During 2007–2012, rates of 

reported cases of chlamydia increased 

in all regions (Figure 2). During 

2012–2013, rates decreased in the 

Northeast, Midwest, and South and 

remained stable in the West. During 

2013–2016, rates increased in all 

regions, with the largest increase 

occurring in the West (421.1 to 485.9 

cases per 100,000 population, 15.4% 

increase) (Table 3).
4

National Profile Centers for Disease Control and Prevention: STD Surveillance 2016

Figure 1. Chlamydia — Rates of Reported Cases by Sex, United 

States, 2000–2016

 0

125

250

375

500

625

750

Year

2000 2002 2004 2006 2008 2010 2012 2014 2016

Rate (per 100,000 population)

Men Women

Total

NOTE: Data collection for chlamydia began in 1984 and chlamydia was made nationally notifiable 

in 1995; however, chlamydia was not reportable in all 50 states and the District of Columbia until 

2000. Refer to the National Notifiable Disease Surveillance System (NNDSS) website for more 

information: https://wwwn.cdc.gov/nndss/conditions/chlamydia-trachomatis-infection/.

Figure 2. Chlamydia — Rates of Reported Cases by Region, United 

States, 2007–2016

 0

100

200

300

400

500

600

Year

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rate (per 100,000 population)

West

Midwest

Northeast

South

Chlamydia by State

In 2016, rates of reported cases of 

chlamydia by state ranged from 260.6 

cases per 100,000 population in New 

Hampshire to 771.6 cases per 100,000 

population in Alaska (Figure 3, Table 

2); the rate in the District of Columbia 

was 1,083.4 cases per 100,000 

population (Table 3). During 2015–

2016, rates of reported chlamydia 

cases increased in 44 states and the 

District of Columbia. The rate of 

reported chlamydia cases in 2016 was 

above the U.S. total in 21 states.

Chlamydia by Metropolitan 

Statistical Area

The rate of reported cases of 

chlamydia in the 50 most populous 

metropolitan statistical areas (MSAs) 

increased 6.2% during 2015–2016 

(489.6 to 520.1 cases per 100,000 

population, respectively) (Table 6). 

In 2016, 57.5% of chlamydia cases 

were reported by these MSAs. During 

2015–2016, the rate of reported 

cases of chlamydia in these MSAs 

increased 3.9% among women (639.8 

to 664.5 cases per 100,000 females) 

and 10.9% among men (331.8 to 

368.0 cases per 100,000 males) 

(Tables 7 and 8).

Chlamydia by County

In 2016, 620 (19.7%) of 3,140 

counties had rates of reported 

chlamydia higher than 520 cases 

per 100,000 population (Figure 4). 

Seventy counties and independent 

cities reported 43.4% of all chlamydia 

cases in 2016 (Table 9). Of the 70 

counties and independent cities 

reporting the highest number of 

chlamydia cases, 47 (67.1%) were 

located in the South and West 

(Table 9).

Chlamydia by Sex

In 2016, 1,072,719 cases of 

chlamydia were reported among 

females for a rate of 657.3 cases per 

100,000 females (Table 4). After 

increasing each year during 2000–

2011, the rate of reported chlamydia 

cases among females decreased 

during 2011–2013, followed by an 

increase in the rate of reported cases 

over each of the next three years 

(Figure 1). The rate among females 

increased 0.4% during 2013–2014, 

3.0% during 2014–2015, and 2.6% 

during 2015–2016, for a total increase 

of 6.2% during 2013–2016.

There were 522,870 cases of 

chlamydia reported among males in 

2016 for a rate of 330.5 cases per 

100,000 males (Table 5). The rate of 

reported cases among males increased 

each year during 2000–2016, with 

the exception of 2012–2013, where 

rates remained stable (Figure 1). 

During 2015–2016 alone, the rate 

among men increased 9.2%; however, 

during 2012–2016, rates of reported 

cases among men increased 26.8% 

(compared with a 2.9% increase 

among women) (Tables 4 and 5). 

This pronounced increase among 

men could be attributed to either 

increased transmission or improved 

case identification (e.g., through 
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

5

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

States and Outlying Areas, 2016

Rate per 100,000

population

Guam 577 

Puerto Rico 207 

Virgin Islands 555 

<= 395 

396 - 463 

464 - 507 

508 - 562 

>=563 

(n= 11)

(n= 11)

(n= 12)

(n= 10)

(n= 10)

VT 270

NH 261

MA 395

RI 467

CT 387

NJ 385

DE 567

MD 510

DC 1083 554

772

512 562

506 469

467

615

482

356

561 466

416

418 413

679

313

463

413

672

507

428

432 507

629

553

578

457

521

548

433

445

576

505

489

520

316

473

436

261

466

352

NOTE: The total rate of reported cases of chlamydia for the United States and outlying areas 

(Guam, Puerto Rico, and Virgin Islands) was 494.2 per 100,000 population.

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

United States, 2016

Rate per 100,000

population

<=180 (n= 621)

181-265 (n= 658)

266-358 (n= 631)

359-520 (n= 610)

>520 (n= 620)

NOTE: Refer to the NCHHSTP Atlas for further county-level rate information: https://www.cdc.gov/

nchhstp/atlas.

intensified extra-genital screening 

efforts) among gay, bisexual, and 

other men who have sex with men 

(collectively referred to as MSM). 

This cannot be assessed, however, as 

most jurisdictions do not routinely 

report sex of sex partner or anatomic 

site of infection. 

Despite this considerable increase in 

men, the rate of reported chlamydia 

cases among females was still about 

two times the rate among males in 

2016, 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.

Chlamydia by Age

The rates of reported cases of 

chlamydia are highest among 

adolescents and young adults aged 

15–24 years (Table 10). In 2016, the 

age-specific rate of reported cases 

of chlamydia among 15–19 year 

olds was 1,929.2 cases per 100,000 

population and the rate among 20–24 

year olds was 2,643.8 cases per 

100,000 population (Table 10).

Among females, the highest agespecific rates of reported cases of 

chlamydia in 2016 were among those 

aged 15–19 years (3,070.9 cases per 

100,000 females) and 20–24 years 

(3,779.0 cases per 100,000 females) 

(Figure 5, Table 10). Within these 

age groups, rates were highest among 

women aged 19 years (4,970.1 cases 

per 100,000 females) and 20 years 

(4,734.8 cases per 100,000 females) 

(Table 12). The rate of reported cases 

among women aged 15–19 and 20–24 

years increased over the last two and 

three years, respectively. The rate 

among 15–19 year olds increased 

2.8% during 2015–2016, with a total 

increase of 4.1% during 2014–2016 

(2,949.3 to 3,070.9 per 100,000 

females). The rate among 20–24 year 

olds increased 0.4% during 2015–

2016, with a total increase of 5.1% 

during 2013–2016 (3594.2 to 3779.0 

per 100,000 females) (Table 10).

In 2016, the age-specific rates of 

reported cases of chlamydia among 

men, although substantially lower 

than rates among women, were 

highest in those aged 20–24 years 

(1,558.6 cases per 100,000 males) 

(Figure 5, Table 10). Similar to trends 

in women, the rate of reported cases 

among men aged 15–19 and 20–24 

years increased over the last two and 

three years, respectively. The rate 

among 15–19 year olds increased 

8.6% during 2015–2016, with a total 

increase of 15.3% during 2014–2016 

(722.4 to 832.6 per 100,000 males). 
6

National Profile Centers for Disease Control and Prevention: STD Surveillance 2016

Figure 5. Chlamydia — Rates of Reported Cases by Age Group and 

Sex, United States, 2016

Men Rate (per 100,000 population) Women

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

12.7 10-14 91.1

832.6 3 15-19 070.9

1558.6 20-24 3779.0

1003.4 1 25-29 657.8

538.0 30-34 688.2

311.3 35-39 341.8

167.3 40-44 154.2

91.9 45-54 57.9

30.1 55-64 15.8

5.5 2 65+ .2

330.5 Total 657.3

The rate among 20–24 year olds 

increased 5.5% during 2015–2016, 

with a total increase of 18.9% during 

2013–2016 (1,310.9 to 1,558.6 per 

100,000 females) (Table 10).

Chlamydia by Race/Ethnicity

Among the 50 states and the District 

of Columbia that submitted race and 

ethnicity data in 2016 according to 

Office of Management and Budget 

(OMB) standards (see Section A1.5 

in the Appendix), rates of reported 

cases of chlamydia were highest 

among Black, American Indian/

Alaska Native, and Native Hawaiian/

Other Pacific Islander women (Figure 

R, Table 11B). Overall, the rate of 

reported cases of chlamydia among 

Blacks was 5.6 times the rate among 

Whites (1,125.9 and 199.8 cases per 

100,000 population, respectively). 

The rate among American Indians/

Alaska Natives (749.8 cases per 

100,000 population) was 3.8 times 

the rate among Whites. The rate 

among Native Hawaiians/Other 

Pacific Islanders (653.4 cases per 

100,000 population) was 3.3 times 

the rate among Whites. The rate 

among Hispanics (374.6 cases per 

100,000 population) was 1.9 times the 

rate among Whites. The rate among 

Asians was lower than the rate among 

Whites (119.3 cases per 100,000 

population).

During 2012–2016, 46 states 

submitted race and ethnicity data 

according to the OMB standards 

(see Section A1.5 in the Appendix). 

During 2012–2016, rates of reported 

chlamydia cases increased among 

Whites (12.7%), Asians (10.2%), 

Native Hawaiians/Other Pacific 

Islanders (8.3%), and Multirace 

(60.6%), and decreased in American 

Indians/Alaska Natives (6.4%) and 

Blacks (3.5%) (Figure 6). Rates 

were stable among Hispanics during 

2012–2016. During 2015–2016, 

rates increased among all racial/

ethnic groups (Whites: 6.3%, Asians: 

5.7%, American Indians/Alaska 

Natives: 5.3%, Native Hawaiians/

Other Pacific Islanders: 4.7%, Blacks: 

3.7%, Hispanics 1.9%, and Multirace: 

27.6%) (Figure 6).

More information on chlamydia rates 

among race/ethnicity groups can be 

found in the Special Focus Profiles.

Chlamydia by Reporting 

Source

In 2016, 6.4% of chlamydia cases 

were reported from STD clinics, 

78.4% were reported from venues 

outside of STD clinics, and 

15.2% had an unknown source of 

report (Table A2). Over time, the 

proportion of male cases reported 

from STD clinic sites has decreased 

substantially, from 33.1% in 2007 

to 11.0% in 2016 (Figure 7). In 

2016, among women, only 4.2% 

of chlamydia cases were reported 

through an STD clinic (Table A2). 

A large proportion of cases among 

women (33.5%) were reported from 

private physicians/HMOs in 2016 

(Figure 8). Among men, 25.9% of 

cases were reported from private 

physicians/HMOs (Figure 7).

Figure 6. Chlamydia — Rates of Reported Cases by Race/Ethnicity, 

United States, 2012–2016

 0

 250

 500

 750

1000

1250

1500

Year

2012 2013 2014 2015 2016

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

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

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

NOTE: Includes 46 states reporting race/ethnicity data in Office of Management and Budget 

compliant formats during 2012–2016 (see Section A1.5 in the Appendix).
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

7

Figure 7. Chlamydia — Percentage of Reported Cases Among Men 

by Reporting Source*, United States, 2007–2016

Percentage

2007 2008 2009 2010 2011

2012 2013 2014 2015 2016

 0

 10

 20

 30

 40

Private

Physician/HMO†

Other HD†

Clinic

Family

Planning Clinic

STD Clinic Hosp-Other All Other Missing/Unk

* Includes the top five reporting sources for chlamydia cases reported among men, plus those with 

reporting sources listed as “All Other” and “Missing/Unknown”.

†

 HMO = health maintenance organization; HD = health department.

NOTE: All 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, Indian Health Service, Military, Emergency Room, HIV Counseling and 

Testing Site, and Other. 

Figure 8. Chlamydia — Percentage of Reported Cases Among 

Women by Reporting Source*, United States, 2007–2016

Percentage

2007 2008 2009 2010 2011

2012 2013 2014 2015 2016

 0

 10

 20

 30

 40

Private

Physician/HMO†

Other HD†

Clinic

Family

Planning Clinic

Laboratory Hosp-Other All Other Missing/Unk

* Includes the top five reporting sources for chlamydia cases reported among women, plus those 

with reporting sources listed as “All Other” and “Missing/Unknown”.

†

 HMO = health maintenance organization; HD = health department.

NOTE: All Other includes: Drug Treatment, Tuberculosis Clinic, Correctional Facility, Blood Bank, 

Labor and Delivery, Prenatal Care, National Job Training Program, School-based Clinic, Mental 

Health Provider, Indian Health Service, Military, Emergency Room, STD Clinic, HIV Counseling and 

Testing Site, and Other.

Chlamydia Prevalence in the 

Population

The National Health and Nutrition 

Examination Survey (NHANES; see 

Section A2.4 in the Appendix) is a 

nationally representative survey of 

the U.S. civilian, non-institutionalized 

population that provides an important 

measure of chlamydia disease burden 

in respondents aged 14–39 years. 

During 2007–2012, the overall 

prevalence of chlamydia among 

persons aged 14–39 years was 1.7% 

(95% Confidence Interval [CI]: 

1.4–2.0) (Figure 9). Among sexually 

active females aged 14–24 years, the 

population targeted for screening, 

prevalence was 4.7% (95% CI: 

3.2–6.1), with the highest prevalence 

among non-Hispanic Black 

females (13.5%, 95% CI: 9.2–17.7) 

(Figure 10).1

Chlamydia Positivity in 

Selected Populations

The STD Surveillance Network 

(SSuN) is an ongoing collaboration 

of 10 state, county, and city health 

departments collecting enhanced 

clinical and behavioral information 

among patients attending 30 STD 

clinics in the SSuN jurisdictions 

(See Section A2.2 of the Appendix).

In 2016, the proportion of STD clinic 

patients testing positive for chlamydia 

varied by age, sex, and sexual 

behavior. Adolescent men who have 

sex with women only (MSW) had the 

highest prevalence (28.9%), either 

reflecting disproportionate testing of 

men with urethritis or targeted testing 

of partners of women diagnosed 

with chlamydia. Prevalence among 

all those tested decreased with age, 

though the variation in prevalence by 

age was not as pronounced for MSM 

(Figure 11).

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 1,598,354 

cases reported in 2016 and increasing 

rates of reported cases over each of 

the last three years. Rates of reported 

chlamydia cases increased 4.7% 

during 2015–2016. The Southern 

region of the U.S. reported the highest 

rate of chlamydial infection in 2016; 

the Northeast reported the largest rate 
8

National Profile Centers for Disease Control and Prevention: STD Surveillance 2016

Figure 9. Chlamydia — Prevalence Among Persons Aged 14–39 

Years by Sex, Race/Ethnicity, or Age Group, National Health and 

Nutrition Examination Survey (NHANES), 2007–2012

Prevalence, %

0

2

4

6

8

Overall Men

 Sex

Women NonHispanic

Whites

NonHispanic

Blacks

Race/Ethnicity

Mexican

Americans 14-19 20-24

 Age Group

25-39

NOTE: Error bars indicate 95% confidence intervals.

SOURCE: Torrone E, Papp J, Weinstock H. Prevalence of Chlamydia trachomatis genital infection 

among persons aged 14–39 years — United States, 2007–2012. MMWR Morb Mortal Wkly Rep 

2014; 63(38):834–838.

Figure 10. Chlamydia — Prevalence Among Sexually-Active Women 

Aged 14–39 Years by Race/Ethnicity and Age Group, National Health 

and Nutrition Examination Survey (NHANES), 2007–2012

Prevalence, %

0

5

10

15

20

14-19 20-24

 Age Group

25-39 All NonHispanic

Whites

NonHispanic Blacks

Among 14-24 Year Olds

Mexican

Americans

NOTE: Error bars indicate 95% confidence intervals.

SOURCE: Torrone E, Papp J, Weinstock H. Prevalence of Chlamydia trachomatis genital infection 

among persons aged 14–39 years — United States, 2007–2012. MMWR Morb Mortal Wkly Rep 

2014; 63(38):834–838.

increase during 2015–2016, at 7.0%. 

In 2016, the rate of reported cases of 

chlamydia in women was two times 

the rate in men. However, during 

2012–2016, the rate in men increased 

26.8%, whereas the rate in women 

increased only 2.9%. Potential reasons 

for this considerable increase in male 

cases could be due to a true increase 

in cases or to improved screening 

coverage in men, especially increased 

extra-genital screening in MSM. 

The facilities reporting chlamydial 

infections have changed over the last 

10 years or so, with most (78.4%) 

chlamydia cases in 2016 reported from 

venues outside of STD clinics. The 

proportion of men being diagnosed 

with chlamydia in STD clinics 

decreased 66.8% from 33.1% in 2007 

to 11.0% in 2016; in 2016 alone, 

approximately one-third of chlamydia 

cases among women were reported 

from private physicians/HMOs. Racial 

differences also persist; reported case 

rates and prevalence estimates among 

Blacks continue to be substantially 

higher than among all other racial/

ethnic groups. Rates of reported cases 

of chlamydia were next highest among 

American Indian/Alaska Native 

and Native Hawaiian/Other Pacific 

Islander women. Ultimately, 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.
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

9

Figure 11. Chlamydia — Proportion* of STD Clinic Patients Testing 

Positive† by Age Group, Sex, and Sexual Behavior, STD Surveillance 

Network (SSuN), 2016

Percentage

Age Group

MSM

MSW

Women

0

10

20

30

40

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

‡

‡

* Proportions represent the overall average of the mean value by jurisdiction. 

†

 Results are based on data obtained from patients with known sexual behavior (n=75,114) 

attending SSuN STD clinics in 2016 in all SSuN jurisdictions, excluding Florida. 

‡

 MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM); 

MSW = Men who have sex with women only.

NOTE: See Section A2.2 in the Appendix for SSuN methods. 

References

1. Torrone E, Papp J, Weinstock H. Prevalence of 

Chlamydia trachomatis genital infection among 

persons aged 14–39 years — United States, 

2007–2012. MMWR 2014; 63(38): 834–838.

2. Stamm WE. Chlamydia trachomatis infections 

in the adult. In: Holmes, KK, Sparling, PF, 

Stamm, WE, Piot, P, Wasserheit, JN, Corey, L, 

Cohen, MS, Watts, DH. Sexually Transmitted 

Diseases. 4th ed. New York, NY: McGraw-Hill; 

2008: 575–606.

3. Scholes D, Stergachis A, Heidrich FE, et al. 

Prevention of pelvic inflammatory disease by 

screening for cervical chlamydial infection. N 

Engl J Med 1996; 334(21): 1362–1366.

4. Oakeshott P, Kerry S, Aghaizu A, 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.

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(1): 

3–17.

6. Centers for Disease Control and Prevention. 

Sexually transmitted diseases treatment 

guidelines, 2015. MMWR Recomm Rep 2015; 

64(RR-3): 1–137. Erratum in: MMWR 2015; 

64(33): 924.

7. National Committee for Quality Assurance. The 

State of Healthcare Quality 2016. Available at: 

http://www.ncqa.org/report-cards/health-plans/

state-of-health-care-quality. Accessed July 27, 

2017.
10

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Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

11

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

 Together, sexual 

behavior and community prevalence 

can increase the risk of acquiring 

gonorrhea. Social determinants of 

health, such as socioeconomic status, 

discrimination, and access to quality 

health care, may contribute to the 

burden of gonorrhea in a community.2

In 2009, the national rate of reported 

gonorrhea cases reached a historic 

low of 98.1 cases per 100,000 

population (Figure 12, Table 1). 

However, during 2009–2012, the rate 

increased slightly each year to 106.7 

cases per 100,000 population in 2012. 

In 2013, the rate decreased slightly to 

105.3 cases per 100,000 population, 

followed by a yearly increase during 

2013–2016. In 2016, a total of 

468,514 cases were reported for a rate 

of 145.8 gonorrhea cases per 100,000 

population (Figure 12, Table 1).

The increase in the gonorrhea rate 

during 2015–2016 was observed 

among both males and females; 

however, the increase was larger 

among males (Figure 13). During 

2015–2016, the gonorrhea rate 

increased in all regions and, during 

2012–2016, the largest increase was 

observed in the West (95.7%; 72.6 to 

142.1 cases per 100,000 population) 

(Figure 14, Table 14). The rate of 

gonorrhea continued to increase 

among persons in every age group 

during 2015–2016 (Table 21).

N. gonorrhoeae has progressively 

developed resistance to each of the 

antimicrobials used for treatment of 

gonorrhea. Declining susceptibility 

to cefixime (an oral cephalosporin 

antibiotic) resulted in a change to 

the CDC treatment guidelines, so 

that dual therapy with ceftriaxone 

(an injectable cephalosporin) and 

azithromycin is now the only CDCrecommended 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 

cephalosporin-resistant gonorrhea 

reinforces the need to better 

understand the epidemiology of 

gonorrhea. 

Figure 12. Gonorrhea — Rates of Reported Cases by Year, United 

States, 1941–2016

 0

100

200

300

400

500

Year

1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 2011 2016

Rate (per 100,000 population)

NOTE: Data collection for gonorrhea began in 1941; however, gonorrhea became nationally 

notifiable in 1944. Refer to the National Notifiable Disease Surveillance System (NNDSS) website for 

more information: https://wwwn.cdc.gov/nndss/conditions/gonorrhea/

Figure 13. Gonorrhea — Rates of Reported Cases by Sex, United 

States, 2007–2016

 0

 50

100

150

200

Year

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rate (per 100,000 population)

Men

Women

Total
12

National Profile Centers for Disease Control and Prevention: STD Surveillance 2016

Figure 14. Gonorrhea — Rates of Reported Cases by Region, United 

States, 2007–2016

 0

 50

100

150

200

Year

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rate (per 100,000 population) West

Midwest

Northeast

South

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 2016, a total of 468,514 cases 

of gonorrhea were reported in the 

United States, yielding a rate of 

145.8 cases per 100,000 population 

(Table 1). During 2015–2016, the rate 

of reported gonorrhea cases increased 

18.5%, and increased 48.6% since the 

historic low in 2009. 

Gonorrhea by Region

The South had the highest rate of 

reported gonorrhea cases (166.8 cases 

per 100,000 population) among the 

four regions of the United States 

in 2016, followed by the Midwest 

(142.9 cases per 100,000 population), 

the West (142.1 cases per 100,000 

population), and the Northeast 

(108.8 cases per 100,000 population) 

(Figure 14, Table 14). During 2015–

2016, the gonorrhea rate increased 

in all four regions: 23.8% in the 

Midwest, 21.9% in the West, 15.7% 

in the Northeast, and 15.4% in the 

South (Figure 14, Table 14). During 

2012–2016, the rate of gonorrhea 

in the West increased by 95.7% 

(72.6 to 142.1 cases per 100,000 

population), while other regions had 

smaller overall increases during this 

time period (i.e., 27.8% in the South, 

25.0% in the Midwest, and 18.0% in 

the Northeast).

Gonorrhea by State

In 2016, rates of reported gonorrhea 

cases per 100,000 population ranged 

by state from 20.1 in Vermont to 

239.2 in Mississippi; the gonorrhea 

rate in the District of Columbia was 

479.9 cases per 100,000 population 

(Figure 15, Table 13).

During 2015–2016, gonorrhea rates 

increased in 96.1% of states and the 

District of Columbia and decreased in 

3.9% of states (Table 14).

Figure 15. Gonorrhea — Rates of Reported Cases by State, United 

States and Outlying Areas, 2016

Guam 82 

Puerto Rico 21 

Virgin Islands 34 

<= 73 

74 - 114 

115 - 148 

149 - 180 

>=181 

(n= 11)

(n= 13)

(n= 9)

(n= 11)

(n= 10)

173

197

151 193

165 110

139

201

103

38

165 143

83

115 131

231

34

126

93

239

189

84

114 152

169

147

196

132

176

194

108

114

188

148

154

155

70

132

114

50

113

47

VT 20

NH 34

MA 73

RI 68

CT 76

NJ 91

DE 180

MD 159

DC 480

Rate per 100,000

population

NOTE: The total rate of reported cases of gonorrhea for the United States and outlying areas 

(Guam, Puerto Rico, and Virgin Islands) was 144.4 per 100,000 population.
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

13

Gonorrhea by Metropolitan 

Statistical Area

The overall rate of reported gonorrhea 

cases in the 50 most populous 

metropolitan statistical areas (MSAs) 

was 162.2 cases per 100,000 

population in 2016, representing a 

19.6% increase compared with the 

rate in 2015 (135.6 cases per 100,000 

population) (Table 17). In 2016, 

61.2% of reported gonorrhea cases 

were reported by these MSAs. Since 

2012, the gonorrhea rate among 

females in the 50 most populous 

MSAs has been lower than the rate 

among males (Tables 18 and 19). In 

2016, the rate among females in these 

MSAs was 120.8 cases per 100,000 

females, while the rate among males 

was 204.7 cases per 100,000 males.

Gonorrhea by County

In 2016, 51.0% of reported gonorrhea 

cases occurred in just 70 counties 

or independent cities (Table 20). In 

2016, 608 counties (19.5%) in the 

United States had a rate less than 

or equal to 16 cases per 100,000 

population (Figure 16). The rate 

ranged from 17 to 38 cases per 

100,000 population in 631 counties 

(20.1%), ranged from 39 to 71 

cases per 100,000 population in 635 

counties (20.2%), ranged from 72 

to 139 cases per 100,000 population 

in 619 counties (19.7%), and was 

more than 139 cases per 100,000 

population in 647 counties (20.6%). 

As in previous years, counties with 

the highest gonorrhea rates were 

concentrated in the South.

Gonorrhea by Sex

As was observed during 2013–2015, 

the rate of reported gonorrhea cases 

among males was higher than the rate 

among females in 2016 (Figure 13, 

Tables 15 and 16). During 2015–

2016, the gonorrhea rate among males 

increased 22.2% (139.7 to 170.7 

cases per 100,000 males), and the 

rate among females increased 13.8% 

(106.3 to 121.0 cases per 100,000 

females). During 2012–2016, the 

rate among males increased 62.6% 

(105.0 to 170.7 cases per 100,000 

males) and the rate among females 

increased 12.1% (107.9 to 121.0 cases 

per 100,000 females). The magnitude 

of the increase among males suggest 

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

In all regions, the rate of gonorrhea 

increased among both males and 

females during 2015–2016 and the 

rate of increase among males was 

larger than the rate of increase among 

females (Tables 15 and 16). The rate 

of reported gonorrhea cases increased 

the most in the Midwest (26.7% 

among males and 21.0% among 

females) and in the West (24.1% 

among males and 17.2% among 

females) (Tables 15 and 16).

Gonorrhea by Age

In 2016, rates of reported gonorrhea 

cases continued to be highest among 

adolescents and young adults 

(Figure 17, Table 21). In 2016, 

the highest rates among females 

were observed among those aged 

20–24 years (595.5 cases per 100,000 

females) and 15–19 years (482.1 

cases per 100,000 females). Among 

males, the rate was highest among 

those aged 20–24 years (616.8 cases 

per 100,000 males) and 25–29 years 

(545.1 cases per 100,000 males).

In 2016, persons aged 15–44 years 

accounted for 91.9% of reported 

gonorrhea cases with known age. 

Among 15–19 year olds, rates 

decreased by 10.7% during 2012–

2015 and increased 11.3% during 

2015–2016. During 2015–2016, the 

gonorrhea rate also increased among 

other age groups: 10.9% among 

those aged 20–24 years, 22.2% 

among those aged 25–29 years, 

26.2% among those aged 30–34 

years, 30.3% among those aged 

35–39 years, and 27.0% among those 

aged 40–44 years (Figures 18 and 

19, Table 21). Among persons aged 

15–44 years, increases were observed 

in all age groups for both men and 

women during 2015–2016.

Figure 16. Gonorrhea — Rates of Reported Cases by County, 

United States, 2016

Rate per 100,000

population

<=16 (n= 608)

17-38 (n= 631)

39-71 (n= 635)

72-139 (n= 619)

>139 (n= 647)

NOTE: Refer to the NCHHSTP Atlas for further county-level rate information: https://www.cdc.gov/

nchhstp/atlas/.
14

National Profile Centers for Disease Control and Prevention: STD Surveillance 2016

Figure 17. Gonorrhea — Rates of Reported Cases by Age Group and 

Sex, United States, 2016

Men Rate (per 100,000 population) Women

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

4.7 10-14 19.1

280.8 4 15-19 82.1

616.8 20-24 595.5

545.1 25-29 351.8

350.7 1 30-34 79.0

233.4 35-39 100.3

140.7 4 40-44 8.5

92.8 45-54 19.8

35.2 55-64 5.6

6.7 0 65+ .7

170.7 Total 121.0

Figure 18. Gonorrhea — Rates of Reported Cases Among Women 

Aged 15–44 Years by Age Group, United States, 2007–2016

 0

 100

 200

 300

 400

 500

 600

 700

Year

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rate (per 100,000 population) Age Group

15-19

20-24

25-29

30-34

35-39

40-44

Figure 19. Gonorrhea — Rates of Reported Cases Among Men Aged 

15–44 Years by Age Group, United States, 2007–2016

 0

 100

 200

 300

 400

 500

 600

 700

Year

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rate (per 100,000 population) Age Group

15-19

20-24

25-29

30-34

35-39

40-44

Gonorrhea by Race/Ethnicity

In 2016, among the 50 states and the 

District of Columbia that submitted 

data in the race and ethnicity 

categories according to Office of 

Management and Budget (OMB) 

standards (see Section A1.5 in the 

Appendix), the rate of reported 

gonorrhea cases remained highest 

among Blacks (481.2 cases per 

100,000 population) (Table 22B). 

The rate among Blacks was 8.6 

times the rate among Whites (55.7 

cases per 100,000 population). The 

gonorrhea rate among American 

Indians/Alaska Natives (242.9 cases 

per 100,000 population) was 4.4 

times that of Whites, the rate among 

Native Hawaiians/Other Pacific 

Islanders (165.8 cases per 100,000 

population) was 3.0 times that of 

Whites, the rate among Hispanics 

(95.9 cases per 100,000 population) 

was 1.7 times that of Whites, the 

rate among Multirace persons (62.3 

cases per 100,000 population) was 

1.1 times that of Whites, and the rate 

among Asians (28.3 cases per 100,000 

population) was half the rate of 

Whites (Table 22B).

During 2012–2016, among the 

46 states that submitted race and 

ethnicity data according to OMB 

standards (see Section A1.5 in the 

Appendix) for all five years during 

that period, the gonorrhea rate 

increased among all race and ethnicity 

groups: 120.4% among Multirace 

persons, 91.4% among Native 

Hawaiians/Other Pacific Islanders, 

82.5% among Whites, 81.3% among 

American Indians/Alaska Natives, 

76.7% among Asians, 61.8% among 

Hispanics, and 10.5% among Blacks 

(Figure 20). 

More information on gonorrhea rates 

among race/ethnicity groups can be 

found in the Special Focus Profiles.
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

15

Figure 20. Gonorrhea — Rates of Reported Cases by Race/Ethnicity, 

United States, 2012–2016

 0

 100

 200

 300

 400

 500

 600

Year

2012 2013 2014 2015 2016

Rate (per 100,000 population)

AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

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

NOTE: Includes 46 states reporting race/ethnicity data in Office of Management and Budget 

compliant formats during 2012–2016 (see Section A1.5 in the Appendix).

Gonorrhea by

Reporting Source

In 2016, 10.5% of gonorrhea cases 

were reported from STD clinics, 

75.4% were reported from venues 

outside of STD clinics, and 14.0% 

had an unknown source of report 

(Table A2).

During 2007–2016, the percent of 

gonorrhea cases reported by STD 

clinics declined 64.8% among males 

and 59.3% among females; however, 

the percent of gonorrhea cases with 

missing/unknown reporting source 

increased 65.2% among males and 

45.7% among females (Figures 21 and 

22). During 2015–2016, the percent 

of gonorrhea cases reported by STD 

clinics decreased 13.5% among males 

and 9.6% among females.

In 2016, among males, private 

physicians/health maintenance 

organizations (HMOs) (22.2%) were 

the most common reporting source, 

followed by STD clinics (13.1%), 

other hospital clinics/facilities 

(12.5%), emergency rooms (6.4%), 

and other health department clinics 

(6.1%) (Figure 21). Among females, 

private physicians/HMOs (26.0%) 

were the most common reporting 

source, followed by other hospital 

clinics/facilities (13.9%), STD clinics 

(7.0%), family planning clinics 

(7.0%), and laboratories (5.8%) 

(Figure 22).

STD Surveillance Network

The STD Surveillance Network 

(SSuN) is an ongoing collaboration 

of states and independently funded 

cities collecting enhanced information 

on a representative sample of 

gonorrhea case reports received 

from all reporting sources in their 

jurisdiction. Enhanced gonorrhea 

case report data for 2016 were 

obtained from Cycle 3 of SSuN, 

which includes 10 jurisdictions 

randomly sampling cases reported 

in their jurisdictions. In 2016, SSuN 

collaborators interviewed 5,177 

gonorrhea cases representing 3.6% of 

all cases reported from participating 

jurisdictions. The estimated burden 

of disease represented by men who 

have sex with men only (MSM-only), 

men who have sex with both men and 

women (MSMW), men who have 

sex with women only (MSW), and 

women varied substantially across 

collaborating sites based on weighted 

analysis (Figure 23). San Francisco 

had the highest proportion of cases 

estimated to be MSM-only (81.4%), 

while Baltimore had the lowest 

proportion of MSM-only cases at 

16.2%. Across all jurisdictions, an 

estimated 6.7% of gonorrhea cases 

were attributable to MSMW, which 

is an important group representing 

a bridge between MSM-only and 

heterosexual populations. (Figure 23). 

In total, across all SSuN sites, 44.7% 

Figure 21. Gonorrhea — Percentage of Reported Cases Among Men 

by Reporting Source*, United States, 2007–2016

Percentage

2007 2008 2009 2010 2011

2012 2013 2014 2015 2016

 0

 10

 20

 30

 40

STD Clinic Other HD†

Clinic

Private

Physician/HMO†

Emergency

Room

Hosp-Other All Other Missing/Unk

* Includes the top five reporting sources for gonorrhea cases reported among men, plus those with 

reporting sources listed as “All Other” and “Missing/Unknown”.

†

 HMO = health maintenance organization; HD = health department.

NOTE: All 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, Indian Health Service, Military, Family Planning, HIV Counseling and Testing 

Site, and Other.
16

National Profile Centers for Disease Control and Prevention: STD Surveillance 2016

Figure 22. Gonorrhea — Percentage of Reported Cases Among 

Women by Reporting Source*, United States, 2007–2016

Percentage

2007 2008 2009 2010 2011

2012 2013 2014 2015 2016

 0

 10

 20

 30

 40

STD Clinic Family

Planning

Clinic

Private

Physician/

HMO†

Laboratory Hosp-Other All Other Missing/Unk

* Includes the top five reporting sources for gonorrhea cases reported among women, plus those 

with reporting sources listed as “All Other” and “Missing/Unknown”.

†

 HMO = health maintenance organization.

NOTE: All Other includes: Drug Treatment, Tuberculosis Clinic, Correctional Facility, Blood Bank, 

Labor and Delivery, Prenatal Care, National Job Training Program, School-based Clinic, Mental 

Health Provider, Indian Health Service, Military, Emergency Room, Other Health Department Clinic, 

HIV Counseling and Testing Site, and Other.

Figure 23. Estimated Proportion* of MSM-Only†, MSMW†, MSW†, and 

Women Among Gonorrhea Cases by Jurisdiction, STD Surveillance 

Network (SSuN), 2016

Percentage

MSM-Only

MSMW

MSW

Women

0

10

20

30

40

50

60

70

80

90

100

San

Francisco

New York

City Multnomah

County

Massachusetts

Washington

California

Minnesota

Philadelphia

Florida

Baltimore

†

†

†

‡

* Estimate based on weighted analysis of data obtained from interviews (n=5,177) conducted 

among a random sample of reported gonorrhea cases during January to December 2016. 

†

 MSM-Only = Men who have sex exclusively with men; MSMW = Men who have sex with both 

men and women; MSW = Men who have sex with women only. 

‡

 California data excludes San Francisco (shown separately). 

NOTE: See section A2.2 in the Appendix for SSuN methods.

of gonorrhea cases were estimated 

to be among MSM-only or MSMW, 

22.6% among MSW, and 32.7% 

among women.

Collaborating SSuN jurisdictions 

also conduct sentinel surveillance on 

all patients seeking care in selected 

STD clinics. Sentinel facility data for 

this report includes information from 

patients attending STD clinics during 

2016 in nine out of the 10 funded 

jurisdictions. In 2016, the proportion 

of STD clinic patients who tested 

positive for gonorrhea varied by age 

group, sex, and sex of sex partner 

(Figure 24). Among those attending 

these clinics, MSM disproportionately 

had higher positivity rates when 

compared to MSW and women in 

all age groups. While positivity rates 

declined with increasing age for 

heterosexual males and females, a 

much slower decline by age was seen 

in MSM-only.

Additional information about SSuN 

methodology can be found in Section 

A2.2 of the Appendix.

Gonococcal Isolate 

Surveillance Project

Antimicrobial resistance remains 

an important consideration in the 

treatment of gonorrhea.3,5–7 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.7

 Data are collected from 

selected STD clinic sentinel sites 

and from regional laboratories 

(Figure 25).

Antimicrobial susceptibility is 

measured by the minimum inhibitory 

concentration (MIC), the lowest 

antimicrobial concentration that 

inhibits bacterial growth in the 

laboratory. Increases in MICs 

demonstrate that the bacteria can 

survive at higher antimicrobial 

concentrations in the laboratory. 

Monitoring of MIC trends is useful 

because increasing MICs can 

oftentimes be an early indicator of the 

emergence of antimicrobial resistance.

Information on the antimicrobial 

susceptibility criteria used in GISP 

can be found in Section A2.3 in the 

Appendix. More information about 

GISP and additional data can be found 

at https://www.cdc.gov/std/GISP.
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

17

Figure 24. Gonorrhea — Proportion* of STD Clinic Patients Testing 

Positive† by Age Group, Sex, and Sexual Behavior, STD Surveillance 

Network (SSuN), 2016

Percentage

Age Group

MSM

MSW

Women

0

10

20

30

40

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

‡

‡

* Proportions represent the overall average of the mean value by jurisdiction. 

†

 Results are based on data obtained from patients with known sexual behavior (n=75,347) 

attending SSuN STD clinics in 2016 in all SSuN jurisdictions, excluding Florida. 

‡

 MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM); 

MSW = Men who have sex with women only.

NOTE: See section A2.2 in the Appendix for SSuN methods.

Figure 25. Location of Participating Sentinel Sites and Regional 

Laboratories, Gonococcal Isolate Surveillance Project (GISP), United 

States, 2016

Sentinel Sites

Sites and 

Regional Labs

 Birmingham Phoenix

 Los Angeles

 Orange Co.

 San Diego

 San Francisco

 Atlanta

 Honolulu

 Tripler AMC

 Chicago

 Indianapolis

 New Orleans

 Boston

 Pontiac Minneapolis

 Kansas City

 Las Vegas

 Albuquerque

 Buffalo

 New York City

 Greensboro

 Cleveland

 Columbus

 Portland

 Philadelphia

 Austin

 Dallas

 Seattle

NOTE: Austin is a regional laboratory only.

Ceftriaxone Susceptibility

Susceptibility testing for ceftriaxone 

began in 1987. During 2006–2016, 

the percentage of GISP isolates that 

exhibited elevated ceftriaxone MICs, 

defined as ≥0.125 μg/ml, fluctuated 

between 0.05% and 0.4% (Figure 26). 

In 2016, 0.3% of isolates had elevated 

ceftriaxone MICs. Five isolates with 

decreased ceftriaxone susceptibility 

(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).

Cefixime Susceptibility

Susceptibility testing for cefixime 

began in 1992, was discontinued in 

2007, and was restarted in 2009. The 

percentage of isolates with elevated 

cefixime MICs (≥0.25μg/ ml) 

declined from 1.4% in 2011 to 0.3% 

in 2016 (Figure 26).

Azithromycin Susceptibility

Susceptibility testing for azithromycin 

began in 1992. Figure 27 displays the 

distribution of azithromycin MICs 

among GISP isolates collected during 

2012–2016. Most isolates had MICs 

of 0.125–0.5 μg/ml. During 2012–

2014, the percentage of isolates with 

elevated azithromycin MICs (MICs ≥ 

2 μg/ml) ranged from 0.02% to 1.0%; 

during 2014–2016, the percentage 

increased from 2.4% to 3.6%.

Susceptibility to Other 

Antimicrobials

In 2016, 44.1% 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, 55.9% 

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 2016. In 

2016, 1.5% of patients were treated 

with gentamicin 240 mg and 0.1% 

were treated with cefixime 400mg.
18

National Profile Centers for Disease Control and Prevention: STD Surveillance 2016

Figure 26. Neisseria gonorrhoeae — Percentage of Isolates with 

Elevated Ceftriaxone Minimum Inhibitory Concentrations (MICs) 

(≥0.125 μg/ml) and Elevated Cefixime MICs (≥0.25 μg/ml), Gonococcal 

Isolate Surveillance Project (GISP), 2006–2016

Percentage

Year

Elevated Cefixime MICs

Elevated Ceftriaxone MICs

 0.0

 0.3

 0.6

 0.9

 1.2

 1.5

2006 2007* 2008* 2009 2010 2011 2012 2013 2014 2015 2016

* Isolates not tested for cefixime susceptibility in 2007 and 2008.

Figure 27. Neisseria gonorrhoeae — Distribution of Azithromycin 

Minimum Inhibitory Concentrations (MICs) by Year, Gonococcal 

Isolate Surveillance Project (GISP), 2012–2016

Percentage

MICs (μg/ml)

2012

2013

2014

2015

2016

 0

 10

 20

 30

 40

 50

<=0.03 0.06 0.125 0.25 0.5 1 248 >=16

Year

Gonorrhea Among Special 

Populations

More information about gonorrhea 

in race/ethnicity groups, females of 

reproductive age, adolescents, and 

MSM can be found in the Special 

Focus Profiles.

Gonorrhea Summary

The national rate of reported 

gonorrhea cases reached a historic 

low in 2009, but increased each year 

during 2009–2012. After a temporary 

decrease in 2013, the gonorrhea rate 

increased again during 2014–2016. 

This increase was largely attributable 

to increases among men. High 

gonorrhea rates persist in certain 

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.
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

19

Figure 28. Neisseria gonorrhoeae — Distribution of Isolates with 

Penicillin, Tetracycline, and/or Ciprofloxacin Resistance, Gonococcal 

Isolate Surveillance Project (GISP), 2016

Susceptible

PenR

TetR

QRNG

PenR/TetR

PenR/QRNG

TetR/QRNG

PenR/TetR/QRNG

55.9%

4.3%

11.4%

10.7%

1.5%

6.5%

4.1%

5.5%

NOTE: PenR = penicillinase-producing Neisseria gonorrhoeae and chromosomally-mediated 

penicillin-resistant N. gonorrhoeae; TetR = chromosomally- and plasmid-mediated tetracyclineresistant N. gonorrhoeae; and QRNG = quinolone-resistant N. gonorrhoeae.

Figure 29. Distribution of Primary Antimicrobial Drugs Used to Treat 

Gonorrhea Among Participants, Gonococcal Isolate Surveillance 

Project (GISP), 1988–2016

0

20

40

60

80

100

Year

1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016

Other Cephalosporins

Ceftriaxone 125 mg

Spectinomycin

Ceftriaxone 250 mg

Cefixime

Penicillins

Ciprofloxacin

Tetracyclines

Ofloxacin

Other

Percentage

Gentamicin

NOTE: For 2016, “Other” includes azithromycin 2g (0.7%), no therapy (0.1%), and other less 

frequently used drugs (0.8%).

References

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. Hogben M, Leichliter JS. Social determinants 

and sexually transmitted disease disparities. Sex 

Transm Dis 2008; 35(12 Suppl): S13–18.

3. Centers for Disease Control and Prevention. 

Sexually transmitted diseases treatment 

guidelines, 2015. MMWR Recomm Rep 2015; 

64(No. RR-3): 1–137.

4. Satterwhite CL, Torrone E, Meites E, et 

al. Sexually transmitted infections among 

US women and men: prevalence and 

incidence estimates, 2008. Sex Transm 

Dis 2013; 40(3): 187–193. DOI: 10.1097/

OLQ.0b013e318286bb53. Review.

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(14): 332–336.

6. Centers for Disease Control and Prevention. 

Sexually transmitted diseases treatment 

guidelines, 2010. MMWR Recomm Rep 2010; 

59(No.RR-12): 1–110.

7. Schwarcz S, Zenilman J, Schnell D, et al. 

National surveillance of antimicrobial resistance 

in Neisseria gonorrhoeae. JAMA 1990; 

264(11): 1413–1417.
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Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

21

Syphilis

Background

Syphilis, a genital ulcerative 

disease caused by the bacterium 

Treponema pallidum, is associated 

with significant complications if 

left untreated and can facilitate the 

transmission and acquisition of HIV 

infection.1–3 Additionally, historical 

data demonstrate that untreated 

early syphilis in pregnant women, if 

acquired during the four years before 

delivery, can lead to infection of the 

fetus in up to 80% of cases and may 

result in stillbirth or death of the 

infant in up to 40% of cases.4

In 2000 and 2001, the national rate 

of reported primary and secondary 

(P&S) syphilis cases was 2.1 cases 

per 100,000 population, the lowest 

rate since reporting began in 1941 

(Figure 30, Table 1). However, the 

P&S syphilis rate has increased 

almost every year since 2000–2001. 

In 2016, a total of 27,814 P&S 

syphilis cases were reported. During 

2015–2016, the national P&S syphilis 

rate increased 17.6% to 8.7 cases per 

100,000 population, the highest rate 

reported since 1993.

During 2000–2016, the rise in the 

rate of reported P&S syphilis was 

primarily attributable to increased 

cases among men and, specifically, 

among gay, bisexual, and other men 

who have sex with men (collectively 

referred to as MSM) (Figures 34 and 

35). However, during 2013–2016, 

the rate increased both among men 

and women (Tables 28 and 29). 

During 2015–2016, the rate increased 

14.7% among men and 35.7% among 

women. These increases among 

women are of particular concern 

because congenital syphilis cases tend 

to increase as the rate of P&S syphilis 

among women increases (Figure 44). 

During 2015–2016, the national, 

male, and female P&S syphilis rates 

increased in every region of the 

country (Figure 31, Tables 27, 28, 

and 29). Nationally, P&S syphilis 

rates increased in every age group 

among those aged 15 years or older 

and in every race/ethnicity group 

during 2015–2016 (Figures 39 and 

40, Table 34).

As in recent years, MSM accounted 

for the majority of reported P&S 

syphilis cases in 2016 (Figures 35 and 

36). Nationally, the highest rates of 

P&S syphilis in 2016 were observed 

among men aged 20–34 years, among 

men in the West, and among Black 

men (Figure 37, Tables 29, 34 and 

35B).

Interpreting Rates of 

Reported Cases of Syphilis

Left untreated, infection with syphilis 

can span decades. P&S syphilis 

are the earliest stages of infection, 

reflect symptomatic disease, and 

are indicators of incident infection.5

For these reasons, trend analyses 

of syphilis focus on reported cases 

and rates of reported cases of P&S 

syphilis. When referring to “P&S 

syphilis”, case counts are the sum of 

both primary and secondary cases, 

and “rate of P&S syphilis” refers to 

this sum per unit population.

Changes in reporting and 

screening practices can complicate 

interpretation of trends over time. 

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.

P&S Syphilis — United States

In 2016, a total of 27,814 cases of 

P&S syphilis were reported in the 

United States, yielding a rate of 

8.7 cases per 100,000 population 

(Figure 30, Table 1). This rate 

represents a 17.6% increase compared 

with 2015 (7.4 cases per 100,000 

population), and a 74.0% increase 

compared with 2012 (5.0 cases per 

100,000 population).

P&S Syphilis by Region

In 2016, the West had the highest 

rate of reported P&S syphilis cases 

(11.4 cases per 100,000 population), 

followed by the South (8.9 cases per 

100,000 population), the Northeast 

(8.0 cases per 100,000 population), 

and the Midwest (5.7 cases per 

100,000 population) (Table 27). 

During 2015–2016, the P&S syphilis 

rate increased in every region: 

21.3% in the Midwest, 21.2% in 

the Northeast, 20.0% in the West, 

and 11.3% in the South (Figure 31, 

Table 27).

P&S Syphilis by State

In 2016, rates of reported P&S 

syphilis cases per 100,000 population 

ranged by state from 1.1 in Alaska 

to 16.1 in Louisiana (Figure 32, 

Table 26). The rate of reported P&S 

syphilis cases in the District of 

Columbia was 24.0 cases per 100,000 

population. During 2015–2016, P&S 

syphilis rates increased in 82.0% 

(41/50) of states and the District of 

Columbia, and remained stable or 

decreased in 18.0% (9/50) of states 

(Table 27).

P&S Syphilis by Metropolitan 

Statistical Area

The overall rate of reported P&S 

syphilis cases in the 50 most populous 

metropolitan statistical areas 

(MSAs) was 11.2 cases per 100,000 

population in 2016, which represents 

a 14.3% increase since 2015 (9.8 

cases per 100,000 population) 

(Table 30). Overall, in 2016, 71.3% 

of reported P&S syphilis cases 

(73.5% of male cases and 53.0% of 
22

National Profile Centers for Disease Control and Prevention: STD Surveillance 2016

Figure 30. Syphilis — Rates of Reported Cases by Stage of Infection, 

United States, 1941–2016

 0

100

200

300

400

Year

1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 2011 2016

Rate (per 100,000 population)

Primary and Secondary

Early Latent

Total Syphilis

NOTE: Data collection for syphilis began in 1941; however, syphilis became nationally notifiable 

in 1944. Refer to the National Notifiable Disease Surveillance System (NNDSS) website for more 

information: https://wwwn.cdc.gov/nndss/conditions/syphilis/.

Figure 31. Primary and Secondary Syphilis — Rates of Reported 

Cases by Region, United States, 2007–2016

 0

 2

 4

 6

 8

10

12

14

Year

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rate (per 100,000 population)

West

Midwest

Northeast

South

female cases) were reported by these 

50 MSAs. In 2016, the rate among 

women in these MSAs was 1.8 

cases per 100,000 females, while the 

rate among men was 21.0 cases per 

100,000 males (Tables 31 and 32).

P&S Syphilis by County

In 2016, 64.2% of reported P&S 

syphilis cases occurred in 70 counties 

or independent cities (Table 33). Of 

3,140 counties in the United States, 

484 (15.4%) had a P&S syphilis rate 

greater than 6.7 cases per 100,000 

population, 480 (15.3%) reported a 

rate from 3.4 to 6.7 cases per 100,000 

population, 477 (15.2%) reported a 

rate from 0.2 to 3.3 cases per 100,000 

population, and 1,699 (54.1%) 

counties reported no cases of P&S 

syphilis in 2016 (Figure 33).

P&S Syphilis by Sex and 

Sexual Behavior

As has been observed in previous 

years, in 2016 the rate of reported 

P&S syphilis cases among men 

(15.6 cases per 100,000 males) was 

much higher than the rate among 

women (1.9 cases per 100,000 

females), and men accounted for 

a large majority (88.9%) of P&S 

syphilis cases (Figure 36, Tables 28 

and 29). Among men, the rate of P&S 

syphilis has increased every year 

since 2000, and during 2015–2016, 

the rate among men increased 14.7% 

(Figure 34, Table 29). In contrast, 

the P&S syphilis rate among women 

fluctuated between 0.8 and 1.7 cases 

per 100,000 females during 2000–

2012, but has increased substantially 

since 2012 (Figure 34, Table 28). 

During 2012–2016, the P&S syphilis 

rate among women more than 

doubled (increased 111.1%). During 

2015–2016, the P&S syphilis rate 

among women increased 35.7%.

These increases in male and female 

P&S syphilis rates were observed in 

every region of the country during 

2015–2016. Among men, the rate 

increased 20.5% in the Northeast, 

19.8% in the Midwest, 16.1% in the 

West, and 9.7% in the South (Table 

29). Among women, the largest 

increases were observed in the West 

(58.8%), followed by the Northeast 

(28.6%), the South (22.2%) and the 

Midwest (20.0%) (Table 28).

MSM continued to account for the 

majority of P&S syphilis cases in 

2016 (Figures 35 and 36). Of 27,814 

reported P&S syphilis cases in 2016, 

16,155 (58.1%) were among MSM, 

including 14,553 (52.3%) cases 

among men who had sex with men 

only and 1,602 (5.8%) cases among 

men who had sex with both men 

and women (Figure 36). Overall, 

3,880 (13.9%) cases were among 

men who had sex with women only 

(MSW), 3,049 (11.0%) were among 

women, 4,689 (16.9%) were among 

men without information about sex 

of sex partner, and 41 (0.1%) were 

cases reported with unknown sex. 

Among the 20,035 male cases with 

information on sex of sex partner, 

80.6% occurred among MSM.

A total of 36 states were able to 

classify at least 70.0% of reported 

P&S syphilis cases as MSM, MSW, 

or women each year during 2012–

2016 (Figure 35). In these states, 

during 2015–2016, the number of 

cases increased 16.4% among MSM, 
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

23

Figure 32. Primary and Secondary Syphilis — Rates of Reported 

Cases by State, United States and Outlying Areas, 2016

Guam 1.2 

Puerto Rico 14.2 

Virgin Islands 0.0 

<= 3.0 

3.1 - 4.9 

5.0 - 6.7 

6.8 - 10.6 

>=10.7 

(n= 11)

(n= 11)

(n= 11)

(n= 11)

(n= 10)

7.7

1.1

10.6 5.0

15.0 4.6

11.9

13.2

7.8

3.0

9.8 4.9

2.8

4.3 4.9

16.1

3.2

3.7

5.6

10.9

6.6

1.4

3.5 15.4

9.1

12.4

10.8

4.4

6.2

6.7

8.1

5.9

6.5

3.0

5.9

7.1

3.1

5.5

7.9

2.9

2.3

1.2

VT 3.7

NH 3.0

MA 7.2

RI 8.5

CT 3.1

NJ 5.3

DE 6.1

MD 8.5

DC 24.0

Rate per 100,000

population

NOTE: The total rate of reported cases of primary and secondary syphilis for the United States and 

outlying areas (Guam, Puerto Rico, and Virgin Islands) was 8.7 per 100,000 population.

Figure 33. Primary and Secondary Syphilis — Rates of Reported 

Cases by County, United States, 2016

Rate per 100,000

population

0* (n= 1,699)

>0-3.3 (n= 477)

3.4-6.7 (n= 480)

>6.7 (n= 484)

* In 2016, 1,699 (54.1%) of 3,140 counties in the United States reported no cases of primary and 

secondary syphilis. Refer to the NCHHSTP Atlas for further county-level rate information: https://

www.cdc.gov/nchhstp/atlas/.

22.2% among MSW, and 31.0% 

among women.

P&S Syphilis by Age

As in previous years, in 2016, rates 

of reported P&S syphilis cases were 

highest among persons aged 25–29 

years and 20–24 years (Figure 37, 

Table 34). In 2016, the highest rates 

were observed among men aged 

25–29 years (48.5 cases per 100,000 

males), 20–24 years (37.9 cases per 

100,000 males), and 30–34 years 

(35.0 cases per 100,000 males). 

The highest rates among women 

were among those aged 20–24 years 

(6.7 cases per 100,000 females) and 

those aged 25–29 years (5.6 cases per 

100,000 females).

During 2015–2016, the overall rate of 

reported P&S syphilis cases increased 

in all age groups among those aged 

15 years or older (Table 34). Rates 

increased 13.0% among those aged 

15–19 years, 8.1% among those aged 

20–24 years, 19.6% among those 

aged 25–29 years, 20.1% among 

those aged 30–34 years, 22.1% 

among those aged 35–39 years, 

12.8% among those aged 40–44 

years, 13.6% among those aged 

45–54 years, 25.0% among those 

aged 55–64 years, and 50.0% among 

those aged 65 or older.

In 2016, persons aged 15–44 years 

accounted for 79.6% of reported 

P&S syphilis cases with known age. 

Among both men and women, the 

P&S syphilis rate increased during 

2015–2016 in all age groups among 

those aged 15–44 years (Figures 38 

and 39, Table 34).

P&S Syphilis by

Race/Ethnicity

In 2016, all 50 states and the 

District of Columbia submitted 

data in the race and ethnicity 

categories according to the Office 

of Management and Budget (OMB) 

standards (see Section A1.5 in the 

Appendix). Among these, the rate 

of reported P&S syphilis cases was 

highest among Blacks (23.1 cases 

per 100,000 population) (Table 35B). 

The P&S syphilis rate among Blacks 

was 4.7 times the rate among Whites 

(4.9 cases per 100,000 population), 

the rate among Native Hawaiians/

Other Pacific Islanders (12.9 cases 

per 100,000 population) was 2.6 

times the rate among Whites, the 

rate among Hispanics (10.9 cases per 

100,000 population) was 2.2 times the 

rate among Whites, the rate among 

American Indians/Alaska Natives (8.0 

cases per 100,000 population) was 

1.6 times the rate among Whites, and 

the rate among Asians (3.9 cases per 

100,000 population) was 0.8 times the 

rate among Whites.
24

National Profile Centers for Disease Control and Prevention: STD Surveillance 2016

Figure 34. Primary and Secondary Syphilis — Rates of Reported 

Cases by Sex and Male-to-Female Rate Ratios, United States, 1990–

2016

 0

 5

 10

 15

 20

 25

Year

2016

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

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

Figure 35. Primary and Secondary Syphilis — Reported Cases by 

Sex and Sexual Behavior, 36 States*, 2012–2016

 0

 2,000

 4,000

 6,000

 8,000

10,000

12,000

14,000

Year

2012 2013 2014 2015 2016

Cases

†

†

MSM

MSW

Women

* 36 states were able to classify ≥70% of reported cases of primary and secondary syphilis as either 

MSM†, MSW†, or women for each year during 2012–2016. † MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM); 

MSW = Men who have sex with women only.

Figure 36. Primary and Secondary Syphilis — Distribution of Cases 

by Sex and Sexual Behavior, United States, 2016

Men who have sex with men only 

(n = 14553)

Men who have sex with men and women 

(n = 1602)

Men who have sex with women only 

(n = 3880)

Men without data on sex of sex partners 

(n = 4689) 

Women (n = 3049)

Cases with unknown sex (n = 41) 

52%

6%

14%

17%

11%

0%

During 2012–2016, among the 

46 states that submitted race and 

ethnicity data according to OMB 

standards (see Section A1.5 in the 

Appendix) for all five years during 

that period, the P&S syphilis rate 

increased among all race/ethnicity 

groups (Figure 40). Among these 46 

states, the greatest increases during 

2015–2016 were observed among 

those who identified as Multiracial 

(34.3%) and Asians (30.0%), 

followed by Native Hawaiians/Other 

Pacific Islanders (26.4%), Hispanics 

(24.4%), Whites (17.1%), and Blacks 

(7.9%).

More information on P&S syphilis 

rates among racial/ethnic groups 

can be found in the Special Focus 

Profiles.

P&S Syphilis and HIV

Co-infection

Reported cases of P&S syphilis 

continue to be characterized by a high 

rate of HIV co-infection, particularly 

among MSM (Figure 41). Among 

2016 P&S syphilis cases with known 

HIV-status, 47.0% of cases among 

MSM were HIV-positive, compared 

with 10.7% of cases among MSW, 

and 4.1% of cases among women.

P&S Syphilis by

Reporting Source

In 2016, 18.4% of P&S syphilis cases 

were reported from STD clinics, 

72.1% were reported from venues 

outside of STD clinics, and 9.5% 

of cases had an unknown source of 

report (Table A2). During 2015–2016, 

the number of P&S syphilis cases 

reported by STD clinics and by 

non-STD clinic settings increased 

(Figure 42). However, the proportion 

of P&S syphilis cases that were 

reported by STD clinics has declined 

over the last decade from 30.3% of 

cases in 2007 to 18.4% of cases in 

2016. In 2016, private physicians/

health maintenance organizations 

(HMOs) and STD clinics were the 

most common reporting sources 
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

25

Figure 37. Primary and Secondary Syphilis — Rates of Reported 

Cases by Age Group and Sex, United States, 2016

Men Rate (per 100,000 population) Women

50 40 30 20 10 0 0 Age Group 10 20 30 40 50

0.1 0 10-14 .1

8.9 3 15-19 .3

37.9 6 20-24 .7

48.5 25-29 5.6

35.0 30-34 4.3

26.8 3 35-39 .0

19.4 40-44 1.9

17.3 1 45-54 .2

6.8 0 55-64 .4

1.3 0 65+ .0

15.6 1 Total .9

Figure 38. Primary and Secondary Syphilis — Rates of Reported 

Cases Among Women Aged 15–44 Years by Age Group, United 

States, 2007–2016

 0

 2

 4

 6

 8

 10

Year

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rate (per 100,000 population)

Age Group

15-19

20-24

25-29

30-34

35-39

40-44

among MSM (29.5% and 23.6%, 

respectively), MSW (21.4% and 

21.6%, respectively), and women 

(24.6% and 15.3%, respectively) 

(Figure 43).

Congenital Syphilis

After decreasing from 10.5 to 8.4 

reported congenital syphilis cases 

per 100,000 live births during 

2008–2012, the rate of reported 

congenital syphilis has subsequently 

increased each year during 2012–

2016 (Table 1). In 2016, there were 

a total of 628 reported cases of 

congenital syphilis, including 41 

syphilitic stillbirths, and the national 

rate was 15.7 cases per 100,000 live 

births. This rate represents a 27.6% 

increase relative to 2015 (12.3 cases 

per 100,000 live births) and a 86.9% 

increase relative to 2012 (8.4 cases 

per 100,000 live births). As has been 

observed historically, these increases 

paralleled increases in P&S syphilis 

among women during 2015–2016 

(35.7%) and during 2012–2016 

(111.1%) (Figure 44, Table 28).

During 2012–2016, the increase in 

reported congenital syphilis cases 

was primarily attributable to an 

increase in the West. During this 

time period, the congenital syphilis 

rate increased 365.5% in the West, 

100.0% in the Northeast, 29.9% in 

the South, and 23.5% in the Midwest 

(Table 41). During 2015–2016, the 

congenital syphilis rate increased 

42.1% in the Northeast, 41.4% in the 

West, and 23.6% in the South, and 

did not change in the Midwest. In 

2016, the highest congenital syphilis 

rates were reported from the West 

(25.6 cases per 100,000 live births), 

followed by the South (17.8 cases per 

100,000 live births), Midwest (8.4 

cases per 100,000 live births), and 

the Northeast (5.4 cases per 100,000 

live births). In addition, rates were 

highest among Blacks (43.1 cases 

per 100,000 live births), followed by 

American Indians/Alaska Natives 

(31.6 cases per 100,000 live births), 

Hispanics (20.5 cases per 100,000 

live births), Asians/Pacific Islanders 

(9.2 cases per 100,000 live births), 

and Whites (5.3 cases per 100,000 

live births) (Table 42).

Syphilis — All Stages (P&S, 

Early Latent, Late, Late 

Latent, and Congenital)

In 2016, the total case count 

of reported syphilis (all stages 

combined: P&S, early latent, late, 

late latent, and congenital) was the 

highest recorded since 1993. The 

total number of cases of syphilis (all 

stages) reported to CDC increased 

17.8% during 2015–2016 (from 

74,707 cases to 88,042 cases) 

(Table 1). The number of cases of 

early latent syphilis reported to CDC 

increased 19.7% (from 24,173 cases 

to 28,924 cases), and the number of 

cases of late and late latent syphilis 

increased 17.2% (from 26,170 cases 

to 30,676 cases) (Tables 1, 36, 

and 38).

Syphilis among

Special Populations

More information about syphilis and 

congenital syphilis in racial/ethnic 

groups, women of reproductive age, 

adolescents, and MSM can be found 

in the Special Focus Profiles.
26

National Profile Centers for Disease Control and Prevention: STD Surveillance 2016

Figure 39. Primary and Secondary Syphilis — Rates of Reported 

Cases Among Men Aged 15–44 Years by Age Group, United States, 

2007–2016

 0

 10

 20

 30

 40

 50

Year

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rate (per 100,000 population)

Age Group

15-19

20-24

25-29

30-34

35-39

40-44

Figure 40. Primary and Secondary Syphilis — Rates of Reported 

Cases by Race/Ethnicity, United States, 2012–2016

 0

 5

 10

 15

 20

 25

Year

2012 2013 2014 2015 2016

Rate (per 100,000 population)

AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

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

NOTE: Includes 46 states reporting race/ethnicity data in Office of Management and Budget 

compliant formats during 2012–2016 (see Section A1.5 in the Appendix).

Syphilis Summary

The national rate of reported P&S 

syphilis cases reached an historic low 

in 2000 and 2001, but has increased 

almost every year since then. This 

increase was largely attributable 

to an increase among men, and in 

particular among MSM. However, 

during 2015–2016, rates increased 

among both men and women in 

every region of the country. Rates 

of reported congenital syphilis cases 

also increased during 2015–2016. 

MSM continued to account for the 

majority of reported P&S syphilis 

cases in 2016. Nationally, the highest 

rates of P&S syphilis in 2016 were 

observed among men aged 20–34 

years, among men in the West, and 

among Black men.
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

27

Figure 41. Primary and Secondary Syphilis — Reported Cases by 

Sex, Sexual Behavior, and HIV Status, United States, 2016

Cases

HIVHIV+

Unknown HIV Status

 0

 2000

 4000

 6000

 8000

MSW* Women MSM*

* MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM); 

MSW = Men who have sex with women only.

Figure 42. Primary and Secondary Syphilis — Reported Cases by 

Reporting Source and Sex, United States, 2007–2016

 0

 5

 10

 15

 20

Year

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Cases (in thousands)

Non-STD Clinic, Men

Non-STD Clinic, Women

STD Clinic, Men

STD Clinic, Women

References

1. Jarzebowski W, Caumes E, Dupin N, et al. 

Effect of early syphilis infection on plasma 

viral load and CD4 cell count in human 

immunodeficiency virus- infected men: results 

from the FHDH- ANRS CO4 cohort. Arch 

Intern Med 2012; 172(16): 1237–1243.

2. Buchacz K, Patel P, Taylor M, et al. Syphilis 

increases HIV viral load and decreases CD4 

cell counts in HIV-infected patients with 

new syphilis infections. AIDS 2004; 18(15): 

2075–2079.

3. 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 Trans Infect 1999; 75(1): 

3–17.

4. Ingraham NR. The value of penicillin alone 

in the prevention and treatment of congenital 

syphilis. Acta Derm Venereol 1951; 31(Suppl 

24): 60–88.

5. Peterman TA, Kahn RH, Ciesielski CA, et 

al. Misclassification of the stages of syphilis: 

implications for surveillance. Sex Transm Dis 

2005; 32(3):144–149.
28

National Profile Centers for Disease Control and Prevention: STD Surveillance 2016

Figure 43. Primary and Secondary Syphilis — Percentage of 

Reported Cases* by Sex, Sexual Behavior, and Selected Reporting 

Sources, United States, 2016

Percentage

†

Correctional Facility

HIV Counseling and Testing Site

Private Physician/HMO

STD Clinic

 0

 10

 20

 30

 40

MSW Women MSM†

†

* Of all primary and secondary cases, 9.5% had a missing or unknown reporting source. Among all 

cases with a known reporting source, the reporting source categories presented represent 57.6% 

of cases; 42.4% were reported from sources other than those shown.

† HMO = health maintenance organization; MSM = Gay, bisexual, and other men who have sex with 

men (collectively referred to as MSM); MSW = Men who have sex with women only.

Figure 44. Congenital Syphilis — Reported Cases by Year of Birth 

and Rates of Reported Cases of Primary and Secondary Syphilis 

Among Women, United States, 2007–2016

CS* Cases P&S* Rate (per 100,000 women)

P&S Rate

CS Cases

0

200

400

600

800

Year

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

0

1

2

3

4

 

* CS = Congenital syphilis; P&S = Primary and secondary syphilis.
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

29

Other Sexually Transmitted Diseases

Figure 45. Chancroid — Reported Cases by Year, United States, 

1941–2016

 0

 2,500

 5,000

 7,500

10,000

Year

1941 1946 1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 2011 2016

Cases

NOTE: Data collection for chancroid began in 1941; however, chancroid became nationally 

notifiable in 1944. Refer to the National Notifiable Disease Surveillance System (NNDSS) website for 

more information: https://wwwn.cdc.gov/nndss/conditions/chancroid/. 

Chancroid

Chancroid is caused by infection with 

the bacterium Haemophilus ducreyi. 

Clinical manifestations include genital 

ulcers and inguinal lymphadenopathy 

or buboes.1

 Reported cases of 

chancroid declined steadily between 

1987 and 2001 (Figure 45, Table 1). 

Since then, the number of reported 

cases has fluctuated somewhat, while 

still appearing to decline overall. In 

2016, a total of 7 cases of chancroid 

were reported in the United States. 

Six states reported one or more cases 

of chancroid in 2016 (Table 43).

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 is difficult to 

culture; as a result, this condition may 

be substantially underdiagnosed.2,3

Human Papillomavirus

Human papillomavirus (HPV) is the 

most common sexually transmitted 

infection in the United States.4

 Over 

40 distinct HPV types can infect 

the genital tract;5

 although most 

infections are asymptomatic and 

appear to resolve spontaneously 

within a few years,6

 prevalence of 

genital infection with any HPV type 

was 42.5% among United States 

adults aged 18–59 years during 

2013–2014.7

 Persistent infection with 

some HPV types can cause cancer 

and genital warts. HPV types 16 and 

18 account for approximately 66% of 

cervical cancers in the United States,8

and approximately 25% of low-grade 

and 50% of high-grade cervical 

intraepithelial lesions, or dysplasia.9,10

HPV types 6 and 11 are responsible 

for approximately 90% of genital 

warts.11,12

Quadrivalent HPV vaccine targets 

HPV types 6, 11, 16, and 18.11 This 

vaccine was licensed in the United 

States in mid-2006 for females13 and 

in late 2009 for males.14 Although 

a bivalent vaccine was also licensed 

for females,15 almost all HPV vaccine 

administered in the United States 

through late 2014 was quadrivalent.16 

A 9-valent vaccine, which protects 

against the quadrivalent and 5 

additional oncogenic HPV types 

(types 31, 33, 45, 52, and 58), was 

licensed in late 2014 for males and 

females.17 All HPV vaccines have 

been recommended for routine use 

in United States females aged 11–12 

years, with catch-up vaccination 

through age 26.13,17 Since late 2011, 

routine use of the quadrivalent 

or 9-valent vaccine has been 

recommended for males aged 11–12, 

with catch-up vaccination through 

age 21.18 Vaccination through 

age 26 is recommended for gay, 

bisexual, and other men who have 

sex with men (collectively referred 

to as MSM)18 and persons who are 

immunocompromised (including 

those infected with HIV).17 

HPV vaccine uptake in the United 

States remains lower than the Healthy 

People 2020 goal of 80% coverage.19 

In 2015, a national survey found that 

63% of girls aged 13–17 years had 

received at least 1 dose of the HPV 

vaccine, and 42% had received all 

recommended doses in the series.20

HPV vaccine uptake is lower among 

boys; 50% of those aged 13–17 years 

received at least 1 dose, but only 28% 

received all recommended doses.20

HPV infection is not a nationally 

reportable condition. Cervicovaginal 

prevalence of quadrivalent HPV 

vaccine types 6, 11, 16, and/or 18 was 

estimated using data for females aged 

14–34 years from the National Health 

and Nutrition Examination Survey 

(NHANES; see Section A2.4 in the 

Appendix). Prevalence decreased 

significantly from the pre-vaccine 

era (2003–2006) to the early postvaccine era (2009–2012) in specimens 

from females aged 14–19 and 20–24 

years, the age groups most likely 

to benefit from HPV vaccination 

(Figure 46).21 Among those aged 

25–34 years, vaccine-type HPV 

prevalence did not differ significantly 

between the two time periods, and 

no differences were observed in the 

prevalence of non-quadrivalent HPV 
30

National Profile Centers for Disease Control and Prevention: STD Surveillance 2016

Figure 46. Human Papillomavirus — Cervicovaginal Prevalence of 

Types 6, 11, 16 and 18 Among Females Aged 14–34 Years by Age 

Group and Time Period, National Health and Nutrition Examination 

Survey (NHANES), 2003–2006 and 2009–2012

Prevalence, %

Age Group

2003-2006

2009-2012

0

5

10

15

20

25

30

14-19 20-24 25-29 30-34

Time Period

NOTE: Error bars indicate 95% confidence interval. 

SOURCE: Markowitz LE, Liu G, Hariri S, et al. Prevalence of HPV After Introduction of the Vaccination 

Program in the United States. Pediatrics 2016; 137(3):e20151968.

vaccine types by time period for any 

age group. An NHANES analysis 

of 2013–2014 HPV prevalence 

from penile swab specimens found 

low prevalence of quadrivalent 

HPV vaccine types in young males, 

which the authors attributed to male 

vaccination and/or herd protection 

from female vaccination.22

Health-care claims data from 9 

million females aged 15–39 years 

in the United States with employerprovided private health insurance 

were used to estimate annual 

prevalence of cytologically-detected 

cervical low-grade and high-grade 

squamous intraepithelial lesions 

(LSIL and HSIL, respectively) and 

high-grade histologically-detected 

cervical intraepithelial neoplasia 

grades 2 and 3 (CIN2+) during 

2007–2014.23 Analyses were restricted 

to females who received cervical 

cancer screening in a given calendar 

year. Among females aged 15–19 

years, LSIL prevalence over the entire 

period increased (Figure 47A); annual 

percent change during 2007–2014 

was 2.0% (P=0.041). Although 

prevalence in those aged 15–19 years 

appeared to decrease somewhat 

during 2013–2014, additional years 

of data are needed to appropriately 

interpret this observation. LSIL 

prevalence in women aged 20–24 

years increased during 2007–2012 

(annual percent change = 3.0%, 

P=0.002), then declined significantly 

during 2012–2014 (annual percent 

change = -8.2%, P=0.005). Prevalence 

of LSIL increased significantly during 

2007–2014 for women aged 25–39 

years. In contrast to LSIL, prevalence 

of HSIL and CIN2+ decreased 

significantly in females aged 15–19 

and 20–24 years during 2007–2014 

(Figures 47B and 47C). Among those 

aged 15–19 years, annual percent 

change in HSIL prevalence during 

2007–2014 was -8.3% (P<0.001), 

while change in CIN2+ prevalence 

was -19.8% (P=0.004) during 

2007–2009 and -12.1% (P=0.002) 

during 2009–2014. For women aged 

20–24 years, annual percent change 

in HSIL was -5.3% (P<0.001) during 

2007–2014; annual percent change 

in CIN2+ was -6.7% (P=0.001) 

during 2007–2012 and -12.5% during 

2012–2014 (P=0.020). No decreases 

in HSIL or CIN2+ prevalence were 

observed in women aged 25–39 

years. Decreases in high-grade lesions 

among young women reflected their 

greater association with HPV types 

16 and 18, compared to low-grade 

lesions, providing ecologic evidence 

of population effectiveness of HPV 

vaccination on clinical sequelae of 

infection among young, privatelyinsured US women. 

Prevalence of genital warts also has 

been examined using health-care 

claims records (Figures 48A and 

48B).24 Prevalence among females 

aged 15–19 years was stable during 

2003–2007, but then significantly 

declined from 2.9 per 1000 personyears in 2006 to 1.8 in 2010. Among 

females aged 20–24 years, genital 

wart prevalence significantly 

increased during 2003–2007, then was 

essentially unchanged at 5.4 to 5.5 per 

1000 person-years during 2007–2009; 

although prevalence among women in 

this age group appeared to decrease in 

2010, more years of data are needed 

to determine whether this observation 

represents a valid inflection in trend. 

Prevalence in women aged 25–39 

years significantly increased from 2.5 

per 1000 person-years in 2003 to 3.7 

in 2010, but a potential inflection in 

trend was also observed in this age 

group during 2009–2010; as with 

women aged 20–24, additional years 

of data are needed to appropriately 

assess this potential change in trend. 

Genital wart prevalence significantly 

increased in males aged 15–39 years 

during 2003–2010, although for 

men aged 20–24 years a potential 

inflection in trend was observed 

during 2009–2010.

Pelvic Inflammatory Disease

For information on pelvic 

inflammatory disease, see Special 

Focus Profiles, STDs in Women and 

Infants.

Herpes Simplex Virus

Herpes simplex virus (HSV) is 

among the most prevalent of 

sexually transmitted infections.4,25

Although most infections are 

subclinical,26 clinical manifestations 

are characterized by recurrent, painful 

genital and/or anal lesions.27 Most 

genital HSV infections in the United 

States are caused by HSV type 2 
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

31

Figure 47. Cervical Low- and High-Grade Squamous Intraepithelial 

Lesions and Intraepithelial Neoplasia Grades 2 and 3 — Prevalence 

per 1000 Person-Years Among Female Enrollees in Private Health 

Plans Aged 15–39 Years, by Age Group and Year, 2007–2014

 0

 20

 40

 60

 80

Year

2007 2008 2009 2010 2011 2012 2013 2014

Prevalence

Age Group

15-19

20-24

25-29

30-34

35-39

A. Low-Grade Squamous Intraepithelial Lesions (LSIL)

 0

 2

 4

 6

 8

 10

Year

2007 2008 2009 2010 2011 2012 2013 2014

Prevalence

B. High-Grade Squamous Intraepithelial Lesions (HSIL)

 0

 6

 12

 18

 24

Year

2007 2008 2009 2010 2011 2012 2013 2014

Prevalence

C. Cervical Intraepithelial Neoplasia Grades 2 and 3 (CIN2+)

SOURCE: Flagg EW, Torrone EA, Weinstock H. Ecological Association of Human Papillomavirus 

Vaccination with Cervical Dysplasia Prevalence in the United States, 2007–2014. Am J Public Health 

2016; 106(12):2211–2218.

(HSV-2), while HSV type 1 (HSV-1) 

infections are typically orolabial and 

acquired during childhood.26,28

HSV infection is not a nationally 

reportable condition. Most persons 

with genital HSV infection have not 

received a diagnosis. The overall 

percentage of HSV-2 seropositive 

NHANES participants aged 14–49 

years 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).29

NHANES data on the gender- and 

race/ethnicity-specific seroprevalence 

of HSV-2 among those aged 14–49 

years were compared across survey 

years 1988–1994, 1999–2002, 2003–

2006, and 2007–2010 (Figure 49). 

Overall, HSV-2 seroprevalence 

decreased between 1988–1994 and 

2007–2010, from 21.2% to 15.5%.29

Among non-Hispanic White females, 

HSV-2 seroprevalence significantly 

decreased from 19.5% in 1988–1994 

to 15.3% in 2007– 2010; HSV-2 

seroprevalence remained stable 

among non-Hispanic Black females, 

from 52.5% during 1988–1994 to 

49.9% during 2007–2010. Similar 

race/ethnicity differences were 

observed for males. These data, along 

with data from NHANES survey 

years 1976–1980,30 indicate that nonHispanic Blacks had higher overall 

seroprevalence than non-Hispanic 

Whites in each survey period.

NHANES data also show that among 

adolescents aged 14–19 years, HSV1 seroprevalence has significantly 

decreased by almost 23%, from 

39.0% during 1999–2004 to 30.1% 

during 2005–2010, indicating 

declining orolabial infection in this 

age group.28 HSV-2 seroprevalence 

in this age group was much 

lower, less than 2% in both time 

periods.28 Other studies have found 

that genital HSV-1 infections are 

increasing among young adults.31,32
32

National Profile Centers for Disease Control and Prevention: STD Surveillance 2016

Figure 48. Genital Warts — Prevalence per 1000 Person-Years 

Among Enrollees in Private Health Plans Aged 10–39 Years by Sex, 

Age Group, and Year, 2003–2010

 0

 2

 4

 6

 8

 10

Year

2003 2004 2005 2006 2007 2008 2009 2010

Prevalence

10-14

15-19

20-24

25-29

30-34

35-39

Age Group

A. Females

 0

 2

 4

 6

 8

 10

Year

2003 2004 2005 2006 2007 2008 2009 2010

Prevalence

B. Males

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):1428–1435.

This has been attributed, in part, 

to the decline in orolabial HSV-1 

infections, because those who lack 

HSV-1 antibodies at sexual debut are 

more susceptible to genital HSV-1 

infection;28,33 increasingly common 

oral sex behavior among adolescents 

and young adults also has been 

suggested as a contributing factor.28,34

The absence of HSV-1 antibodies also 

increases the likelihood of developing 

symptomatic disease from newlyacquired (i.e., primary) genital HSV-2 

infection.35 Young women may 

therefore be increasingly likely to first 

acquire HSV-1 infection genitally, 

or acquire a primary genital HSV-2 

infection during their child-bearing 

years,33,36 and first-episode primary 

HSV infection during pregnancy 

increases the risk of neonatal HSV 

transmission.33,37

For information on neonatal HSV 

infections, see Special Focus Profiles, 

STDs in Women and Infants.

Trichomonas Vaginalis

Trichomonas vaginalis is a common 

sexually transmitted protozoal 

infection associated with adverse 

health outcomes such as preterm 

birth and symptomatic vaginitis.4,38,39

It is not a nationally reportable 

condition, and trend data are limited 

to estimates of initial physician office 

visits for this condition from the 

National Disease and Therapeutic 

Index (NDTI; see Section A2.5 in 

the Appendix) (Figure 50, Table 44). 

Visits appear to be fairly stable since 

the 1990’s; the number of initial visits 

for Trichomonas vaginalis infection 

in 2015 was 139,000. The 2016 NDTI 

data were not obtained in time to 

include them in this report. NHANES 

data from 2001–2004 indicated 

an overall Trichomonas vaginalis

infection prevalence of 3.1%, with the 

highest prevalence of 13.3% observed 

among non-Hispanic Blacks.39
Centers for Disease Control and Prevention: STD Surveillance 2016 National Profile

33

Figure 49. Herpes Simplex Virus Type 2 — Seroprevalence Among 

Non-Hispanic Whites and Non-Hispanic Blacks by Sex and Age 

Group, National Health and Nutrition Examination Survey (NHANES), 

1988–1994, 1999–2002, 2003–2006, and 2007–2010

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

Time Period

NOTE: Error bars indicate 95% confidence interval.

SOURCE: Fanfair RN, Zaidi A, Taylor LD, et al. 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):860–864.

Figure 50. Trichomonas vaginalis and Other Vaginal Infections 

Among Females — Initial Visits to Physicians’ Offices, United States, 

1966–2015

 0

1,125

2,250

3,375

4,500

Year

1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Visits (in thousands)

Trichomonas vaginalis Infections

Other Vaginal Infections

NOTE: The relative standard errors for Trichomonas vaginalis infection estimates range from 23% 

to 17% and for other vaginal infection estimates range from 13% to 8%. See Section A2.5 in the 

Appendix and Table 44. 

SOURCE: National Disease and Therapeutic Index, IMS Health, Integrated Promotional ServicesTM, 

IMS Health Report, 1966–2015. The 2016 data were not obtained in time to include them in this 

report.

References

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Diagnosis, and Management. Sex Transm Infect 

2003; 79:68–71.

2. Schulte JM, Martich FA, Schmid GP. Chancroid 

in the United States, 1981–1990: Evidence for 

Underreporting of Cases. MMWR Morb Mortal 

Wkly Rep Surveill Summ 1992; 41(SS-3):57–

61.

3. Mertz KJ, Trees D, Levine WC, et al. Etiology 

of Genital Ulcers and Prevalence of Human 

Immunodeficiency Virus Coinfection in 10 US 

Cities. J Infect Dis 1998; 178(6):1795–1798.

4. Satterwhite CL, Torrone E, Meites E, et al. 

Sexually Transmitted Infections among US 

Women and Men: Prevalence and Incidence 

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Classification of Papillomaviruses. Virology 

2004; 324:17–27.

6. Insinga RP, Perez G, Wheeler CM, et al. 

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Women: Transition Probabilities for CIN 

and Infection Clearance. Cancer Epidemiol 

Biomarkers Prev 2011; 20(2):287–296.

7. McQuillan G, Kruszon-Moran D, Markowitz 

LE, et al. Prevalence of HPV in Adults Aged 

18–69: United States, 2011–2014. NCHS Data 

Brief, No 280. Hyattsville, MD: National Center 

for Health Statistics; 2017.

8. Saraiya M, Unger ER, Thompson TD, et al. 

US Assessment of HPV types in Cancers: 

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HPV Vaccines. J Natl Cancer Inst 2015; 

107(6):djv086.

9. Clifford GM, Rana RK, Franceschi S, et al. 

Human Papillomavirus Genotype Distribution 

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14(5):1157–1164.

10. Porras C, Rodriguez AC, Hildesheim A, et 

al. Human Papillomavirus Types by Age in 

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Cancer Epidemiol Biomarkers Prev 2009; 

18(3):863–865.

11. Garland SM, Steben M, Sings HL, 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):805–814.

12. Gissmann L, Wolnik L, Ikenberg H, et al. 

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): 560–563.

13. Markowitz LE, Dunne EF, Saraiya M, et al. 

Quadrivalent Human Papillomavirus Vaccine. 

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on Immunization Practices (ACIP). MMWR 

Morb Mortal Wkly Rep Recomm Rep 2007; 

56(RR-2):1–24.
34

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14. 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):630–632.

15. 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 

Committee on Immunization Practices (ACIP). 

MMWR Morb Mortal Wkly Rep 2010; 

59(20):626–629.

16. Stokley S, Jeyarajah J, Yankey D, 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):620–624.

17. Petrosky E, Bocchini Jr. JA, Hariri S, et 

al. Use of 9-Valent Human Papillomavirus 

(HPV) Vaccine: Updated HPV Vaccination 

Recommendations of the Advisory Committee 

on Immunization Practices. MMWR Morb 

Mortal Wkly Rep 2015; 64(11):300–304.

18. 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):1705–1708.

19. HealthyPeople.gov. Healthy People 2020 Topics 

& Objectives. Immunization and Infectious 

Diseases. Objectives IID-11.4 and IID-11.5. 

Available at: https://www.healthypeople.

gov/2020/topics-objectives/topic/immunizationand-infectious-diseases/objectives. Accessed 

July 20, 2016.

20. Reagan-Steiner S, Yankey D, Jeyarajah J, et al. 

National, Regional, State, and Selected Local 

Area Vaccination Coverage among Adolescents 

Aged 13–17 years — United States, 2015. 

MMWR Morb Mortal Wkly Rep 2016; 

65(33):850–858.

21. Markowitz LE, Gui L, Hariri S, et al. 

Prevalence of HPV After Introduction of the 

Vaccination Program in the United States. 

Pediatrics 2016; 137(3):e20151968.

22. Gargano JW, Unger ER, Liu G, et al. 

Prevalence of Genital Human Papillomavirus in 

Males, United States, 2013–2014. J Infect Dis 

2017; 215(7):1070–1079. 

23. Flagg EW, Torrone EA, Weinstock 

H. Ecological Association of Human 

Papillomavirus Vaccination with Cervical 

Dysplasia Prevalence in the United States, 

2007–2014. Am J Public Health 2016; 

106(12):2211–2218.

24. 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):1428–1435.

25. Smith JS, Robinson NJ. Age-Specific 

Prevalence of Infection with Herpes Simplex 

Virus Types 2 and 1: A Global Review. J Infect 

Dis 2002; 186(Suppl 1):S3–S28.

26. Corey L, Wald A. Genital Herpes. In: Holmes 

KK, Sparling FP, Stamm WE, et al., eds. 

Sexually Transmitted Diseases. 4th ed. New 

York, NY: McGraw-Hill; 2008:399–437.

27. Kimberlin DW, Rouse DJ. Genital Herpes. N 

Engl J Med 2004; 350(19):1970–1977.

28. Bradley H, Markowitz LE, Gibson T, et al. 

Seroprevalence of Herpes Simplex Virus Types 

1 and 2 — United States, 1999–2010. J Infect 

Dis 2014; 209(3):325–333.

29. Fanfair RN, Zaidi A, Taylor LD, et al. Trends 

in Seroprevalence of Herpes Simplex Virus 

Type 2 among Non-Hispanic Blacks and NonHispanic Whites Aged 14 to 49 Years — United 

States, 1988 to 2010. Sex Transm Dis 2013; 

40(11):860–864.

30. Xu F, Sternberg MR, Kottiri BJ, et al. Trends 

in Herpes Simplex Virus Type 1 and Type 2 

Seroprevalence in the United States. JAMA 

2006; 296(8):964–973.

31. Bernstein DI, Bellamy AR, Hook EW III, et. 

al. Epidemiology, Clinical Presentation, and 

Antibody Response to Primary Infection with 

Herpes Simplex Virus Type 1 and Type 2 in 

Young Women. Clin Infect Dis 2013; 56:344–

351.

32. Roberts CM, Pfister JR, Spear SJ. Increasing 

Proportion of Herpes Simplex Virus Type 1 as 

a Cause of Genital Herpes Infection in College 

Students. Sex Transm Dis 2003; 30(10):797–

800.

33. Kimberlin DW. The Scarlet H. J Infect Dis 

2014; 209(3):315–317.

34. Copen CE, Chandra A, Martinez G. Prevalence 

and Timing of Oral Sex with Opposite-sex 

Partners among Females and Males Aged 15–24 

Years: United States, 2007–2010. National 

Health Statistics Reports; No. 56. Hyattsville, 

MD: National Center for Health Statistics; 

2012.

35. Langenberg AGM, Corey L, Ashley RL, et al. 

A Prospective Study of New Infections with 

Herpes Simplex Virus Type 1 and Type 2. N 

Engl J Med 1999; 341:1432–1438.

36. Sampath A, Maduro G, Schillinger JA. 

Infant Deaths Due to Herpes Simplex Virus, 

Congenital Syphilis, and HIV in New York City. 

Pediatrics 2016; 137(4):e20152387.

37. Brown ZA, Wald A, Morrow RA, et al. Effect 

of Serologic Status and Cesarean Delivery 

on Transmission Rates of Herpes Simplex 

Virus from Mother to Infant. JAMA 2003; 

289(2):203–209.

38. French JI, McGregor JA, Parker R. Readily 

Treatable Reproductive Tract Infections and 

Preterm Birth among Black Women. Am J 

Obstet Gynecol 2006; 194:1717–1727.

39. Sutton M, Sternberg M, Koumans EH, et al. The 

Prevalence of Trichomonas vaginalis Infection 

Among Reproductive-Age Women in the 

United States, 2001–2004. Clin Infect Dis 2007; 

45(10):1319–1326.
Centers for Disease Control and Prevention: STD Surveillance 2016 Special Focus Profiles

35

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, bisexual, and other men who have sex with men (collectively referred to as MSM). 

STDs in Women and Infants

Public Health Impact

Women and their infants are uniquely 

vulnerable to the consequences of 

sexually transmitted infections (STI). 

While individual-level determinants, 

including high-risk behaviors, 

contribute to disease transmission and 

acquisition risk, it is widely accepted 

that social barriers to STD prevention 

and control efforts also contribute 

to infectious disease prevalence. A 

woman’s relationship status with her 

male partner, such as the concurrency 

of the relationship, may be an 

important predictor of her sexual 

health.1–3 In addition to social factors 

such as poverty and lack of access to 

quality STD services, homelessness 

or unstable housing may influence 

a woman’s sexual risk.4

 For some 

women, maintaining the relationship 

with a partner may take a higher 

priority than STD risk reduction,5

affecting her sexual and reproductive 

health, as well as the health of her 

unborn baby.6,7 A woman can also be 

placed at risk for STIs through her 

partner’s sexual encounter with an 

infected partner. Consequently, even a 

woman who has only partner may be 

obliged to practice safer sex, such as 

using condoms.8

Chlamydia and gonorrhea 

disproportionately affect women 

because early infection may be 

asymptomatic and, if untreated, 

infection may ascend to the upper 

reproductive tract resulting in pelvic 

inflammatory disease (PID). Data 

from prospective studies suggest that 

about 15% of untreated chlamydial 

infections progress to clinically 

diagnosed PID and the risk with 

untreated gonococcal infection may 

be even higher.9–11 PID is a major 

concern because it can result in 

inflammation and damage to the 

fallopian tubes, elevating the risk 

of infertility and ectopic pregnancy. 

Tubal factor infertility ranks among 

the most common causes of infertility, 

accounting for 30% of female 

infertility in the United States,12 and 

much of this damage results from 

previous episodes of PID.13

An important public health measure 

for preventing PID, and ultimately 

tubal factor infertility, is through 

the prevention and control of C. 

trachomatis and N. gonorrhoeae. 

Strategies to improve the early 

detection and treatment of chlamydia 

and gonorrhea, as demonstrated in 

a number of randomized controlled 

trials,14 has been shown to reduce a 

woman’s risk for PID and ultimately 

protect the fertility of women. 
36

Special Focus Profiles Centers for Disease Control and Prevention: STD Surveillance 2016

Human papillomavirus (HPV) 

infections are highly prevalent 

in the United States, especially 

among young sexually active adults. 

Although most HPV infections 

in women appear to be transient 

and may not result in clinically 

significant sequelae, high-risk HPVtype infections can cause abnormal 

changes in the uterine cervical 

epithelium, which are detected 

by cytological examination of 

Papanicolaou (Pap) smears. Persistent 

high-risk HPV-type infections may 

lead to cervical cancer precursors, 

which, if undetected can result in 

cancer. Other low-risk HPV-type 

infections can cause genital warts, 

low-grade Pap smear abnormalities, 

and, rarely, recurrent respiratory 

papillomatosis in infants born 

to infected mothers.15 For more 

information on adolescent and adult 

HPV infections, see Other STDs.

Impact on Maternal and Fetal 

Outcomes

Similar to non-pregnant women, a 

high proportion of pregnant women 

with chlamydial and gonococcal 

infections are asymptomatic. 

Documented sequelae of untreated 

infections in pregnancy include 

stillbirth, premature delivery, 

premature rupture of the membranes, 

and low birth weight. Maternal 

infection can also affect the infant, 

leading to conjunctivitis infections 

(termed ophthalmia neonatorum 

in the first four weeks of life), 

and, in the case of C. trachomatis, 

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. The 

clinical presentation of conjunctivitis 

can be variable and these infections 

are especially important to treat 

promptly, as they can lead to visual 

impairment.16

Syphilis has long been known to 

be an important risk factor for 

adverse pregnancy outcomes. The 

consequences of untreated maternal 

infection include fetal death, preterm 

birth, and also congenital infection 

in a proportion of surviving infants 

resulting in both 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

Genital infections with herpes 

simplex virus (HSV) are extremely 

common, can cause painful outbreaks, 

and can have serious consequences 

for pregnant women and their 

infants.18 Neonatal herpes can be 

a severe illness presenting with 

pulmonary disease, seizures, fever, 

and a high case fatality rate following 

contact with infected cervical or 

vaginal secretions during delivery. 

Risk of transmission to the infant 

is greatest when the mother has a 

first-episode primary genital infection 

during pregnancy, especially if she 

acquires infection towards the end of 

her pregnancy.19,20

Observations

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 United 

States rates of women diagnosed with 

PID in both hospital and ambulatory 

settings.21–23 The National Disease and 

Therapeutic Index (NDTI; see Section 

A2.5 in the Appendix) provides 

estimates of initial visits to officebased, private physicians for PID. 

NDTI estimated that from 2006–2015 

the number of initial visits to such 

physicians for PID among women 

aged 15–44 years have decreased by 

35.8% from 106,000 to 68,000 visits 

(Figure A). The 2016 NDTI data were 

not obtained in time to include them 

in this report. Several factors may be 

contributing to declining PID rates, 

including increases in chlamydia and 

gonorrhea screening coverage, more 

sensitive diagnostic technologies, 

and availability of single-dose 

therapies that increase adherence to 

Figure A. Pelvic Inflammatory Disease — Initial Visits to Physicians’ 

Offices Among Women Aged 15–44 Years, United States, 2006–2015

 0

 40

 80

120

160

200

Year

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Visits (in thousands)

NOTE: The relative standard errors for these estimates are 16%–23%. See section A2.5 in the 

Appendix and Table 44.

SOURCE: National Disease and Therapeutic Index, IMS Health, Integrated Promotional ServicesTM, 

IMS Health Report, 1966–2015. The 2016 data were not obtained in time to include them in this 

report.
Centers for Disease Control and Prevention: STD Surveillance 2016 Special Focus Profiles

37

treatment.22–24 While PID is declining 

nationally, it still causes an enormous 

amount of unnecessary and expensive 

morbidity.

Differences in self-reported lifetime 

diagnosis of PID by race/ethnicity 

in reproductive age women have 

been observed in earlier research.25

Data from the 2013–2014 cycle of 

the National Health and Nutrition 

Examination Survey (NHANES) 

indicates that non-Hispanic Black 

and non-Hispanic White women 

reporting a previous STI diagnosis 

had nearly equal self-reported lifetime 

PID prevalence (10.0% vs. 10.3%). 

However, the lifetime prevalence 

of PID among non-Hispanic Black 

women was 2.2 times that among 

non-Hispanic White women if no 

previous STI was diagnosed (6.0% 

vs. 2.7%) (Figure B). These findings 

suggest that PID is associated with 

previous STI diagnoses and it is 

therefore important for physicians 

to screen female patients for 

chlamydia and gonorrhea to reduce 

the incidence of PID. The racial 

disparities observed in PID diagnoses 

are consistent 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 is a potentially 

life-threatening condition that requires 

prompt evaluation and treatment. Up 

until the early 1990’s, a primary data 

source used to estimate the incidence 

of ectopic pregnancy was the 

National Hospital Discharge Survey, 

a sample of inpatient discharge 

records from select hospitals. 

However, the ability to ascertain 

the number of ectopic pregnancies 

occurring in the United States has 

been affected by a shift in clinical 

management from an inpatient to an 

outpatient event, making national 

surveillance data sources unreliable. 

As a result, alternative surveillance 

methods, including data from large 

administrative claims,26,27 are needed 

to evaluate trends and assess the 

continued public health burden of 

this condition. Data from MarketScan 

Commercial Claims and Encounters 

Database, a large administrative 

claims database of United States 

commercial health plans, indicate that 

rates of ectopic pregnancy increased 

with age and that trends in the rate 

of ectopic pregnancy among women 

with live births aged 15–44 years 

during the period of 2004–2014 were 

relatively stable across all age groups. 

However, a potential deflection in 

the trend is observed from 2014–

2015 across all 5-year age groups, 

for which additional years of data 

are needed to appropriately assess 

(Figure C). As in previous years, in 

2015, rates of ectopic pregnancy were 

highest among women in the 35–39 

and 40–44 year age groups. 

Chlamydia

Chlamydial infections in women 

are usually asymptomatic and 

screening is necessary to identify 

most infections. Routine chlamydia 

screening of sexually-active young 

women has been recommended by the 

CDC since 1993.28 Rates of reported 

cases of chlamydia among women 

increased steadily from the early 

1990s, likely reflecting expanded 

screening coverage and use of more 

sensitive diagnostic tests (Figure 1, 

Table 1). During 2011–2013, 

chlamydia case rates decreased from 

643.4 to 619.0 cases per 100,000 

females and then increased 6.2% over 

the next 3 years, resulting in a rate of 

657.3 cases per 100,000 females in 

2016 (Table 4).

Figure B. Pelvic Inflammatory Disease — Lifetime Prevalence* 

Among Sexually Experienced Women† Aged 18–44 Years by Race/

Ethnicity and Previous STI‡ Diagnosis, National Health and Nutrition 

Examination Survey (NHANES), 2013–2014

Prevalence, %

White, Non-Hispanic

Black, Non-Hispanic

0

5

10

15

20

Yes No

Previous STD Diagnosis

* Prevalence estimates based on response to the question, “Have you ever been treated for 

an infection in your fallopian tubes, uterus or ovaries, also called a pelvic infection, pelvic 

inflammatory disease, or PID?”. Estimates were weighted to be nationally representative of the U.S. 

population, accounting for unequal probabilities of selection and nonresponse.

†

 Based on a response of “Yes” to the question, “Have you ever had vaginal, anal, or oral sex?”.

‡

 STI = sexually transmitted infection. Participants who have been told by a doctor or other 

healthcare professional in the last 12 months that they had chlamydia or gonorrhea or have ever 

been told they have herpes, human papillomavirus, or genital warts.

NOTE: Error bars indicate 95% confidence intervals. Prevalence estimates among non-Hispanic 

Black women with a previous STI diagnosis have a relative standard error >40% but <50%.

SOURCE: Kreisel, K, Torrone, E, Bernstein, K, et al. Prevalence of pelvic inflammatory disease in 

sexually experienced women of reproductive age — United States, 2013–2014. MMWR Morb 

Mortal Wkly Rep 2017; 66(3):80–83.
38

Special Focus Profiles Centers for Disease Control and Prevention: STD Surveillance 2016

Chlamydia rates are highest among 

young women, the population 

targeted for screening (Figure 5, 

Table 10). During 2015–2016, rates 

of reported chlamydia cases increased 

2.8% and 0.4% among females aged 

15–19 and 20–24 years, respectively. 

Regionally, chlamydia case rates were 

highest among women in the South, 

with a rate of 718.6 cases per 100,000 

females in 2016 (Table 4). Rates of 

reported chlamydia cases exceeded 

gonorrhea case rates among women in 

all regions (Figures D and E, Tables 4 

and 15).

Chlamydia Positivity in 

Selected Populations

The STD Surveillance Network 

(SSuN) is an ongoing collaboration 

of state, county, and city health 

departments from 10 participating 

jurisdictions where demographic, 

clinical, and laboratory data are 

collected from women aged 15–44 

years attending facilities that provide 

family planning and reproductive 

health services (See Section A2.2 

of the Appendix). Figure F shows 

chlamydia testing and positivity 

reported only among facilities that 

tested more than 100 women and 

more than 60% of young women aged 

14–24 years. In 2016, the overall 

positivity of chlamydia among women 

aged 14–24 years was 8.4%, but for 

women 14–19 years of age, chlamydia 

positivity was 9.4%. For women 

between the ages of 14–24 years, 

chlamydia positivity among nonHispanic Blacks was almost twice that 

of non-Hispanic Whites or Hispanics. 

Gonorrhea

Like chlamydia, gonorrhea is often 

asymptomatic in women. Therefore, 

gonorrhea screening is an important 

strategy for the identification of 

gonorrhea among women. Large-scale 

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. However, more 

recently, there have been increases in 

overall cases. (Figure 12, Table 1).

After reaching a 40-year low in 

2009 (104.5 cases per 100,000 

females), the rate of reported cases 

of gonorrhea for women increased 

slightly each year during 2009–2011, 

and then decreased during 2012–2014 

(Figure 13). During 2015–2016, 

the gonorrhea rate among women 

increased 13.8% to 121.0 cases per 

100,000 females (Figure 13, Table 

15).

The gonorrhea case rate among 

women was slightly higher than the 

rate among men during 2007–2012; 

however, the rate among men was 

higher than the rate among women 

during 2013–2016 (Figure 13, Tables 

15 and 16). During 2012–2016, 

gonorrhea rates among women were 

highest among those aged 15–24 

Figure C. Ectopic Pregnancy — Rates Among Commercially Insured 

Women with Live Births Aged 15–44 Years by Age Group, 2004–2015

0.0

0.6

1.2

1.8

2.4

3.0

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rate (per 100,000 live births) Age Group

15-19

20-24

25-29

30-34

35-39

40-44

SOURCE: MarketScan Commercial Claims and Encounters Database, Truven Health Analytics, Ann 

Arbor, MI, 2004–2015.

Figure D. Chlamydia — Rates of Reported Cases Among Women by 

State, United States and Outlying Areas, 2016

Guam 820 

Puerto Rico 306 

Virgin Islands 734 

<= 524 

525 - 602 

603 - 664 

665 - 764 

>=765 

(n= 11)

(n= 11)

(n= 11)

(n= 11)

(n= 10)

764

1090

689 806

629 625

612

829

634

487

735 645

564

596 550

961

412

624

542

917

670

577

581 684

885

664

798

594

705

756

567

566

786

720

642

735

405

614

566

357

633

472

VT 369

NH 344

MA 495

RI 602

CT 516

NJ 524

DE 754

MD 651

DC 1136

Rate per 100,000

population

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 653.6 per 100,000 females.
Centers for Disease Control and Prevention: STD Surveillance 2016 Special Focus Profiles

39

years (Figure 17, Table 21). For 

women in this age group, rates were 

highest among 19-year olds in 2016 

(736.2 cases per 100,000 females) 

(Table 23).

Neonatal Conjunctivitis

During 2010–2015, 563 chlamydia 

or gonorrhea cases among infants 

aged <1 year with a specimen source 

of either ‘eye’ or ‘conjunctiva’ 

(conjunctivitis infections) were 

reported to CDC.29 During 2010–

2014, the overall reported rate of 

chlamydial conjunctivitis in infants 

decreased by 40.7% (2.7 to 1.6 cases 

per 100,000 live births), followed 

by an increase of 31.2% during 

2014–2015 to 2.1 cases per 100,000 

live births (Figure G). The rate of 

gonococcal conjunctivitis in infants 

remained relatively constant and low 

during 2010–2015, at 0.2 cases or 

less per 100,000 live births each year. 

The rate of reported cases is heavily 

influenced by the completeness of 

reported data on specimen source. 

Of all cases reported to CDC of 

chlamydia or gonorrhea in infants 

aged <1 year during 2010–2015 

(n=3,703), nearly 85% did not have 

a specimen source of either ‘eye’ 

or ‘conjunctiva’; of those, 52% had 

a specimen source of ‘unknown’ 

(40.1%), ‘other-not specified’ (8.7%), 

or was missing (3.2%). When 

evaluating rates including these cases, 

the rate of chlamydia and gonorrhea 

infections follows similar trends 

but is higher in all years, indicating 

potential missed cases for surveillance 

(Figure G).

Congenital Syphilis

Trends in congenital syphilis 

usually follow trends in primary and 

secondary (P&S) syphilis among 

women (Figure 44). After plateauing 

at a relatively low rate (0.9 cases per 

100,000 females) during 2011–2013, 

the rate of reported P&S syphilis 

cases has increased each year since 

then. During 2015–2016, the rate 

among women increased 35.7% to 1.9 

cases per 100,000 females (Figure 44, 

Table 28).

Figure E. Gonorrhea — Rates of Reported Cases Among Women by 

State, United States and Outlying Areas, 2016

Guam 74 

Puerto Rico 17 

Virgin Islands 25 

<= 48 

49 - 94 

95 - 126 

127 - 171 

>=172 

(n= 11)

(n= 11)

(n= 11)

(n= 11)

(n= 10)

163

211

126 196

106 86

111

175

78

29

136 143

81

116 121

230

20

123

80

238

169

96

111 112

147

86

185

140

171

205

75

94

187

178

138

135

48

119

82

45

110

42

VT 10

NH 20

MA 40

RI 41

CT 63

NJ 73

DE 164

MD 127

DC 242

Rate per 100,000

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 119.8 per 100,000 females.

Figure F. Chlamydia — Positivity* Among Women Aged 14–39 

Years by Race/Ethnicity and Age Group in Clinics† Providing Family 

Planning and Reproductive Health Services, STD Surveillance 

Network (SSuN), 2016

Percentage 

0

5

10

15

20

14-19 20-24

 Age Group 

25-39 All NonHispanic

Whites

NonHispanic Blacks

Among 14-24 Year Olds

Hispanics

* Positivity represents the overall average of the mean value by jurisdiction. 

† Only clinics that tested >100 women for chlamydia and those with testing coverage >60% were 

included (n = 58). 

NOTE: See section A2.2 in the Appendix for SSuN methods.
40

Special Focus Profiles Centers for Disease Control and Prevention: STD Surveillance 2016

Similarly, the rate of reported 

congenital syphilis cases has 

increased each year since 2012 

(Figure 44, Table 1). In 2016, there 

were 628 reported cases of congenital 

syphilis and the national congenital 

syphilis rate was 15.7 cases per 

100,000 live births, the highest rate 

reported since 1998. This increase 

in 2016 represents a 27.6% increase 

relative to 2015 and an 86.9% 

increase relative to 2012 (Table 41).

In 2016, the highest rates of P&S 

syphilis among women and the 

highest rates of congenital syphilis 

were observed in the West and in 

the South (Figures H and I, Tables 

28 and 41). The P&S syphilis rates 

among women increased in every 

region during 2015–2016. During 

2015–2016, the largest increases in 

the P&S syphilis rates among women 

were seen in the West (58.8%), 

followed by the Northeast (28.6%), 

South (22.2%), and Midwest (20.0%). 

The congenital syphilis rate increased 

42.1% in the Northeast, 41.4% in 

the West, and 23.6% in the South, 

and remained stable in the Midwest 

during 2015–2016 (Table 41).

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.17

Neonatal Herpes Simplex 

Virus

Neonatal HSV infections, although 

relatively rare, cause significant 

morbidity and mortality.18 Most 

neonatal HSV infections result 

from perinatal transmission 

from mother to neonate,20 but 

postnatal infection can occur.30

Although reporting of neonatal 

HSV infection is required in a 

few jurisdictions,31,32 it is not a 

nationally reportable disease.

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 2006.33 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 cases 

per 100,000 live births) compared 

with private insurance or managed 

Figure H. Primary and Secondary Syphilis — Rates of Reported 

Cases Among Women by State, United States and Outlying Areas, 

2016

Guam 0.0 

Puerto Rico 4.7 

Virgin Islands 0.0 

<= 0.5 

0.6 - 0.9 

1.0 - 1.4 

1.5 - 2.2 

>=2.3 

(n= 11)

(n= 13)

(n= 9)

(n= 11)

(n= 10)

3.2

0.0

2.3 2.4

3.8 0.6

2.6

2.2

1.4

0.7

1.5 1.1

0.4

0.8 0.9

8.0

0.4

0.6

1.3

3.8

2.1

0.2

0.5 3.5

2.6

1.1

2.1

0.8

1.6

2.1

1.7

0.9

2.1

1.4

1.7

1.7

0.4

1.1

1.4

1.1

0.2

0.3

Rate per 100,000

population

VT 0.9

NH 0.6

MA 0.7

RI 0.6

CT 0.7

NJ 0.5

DE 0.6

MD 1.7

DC 1.4

NOTE: The total rate of reported cases of primary and secondary syphilis among women in the 

United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 1.9 per 100,000 

females.

Figure G. Chlamydia and Gonorrhea — Rates of Reported Cases 

Among Infants <1 Year of Age by Year and Specimen Source, United 

States, 2010–2015

 0

 3

 6

 9

 12

 15

Year

2010 2011 2012 2013 2014 2015

Rate (per 100,000 live births)

CT from Conjunctiva, plus Missing/Unk/Oth

GC from Conjunctiva, plus Missing/Unk/Oth

CT from Conjunctiva

GC from Conjunctiva

NOTE: CT = Chlamydia; GC = Gonorrhea.

SOURCE: Kreisel, K, Weston, E, Braxton, et al. Keeping an eye on chlamydia and gonorrhea 

conjunctivitis in infants in the United States, 2010–2015. Sex Transm Dis 2017; 44(6): 356–358.
Centers for Disease Control and Prevention: STD Surveillance 2016 Special Focus Profiles

41

health care (5.4 cases per 100,000 

live births).

In New York City, 76 cases of 

neonatal HSV infection were 

identified through populationbased surveillance during a 

4.5 year period (April 2006–

September 2010), for an average 

annual incidence of 13.3 cases per 

100,000 live births.34 Forty-one 

percent of the confirmed cases 

were infected with HSV type 1. 

A review of certificates of death 

or stillbirth issued in New York 

City during 1981–2013 identified 

34 deaths due to neonatal HSV 

infection, or 0.82 deaths per 

100,000 live births.33

For information on adolescent and 

adult HSV infections, see Other 

STDs.

Figure I. Congenital Syphilis — Rates of Reported Cases Among 

Infants by Year of Birth and State, United States and Outlying Areas, 

2016

Guam 0.0 

Puerto Rico 11.6 

Virgin Islands 0.0 

0.0 

0.1 - 5.2 

5.3 - 9.9 

10.0 - 15.6 

>=15.7 

(n= 15)

(n= 7)

(n= 11)

(n= 12)

(n= 9)

6.7

0.0

17.3 15.6

41.0 6.1

26.8

16.0

5.4

0.0

11.4 9.5

2.5

2.5 5.3

74.4

0.0

11.4

10.0

5.2

10.6

0.0

0.0 33.5

11.5

5.4

13.2

0.0

7.9

5.6

13.2

3.5

15.6

16.3

9.8

17.8

0.0

4.8

3.4

9.9

1.5

0.0

Rate per 100,000

live births

VT 0.0

NH 0.0

MA 5.6

RI 0.0

CT 0.0

NJ 11.6

DE 0.0

MD 21.6

DC 10.5

NOTE: The total rate of reported cases of congenital syphilis for infants by year of birth for the 

United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 15.7 per 100,000 live 

births.

References

1. Jolly DH, Mueller MP, Chen M, et al. 

Concurrency and other sexual risk behaviors 

among black young adults in a southeastern city. 

AIDS Educ Prev 2016; 28(1):59–76.

2. Dolwick Grieb SM, Davey-Rothwell M, Latkin 

CA. Concurrent sexual partnerships among 

urban African American high risk women 

with main sex partners. AIDS Behav 2012; 

16(2):323–333. DOI: 10.1007/s10461-011-

9954-6.

3. Hogben M, Leichliter JS. Social determinants 

and sexually transmitted disease disparities. Sex 

Transm Dis 2008; 35(12):S13–S18.

4. Kelly J, Cohen J, Grimes B, et al. High rates 

of herpes simplex virus type 2 infection in 

homeless women: informing public health 

strategies. J Womens Health (Larchmt) 2016; 

25(8):840–845. DOI: 10.1089/jwh.2015.5579. 

5. Tschann JM, Flores E, de Groat CL, et al. 

Condom negotiation strategies and actual 

condom use among Latino youth. J Adolesc 

Health 2010; 47(3):254–262. DOI: 10.1016/j.

jadohealth.2010.01.018.

 6. Pulerwitz J, Amaro H, De Jong W, et al. 

Relationship power, condom use and HIV risk 

among women in the USA. AIDS Care 2002; 

14(6):789–800.

7. 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, eds. Behavioral Interventions for 

Prevention and Control of Sexually Transmitted 

Diseases. New York, NY: Springer; 2007:310–

324.

8. Swartzendruber A, Zenilman JM, Niccolai LM, 

et al. It takes 2: partner attributes associated 

with sexually transmitted infections among 

adolescents. STD 2013; 40(5):372–378.

9. Haggerty CL, Gottlieb SL, Taylor BD, et al. 

Risk of sequelae after Chlamydia trachomatis 

genital infection in women. J Infect Dis 2010; 

201:S134–S155.

10. Oakeschott, P, Kerry S, Aghaizu A, 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.

11. Price MJ, Ades AE, De Angelis D, et al. Risk 

of pelvic inflammatory following Chlamydia 

trachomatis infection: analysis of prospective 

studies with a multistate model. Am J Epidemiol 

2013; 178(3):484–492.

 12. Tsevat DG, Wiesenfeld HC, Parks C, et al. 

Sexually transmitted diseases and infertility. Am 

J Obstet Gynecol 2017; 216(1):1–9.

 13. Ness RB, Trautmann G, Richter HE, et al. 

Effectiveness of treatment strategies of some 

women with pelvic inflammatory disease: 

A randomized trial. Obste Gyneco 2005; 

106(3):573–580.
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14. Gottlieb SL, Xu F, Brunham RC. Screening 

and treating chlamydia genital infections to 

prevent PID: interpretation of findings from 

randomized controlled trials. Sex Transm Dis 

2013; 40(2):97–102.

15. Markowitz LE, Dunne EF, Saraiya M, et 

al. Human papillomavirus vaccination. 

Recommendations of the Advisory Committee 

on Immunization Practices (ACIP). MMWR 

Morb Mortal Wkly Rep 2014; 63(RR05):1–30.

16. Kohlhoff, SA, Hammerschlag, MR. Gonococcal 

and chlamydial infections in infants and 

children. In: Sexually Transmitted Diseases. 4th 

ed. New York, NY: McGraw Hill; 2007:1613–

1627.

17. Centers for Disease Control and Prevention. 

Congenital syphilis — United States, 2003–

2008. MMWR Morb Mortal Wkly Rep 2010; 

59(14):413–417.

18. Kimberlin DW. Herpes simplex virus infections 

of the newborn. Semin Perinatol 2007; 

31(1):19–25.

19. Kimberlin DW. The scarlet H. J Infect Dis 2014; 

209(3):315–317.

20. Corey L, Wald A. Maternal and neonatal herpes 

simplex virus infections. N Engl J Med 2009; 

361(14):1376–1385.

21. Sutton MY, Sternberg M, Zaidi A, et al. 

Trends in pelvic inflammatory disease hospital 

discharges and ambulatory visits, United States, 

1985–2001. Sex Transm Dis 2005; 32(12):778–

784.

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(3):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(6):541.e1–6.

24. Owusu Edusei K Jr, Bohm MK, Chesson 

HW, et al. Chlamydia screening and pelvic 

inflammatory disease: Insights from exploratory 

time-series analyses. Am J Prev Med 2010; 

38(6):652–657.

25. Leichliter JS., Chandra A., Aral SO. Correlates 

of self-reported pelvic inflammatory disease 

treatment in sexually experienced reproductiveaged women in the United States, 1995 and 

2006–2010. Sex Transm Dis 2013; 40(5):413–

418.

26. Trabert B, Holt VL, Yu O, et al. PopulationBased ectopic pregnancy trends, 1993–2007. 

Am J Prev Med 2011; 40(5):556–560.

27. Hoover KW, Tao G, Kent CK. Trends in the 

diagnosis and treatment of ectopic pregnancy 

in the United States. Obstet Gynecol 2010; 

115(3):495–502.

28. Centers for Disease Control and Prevention. 

Recommendations for the prevention and 

management of Chlamydia trachomatis 

infections, 1993. MMWR Morb Mortal Wkly 

Rep 1993; 42(RR-12):1–39.

29. Kreisel, K, Weston, E, Braxton, et al. 

Keeping an eye on chlamydia and gonorrhea 

conjunctivitis in infants in the United States, 

2010–2015. Sex Transm Dis 2017; 44(6): 

356–358.

30. Centers for Disease Control and Prevention. 

Neonatal herpes simplex virus infection 

following Jewish ritual circumcisions that 

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Rep 2012; 61(22):405–409.

31. Dinh T-H, Dunne EF, Markowitz LE, et al. 

Assessing neonatal herpes reporting in the 

United States, 2000–2005. Sex Transm Dis 

2008; 35(1):19–21.

32. Handel S, Klingler EJ, Washburn K, et al. 

Population-based surveillance for neonatal 

herpes in New York City, April 2006–September 

2010. Sex Transm Dis 2011; 38(8):705–711.

33. Flagg EW, Weinstock H. Incidence of neonatal 

herpes simplex virus infections in the United 

States, 2006. Pediatrics 2011; 127(1):e1–8.

34. Sampath A, Maduro G, Schillinger JA. Infant 

deaths due to herpes simplex virus, congenital 

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2016; 137(4):e20152387.
Centers for Disease Control and Prevention: STD Surveillance 2016 Special Focus Profiles

43

STDs in Adolescents and Young Adults

Public Health Impact

Incidence and prevalence estimates 

suggest that young people aged 

15–24 years acquire half of all new 

STDs1

 and that one in four sexually 

active adolescent females has 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. 

Cervical ectopy refers to columnar 

cells, which are typically found 

within the cervical canal, located 

on the outer surface of the cervix. 

Although this is a normal finding in 

adolescent and young women, these 

cells are more susceptible to infection. 

The higher prevalence of STDs 

among adolescents may also reflect 

multiple barriers to accessing quality 

STD prevention and management 

services, including inability to pay, 

lack of transportation, long waiting 

times, conflict between clinic hours 

and work and school schedules, 

embarrassment attached to seeking 

STD services, method of specimen 

collection, and concerns about 

confidentiality (e.g., Explanation of 

Benefits for services received mailed 

to parents or guardians).3

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.4

 Interventions for atrisk adolescents and young adults 

that address underlying aspects of 

the social and cultural conditions 

affecting sexual risk-taking behaviors 

are needed, as are strategies designed 

to improve the underlying social 

conditions themselves.5,6 In addition, 

in designing STD programs, 

consideration should be given to the 

needs of adolescent and young adult 

populations including extended hours, 

optimizing privacy in waiting rooms, 

and urine based specimen collection.3

Observations

Chlamydia

In 2016, there were 1,008,403 

reported cases of chlamydial infection 

among persons aged 15–24 years, 

representing 63.1% of all reported 

chlamydia cases. Among those aged 

15–19 years, the rate of reported cases 

of chlamydia increased 4.0% during 

2015–2016 (1,854.2 to 1,929.2 cases 

per 100,000 population) (Table 10). 

Among those aged 20–24 years, the 

rate increased 1.9% during 2015–

2016 (2,594.5 to 2,643.8 cases per 

100,000 population) (Table 10).

Among women aged 15–24 years, 

the population targeted for chlamydia 

screening, the overall rate of reported 

cases of chlamydia was 3,437.5 cases 

per 100,000 females. Among men 

aged 15–24 years, the overall rate 

of reported cases of chlamydia was 

1,209.6 cases per 100,000 males. 

Rates varied by state for both males 

and females, with the majority of 

states having the highest reported case 

rates in the South (Figures J and K).

15–19 Year Old Females — In 2016, 

the rate of reported chlamydia cases 

among women aged 15–19 years was 

3,070.9 cases per 100,000 females, 

a 2.8% increase from the 2015 

rate of 2,986.5 cases per 100,000 

females (Table 10). Increases in 

rates of reported cases of chlamydia 

during 2015–2016 were largest 

among 16–year old and 18–year old 

women (3.4% and 4.1% increases, 

respectively) (Table 12). During 

2012–2016, the overall rate of 

reported cases for women aged 15–19 

years decreased 7.8% (Table 10).

20–24 Year Old Females — In 2016, 

women aged 20–24 years had the 

highest rate of reported chlamydia 

Figure J. Chlamydia — Rates of Reported Cases Among Women 

Aged 15–24 Years by State, United States and Outlying Areas, 2016

Guam 2371 

Puerto Rico 1424 

Virgin Islands 5093 

<= 2579 

2580 - 3052 

3053 - 3382 

3383 - 4016 

>=4017 

(n= 11)

(n= 11)

(n= 11)

(n= 11)

(n= 10)

3702

4832

3382 4241

2908 3189

3438

3712

3297

2554

3873 3354

2762

3166 3052

5264

2618

3460

2967

5056

3661

3285

2931 3600

4248

3293

4346

2663

4016

2628

3126

3195

4330

3129

3637

3625

1742

2516

2958

2248

3286

2579

VT 1674

NH 2736

MA 2491

RI 2201

CT 2690

NJ 2557

DE 4335

MD 3660

DC 5215

Rate per 100,000

population

NOTE: Rates for Guam and the Virgin Islands were calculated by using the 2010 population 

estimates (see Section A1.2 in the Appendix).
44

Special Focus Profiles Centers for Disease Control and Prevention: STD Surveillance 2016

Figure K. Chlamydia — Rates of Reported Cases Among Men Aged 

15–24 Years by State, United States and Outlying Areas, 2016

Guam 582 

Puerto Rico 307 

Virgin Islands 2003 

<= 965 

966 - 1063 

1064 - 1207 

1208 - 1384 

>=1385 

(n= 11)

(n= 11)

(n= 11)

(n= 11)

(n= 10)

1236

1513

1204 1263

1044 1079

1239

1316

1117

868

1394 1096

966

966 1069

1649

909

1243

1070

1818

1384

1177

1049 1207

1289

1349

1369

1067

1413

974

1040

1326

1391

1021

1379

1092

622

965

987

737

1173

989

VT 504

NH 1063

MA 973

RI 887

CT 903

NJ 837

DE 1619

MD 1487

DC 2881

Rate per 100,000

population

NOTE: Rates for Guam and the Virgin Islands were calculated by using the 2010 population 

estimates (see Section A1.2 in the Appendix).

cases (3,779.0 cases per 100,000 

females) compared with any other 

age group for either sex (Figure 5, 

Table 10). During 2015–2016, the 

overall rate of reported chlamydia 

cases among women in this age group 

remained relatively stable; however, 

this rate increased 4.1% during 

2012–2016 (Table 10).

15–19 Year Old Males — In 2016, 

the rate of reported chlamydia cases 

among men aged 15–19 years was 

832.6 cases per 100,000 males, an 

8.6% increase from 2015. During 

2012–2016, the rate of reported 

chlamydia cases for men aged 15–19 

years increased 6.0% (Table 10).

20–24 Year Old Males — In 2016, as 

in previous years, men aged 20–24 

years had the highest rate of reported 

chlamydia cases among all men 

(1,558.6 cases per 100,000 males). 

The rate for men in this age group 

increased 5.5% during 2015–2016 

(Table 10). Similarly, during 2012–

2016, the rate for men aged 20–24 

years increased 17.8% (Table 10).

Gonorrhea

During 2015–2016, the rate of 

reported gonorrhea cases increased 

11.3% for persons aged 15–19 years 

and 10.9% for persons aged 20–24 

years (Table 21). In 2016, among 

women aged 15–24 years, the rate 

was 540.8 cases per 100,000 females 

and among men aged 15–24 years, 

the rate was 455.3 cases per 100,000 

males. For both women and men, 

rates varied by state. The majority of 

states with the highest reported case 

rates were in the South (Figures L and 

M). 

15–19 Year Old Females — In 

2016, women aged 15–19 years had 

the second highest rate of reported 

gonorrhea cases (482.1 cases per 

100,000 females) compared with 

other age groups among women 

(Figure 17, Table 21). During 2015–

2016, the rate of reported gonorrhea 

cases for women in this age group 

increased 9.3% and decreased 8.6% 

during 2012–2016 (Table 21).

20–24 Year Old Females — In 2016, 

women aged 20–24 years had the 

highest rate of reported gonorrhea 

cases (595.5 cases per 100,000 

females) compared with other age 

groups among women (Figure 17, 

Table 21). During 2015–2016, the 

rate of reported gonorrhea for women 

in this age group increased 7.9% and 

4.8% during 2012–2016 (Table 21).

15–19 Year Old Males — In 2016, 

the rate of reported gonorrhea cases 

among men aged 15–19 years was 

Figure L. Gonorrhea — Rates of Reported Cases Among Women 

Aged 15–24 Years by State, United States and Outlying Areas, 2016

Guam 249 

Puerto Rico 77 

Virgin Islands 161 

<= 218 

219 - 376 

377 - 530 

531 - 693 

>=694 

(n= 11)

(n= 11)

(n= 12)

(n= 10)

(n= 10)

721

601

490 879

376 358

530

685

297

84

693 624

310

443 530

1196

79

570

370

1194

773

330

434 478

481

384

856

477

815

614

249

446

902

538

682

609

128

415

301

218

513

161

Rate per 100,000

population

VT 32

NH 84

MA 149

RI 116

CT 249

NJ 310

DE 736

MD 632

DC 1106

NOTE: Rates for Guam and the Virgin Islands were calculated by using the 2010 population 

estimates (see Section A1.2 in the Appendix).
Centers for Disease Control and Prevention: STD Surveillance 2016 Special Focus Profiles

45

Figure M. Gonorrhea — Rates of Reported Cases Among Men Aged 

15–24 Years by State, United States and Outlying Areas, 2016

Guam 126 

Puerto Rico 81 

Virgin Islands 108 

<= 163 

164 - 295 

296 - 420 

421 - 553 

>=554 

(n= 11)

(n= 11)

(n= 11)

(n= 11)

(n= 10)

553

296

469 604

420 322

491

557

278

122

564 436

229

310 356

810

125

388

289

906

648

194

312 469

431

447

617

295

543

377

262

402

589

250

557

522

152

319

291

153

382

155

Rate per 100,000

population

VT 45

NH 133

MA 227

RI 163

CT 201

NJ 276

DE 512

MD 543

DC 1546

NOTE: Rates for Guam and the Virgin Islands were calculated by using the 2010 population 

estimates (see Section A1.2 in the Appendix).

280.8 cases per 100,000 males 

(Figure 17, Table 21). During 2015–

2016, the rate of reported gonorrhea 

cases for men in this age group 

increased 14.8% and 15.8% during 

2012–2016 (Table 21).

20–24 Year Old Males — In 2016, 

as in previous years, men aged 

20–24 years had the highest rate of 

reported gonorrhea cases (616.8 cases 

per 100,000 males) compared with 

any other age group for either sex 

(Figure 17, Table 21). During 2015–

2016, the rate of reported gonorrhea 

for men in this age group increased 

13.7% and 36.1% during 2012–2016 

(Table 21).

Primary and Secondary 

Syphilis

During 2015–2016, the rate of 

reported primary and secondary 

(P&S) syphilis cases increased 13.0% 

among persons aged 15–19 years 

and 8.1% among persons aged 20–24 

years (Table 34).

15–19 Year Old Females — The rate 

of reported P&S syphilis cases among 

women aged 15–19 years decreased 

each year during 2009–2013 (from 

3.3 to 1.9 cases per 100,000 females) 

(Figure 38, Table 34). However, the 

rate has subsequently increased each 

year since then. During 2015–2016, 

the rate increased 22.2%, from 2.7 

to 3.3 cases per 100,000 females 

(Figure 38, Table 34).

20–24 Year Old Females — In 2016, 

women aged 20–24 years had the 

highest rate of P&S syphilis (6.7 

cases per 100,000 females) compared 

with other age groups among women 

(Figure 37, Table 34). The P&S 

syphilis rate among women in this age 

group has increased each year since 

2011 (Figure 38, Table 34). During 

2015–2016, the rate increased 28.8%.

15–19 Year Old Males — In 2016, 

the rate of reported P&S syphilis 

cases among men aged 15–19 years 

was 8.9 cases per 100,000 males 

(Figure 37, Table 34). The P&S 

syphilis rate among men in this age 

group has increased each year since 

2011 (Figure 39, Table 34). During 

2015–2016, the rate increased 11.3%.

20–24 Year Old Males — In 2016, 

men aged 20–24 years had the second 

highest rate of reported P&S syphilis 

(37.9 cases per 100,000 males) 

compared with any other age group 

for either sex (Figure 37, Table 34). 

The P&S syphilis rate among men 

in this age group has increased each 

year since 2006 (Figure 39, Table 34). 

During 2015–2016, the rate increased 

5.6%.

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*.

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. 

Additional information about NJTP 

can be found in Section A2.1 in the 

Appendix.

Among women entering the program 

in 45 states, the District of Columbia, 

and Puerto Rico, the median statespecific chlamydia prevalence in 2016 

was 11.4% (range: 6.0% to 25.3%) 

(Figure N). Among men entering 

the program in 49 states, the District 

of Columbia, and Puerto Rico, the 

median state-specific chlamydia 

prevalence was 7.1% (range: 2.4% to 

12.9%) (Figure O).

Among women entering the program 

in 45 states, the District of Columbia, 

and Puerto Rico, the median statespecific gonorrhea prevalence in 2016 

was 2.0% (range: 0.0% to 6.7%) 

(Figure P). Among men entering the 

* Laboratory tests are conducted by the Center for 

Disease Detection, LLC San Antonio, Texas.
46

Special Focus Profiles Centers for Disease Control and Prevention: STD Surveillance 2016

Figure N. Chlamydia — Prevalence Among Women Aged 16–24 

Years Entering the National Job Training Program (NJTP) by State of 

Residence, United States and Outlying Areas, 2016

Prevalence (%)

Puerto Rico 14.7 

Virgin Islands *

* 

<= 9.1 

9.2 - 10.2 

10.3 - 13.4 

13.5 - 15.6 

>=15.7 

(n= 6)

(n= 10)

(n= 9)

(n= 10)

(n= 9)

(n= 9)

14.5

11.4

9.1 25.3

8.6 9.3

13.7

18.5

22.1

*

15.8 16.4

6.0

14.4 10.9

15.3

6.0

15.8

8.0

20.1

14.0

12.3

9.4 *

12.9

10.1

13.4

9.6

15.6

14.1

6.8

10.2

11.7

*

22.5

14.8

11.2

11.6

9.2

8.8

8.9

9.9

VT *

NH 6.0

MA 7.0

RI *

CT 9.3

NJ 11.4

DE 18.3

MD 10.6

DC 10.2

* Fewer than 100 women who resided in these states/areas and entered the NJTP were screened 

for chlamydia in 2016.

NOTE: See Section A2.1 in the Appendix for more information regarding NJTP methods.

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

Entering the National Job Training Program (NJTP) by State of 

Residence, United States and Outlying Areas, 2016

Prevalence (%)

Puerto Rico 3.6 

Virgin Islands *

* 

<= 4.3 

4.4 - 6.1 

6.2 - 8.0 

8.1 - 9.6 

>=9.7 

(n= 2)

(n= 11)

(n= 11)

(n= 9)

(n= 10)

(n= 10)

8.9

4.9

4.2 11.6

4.8 6.7

7.9

10.3

8.9

2.4

12.2 7.1

5.1

8.8 9.6

11.7

5.0

12.9

4.3

11.1

8.0

6.1

2.9 5.6

6.0

6.4

8.7

3.8

9.1

5.2

4.0

9.5

9.4

7.1

10.3

9.3

3.4

7.3

3.0

9.6

5.7

5.8

VT 2.9

NH 4.1

MA 6.1

RI *

CT 7.5

NJ 10.9

DE 10.6

MD 6.4

DC 10.5

* Fewer than 100 men who resided in these states/areas and entered the NJTP were screened for 

chlamydia in 2016.

NOTE: See Section A2.1 in the Appendix for more information regarding NJTP methods.

program in 44 states and Puerto Rico, 

the median state-specific gonorrhea 

prevalence was 0.5% (range: 0.0% to 

2.7%) (Figure Q).

Adolescents and Young 

Adults Summary

The rate of reported cases of 

chlamydia, gonorrhea, and P&S 

syphilis increased for both sexes in 

both the adolescent (15–19 years) 

and young adult (20–24 years) age 

groups during 2012–2016. For 

chlamydia, rates of reported cases 

are consistently highest among 

women aged 15–24 years, likely 

reflecting targeted screening of 

young women; however, the rate 

of reported chlamydia in males 

increased 14.0% during 2012–2016, 

while the rate in females decreased 

1.4%. Similarly, in 2016, the rate 

of reported cases of gonorrhea in 

females aged 15–24 years was higher 

than in men of the same age group; 

however, during 2012–2016, the rate 

of reported gonorrhea in males aged 

15–24 years increased 29.9%, while 

the rate in females decreased 1.4%. 

Increases in chlamydia and gonorrhea 

diagnoses among men likely reflect a 

combination of increased screening 

among young men, including extragenital screening, and increased 

incidence. Conversely, rates of 

reported cases of P&S syphilis have 

been consistently higher among 

adolescent and young adult men 

compared to women, and during 

2012–2016, rates of reported P&S 

syphilis cases increased substantially 

in both adolescent and young adult 

males and females, with 54.2% and 

64.5% increases, respectively.
Centers for Disease Control and Prevention: STD Surveillance 2016 Special Focus Profiles

47

Figure P. Gonorrhea — Prevalence Among Women Aged 16–24 

Years Entering the National Job Training Program (NJTP) by State of 

Residence, United States and Outlying Areas, 2016

Prevalence (%)

Puerto Rico 0.4 

Virgin Islands *

* 

<= 0.8 

0.9 - 1.7 

1.8 - 3.0 

3.1 - 3.9 

>=4.0 

(n= 6)

(n= 10)

(n= 9)

(n= 10)

(n= 10)

(n= 8)

3.3

1.6

1.3 6.6

0.7 0.8

3.0

5.9

4.5

*

4.1 3.7

0.4

2.1 2.4

4.0

0.5

3.6

1.2

3.3

3.9

1.3

0.9 *

1.8

1.6

2.6

5.2

3.2

4.4

0.3

1.0

3.9

*

6.7

3.1

0.0

1.8

0.0

0.7

3.7

2.0

VT *

NH 0.0

MA 1.2

RI *

CT 2.0

NJ 2.4

DE 1.7

MD 3.2

DC 2.0

* Fewer than 100 women who resided in these states/areas and entered the NJTP were screened 

for gonorrhea in 2016.

NOTE: See Section A2.1 in the Appendix for more information regarding NJTP methods.

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

Entering the National Job Training Program (NJTP) by State of 

Residence, United States and Outlying Areas, 2016

Prevalence (%)

Puerto Rico 0.0 

Virgin Islands *

* 

<= 0.2 

0.3 - 0.4 

0.5 - 0.8 

0.9 - 1.3 

>=1.4 

(n= 9)

(n= 13)

(n= 5)

(n= 9)

(n= 9)

(n= 8)

1.3

0.7

0.0 2.7

0.4 *

0.4

1.6

*

*

2.4 0.8

0.4

* 1.1

1.8

0.2

0.9

0.4

1.0

1.0

0.9

1.0 0.8

0.2

0.5

0.9

1.6

2.2

0.5

0.2

1.7

0.5

0.0

0.9

0.2

0.0

0.3

0.2

1.5

*

0.0

VT 0.0

NH 0.5

MA 0.0

RI *

CT 0.0

NJ 0.7

DE *

MD 0.5

DC *

* Fewer than 100 men who resided in these states/areas and entered the NJTP were screened for 

gonorrhea in 2016.

NOTE: See Section A2.1 in the Appendix for more information regarding NJTP methods.

References

1. Satterwhite CL, Torrone E, Meites E, et al. 

Sexually transmitted infections among US 

women and men: prevalence and incidence 

estimates, 2008. Sex Trans Dis 2013; 40(3)187–

193.

2. Forhan SE, Gottlieb SL, Sternberg MR, et al. 

Prevalence of sexually transmitted infections 

among female adolescents aged 14 to 19 in the 

United States. Pediatrics 2009; 124(6):1505–

1512.

3. Tilson EC, Sanchez V, Ford CL, et al. Barriers 

to asymptomatic screening and other STD 

services for adolescents and young adults: focus 

group discussions. BMC Public Health 2004; 

4(1):21.

4. 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.

5. Sieving RE, Bernat DH, Resnick MD, 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):462–471.

6. Upchurch DM, Mason WM, Kusunoki Y, et 

al. Social and behavioral determinants of selfreported STD among adolescents. Perspect Sex 

Reprod Health 2004; 36(6):276–287.
48

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Centers for Disease Control and Prevention: STD Surveillance 2016 Special Focus Profiles

49

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 Hispanic ethnicity in 

the United States are population 

characteristics that are correlated 

with other factors affecting health 

status such as unemployment and 

low educational attainment.3-5 In 

2015, the overall proportion of the 

United States population living in 

poverty was 14.7% (or 48.2 million) 

and decreased slightly from 2014. 

Although the overall poverty rate is 

currently stable, many Americans face 

challenges overcoming inequalities 

in economic opportunity. The poverty 

rate in 2015 for Whites was 9.1% 

(17.7 million), for Blacks it was 

24.1% (or 10.0 million), and for 

Hispanics it was 21.4% (or 13.1 

million).3

 Those who cannot afford 

basic life necessities often have 

trouble accessing and affording 

quality sexual health services.6

 People 

who struggle financially are often 

experiencing life circumstances that 

potentially increase their risk for 

STDs.6

Access to quality STD prevention and 

treatment services is key to reducing 

STD disparities in the United States. 

Of the estimated 19 million new cases 

of sexually transmitted infections 

that occur each year, approximately 

half of the cases occur among people 

aged 15–24 years.7

 Although the 

overall proportion of adults without 

health insurance decreased from 

13.3% in 2013 to 9.1% (or 29.0 

million) in 2015, many people in 

the United States continue to lack 

access to health care.8

 Among all 

races and ethnicities in the United 

States, Hispanics had the lowest rate 

of health insurance coverage in 2015 

at 83.8%.8

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.9,10 Moreover, the quality of care 

can differ substantially for minority 

patients.11 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 because of 

these factors, persons can experience 

difficulties reducing their risk for 

sexually transmitted infections. With 

each sexual encounter, they can face 

a greater chance of encountering an 

infected partner than those in lower 

prevalence settings.2

 Acknowledging 

inequities 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 Section 

A.1 in the Appendix). In many 

state and local health departments, 

electronic laboratory reporting is 

increasingly a primary source of 

initial case notification. The reports 

are often missing race and ethnicity 

of the patient; ascertainment of 

information on race and Hispanic 

ethnicity is therefore a function 

of active follow-up or dependent 

on previous information available 

about the patient in existing health 

department surveillance databases. 

Prevalence data from populationbased surveys, such as the National 

Health and Nutrition Examination 

Survey (NHANES) and the National 

Longitudinal Study of Adolescent 

Health, confirm the existence of 

marked STD disparities in some 

minority populations.12,13

Method of Classifying Race 

and 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. 

Race/ethnicity data are presented in 

Office of Management and Budget 

(OMB) race and ethnicity categories 

according to the 1997 revised 

OMB standards.14 However, the 

National Center for Health Statistics 

(NCHS) bridged-race categories 

are used where OMB categories 

are not available (i.e., congenital 

syphilis). As of 2016, all reporting 

jurisdictions collect and report data 

in OMB-compliant formats for 

syphilis, chlamydia, and gonorrhea. 

Historical trend and rate data by race 

and Hispanic ethnicity displayed in 

figures and interpreted in this report 

for 2012–2016 include only those 

states and/or reporting jurisdictions 

(46 jurisdictions for chlamydia, 

gonorrhea, and syphilis) reporting 

in the current standard consistently 

for all years from 2012 through 2016 

(See Section A1.5 of the Appendix for 

additional information on reporting of 

race and Hispanic ethnicity).

Completeness of Race/

Ethnicity Data in 2016

Chlamydia — 28.8% of chlamydia 

case reports were missing race or 

ethnicity data, ranging by jurisdiction 

from 0.1% to 76.6% (Table A1).
50

Special Focus Profiles Centers for Disease Control and Prevention: STD Surveillance 2016

Gonorrhea — 19.0% of gonorrhea 

case reports were missing information 

on race or ethnicity, ranging by 

jurisdiction from 0.1% to 69.9% 

(Table A1).

Syphilis — 3.8% of all primary and 

secondary (P&S) syphilis case reports 

were missing information on race or 

ethnicity, ranging from no missing 

cases to 30.4% missing information 

on race or ethnicity among 

jurisdictions with 10 or more cases of 

P&S syphilis (Table A1).

Observations

Chlamydia

Among the 46 states that submitted 

data on race and ethnicity for 

chlamydia cases each year during 

2012–2016 according to the OMB 

standards, rates of reported chlamydia 

cases increased during that time 

frame among Whites (12.7%), Asians 

(10.2%), Native Hawaiians/Other 

Pacific Islanders (NHOPI) (8.3%), 

and Multirace (60.6%), and decreased 

in American Indians/Alaska Natives 

(AI/AN) (-6.4%) and Blacks (-3.5%) 

(Figure 6). Rates were stable among 

Hispanics during 2012–2016.

In 2016, 50 states and the District 

of Columbia submitted data on race 

and ethnicity for chlamydia cases 

according to the OMB standards. 

Blacks — In 2016, the overall rate 

of reported chlamydia cases among 

Blacks in the United States was 

1,125.9 cases per 100,000 population 

(Table 11B). The rate of reported 

chlamydia cases among Black women 

was 5.1 times the rate among White 

women (1,387.2 and 271.1 cases 

per 100,000 females, respectively) 

(Figure R and Table 11B). The 

rate of reported chlamydia cases 

among Black men was 6.6 times 

the rate among White men (839.0 

and 126.4 cases per 100,000 males, 

respectively). Rates of reported cases 

of chlamydia were highest for Blacks 

aged 15–19 and 20–24 years in 2016 

Figure R. Chlamydia — Rates of Reported Cases by Race/Ethnicity 

and Sex, United States, 2016

Men Rate (per 100,000 population) Women

Race/

Ethnicity

2250 1800 1350 900 450 0 0 450 900 1350 1800 2250

376.7 1 AI/AN* 112.1

84.0 Asians 151.0

839.0 Blacks 1387.2

219.8 Hispanics 532.4

333.4 9 NHOPI* 78.1

126.4 2 Whites 71.1

101.7 Multirace 197.0

330.5 Total 657.3

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

NOTE: Includes 50 states and the District of Columbia reporting race/ethnicity data in Office of 

Management and Budget compliant formats in 2016 (see Section A1.5 in the Appendix).

(Table 11B). The rate of reported 

chlamydia cases among Black women 

aged 15–19 years (6,485.2 cases per 

100,000 females) was 4.5 times the 

rate among White women in the same 

age group (1,433.3 cases per 100,000 

females). The rate of reported 

chlamydia cases among Black women 

aged 20–24 years was 3.7 times the 

rate among White women in the same 

age group (6,747.6 and 1,836.2 cases 

per 100,000 females, respectively) 

(Table 11B).

Similar racial disparities in reported 

chlamydia rates exist among men. 

Among men aged 15–19 years, the 

rate of reported chlamydia cases 

among Blacks was 8.8 times the rate 

among Whites (2,337.7 and 266.9 

cases per 100,000 males, respectively) 

(Table 11B). The rate of reported 

chlamydia cases among Black men 

aged 20–24 years was 4.9 times the 

rate among White men of the same 

age group (3,316.9 and 682.5 cases 

per 100,000 males, respectively).

American Indians/Alaska Natives 

— In 2016, the rate of reported 

chlamydia cases among AI/AN was 

749.8 cases per 100,000 population 

(Table 11B). Overall, the rate of 

reported chlamydia cases among AI/

AN in the United States was 3.8 times 

the rate among Whites.

Native Hawaiians/Other Pacific 

Islanders — In 2016, the rate of 

reported chlamydia cases among 

NHOPI was 653.4 cases per 100,000 

population (Table 11B). The overall 

rate of reported chlamydia cases 

among NHOPI was 3.3 times the rate 

among Whites and 5.5 times the rate 

among Asians.

Hispanics — In 2016, the rate of 

reported chlamydia cases among 

Hispanics was 374.6 cases per 

100,000 population, which was 1.9 

times the rate among Whites (Table 

11B).

Asians — In 2016, the rate of 

reported chlamydia cases among 

Asians was 119.3 cases per 100,000 

population (Table 11B). The overall 

rate of reported chlamydia cases 

among Whites was 1.7 times the rate 

among Asians.
Centers for Disease Control and Prevention: STD Surveillance 2016 Special Focus Profiles

51

Gonorrhea

Among 46 states submitting race 

and ethnicity data for gonorrhea 

cases consistently according to 

OMB standards each year during 

2012–2016, rates of reported 

gonorrhea cases increased 120.4% 

among Multirace persons (25.0 to 

55.1 cases per 100,000 population), 

91.4% among NHOPI (84.4 to 161.5 

cases per 100,000 population), 82.5% 

among Whites (31.4 to 57.3 cases per 

100,00 population), 81.3% among AI/

AN (125.8 to 228.1 cases per 100,000 

population), 76.7% among Asians 

(16.3 to 28.8 cases per 100,000 

population), 61.8% among Hispanics 

(59.4 to 96.1 cases per 100,000 

population), and 10.5% among Blacks 

(455.3 to 503.2 cases per 100,000 

population) (Figure 20). 

In 2016, 50 states and the District 

of Columbia submitted data on race 

and ethnicity for gonorrhea cases 

according to the OMB standards. 

Blacks — In 2016, 51.0% of reported 

gonorrhea cases with known race 

and 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 reported gonorrhea cases among 

Blacks in 2016 (481.2 cases per 

100,000 population) was 8.6 times 

the rate among Whites (55.7 cases 

per 100,000 population) (Table 22B). 

Although the calculated rate ratio for 

2016 differs when considering only 

the 46 jurisdictions that submitted 

data in race and ethnicity categories 

according to the OMB standards for 

each year during 2012–2016, this 

disparity has decreased slightly in 

recent years (Figure S). In 2016, this 

disparity was similar for Black men 

(8.9 times the rate among White men) 

and Black women (8.4 times the rate 

among White women) (Figure T, 

Table 22B). As in previous years, the 

disparity in gonorrhea rates for Blacks 

in 2016 was larger in the Midwest and 

Northeast than in the South and West 

(Figure U).

Figure S. Gonorrhea — Rate Ratios* by Race/Ethnicity, United States, 

2012–2016

1:4

1:2

1:1

2:1

4:1

8:1

16:1

32:1

Year

2012 2013 2014 2015 2016

Rate Ratio† ‡

‡ AI/AN

Asians

Blacks

Hispanics

NHOPI

* 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 Whites. Any population with a lower rate of reported cases of gonorrhea 

than the 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 reporting race/ethnicity data in Office of Management and Budget 

compliant formats during 2012–2016 (see Section A1.5 in the Appendix).

Figure T. Gonorrhea — Rates of Reported Cases by Race/Ethnicity 

and Sex, United States, 2016

Men Rate (per 100,000 population) Women

Race/

Ethnicity

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

196.8 2 AI/AN* 87.7

43.4 Asians 14.5

568.4 Blacks 400.7

117.0 Hispanics 74.2

171.1 1 NHOPI* 60.0

64.1 Whites 47.5

75.1 Multirace 49.7

170.7 1 Total 21.0

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

NOTE: Includes 50 states and the District of Columbia reporting race/ethnicity data in Office of 

Management and Budget compliant formats in 2016 (see Section A1.5 in the Appendix).

Considering all race, ethnicity, and 

age categories, rates of reported 

gonorrhea cases were highest for 

Blacks aged 20–24, 15–19, and 25–29 

years in 2016 (Table 22B). The rate 

of reported gonorrhea cases among 

Black women aged 20–24 years 

(1,856.5 cases per 100,000 females) 

was 8.0 times the rate among White 

women in the same age group (232.0 

cases per 100,000 females). The rate 

of reported gonorrhea cases among 

Black women aged 15–19 years 

(1,663.1 cases per 100,000 females) 

was 10.3 times the rate among White 

women in the same age group (161.9 

cases per 100,000 females). Among 

Black men aged 20–24 years, the rate 
52

Special Focus Profiles Centers for Disease Control and Prevention: STD Surveillance 2016

Figure U. Gonorrhea — Rate Ratios* by Race/Ethnicity and Region, 

United States, 2016

Rate Ratio†

‡

West

Midwest

Northeast

South

1:4

1:2

1:1

2:1

4:1

8:1

16:1

AI/AN Asians Blacks Hispanics NHOPI ‡

* 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 Whites. Any population with a lower rate of reported cases of gonorrhea 

than the 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 50 states and the District of Columbia reporting race/ethnicity data in Office of 

Management and Budget compliant formats in 2016 (see Section A1.5 in the Appendix).

of reported gonorrhea cases (1,892.7 

cases per 100,000 males) was 9.1 

times the rate among White men in 

the same age group (207.0 cases per 

100,000 males). The rate of reported 

gonorrhea cases among Black men 

aged 25–29 years (1,641.0 cases per 

100,000 males) was 7.4 times the 

rate among White men in the same 

age group (222.3 cases per 100,000 

males).

American Indians/Alaska Natives 

— In 2016, the rate of reported 

gonorrhea cases among AI/AN (242.9 

cases per 100,000 population) was 

4.4 times the rate among Whites 

(Table 22B). The disparity between 

gonorrhea rates for AI/AN and 

Whites was larger for AI/AN women 

(6.1 times the rate among White 

women) than for AI/AN men (3.1 

times the rate among White men) 

(Figure T, Table 22B). The disparity 

in gonorrhea rates for AI/AN in 

2016 was larger in the Midwest than 

in the West, Northeast, and South 

(Figure U).

Native Hawaiians/Other Pacific 

Islanders — In 2016, the rate of 

reported gonorrhea cases among 

NHOPI (165.8 cases per 100,000 

population) was 3.0 times the rate 

among Whites (Table 22B). The 

disparity between gonorrhea rates for 

NHOPI and Whites was larger for 

NHOPI women (3.4 times the rate 

among White women) than NHOPI 

men (2.7 times the rate among 

White men) (Figure T, Table 22B). 

The disparity in gonorrhea rates for 

NHOPI in 2016 was lower in the West 

than in the Midwest, Northeast, or 

South (Figure U).

Hispanics — In 2016, the rate of 

reported gonorrhea cases among 

Hispanics was 95.9 cases per 100,000 

population, which was 1.7 times the 

rate among Whites (Table 22B). This 

disparity was similar for Hispanic 

women (1.6 times the rate among 

White women) and Hispanic men 

(1.8 times the rate among White men) 

(Figure T, Table 22B). The disparity 

in gonorrhea rates for Hispanics in 

2016 was higher in the Northeast 

than in the Midwest, South, or West 

(Figure U).

Asians — In 2016, the rate of 

reported gonorrhea cases among 

Asians (28.3 cases per 100,000 

population) was 0.5 times the rate 

among Whites (Table 22B). This 

difference is larger for Asian women 

than for Asian men (Figure T, Table 

22B). In 2016, rates among Asians 

were lower than rates among Whites 

in all four regions of the United States 

(Figure U).

Primary and Secondary 

Syphilis

During 2012–2016, 46 states 

submitted race and ethnicity data 

for syphilis each year according to 

the OMB standards. In these states, 

rates of reported P&S syphilis 

cases increased 186.2% among AI/

AN (2.9 to 8.3 cases per 100,000 

population), 147.4% among those 

who identified as Multirace (1.9 to 

4.7 cases per 100,000 population), 

105.3% among Asians (1.9 to 3.9 

cases per 100,000 population), 91.1% 

among Hispanics (5.6 to 10.7 cases 

per 100,000 population), 77.8% 

among Whites (2.7 to 4.8 cases per 

100,000 population), 61.6% among 

NHOPI (8.6 to 13.9 cases per 100,000 

population), and 43.8% among Blacks 

(16.2 to 23.3 cases per 100,000 

population) (Figure 40).

In 2016, all 50 states and the District 

of Columbia submitted syphilis data 

by race and ethnicity according to the 

OMB standards.

Blacks — In 2016, 36.6% of reported 

P&S syphilis cases with known 

race and ethnicity occurred among 

Blacks (excluding cases with missing 

information on race or ethnicity, 

and cases whose reported race or 

ethnicity was Other) (Table 35A). The 

rate of reported P&S syphilis cases 

among Blacks in 2016 (23.1 cases per 

100,000 population) was 4.7 times 
Centers for Disease Control and Prevention: STD Surveillance 2016 Special Focus Profiles

53

the rate among Whites (4.9 cases per 

100,000 population) (Table 35B). 

The disparity was higher for Black 

women (7.0 times the rate among 

White women) than for Black men 

(4.6 times the rate among White men) 

(Figure V, Table 35B).

Considering all race, ethnicity, sex, 

and age categories, rates of reported 

P&S syphilis cases were highest 

among Black men aged 20–24 years 

and 25–29 years in 2016 (Table 35B). 

The rate of reported P&S syphilis 

cases among Black men aged 20–24 

years (105.0 cases per 100,000 males) 

was 6.4 times the rate among White 

men in the same age group (16.4 

cases per 100,000 males). The rate of 

reported P&S syphilis cases among 

Black men aged 25–29 years (144.6 

cases per 100,000 males) was 6.2 

times the rate among White men in 

the same age group (23.5 cases per 

100,000 males).

Native Hawaiians/Other Pacific 

Islanders — In 2016, the rate of 

reported P&S syphilis cases among 

NHOPI was 12.9 cases per 100,000 

population, which was 2.6 times the 

rate among Whites (Table 35B). This 

disparity was similar for NHOPI 

women (2.8 times the rate among 

White women) and NHOPI men (2.6 

times the rate among White men).

American Indians/Alaska Natives

— In 2016, the rate of reported P&S 

syphilis cases among AI/AN (8.0 

cases per 100,000 population) was 1.6 

times the rate among Whites (Table 

35B). This disparity was larger for 

AI/AN women (4.1 times the rate 

among White women) than for AI/AN 

men (1.4 times the rate among White 

men).

Hispanics — In 2016, the rate of 

reported P&S syphilis cases among 

Hispanics (10.9 cases per 100,000 

population) was 2.2 times the rate 

among Whites (Table 35B). This 

disparity was similar for Hispanic 

women (2.1 times the rate among 

White women) and Hispanic men 

Figure V. Primary and Secondary Syphilis — Rates of Reported 

Cases by Race/Ethnicity and Sex, United States, 2016

Men Rate (per 100,000 population) Women

Race/

Ethnicity

50 40 30 20 10 0 0 10 20 30 40 50

12.4 3 AI/AN* .7

7.6 0 Asians .4

41.3 6 Blacks .3

19.7 Hispanics 1.9

23.0 2 NHOPI* .5

9.0 0 Whites .9

11.2 1 Multirace .2

15.6 1 Total .9

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

NOTE: Includes 50 states and the District of Columbia reporting race/ethnicity data in Office of 

Management and Budget compliant formats in 2016 (see Section A1.5 in the Appendix).

(2.2 times the rate among White 

men).

Asians — In 2016, the rate of 

reported P&S syphilis cases among 

Asians was 3.9 cases per 100,000 

population, which was 0.8 times 

the rate among Whites (Table 35B). 

This difference was larger for Asian 

women (0.4 times the rate among 

White women) than for Asian men 

(0.8 times the rate among White 

men).

Congenital Syphilis

Race and ethnicity for cases of 

congenital syphilis is based on 

the mother’s race and ethnicity. 

During 2015–2016, rates of reported 

congenital syphilis cases increased in 

all race and ethnicity groups. Rates 

increased 201% among AI/AN, 67.3% 

among Asians/Pacific Islanders, 

31.4% among Hispanics, 23.5% 

among Blacks, and 17.8% among 

Whites (Figure W, Table 42).

In 2016, 43.0% of congenital syphilis 

cases with known race and ethnicity 

occurred among Blacks (excluding 

cases with missing information on 

race or ethnicity, and cases whose 

reported race or ethnicity was 

‘Other’) (Table 42). The rate of 

reported cases of congenital syphilis 

among Blacks in 2016 (43.1 cases 

per 100,000 live births) was 8.1 times 

the rate among Whites (5.3 cases 

per 100,000 live births). The rate of 

reported cases of congenital syphilis 

was 31.6 cases per 100,000 live 

births among AI/AN (6.0 times the 

rate among Whites), 20.5 cases per 

100,000 live births among Hispanics 

(3.9 times the rate among Whites), 

and 9.2 cases per 100,000 live births 

among Asians/Pacific Islanders (1.7 

times the rate among Whites).
54

Special Focus Profiles Centers for Disease Control and Prevention: STD Surveillance 2016

Figure W. Congenital Syphilis — Rates of Reported Cases by Year of 

Birth and Race/Ethnicity of Mother, United States, 2007–2016

 0

 10

 20

 30

 40

 50

Year

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rate (per 100,000 live births) AI/AN*

Asians/Pacific Islanders

Blacks

Hispanics

Whites

* 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.

References

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):S13–18.

3. U.S. Census Bureau, Current Population Survey, 

2016 Annual Social and Economic Supplement. 

Available at: https://www.census.gov/data/

tables/time-series/demo/income-poverty/

cps-pov/pov-01.2015.html#par_textimage_10 

Accessed July 31, 2017.

4. Harling G, Subramanian SV, Barnighausen T, 

et al. 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. Institute of Medicine. The Hidden Epidemic: 

Confronting Sexually Transmitted Diseases. 

Washington, DC: National Academy Press; 

1997.

7. Satterwhite CL, Torrone E, Meites E, et al. 

Sexually transmitted infections among US 

women and men: prevalence and incidence 

estimates, 2008. Sex Transm Dis 2013; 

40(3):187–193.

8. Barnett JC, Vornovitsky MS. Current 

Population Reports, P60-257(RV), Health 

Insurance Coverage in the United States: 2015. 

Washington, DC: U.S. Government Printing 

Office; 2016.

9. Pérez-Escamilla R. Health care access among 

Latinos: Implications for social and health care 

reform. J Hispanic High Educ 2010: 9(1):43–60.

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. Datta SD, Sternberg M, Johnson RE, 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.

13. Miller WC, Ford CA, Morris M, et al. 

Prevalence of chlamydial and gonococcal 

infections among young adults in the United 

States. JAMA 2004; 291(18):2229–2236.

14. Office of Management and Budget. Provisional 

guidance on the implementation of the 1997 

standards for federal data on race and ethnicity. 

Available at: https://www.whitehouse.gov/omb/

fedreg_1997standards Accessed July 29, 2013.
Centers for Disease Control and Prevention: STD Surveillance 2016 Special Focus Profiles

55

STDs in Men Who Have Sex with Men

Public Health Impact

The incidence of many STDs in gay, 

bisexual, and other men who have 

sex with men (collectively referred 

to as MSM) – including primary 

and secondary (P&S) syphilis and 

antimicrobial-resistant gonorrhea – is 

greater than that reported in women 

and men who have sex with women 

only (MSW).1-6 In addition to the 

negative effects of untreated STDs, 

elevated STD burden is of concern 

because it may indicate high risk for 

subsequent HIV infection. Annual 

increases in reported STD cases 

could reflect increased frequency of 

behaviors that transmit both STDs and 

HIV (e.g., condomless anal sex), and 

having an STD increases the risk of 

acquisition or transmission of HIV.7-14 

The relatively high incidence of 

STD infection among MSM may be 

related to multiple factors, including 

individual behaviors and sexual 

network characteristics.15-17 The 

number of lifetime or recent sex 

partners, rate of partner exchange, and 

frequency of condomless sex each 

influence an individual’s probability 

of exposure to STDs.15 However, 

MSM network characteristics 

such as high prevalence of STDs, 

interconnectedness and concurrency 

of sex partners, and possibly limited 

access to health care also affect 

the risk of acquiring an STD.15, 18

Furthermore, experiences of stigma – 

verbal harassment, discrimination, or 

physical assault based on attraction to 

men – are associated with increased 

sexual risk behavior among MSM.19

Disparities among MSM reflect those 

observed in the general population, 

with disproportionate incidence of 

STDs reported among racial and 

ethnic minority MSM, MSM of 

lower socioeconomic status, and 

young MSM.20-24 The higher burden 

of STDs among MSM with these 

characteristics, relative to the general 

population of MSM, may suggest 

distinct mixing patterns in their 

sexual networks, reduced access 

to screening and treatment, and 

differential experiences of stigma 

and discrimination, rather than 

greater numbers of sexual partners 

or frequency of condomless sex.15, 

21-22, 24-26 Disparities may also be 

more pronounced for racial and 

ethnic minority MSM who are also 

unemployed, young, and/or of lower 

socioeconomic status.26-27

With the exception of reported 

syphilis cases, nationally notifiable 

STD surveillance data do not 

routinely include information on 

sexual behaviors and these data are 

missing for the majority of gonorrhea 

and chlamydia cases reported to 

CDC. Therefore, trends in STDs 

among MSM in the United States 

are based on findings from sentinel 

and enhanced surveillance systems. 

Testing strategies are also evolving 

to include more extragenital STD 

screening, which may increase 

detection of asymptomatic infections. 

Until recently, testing for gonorrhea 

and chlamydia in MSM largely 

focused on detecting urethral 

infections, which are more likely to 

be symptomatic than pharyngeal or 

rectal infections.28

For data reported in this chapter, 

MSM were defined as men who either 

reported having one or more male sex 

partners 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. 

Data presented in this chapter are 

derived from the National Notifiable 

Diseases Surveillance System 

(NNDSS), the Gonococcal Isolate 

Surveillance Project (GISP), and the 

STD Surveillance Network (SSuN), 

a sentinel and enhanced surveillance 

project established in 2005 to provide 

supplemental information on STDs.

Nationally Notifiable Syphilis 

Surveillance Data

MSM accounted for 80.6% of male 

P&S syphilis cases with information 

about sex of sex partners in 2016 

(Figure 36). Of MSM P&S syphilis 

cases, 36.8% were White, 29.1% 

were Black, and 24.0% were Hispanic 

(Figure X). Relative to the percentage 

of the US population that is White 

(62.3%), Black (12.3%), and Hispanic 

(17.1%), this represents a significant 

inequality in the burden of disease 

for non-White MSM, which was also 

evident among MSW and women.30

In addition, among MSM P&S 

syphilis cases with known HIV status 

in 2016, 47.0% were also reported to 

be HIV-positive (Figure 41).

In 2016, 44 areas (43 states and the 

District of Columbia) provided data 

to classify at least 70% of cases as 

MSM, MSW, or women. Among 

these areas, estimated rates of P&S 

syphilis cases in MSM ranged from 0 

cases per 100,000 MSM in Wyoming 

to 861 cases per 100,000 MSM in 

Mississippi, with 26 states (59%) 

estimated to have rates between 200 

and 400 cases per 100,000 MSM 

(Figure Y). 

When examining reported P&S 

syphilis cases over time, 36 states 

were able to classify at least 70% 

of reported P&S syphilis cases as 

MSM, MSW, or women each year 

during 2012–2016. In these states, 

cases among MSM increased 16.4% 

during 2015–2016 and 63.7% during 

2012–2016 (Figure 35). However, 

the percentage of P&S syphilis cases 

that were attributed to MSM in those 

states fell slightly from 73.2% in 2012 

to 68.6% in 2016.
56

Special Focus Profiles Centers for Disease Control and Prevention: STD Surveillance 2016

Figure X. Primary and Secondary Syphilis — Reported Cases* by 

Sex, Sexual Behavior, and Race/Ethnicity, United States, 2016 

Cases

†

Whites

Blacks

Hispanics

Other

 0

 1625

 3250

 4875

 6500

MSW Women MSM†

* Of all reported cases of primary and secondary syphilis, 16.9% were among men without data 

on sex of sex partner, and <1% were cases with unknown sex; 4.6% of all cases had missing or 

unknown race/ethnicity. Cases with missing or unknown race/ethnicity are included in the “Other” 

category.

†

 MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM); 

MSW = Men who have sex with women only. 

Figure Y. Primary and Secondary Syphilis — Estimated Rates of 

Reported Cases Among MSM† by State, United States, 2016

Rate per 100,000

population

* 

<= 209.5 

209.6 - 274.0 

274.1 - 329.7 

329.8 - 450.7 

>=450.8 

(n= 7)

(n= 9)

(n= 9)

(n= 9)

(n= 9)

(n= 8)

329.2

79.8

440.8 349.1

450.7 154.7

352.2

*

328.0

136.2

341.4 312.8

358.2

381.4 251.7

714.5

190.2

226.7

230.7

861.4

309.7

79.5

682.2 *

455.9

*

589.1

547.8

274.0

388.0

274.2

384.3

498.9

320.5

*

268.0

213.2

224.2

299.9

169.4

*

0.0

VT 188.3

NH 261.1

MA 496.8

RI *

CT 219.6

NJ 307.4

DE *

MD 329.7

DC 209.5

* States reporting less than 70% of cases identified as MSM†, MSW†, or women in 2016 are 

suppressed.

†

 MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM); 

MSW = Men who have sex with women only.

NOTE: Estimates based on reported P&S syphilis cases among MSM in 2016 (numerator) and a 

published method of estimating the population size of MSM (denominator) by state. See Section 

A1.2 in the Appendix for information on estimating MSM population sizes for rate denominators.

A description of the methods for 

estimating MSM population sizes for 

rate denominators can be found in 

Section A1.2 of the Appendix. 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 Neisseria 

gonorrhoeae strains in the United 

States.31 Overall, the proportion of 

isolates collected in selected STD 

clinics participating in GISP that 

were from MSM increased steadily, 

from 3.9% in 1989 to 38.1% in 

2015 and decreased to 37.8% in 

2016 (Figure Z). The reason for 

this increase over time is unclear, 

but might reflect changes in the 

epidemiology of gonorrhea or in 

health care seeking behavior of men 

infected with gonorrhea. GISP has 

demonstrated that gonococcal isolates 

from MSM are more likely to exhibit 

antimicrobial resistance than isolates 

from MSW.3, 4 During 2007–2016, the 

proportion of isolates with elevated 

ceftriaxone minimum inhibitory 

concentrations (MICs) (≥0.125 μg/

ml) was higher in isolates from MSM 

than from MSW (Figure AA). 

Information on the antimicrobial 

susceptibility criteria used in GISP 

can be found in Section A2.3 of the 

Appendix. More information about 

GISP and additional data can be 

found at https://www.cdc.gov/std/

GISP. 

STD Surveillance Network

SSuN is an ongoing collaboration 

of state, county and city health 

departments collecting enhanced 

provider- and patient-based 

information among a random sample 

of reported gonorrhea cases, as well 

as clinical and behavioral information 

among all patients attending STD 

clinics in collaborating jurisdictions.29

Data for 2016 were obtained from 29 

STD clinics in SSuN jurisdictions.

Additional information about SSuN 

can be found in Section A2.2 of the 

Appendix.
Centers for Disease Control and Prevention: STD Surveillance 2016 Special Focus Profiles

57

Figure Z. Neisseria gonorrhoeae — Percentage of Urethral Isolates 

Obtained from MSM* Attending STD Clinics, Gonococcal Isolate 

Surveillance Project (GISP), 1989–2016

 0

 8

 16

 24

 32

 40

Year

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016

Percentage

* MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM).

Figure AA. 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), 2006–2016

Percentage

MSM*

MSW*

0.0

0.5

1.0

1.5

2.0

Year

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

* MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM); 

MSW = Men who have sex with women only.

Gonorrhea, 2010–2015

The number of diagnosed and 

reported gonorrhea cases among 

MSM was estimated at the county 

level based on patient interviews 

conducted among a random 

sample of all cases reported to six 

health departments continuously 

collaborating in the STD Surveillance 

Network between January 2010 and 

June 2013, and again July through 

December 2015. Estimates of the 

size of the MSM population in 

each county were obtained from 

published estimates and used to 

estimate the incidence of reported 

gonorrhea by year among MSM in 

the six collaborating SSuN sites.32, 

33 Estimated gonorrhea incidence 

among MSM increased 151.0% 

across the study period from 1,368.6 

cases per 100,000 MSM in 2010 to 

3,434.7 cases per 100,000 MSM in 

2015 (Figure BB). Over the same 

time period, estimated gonorrhea 

rates among women and MSW also 

increased, but by a significantly 

smaller proportion (39.8% and 31.7%, 

respectively).33

Gonorrhea and Chlamydia in 

STD Clinics, 2016

In 2016, 25,880 unique MSM 

presented for care in the 29 STD 

clinics in nine SSuN jurisdictions. 

In total, 22,418 unique MSM were 

tested for urogenital gonorrhea and/

or chlamydia (22,404 for gonorrhea, 

22,152 for chlamydia). The proportion 

of men tested for urogenital infections 

was similar across SSuN jurisdictions, 

though the proportion who tested 

positive (positivity) varied by SSuN 

jurisdiction (Figure CC). In general, 

urogenital gonorrhea positivity was 

higher than urogenital chlamydia 

positivity (except in Massachusetts 

and Multnomah County); median 

site-specific positivity for gonorrhea 

was 8.8% (range by jurisdiction: 

2.8%–15.3%) and for chlamydia was 

6.3% (range: 4.8%–10.3%). 

A total of 17,489 unique MSM were 

tested for rectal gonorrhea and/

or chlamydia in 2016 (17,467 for 

gonorrhea, 17,445 for chlamydia) 

(Figure DD). In most jurisdictions, 

similar proportions of MSM were 

tested for rectal gonorrhea and 

chlamydia, likely reflecting use of 

dual diagnostic tests. Compared to 

urogenital testing, a lower proportion 

of MSM were tested for rectal 

infection. The median site-specific 

positivity for rectal gonorrhea was 

15.9% (range: 9.9%–30.3%) and for 

rectal chlamydia was 17.2% (range: 

12.3%–20.0%). 

During 2016, 15,680 MSM were 

tested at the oropharyngeal site 

for gonorrhea (Figure EE). The 

median site-specific positivity for 

oropharyngeal gonorrhea was 8.8% 

(range by jurisdiction: 1.0%–16.1%). 

Oropharyngeal chlamydia data are 

not shown as some of the SSuN 

jurisdictions do not offer routine 
58

Special Focus Profiles Centers for Disease Control and Prevention: STD Surveillance 2016

Figure BB. Gonorrhea — Estimated* Rates of Reported Gonorrhea 

Cases by MSM†, MSW†, and Women, STD Surveillance Network 

(SSuN)‡, 2010–2015

 0

1,000

2,000

3,000

4,000

Year

2010 2011 2012 2013 2014 2015

Rate (per 100,000 population)

MSM

MSW

Women

†

†

* Estimates based on interviews among a random sample of reported cases of gonorrhea 

(N=14,080); cases weighted for analysis.

†

 MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM); 

MSW = Men who have sex with women only.

‡

 Sites include Baltimore, Philadelphia, New York City, Washington State, San Francisco, and 

California (excluding San Francisco).

NOTE: Data not available for 2014; 2013–2015 trend interpolated shown in dashed line; trends 

lines overlap for MSW and Women in this figure. See section A2.2 in the Appendix for SSuN 

methods.

SOURCE: Stenger M, Pathela P, Anschuetz G, et al. Increases in the rate of Neisseria gonorrhoeae 

among gay, bisexual and other men who have sex with men (MSM) — findings from the STD 

Surveillance Network 2010–2015. Sex Transm Dis 2017; 44(7):393–397.

Figure CC. Gonorrhea and Chlamydia — Proportion* of MSM†

Attending STD Clinics Testing Positive for Urogenital‡ Gonorrhea 

and Chlamydia by Jurisdiction, STD Surveillance Network (SSuN), 

2016

100

80

60

40

20

0

Percentage

Jurisdiction

 Baltimore Los Angeles Massachusetts Multnomah Minnesota New York City Philadelphia San Francisco

 County 

% of MSM who tested positive for gonorrhea % of MSM who tested positive for chlamydia

% of MSM tested for gonorrhea % of MSM tested for chlamydia

15.3 6.2 9.1 6.2 2.8 4.8 6.4 6.4 7.2 6.0 8.6 6.1 14.4 7.9 9.0 6.7

* Results based on data obtained from 22,404 patients tested for urogenital gonorrhea and 22,152 

patients tested for urogenital chlamydia attending SSuN STD clinics in 2016; data from Florida and 

Seattle were not available.

†

 MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM).

‡

 Urogenital includes results from both urethral and urine specimens. 

NOTE: See section A2.2 in the Appendix for SSuN methods.

testing for oropharyngeal chlamydia 

infections.

HIV Status and STDs in STD 

Clinics, 2016

Among HIV-positive MSM visiting 

SSuN STD clinics in 2016, urogenital 

chlamydia positivity was 8.6% and 

urogenital gonorrhea positivity was 

14.0% (compared to 6.7% and 9.0%, 

respectively, among HIV-negative 

MSM) (Figure FF). Among HIVpositive MSM, 7.4% were diagnosed 

with P&S syphilis compared to 3.1% 

of HIV-negative MSM. Percentages 

represent the overall average of the 

mean value by jurisdiction. 

Summary

The number of reported P&S syphilis 

cases among MSM continued to 

rise in 2016 and the majority of 

P&S syphilis cases remained among 

MSM. Estimated rates of reported 

gonorrhea incidence increased among 

MSM in SSuN jurisdictions in recent 

years. Furthermore, the proportion of 

GISP isolates with elevated MICs to 

antimicrobials currently used to treat 

gonorrhea was higher among MSM 

than among MSW. 

Beyond STD burden in the general 

MSM population, the data indicated 

heterogeneity of STD prevalence 

among MSM according to geography, 

race and ethnicity, and HIV status. 

State-specific P&S syphilis rate 

estimates among MSM varied from 0 

to over 800 cases per 100,000 MSM 

and the prevalence of diagnosed 

STDs among MSM differed by SSuN 

jurisdiction. Reported P&S syphilis 

was disproportionately prevalent 

among Black and Hispanic MSM, and 

data from MSM who attended SSuN 

clinics suggested that P&S syphilis, 

urogenital gonorrhea, and urogenital 

chlamydia may be more prevalent 

among MSM living with diagnosed 

HIV infection than among HIVnegative MSM.
Centers for Disease Control and Prevention: STD Surveillance 2016 Special Focus Profiles

59

Figure DD. Gonorrhea and Chlamydia — Proportion* of MSM†

Attending STD Clinics Testing Positive for Rectal Gonorrhea and 

Chlamydia by Jurisdiction, STD Surveillance Network (SSuN), 2016 

100

80

60

40

20

0

Percentage

Jurisdiction

 Baltimore Massachusetts Minnesota Philadelphia Seattle

 

30.3

17.1 16.0 15.9 9.9 12.3 15.2 17.1 15.9 20.0 12.1 12.7 19.1 18.2 14.5 16.8 16.2 18.3

Los Angeles Multnomah County New York City San Francisco

% of MSM who tested positive for gonorrhea % of MSM who tested positive for chlamydia

% of MSM tested for gonorrhea % of MSM tested for chlamydia

* Results based on data obtained from 17,467 patients tested for rectal gonorrhea and 17,445 

patients tested for rectal chlamydia attending SSuN STD clinics in 2016; data from Florida were not 

available.

†

 MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM).

NOTE: See section A2.2 in the Appendix for SSuN methods. 

Figure EE. Gonorrhea — Proportion* of MSM† Attending STD Clinics 

Testing Positive for Oropharyngeal Gonorrhea by Jurisdiction, STD 

Surveillance Network (SSuN), 2016 

100

80

60

40

20

0

Jurisdiction

% of MSM tested for gonorrhea

% of MSM who tested positive for gonorrhea

15.3 15.2 1.0

13.5 14.8 16.1 13.9 12.2

Percentage

 Baltimore Los Angeles Massachusetts Multnomah Minnesota Philadelphia San Francisco Seattle

 County

* Results based on data obtained from 15,190 patients tested for oropharyngeal gonorrhea 

attending SSuN STD clinics in 2016; data from Florida and New York city were not available.

†

 MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM).

NOTE: See section A2.2 in the Appendix for SSuN methods.

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Figure FF. Proportion* of MSM†

 Attending STD Clinics with Primary 

and Secondary Syphilis‡, Urogenital§ Gonorrhea, or Urogenital§

Chlamydia by HIV Statusǁ, STD Surveillance Network (SSuN), 2016

Percentage

HIVHIV+

 0

 5

 10

 15

 20

P&S 

syphilis

GC 

urogenital

CT

urogenital § §

* Proportions represent the overall average of the mean value by jurisdiction. 

†

 MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM).

‡

 Includes SSuN jurisdictions that reported data on at least 20 patients with a diagnosis of primary 

and secondary syphilis in 2016.

§

 Urogenital includes results from both urethral and urine specimens.

ǁ

 Excludes all persons for whom there was no laboratory documentation or self-report of HIV status.

NOTE: See section A2.2 in the Appendix for SSuN methods.

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41.

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secondary syphilis among black and Hispanic 

men who have sex with men: case report 

data from 27 States. Ann Intern Med 2011; 

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24. 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 

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2004; 10(3):255–267.

25. Millett GA, Flores SA, Peterson JL, et al. 

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black and white men who have sex with men: 

a meta-analysis of HIV risk behaviors. AIDS 

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26. Sullivan PS, Peterson J, Rosenberg ES, et 

al. Understanding racial HIV/STI disparities 

in black and white men who have sex with 

men: a multilevel approach. PLoS One 2014; 

9(3):e90514.

27. Mayer KH, Wang L, Koblin B, et al. 

Concomitant socioeconomic, behavioral, 

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disproportionate HIV infection burden among 

black men who have sex with men in 6 US 

cities. PLoS One 2014; 9(1):e87298.

28. Patton ME, Kidd S, Llata E, 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):1564–1570.

29. Rietmeijer K, Donnelly J, Bernstein K, et al. 

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the STD Surveillance Network. Pub Health Rep 

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30. 2011–2015 American Community Survey 

5-Year Summary File. Table DP05 — 

ACS demographic and housing estimates. 

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31. Schwarcz S, Zenilman J, Schnell D, et al. 

National surveillance of antimicrobial resistance 

in Neisseria gonorrhoeae. JAMA 1990; 

264(11):1413–1417.

32. Grey JA, Bernstein KT, Sullivan PS, et al. 

Estimating the population sizes of men who 

have sex with men in US states and counties 

using data from the American Community 

Survey. JMIR Public Health Surveill 2016; 

2(1):e14.

33. Stenger M, Pathela P, Anschuetz G, et al. 

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Tables
62

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

Syphilis

All Stages†

Primary and

Secondary

Early

Latent

Late and

Late Latent‡ Congenital Chlamydia Gonorrhea Chancroid

Year* 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 130,697 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 19,779 8.5 259 7.0 NR — 960,633 414.7 1,392 0.6

Continued on next page.

Table 1. Sexually Transmitted Diseases — Reported Cases and Rates of Reported Cases per 100,000 Population, 

United States, 1941–2016
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

63

Table 1. Sexually Transmitted Diseases — Reported Cases and Rates of Reported Cases per 100,000 Population, 

United States, 1941–2016 (continued)

Syphilis

All Stages†

Primary and

Secondary

Early

Latent

Late and

Late Latent‡ Congenital Chlamydia Gonorrhea Chancroid

Year* Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

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

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 9.7 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 9.1 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 56,484 17.9 17,375 5.5 16,929 5.4 21,819 6.9 361 9.2 1,401,906 443.5 333,004 105.3 10 0.0

2014 63,453 19.9 19,999 6.3 19,452 6.1 23,541 7.4 461 11.6 1,441,789 452.2 350,062 109.8 6 0.0

2015 74,707 23.2 23,872 7.4 24,173 7.5 26,170 8.1 492 12.3 1,526,658 475.0 395,216 123.0 11 0.0

2016 88,042 27.4 27,814 8.7 28,924 9.0 30,676 9.5 628 15.7 1,598,354 497.3 468,514 145.8 7 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, late syphilis with clinical manifestations other than 

neurosyphilis, and late syphilis with clinical manifestations (including late benign syphilis and cardiovascular syphilis).

§

 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 7, 2017. The number of cases and the rates shown here supersede those published in previous reports. See Section A1.1 in the Appendix for more information. 

Cases and rates shown in this table exclude the outlying areas of Guam, Puerto Rico, and Virgin Islands. Case definitions have changed over time. See Section 

Appendix C.1 in the Appendix for more information.
64

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

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

2016

Rank* State Cases Rate per 100,000 Population

1 Alaska 5,698 771.6

2 Louisiana 31,727 679.3

3 Mississippi 20,112 672.1

4 New Mexico 13,108 628.6

5 Georgia 62,776 614.6

6 North Carolina 58,006 577.6

7 South Carolina 28,179 575.5

8 Delaware 5,365 567.2

9 Arkansas 16,737 562.0

10 Illinois 72,201 561.4

11 Alabama 26,901 553.6

12 New York 109,433 552.8

13 Oklahoma 21,449 548.4

14 Ohio 60,496 520.9

15 Texas 142,952 520.4

16 Arizona 34,923 511.5

17 Maryland 30,658 510.4

18 Missouri 30,843 507.0

19 Nevada 14,649 506.7

20 California 198,155 506.2

21 South Dakota 4,331 504.5

U.S. TOTAL† 1,598,354 497.3

22 Tennessee 32,304 489.4

23 Hawaii 6,902 482.1

24 Virginia 39,666 473.2

25 Colorado 25,569 468.6

26 Florida 94,742 467.4

27 Rhode Island 4,936 467.3

28 Wisconsin 26,894 466.0

29 Indiana 30,847 466.0

30 Michigan 45,936 462.9

31 North Dakota 3,455 456.5

32 Pennsylvania 56,930 444.7

33 Washington 31,254 435.9

34 Oregon 17,425 432.5

35 Nebraska 8,197 432.3

36 Montana 4,416 427.5

37 Kansas 12,160 417.6

38 Iowa 12,983 415.6

39 Minnesota 22,685 413.2

40 Kentucky 18,286 413.2

41 Massachusetts 26,807 394.5

42 Connecticut 13,911 387.4

43 New Jersey 34,519 385.3

44 Idaho 5,897 356.3

45 Wyoming 2,060 351.5

46 Utah 9,457 315.7

47 Maine 4,156 312.6

48 Vermont 1,690 269.9

49 West Virginia 4,821 261.4

50 New Hampshire 3,467 260.6

* 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 7,283 cases and a rate of 1,083.4, but excludes outlying areas (Guam with 934 cases and rate of 

577.3, Puerto Rico with 7,198 cases and rate of 207.2, and Virgin Islands with 571 cases and rate of 554.6).
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

65

Table 3. Chlamydia — Reported Cases and Rates of Reported Cases by State/Area and Region in Alphabetical 

Order, United States and Outlying Areas, 2012–2016

Cases Rates per 100,000 Population

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Alabama 30,621 29,464 29,010 26,359 26,901 635.0 609.6 598.2 542.5 553.6

Alaska 5,462 5,774 5,789 5,660 5,698 746.7 785.4 785.8 766.5 771.6

Arizona 30,444 30,564 32,397 32,387 34,923 464.6 461.2 481.3 474.3 511.5

Arkansas 16,611 15,447 15,605 16,166 16,737 563.3 522.0 526.1 542.8 562.0

California 167,695 167,346 176,308 189,170 198,155 440.8 436.6 454.4 483.3 506.2

Colorado 21,631 20,386 21,863 23,857 25,569 417.0 387.0 408.2 437.2 468.6

Connecticut 13,065 12,775 13,382 13,126 13,911 363.9 355.2 372.1 365.5 387.4

Delaware 4,438 5,213 4,473 4,605 5,365 483.9 563.1 478.1 486.8 567.2

District of Columbia 6,808 6,414 5,293 7,894 7,283 1,076.7 992.2 803.3 1,174.3 1,083.4

Florida 77,644 80,182 84,194 90,468 94,742 401.9 410.1 423.2 446.3 467.4

Georgia 52,418 51,070 51,945 57,639 62,776 528.4 511.1 514.4 564.3 614.6

Hawaii 6,340 6,640 6,419 7,074 6,902 455.4 472.9 452.2 494.1 482.1

Idaho 4,550 5,428 5,442 5,631 5,897 285.1 336.7 333.0 340.3 356.3

Illinois 67,701 63,797 66,536 69,610 72,201 525.8 495.2 516.6 541.3 561.4

Indiana 29,505 28,023 28,519 28,886 30,847 451.3 426.5 432.3 436.4 466.0

Iowa 11,377 10,953 11,804 12,085 12,983 370.1 354.4 379.9 386.9 415.6

Kansas 11,135 11,012 11,116 11,464 12,160 385.8 380.5 382.8 393.7 417.6

Kentucky 17,273 17,134 17,664 17,444 18,286 394.3 389.8 400.2 394.2 413.2

Louisiana 27,353 28,739 28,955 32,325 31,727 594.4 621.3 622.7 692.1 679.3

Maine 3,413 3,438 3,530 3,965 4,156 256.8 258.8 265.4 298.3 312.6

Maryland 26,534 26,723 27,424 27,450 30,658 450.9 450.7 458.9 457.0 510.4

Massachusetts 23,550 23,210 21,271 24,100 26,807 354.3 346.8 315.3 354.7 394.5

Michigan 47,566 44,835 44,256 46,486 45,936 481.3 453.1 446.6 468.5 462.9

Minnesota 18,056 18,742 19,907 21,243 22,685 335.7 345.8 364.8 387.0 413.2

Mississippi 23,054 17,464 19,605 17,371 20,112 772.3 583.8 654.8 580.5 672.1

Missouri 27,835 27,328 27,981 28,948 30,843 462.2 452.1 461.5 475.8 507.0

Montana 3,827 3,818 4,193 4,184 4,416 380.7 376.1 409.6 405.1 427.5

Nebraska 6,748 7,301 7,499 7,956 8,197 363.7 390.7 398.6 419.6 432.3

Nevada 11,137 11,781 11,841 12,925 14,649 403.7 422.2 417.1 447.1 506.7

New Hampshire 3,072 3,119 3,586 3,095 3,467 232.6 235.7 270.3 232.6 260.6

New Jersey 27,271 28,327 29,904 31,337 34,519 307.6 318.3 334.6 349.8 385.3

New Mexico 11,898 12,249 11,558 12,632 13,108 570.5 587.4 554.2 605.8 628.6

New York 100,546 95,803 98,814 103,615 109,433 513.8 487.5 500.4 523.4 552.8

North Carolina 50,596 48,416 47,147 64,376 58,006 518.8 491.6 474.1 641.0 577.6

North Dakota 2,908 2,932 3,451 3,159 3,455 415.6 405.3 466.7 417.3 456.5

Ohio 53,141 53,121 54,858 56,726 60,496 460.3 459.1 473.2 488.5 520.9

Oklahoma 16,843 18,278 20,662 21,025 21,449 441.5 474.7 532.8 537.5 548.4

Oregon 13,454 14,181 15,508 16,305 17,425 345.0 360.8 390.6 404.7 432.5

Pennsylvania 54,993 52,056 50,536 53,460 56,930 430.9 407.5 395.2 417.6 444.7

Rhode Island 4,313 4,312 4,349 4,575 4,936 410.6 410.1 412.2 433.1 467.3

South Carolina 27,149 25,594 28,087 27,538 28,179 574.7 536.0 581.2 562.4 575.5

South Dakota 3,924 3,927 4,166 3,949 4,331 470.9 464.8 488.3 460.0 504.5

Tennessee 32,525 30,370 30,793 31,272 32,304 503.8 467.5 470.2 473.8 489.4

Texas 127,036 129,861 131,219 141,158 142,952 487.5 491.0 486.8 513.9 520.4

Utah 7,615 7,535 8,223 8,633 9,457 266.7 259.7 279.4 288.2 315.7

Vermont 1,724 1,842 2,237 1,901 1,690 275.4 294.0 357.0 303.7 269.9

Virginia 34,963 33,316 36,048 35,349 39,666 427.1 403.3 432.9 421.7 473.2

Washington 24,596 24,950 26,577 28,699 31,254 356.6 357.9 376.4 400.2 435.9

West Virginia 4,790 5,139 4,719 4,958 4,821 258.2 277.1 255.0 268.9 261.4

Wisconsin 23,726 23,572 23,154 24,381 26,894 414.3 410.5 402.1 422.4 466.0

Wyoming 2,102 2,005 1,972 2,037 2,060 364.7 344.1 337.6 347.5 351.5

U.S. TOTAL 1,422,976 1,401,906 1,441,789 1,526,658 1,598,354 453.3 443.5 452.2 475.0 497.3

Northeast 231,947 224,882 227,609 239,174 255,849 416.0 402.0 405.3 424.9 454.6

Midwest 303,622 295,543 303,247 314,893 331,028 451.0 437.5 447.6 463.7 487.5

South 576,656 568,824 582,843 623,397 641,964 491.8 480.5 486.6 514.4 529.7

West 310,751 312,657 328,090 349,194 369,513 422.3 421.1 436.4 459.2 485.9

Guam 1,031 937 839 881 934 644.7 584.2 521.1 544.5 577.3

Puerto Rico 6,227 5,969 4,899 5,295 7,198 169.8 165.1 138.1 152.4 207.2

Virgin Islands 802 775 791 743 571 761.8 739.9 759.3 721.7 554.6

OUTLYING AREAS 8,060 7,681 6,529 6,919 8,703 205.0 198.0 171.2 185.1 232.8

TOTAL 1,431,036 1,409,587 1,448,318 1,533,577 1,607,057 450.2 440.5 448.9 471.6 494.2
66

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

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, 2012–2016

Cases Rates per 100,000 Population

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Alabama 22,099 21,096 20,619 18,674 19,131 889.8 847.8 825.0 745.2 763.5

Alaska 3,670 3,899 3,940 3,786 3,807 1,047.9 1,115.4 1,127.5 1,083.6 1,089.6

Arizona 22,087 21,950 22,747 22,299 23,693 670.4 658.9 671.5 648.9 689.4

Arkansas 12,247 11,334 11,625 12,088 12,216 816.1 752.7 770.4 797.7 806.2

California 114,396 112,460 115,339 121,387 123,906 598.2 583.7 590.5 616.1 628.9

Colorado 15,476 14,336 14,906 16,151 16,945 598.9 546.8 559.4 595.4 624.6

Connecticut 9,464 9,210 9,512 9,089 9,495 514.2 500.0 516.4 494.2 516.3

Delaware 3,181 3,714 3,084 3,118 3,678 672.9 777.3 638.6 638.8 753.5

District of Columbia 4,426 3,992 3,709 4,632 4,018 1,328.0 1,173.4 1,071.1 1,309.9 1,136.2

Florida 55,628 56,688 58,800 62,048 63,415 563.6 567.4 578.2 598.4 611.6

Georgia 37,456 36,559 36,871 40,302 43,377 738.9 715.3 713.1 769.9 828.6

Hawaii 4,452 4,646 4,469 4,720 4,480 644.9 669.0 637.1 668.3 634.4

Idaho 3,206 3,885 3,895 3,963 4,022 402.2 482.6 477.3 479.7 486.8

Illinois 48,575 45,764 46,516 47,268 48,128 740.9 698.1 709.1 722.1 735.3

Indiana 21,633 20,307 20,586 20,385 21,664 651.8 609.0 615.0 607.1 645.2

Iowa 8,194 7,895 8,385 8,372 8,872 528.7 507.1 536.1 532.6 564.4

Kansas 8,440 8,323 8,276 8,325 8,688 581.8 573.2 568.1 571.0 595.9

Kentucky 12,366 12,086 12,404 12,140 12,345 556.3 541.5 553.7 540.5 549.6

Louisiana 20,507 21,258 21,297 23,351 22,942 872.7 900.2 896.4 978.3 961.2

Maine 2,420 2,404 2,478 2,735 2,795 356.5 354.5 365.0 403.4 412.2

Maryland 19,295 19,049 19,162 18,612 20,145 635.9 623.7 622.1 601.3 650.8

Massachusetts 16,319 15,851 14,000 15,588 17,299 476.4 459.7 402.9 445.6 494.5

Michigan 34,510 32,056 31,470 32,425 31,497 685.7 636.5 624.2 642.8 624.4

Minnesota 12,568 12,950 13,484 14,112 14,967 464.3 474.9 491.2 511.4 542.3

Mississippi 16,771 12,676 14,008 12,335 14,123 1,092.1 824.9 909.9 800.7 916.8

Missouri 19,745 19,303 19,549 19,926 20,757 643.0 626.7 632.8 643.1 669.9

Montana 2,655 2,701 2,878 2,846 2,962 530.8 534.5 564.9 554.1 576.7

Nebraska 4,628 4,945 5,110 5,409 5,527 495.9 526.8 540.9 568.8 581.2

Nevada 7,628 8,183 8,039 8,743 9,849 557.7 591.0 569.2 607.0 683.8

New Hampshire 2,150 2,187 2,452 2,089 2,316 321.6 326.5 365.2 310.4 344.2

New Jersey 20,231 20,771 21,556 22,274 24,021 445.5 456.0 471.0 485.7 523.8

New Mexico 8,724 9,033 8,395 9,227 9,306 828.6 858.9 797.5 877.4 884.9

New York 68,337 64,454 65,114 66,164 67,602 677.9 637.2 640.6 649.7 663.8

North Carolina 39,140 37,146 35,494 47,178 41,085 782.9 735.9 696.0 915.9 797.6

North Dakota 1,898 1,923 2,202 2,028 2,187 551.9 544.2 610.9 551.0 594.2

Ohio 38,879 38,293 39,033 39,825 41,797 658.8 647.8 659.4 671.9 705.2

Oklahoma 12,341 13,065 14,855 14,904 14,933 641.1 672.3 758.7 754.9 756.4

Oregon 9,425 9,932 10,545 11,075 11,542 478.8 500.2 525.6 544.0 566.9

Pennsylvania 37,569 35,657 34,170 35,201 37,030 575.0 545.9 523.0 538.4 566.4

Rhode Island 3,091 3,044 3,037 3,064 3,278 570.3 561.5 558.5 562.9 602.2

South Carolina 20,497 19,103 20,581 19,743 19,783 844.7 779.2 828.8 784.3 785.9

South Dakota 2,801 2,793 2,942 2,831 3,072 674.9 664.2 694.1 663.8 720.3

Tennessee 22,732 21,057 21,203 21,112 21,714 687.3 632.6 631.6 624.1 641.9

Texas 96,405 96,923 96,959 102,141 101,618 735.3 728.7 714.3 738.5 734.7

Utah 5,149 5,050 5,414 5,704 6,031 362.8 350.2 370.0 383.1 405.1

Vermont 1,296 1,319 1,613 1,352 1,171 408.5 415.5 507.7 425.8 368.8

Virginia 24,670 23,167 24,754 23,859 26,146 592.4 551.8 585.1 560.3 614.0

Washington 17,271 17,452 18,193 19,047 20,276 499.8 500.2 515.1 531.2 565.5

West Virginia 3,405 3,624 3,356 3,449 3,330 362.2 386.1 358.4 369.6 356.9

Wisconsin 16,727 16,448 16,063 16,660 18,382 580.1 569.0 554.3 573.7 633.0

Wyoming 1,492 1,387 1,352 1,387 1,356 528.8 486.0 472.5 482.9 472.1

U.S. TOTAL 1,018,272 993,348 1,006,441 1,045,143 1,072,719 638.7 619.0 621.6 640.4 657.3

Northeast 160,877 154,897 153,932 157,556 165,007 562.0 539.7 534.4 546.0 571.8

Midwest 218,598 211,000 213,616 217,566 225,538 639.9 615.9 621.9 632.2 655.4

South 423,166 412,537 418,781 439,686 443,999 708.3 684.1 685.9 711.7 718.6

West 215,631 214,914 220,112 230,335 238,175 584.6 577.5 583.6 604.0 624.5

Guam 726 700 595 618 654 921.9 885.8 749.6 774.4 819.5

Puerto Rico 5,102 4,766 3,770 3,950 5,551 267.1 252.7 204.4 217.4 305.5

Virgin Islands 592 579 590 563 405 1,056.8 1,037.1 1,060.7 1,020.6 734.1

OUTLYING AREAS 6,420 6,045 4,955 5,131 6,610 314.0 299.1 250.4 262.9 338.6

TOTAL 1,024,692 999,393 1,011,396 1,050,274 1,079,329 634.6 615.0 617.1 636.0 653.6

NOTE: Cases reported with unknown sex are not included in this table.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

67

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, 2012–2016

Cases Rates per 100,000 Population

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Alabama 8,295 8,201 8,318 7,549 7,585 354.7 349.7 354.0 320.8 322.3

Alaska 1,792 1,875 1,849 1,871 1,891 470.0 486.3 477.4 480.9 486.1

Arizona 8,354 8,610 9,650 10,028 11,217 256.4 261.3 288.6 295.7 330.7

Arkansas 4,360 4,104 3,964 4,078 4,521 301.0 282.3 272.0 278.8 309.1

California 52,983 54,679 60,687 67,475 73,625 280.1 286.8 314.9 347.0 378.7

Colorado 6,155 6,050 6,957 7,706 8,624 236.4 228.6 258.5 280.9 314.3

Connecticut 3,524 3,481 3,757 3,926 4,268 201.4 198.4 214.1 224.1 243.6

Delaware 1,257 1,499 1,389 1,487 1,687 282.9 334.6 306.8 324.8 368.5

District of Columbia 2,345 2,400 1,555 3,108 3,112 784.2 783.7 497.4 975.5 976.8

Florida 22,009 23,300 25,239 28,332 31,275 233.0 243.7 259.6 286.1 315.8

Georgia 14,521 14,063 14,736 17,212 19,338 299.3 288.1 299.1 345.6 388.3

Hawaii 1,888 1,994 1,950 2,352 2,421 269.0 281.0 271.6 324.2 333.8

Idaho 1,344 1,528 1,547 1,663 1,869 168.3 189.3 189.0 200.7 225.5

Illinois 18,977 17,943 19,908 21,966 24,008 300.3 283.6 315.0 347.9 380.2

Indiana 7,850 7,708 7,921 8,492 9,174 243.9 238.2 243.8 260.3 281.3

Iowa 3,183 3,058 3,419 3,712 4,111 208.8 199.4 221.6 239.2 264.9

Kansas 2,695 2,689 2,840 3,139 3,472 187.8 186.5 196.2 215.9 238.8

Kentucky 4,851 4,989 5,194 5,273 5,590 224.8 230.6 239.0 242.0 256.5

Louisiana 6,846 7,481 7,655 8,974 8,784 304.0 330.4 336.6 392.9 384.6

Maine 990 1,031 1,050 1,230 1,356 152.2 158.6 161.2 188.9 208.2

Maryland 7,193 7,654 8,237 8,780 10,479 252.4 266.2 284.4 301.6 360.0

Massachusetts 7,193 7,341 7,197 8,406 9,433 223.4 226.2 220.0 255.0 286.2

Michigan 12,962 12,683 12,723 14,015 14,417 267.2 261.0 261.3 287.3 295.5

Minnesota 5,430 5,791 6,414 7,122 7,703 203.2 215.0 236.5 260.9 282.2

Mississippi 6,281 4,788 5,588 5,018 5,955 433.4 329.2 384.2 345.6 410.2

Missouri 8,090 8,025 8,432 9,022 10,086 274.1 270.8 283.5 302.2 337.9

Montana 1,172 1,116 1,314 1,338 1,454 232.1 218.9 255.6 257.6 280.0

Nebraska 2,093 2,196 2,357 2,531 2,649 226.9 236.2 251.6 267.8 280.3

Nevada 3,508 3,590 3,786 4,152 4,777 252.2 255.4 265.4 286.2 329.3

New Hampshire 922 932 1,130 1,006 1,150 141.4 142.6 172.4 153.0 174.9

New Jersey 6,958 7,476 8,272 9,025 10,435 160.9 172.1 189.6 206.4 238.7

New Mexico 3,170 3,209 3,148 3,400 3,794 307.0 310.5 304.8 329.0 367.1

New York 32,147 31,273 33,634 37,346 41,722 338.8 327.9 351.0 388.6 434.1

North Carolina 11,354 11,254 11,638 17,195 16,918 238.9 234.4 240.2 351.5 345.8

North Dakota 1,010 1,009 1,249 1,131 1,268 283.9 272.7 329.5 290.9 326.1

Ohio 14,262 14,828 15,825 16,901 18,699 252.8 262.0 278.9 297.2 328.8

Oklahoma 4,498 5,213 5,802 6,121 6,516 238.0 273.3 302.2 316.0 336.4

Oregon 4,028 4,243 4,953 5,223 5,876 208.6 218.2 252.2 262.0 294.8

Pennsylvania 17,388 16,360 16,315 18,201 19,840 279.1 262.1 260.9 290.5 316.7

Rhode Island 1,222 1,268 1,312 1,511 1,656 240.4 248.9 256.6 295.1 323.5

South Carolina 6,588 6,432 7,376 7,705 8,286 286.8 276.9 314.0 323.9 348.3

South Dakota 1,123 1,134 1,224 1,118 1,259 268.5 267.2 285.1 258.8 291.5

Tennessee 9,754 9,311 9,587 10,158 10,584 309.8 294.0 300.3 315.7 329.0

Texas 30,532 31,980 34,110 38,539 40,992 235.8 243.2 254.9 282.6 300.6

Utah 2,466 2,485 2,808 2,929 3,424 171.7 170.3 189.8 194.3 227.2

Vermont 428 523 622 549 518 138.6 169.2 201.4 177.9 167.9

Virginia 10,247 10,112 11,244 11,460 13,395 254.8 248.9 274.6 277.8 324.7

Washington 7,325 7,498 8,384 9,651 10,975 212.8 215.3 237.5 269.2 306.1

West Virginia 1,385 1,514 1,363 1,509 1,491 151.3 165.4 149.1 165.6 163.7

Wisconsin 6,999 7,114 7,077 7,703 8,487 246.2 249.4 247.5 268.6 296.0

Wyoming 610 617 619 643 704 207.3 207.5 207.7 215.1 235.5

U.S. TOTAL 402,557 405,652 433,325 478,981 522,870 260.6 260.6 276.1 302.7 330.5

Northeast 70,772 69,685 73,289 81,200 90,378 260.8 255.8 268.0 296.1 329.5

Midwest 84,674 84,178 89,389 96,852 105,333 255.4 252.9 267.7 289.2 314.5

South 152,316 154,295 162,995 182,498 196,508 264.8 265.7 277.6 307.2 330.8

West 94,795 97,494 107,652 118,431 130,651 258.3 263.2 287.3 312.4 344.6

Guam 305 234 244 263 280 375.8 287.6 298.9 320.8 341.6

Puerto Rico 1,125 1,203 1,126 1,319 1,647 64.0 69.6 66.1 79.6 99.4

Virgin Islands 210 196 201 180 166 426.3 400.7 414.0 376.7 347.4

OUTLYING AREAS 1,640 1,633 1,571 1,762 2,093 86.9 87.8 85.6 98.6 117.1

TOTAL 404,197 407,285 434,896 480,743 524,963 258.5 258.6 273.9 300.4 328.1

NOTE: Cases reported with unknown sex are not included in this table.
68

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

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

(MSAs)* in Alphabetical Order, United States, 2012–2016

Cases Rates per 100,000 Population

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Atlanta-Sandy Springs-Roswell, GA 26,470 16,429† 25,744 19,106† 33,273 485.0 297.5† 458.5 334.6† 582.6

Austin-Round Rock, TX 9,810 10,138 10,920 11,679 12,299 534.8 538.4 561.9 583.7 614.7

Baltimore-Columbia-Towson, MD 13,578 13,749 14,095 14,016 15,829 493.2 496.2 505.9 501.0 565.8

Birmingham-Hoover, AL 6,868 6,552 6,309 5,839 1,179† 604.2 574.6 551.6 509.7 102.9†

Boston-Cambridge-Newton, MA-NH 16,339 16,127 14,264† 14,378† 15,880† 352.1 344.3 301.4† 301.2† 332.6†

Buffalo-Cheektowaga-Niagara Falls, NY 6,010 5,724 5,841 5,900 6,252 529.9 504.7 514.0 519.7 550.7

Charlotte-Concord-Gastonia, NC-SC 11,548 11,418 11,766 16,284 14,314 502.8 488.9 494.3 671.1 589.9

Chicago-Naperville-Elgin, IL-IN-WI 51,329 47,837 51,457 54,248 56,478 539.0 501.6 538.6 568.0 591.3

Cincinnati, OH-KY-IN 10,234 10,207 10,516 11,219 11,392 480.8 477.5 489.2 519.9 528.0

Cleveland-Elyria, OH 12,339 12,126 11,363 11,312 12,475 598.0 587.3 550.6 548.9 605.3

Columbus, OH 8,946 9,734 10,258 11,327 12,113 460.2 494.8 514.3 560.3 599.2

Dallas-Fort Worth-Arlington, TX 31,697 30,684 30,549 35,900 32,771 473.0 450.5 439.3 505.4 461.4

Denver-Aurora-Lakewood, CO 12,764 12,131 13,346 13,942 14,282 482.5 449.7 484.6 495.4 507.5

Detroit-Warren-Dearborn, MI 24,229 22,567 21,012 22,238 21,966 564.5 525.4 489.0 516.9 510.6

Hartford-West Hartford-East Hartford, CT 4,562† 4,311 4,713 4,689 4,898 375.7† 354.8 388.1 387.1 404.4

Houston-The Woodlands-Sugar Land, TX 26,807 29,120 30,554 32,823 35,594 434.0 461.3 470.8 493.1 534.7

Indianapolis-Carmel-Anderson, IN 12,714 11,835 11,952 11,544 12,794 659.1 605.7 606.3 580.4 643.3

Jacksonville, FL 6,813 7,138 7,391 8,012 8,434 494.5 511.8 520.8 552.7 581.9

Kansas City, MO-KS 10,152 9,513 9,866 10,240 11,043 498.0 463.0 476.4 490.5 529.0

Las Vegas-Henderson-Paradise, NV 8,587 9,286 9,485 10,049 11,362 429.2 457.9 458.3 475.2 537.3

Los Angeles-Long Beach-Anaheim, CA 60,231 59,386 64,263 68,285 71,943 461.4 452.2 484.6 511.9 539.3

Louisville-Jefferson County, KY-IN 6,658 6,384 6,751 6,735 6,881 532.1 505.8 531.7 526.8 538.2

Memphis, TN-MS-AR 12,744 10,763 10,554 10,342 10,365 949.8 802.2 785.7 769.4 771.1

Miami-Fort Lauderdale-West Palm Beach, FL 20,933 22,821 24,599 26,746 28,070 363.2 391.6 414.8 444.9 466.9

Milwaukee-Waukesha-West Allis, WI 10,929 10,754 10,303 10,645 11,891 697.5 685.1 655.3 675.6 754.6

Minneapolis-St. Paul-Bloomington, MN-WI 12,144† 12,227† 13,589 14,709† 15,584 354.9† 353.5† 388.8 417.3† 442.2

Nashville-Davidson-Murfreesboro-Franklin, TN 7,151 7,356 7,878 8,066 8,196 414.1 418.5 439.5 440.7 447.8

New Orleans-Metairie, LA 7,118 8,134 8,595 9,291 9,626 580.1 655.5 686.6 735.7 762.2

New York-Newark-Jersey City, NY-NJ-PA 92,763 89,211 93,515 97,835 105,463 467.7 447.2 465.4 484.8 522.6

Oklahoma City, OK 5,640 6,190 7,293 7,633 7,693 435.0 469.1 545.6 561.9 566.3

Orlando-Kissimmee-Sanford, FL 9,928 10,230 11,001 12,026 12,492 446.5 451.1 473.9 503.8 523.3

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 35,513 34,741 33,376 34,910 38,182 590.0 575.7 551.6 575.1 629.0

Phoenix-Mesa-Scottsdale, AZ 20,358 20,164 21,576 21,795 23,567 470.2 458.4 480.6 476.4 515.2

Pittsburgh, PA 8,994 8,605 8,059 8,604 8,623 381.0 364.5 342.1 365.7 366.5

Portland-Vancouver-Hillsboro, OR-WA 7,797 8,536 9,283 9,982 11,052 340.5 368.8 395.3 417.8 462.6

Providence-Warwick, RI-MA 5,941 5,828 5,695† 5,907† 6,668† 371.0 363.3 353.9† 366.2† 413.4†

Raleigh, NC 5,373 4,966 5,126 6,911 6,493 452.1 408.9 412.4 542.6 509.8

Richmond, VA 7,224 6,817 7,817 7,878 8,592 586.4 547.2 620.4 619.7 675.8

Riverside-San Bernardino-Ontario, CA 20,994 19,819 19,560 20,778 20,081 482.6 452.4 440.4 462.8 447.3

Sacramento-Roseville-Arden-Arcade, CA 9,852 9,771 9,674 10,621 10,892 448.5 441.0 431.0 467.0 478.9

Salt Lake City, UT 4,041 3,947 4,423 4,751 5,264 359.6 346.1 383.5 406.0 449.8

San Antonio-New Braunfels, TX 13,023 13,335 11,573 14,465 15,149 582.9 585.5 497.0 606.7 635.4

San Diego-Carlsbad, CA 16,524 14,706 15,754 17,378 18,937 520.1 458.0 482.7 526.7 573.9

San Francisco-Oakland-Hayward, CA 17,171 18,254 20,377 23,519 24,894 385.4 404.2 443.6 505.1 534.6

San Jose-Sunnyvale-Santa Clara, CA 4,676 6,717 6,278 6,898 7,166 246.8 349.9 321.5 348.9 362.5

Seattle-Tacoma-Bellevue, WA 12,965 12,971 13,861 15,257 16,886 365.0 359.3 377.5 408.6 452.3

St. Louis, MO-IL 14,843 14,783 14,711 14,961 15,512 530.9 527.8 524.2 532.1 551.7

Tampa-St. Petersburg-Clearwater, FL 12,274 12,752 12,952 13,472 13,996 431.7 444.2 444.2 452.8 470.4

Virginia Beach-Norfolk-Newport News, VA-NC 12,409 11,852 12,192 11,281 13,223 730.0 694.2 710.2 654.0 766.6

Washington-Arlington-Alexandria, DC-VA-MD-WV 23,872 23,531 18,342 18,890 21,269 407.3 395.5 304.0 309.8 348.8

SELECTED MSAs TOTAL 811,879 792,177 820,371 865,316 919,278 474.2 458.3 469.1 489.6 520.1

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

†

 The variable used to identify county, which is used to classify cases into MSAs, was complete for ≤95% of cases in a state contributing data to this MSA. 

See Appendix A1.4 for more information.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

69

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

Statistical Areas (MSAs)* in Alphabetical Order, United States, 2012–2016

Cases Rates per 100,000 Population

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Atlanta-Sandy Springs-Roswell, GA 18,298 11,221† 17,564 12,640† 22,235 652.7 395.0† 607.2 429.0† 754.6

Austin-Round Rock, TX 6,909 6,691 7,513 7,779 7,827 755.2 712.3 773.7 777.8 782.6

Baltimore-Columbia-Towson, MD 9,933 9,848 9,780 9,453 10,359 696.7 686.9 678.0 652.7 715.3

Birmingham-Hoover, AL 4,866 4,486 4,300 3,940 861† 826.1 759.2 724.5 662.3 144.7†

Boston-Cambridge-Newton, MA-NH 11,234 10,791 9,243† 9,137† 9,987† 469.9 447.5 379.6† 372.0† 406.7†

Buffalo-Cheektowaga-Niagara Falls, NY 4,317 4,024 4,077 4,035 4,142 737.4 688.0 696.2 690.1 708.4

Charlotte-Concord-Gastonia, NC-SC 8,731 8,605 8,633 11,672 10,033 740.1 717.0 705.1 935.2 803.9

Chicago-Naperville-Elgin, IL-IN-WI 36,701 34,216 35,696 36,547 37,102 754.3 702.5 730.9 749.1 760.5

Cincinnati, OH-KY-IN 7,750 7,527 7,724 8,050 8,052 713.0 690.0 703.9 731.0 731.2

Cleveland-Elyria, OH 8,877 8,550 7,914 7,815 8,601 829.5 799.4 740.8 732.5 806.2

Columbus, OH 6,280 6,749 6,895 7,704 8,027 635.3 674.7 680.3 750.2 781.6

Dallas-Fort Worth-Arlington, TX 24,018 22,744 22,213 25,902 22,719 707.6 658.7 628.6 717.3 629.2

Denver-Aurora-Lakewood, CO 9,117 8,447 9,020 9,265 9,360 686.4 624.1 652.7 656.7 663.4

Detroit-Warren-Dearborn, MI 17,460 16,152 14,822 15,410 14,957 789.8 730.5 670.3 696.5 676.0

Hartford-West Hartford-East Hartford, CT 3,301† 3,109 3,349 3,226 3,307 529.8† 499.0 538.2 520.0 533.0

Houston-The Woodlands-Sugar Land, TX 20,858 22,027 22,832 23,828 25,470 672.3 695.0 699.6 711.6 760.6

Indianapolis-Carmel-Anderson, IN 8,899 8,149 8,398 7,816 8,604 902.5 816.1 832.9 768.7 846.2

Jacksonville, FL 4,812 5,131 5,238 5,637 5,757 680.7 717.4 719.3 758.6 774.8

Kansas City, MO-KS 7,295 6,795 6,991 7,108 7,544 701.5 649.2 662.4 668.8 709.9

Las Vegas-Henderson-Paradise, NV 5,942 6,571 6,486 6,885 7,697 597.1 650.5 627.4 650.6 727.3

Los Angeles-Long Beach-Anaheim, CA 39,470 38,456 40,401 42,385 43,278 597.1 578.5 600.7 626.6 639.8

Louisville-Jefferson County, KY-IN 4,884 4,574 4,827 4,686 4,735 762.7 708.1 742.6 716.8 724.3

Memphis, TN-MS-AR 9,367 7,717 7,758 7,238 7,324 1,342.7 1,105.5 1,109.2 1,033.5 1,045.8

Miami-Fort Lauderdale-West Palm Beach, FL 14,692 15,645 16,473 17,461 17,881 495.4 521.9 539.6 563.6 577.1

Milwaukee-Waukesha-West Allis, WI 7,760 7,463 7,183 7,242 8,013 964.7 926.6 890.0 895.8 991.2

Minneapolis-St. Paul-Bloomington, MN-WI 8,326† 8,293† 8,957 9,497† 9,958 481.1† 474.2† 507.0 533.5† 559.4

Nashville-Davidson-Murfreesboro-Franklin, TN 4,928 5,084 5,278 5,322 5,374 557.8 565.0 574.5 567.4 573.0

New Orleans-Metairie, LA 5,326 6,062 6,301 6,710 6,843 843.9 948.7 975.3 1,028.6 1,049.0

New York-Newark-Jersey City, NY-NJ-PA 63,588 60,539 62,097 62,905 65,594 620.5 587.7 598.4 603.9 629.7

Oklahoma City, OK 3,951 4,430 5,255 5,420 5,308 601.6 662.5 775.0 786.4 770.2

Orlando-Kissimmee-Sanford, FL 7,373 7,503 8,021 8,505 8,593 649.6 648.3 675.8 696.6 703.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 24,166 23,532 22,317 22,967 24,813 776.5 754.4 713.7 732.2 791.1

Phoenix-Mesa-Scottsdale, AZ 14,396 14,206 14,841 14,607 15,621 661.6 642.4 656.9 634.3 678.4

Pittsburgh, PA 6,325 6,046 5,509 5,681 5,551 519.7 497.4 454.6 469.9 459.2

Portland-Vancouver-Hillsboro, OR-WA 5,359 5,809 6,158 6,559 7,076 462.8 496.1 518.4 542.7 585.5

Providence-Warwick, RI-MA 4,256 4,124 3,945† 3,989† 4,501† 515.3 498.7 475.6† 479.9† 541.5†

Raleigh, NC 3,691 3,490 3,502 4,685 4,244 606.8 561.5 550.1 718.3 650.7

Richmond, VA 5,083 4,792 5,311 5,330 5,725 798.4 744.7 815.9 811.1 871.2

Riverside-San Bernardino-Ontario, CA 15,296 14,536 13,988 14,693 13,893 700.5 661.1 626.6 651.4 616.0

Sacramento-Roseville-Arden-Arcade, CA 7,122 6,915 6,686 7,284 7,282 635.9 611.8 583.6 627.3 627.1

Salt Lake City, UT 2,679 2,541 2,873 3,067 3,275 479.6 448.0 500.3 526.4 562.1

San Antonio-New Braunfels, TX 9,436 9,576 8,158 10,005 10,466 832.1 829.5 690.9 828.4 866.6

San Diego-Carlsbad, CA 11,102 9,684 10,211 11,154 11,690 702.5 606.3 628.9 680.1 712.7

San Francisco-Oakland-Hayward, CA 10,391 10,845 11,509 12,508 12,900 460.5 474.3 494.3 530.5 547.1

San Jose-Sunnyvale-Santa Clara, CA 3,260 4,530 4,100 4,328 4,445 345.9 474.6 422.3 440.8 452.7

Seattle-Tacoma-Bellevue, WA 8,460 8,411 8,751 9,306 10,085 474.8 465.4 476.5 498.4 540.2

St. Louis, MO-IL 10,351 10,364 10,271 10,158 10,417 717.8 717.6 709.9 701.1 719.0

Tampa-St. Petersburg-Clearwater, FL 8,738 8,948 9,066 9,269 9,360 596.5 604.2 602.5 603.7 609.6

Virginia Beach-Norfolk-Newport News, VA-NC 8,771 8,259 8,425 7,677 8,791 1,015.2 952.5 966.9 877.4 1,004.8

Washington-Arlington-Alexandria, DC-VA-MD-WV 16,349 15,768 12,501 12,517 13,635 544.5 518.1 405.0 401.3 437.2

SELECTED MSAs TOTAL 570,494 549,975 559,361 577,004 599,312 653.1 623.8 626.7 639.8 664.5

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

†

 The variable used to identify county, which is used to classify cases into MSAs, was complete for ≤95% of cases in a state contributing data to this MSA. See 

Appendix A1.4 for more information.

NOTE: Cases reported with unknown sex are not included in this table.
70

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

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

Statistical Areas (MSAs)* in Alphabetical Order, United States, 2012–2016

Cases Rates per 100,000 Population

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Atlanta-Sandy Springs-Roswell, GA 7,917 5,061† 7,979 6,429† 11,000 298.3 188.7† 293.2 232.6† 397.9

Austin-Round Rock, TX 2,890 2,592 3,372 3,871 4,444 314.3 274.7 346.8 386.8 444.1

Baltimore-Columbia-Towson, MD 3,608 3,889 4,294 4,514 5,446 271.8 290.9 319.6 334.6 403.6

Birmingham-Hoover, AL 1,985 2,031 1,990 1,886 306† 362.5 369.7 361.6 342.4 55.6†

Boston-Cambridge-Newton, MA-NH 5,086 5,328 4,988† 5,211† 5,861† 226.0 234.4 217.2† 224.8† 252.8†

Buffalo-Cheektowaga-Niagara Falls, NY 1,693 1,700 1,764 1,865 2,110 308.5 309.5 320.3 338.8 383.3

Charlotte-Concord-Gastonia, NC-SC 2,794 2,804 3,125 4,607 4,278 250.2 247.0 270.4 391.0 363.1

Chicago-Naperville-Elgin, IL-IN-WI 14,518 13,553 15,679 17,517 19,320 311.8 290.4 335.7 374.9 413.5

Cincinnati, OH-KY-IN 2,482 2,676 2,787 3,168 3,333 238.3 255.7 264.9 299.9 315.5

Cleveland-Elyria, OH 3,462 3,576 3,449 3,497 3,874 348.5 359.4 346.5 351.8 389.7

Columbus, OH 2,666 2,985 3,363 3,623 4,086 279.0 308.7 342.8 364.2 410.8

Dallas-Fort Worth-Arlington, TX 7,669 7,916 8,313 9,941 10,006 231.9 235.7 243.0 284.7 286.5

Denver-Aurora-Lakewood, CO 3,647 3,684 4,326 4,677 4,922 276.9 274.1 315.2 333.3 350.7

Detroit-Warren-Dearborn, MI 6,718 6,350 6,153 6,795 6,992 322.8 304.7 295.0 325.2 334.6

Hartford-West Hartford-East Hartford, CT 1,245† 1,181 1,333 1,443 1,541 210.5† 199.4 225.1 244.2 260.8

Houston-The Woodlands-Sugar Land, TX 5,944 7,078 7,700 8,939 10,004 193.3 225.1 238.6 270.2 302.4

Indianapolis-Carmel-Anderson, IN 3,802 3,681 3,544 3,723 4,185 403.2 385.3 368.0 383.0 430.6

Jacksonville, FL 2,001 1,989 2,138 2,367 2,672 298.2 292.7 309.4 335.1 378.2

Kansas City, MO-KS 2,857 2,718 2,875 3,132 3,499 286.1 269.7 283.1 305.6 341.5

Las Vegas-Henderson-Paradise, NV 2,644 2,708 2,986 3,139 3,646 262.9 266.1 288.3 297.1 345.1

Los Angeles-Long Beach-Anaheim, CA 20,633 20,831 23,766 25,764 28,299 320.3 321.3 363.6 391.8 430.4

Louisville-Jefferson County, KY-IN 1,744 1,781 1,896 2,031 2,131 285.4 289.0 305.9 325.1 341.1

Memphis, TN-MS-AR 3,377 3,046 2,795 3,104 3,035 524.3 473.2 434.1 482.2 471.4

Miami-Fort Lauderdale-West Palm Beach, FL 6,238 7,134 8,086 9,270 10,172 223.0 252.0 281.1 318.1 349.1

Milwaukee-Waukesha-West Allis, WI 3,169 3,284 3,111 3,394 3,860 415.5 429.7 406.6 442.3 503.1

Minneapolis-St. Paul-Bloomington, MN-WI 3,813† 3,933† 4,623 5,206† 5,614 225.4† 229.9† 267.5 298.4† 321.8

Nashville-Davidson-Murfreesboro-Franklin, TN 2,185 2,271 2,598 2,744 2,822 259.1 264.6 297.3 307.5 316.2

New Orleans-Metairie, LA 1,792 2,072 2,294 2,581 2,783 300.7 344.2 378.7 422.7 455.8

New York-Newark-Jersey City, NY-NJ-PA 29,065 28,546 31,310 34,799 39,725 303.3 295.8 322.3 356.3 406.8

Oklahoma City, OK 1,688 1,760 2,036 2,213 2,385 263.8 270.4 309.1 330.7 356.4

Orlando-Kissimmee-Sanford, FL 2,555 2,708 2,964 3,511 3,896 234.7 243.9 261.2 301.0 334.1

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 11,314 11,178 11,010 11,912 13,315 389.2 383.4 376.5 406.1 453.9

Phoenix-Mesa-Scottsdale, AZ 5,960 5,957 6,735 7,173 7,944 276.8 272.3 302.0 315.7 349.7

Pittsburgh, PA 2,668 2,550 2,541 2,909 3,062 233.3 222.6 222.1 254.3 267.6

Portland-Vancouver-Hillsboro, OR-WA 2,437 2,723 3,124 3,416 3,970 215.3 238.1 269.2 289.3 336.2

Providence-Warwick, RI-MA 1,683 1,702 1,744† 1,913† 2,163† 217.1 218.9 223.6† 244.7† 276.6†

Raleigh, NC 1,673 1,474 1,622 2,226 2,248 288.3 248.6 267.5 358.3 361.8

Richmond, VA 2,129 2,011 2,503 2,540 2,827 357.6 333.9 410.9 413.5 460.3

Riverside-San Bernardino-Ontario, CA 5,683 5,271 5,542 6,070 6,141 262.3 241.5 250.8 271.8 274.9

Sacramento-Roseville-Arden-Arcade, CA 2,712 2,846 2,976 3,322 3,580 251.9 262.2 270.9 298.5 321.6

Salt Lake City, UT 1,362 1,406 1,550 1,684 1,989 241.0 245.2 267.7 286.6 338.5

San Antonio-New Braunfels, TX 3,587 3,757 3,412 4,459 4,683 326.1 334.5 297.2 379.1 398.1

San Diego-Carlsbad, CA 5,418 5,013 5,508 6,190 7,195 339.3 310.6 335.9 373.0 433.6

San Francisco-Oakland-Hayward, CA 6,739 7,370 8,823 10,961 11,936 306.5 330.5 389.4 476.9 519.3

San Jose-Sunnyvale-Santa Clara, CA 1,353 2,186 2,163 2,565 2,717 142.1 226.5 220.3 257.8 273.1

Seattle-Tacoma-Bellevue, WA 4,505 4,560 5,110 5,951 6,799 254.5 253.0 278.5 318.8 364.3

St. Louis, MO-IL 4,474 4,411 4,429 4,762 5,091 330.5 325.1 325.8 349.4 373.6

Tampa-St. Petersburg-Clearwater, FL 3,532 3,752 3,835 4,195 4,632 256.3 270.0 271.8 291.3 321.7

Virginia Beach-Norfolk-Newport News, VA-NC 3,631 3,584 3,748 3,595 4,406 434.3 426.5 443.4 423.0 518.4

Washington-Arlington-Alexandria, DC-VA-MD-WV 7,461 7,725 5,813 6,359 7,595 261.1 265.8 197.2 213.5 255.0

SELECTED MSAs TOTAL 240,208 240,342 259,825 287,163 318,540 286.5 283.8 303.4 331.8 368.0

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

†

 The variable used to identify county, which is used to classify cases into MSAs, was complete for ≤95% of cases in a state contributing data to this MSA. 

See Appendix A1.4 for more information.

NOTE: Cases reported with unknown sex are not included in this table.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

71

Table 9. Chlamydia — Reported Cases and Rates of Reported Cases in Counties and Independent Cities* Ranked 

by Number of Reported Cases, United States, 2016

Rank* County/Independent City Cases Rate per 100,000 Population Cumulative Percentage

1 Los Angeles County, CA 59,116 581.3 3

2 Cook County, IL 41,056 783.8 6

3 Harris County, TX 27,847 613.6 8

4 Maricopa County, AZ 22,134 531.1 9

5 Philadelphia County, PA 19,992 1,275.5 10

6 Kings County, NY 19,900 754.7 11

7 San Diego County, CA 18,937 573.9 13

8 Bronx County, NY 17,043 1,171.0 14

9 New York County, NY 15,216 925.3 15

10 Wayne County, MI 14,082 800.4 15

11 Bexar County, TX 13,724 723.2 16

12 Queens County, NY 12,904 551.7 17

13 Orange County, CA 12,827 404.7 18

14 Miami-Dade County, FL 12,687 471.1 19

15 Dallas County, TX 12,216 478.4 20

16 San Bernardino County, CA 11,495 540.1 20

17 Clark County, NV 11,362 537.3 21

18 Milwaukee County, WI 10,751 1,122.5 22

19 Cuyahoga County, OH 10,090 803.4 22

20 Broward County, FL 9,928 523.5 23

21 Marion County, IN 9,815 1,045.2 23

22 Franklin County, OH 9,712 775.9 24

23 King County, WA 9,422 445.0 25

24 Tarrant County, TX 9,230 465.6 25

25 Travis County, TX 8,618 732.5 26

26 Riverside County, CA 8,586 363.7 26

27 Sacramento County, CA 8,525 567.8 27

28 Orange County, FL 8,354 648.5 27

29 Fulton County, GA 8,292 820.5 28

30 San Francisco County, CA 8,175 945.3 28

31 Alameda County, CA 8,166 498.5 29

32 Hillsborough County, FL 8,066 597.9 29

33 Mecklenburg County, NC 7,969 770.6 30

34 Shelby County, TN 7,838 835.5 30

35 Hennepin County, MN 7,575 619.3 31

36 Baltimore (City), MD 7,394 1,189.0 31

37 Santa Clara County, CA 6,979 363.9 32

38 Hamilton County, OH 6,915 856.2 32

39 Prince George's County, MD 6,753 742.5 33

40 Duval County, FL 6,634 726.6 33

41 Fresno County, CA 6,473 664.0 33

42 Collin County, TX 6,364 696.2 34

43 Kern County, CA 6,307 714.9 34

44 Denver County, CO 6,300 923.0 35

45 Allegheny County, PA 6,020 489.2 35

46 Pima County, AZ 5,819 576.1 35

47 DeKalb County, GA 5,799 789.1 36

48 Essex County, NJ 5,726 718.1 36

49 St. Louis County, MO 5,698 567.9 36

50 Jackson County, MO 5,585 812.2 37

51 Wake County, NC 5,502 537.2 37

52 Palm Beach County, FL 5,455 383.4 37

53 Honolulu County, HI 5,399 540.6 38

54 Oklahoma County, OK 5,273 678.8 38

55 Jefferson County, KY 5,221 683.7 38

56 Contra Costa County, CA 5,205 462.0 39

57 Erie County, NY 5,201 563.7 39

58 Salt Lake County, UT 5,106 461.1 39

59 Multnomah County, OR 5,065 640.9 40

60 Pierce County, WA 4,965 588.3 40

61 Bernalillo County, NM 4,759 703.3 40

62 Middlesex County, MA 4,729 298.3 41

63 Monroe County, NY 4,706 627.8 41

64 Orleans Parish, LA 4,632 1,188.9 41

65 Guilford County, NC 4,594 887.6 42

66 Suffolk County, NY 4,506 300.1 42

67 Davidson County, TN 4,476 659.3 42

68 Etowah County, AL 4,348 4,219.0 42

69 Hartford County, CT 4,219 471.0 43

70 Baltimore County, MD 4,190 504.1 43

* The top 70 counties and independent cities ranked in descending order by number of cases reported in 2016 then by rate are displayed.

NOTE: Relative rankings of counties may be impacted by completeness of the variable used to identify county. In 2016, the variable used to identify county was 

complete for ≤95% of cases in Alabama and Massachusetts. See Appendix A1.4 for more information.
72

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

Table 10. Chlamydia — Reported Cases and Rates of Reported Cases by Age Group and Sex, United States, 

2012–2016

Age Cases Rates per 100,000 Population*

Group Total Male Female Unknown Sex Total Male Female

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 1,869.7 722.9 3,068.4

20–24 553,658 153,102 399,545 1,011 2,428.8 1,310.9 3,594.2

25–29 233,429 82,190 150,733 506 1,081.7 749.9 1,419.3

30–34 103,675 41,017 62,414 244 487.6 384.0 589.8

35–39 46,991 20,157 26,720 114 239.7 206.0 272.1

40–44 24,774 12,200 12,501 73 118.8 117.8 119.2

45–54 21,511 12,180 9,299 32 49.1 56.5 41.9

55–64 5,424 3,154 2,259 11 13.8 16.6 11.1

65+ 1,377 750 616 11 3.1 3.8 2.5

Unknown Age 2,044 658 1,297 89

TOTAL 1,401,906 405,652 993,348 2,906 443.5 260.6 619.0

0–4 603 200 388 15 3.0 2.0 4.0

2014

5–9 181 26 152 3 0.9 0.2 1.5

10–14 11,406 1,342 10,041 23 55.2 12.7 99.2

15–19 381,717 77,908 303,294 515 1,811.9 722.4 2,949.3

20–24 566,385 159,804 405,876 705 2,472.0 1,361.3 3,632.7

25–29 253,825 91,729 161,793 303 1,154.4 821.8 1,494.4

30–34 113,208 45,990 67,060 158 525.9 425.5 625.6

35–39 52,536 22,894 29,545 97 263.7 230.3 296.0

40–44 27,426 13,711 13,662 53 133.2 134.2 131.7

45–54 24,773 14,318 10,424 31 57.0 66.8 47.3

55–64 6,527 3,911 2,603 13 16.3 20.2 12.5

65+ 1,449 871 570 8 3.1 4.3 2.2

Unknown Age 1,753 621 1,033 99

TOTAL 1,441,789 433,325 1,006,441 2,023 452.2 276.1 621.6

0–4 518 196 322 0 2.6 1.9 3.3

2015

5–9 148 18 130 0 0.7 0.2 1.3

10–14 10,642 1,216 9,394 32 51.6 11.6 93.0

15–19 391,396 82,775 307,937 684 1,854.2 766.6 2,986.5

20–24 589,963 172,313 416,772 878 2,594.5 1,476.8 3,764.4

25–29 280,429 104,679 175,291 459 1,248.5 917.5 1,586.0

30–34 123,866 52,019 71,653 194 571.5 477.7 664.3

35–39 59,905 27,180 32,621 104 294.0 267.2 319.8

40–44 30,379 15,210 15,118 51 150.3 151.6 148.4

45–54 28,833 17,011 11,764 58 66.8 79.9 53.7

55–64 7,756 4,901 2,840 15 19.0 24.9 13.4

65+ 1,596 1,043 546 7 3.3 4.9 2.0

Unknown Age 1,227 420 755 52

TOTAL 1,526,658 478,981 1,045,143 2,534 475.0 302.7 640.4

0–4 597 225 368 4 3.0 2.2 3.8

2016

5–9 188 25 161 2 0.9 0.2 1.6

10–14 10,571 1,341 9,206 24 51.3 12.7 91.1

15–19 407,230 89,899 316,639 692 1,929.2 832.6 3,070.9

20–24 601,173 181,857 418,388 928 2,643.8 1,558.6 3,779.0

25–29 298,176 114,484 183,222 470 1,327.5 1,003.4 1,657.8

30–34 133,062 58,583 74,226 253 613.9 538.0 688.2

35–39 66,669 31,671 34,872 126 327.2 311.3 341.8

40–44 32,548 16,784 15,705 59 161.0 167.3 154.2

45–54 32,316 19,569 12,683 64 74.8 91.9 57.9

55–64 9,321 5,942 3,354 25 22.8 30.1 15.8

65+ 1,772 1,161 597 14 3.7 5.5 2.2

Unknown Age 4,731 1,329 3,298 104

TOTAL 1,598,354 522,870 1,072,719 2,765 497.3 330.5 657.3

* 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.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

73

Table 11A. Chlamydia — Reported Cases by Race/Ethnicity, Age Group, and Sex, United States*, 2016

Age 

Group

American Indians/

Alaska Natives Asians Blacks Native Hawaiians/Other Pacific Islanders

Total† Male Female Total† Male Female Total† Male Female Total† Male Female

0–4 3 1 2 1 0 1 134 53 81 5 3 2

5–9 7 0 7 3 0 3 50 8 42 2 0 2

10–14 177 13 164 37 4 33 4,113 683 3,426 9 2 7

15–19 4,332 862 3,470 2,823 442 2,375 131,081 35,461 95,551 789 127 662

20–24 5,887 1,411 4,475 7,339 1,917 5,416 170,169 57,223 112,858 1,356 299 1,055

25–29 3,714 977 2,737 4,696 1,806 2,883 81,647 33,340 48,261 773 237 536

30–34 1,907 553 1,354 2,567 1,119 1,444 32,095 15,546 16,530 371 128 243

35–39 902 269 633 1,381 625 754 14,804 8,080 6,713 198 75 123

40–44 408 129 279 821 418 401 6,580 4,017 2,560 72 28 44

45–54 335 142 192 813 456 352 6,120 4,040 2,075 65 33 32

55–64 80 34 46 237 132 105 1,906 1,253 651 13 9 4

65+ 10 5 5 38 22 16 261 179 81 1 0 1

Unknown Age 6 4 2 25 10 15 550 174 371 3 0 3

TOTAL 17,768 4,400 13,366 20,781 6,951 13,798 449,510 160,057 289,200 3,657 941 2,714

Age 

Group

Whites Multirace Hispanics Other/

Unknown

Total† Male Female Total† Male Female Total† Male Female Total† Male Female

0–4 105 33 72 5 4 1 67 26 41 277 105 168

5–9 29 6 23 0 0 0 27 4 23 70 7 61

10–14 1,881 105 1,775 86 3 83 1,411 173 1,238 2,857 358 2,480

15–19 95,731 15,715 79,975 2,830 485 2,344 50,984 9,993 40,968 118,660 26,814 91,294

20–24 154,572 43,536 110,984 3,552 958 2,591 77,237 20,639 56,552 181,061 55,874 124,457

25–29 73,929 28,222 45,677 1,731 778 952 41,273 14,517 26,724 90,413 34,607 55,452

30–34 33,089 14,843 18,240 834 487 347 19,960 8,024 11,918 42,239 17,883 24,150

35–39 16,352 8,113 8,236 380 230 150 10,529 4,319 6,198 22,123 9,960 12,065

40–44 7,825 4,254 3,570 179 113 65 5,130 2,279 2,837 11,533 5,546 5,949

45–54 8,685 6,019 2,661 229 188 41 4,244 2,307 1,932 11,825 6,384 5,398

55–64 2,625 2,012 612 55 44 11 851 446 404 3,554 2,012 1,521

65+ 531 393 138 4 4 0 119 79 40 808 479 316

Unknown Age 255 85 163 2 0 2 190 54 134 3,700 1,002 2,608

TOTAL 395,609 123,336 272,126 9,887 3,294 6,587 212,022 62,860 149,009 489,120 161,031 325,919

* Includes 50 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2016.

†

 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.
74

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

Table 11B. Chlamydia — Rates of Reported Cases per 100,000 Population by Race/Ethnicity, Age Group, and Sex, 

United States*, 2016

Age 

Group

American Indians/

Alaska Natives Asians Blacks Native Hawaiians/Other Pacific Islanders

Total† Male Female Total† Male Female Total† Male Female Total† Male Female

0–4 1.8 1.2 2.4 0.1 0.0 0.2 4.9 3.8 6.0 12.4 14.3 10.3

5–9 4.0 0.0 8.1 0.3 0.0 0.6 1.8 0.6 3.0 4.9 0.0 9.9

10–14 100.4 14.5 189.1 3.6 0.8 6.5 146.3 47.9 247.0 22.3 9.8 35.1

15–19 2,378.1 930.0 3,878.3 274.9 85.3 466.8 4,383.6 2,337.7 6,485.2 1,943.2 606.5 3,366.6

20–24 2,956.3 1,382.0 4,611.6 583.1 300.1 873.9 5,008.3 3,316.9 6,747.6 2,890.0 1,243.3 4,612.8

25–29 2,026.3 1,047.6 3,040.3 316.4 249.6 379.1 2,621.1 2,164.0 3,065.4 1,485.7 879.1 2,138.1

30–34 1,171.7 682.1 1,657.6 170.6 157.4 181.9 1,159.1 1,167.8 1,149.8 761.0 512.2 1,022.8

35–39 609.0 365.2 850.1 97.7 95.1 99.8 567.7 653.8 489.3 466.8 347.7 590.0

40–44 284.6 182.7 383.5 58.1 63.3 53.3 257.9 335.1 189.2 193.2 148.7 238.6

45–54 108.4 94.8 120.5 34.0 40.9 27.6 115.5 162.4 73.8 93.3 95.3 91.4

55–64 28.9 26.1 31.4 12.3 15.1 9.9 41.3 59.5 25.9 24.0 34.0 14.4

65+ 4.1 4.5 3.7 1.9 2.5 1.4 6.2 10.6 3.2 2.2 0.0 4.1

Unknown Age

TOTAL 749.8 376.7 1,112.1 119.3 84.0 151.0 1,125.9 839.0 1,387.2 653.4 333.4 978.1

Age 

Group

Whites Multirace Hispanics

Total† Male Female Total† Male Female Total† Male Female

0–4 1.1 0.7 1.5 0.5 0.8 0.2 1.3 1.0 1.6

5–9 0.3 0.1 0.5 0.0 0.0 0.0 0.5 0.2 0.9

10–14 17.3 1.9 33.5 11.1 0.8 21.8 28.6 6.9 51.1

15–19 834.7 266.9 1,433.3 413.2 139.8 693.6 1,081.1 414.0 1,779.8

20–24 1,244.2 682.5 1,836.2 591.5 318.9 863.4 1,604.7 826.1 2,443.1

25–29 585.2 439.7 734.9 374.8 351.1 396.2 910.8 608.7 1,244.9

30–34 267.8 238.1 298.0 217.6 269.4 171.4 448.4 345.0 560.5

35–39 141.0 138.8 143.2 116.9 150.7 87.0 248.1 197.5 301.4

40–44 66.0 71.4 60.5 64.0 85.9 43.9 130.4 114.4 146.2

45–54 30.9 43.1 18.9 46.7 81.0 15.9 64.9 69.9 59.7

55–64 9.0 14.1 4.1 14.1 23.7 5.4 19.8 21.5 18.2

65+ 1.4 2.4 0.7 1.2 2.6 0.0 3.2 4.8 1.9

Unknown Age

TOTAL 199.8 126.4 271.1 150.2 101.7 197.0 374.6 219.8 532.4

* Includes 50 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2016.

†

 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.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

75

Table 12. Chlamydia Among Women Aged 15–24 Years — Reported Cases and Rates of Reported Cases by Age, 

United States, 2012–2016

Age Cases Rate per 100,000 Population

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

2013

15 21,680 1,070.3

16 40,528 1,994.3

17 61,666 3,018.5

18 90,330 4,332.6

19 102,234 4,806.0

20 99,556 4,617.4

21 93,713 4,219.8

22 81,884 3,600.6

23 68,600 3,013.5

24 55,792 2,548.7

2014

15 20,096 987.4

16 38,507 1,891.0

17 58,940 2,880.9

18 87,040 4,224.2

19 98,711 4,688.0

20 98,480 4,581.9

21 94,204 4,323.2

22 82,581 3,679.3

23 71,535 3,112.0

24 59,076 2,567.1

2015

15 19,643 945.9

16 37,786 1,847.7

17 60,149 2,935.4

18 89,481 4,339.6

19 100,878 4,854.1

20 99,861 4,703.6

21 95,927 4,427.2

22 84,740 3,855.7

23 73,686 3,254.1

24 62,558 2,697.2

2016

15 19,704 948.8

16 39,066 1,910.3

17 61,406 2,996.7

18 93,174 4,518.7

19 103,289 4,970.1

20 100,524 4,734.8

21 96,723 4,463.9

22 84,813 3,859.0

23 73,054 3,226.2

24 63,274 2,728.0

NOTE: This table should be used only for age comparisons. Cases reported with unknown sex are not included in this table.
76

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

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

United States, 2016

Rank* State Cases Rate per 100,000 Population

1 Mississippi 7,157 239.2

2 Louisiana 10,782 230.8

3 Georgia 20,553 201.2

4 Alaska 1,454 196.9

5 North Carolina 19,687 196.0

6 Oklahoma 7,574 193.6

7 Arkansas 5,732 192.5

8 Missouri 11,479 188.7

9 South Carolina 9,194 187.8

10 Delaware 1,702 179.9

11 Ohio 20,487 176.4

12 Alabama 8,408 173.0

13 New Mexico 3,516 168.6

14 California 64,551 164.9

15 Illinois 21,199 164.8

16 Maryland 9,523 158.5

17 Texas 42,472 154.6

18 Tennessee 10,179 154.2

19 Nevada 4,380 151.5

20 Arizona 10,330 151.3

21 South Dakota 1,269 147.8

22 New York 29,000 146.5

U.S. TOTAL† 468,514 145.8

23 Indiana 9,451 142.8

24 Florida 28,162 138.9

25 Virginia 11,084 132.2

26 North Dakota 1,000 132.1

27 Kentucky 5,812 131.3

28 Michigan 12,450 125.5

29 Kansas 3,353 115.2

30 Pennsylvania 14,603 114.1

31 Washington 8,174 114.0

32 Nebraska 2,156 113.7

33 Wisconsin 6,498 112.6

34 Colorado 5,975 109.5

35 Oregon 4,353 108.0

36 Hawaii 1,467 102.5

37 Minnesota 5,104 93.0

38 New Jersey 8,162 91.1

39 Montana 867 83.9

40 Iowa 2,600 83.2

41 Connecticut 2,731 76.1

42 Massachusetts 4,980 73.3

43 Utah 2,100 70.1

44 Rhode Island 716 67.8

45 West Virginia 919 49.8

46 Wyoming 275 46.9

47 Idaho 635 38.4

48 New Hampshire 456 34.3

49 Maine 451 33.9

50 Vermont 126 20.1

* 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 3,226 cases and a rate of 479.9, but excludes outlying areas (Guam with 133 cases and rate of 82.2, 

Puerto Rico with 744 cases and rate of 21.4, and Virgin Islands with 35 cases and rate of 34.0).
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

77

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

Order, United States and Outlying Areas, 2012–2016

Cases Rates per 100,000 Population

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Alabama 9,270 8,377 7,677 7,196 8,408 192.2 173.3 158.3 148.1 173.0

Alaska 726 1,128 1,341 1,113 1,454 99.3 153.4 182.0 150.7 196.9

Arizona 5,809 6,412 7,750 8,245 10,330 88.6 96.8 115.1 120.8 151.3

Arkansas 4,307 4,007 4,539 4,780 5,732 146.0 135.4 153.0 160.5 192.5

California 33,579 38,166 45,408 54,135 64,551 88.3 99.6 117.0 138.3 164.9

Colorado 2,822 2,820 3,170 4,387 5,975 54.4 53.5 59.2 80.4 109.5

Connecticut 2,133 2,860 2,333 2,088 2,731 59.4 79.5 64.9 58.1 76.1

Delaware 899 1,390 1,279 1,310 1,702 98.0 150.1 136.7 138.5 179.9

District of Columbia 2,402 2,478 1,883 2,742 3,226 379.9 383.3 285.8 407.9 479.9

Florida 19,462 20,818 20,944 24,125 28,162 100.7 106.5 105.3 119.0 138.9

Georgia 15,326 14,252 13,770 15,982 20,553 154.5 142.6 136.4 156.5 201.2

Hawaii 815 718 1,020 1,239 1,467 58.5 51.1 71.9 86.5 102.5

Idaho 167 211 443 472 635 10.5 13.1 27.1 28.5 38.4

Illinois 18,149 16,464 15,970 17,130 21,199 141.0 127.8 124.0 133.2 164.8

Indiana 7,338 7,144 7,289 7,843 9,451 112.2 108.7 110.5 118.5 142.8

Iowa 2,006 1,472 1,641 2,247 2,600 65.3 47.6 52.8 71.9 83.2

Kansas 2,228 2,161 2,568 2,536 3,353 77.2 74.7 88.4 87.1 115.2

Kentucky 4,283 4,315 4,353 4,678 5,812 97.8 98.2 98.6 105.7 131.3

Louisiana 8,873 8,669 9,002 10,282 10,782 192.8 187.4 193.6 220.1 230.8

Maine 456 245 237 417 451 34.3 18.4 17.8 31.4 33.9

Maryland 5,686 5,989 6,108 6,858 9,523 96.6 101.0 102.2 114.2 158.5

Massachusetts 2,628 3,106 3,817 3,817 4,980 39.5 46.4 56.6 56.2 73.3

Michigan 12,584 10,569 9,688 10,330 12,450 127.3 106.8 97.8 104.1 125.5

Minnesota 3,082 3,873 4,073 4,097 5,104 57.3 71.5 74.6 74.6 93.0

Mississippi 6,875 5,096 5,625 5,775 7,157 230.3 170.4 187.9 193.0 239.2

Missouri 7,889 7,546 7,387 8,942 11,479 131.0 124.8 121.8 147.0 188.7

Montana 108 224 434 844 867 10.7 22.1 42.4 81.7 83.9

Nebraska 1,429 1,385 1,459 1,703 2,156 77.0 74.1 77.5 89.8 113.7

Nevada 2,264 2,714 3,188 3,630 4,380 82.1 97.3 112.3 125.6 151.5

New Hampshire 147 121 226 245 456 11.1 9.1 17.0 18.4 34.3

New Jersey 7,486 7,014 6,636 7,228 8,162 84.4 78.8 74.2 80.7 91.1

New Mexico 1,883 1,918 2,246 2,489 3,516 90.3 92.0 107.7 119.4 168.6

New York 22,571 19,919 20,758 25,561 29,000 115.3 101.4 105.1 129.1 146.5

North Carolina 14,318 13,666 14,415 19,809 19,687 146.8 138.8 145.0 197.2 196.0

North Dakota 335 492 694 684 1,000 47.9 68.0 93.8 90.4 132.1

Ohio 16,493 16,619 16,237 16,564 20,487 142.9 143.6 140.0 142.6 176.4

Oklahoma 4,441 5,303 6,137 6,542 7,574 116.4 137.7 158.2 167.3 193.6

Oregon 1,464 1,729 2,320 3,232 4,353 37.5 44.0 58.4 80.2 108.0

Pennsylvania 15,390 13,874 12,710 12,791 14,603 120.6 108.6 99.4 99.9 114.1

Rhode Island 507 454 590 580 716 48.3 43.2 55.9 54.9 67.8

South Carolina 7,638 7,194 8,253 8,206 9,194 161.7 150.7 170.8 167.6 187.8

South Dakota 707 784 892 1,048 1,269 84.8 92.8 104.6 122.1 147.8

Tennessee 9,098 7,376 7,199 8,386 10,179 140.9 113.5 109.9 127.1 154.2

Texas 32,473 33,835 35,322 39,717 42,472 124.6 127.9 131.0 144.6 154.6

Utah 479 951 1,441 1,562 2,100 16.8 32.8 49.0 52.1 70.1

Vermont 99 97 84 155 126 15.8 15.5 13.4 24.8 20.1

Virginia 6,885 6,952 8,250 8,099 11,084 84.1 84.2 99.1 96.6 132.2

Washington 3,238 4,369 6,221 7,171 8,174 46.9 62.7 88.1 100.0 114.0

West Virginia 831 1,063 841 769 919 44.8 57.3 45.5 41.7 49.8

Wisconsin 4,704 4,599 4,078 5,260 6,498 82.1 80.1 70.8 91.1 112.6

Wyoming 44 66 116 175 275 7.6 11.3 19.9 29.9 46.9

U.S. TOTAL 334,826 333,004 350,062 395,216 468,514 106.7 105.3 109.8 123.0 145.8

Northeast 51,417 47,690 47,391 52,882 61,225 92.2 85.2 84.4 94.0 108.8

Midwest 76,944 73,108 71,976 78,384 97,046 114.3 108.2 106.2 115.4 142.9

South 153,067 150,780 155,597 175,256 202,166 130.5 127.4 129.9 144.6 166.8

West 53,398 61,426 75,098 88,694 108,077 72.6 82.7 99.9 116.6 142.1

Guam 92 92 99 147 133 57.5 57.4 61.5 90.9 82.2

Puerto Rico 345 356 454 620 744 9.4 9.8 12.8 17.8 21.4

Virgin Islands 136 58 84 52 35 129.2 55.4 80.6 50.5 34.0

OUTLYING AREAS 573 506 637 819 912 14.6 13.0 16.7 21.9 24.4

TOTAL 335,399 333,510 350,699 396,035 469,426 105.5 104.2 108.7 121.8 144.4
78

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

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, 2012–2016

Cases Rates per 100,000 Population

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Alabama 5,187 4,668 4,090 3,629 4,088 208.9 187.6 163.6 144.8 163.1

Alaska 385 589 665 567 738 109.9 168.5 190.3 162.3 211.2

Arizona 2,827 3,102 3,564 3,505 4,315 85.8 93.1 105.2 102.0 125.6

Arkansas 2,432 2,160 2,527 2,510 2,964 162.1 143.4 167.5 165.6 195.6

California 13,045 14,258 16,009 18,404 20,914 68.2 74.0 82.0 93.4 106.2

Colorado 1,362 1,243 1,318 1,832 2,323 52.7 47.4 49.5 67.5 85.6

Connecticut 1,153 1,419 1,108 851 1,165 62.6 77.0 60.1 46.3 63.3

Delaware 496 763 693 641 799 104.9 159.7 143.5 131.3 163.7

District of Columbia 1,006 953 858 874 857 301.8 280.1 247.8 247.2 242.3

Florida 9,570 9,718 9,228 10,078 11,488 97.0 97.3 90.7 97.2 110.8

Georgia 7,921 7,060 6,552 7,322 9,156 156.3 138.1 126.7 139.9 174.9

Hawaii 299 264 350 446 551 43.3 38.0 49.9 63.2 78.0

Idaho 63 87 196 197 237 7.9 10.8 24.0 23.8 28.7

Illinois 9,837 8,574 7,559 7,698 8,920 150.1 130.8 115.2 117.6 136.3

Indiana 4,139 3,796 3,819 3,984 4,811 124.7 113.8 114.1 118.6 143.3

Iowa 1,170 812 862 1,122 1,267 75.5 52.2 55.1 71.4 80.6

Kansas 1,339 1,222 1,464 1,262 1,695 92.3 84.2 100.5 86.6 116.3

Kentucky 2,328 2,331 2,270 2,242 2,716 104.7 104.4 101.3 99.8 120.9

Louisiana 5,080 4,927 5,049 5,535 5,493 216.2 208.6 212.5 231.9 230.1

Maine 240 119 98 143 134 35.4 17.5 14.4 21.1 19.8

Maryland 2,878 2,841 2,793 3,090 3,944 94.9 93.0 90.7 99.8 127.4

Massachusetts 1,076 1,168 1,215 1,027 1,390 31.4 33.9 35.0 29.4 39.7

Michigan 7,194 5,865 5,129 5,191 6,201 142.9 116.5 101.7 102.9 122.9

Minnesota 1,676 2,037 1,802 1,675 2,214 61.9 74.7 65.6 60.7 80.2

Mississippi 3,834 2,726 2,987 3,131 3,665 249.7 177.4 194.0 203.2 237.9

Missouri 4,209 3,944 3,620 4,187 5,228 137.1 128.0 117.2 135.1 168.7

Montana 58 127 221 462 493 11.6 25.1 43.4 89.9 96.0

Nebraska 784 694 770 870 1,055 84.0 73.9 81.5 91.5 110.9

Nevada 982 1,203 1,294 1,402 1,611 71.8 86.9 91.6 97.3 111.9

New Hampshire 61 52 91 65 132 9.1 7.8 13.6 9.7 19.6

New Jersey 3,798 3,484 3,082 3,110 3,338 83.6 76.5 67.3 67.8 72.8

New Mexico 857 823 961 1,087 1,542 81.4 78.3 91.3 103.4 146.6

New York 10,021 8,020 7,077 8,593 8,709 99.4 79.3 69.6 84.4 85.5

North Carolina 8,093 7,547 7,759 10,064 9,527 161.9 149.5 152.2 195.4 185.0

North Dakota 207 301 385 375 516 60.2 85.2 106.8 101.9 140.2

Ohio 9,706 9,176 8,735 8,466 10,130 164.5 155.2 147.6 142.8 170.9

Oklahoma 2,652 3,000 3,451 3,580 4,052 137.8 154.4 176.3 181.3 205.2

Oregon 528 566 786 1,158 1,519 26.8 28.5 39.2 56.9 74.6

Pennsylvania 8,360 7,206 6,164 5,889 6,135 128.0 110.3 94.3 90.1 93.8

Rhode Island 232 192 218 172 221 42.8 35.4 40.1 31.6 40.6

South Carolina 4,416 4,050 4,527 4,401 4,709 182.0 165.2 182.3 174.8 187.1

South Dakota 446 464 557 621 757 107.5 110.3 131.4 145.6 177.5

Tennessee 4,721 3,617 3,419 3,809 4,681 142.7 108.7 101.8 112.6 138.4

Texas 17,151 17,206 17,253 17,843 18,620 130.8 129.4 127.1 129.0 134.6

Utah 132 373 565 507 717 9.3 25.9 38.6 34.1 48.2

Vermont 54 46 35 85 32 17.0 14.5 11.0 26.8 10.1

Virginia 3,734 3,678 4,361 4,007 5,056 89.7 87.6 103.1 94.1 118.7

Washington 1,230 1,704 2,504 2,797 2,943 35.6 48.8 70.9 78.0 82.1

West Virginia 438 539 461 365 422 46.6 57.4 49.2 39.1 45.2

Wisconsin 2,640 2,455 2,046 2,557 3,189 91.6 84.9 70.6 88.1 109.8

Wyoming 19 39 61 86 120 6.7 13.7 21.3 29.9 41.8

U.S. TOTAL 172,066 163,208 162,608 173,514 197,499 107.9 101.7 100.4 106.3 121.0

Northeast 24,995 21,706 19,088 19,935 21,256 87.3 75.6 66.3 69.1 73.7

Midwest 43,347 39,340 36,748 38,008 45,983 126.9 114.8 107.0 110.4 133.6

South 81,937 77,784 78,278 83,121 92,237 137.1 129.0 128.2 134.5 149.3

West 21,787 24,378 28,494 32,450 38,023 59.1 65.5 75.6 85.1 99.7

Guam 46 43 47 67 59 58.4 54.4 59.2 84.0 73.9

Puerto Rico 157 120 161 259 313 8.2 6.4 8.7 14.3 17.2

Virgin Islands 92 41 54 28 14 164.2 73.4 97.1 50.8 25.4

OUTLYING AREAS 295 204 262 354 386 14.4 10.1 13.2 18.1 19.8

TOTAL 172,361 163,412 162,870 173,868 197,885 106.7 100.6 99.4 105.3 119.8

NOTE: Cases reported with unknown sex are not included in this table.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

79

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, 2012–2016

Cases Rates per 100,000 Population

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Alabama 4,034 3,680 3,563 3,519 4,265 172.5 156.9 151.6 149.5 181.2

Alaska 341 539 676 546 716 89.4 139.8 174.5 140.4 184.0

Arizona 2,981 3,310 4,186 4,724 6,011 91.5 100.5 125.2 139.3 177.2

Arkansas 1,873 1,843 2,007 2,270 2,768 129.3 126.8 137.7 155.2 189.2

California 20,431 23,849 29,310 35,644 43,259 108.0 125.1 152.1 183.3 222.5

Colorado 1,460 1,577 1,852 2,555 3,652 56.1 59.6 68.8 93.1 133.1

Connecticut 978 1,440 1,219 1,237 1,564 55.9 82.1 69.5 70.6 89.3

Delaware 403 627 586 669 903 90.7 140.0 129.4 146.1 197.2

District of Columbia 1,386 1,519 1,011 1,817 2,298 463.5 496.0 323.4 570.3 721.3

Florida 9,892 11,049 11,686 14,039 16,661 104.7 115.5 120.2 141.8 168.2

Georgia 7,301 7,075 7,137 8,631 11,378 150.5 144.9 144.9 173.3 228.5

Hawaii 516 454 669 793 914 73.5 64.0 93.2 109.3 126.0

Idaho 104 124 247 275 396 13.0 15.4 30.2 33.2 47.8

Illinois 8,283 7,872 8,386 9,335 12,255 131.1 124.4 132.7 147.8 194.1

Indiana 3,188 3,347 3,465 3,854 4,636 99.1 103.4 106.6 118.2 142.1

Iowa 836 660 779 1,122 1,332 54.8 43.0 50.5 72.3 85.8

Kansas 889 939 1,104 1,274 1,658 61.9 65.1 76.3 87.6 114.1

Kentucky 1,948 1,966 2,068 2,430 3,006 90.3 90.9 95.2 111.5 137.9

Louisiana 3,793 3,742 3,953 4,747 5,289 168.4 165.3 173.8 207.9 231.6

Maine 216 126 137 274 316 33.2 19.4 21.0 42.1 48.5

Maryland 2,806 3,145 3,304 3,755 5,573 98.4 109.4 114.1 129.0 191.4

Massachusetts 1,551 1,932 2,590 2,768 3,575 48.2 59.5 79.2 84.0 108.5

Michigan 5,372 4,694 4,551 5,129 6,245 110.8 96.6 93.5 105.1 128.0

Minnesota 1,395 1,835 2,260 2,420 2,881 52.2 68.1 83.3 88.6 105.5

Mississippi 3,039 2,370 2,637 2,638 3,486 209.7 162.9 181.3 181.7 240.1

Missouri 3,680 3,602 3,767 4,755 6,251 124.7 121.5 126.7 159.3 209.4

Montana 50 97 213 381 374 9.9 19.0 41.4 73.4 72.0

Nebraska 641 674 686 833 1,097 69.5 72.5 73.2 88.1 116.1

Nevada 1,280 1,509 1,892 2,218 2,763 92.0 107.4 132.6 152.9 190.5

New Hampshire 86 69 135 180 324 13.2 10.6 20.6 27.4 49.3

New Jersey 3,673 3,514 3,544 4,108 4,810 85.0 80.9 81.2 94.0 110.0

New Mexico 1,025 1,095 1,284 1,401 1,971 99.3 105.9 124.3 135.6 190.7

New York 12,529 11,844 13,624 16,893 20,224 132.0 124.2 142.2 175.8 210.4

North Carolina 6,180 6,113 6,652 9,744 10,160 130.0 127.3 137.3 199.2 207.7

North Dakota 127 191 309 309 484 35.7 51.6 81.5 79.5 124.5

Ohio 6,787 7,443 7,502 8,098 10,357 120.3 131.5 132.2 142.4 182.1

Oklahoma 1,789 2,303 2,685 2,962 3,521 94.7 120.7 139.8 152.9 181.8

Oregon 936 1,163 1,532 2,073 2,834 48.5 59.8 78.0 104.0 142.2

Pennsylvania 7,025 6,659 6,543 6,892 8,449 112.8 106.7 104.6 110.0 134.9

Rhode Island 275 262 372 408 495 54.1 51.4 72.7 79.7 96.7

South Carolina 3,196 3,133 3,689 3,781 4,436 139.1 134.9 157.0 158.9 186.5

South Dakota 259 320 335 427 512 61.9 75.4 78.0 98.8 118.5

Tennessee 4,368 3,758 3,778 4,577 5,497 138.7 118.7 118.4 142.3 170.8

Texas 15,286 16,410 18,035 21,792 23,779 118.1 124.8 134.8 159.8 174.4

Utah 347 578 876 1,055 1,383 24.2 39.6 59.2 70.0 91.8

Vermont 45 51 49 70 94 14.6 16.5 15.9 22.7 30.5

Virginia 3,145 3,272 3,879 4,085 5,996 78.2 80.5 94.7 99.0 145.4

Washington 2,008 2,665 3,717 4,374 5,231 58.3 76.5 105.3 122.0 145.9

West Virginia 393 524 380 404 497 42.9 57.2 41.6 44.3 54.6

Wisconsin 2,064 2,140 2,027 2,697 3,302 72.6 75.0 70.9 94.1 115.1

Wyoming 25 27 55 88 155 8.5 9.1 18.5 29.4 51.9

U.S. TOTAL 162,235 169,130 186,943 221,070 270,033 105.0 108.7 119.1 139.7 170.7

Northeast 26,378 25,897 28,213 32,830 39,851 97.2 95.1 103.2 119.7 145.3

Midwest 33,521 33,717 35,171 40,253 51,010 101.1 101.3 105.3 120.2 152.3

South 70,832 72,529 77,050 91,860 109,513 123.2 124.9 131.2 154.6 184.4

West 31,504 36,987 46,509 56,127 69,659 85.9 99.9 124.1 148.1 183.8

Guam 46 49 52 80 74 56.7 60.2 63.7 97.6 90.3

Puerto Rico 188 236 293 359 431 10.7 13.6 17.2 21.7 26.0

Virgin Islands 44 17 30 24 21 89.3 34.8 61.8 50.2 43.9

OUTLYING AREAS 278 302 375 463 526 14.7 16.2 20.4 25.9 29.4

TOTAL 162,513 169,432 187,318 221,533 270,559 103.9 107.6 118.0 138.4 169.1

NOTE: Cases reported with unknown sex are not included in this table.
80

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

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

(MSAs)* in Alphabetical Order, United States, 2012–2016

Cases Rates per 100,000 Population

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Atlanta-Sandy Springs-Roswell, GA 8,299 5,452† 7,256 6,471† 11,670 152.1 98.7† 129.2 113.3† 204.3

Austin-Round Rock, TX 2,204 2,570 2,860 3,199 3,670 120.2 136.5 147.2 159.9 183.4

Baltimore-Columbia-Towson, MD 2,974 3,233 3,459 4,179 5,854 108.0 116.7 124.2 149.4 209.3

Birmingham-Hoover, AL 2,340 2,130 1,957 2,088 316† 205.9 186.8 171.1 182.3 27.6†

Boston-Cambridge-Newton, MA-NH 1,995 2,372 2,716† 2,487† 3,002† 43.0 50.6 57.4† 52.1† 62.9†

Buffalo-Cheektowaga-Niagara Falls, NY 2,172 1,232 1,342 1,982 2,180 191.5 108.6 118.1 174.6 192.0

Charlotte-Concord-Gastonia, NC-SC 3,172 3,058 3,645 4,673 4,749 138.1 130.9 153.1 192.6 195.7

Chicago-Naperville-Elgin, IL-IN-WI 14,304 12,793 12,630 13,529 16,634 150.2 134.1 132.2 141.6 174.2

Cincinnati, OH-KY-IN 3,227 3,229 3,346 3,713 4,096 151.6 151.1 155.7 172.1 189.8

Cleveland-Elyria, OH 4,203 4,155 3,802 3,428 4,205 203.7 201.2 184.2 166.3 204.0

Columbus, OH 2,859 3,220 3,260 3,676 4,821 147.1 163.7 163.4 181.8 238.5

Dallas-Fort Worth-Arlington, TX 7,842 8,354 9,195 11,334 11,092 117.0 122.7 132.2 159.6 156.2

Denver-Aurora-Lakewood, CO 2,055 1,828 2,016 2,838 3,848 77.7 67.8 73.2 100.8 136.7

Detroit-Warren-Dearborn, MI 8,062 6,564 5,311 5,494 6,816 187.8 152.8 123.6 127.7 158.4

Hartford-West Hartford-East Hartford, CT 744 1,065 894 726† 963† 61.3 87.6 73.6 59.9† 79.5†

Houston-The Woodlands-Sugar Land, TX 7,582 7,783 8,299 9,290 10,378 122.7 123.3 127.9 139.6 155.9

Indianapolis-Carmel-Anderson, IN 3,738 3,616 3,759 3,716 4,808 193.8 185.1 190.7 186.8 241.8

Jacksonville, FL 1,948 2,321 2,608 2,740 3,168 141.4 166.4 183.8 189.0 218.6

Kansas City, MO-KS 2,919 2,696 2,642 2,943 4,009 143.2 131.2 127.6 141.0 192.1

Las Vegas-Henderson-Paradise, NV 1,968 2,256 2,653 2,975 3,653 98.4 111.2 128.2 140.7 172.7

Los Angeles-Long Beach-Anaheim, CA 13,102 14,449 17,130 19,867 25,438 100.4 110.0 129.2 148.9 190.7

Louisville-Jefferson County, KY-IN 2,040 2,063 1,962 2,187 2,957 163.0 163.4 154.5 171.1 231.3

Memphis, TN-MS-AR 4,498 3,086 2,625 3,143 3,746 335.2 230.0 195.4 233.8 278.7

Miami-Fort Lauderdale-West Palm Beach, FL 5,291 5,801 6,128 6,905 7,984 91.8 99.5 103.3 114.8 132.8

Milwaukee-Waukesha-West Allis, WI 3,277 3,179 2,584 3,719 4,454 209.1 202.5 164.4 236.0 282.7

Minneapolis-St. Paul-Bloomington, MN-WI 2,534† 3,188† 3,341 3,289 4,123 74.0† 92.2† 95.6 93.3 117.0

Nashville-Davidson-Murfreesboro-Franklin, TN 1,900 1,806 1,922 2,200 2,695 110.0 102.7 107.2 120.2 147.2

New Orleans-Metairie, LA 2,198 2,448 2,667 2,929 3,414 179.1 197.3 213.0 231.9 270.3

New York-Newark-Jersey City, NY-NJ-PA 21,310 19,319 20,054 23,721 26,186 107.5 96.8 99.8 117.5 129.7

Oklahoma City, OK 1,947 2,352 2,366 2,403 2,953 150.2 178.2 177.0 176.9 217.4

Orlando-Kissimmee-Sanford, FL 2,328 2,514 2,571 3,073 3,393 104.7 110.9 110.8 128.7 142.1

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 11,026 10,557 9,618 9,724 11,394 183.2 174.9 158.9 160.2 187.7

Phoenix-Mesa-Scottsdale, AZ 4,526 4,918 5,944 6,495 8,086 104.5 111.8 132.4 142.0 176.8

Pittsburgh, PA 3,048 2,827 2,602 2,422 2,601 129.1 119.7 110.4 102.9 110.5

Portland-Vancouver-Hillsboro, OR-WA 1,183 1,199 1,499 2,386 3,177 51.7 51.8 63.8 99.9 133.0

Providence-Warwick, RI-MA 643 593 913† 834† 1,108† 40.2 37.0 56.7† 51.7† 68.7†

Raleigh, NC 1,532 1,384 1,408 2,018 1,915 128.9 114.0 113.3 158.5 150.4

Richmond, VA 1,671 1,658 2,173 2,200 3,198 135.6 133.1 172.5 173.0 251.5

Riverside-San Bernardino-Ontario, CA 3,031 3,273 4,292 4,904 5,958 69.7 74.7 96.6 109.2 132.7

Sacramento-Roseville-Arden-Arcade, CA 2,324 2,597 2,616 3,317 3,402 105.8 117.2 116.6 145.9 149.6

Salt Lake City, UT 342 690 1,026 1,078 1,462 30.4 60.5 89.0 92.1 124.9

San Antonio-New Braunfels, TX 3,672 3,352 3,155 4,160 4,779 164.4 147.2 135.5 174.5 200.5

San Diego-Carlsbad, CA 2,620 2,825 3,420 3,691 4,989 82.5 88.0 104.8 111.9 151.2

San Francisco-Oakland-Hayward, CA 5,263 5,681 7,110 9,330 10,669 118.1 125.8 154.8 200.4 229.1

San Jose-Sunnyvale-Santa Clara, CA 1,020 1,145 1,552 1,857 1,976 53.8 59.6 79.5 93.9 100.0

Seattle-Tacoma-Bellevue, WA 2,323 2,990 3,931 4,766 5,149 65.4 82.8 107.1 127.7 137.9

St. Louis, MO-IL 4,810 4,492 4,346 5,257 6,558 172.0 160.4 154.9 187.0 233.2

Tampa-St. Petersburg-Clearwater, FL 3,422 3,660 3,455 3,916 4,408 120.4 127.5 118.5 131.6 148.2

Virginia Beach-Norfolk-Newport News, VA-NC 2,630 2,581 3,206 3,300 4,320 154.7 151.2 186.8 191.3 250.5

Washington-Arlington-Alexandria, DC-VA-MD-WV 5,369 5,616 2,974 3,008 4,335 91.6 94.4 49.3 49.3 71.1

SELECTED MSAs TOTAL 205,487 202,170 212,240 239,580 286,759 120.0 117.0 121.4 135.6 162.2

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

†

 The variable used to identify county, which is used to classify cases into MSAs, was complete for ≤95% of cases in a state contributing data to this MSA. 

See Appendix A1.4 for more information.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

81

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

Statistical Areas (MSAs)* in Alphabetical Order, United States, 2012–2016

Cases Rates per 100,000 Population

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Atlanta-Sandy Springs-Roswell, GA 3,907 2,458† 3,030 2,578† 4,696 139.4 86.5† 104.7 87.5† 159.4

Austin-Round Rock, TX 993 1,078 1,213 1,039 1,162 108.5 114.8 124.9 103.9 116.2

Baltimore-Columbia-Towson, MD 1,527 1,542 1,608 1,964 2,492 107.1 107.5 111.5 135.6 172.1

Birmingham-Hoover, AL 1,280 1,099 970 999 160† 217.3 186.0 163.4 167.9 26.9†

Boston-Cambridge-Newton, MA-NH 738 828 844† 601† 720† 30.9 34.3 34.7† 24.5† 29.3†

Buffalo-Cheektowaga-Niagara Falls, NY 1,173 594 664 959 985 200.4 101.6 113.4 164.0 168.5

Charlotte-Concord-Gastonia, NC-SC 1,778 1,700 1,962 2,419 2,296 150.7 141.7 160.2 193.8 184.0

Chicago-Naperville-Elgin, IL-IN-WI 7,464 6,374 5,662 5,696 6,481 153.4 130.9 115.9 116.8 132.8

Cincinnati, OH-KY-IN 2,051 1,932 1,913 2,020 2,183 188.7 177.1 174.3 183.4 198.2

Cleveland-Elyria, OH 2,426 2,328 2,021 1,745 2,134 226.7 217.6 189.2 163.6 200.0

Columbus, OH 1,514 1,500 1,473 1,638 2,105 153.2 150.0 145.3 159.5 205.0

Dallas-Fort Worth-Arlington, TX 4,157 3,921 4,153 4,963 4,577 122.5 113.6 117.5 137.4 126.8

Denver-Aurora-Lakewood, CO 965 724 780 1,096 1,403 72.7 53.5 56.4 77.7 99.4

Detroit-Warren-Dearborn, MI 4,406 3,614 2,698 2,592 3,190 199.3 163.5 122.0 117.2 144.2

Hartford-West Hartford-East Hartford, CT 422 543 425 310† 412† 67.7 87.2 68.3 50.0† 66.4†

Houston-The Woodlands-Sugar Land, TX 4,039 4,033 4,151 4,113 4,422 130.2 127.2 127.2 122.8 132.1

Indianapolis-Carmel-Anderson, IN 1,957 1,761 1,828 1,791 2,264 198.5 176.4 181.3 176.1 222.7

Jacksonville, FL 983 1,121 1,288 1,237 1,402 139.1 156.7 176.9 166.5 188.7

Kansas City, MO-KS 1,585 1,424 1,361 1,409 1,875 152.4 136.0 128.9 132.6 176.4

Las Vegas-Henderson-Paradise, NV 847 1,015 1,039 1,129 1,341 85.1 100.5 100.5 106.7 126.7

Los Angeles-Long Beach-Anaheim, CA 4,359 4,578 5,029 5,778 7,083 65.9 68.9 74.8 85.4 104.7

Louisville-Jefferson County, KY-IN 1,096 1,079 992 1,012 1,278 171.2 167.0 152.6 154.8 195.5

Memphis, TN-MS-AR 2,418 1,550 1,371 1,469 1,818 346.6 222.0 196.0 209.8 259.6

Miami-Fort Lauderdale-West Palm Beach, FL 2,198 2,225 2,123 2,252 2,606 74.1 74.2 69.5 72.7 84.1

Milwaukee-Waukesha-West Allis, WI 1,814 1,655 1,298 1,850 2,208 225.5 205.5 160.8 228.8 273.1

Minneapolis-St. Paul-Bloomington, MN-WI 1,322† 1,641† 1,388 1,229 1,676 76.4† 93.8† 78.6 69.0 94.2

Nashville-Davidson-Murfreesboro-Franklin, TN 858 838 790 888 1,129 97.1 93.1 86.0 94.7 120.4

New Orleans-Metairie, LA 1,186 1,317 1,339 1,423 1,527 187.9 206.1 207.2 218.1 234.1

New York-Newark-Jersey City, NY-NJ-PA 9,157 7,615 6,544 7,349 7,134 89.3 73.9 63.1 70.6 68.5

Oklahoma City, OK 1,081 1,305 1,310 1,267 1,558 164.6 195.1 193.2 183.8 226.1

Orlando-Kissimmee-Sanford, FL 1,087 1,114 1,109 1,254 1,326 95.8 96.3 93.4 102.7 108.6

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 5,581 5,052 4,461 4,277 4,640 179.3 162.0 142.7 136.4 147.9

Phoenix-Mesa-Scottsdale, AZ 2,118 2,318 2,658 2,708 3,259 97.3 104.8 117.6 117.6 141.5

Pittsburgh, PA 1,857 1,715 1,415 1,239 1,153 152.6 141.1 116.8 102.5 95.4

Portland-Vancouver-Hillsboro, OR-WA 393 325 382 764 1,005 33.9 27.8 32.2 63.2 83.2

Providence-Warwick, RI-MA 294 261 325† 260† 368† 35.6 31.6 39.2† 31.3† 44.3†

Raleigh, NC 807 677 638 857 785 132.7 108.9 100.2 131.4 120.4

Richmond, VA 908 957 1,194 1,141 1,473 142.6 148.7 183.4 173.6 224.2

Riverside-San Bernardino-Ontario, CA 1,562 1,576 1,966 2,208 2,515 71.5 71.7 88.1 97.9 111.5

Sacramento-Roseville-Arden-Arcade, CA 1,212 1,323 1,246 1,538 1,463 108.2 117.0 108.8 132.5 126.0

Salt Lake City, UT 88 263 376 325 480 15.8 46.4 65.5 55.8 82.4

San Antonio-New Braunfels, TX 1,865 1,624 1,445 1,785 1,981 164.5 140.7 122.4 147.8 164.0

San Diego-Carlsbad, CA 847 827 1,038 1,018 1,479 53.6 51.8 63.9 62.1 90.2

San Francisco-Oakland-Hayward, CA 1,493 1,491 1,836 2,101 2,183 66.2 65.2 78.9 89.1 92.6

San Jose-Sunnyvale-Santa Clara, CA 372 446 557 642 614 39.5 46.7 57.4 65.4 62.5

Seattle-Tacoma-Bellevue, WA 732 988 1,412 1,662 1,556 41.1 54.7 76.9 89.0 83.3

St. Louis, MO-IL 2,467 2,313 2,087 2,436 2,911 171.1 160.2 144.3 168.1 200.9

Tampa-St. Petersburg-Clearwater, FL 1,701 1,774 1,619 1,676 1,815 116.1 119.8 107.6 109.2 118.2

Virginia Beach-Norfolk-Newport News, VA-NC 1,402 1,341 1,711 1,701 2,118 162.3 154.7 196.4 194.4 242.1

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,355 2,278 1,163 1,064 1,489 78.4 74.8 37.7 34.1 47.7

SELECTED MSAs TOTAL 98,842 92,055 89,905 95,471 108,930 113.1 104.4 100.7 105.9 120.8

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

†

 The variable used to identify county, which is used to classify cases into MSAs, was complete for ≤95% of cases in a state contributing data to this MSA. See 

Appendix A1.4 for more information.

NOTE: Cases reported with unknown sex are not included in this table.
82

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

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

Statistical Areas (MSAs)* in Alphabetical Order, United States, 2012–2016

Cases Rates per 100,000 Population

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Atlanta-Sandy Springs-Roswell, GA 4,329 2,952† 4,177 3,885† 6,960 163.1 110.1† 153.5 140.5† 251.8

Austin-Round Rock, TX 1,196 1,295 1,635 2,144 2,499 130.1 137.2 168.2 214.2 249.7

Baltimore-Columbia-Towson, MD 1,447 1,690 1,840 2,202 3,359 109.0 126.4 137.0 163.2 249.0

Birmingham-Hoover, AL 1,057 1,029 979 1,075 152† 193.0 187.3 177.9 195.2 27.6†

Boston-Cambridge-Newton, MA-NH 1,257 1,541 1,870† 1,881† 2,274† 55.9 67.8 81.4† 81.1† 98.1†

Buffalo-Cheektowaga-Niagara Falls, NY 999 638 678 1,023 1,195 182.1 116.2 123.1 185.8 217.1

Charlotte-Concord-Gastonia, NC-SC 1,384 1,356 1,683 2,251 2,451 123.9 119.4 145.6 191.0 208.0

Chicago-Naperville-Elgin, IL-IN-WI 6,819 6,407 6,947 7,780 10,133 146.4 137.3 148.7 166.5 216.9

Cincinnati, OH-KY-IN 1,176 1,297 1,431 1,693 1,913 112.9 123.9 136.0 160.2 181.1

Cleveland-Elyria, OH 1,777 1,827 1,781 1,683 2,071 178.9 183.6 178.9 169.3 208.4

Columbus, OH 1,345 1,720 1,787 2,038 2,716 140.8 177.9 182.2 204.9 273.1

Dallas-Fort Worth-Arlington, TX 3,682 4,426 5,033 6,357 6,498 111.4 131.8 147.1 182.0 186.1

Denver-Aurora-Lakewood, CO 1,090 1,104 1,236 1,742 2,445 82.8 82.1 90.1 124.1 174.2

Detroit-Warren-Dearborn, MI 3,642 2,942 2,606 2,894 3,622 175.0 141.2 125.0 138.5 173.3

Hartford-West Hartford-East Hartford, CT 322 522 466 416† 551† 54.5 88.1 78.7 70.4† 93.2†

Houston-The Woodlands-Sugar Land, TX 3,543 3,749 4,146 5,167 5,930 115.2 119.3 128.5 156.2 179.2

Indianapolis-Carmel-Anderson, IN 1,772 1,854 1,927 1,920 2,542 187.9 194.0 200.1 197.5 261.5

Jacksonville, FL 965 1,198 1,316 1,501 1,764 143.8 176.3 190.5 212.5 249.7

Kansas City, MO-KS 1,334 1,272 1,281 1,534 2,134 133.6 126.2 126.1 149.7 208.3

Las Vegas-Henderson-Paradise, NV 1,119 1,239 1,612 1,837 2,306 111.3 121.8 155.6 173.9 218.3

Los Angeles-Long Beach-Anaheim, CA 8,712 9,849 12,071 14,066 18,060 135.2 151.9 184.7 213.9 274.6

Louisville-Jefferson County, KY-IN 940 969 961 1,170 1,670 153.8 157.2 155.1 187.3 267.3

Memphis, TN-MS-AR 2,080 1,536 1,254 1,674 1,926 323.0 238.6 194.8 260.0 299.2

Miami-Fort Lauderdale-West Palm Beach, FL 3,093 3,564 3,999 4,651 5,374 110.6 125.9 139.0 159.6 184.4

Milwaukee-Waukesha-West Allis, WI 1,463 1,521 1,281 1,864 2,241 191.8 199.0 167.4 242.9 292.1

Minneapolis-St. Paul-Bloomington, MN-WI 1,209† 1,546† 1,942 2,058 2,439 71.5† 90.4† 112.4 118.0 139.8

Nashville-Davidson-Murfreesboro-Franklin, TN 1,034 968 1,130 1,312 1,566 122.6 112.8 129.3 147.0 175.5

New Orleans-Metairie, LA 1,012 1,131 1,328 1,506 1,887 169.8 187.9 219.2 246.7 309.1

New York-Newark-Jersey City, NY-NJ-PA 12,124 11,639 13,448 16,290 18,976 126.5 120.6 138.4 166.8 194.3

Oklahoma City, OK 866 1,047 1,056 1,136 1,394 135.3 160.8 160.3 169.7 208.3

Orlando-Kissimmee-Sanford, FL 1,241 1,399 1,461 1,818 2,067 114.0 126.0 128.8 155.9 177.2

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 5,439 5,501 5,152 5,439 6,736 187.1 188.7 176.2 185.4 229.6

Phoenix-Mesa-Scottsdale, AZ 2,407 2,600 3,286 3,780 4,824 111.8 118.9 147.4 166.4 212.3

Pittsburgh, PA 1,191 1,110 1,187 1,182 1,448 104.1 96.9 103.7 103.3 126.6

Portland-Vancouver-Hillsboro, OR-WA 790 874 1,116 1,621 2,172 69.8 76.4 96.2 137.3 184.0

Providence-Warwick, RI-MA 349 331 587† 572† 740† 45.0 42.6 75.3† 73.2† 94.6†

Raleigh, NC 724 707 770 1,161 1,130 124.8 119.2 127.0 186.9 181.9

Richmond, VA 761 701 978 1,058 1,712 127.8 116.4 160.6 172.3 278.7

Riverside-San Bernardino-Ontario, CA 1,467 1,695 2,321 2,692 3,437 67.7 77.7 105.0 120.5 153.9

Sacramento-Roseville-Arden-Arcade, CA 1,104 1,271 1,362 1,771 1,934 102.6 117.1 124.0 159.1 173.8

Salt Lake City, UT 254 427 650 753 982 44.9 74.5 112.3 128.1 167.1

San Antonio-New Braunfels, TX 1,807 1,728 1,710 2,375 2,798 164.3 153.9 149.0 201.9 237.9

San Diego-Carlsbad, CA 1,766 1,995 2,354 2,668 3,498 110.6 123.6 143.5 160.8 210.8

San Francisco-Oakland-Hayward, CA 3,746 4,167 5,261 7,201 8,441 170.4 186.9 232.2 313.3 367.3

San Jose-Sunnyvale-Santa Clara, CA 626 699 995 1,212 1,361 65.8 72.4 101.3 121.8 136.8

Seattle-Tacoma-Bellevue, WA 1,591 2,002 2,519 3,104 3,593 89.9 111.1 137.3 166.3 192.5

St. Louis, MO-IL 2,340 2,178 2,256 2,802 3,646 172.8 160.5 166.0 205.6 267.5

Tampa-St. Petersburg-Clearwater, FL 1,721 1,871 1,823 2,240 2,592 124.9 134.6 129.2 155.6 180.0

Virginia Beach-Norfolk-Newport News, VA-NC 1,226 1,239 1,489 1,595 2,195 146.7 147.5 176.2 187.7 258.3

Washington-Arlington-Alexandria, DC-VA-MD-WV 3,001 3,330 1,811 1,943 2,838 105.0 114.6 61.4 65.2 95.3

SELECTED MSAs TOTAL 106,339 109,653 121,989 143,737 177,192 126.8 129.5 142.5 166.1 204.7

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

†

 The variable used to identify county, which is used to classify cases into MSAs, was complete for ≤95% of cases in a state contributing data to this MSA. 

See Appendix A1.4 for more information.

NOTE: Cases reported with unknown sex are not included in this table.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

83

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

Ranked by Number of Reported Cases, United States, 2016

Rank* County/Independent City Cases Rate per 100,000 Population Cumulative Percentage

1 Los Angeles County, CA 22,376 220.0 4

2 Cook County, IL 13,608 259.8 7

3 Harris County, TX 8,496 187.2 9

4 Maricopa County, AZ 7,701 184.8 11

5 Philadelphia County, PA 6,967 444.5 12

6 New York County, NY 6,329 384.9 13

7 Kings County, NY 5,840 221.5 15

8 San Francisco County, CA 5,278 610.3 16

9 San Diego County, CA 4,989 151.2 17

10 Wayne County, MI 4,949 281.3 18

11 Dallas County, TX 4,597 180.0 19

12 Bexar County, TX 4,480 236.1 20

13 Milwaukee County, WI 4,298 448.8 21

14 Franklin County, OH 4,243 339.0 22

15 Marion County, IN 4,030 429.2 23

16 Fulton County, GA 3,838 379.8 23

17 Cuyahoga County, OH 3,744 298.1 24

18 Bronx County, NY 3,682 253.0 25

19 Clark County, NV 3,653 172.7 26

20 Broward County, FL 3,632 191.5 27

21 Baltimore (City), MD 3,534 568.3 27

22 San Bernardino County, CA 3,377 158.7 28

23 King County, WA 3,355 158.5 29

24 Tarrant County, TX 3,134 158.1 29

25 Miami-Dade County, FL 3,064 113.8 30

26 Orange County, CA 3,062 96.6 31

27 Alameda County, CA 3,045 185.9 31

28 Shelby County, TN 2,924 311.7 32

29 Hamilton County, OH 2,866 354.9 33

30 Sacramento County, CA 2,854 190.1 33

31 Queens County, NY 2,808 120.0 34

32 Travis County, TX 2,787 236.9 34

33 Mecklenburg County, NC 2,778 268.6 35

34 Duval County, FL 2,713 297.1 36

35 St. Louis County, MO 2,623 261.4 36

36 Riverside County, CA 2,581 109.3 37

37 Jackson County, MO 2,480 360.7 37

38 Orange County, FL 2,476 192.2 38

39 Hennepin County, MN 2,455 200.7 38

40 Jefferson County, KY 2,447 320.4 39

41 St. Louis (City), MO 2,369 750.4 39

42 Hillsborough County, FL 2,365 175.3 40

43 DeKalb County, GA 2,315 315.0 40

44 Monroe County, NY 2,207 294.4 41

45 Oklahoma County, OK 2,206 284.0 41

46 Collin County, TX 2,058 225.1 42

47 Allegheny County, PA 2,018 164.0 42

48 Fresno County, CA 1,997 204.8 43

49 Denver County, CO 1,975 289.4 43

50 Multnomah County, OR 1,966 248.8 43

51 Orleans Parish, LA 1,956 502.0 44

52 Santa Clara County, CA 1,936 100.9 44

53 Davidson County, TN 1,874 276.0 45

54 Erie County, NY 1,874 203.1 45

55 Prince George's County, MD 1,832 201.4 45

56 Kern County, CA 1,790 202.9 46

57 Etowah County, AL 1,778 1725.3 46

58 Guilford County, NC 1,768 341.6 47

59 Essex County, NJ 1,759 220.6 47

60 Tulsa County, OK 1,723 269.5 47

61 Wake County, NC 1,618 158.0 48

62 Contra Costa County, CA 1,574 139.7 48

63 Bernalillo County, NM 1,567 231.6 48

64 Pinellas County, FL 1,561 164.3 49

65 Bell County, TX 1,466 437.7 49

66 Salt Lake County, UT 1,434 129.5 49

67 Montgomery County, OH 1,415 265.8 50

68 Douglas County, NE 1,402 254.9 50

69 Richmond (City), VA 1,383 627.8 50

70 Baltimore County, MD 1,321 158.9 50

* The top 70 counties and independent cities ranked in descending order by number of cases reported in 2016 then by rate are displayed.

NOTE: Relative rankings of counties may be impacted by completeness of the variable used to identify county. In 2016, the variable used to identify county was 

complete for ≤95% of cases in Alabama, Connecticut, and Massachusetts. See Appendix A1.4 for more information.
84

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

Table 21. Gonorrhea — Reported Cases and Rates of Reported Cases by Age Group and Sex, United States, 

2012–2016

Age Cases Rates per 100,000 Population*

Group Total Male Female Unknown Sex Total Male Female

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 47,749 131 340.7 223.2 463.0

20–24 113,035 53,055 59,760 220 495.9 454.3 537.6

25–29 62,102 34,718 27,266 118 287.8 316.8 256.7

30–34 34,065 20,855 13,143 67 160.2 195.2 124.2

35–39 18,034 11,850 6,145 39 92.0 121.1 62.6

40–44 11,817 8,590 3,192 35 56.7 82.9 30.4

45–54 13,823 11,087 2,714 22 31.6 51.4 12.2

55–64 3,802 3,176 621 5 9.7 16.8 3.1

65+ 825 696 128 1 1.8 3.6 0.5

Unknown Age 525 312 193 20

TOTAL 333,004 169,130 163,208 666 105.3 108.7 101.7

0–4 154 47 105 2 0.8 0.5 1.1

2014

5–9 53 7 46 0 0.3 0.1 0.5

10–14 2,450 440 2,005 5 11.9 4.2 19.8

15–19 68,468 23,981 44,399 88 325.0 222.4 431.7

20–24 116,200 56,714 59,329 157 507.2 483.1 531.0

25–29 69,587 40,602 28,899 86 316.5 363.8 266.9

30–34 38,393 24,349 13,988 56 178.3 225.3 130.5

35–39 20,803 14,129 6,654 20 104.4 142.1 66.7

40–44 12,687 9,349 3,320 18 61.6 91.5 32.0

45–54 15,322 12,388 2,917 17 35.3 57.8 13.2

55–64 4,549 3,859 680 10 11.4 20.0 3.3

65+ 911 790 121 0 2.0 3.9 0.5

Unknown Age 485 288 145 52

TOTAL 350,062 186,943 162,608 511 109.8 119.1 100.4

0–4 148 47 98 3 0.7 0.5 1.0

2015

5–9 78 11 66 1 0.4 0.1 0.7

10–14 2,312 385 1,923 4 11.2 3.7 19.0

15–19 72,001 26,401 45,477 123 341.1 244.5 441.1

20–24 124,592 63,289 61,105 198 547.9 542.4 551.9

25-29 82,867 50,089 32,662 116 368.9 439.0 295.5

30–34 45,681 29,751 15,867 63 210.7 273.2 147.1

35–39 26,137 18,198 7,897 42 128.3 178.9 77.4

40–44 15,042 11,116 3,898 28 74.4 110.8 38.3

45–54 18,779 15,379 3,375 25 43.5 72.2 15.4

55–64 6,035 5,175 849 11 14.8 26.2 4.0

65+ 1,191 1,032 158 1 2.5 4.9 0.6

Unknown Age 353 197 139 17

TOTAL 395,216 221,070 173,514 632 123.0 139.7 106.3

0–4 187 72 113 2 0.9 0.7 1.2

2016

5–9 98 16 81 1 0.5 0.2 0.8

10–14 2,436 498 1,929 9 11.8 4.7 19.1

15–19 80,172 30,316 49,710 146 379.8 280.8 482.1

20–24 138,130 71,967 65,930 233 607.5 616.8 595.5

25–29 101,283 62,189 38,881 213 450.9 545.1 351.8

30–34 57,646 38,193 19,306 147 265.9 350.7 179.0

35–39 34,058 23,744 10,230 84 167.2 233.4 100.3

40–44 19,104 14,116 4,935 53 94.5 140.7 48.5

45–54 24,142 19,762 4,330 50 55.9 92.8 19.8

55–64 8,138 6,947 1,178 13 19.9 35.2 5.6

65+ 1,599 1,403 191 5 3.3 6.7 0.7

Unknown Age 1,521 810 685 26

TOTAL 468,514 270,033 197,499 982 145.8 170.7 121.0

* 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.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

85

Table 22A. Gonorrhea — Reported Cases by Race/Ethnicity, Age Group, and Sex, United States*, 2016

Age 

Group

American Indians/

Alaska Natives Asians Blacks Native Hawaiians/Other Pacific Islanders

Total† Male Female Total† Male Female Total† Male Female Total† Male Female

0–4 1 0 1 1 1 0 63 25 38 1 1 0

5–9 3 0 3 0 0 0 32 7 25 0 0 0

10–14 29 3 26 11 3 8 1,306 307 998 3 1 2

15–19 810 237 573 397 184 212 40,280 15,755 24,503 150 46 104

20–24 1,606 599 1,007 1,221 789 430 63,737 32,652 31,051 256 104 152

25–29 1,433 588 845 1,230 940 287 40,771 25,282 15,461 210 122 88

30–34 872 386 486 789 637 152 19,653 13,525 6,106 126 76 50

35–39 463 195 268 511 402 109 10,708 7,867 2,833 90 62 27

40–44 217 104 113 326 263 61 5,659 4,497 1,156 46 32 14

45–54 257 135 122 335 292 41 6,787 5,841 943 33 26 7

55–64 57 44 13 86 67 19 2,405 2,140 264 13 13 0

65+ 8 7 1 25 17 8 432 401 30 0 0 0

Unknown Age 1 1 0 2 2 0 281 145 135 0 0 0

TOTAL 5,757 2,299 3,458 4,934 3,597 1,327 192,114 108,444 83,543 928 483 444

Age 

Group

Whites Multirace Hispanics Other/

Unknown

Total† Male Female Total† Male Female Total† Male Female Total† Male Female

0–4 35 12 23 2 1 1 27 8 19 57 24 31

5–9 21 4 17 0 0 0 19 1 18 23 4 18

10–14 271 25 246 14 1 13 262 46 216 540 112 420

15–19 12,795 3,758 9,033 708 204 504 8,056 3,198 4,854 16,976 6,934 9,927

20–24 27,243 13,202 14,025 1,194 576 615 15,976 9,122 6,839 26,897 14,923 11,811

25–29 25,018 14,266 10,736 862 570 291 12,414 8,217 4,180 19,345 12,204 6,993

30–34 16,660 10,314 6,337 602 474 128 7,475 5,244 2,219 11,469 7,537 3,828

35–39 10,272 6,786 3,482 305 239 64 4,515 3,285 1,225 7,194 4,908 2,222

40–44 6,018 4,288 1,728 151 125 23 2,395 1,813 577 4,292 2,994 1,263

45–54 8,306 6,790 1,514 210 187 23 2,504 2,022 477 5,710 4,469 1,203

55–64 2,965 2,567 397 49 48 1 549 440 108 2,014 1,628 376

65+ 593 512 79 5 5 0 75 65 10 461 396 63

Unknown Age 114 57 55 1 1 0 32 11 20 1,090 593 475

TOTAL 110,311 62,581 47,672 4,103 2,431 1,663 54,299 33,472 20,762 96,068 56,726 38,630

* Includes 50 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2016.

†

 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.
86

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

Table 22B. Gonorrhea — Rates of Reported Cases per 100,000 Population by Race/Ethnicity, Age Group, and Sex, 

United States*, 2016

Age 

Group

American Indians/

Alaska Natives Asians Blacks Native Hawaiians/Other Pacific Islanders

Total† Male Female Total† Male Female Total† Male Female Total† Male Female

0–4 0.6 0.0 1.2 0.1 0.2 0.0 2.3 1.8 2.8 2.5 4.8 0.0

5–9 1.7 0.0 3.5 0.0 0.0 0.0 1.1 0.5 1.8 0.0 0.0 0.0

10–14 16.5 3.4 30.0 1.1 0.6 1.6 46.5 21.6 72.0 7.4 4.9 10.0

15–19 444.7 255.7 640.4 38.7 35.5 41.7 1,347.0 1,038.6 1,663.1 369.4 219.7 528.9

20–24 806.5 586.7 1,037.7 97.0 123.5 69.4 1,875.9 1,892.7 1,856.5 545.6 432.5 664.6

25–29 781.8 630.5 938.6 82.9 129.9 37.7 1,308.8 1,641.0 982.0 403.6 452.5 351.0

30–34 535.8 476.1 595.0 52.4 89.6 19.1 709.8 1,016.0 424.7 258.5 304.1 210.4

35–39 312.6 264.7 359.9 36.2 61.1 14.4 410.6 636.6 206.5 212.2 287.4 129.5

40–44 151.4 147.3 155.3 23.1 39.8 8.1 221.8 375.2 85.4 123.4 169.9 75.9

45–54 83.2 90.1 76.6 14.0 26.2 3.2 128.1 234.8 33.6 47.4 75.1 20.0

55–64 20.6 33.8 8.9 4.5 7.7 1.8 52.1 101.6 10.5 24.0 49.1 0.0

65+ 3.3 6.3 0.7 1.2 2.0 0.7 10.3 23.7 1.2 0.0 0.0 0.0

Unknown Age

TOTAL 242.9 196.8 287.7 28.3 43.4 14.5 481.2 568.4 400.7 165.8 171.1 160.0

Age 

Group

Whites Multirace Hispanics

Total† Male Female Total† Male Female Total† Male Female

0–4 0.4 0.2 0.5 0.2 0.2 0.2 0.5 0.3 0.8

5–9 0.2 0.1 0.3 0.0 0.0 0.0 0.4 0.0 0.7

10–14 2.5 0.4 4.6 1.8 0.3 3.4 5.3 1.8 8.9

15–19 111.6 63.8 161.9 103.4 58.8 149.1 170.8 132.5 210.9

20–24 219.3 207.0 232.0 198.8 191.8 204.9 331.9 365.1 295.4

25–29 198.0 222.3 172.7 186.6 257.2 121.1 274.0 344.5 194.7

30–34 134.8 165.4 103.5 157.1 262.2 63.2 167.9 225.5 104.4

35–39 88.6 116.1 60.6 93.8 156.5 37.1 106.4 150.2 59.6

40–44 50.8 72.0 29.3 54.0 95.0 15.5 60.9 91.0 29.7

45–54 29.6 48.6 10.7 42.8 80.6 8.9 38.3 61.3 14.7

55–64 10.1 17.9 2.6 12.6 25.8 0.5 12.8 21.2 4.9

65+ 1.6 3.1 0.4 1.5 3.3 0.0 2.0 4.0 0.5

Unknown Age

TOTAL 55.7 64.1 47.5 62.3 75.1 49.7 95.9 117.0 74.2

* Includes 50 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2016.

†

 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.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

87

Table 23. Gonorrhea Among Women Aged 15–24 Years — Reported Cases and Rates of Reported Cases by Age, 

United States, 2012–2016

Age Cases Rate per 100,000 Population

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

2013

15 3,776 186.4

16 6,503 320.0

17 9,374 458.8

18 13,393 642.4

19 14,703 691.2

20 14,420 668.8

21 13,394 603.1

22 12,272 539.6

23 10,819 475.3

24 8,855 404.5

2014

15 3,487 171.3

16 6,188 303.9

17 8,830 431.6

18 12,196 591.9

19 13,698 650.5

20 13,801 642.1

21 13,324 611.5

22 12,031 536.0

23 10,746 467.5

24 9,427 409.6

2015

15 3,477 167.4

16 6,090 297.8

17 9,117 444.9

18 12,769 619.3

19 14,024 674.8

20 13,835 651.7

21 13,331 615.2

22 12,597 573.2

23 11,271 497.7

24 10,071 434.2

2016

15 3,678 177.1

16 6,573 321.4

17 9,855 480.9

18 14,304 693.7

19 15,300 736.2

20 14,657 690.4

21 14,149 653.0

22 13,540 616.1

23 12,245 540.8

24 11,339 488.9

NOTE: This table should be used only for age comparisons. Cases reported with unknown sex are not included in this table.
88

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

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, 2012–2016

Cases Rates per 100,000 Population

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Alabama 705 679 475 657 905 14.6 14.0 9.8 13.5 18.6

Alaska 34 35 45 24 24 4.6 4.8 6.1 3.3 3.3

Arizona 787 962 1,459 1,496 1,904 12.0 14.5 21.7 21.9 27.9

Arkansas 468 527 390 500 567 15.9 17.8 13.1 16.8 19.0

California 8,016 9,973 11,443 14,449 17,602 21.1 26.0 29.5 36.9 45.0

Colorado 503 475 355 553 739 9.7 9.0 6.6 10.1 13.5

Connecticut 121 133 169 220 217 3.4 3.7 4.7 6.1 6.0

Delaware 106 146 110 110 149 11.6 15.8 11.8 11.6 15.8

District of Columbia 589 609 281 322 568 93.1 94.2 42.6 47.9 84.5

Florida 4,483 5,022 6,103 7,132 8,332 23.2 25.7 30.7 35.2 41.1

Georgia 2,434 2,990 3,384 4,156 4,112 24.5 29.9 33.5 40.7 40.3

Hawaii 43 87 106 163 215 3.1 6.2 7.5 11.4 15.0

Idaho 54 42 46 102 127 3.4 2.6 2.8 6.2 7.7

Illinois 2,424 2,661 2,796 3,290 4,039 18.8 20.7 21.7 25.6 31.4

Indiana 531 543 475 699 778 8.1 8.3 7.2 10.6 11.8

Iowa 143 226 239 232 276 4.7 7.3 7.7 7.4 8.8

Kansas 129 196 200 240 303 4.5 6.8 6.9 8.2 10.4

Kentucky 390 395 447 433 570 8.9 9.0 10.1 9.8 12.9

Louisiana 1,780 2,006 2,173 2,466 2,599 38.7 43.4 46.7 52.8 55.6

Maine 22 21 23 38 64 1.7 1.6 1.7 2.9 4.8

Maryland 1,243 1,361 1,475 1,870 1,842 21.1 23.0 24.7 31.1 30.7

Massachusetts 806 990 813 1,263 1,447 12.1 14.8 12.1 18.6 21.3

Michigan 786 1,068 1,095 1,089 1,092 8.0 10.8 11.0 11.0 11.0

Minnesota 335 541 631 653 853 6.2 10.0 11.6 11.9 15.5

Mississippi 456 293 642 760 925 15.3 9.8 21.4 25.4 30.9

Missouri 426 609 771 778 955 7.1 10.1 12.7 12.8 15.7

Montana 3 8 9 20 24 0.3 0.8 0.9 1.9 2.3

Nebraska 35 95 96 81 120 1.9 5.1 5.1 4.3 6.3

Nevada 445 523 893 915 1,313 16.1 18.7 31.5 31.7 45.4

New Hampshire 65 79 79 84 100 4.9 6.0 6.0 6.3 7.5

New Jersey 883 968 1,172 1,306 1,620 10.0 10.9 13.1 14.6 18.1

New Mexico 234 247 283 332 470 11.2 11.8 13.6 15.9 22.5

New York 5,312 6,173 7,129 7,795 9,456 27.1 31.4 36.1 39.4 47.8

North Carolina 1,037 1,153 1,998 2,741 2,653 10.6 11.7 20.1 27.3 26.4

North Dakota 14 25 51 42 61 2.0 3.5 6.9 5.5 8.1

Ohio 1,141 1,096 1,229 1,348 1,599 9.9 9.5 10.6 11.6 13.8

Oklahoma 256 383 414 521 696 6.7 9.9 10.7 13.3 17.8

Oregon 424 527 582 783 810 10.9 13.4 14.7 19.4 20.1

Pennsylvania 1,349 1,486 1,523 1,788 2,037 10.6 11.6 11.9 14.0 15.9

Rhode Island 93 94 160 163 234 8.9 8.9 15.2 15.4 22.2

South Carolina 624 753 750 834 974 13.2 15.8 15.5 17.0 19.9

South Dakota 29 61 95 71 57 3.5 7.2 11.1 8.3 6.6

Tennessee 1,068 980 977 1,241 1,448 16.5 15.1 14.9 18.8 21.9

Texas 7,057 7,044 7,804 8,250 9,564 27.1 26.6 28.9 30.0 34.8

Utah 101 172 149 169 259 3.5 5.9 5.1 5.6 8.6

Vermont 12 10 12 15 37 1.9 1.6 1.9 2.4 5.9

Virginia 906 1,001 702 1,023 1,301 11.1 12.1 8.4 12.2 15.5

Washington 709 711 854 1,109 1,414 10.3 10.2 12.1 15.5 19.7

West Virginia 24 39 55 109 151 1.3 2.1 3.0 5.9 8.2

Wisconsin 268 257 285 262 423 4.7 4.5 5.0 4.5 7.3

Wyoming 12 9 6 10 17 2.1 1.5 1.0 1.7 2.9

U.S. TOTAL 49,915 56,484 63,453 74,707 88,042 15.9 17.9 19.9 23.2 27.4

Northeast 8,663 9,954 11,080 12,672 15,212 15.5 17.8 19.7 22.5 27.0

Midwest 6,261 7,378 7,963 8,785 10,556 9.3 10.9 11.8 12.9 15.5

South 23,626 25,381 28,180 33,125 37,356 20.1 21.4 23.5 27.3 30.8

West 11,365 13,771 16,230 20,125 24,918 15.4 18.5 21.6 26.5 32.8

Guam 27 24 13 22 13 16.9 15.0 8.1 13.6 8.0

Puerto Rico 704 811 960 1,267 1,184 19.2 22.4 27.1 36.5 34.1

Virgin Islands 2 9 6 25 2 1.9 8.6 5.8 24.3 1.9

OUTLYING AREAS 733 844 979 1,314 1,199 18.6 21.8 25.7 35.1 32.1

TOTAL 50,648 57,328 64,432 76,021 89,241 15.9 17.9 20.0 23.4 27.4

* See Section A1.9 in the Appendix for definition.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

89

Table 25. All Stages of Syphilis* — Reported Cases and Rates of Reported Cases in Selected Metropolitan 

Statistical Areas (MSAs)† in Alphabetical Order, United States, 2012–2016

Cases Rates per 100,000 Population

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Atlanta-Sandy Springs-Roswell, GA 1,822 2,257 2,669 3,105 3,219 33.4 40.9 47.5 54.4 56.4

Austin-Round Rock, TX 478 500 680 623 825 26.1 26.6 35.0 31.1 41.2

Baltimore-Columbia-Towson, MD 726 732 815 1,005 1,025 26.4 26.4 29.3 35.9 36.6

Birmingham-Hoover, AL 226 236 157 197 245‡ 19.9 20.7 13.7 17.2 21.4‡

Boston-Cambridge-Newton, MA-NH 570 758 596‡ 811‡ 997‡ 12.3 16.2 12.6‡ 17.0‡ 20.9‡

Buffalo-Cheektowaga-Niagara Falls, NY 70 115 130 180 141 6.2 10.1 11.4 15.9 12.4

Charlotte-Concord-Gastonia, NC-SC 310 360 530 731 848 13.5 15.4 22.3 30.1 34.9

Chicago-Naperville-Elgin, IL-IN-WI 2,269 2,499 2,559 3,060 3,805 23.8 26.2 26.8 32.0 39.8

Cincinnati, OH-KY-IN 529 437 381 319 268 24.9 20.4 17.7 14.8 12.4

Cleveland-Elyria, OH 140 111 199 229 376 6.8 5.4 9.6 11.1 18.2

Columbus, OH 316 342 441 517 578 16.3 17.4 22.1 25.6 28.6

Dallas-Fort Worth-Arlington, TX 2,141 2,093 2,231 2,261 2,661 32.0 30.7 32.1 31.8 37.5

Denver-Aurora-Lakewood, CO 434 382 298 426 552 16.4 14.2 10.8 15.1 19.6

Detroit-Warren-Dearborn, MI 607 830 791 773 738 14.1 19.3 18.4 18.0 17.2

Hartford-West Hartford-East Hartford, CT 21 43 52 84 55 1.7 3.5 4.3 6.9 4.5

Houston-The Woodlands-Sugar Land, TX 2,246 1,891 2,316 2,568 2,817 36.4 30.0 35.7 38.6 42.3

Indianapolis-Carmel-Anderson, IN 336 340 285 408 415 17.4 17.4 14.5 20.5 20.9

Jacksonville, FL 177 189 270 435 445 12.8 13.6 19.0 30.0 30.7

Kansas City, MO-KS 164 320 406 365 434 8.0 15.6 19.6 17.5 20.8

Las Vegas-Henderson-Paradise, NV 403 438 830 826 1,194 20.1 21.6 40.1 39.1 56.5

Los Angeles-Long Beach-Anaheim, CA 3,540 4,537 4,738 5,812 7,095 27.1 34.6 35.7 43.6 53.2

Louisville-Jefferson County, KY-IN 201 210 239 270 379 16.1 16.6 18.8 21.1 29.6

Memphis, TN-MS-AR 591 578 475 575 760 44.0 43.1 35.4 42.8 56.5

Miami-Fort Lauderdale-West Palm Beach, FL 2,591 2,740 3,313 3,635 4,093 45.0 47.0 55.9 60.5 68.1

Milwaukee-Waukesha-West Allis, WI 159 153 184 147 228 10.1 9.7 11.7 9.3 14.5

Minneapolis-St. Paul-Bloomington, MN-WI 313 487 585 592 742 9.1 14.1 16.7 16.8 21.1

Nashville-Davidson-Murfreesboro-Franklin, TN 271 239 305 359 383 15.7 13.6 17.0 19.6 20.9

New Orleans-Metairie, LA 547 634 723 757 843 44.6 51.1 57.8 59.9 66.8

New York-Newark-Jersey City, NY-NJ-PA 5,670 6,506 7,476 8,166 10,103 28.6 32.6 37.2 40.5 50.1

Oklahoma City, OK 148 213 231 264 406 11.4 16.1 17.3 19.4 29.9

Orlando-Kissimmee-Sanford, FL 499 631 782 915 1,183 22.4 27.8 33.7 38.3 49.6

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 1,119 1,333 1,273 1,393 1,646 18.6 22.1 21.0 22.9 27.1

Phoenix-Mesa-Scottsdale, AZ 624 713 1,065 1,125 1,501 14.4 16.2 23.7 24.6 32.8

Pittsburgh, PA 128 95 154 273 236 5.4 4.0 6.5 11.6 10.0

Portland-Vancouver-Hillsboro, OR-WA 410 475 470 587 650 17.9 20.5 20.0 24.6 27.2

Providence-Warwick, RI-MA 125 138 204‡ 230‡ 288‡ 7.8 8.6 12.7‡ 14.3‡ 17.9‡

Raleigh, NC 150 179 315 409 381 12.6 14.7 25.3 32.1 29.9

Richmond, VA 194 204 145 207 305 15.7 16.4 11.5 16.3 24.0

Riverside-San Bernardino-Ontario, CA 775 803 950 1,165 1,554 17.8 18.3 21.4 26.0 34.6

Sacramento-Roseville-Arden-Arcade, CA 249 289 371 607 609 11.3 13.0 16.5 26.7 26.8

Salt Lake City, UT 74 136 109 122 187 6.6 11.9 9.5 10.4 16.0

San Antonio-New Braunfels, TX 983 1,167 1,017 988 1,126 44.0 51.2 43.7 41.4 47.2

San Diego-Carlsbad, CA 717 792 987 1,208 1,419 22.6 24.7 30.2 36.6 43.0

San Francisco-Oakland-Hayward, CA 1,595 1,892 2,106 2,352 2,419 35.8 41.9 45.8 50.5 52.0

San Jose-Sunnyvale-Santa Clara, CA 233 276 304 359 501 12.3 14.4 15.6 18.2 25.3

Seattle-Tacoma-Bellevue, WA 559 539 590 759 968 15.7 14.9 16.1 20.3 25.9

St. Louis, MO-IL 280 338 412 417 528 10.0 12.1 14.7 14.8 18.8

Tampa-St. Petersburg-Clearwater, FL 582 632 806 956 1,128 20.5 22.0 27.6 32.1 37.9

Virginia Beach-Norfolk-Newport News, VA-NC 296 302 220 375 516 17.4 17.7 12.8 21.7 29.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 1,374 1,543 811 1,057 1,104 23.4 25.9 13.4 17.3 18.1

SELECTED MSAs TOTAL 38,982 43,647 47,996 55,004 64,919 22.8 25.3 27.4 31.1 36.7

* See Section A1.9 in the Appendix for definition.

†

 MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

‡

 The variable used to identify county, which is used to classify cases into MSAs, was complete for ≤95% of cases in a state contributing data to this MSA. 

See Appendix A1.4 for more information.
90

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

Table 26. Primary and Secondary Syphilis — Reported Cases and Rates of Reported Cases by State, Ranked by 

Rates, United States, 2016

Rank* State Cases Rate per 100,000 Population

1 Louisiana 750 16.1

2 Nevada 444 15.4

3 California 5,891 15.0

4 Georgia 1,350 13.2

5 New York 2,455 12.4

6 Florida 2,406 11.9

7 Mississippi 326 10.9

8 North Carolina 1,082 10.8

9 Arizona 721 10.6

10 Illinois 1,260 9.8

11 New Mexico 189 9.1

U.S. TOTAL† 27,814 8.7

12 Rhode Island 90 8.5

13 Maryland 509 8.5

14 Oregon 327 8.1

15 Washington 565 7.9

16 Hawaii 112 7.8

17 Alabama 376 7.7

18 Massachusetts 489 7.2

19 Texas 1,955 7.1

20 Oklahoma 264 6.7

21 Missouri 400 6.6

22 South Carolina 316 6.5

23 Ohio 716 6.2

24 Delaware 58 6.1

25 Tennessee 390 5.9

26 Pennsylvania 755 5.9

27 Minnesota 306 5.6

28 Virginia 459 5.5

29 New Jersey 472 5.3

30 Arkansas 150 5.0

31 Kentucky 219 4.9

32 Indiana 326 4.9

33 Colorado 250 4.6

34 North Dakota 33 4.4

35 Kansas 124 4.3

36 Michigan 365 3.7

37 Vermont 23 3.7

38 Nebraska 67 3.5

39 Maine 42 3.2

40 Utah 92 3.1

41 Connecticut 110 3.1

42 South Dakota 26 3.0

43 Idaho 50 3.0

44 New Hampshire 40 3.0

45 West Virginia 53 2.9

46 Iowa 89 2.8

47 Wisconsin 132 2.3

48 Montana 14 1.4

49 Wyoming 7 1.2

50 Alaska 8 1.1

* 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 161 cases and a rate of 24.0, but excludes outlying areas (Guam with 2 cases and rate of 1.2, 

Puerto Rico with 493 cases and rate of 14.2, and Virgin Islands with 0 cases and rate of 0.0).
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

91

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, 2012–2016

Cases Rates per 100,000 Population

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Alabama 216 183 161 280 376 4.5 3.8 3.3 5.8 7.7

Alaska 11 23 15 8 8 1.5 3.1 2.0 1.1 1.1

Arizona 202 287 577 589 721 3.1 4.3 8.6 8.6 10.6

Arkansas 173 177 121 134 150 5.9 6.0 4.1 4.5 5.0

California 2,953 3,532 3,835 4,908 5,891 7.8 9.2 9.9 12.5 15.0

Colorado 208 163 186 245 250 4.0 3.1 3.5 4.5 4.6

Connecticut 55 56 86 92 110 1.5 1.6 2.4 2.6 3.1

Delaware 38 52 47 41 58 4.1 5.6 5.0 4.3 6.1

District of Columbia 165 168 116 95 161 26.1 26.0 17.6 14.1 24.0

Florida 1,369 1,513 1,740 2,083 2,406 7.1 7.7 8.7 10.3 11.9

Georgia 937 1,017 1,234 1,413 1,350 9.4 10.2 12.2 13.8 13.2

Hawaii 23 46 68 91 112 1.7 3.3 4.8 6.4 7.8

Idaho 26 15 12 57 50 1.6 0.9 0.7 3.4 3.0

Illinois 804 798 863 1,085 1,260 6.2 6.2 6.7 8.4 9.8

Indiana 224 215 168 285 326 3.4 3.3 2.5 4.3 4.9

Iowa 70 106 72 75 89 2.3 3.4 2.3 2.4 2.8

Kansas 24 51 60 87 124 0.8 1.8 2.1 3.0 4.3

Kentucky 150 122 158 145 219 3.4 2.8 3.6 3.3 4.9

Louisiana 339 423 575 696 750 7.4 9.1 12.4 14.9 16.1

Maine 17 10 16 28 42 1.3 0.8 1.2 2.1 3.2

Maryland 431 456 449 509 509 7.3 7.7 7.5 8.5 8.5

Massachusetts 316 360 301 418 489 4.8 5.4 4.5 6.2 7.2

Michigan 295 487 421 403 365 3.0 4.9 4.2 4.1 3.7

Minnesota 118 193 257 246 306 2.2 3.6 4.7 4.5 5.6

Mississippi 150 78 189 219 326 5.0 2.6 6.3 7.3 10.9

Missouri 157 251 352 307 400 2.6 4.2 5.8 5.0 6.6

Montana 2 5 8 13 14 0.2 0.5 0.8 1.3 1.4

Nebraska 8 41 50 45 67 0.4 2.2 2.7 2.4 3.5

Nevada 113 205 357 335 444 4.1 7.3 12.6 11.6 15.4

New Hampshire 36 28 36 40 40 2.7 2.1 2.7 3.0 3.0

New Jersey 229 233 297 372 472 2.6 2.6 3.3 4.2 5.3

New Mexico 101 78 126 118 189 4.8 3.7 6.0 5.7 9.1

New York 1,224 1,459 1,727 2,006 2,455 6.3 7.4 8.7 10.1 12.4

North Carolina 347 404 733 1,196 1,082 3.6 4.1 7.4 11.9 10.8

North Dakota 4 12 13 11 33 0.6 1.7 1.8 1.5 4.4

Ohio 425 436 568 560 716 3.7 3.8 4.9 4.8 6.2

Oklahoma 83 118 151 209 264 2.2 3.1 3.9 5.3 6.7

Oregon 212 267 272 345 327 5.4 6.8 6.9 8.6 8.1

Pennsylvania 494 471 532 655 755 3.9 3.7 4.2 5.1 5.9

Rhode Island 44 45 71 77 90 4.2 4.3 6.7 7.3 8.5

South Carolina 225 271 250 294 316 4.8 5.7 5.2 6.0 6.5

South Dakota 18 44 53 39 26 2.2 5.2 6.2 4.5 3.0

Tennessee 266 214 237 349 390 4.1 3.3 3.6 5.3 5.9

Texas 1,627 1,475 1,636 1,680 1,955 6.2 5.6 6.1 6.1 7.1

Utah 42 74 47 65 92 1.5 2.6 1.6 2.2 3.1

Vermont 6 3 5 9 23 1.0 0.5 0.8 1.4 3.7

Virginia 285 315 289 334 459 3.5 3.8 3.5 4.0 5.5

Washington 302 284 344 445 565 4.4 4.1 4.9 6.2 7.9

West Virginia 8 15 28 52 53 0.4 0.8 1.5 2.8 2.9

Wisconsin 91 95 86 79 132 1.6 1.7 1.5 1.4 2.3

Wyoming 4 1 4 5 7 0.7 0.2 0.7 0.9 1.2

U.S. TOTAL 15,667 17,375 19,999 23,872 27,814 5.0 5.5 6.3 7.4 8.7

Northeast 2,421 2,665 3,071 3,697 4,476 4.3 4.8 5.5 6.6 8.0

Midwest 2,238 2,729 2,963 3,222 3,844 3.3 4.0 4.4 4.7 5.7

South 6,809 7,001 8,114 9,729 10,824 5.8 5.9 6.8 8.0 8.9

West 4,199 4,980 5,851 7,224 8,670 5.7 6.7 7.8 9.5 11.4

Guam 6 6 7 2 2 3.8 3.7 4.3 1.2 1.2

Puerto Rico 306 385 484 531 493 8.3 10.6 13.6 15.3 14.2

Virgin Islands 0 2 2 8 0 0.0 1.9 1.9 7.8 0.0

OUTLYING AREAS 312 393 493 541 495 7.9 10.1 12.9 14.5 13.2

TOTAL 15,979 17,768 20,492 24,413 28,309 5.0 5.6 6.4 7.5 8.7
92

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

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, 2012–2016

Cases Rates per 100,000 Population

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Alabama 38 22 17 37 80 1.5 0.9 0.7 1.5 3.2

Alaska 1 2 1 1 0 0.3 0.6 0.3 0.3 0.0

Arizona 16 27 50 47 80 0.5 0.8 1.5 1.4 2.3

Arkansas 49 44 23 26 37 3.3 2.9 1.5 1.7 2.4

California 116 210 318 476 744 0.6 1.1 1.6 2.4 3.8

Colorado 3 4 6 6 16 0.1 0.2 0.2 0.2 0.6

Connecticut 9 8 7 15 12 0.5 0.4 0.4 0.8 0.7

Delaware 2 3 2 2 3 0.4 0.6 0.4 0.4 0.6

District of Columbia 6 19 5 6 5 1.8 5.6 1.4 1.7 1.4

Florida 134 137 137 210 266 1.4 1.4 1.3 2.0 2.6

Georgia 66 87 96 94 113 1.3 1.7 1.9 1.8 2.2

Hawaii 2 0 2 1 10 0.3 0.0 0.3 0.1 1.4

Idaho 2 0 0 9 6 0.3 0.0 0.0 1.1 0.7

Illinois 73 66 81 84 95 1.1 1.0 1.2 1.3 1.5

Indiana 22 18 11 28 36 0.7 0.5 0.3 0.8 1.1

Iowa 7 10 6 5 6 0.5 0.6 0.4 0.3 0.4

Kansas 2 4 14 17 12 0.1 0.3 1.0 1.2 0.8

Kentucky 13 17 22 23 21 0.6 0.8 1.0 1.0 0.9

Louisiana 127 115 132 189 192 5.4 4.9 5.6 7.9 8.0

Maine 2 1 3 6 3 0.3 0.1 0.4 0.9 0.4

Maryland 45 61 49 58 54 1.5 2.0 1.6 1.9 1.7

Massachusetts 15 17 23 25 24 0.4 0.5 0.7 0.7 0.7

Michigan 30 29 31 34 31 0.6 0.6 0.6 0.7 0.6

Minnesota 7 12 21 39 37 0.3 0.4 0.8 1.4 1.3

Mississippi 34 19 17 32 58 2.2 1.2 1.1 2.1 3.8

Missouri 12 19 34 54 66 0.4 0.6 1.1 1.7 2.1

Montana 0 1 2 1 1 0.0 0.2 0.4 0.2 0.2

Nebraska 1 4 4 3 5 0.1 0.4 0.4 0.3 0.5

Nevada 4 14 23 23 50 0.3 1.0 1.6 1.6 3.5

New Hampshire 0 1 4 3 4 0.0 0.1 0.6 0.4 0.6

New Jersey 19 13 16 26 24 0.4 0.3 0.3 0.6 0.5

New Mexico 9 20 14 11 27 0.9 1.9 1.3 1.0 2.6

New York 45 44 49 59 115 0.4 0.4 0.5 0.6 1.1

North Carolina 37 36 68 112 109 0.7 0.7 1.3 2.2 2.1

North Dakota 0 1 5 0 3 0.0 0.3 1.4 0.0 0.8

Ohio 85 63 76 68 94 1.4 1.1 1.3 1.1 1.6

Oklahoma 6 13 15 21 41 0.3 0.7 0.8 1.1 2.1

Oregon 6 12 22 35 35 0.3 0.6 1.1 1.7 1.7

Pennsylvania 34 26 47 52 62 0.5 0.4 0.7 0.8 0.9

Rhode Island 1 1 5 4 3 0.2 0.2 0.9 0.7 0.6

South Carolina 34 39 23 37 52 1.4 1.6 0.9 1.5 2.1

South Dakota 1 15 34 7 6 0.2 3.6 8.0 1.6 1.4

Tennessee 31 22 34 23 56 0.9 0.7 1.0 0.7 1.7

Texas 269 179 242 230 230 2.1 1.3 1.8 1.7 1.7

Utah 0 2 1 2 6 0.0 0.1 0.1 0.1 0.4

Vermont 0 0 0 0 3 0.0 0.0 0.0 0.0 0.9

Virginia 21 17 17 17 47 0.5 0.4 0.4 0.4 1.1

Washington 9 13 18 30 51 0.3 0.4 0.5 0.8 1.4

West Virginia 2 4 6 9 10 0.2 0.4 0.6 1.0 1.1

Wisconsin 11 9 7 0 7 0.4 0.3 0.2 0.0 0.2

Wyoming 0 0 0 1 1 0.0 0.0 0.0 0.3 0.3

U.S. TOTAL 1,458 1,500 1,840 2,298 3,049 0.9 0.9 1.1 1.4 1.9

Northeast 125 111 154 190 250 0.4 0.4 0.5 0.7 0.9

Midwest 251 250 324 339 398 0.7 0.7 0.9 1.0 1.2

South 914 834 905 1,126 1,374 1.5 1.4 1.5 1.8 2.2

West 168 305 457 643 1,027 0.5 0.8 1.2 1.7 2.7

Guam 1 5 2 0 0 1.3 6.3 2.5 0.0 0.0

Puerto Rico 20 35 30 70 86 1.0 1.9 1.6 3.9 4.7

Virgin Islands 0 1 1 4 0 0.0 1.8 1.8 7.3 0.0

OUTLYING AREAS 21 41 33 74 86 1.0 2.0 1.7 3.8 4.4

TOTAL 1,479 1,541 1,873 2,372 3,135 0.9 0.9 1.1 1.4 1.9

NOTE: Cases reported with unknown sex are not included in this table.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

93

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, 2012–2016

Cases Rates per 100,000 Population

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Alabama 178 161 144 243 296 7.6 6.9 6.1 10.3 12.6

Alaska 10 21 14 7 8 2.6 5.4 3.6 1.8 2.1

Arizona 186 260 527 542 641 5.7 7.9 15.8 16.0 18.9

Arkansas 124 133 98 108 113 8.6 9.1 6.7 7.4 7.7

California 2,823 3,319 3,515 4,430 5,143 14.9 17.4 18.2 22.8 26.5

Colorado 205 159 180 239 234 7.9 6.0 6.7 8.7 8.5

Connecticut 46 48 79 77 98 2.6 2.7 4.5 4.4 5.6

Delaware 36 49 45 39 55 8.1 10.9 9.9 8.5 12.0

District of Columbia 159 149 106 83 152 53.2 48.7 33.9 26.1 47.7

Florida 1,235 1,376 1,602 1,873 2,140 13.1 14.4 16.5 18.9 21.6

Georgia 870 930 1,138 1,319 1,237 17.9 19.1 23.1 26.5 24.8

Hawaii 21 46 66 90 102 3.0 6.5 9.2 12.4 14.1

Idaho 24 15 12 48 44 3.0 1.9 1.5 5.8 5.3

Illinois 731 731 782 1,001 1,165 11.6 11.6 12.4 15.9 18.4

Indiana 202 197 157 257 290 6.3 6.1 4.8 7.9 8.9

Iowa 63 96 66 70 83 4.1 6.3 4.3 4.5 5.3

Kansas 22 47 46 70 112 1.5 3.3 3.2 4.8 7.7

Kentucky 137 105 136 122 198 6.3 4.9 6.3 5.6 9.1

Louisiana 212 308 443 507 558 9.4 13.6 19.5 22.2 24.4

Maine 15 9 13 22 39 2.3 1.4 2.0 3.4 6.0

Maryland 386 395 400 451 455 13.5 13.7 13.8 15.5 15.6

Massachusetts 301 343 277 391 464 9.3 10.6 8.5 11.9 14.1

Michigan 265 458 390 369 334 5.5 9.4 8.0 7.6 6.8

Minnesota 111 178 235 207 267 4.2 6.6 8.7 7.6 9.8

Mississippi 116 59 172 187 268 8.0 4.1 11.8 12.9 18.5

Missouri 145 232 318 253 334 4.9 7.8 10.7 8.5 11.2

Montana 2 4 6 12 13 0.4 0.8 1.2 2.3 2.5

Nebraska 7 37 46 42 62 0.8 4.0 4.9 4.4 6.6

Nevada 109 191 334 312 394 7.8 13.6 23.4 21.5 27.2

New Hampshire 36 27 32 37 36 5.5 4.1 4.9 5.6 5.5

New Jersey 210 220 281 346 448 4.9 5.1 6.4 7.9 10.2

New Mexico 92 58 112 107 162 8.9 5.6 10.8 10.4 15.7

New York 1,175 1,408 1,675 1,933 2,319 12.4 14.8 17.5 20.1 24.1

North Carolina 310 368 665 1,084 973 6.5 7.7 13.7 22.2 19.9

North Dakota 4 11 8 11 30 1.1 3.0 2.1 2.8 7.7

Ohio 340 373 492 492 622 6.0 6.6 8.7 8.7 10.9

Oklahoma 77 105 136 188 223 4.1 5.5 7.1 9.7 11.5

Oregon 206 255 250 310 292 10.7 13.1 12.7 15.6 14.7

Pennsylvania 460 445 485 602 693 7.4 7.1 7.8 9.6 11.1

Rhode Island 43 44 66 73 87 8.5 8.6 12.9 14.3 17.0

South Carolina 191 232 227 257 264 8.3 10.0 9.7 10.8 11.1

South Dakota 17 29 19 32 20 4.1 6.8 4.4 7.4 4.6

Tennessee 235 192 203 326 334 7.5 6.1 6.4 10.1 10.4

Texas 1,358 1,296 1,394 1,450 1,725 10.5 9.9 10.4 10.6 12.6

Utah 42 72 46 63 86 2.9 4.9 3.1 4.2 5.7

Vermont 6 3 5 9 20 1.9 1.0 1.6 2.9 6.5

Virginia 264 298 272 316 403 6.6 7.3 6.6 7.7 9.8

Washington 293 271 326 414 514 8.5 7.8 9.2 11.5 14.3

West Virginia 6 11 22 43 43 0.7 1.2 2.4 4.7 4.7

Wisconsin 80 86 79 79 125 2.8 3.0 2.8 2.8 4.4

Wyoming 4 1 4 4 6 1.4 0.3 1.3 1.3 2.0

U.S. TOTAL 14,190 15,861 18,146 21,547 24,724 9.2 10.2 11.6 13.6 15.6

Northeast 2,292 2,547 2,913 3,490 4,204 8.4 9.3 10.7 12.7 15.3

Midwest 1,987 2,475 2,638 2,883 3,444 6.0 7.4 7.9 8.6 10.3

South 5,894 6,167 7,203 8,596 9,437 10.2 10.6 12.3 14.5 15.9

West 4,017 4,672 5,392 6,578 7,639 10.9 12.6 14.4 17.4 20.2

Guam 5 1 5 2 2 6.2 1.2 6.1 2.4 2.4

Puerto Rico 286 350 454 461 407 16.3 20.2 26.6 27.8 24.6

Virgin Islands 0 1 1 4 0 0.0 2.0 2.1 8.4 0.0

OUTLYING AREAS 291 352 460 467 409 15.4 18.9 25.1 26.1 22.9

TOTAL 14,481 16,213 18,606 22,014 25,133 9.3 10.3 11.7 13.8 15.7

NOTE: Cases reported with unknown sex are not included in this table.
94

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

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

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2012–2016

Cases Rates per 100,000 Population

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Atlanta-Sandy Springs-Roswell, GA 745 789 996 1,097 1,018 13.7 14.3 17.7 19.2 17.8

Austin-Round Rock, TX 154 145 227 203 317 8.4 7.7 11.7 10.1 15.8

Baltimore-Columbia-Towson, MD 307 288 282 343 332 11.2 10.4 10.1 12.3 11.9

Birmingham-Hoover, AL 73 69 58 74 115 6.4 6.1 5.1 6.5 10.0

Boston-Cambridge-Newton, MA-NH 204 268 227 271† 320† 4.4 5.7 4.8 5.7† 6.7†

Buffalo-Cheektowaga-Niagara Falls, NY 27 38 49 92 63 2.4 3.4 4.3 8.1 5.5

Charlotte-Concord-Gastonia, NC-SC 116 134 220 333 378 5.1 5.7 9.2 13.7 15.6

Chicago-Naperville-Elgin, IL-IN-WI 759 763 811 1,047 1,202 8.0 8.0 8.5 11.0 12.6

Cincinnati, OH-KY-IN 166 166 153 93 81 7.8 7.8 7.1 4.3 3.8

Cleveland-Elyria, OH 44 32 80 72 156 2.1 1.5 3.9 3.5 7.6

Columbus, OH 159 167 250 274 316 8.2 8.5 12.5 13.6 15.6

Dallas-Fort Worth-Arlington, TX 391 445 508 476 542 5.8 6.5 7.3 6.7 7.6

Denver-Aurora-Lakewood, CO 183 135 153 192 187 6.9 5.0 5.6 6.8 6.6

Detroit-Warren-Dearborn, MI 235 394 317 284 253 5.5 9.2 7.4 6.6 5.9

Hartford-West Hartford-East Hartford, CT 9 14 26 44 32 0.7 1.2 2.1 3.6 2.6

Houston-The Woodlands-Sugar Land, TX 537 363 414 439 411 8.7 5.7 6.4 6.6 6.2

Indianapolis-Carmel-Anderson, IN 150 146 109 172 158 7.8 7.5 5.5 8.6 7.9

Jacksonville, FL 44 40 69 91 118 3.2 2.9 4.9 6.3 8.1

Kansas City, MO-KS 65 155 220 191 201 3.2 7.5 10.6 9.1 9.6

Las Vegas-Henderson-Paradise, NV 97 164 318 305 398 4.8 8.1 15.4 14.4 18.8

Los Angeles-Long Beach-Anaheim, CA 1,049 1,299 1,407 1,832 2,123 8.0 9.9 10.6 13.7 15.9

Louisville-Jefferson County, KY-IN 81 71 83 87 149 6.5 5.6 6.5 6.8 11.7

Memphis, TN-MS-AR 110 105 94 121 173 8.2 7.8 7.0 9.0 12.9

Miami-Fort Lauderdale-West Palm Beach, FL 705 762 821 884 925 12.2 13.1 13.8 14.7 15.4

Milwaukee-Waukesha-West Allis, WI 43 54 52 39 50 2.7 3.4 3.3 2.5 3.2

Minneapolis-St. Paul-Bloomington, MN-WI 116 181 243 228 261 3.4 5.2 7.0 6.5 7.4

Nashville-Davidson-Murfreesboro-Franklin, TN 88 57 74 116 115 5.1 3.2 4.1 6.3 6.3

New Orleans-Metairie, LA 66 103 221 218 235 5.4 8.3 17.7 17.3 18.6

New York-Newark-Jersey City, NY-NJ-PA 1,315 1,491 1,721 2,037 2,551 6.6 7.5 8.6 10.1 12.6

Oklahoma City, OK 54 78 91 113 162 4.2 5.9 6.8 8.3 11.9

Orlando-Kissimmee-Sanford, FL 168 201 239 299 384 7.6 8.9 10.3 12.5 16.1

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 369 396 446 458 639 6.1 6.6 7.4 7.5 10.5

Phoenix-Mesa-Scottsdale, AZ 162 219 416 452 574 3.7 5.0 9.3 9.9 12.5

Pittsburgh, PA 61 39 78 150 100 2.6 1.7 3.3 6.4 4.2

Portland-Vancouver-Hillsboro, OR-WA 209 240 206 261 263 9.1 10.4 8.8 10.9 11.0

Providence-Warwick, RI-MA 58 65 93 111† 115† 3.6 4.1 5.8 6.9† 7.1†

Raleigh, NC 56 70 129 168 137 4.7 5.8 10.4 13.2 10.8

Richmond, VA 64 70 68 73 104 5.2 5.6 5.4 5.7 8.2

Riverside-San Bernardino-Ontario, CA 166 203 288 341 445 3.8 4.6 6.5 7.6 9.9

Sacramento-Roseville-Arden-Arcade, CA 151 147 162 265 272 6.9 6.6 7.2 11.7 12.0

Salt Lake City, UT 34 65 39 49 69 3.0 5.7 3.4 4.2 5.9

San Antonio-New Braunfels, TX 329 310 247 237 243 14.7 13.6 10.6 9.9 10.2

San Diego-Carlsbad, CA 331 333 371 493 524 10.4 10.4 11.4 14.9 15.9

San Francisco-Oakland-Hayward, CA 744 814 767 830 872 16.7 18.0 16.7 17.8 18.7

San Jose-Sunnyvale-Santa Clara, CA 105 146 120 134 222 5.5 7.6 6.1 6.8 11.2

Seattle-Tacoma-Bellevue, WA 248 211 235 311 397 7.0 5.8 6.4 8.3 10.6

St. Louis, MO-IL 95 108 153 112 215 3.4 3.9 5.5 4.0 7.6

Tampa-St. Petersburg-Clearwater, FL 230 226 320 393 436 8.1 7.9 11.0 13.2 14.7

Virginia Beach-Norfolk-Newport News, VA-NC 106 102 85 117 206 6.2 6.0 5.0 6.8 11.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 358 418 226 230 273 6.1 7.0 3.7 3.8 4.5

SELECTED MSAs TOTAL 12,136 13,299 14,982 17,252 19,832 7.1 7.7 8.6 9.8 11.2

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

†

 The variable used to identify county, which is used to classify cases into MSAs, was complete for ≤95% of cases in a state contributing data to this MSA. 

See Appendix A1.4 for more information.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

95

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, 2012–2016

Cases Rates per 100,000 Population

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Atlanta-Sandy Springs-Roswell, GA 33 52 58 61 61 1.2 1.8 2.0 2.1 2.1

Austin-Round Rock, TX 8 6 14 16 17 0.9 0.6 1.4 1.6 1.7

Baltimore-Columbia-Towson, MD 39 46 42 49 46 2.7 3.2 2.9 3.4 3.2

Birmingham-Hoover, AL 7 5 5 8 25 1.2 0.8 0.8 1.3 4.2

Boston-Cambridge-Newton, MA-NH 5 10 14 13† 9† 0.2 0.4 0.6 0.5† 0.4†

Buffalo-Cheektowaga-Niagara Falls, NY 1 2 1 0 1 0.2 0.3 0.2 0.0 0.2

Charlotte-Concord-Gastonia, NC-SC 15 6 6 16 25 1.3 0.5 0.5 1.3 2.0

Chicago-Naperville-Elgin, IL-IN-WI 77 65 76 86 88 1.6 1.3 1.6 1.8 1.8

Cincinnati, OH-KY-IN 63 31 33 21 11 5.8 2.8 3.0 1.9 1.0

Cleveland-Elyria, OH 5 2 5 1 12 0.5 0.2 0.5 0.1 1.1

Columbus, OH 14 18 34 27 48 1.4 1.8 3.4 2.6 4.7

Dallas-Fort Worth-Arlington, TX 56 41 63 56 62 1.6 1.2 1.8 1.6 1.7

Denver-Aurora-Lakewood, CO 3 3 4 6 11 0.2 0.2 0.3 0.4 0.8

Detroit-Warren-Dearborn, MI 27 25 23 26 26 1.2 1.1 1.0 1.2 1.2

Hartford-West Hartford-East Hartford, CT 3 0 2 9 2 0.5 0.0 0.3 1.5 0.3

Houston-The Woodlands-Sugar Land, TX 97 59 64 58 49 3.1 1.9 2.0 1.7 1.5

Indianapolis-Carmel-Anderson, IN 10 9 5 12 15 1.0 0.9 0.5 1.2 1.5

Jacksonville, FL 4 5 9 8 26 0.6 0.7 1.2 1.1 3.5

Kansas City, MO-KS 1 9 23 41 39 0.1 0.9 2.2 3.9 3.7

Las Vegas-Henderson-Paradise, NV 2 6 17 17 40 0.2 0.6 1.6 1.6 3.8

Los Angeles-Long Beach-Anaheim, CA 26 50 67 108 144 0.4 0.8 1.0 1.6 2.1

Louisville-Jefferson County, KY-IN 9 11 14 10 12 1.4 1.7 2.2 1.5 1.8

Memphis, TN-MS-AR 22 17 22 13 25 3.2 2.4 3.1 1.9 3.6

Miami-Fort Lauderdale-West Palm Beach, FL 63 65 44 75 66 2.1 2.2 1.4 2.4 2.1

Milwaukee-Waukesha-West Allis, WI 5 5 6 0 1 0.6 0.6 0.7 0.0 0.1

Minneapolis-St. Paul-Bloomington, MN-WI 7 9 19 37 31 0.4 0.5 1.1 2.1 1.7

Nashville-Davidson-Murfreesboro-Franklin, TN 1 4 5 4 12 0.1 0.4 0.5 0.4 1.3

New Orleans-Metairie, LA 9 10 18 29 25 1.4 1.6 2.8 4.4 3.8

New York-Newark-Jersey City, NY-NJ-PA 57 46 52 69 123 0.6 0.4 0.5 0.7 1.2

Oklahoma City, OK 1 5 7 14 27 0.2 0.7 1.0 2.0 3.9

Orlando-Kissimmee-Sanford, FL 15 9 8 14 21 1.3 0.8 0.7 1.1 1.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 30 24 39 43 49 1.0 0.8 1.2 1.4 1.6

Phoenix-Mesa-Scottsdale, AZ 14 22 42 39 56 0.6 1.0 1.9 1.7 2.4

Pittsburgh, PA 5 2 6 11 11 0.4 0.2 0.5 0.9 0.9

Portland-Vancouver-Hillsboro, OR-WA 9 9 9 19 20 0.8 0.8 0.8 1.6 1.7

Providence-Warwick, RI-MA 1 3 8 8† 6† 0.1 0.4 1.0 1.0† 0.7†

Raleigh, NC 5 9 6 13 10 0.8 1.4 0.9 2.0 1.5

Richmond, VA 10 4 2 4 15 1.6 0.6 0.3 0.6 2.3

Riverside-San Bernardino-Ontario, CA 3 7 15 17 47 0.1 0.3 0.7 0.8 2.1

Sacramento-Roseville-Arden-Arcade, CA 5 10 11 26 34 0.4 0.9 1.0 2.2 2.9

Salt Lake City, UT 0 1 1 1 5 0.0 0.2 0.2 0.2 0.9

San Antonio-New Braunfels, TX 59 44 47 43 43 5.2 3.8 4.0 3.6 3.6

San Diego-Carlsbad, CA 12 10 20 17 20 0.8 0.6 1.2 1.0 1.2

San Francisco-Oakland-Hayward, CA 28 40 34 46 50 1.2 1.7 1.5 2.0 2.1

San Jose-Sunnyvale-Santa Clara, CA 3 9 12 10 32 0.3 0.9 1.2 1.0 3.3

Seattle-Tacoma-Bellevue, WA 6 10 10 6 15 0.3 0.6 0.5 0.3 0.8

St. Louis, MO-IL 9 6 17 14 24 0.6 0.4 1.2 1.0 1.7

Tampa-St. Petersburg-Clearwater, FL 29 31 41 44 48 2.0 2.1 2.7 2.9 3.1

Virginia Beach-Norfolk-Newport News, VA-NC 5 5 8 5 22 0.6 0.6 0.9 0.6 2.5

Washington-Arlington-Alexandria, DC-VA-MD-WV 15 35 7 10 8 0.5 1.2 0.2 0.3 0.3

SELECTED MSAs TOTAL 933 912 1,095 1,280 1,615 1.1 1.0 1.2 1.4 1.8

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

†

 The variable used to identify county, which is used to classify cases into MSAs, was complete for ≤95% of cases in a state contributing data to this MSA. 

See Appendix A1.4 for more information.

NOTE: Cases reported with unknown sex are not included in this table.
96

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

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, 2012–2016

Cases Rates per 100,000 Population

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Atlanta-Sandy Springs-Roswell, GA 712 737 938 1,036 957 26.8 27.5 34.5 37.5 34.6

Austin-Round Rock, TX 146 139 213 187 300 15.9 14.7 21.9 18.7 30.0

Baltimore-Columbia-Towson, MD 268 242 240 294 286 20.2 18.1 17.9 21.8 21.2

Birmingham-Hoover, AL 66 64 53 66 90 12.1 11.6 9.6 12.0 16.3

Boston-Cambridge-Newton, MA-NH 199 258 213 257† 311† 8.8 11.4 9.3 11.1† 13.4†

Buffalo-Cheektowaga-Niagara Falls, NY 26 36 48 92 62 4.7 6.6 8.7 16.7 11.3

Charlotte-Concord-Gastonia, NC-SC 101 128 214 317 353 9.0 11.3 18.5 26.9 30.0

Chicago-Naperville-Elgin, IL-IN-WI 682 697 735 961 1,114 14.6 14.9 15.7 20.6 23.8

Cincinnati, OH-KY-IN 103 135 120 72 70 9.9 12.9 11.4 6.8 6.6

Cleveland-Elyria, OH 39 30 75 71 144 3.9 3.0 7.5 7.1 14.5

Columbus, OH 145 149 216 247 268 15.2 15.4 22.0 24.8 26.9

Dallas-Fort Worth-Arlington, TX 335 404 445 420 480 10.1 12.0 13.0 12.0 13.7

Denver-Aurora-Lakewood, CO 180 132 149 186 176 13.7 9.8 10.9 13.3 12.5

Detroit-Warren-Dearborn, MI 208 369 294 258 227 10.0 17.7 14.1 12.3 10.9

Hartford-West Hartford-East Hartford, CT 6 14 24 35 30 1.0 2.4 4.1 5.9 5.1

Houston-The Woodlands-Sugar Land, TX 440 304 350 381 362 14.3 9.7 10.8 11.5 10.9

Indianapolis-Carmel-Anderson, IN 140 137 104 160 143 14.8 14.3 10.8 16.5 14.7

Jacksonville, FL 40 35 60 83 92 6.0 5.2 8.7 11.7 13.0

Kansas City, MO-KS 64 146 197 150 162 6.4 14.5 19.4 14.6 15.8

Las Vegas-Henderson-Paradise, NV 95 158 301 288 358 9.4 15.5 29.1 27.3 33.9

Los Angeles-Long Beach-Anaheim, CA 1,019 1,248 1,340 1,724 1,978 15.8 19.2 20.5 26.2 30.1

Louisville-Jefferson County, KY-IN 72 60 69 77 137 11.8 9.7 11.1 12.3 21.9

Memphis, TN-MS-AR 88 88 72 108 148 13.7 13.7 11.2 16.8 23.0

Miami-Fort Lauderdale-West Palm Beach, FL 642 697 777 809 859 23.0 24.6 27.0 27.8 29.5

Milwaukee-Waukesha-West Allis, WI 38 49 46 39 49 5.0 6.4 6.0 5.1 6.4

Minneapolis-St. Paul-Bloomington, MN-WI 109 169 223 191 228 6.4 9.9 12.9 10.9 13.1

Nashville-Davidson-Murfreesboro-Franklin, TN 87 53 69 112 103 10.3 6.2 7.9 12.5 11.5

New Orleans-Metairie, LA 57 93 203 189 210 9.6 15.4 33.5 31.0 34.4

New York-Newark-Jersey City, NY-NJ-PA 1,254 1,438 1,666 1,954 2,407 13.1 14.9 17.1 20.0 24.6

Oklahoma City, OK 53 73 84 99 135 8.3 11.2 12.8 14.8 20.2

Orlando-Kissimmee-Sanford, FL 153 192 231 285 363 14.1 17.3 20.4 24.4 31.1

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 339 372 407 415 590 11.7 12.8 13.9 14.1 20.1

Phoenix-Mesa-Scottsdale, AZ 148 197 374 413 518 6.9 9.0 16.8 18.2 22.8

Pittsburgh, PA 56 37 72 139 89 4.9 3.2 6.3 12.1 7.8

Portland-Vancouver-Hillsboro, OR-WA 200 231 197 242 243 17.7 20.2 17.0 20.5 20.6

Providence-Warwick, RI-MA 57 62 84 103† 109† 7.4 8.0 10.8 13.2† 13.9†

Raleigh, NC 51 61 123 155 127 8.8 10.3 20.3 24.9 20.4

Richmond, VA 54 66 66 69 87 9.1 11.0 10.8 11.2 14.2

Riverside-San Bernardino-Ontario, CA 163 196 273 324 398 7.5 9.0 12.4 14.5 17.8

Sacramento-Roseville-Arden-Arcade, CA 144 137 151 239 238 13.4 12.6 13.7 21.5 21.4

Salt Lake City, UT 34 64 38 48 64 6.0 11.2 6.6 8.2 10.9

San Antonio-New Braunfels, TX 270 266 200 194 200 24.5 23.7 17.4 16.5 17.0

San Diego-Carlsbad, CA 318 323 351 476 504 19.9 20.0 21.4 28.7 30.4

San Francisco-Oakland-Hayward, CA 713 773 731 783 820 32.4 34.7 32.3 34.1 35.7

San Jose-Sunnyvale-Santa Clara, CA 102 137 108 124 190 10.7 14.2 11.0 12.5 19.1

Seattle-Tacoma-Bellevue, WA 242 201 225 305 382 13.7 11.2 12.3 16.3 20.5

St. Louis, MO-IL 86 102 136 98 191 6.4 7.5 10.0 7.2 14.0

Tampa-St. Petersburg-Clearwater, FL 201 195 278 349 388 14.6 14.0 19.7 24.2 26.9

Virginia Beach-Norfolk-Newport News, VA-NC 101 97 77 112 178 12.1 11.5 9.1 13.2 20.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 343 383 219 219 264 12.0 13.2 7.4 7.4 8.9

SELECTED MSAs TOTAL 11,189 12,374 13,879 15,955 18,182 13.3 14.6 16.2 18.4 21.0

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

†

 The variable used to identify county, which is used to classify cases into MSAs, was complete for ≤95% of cases in a state contributing data to this MSA. 

See Appendix A1.4 for more information.

NOTE: Cases reported with unknown sex are not included in this table.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

97

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, 2016

Rank* County/Independent City Cases Rate per 100,000 Population Cumulative Percentage

1 Los Angeles County, CA 1,814 17.8 6

2 Cook County, IL 1,018 19.4 10

3 New York County, NY 719 43.7 12

4 Maricopa County, AZ 542 13.0 14

5 Miami-Dade County, FL 537 19.9 16

6 San Diego County, CA 524 15.9 18

7 San Francisco County, CA 522 60.4 20

8 Kings County, NY 497 18.8 22

9 Philadelphia County, PA 428 27.3 23

10 Fulton County, GA 410 40.6 25

11 Clark County, NV 398 18.8 26

12 Bronx County, NY 396 27.2 28

13 Fresno County, CA 390 40.0 29

14 Harris County, TX 357 7.9 30

15 Dallas County, TX 333 13.0 31

16 Orange County, CA 309 9.7 33

17 Orange County, FL 297 23.1 34

18 Mecklenburg County, NC 295 28.5 35

19 Broward County, FL 295 15.6 36

20 King County, WA 293 13.8 37

21 Queens County, NY 287 12.3 38

22 Franklin County, OH 286 22.8 39

23 Riverside County, CA 279 11.8 40

24 Travis County, TX 278 23.6 41

25 San Joaquin County, CA 266 36.6 42

26 DeKalb County, GA 265 36.1 43

27 Kern County, CA 257 29.1 44

28 Sacramento County, CA 228 15.2 45

29 Bexar County, TX 224 11.8 45

30 Hillsborough County, FL 217 16.1 46

31 Santa Clara County, CA 217 11.3 47

32 Baltimore (City), MD 197 31.7 48

33 Pinellas County, FL 187 19.7 48

34 Alameda County, CA 184 11.2 49

35 Hennepin County, MN 170 13.9 50

36 San Bernardino County, CA 166 7.8 50

37 Multnomah County, OR 165 20.9 51

38 Wayne County, MI 158 9.0 51

39 Shelby County, TN 149 15.9 52

40 Orleans Parish, LA 143 36.7 52

41 Jackson County, MO 141 20.5 53

42 Cuyahoga County, OH 139 11.1 53

43 Marion County, IN 138 14.7 54

44 Oklahoma County, OK 129 16.6 54

45 Wake County, NC 127 12.4 55

46 El Paso County, TX 126 15.1 55

47 Tarrant County, TX 125 6.3 56

48 Bernalillo County, NM 120 17.7 56

49 Jefferson County, KY 117 15.3 57

50 Prince George's County, MD 110 12.1 57

51 Pima County, AZ 108 10.7 57

52 Caddo Parish, LA 107 42.6 58

53 Denver County, CO 107 15.7 58

54 Gwinnett County, GA 107 11.9 58

55 Hudson County, NJ 103 15.3 59

56 East Baton Rouge Parish, LA 102 22.8 59

57 Duval County, FL 102 11.2 60

58 Jefferson County, AL 100 15.1 60

59 Middlesex County, MA 99 6.2 60

60 Essex County, NJ 98 12.3 61

61 Guilford County, NC 96 18.5 61

62 Palm Beach County, FL 93 6.5 61

63 Cobb County, GA 88 11.9 62

64 Allegheny County, PA 87 7.1 62

65 Contra Costa County, CA 86 7.6 62

66 St. Louis (City), MO 85 26.9 63

67 Alachua County, FL 84 32.3 63

68 Stanislaus County, CA 83 15.4 63

69 Honolulu County, HI 83 8.3 63

70 Richland County, SC 80 19.7 64

* The top 70 counties and independent cities ranked in descending order by number of cases reported in 2016 then by rate are displayed.

NOTE: Relative rankings of counties may be impacted by completeness of the variable used to identify county. In 2016, the variable used to identify county was 

complete for ≤95% of cases in Massachusetts. See Appendix A1.4 for more information.
98

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

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

Sex, United States, 2012–2016

Age Cases Rates per 100,000 Population*

Group Total Male Female Unknown Sex Total Male Female

0–4 1 1 0 0 0.0 0.0 0.0

2012

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

0–4 5 2 3 0 0.0 0.0 0.0

2013

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 4.3 6.5 1.9

20–24 3,642 3,204 435 3 16.0 27.4 3.9

25–29 3,329 3,037 286 6 15.4 27.7 2.7

30–34 2,447 2,272 172 3 11.5 21.3 1.6

35–39 1,800 1,674 125 1 9.2 17.1 1.3

40–44 1,693 1,587 105 1 8.1 15.3 1.0

45–54 2,614 2,495 119 0 6.0 11.6 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 10.2 0.9

0–4 0 0 0 0 0.0 0.0 0.0

2014

5–9 0 0 0 0 0.0 0.0 0.0

10–14 12 4 8 0 0.1 0.0 0.1

15–19 1,023 761 262 0 4.9 7.1 2.5

20–24 4,137 3,632 503 2 18.1 30.9 4.5

25–29 4,092 3,727 361 4 18.6 33.4 3.3

30–34 2,887 2,635 248 4 13.4 24.4 2.3

35–39 2,045 1,868 177 0 10.3 18.8 1.8

40–44 1,758 1,654 103 1 8.5 16.2 1.0

45–54 2,966 2,830 135 1 6.8 13.2 0.6

55–64 897 860 36 1 2.2 4.5 0.2

65+ 176 169 7 0 0.4 0.8 0.0

Unknown Age 6 6 0 0

TOTAL 19,999 18,146 1,840 13 6.3 11.6 1.1

0–4 2 0 1 1 0.0 0.0 0.0

2015

5–9 1 0 1 0 0.0 0.0 0.0

10–14 9 1 8 0 0.0 0.0 0.1

15–19 1,148 865 283 0 5.4 8.0 2.7

20–24 4,766 4,186 573 7 21.0 35.9 5.2

25–29 5,168 4,671 491 6 23.0 40.9 4.4

30–34 3,549 3,234 311 4 16.4 29.7 2.9

35–39 2,482 2,249 229 4 12.2 22.1 2.2

40–44 1,897 1,744 152 1 9.4 17.4 1.5

45–54 3,488 3,294 190 4 8.1 15.5 0.9

55–64 1,153 1,099 54 0 2.8 5.6 0.3

65+ 207 202 5 0 0.4 1.0 0.0

Unknown Age 2 2 0 0

TOTAL 23,872 21,547 2,298 27 7.4 13.6 1.4

0–4 2 0 2 0 0.0 0.0 0.0

2016

5–9 2 1 1 0 0.0 0.0 0.0

10–14 15 6 9 0 0.1 0.1 0.1

15–19 1,298 957 340 1 6.1 8.9 3.3

20–24 5,172 4,418 744 10 22.7 37.9 6.7

25–29 6,177 5,538 624 15 27.5 48.5 5.6

30–34 4,278 3,806 464 8 19.7 35.0 4.3

35–39 3,043 2,729 311 3 14.9 26.8 3.0

40–44 2,140 1,944 193 3 10.6 19.4 1.9

45–54 3,953 3,691 261 1 9.2 17.3 1.2

55–64 1,418 1,338 80 0 3.5 6.8 0.4

65+ 279 269 10 0 0.6 1.3 0.0

Unknown Age 37 27 10 0

TOTAL 27,814 24,724 3,049 41 8.7 15.6 1.9

* 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.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

99

Table 35A. Primary and Secondary Syphilis — Reported Cases by Race/Ethnicity, Age Group, and Sex, 

United States*, 2016

Age 

Group

American Indians/

Alaska Natives Asians Blacks Native Hawaiians/Other Pacific Islanders

Total† Male Female Total† Male Female Total† Male Female Total† Male Female

0–4 0 0 0 0 0 0 2 0 2 0 0 0

5–9 0 0 0 0 0 0 0 0 0 0 0 0

10–14 0 0 0 1 1 0 12 4 8 0 0 0

15–19 9 6 3 28 26 2 614 412 201 4 2 2

20–24 39 31 8 107 99 8 2,184 1,811 367 16 14 2

25–29 47 34 13 151 144 6 2,522 2,227 287 15 15 0

30–34 35 25 10 121 114 7 1,406 1,241 162 9 9 0

35–39 20 14 6 86 77 9 835 733 100 10 7 3

40–44 9 6 3 75 69 5 470 418 51 8 8 0

45–54 26 24 2 86 85 1 835 736 98 10 10 0

55–64 5 5 0 16 14 2 269 243 26 0 0 0

65+ 0 0 0 3 3 0 46 43 3 0 0 0

Unknown Age 0 0 0 0 0 0 27 19 8 0 0 0

TOTAL 190 145 45 674 632 40 9,222 7,887 1,313 72 65 7

Age 

Group

Whites Multirace Hispanics Other/

Unknown

Total† Male Female Total† Male Female Total† Male Female Total† Male Female

0–4 0 0 0 0 0 0 0 0 0 0 0 0

5–9 0 0 0 0 0 0 2 1 1 0 0 0

10–14 0 0 0 0 0 0 1 1 0 1 0 1

15–19 268 207 61 11 7 4 304 253 51 60 44 16

20–24 1,230 1,047 183 88 74 14 1,291 1,148 139 217 194 23

25–29 1,698 1,507 188 94 85 9 1,374 1,270 103 276 256 18

30–34 1,377 1,216 160 78 72 4 1,054 948 105 198 181 16

35–39 1,150 1,029 121 34 31 3 742 690 52 166 148 17

40–44 940 863 77 39 34 5 497 458 38 102 88 14

45–54 1,996 1,886 110 45 43 2 712 675 37 243 232 11

55–64 841 803 38 14 14 0 181 171 10 92 88 4

65+ 180 176 4 2 2 0 33 31 2 15 14 1

Unknown Age 8 7 1 0 0 0 1 1 0 1 0 1

TOTAL 9,688 8,741 943 405 362 41 6,192 5,647 538 1,371 1,245 122

* Includes 50 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2016.

†

 Total includes cases reported with unknown sex.

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 34 for age-specific cases and rates and Tables 27–29 for total and sex-specific 

cases and rates.
100

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

Table 35B. Primary and Secondary Syphilis — Rates of Reported Cases per 100,000 Population by Race/

Ethnicity, Age Group, and Sex, United States*, 2016

Age 

Group

American Indians/

Alaska Natives Asians Blacks Native Hawaiians/Other Pacific Islanders

Total† Male Female 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 0.1 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 0.0 0.0 0.0

10–14 0.0 0.0 0.0 0.1 0.2 0.0 0.4 0.3 0.6 0.0 0.0 0.0

15–19 4.9 6.5 3.4 2.7 5.0 0.4 20.5 27.2 13.6 9.9 9.6 10.2

20–24 19.6 30.4 8.2 8.5 15.5 1.3 64.3 105.0 21.9 34.1 58.2 8.7

25–29 25.6 36.5 14.4 10.2 19.9 0.8 81.0 144.6 18.2 28.8 55.6 0.0

30–34 21.5 30.8 12.2 8.0 16.0 0.9 50.8 93.2 11.3 18.5 36.0 0.0

35–39 13.5 19.0 8.1 6.1 11.7 1.2 32.0 59.3 7.3 23.6 32.5 14.4

40–44 6.3 8.5 4.1 5.3 10.4 0.7 18.4 34.9 3.8 21.5 42.5 0.0

45–54 8.4 16.0 1.3 3.6 7.6 0.1 15.8 29.6 3.5 14.4 28.9 0.0

55–64 1.8 3.8 0.0 0.8 1.6 0.2 5.8 11.5 1.0 0.0 0.0 0.0

65+ 0.0 0.0 0.0 0.1 0.3 0.0 1.1 2.5 0.1 0.0 0.0 0.0

Unknown Age

TOTAL 8.0 12.4 3.7 3.9 7.6 0.4 23.1 41.3 6.3 12.9 23.0 2.5

Age 

Group

Whites Multirace Hispanics

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 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

15–19 2.3 3.5 1.1 1.6 2.0 1.2 6.4 10.5 2.2

20–24 9.9 16.4 3.0 14.7 24.6 4.7 26.8 46.0 6.0

25–29 13.4 23.5 3.0 20.4 38.4 3.7 30.3 53.3 4.8

30–34 11.1 19.5 2.6 20.4 39.8 2.0 23.7 40.8 4.9

35–39 9.9 17.6 2.1 10.5 20.3 1.7 17.5 31.6 2.5

40–44 7.9 14.5 1.3 14.0 25.8 3.4 12.6 23.0 2.0

45–54 7.1 13.5 0.8 9.2 18.5 0.8 10.9 20.4 1.1

55–64 2.9 5.6 0.3 3.6 7.5 0.0 4.2 8.2 0.5

65+ 0.5 1.1 0.0 0.6 1.3 0.0 0.9 1.9 0.1

Unknown Age

TOTAL 4.9 9.0 0.9 6.2 11.2 1.2 10.9 19.7 1.9

* Includes 50 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2016.

†

 Total includes cases reported with unknown sex.

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 34 for age-specific cases and rates and Tables 27–29 for total and sex-specific 

cases and rates. No population data exist for unknown sex, unknown age, or unknown race; therefore rates are not calculated.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

101

Table 36. Early Latent Syphilis — Reported Cases and Rates of Reported Cases by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2012–2016

Cases Rates per 100,000 Population

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Alabama 237 202 144 177 293 4.9 4.2 3.0 3.6 6.0

Alaska 8 8 25 13 13 1.1 1.1 3.4 1.8 1.8

Arizona 147 207 311 361 488 2.2 3.1 4.6 5.3 7.1

Arkansas 152 163 152 216 280 5.2 5.5 5.1 7.3 9.4

California 2,519 2,844 3,396 4,435 5,289 6.6 7.4 8.8 11.3 13.5

Colorado 194 195 164 212 274 3.7 3.7 3.1 3.9 5.0

Connecticut 52 55 62 97 84 1.4 1.5 1.7 2.7 2.3

Delaware 38 30 33 47 57 4.1 3.2 3.5 5.0 6.0

District of Columbia 244 243 142 200 355 38.6 37.6 21.6 29.8 52.8

Florida 1,384 1,540 1,886 2,288 2,634 7.2 7.9 9.5 11.3 13.0

Georgia 639 863 1,078 1,477 1,263 6.4 8.6 10.7 14.5 12.4

Hawaii 9 22 25 56 89 0.6 1.6 1.8 3.9 6.2

Idaho 21 6 12 24 33 1.3 0.4 0.7 1.5 2.0

Illinois 690 809 819 889 1,138 5.4 6.3 6.4 6.9 8.8

Indiana 148 157 129 220 247 2.3 2.4 2.0 3.3 3.7

Iowa 15 63 82 69 59 0.5 2.0 2.6 2.2 1.9

Kansas 54 84 92 153 178 1.9 2.9 3.2 5.3 6.1

Kentucky 139 167 169 164 189 3.2 3.8 3.8 3.7 4.3

Louisiana 343 276 372 439 568 7.5 6.0 8.0 9.4 12.2

Maine 2 6 7 10 6 0.2 0.5 0.5 0.8 0.5

Maryland 361 387 529 594 598 6.1 6.5 8.9 9.9 10.0

Massachusetts 231 350 282 355 538 3.5 5.2 4.2 5.2 7.9

Michigan 150 204 243 282 290 1.5 2.1 2.5 2.8 2.9

Minnesota 96 139 159 185 251 1.8 2.6 2.9 3.4 4.6

Mississippi 253 184 336 405 490 8.5 6.2 11.2 13.5 16.4

Missouri 135 220 240 247 276 2.2 3.6 4.0 4.1 4.5

Montana 0 2 1 5 6 0.0 0.2 0.1 0.5 0.6

Nebraska 8 14 19 5 19 0.4 0.7 1.0 0.3 1.0

Nevada 214 232 389 439 510 7.8 8.3 13.7 15.2 17.6

New Hampshire 9 21 22 16 33 0.7 1.6 1.7 1.2 2.5

New Jersey 410 539 612 714 755 4.6 6.1 6.8 8.0 8.4

New Mexico 68 67 76 71 118 3.3 3.2 3.6 3.4 5.7

New York 1,413 1,945 2,307 2,802 3,504 7.2 9.9 11.7 14.2 17.7

North Carolina 244 236 468 753 799 2.5 2.4 4.7 7.5 8.0

North Dakota 0 2 22 17 12 0.0 0.3 3.0 2.2 1.6

Ohio 171 211 265 326 389 1.5 1.8 2.3 2.8 3.3

Oklahoma 146 237 198 222 339 3.8 6.2 5.1 5.7 8.7

Oregon 94 127 149 214 250 2.4 3.2 3.8 5.3 6.2

Pennsylvania 484 581 641 770 982 3.8 4.5 5.0 6.0 7.7

Rhode Island 24 22 49 38 63 2.3 2.1 4.6 3.6 6.0

South Carolina 336 415 467 496 613 7.1 8.7 9.7 10.1 12.5

South Dakota 3 5 23 11 14 0.4 0.6 2.7 1.3 1.6

Tennessee 255 267 236 312 337 3.9 4.1 3.6 4.7 5.1

Texas 1,767 1,902 1,984 2,471 2,872 6.8 7.2 7.4 9.0 10.5

Utah 8 47 41 31 61 0.3 1.6 1.4 1.0 2.0

Vermont 6 2 7 6 14 1.0 0.3 1.1 1.0 2.2

Virginia 303 354 274 410 602 3.7 4.3 3.3 4.9 7.2

Washington 181 204 198 293 446 2.6 2.9 2.8 4.1 6.2

West Virginia 10 10 23 40 51 0.5 0.5 1.2 2.2 2.8

Wisconsin 86 62 91 95 150 1.5 1.1 1.6 1.6 2.6

Wyoming 2 1 1 1 5 0.3 0.2 0.2 0.2 0.9

U.S. TOTAL 14,503 16,929 19,452 24,173 28,924 4.6 5.4 6.1 7.5 9.0

Northeast 2,631 3,521 3,989 4,808 5,979 4.7 6.3 7.1 8.5 10.6

Midwest 1,556 1,970 2,184 2,499 3,023 2.3 2.9 3.2 3.7 4.5

South 6,851 7,476 8,491 10,711 12,340 5.8 6.3 7.1 8.8 10.2

West 3,465 3,962 4,788 6,155 7,582 4.7 5.3 6.4 8.1 10.0

Guam 1 3 1 2 1 0.6 1.9 0.6 1.2 0.6

Puerto Rico 222 270 375 565 570 6.1 7.5 10.6 16.3 16.4

Virgin Islands 0 2 0 7 2 0.0 1.9 0.0 6.8 1.9

OUTLYING AREAS 223 275 376 574 573 5.7 7.1 9.9 15.4 15.3

TOTAL 14,726 17,204 19,828 24,747 29,497 4.6 5.4 6.1 7.6 9.1
102

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

Table 37. Early Latent Syphilis — Reported Cases and Rates of Reported Cases in Selected Metropolitan 

Statistical Areas (MSAs)* in Alphabetical Order, United States, 2012–2016

Cases Rates per 100,000 Population

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Atlanta-Sandy Springs-Roswell, GA 491 672 863 1,067 1,053 9.0 12.2 15.4 18.7 18.4

Austin-Round Rock, TX 170 220 207 242 291 9.3 11.7 10.7 12.1 14.5

Baltimore-Columbia-Towson, MD 206 216 296 344 358 7.5 7.8 10.6 12.3 12.8

Birmingham-Hoover, AL 74 71 46 60 75† 6.5 6.2 4.0 5.2 6.5†

Boston-Cambridge-Newton, MA-NH 158 278 208 235† 408† 3.4 5.9 4.4 4.9† 8.5†

Buffalo-Cheektowaga-Niagara Falls, NY 11 15 19 37 29 1.0 1.3 1.7 3.3 2.6

Charlotte-Concord-Gastonia, NC-SC 70 74 129 206 264 3.0 3.2 5.4 8.5 10.9

Chicago-Naperville-Elgin, IL-IN-WI 630 751 734 814 1,058 6.6 7.9 7.7 8.5 11.1

Cincinnati, OH-KY-IN 78 70 98 92 74 3.7 3.3 4.6 4.3 3.4

Cleveland-Elyria, OH 13 14 31 37 63 0.6 0.7 1.5 1.8 3.1

Columbus, OH 49 71 82 130 149 2.5 3.6 4.1 6.4 7.4

Dallas-Fort Worth-Arlington, TX 604 550 644 932 1,038 9.0 8.1 9.3 13.1 14.6

Denver-Aurora-Lakewood, CO 177 166 145 175 212 6.7 6.2 5.3 6.2 7.5

Detroit-Warren-Dearborn, MI 113 152 163 206 194 2.6 3.5 3.8 4.8 4.5

Hartford-West Hartford-East Hartford, CT 9 19 16 31 20 0.7 1.6 1.3 2.6 1.7

Houston-The Woodlands-Sugar Land, TX 419 348 444 522 585 6.8 5.5 6.8 7.8 8.8

Indianapolis-Carmel-Anderson, IN 102 104 91 143 165 5.3 5.3 4.6 7.2 8.3

Jacksonville, FL 57 73 69 162 137 4.1 5.2 4.9 11.2 9.5

Kansas City, MO-KS 61 111 132 133 140 3.0 5.4 6.4 6.4 6.7

Las Vegas-Henderson-Paradise, NV 207 218 375 413 470 10.3 10.8 18.1 19.5 22.2

Los Angeles-Long Beach-Anaheim, CA 1,393 1,520 1,619 2,052 2,403 10.7 11.6 12.2 15.4 18.0

Louisville-Jefferson County, KY-IN 72 85 82 90 118 5.8 6.7 6.5 7.0 9.2

Memphis, TN-MS-AR 188 188 143 195 246 14.0 14.0 10.6 14.5 18.3

Miami-Fort Lauderdale-West Palm Beach, FL 831 885 1,094 1,220 1,282 14.4 15.2 18.4 20.3 21.3

Milwaukee-Waukesha-West Allis, WI 57 43 69 66 108 3.6 2.7 4.4 4.2 6.9

Minneapolis-St. Paul-Bloomington, MN-WI 91 131 155 170 226 2.7 3.8 4.4 4.8 6.4

Nashville-Davidson-Murfreesboro-Franklin, TN 50 62 83 82 72 2.9 3.5 4.6 4.5 3.9

New Orleans-Metairie, LA 90 81 122 171 242 7.3 6.5 9.7 13.5 19.2

New York-Newark-Jersey City, NY-NJ-PA 1,668 2,299 2,681 3,210 4,008 8.4 11.5 13.3 15.9 19.9

Oklahoma City, OK 79 124 107 114 195 6.1 9.4 8.0 8.4 14.4

Orlando-Kissimmee-Sanford, FL 136 175 180 266 377 6.1 7.7 7.8 11.1 15.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 408 497 512 616 736 6.8 8.2 8.5 10.1 12.1

Phoenix-Mesa-Scottsdale, AZ 120 150 240 268 381 2.8 3.4 5.3 5.9 8.3

Pittsburgh, PA 46 45 63 111 125 1.9 1.9 2.7 4.7 5.3

Portland-Vancouver-Hillsboro, OR-WA 101 117 124 170 226 4.4 5.1 5.3 7.1 9.5

Providence-Warwick, RI-MA 35 28 64 48† 71† 2.2 1.7 4.0 3.0† 4.4†

Raleigh, NC 31 41 77 115 135 2.6 3.4 6.2 9.0 10.6

Richmond, VA 78 75 68 98 162 6.3 6.0 5.4 7.7 12.7

Riverside-San Bernardino-Ontario, CA 138 159 223 311 379 3.2 3.6 5.0 6.9 8.4

Sacramento-Roseville-Arden-Arcade, CA 38 33 74 137 133 1.7 1.5 3.3 6.0 5.8

Salt Lake City, UT 7 37 31 23 43 0.6 3.2 2.7 2.0 3.7

San Antonio-New Braunfels, TX 269 381 308 258 339 12.0 16.7 13.2 10.8 14.2

San Diego-Carlsbad, CA 236 211 299 343 461 7.4 6.6 9.2 10.4 14.0

San Francisco-Oakland-Hayward, CA 528 656 839 964 919 11.9 14.5 18.3 20.7 19.7

San Jose-Sunnyvale-Santa Clara, CA 44 60 58 96 135 2.3 3.1 3.0 4.9 6.8

Seattle-Tacoma-Bellevue, WA 142 167 143 221 303 4.0 4.6 3.9 5.9 8.1

St. Louis, MO-IL 89 125 139 138 151 3.2 4.5 5.0 4.9 5.4

Tampa-St. Petersburg-Clearwater, FL 176 176 227 258 364 6.2 6.1 7.8 8.7 12.2

Virginia Beach-Norfolk-Newport News, VA-NC 90 112 90 167 245 5.3 6.6 5.2 9.7 14.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 497 520 286 320 355 8.5 8.7 4.7 5.2 5.8

SELECTED MSAs TOTAL 11,427 13,376 14,992 18,279 21,723 6.7 7.7 8.6 10.3 12.3

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

†

 The variable used to identify county, which is used to classify cases into MSAs, was complete for ≤95% of cases in a state contributing data to this MSA. 

See Appendix A1.4 for more information.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

103

Table 38. 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, 2012–2016

Cases Rates per 100,000 Population

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Alabama 248 292 167 197 232 5.1 6.0 3.4 4.1 4.8

Alaska 14 3 5 3 3 1.9 0.4 0.7 0.4 0.4

Arizona 424 455 558 532 680 6.5 6.9 8.3 7.8 10.0

Arkansas 132 175 110 145 131 4.5 5.9 3.7 4.9 4.4

California 2,509 3,539 4,110 4,966 6,216 6.6 9.2 10.6 12.7 15.9

Colorado 101 117 5 96 211 1.9 2.2 0.1 1.8 3.9

Connecticut 14 22 21 30 23 0.4 0.6 0.6 0.8 0.6

Delaware 29 63 30 21 34 3.2 6.8 3.2 2.2 3.6

District of Columbia 180 196 23 26 51 28.5 30.3 3.5 3.9 7.6

Florida 1,693 1,934 2,429 2,723 3,233 8.8 9.9 12.2 13.4 15.9

Georgia 842 1,090 1,055 1,245 1,478 8.5 10.9 10.4 12.2 14.5

Hawaii 11 19 13 14 13 0.8 1.4 0.9 1.0 0.9

Idaho 6 21 22 21 44 0.4 1.3 1.3 1.3 2.7

Illinois 902 1,031 1,087 1,285 1,623 7.0 8.0 8.4 10.0 12.6

Indiana 159 171 170 189 197 2.4 2.6 2.6 2.9 3.0

Iowa 58 57 84 88 127 1.9 1.8 2.7 2.8 4.1

Kansas 51 61 48 0 0 1.8 2.1 1.7 0.0 0.0

Kentucky 99 102 117 123 159 2.3 2.3 2.7 2.8 3.6

Louisiana 1,065 1,267 1,180 1,277 1,233 23.1 27.4 25.4 27.3 26.4

Maine 3 5 0 0 16 0.2 0.4 0.0 0.0 1.2

Maryland 439 504 481 749 719 7.5 8.5 8.0 12.5 12.0

Massachusetts 258 276 227 486 416 3.9 4.1 3.4 7.2 6.1

Michigan 334 368 416 393 424 3.4 3.7 4.2 4.0 4.3

Minnesota 120 209 215 220 289 2.2 3.9 3.9 4.0 5.3

Mississippi 53 31 116 136 107 1.8 1.0 3.9 4.5 3.6

Missouri 133 135 178 220 271 2.2 2.2 2.9 3.6 4.5

Montana 1 1 0 2 4 0.1 0.1 0.0 0.2 0.4

Nebraska 18 40 26 31 34 1.0 2.1 1.4 1.6 1.8

Nevada 117 84 142 133 347 4.2 3.0 5.0 4.6 12.0

New Hampshire 19 30 21 28 27 1.4 2.3 1.6 2.1 2.0

New Jersey 243 196 263 220 381 2.7 2.2 2.9 2.5 4.3

New Mexico 64 100 80 141 160 3.1 4.8 3.8 6.8 7.7

New York 2,667 2,758 3,073 2,975 3,484 13.6 14.0 15.6 15.0 17.6

North Carolina 444 509 791 783 756 4.6 5.2 8.0 7.8 7.5

North Dakota 10 11 16 14 16 1.4 1.5 2.2 1.8 2.1

Ohio 526 431 381 445 483 4.6 3.7 3.3 3.8 4.2

Oklahoma 27 28 59 83 90 0.7 0.7 1.5 2.1 2.3

Oregon 117 133 159 218 227 3.0 3.4 4.0 5.4 5.6

Pennsylvania 365 431 346 356 295 2.9 3.4 2.7 2.8 2.3

Rhode Island 25 27 40 48 81 2.4 2.6 3.8 4.5 7.7

South Carolina 56 66 28 41 36 1.2 1.4 0.6 0.8 0.7

South Dakota 8 12 16 21 15 1.0 1.4 1.9 2.4 1.7

Tennessee 545 497 502 575 713 8.4 7.7 7.7 8.7 10.8

Texas 3,585 3,593 4,110 4,047 4,666 13.8 13.6 15.2 14.7 17.0

Utah 51 51 61 73 106 1.8 1.8 2.1 2.4 3.5

Vermont 0 5 0 0 0 0.0 0.8 0.0 0.0 0.0

Virginia 317 329 137 276 235 3.9 4.0 1.6 3.3 2.8

Washington 226 223 310 366 400 3.3 3.2 4.4 5.1 5.6

West Virginia 6 14 4 17 45 0.3 0.8 0.2 0.9 2.4

Wisconsin 91 100 108 88 140 1.6 1.7 1.9 1.5 2.4

Wyoming 6 7 1 4 5 1.0 1.2 0.2 0.7 0.9

U.S. TOTAL 19,411 21,819 23,541 26,170 30,676 6.2 6.9 7.4 8.1 9.5

Northeast 3,594 3,750 3,991 4,143 4,723 6.4 6.7 7.1 7.4 8.4

Midwest 2,410 2,626 2,745 2,994 3,619 3.6 3.9 4.1 4.4 5.3

South 9,760 10,690 11,339 12,464 13,918 8.3 9.0 9.5 10.3 11.5

West 3,647 4,753 5,466 6,569 8,416 5.0 6.4 7.3 8.6 11.1

Guam 20 14 5 16 10 12.5 8.7 3.1 9.9 6.2

Puerto Rico 175 154 101 166 117 4.8 4.3 2.8 4.8 3.4

Virgin Islands 2 5 4 10 0 1.9 4.8 3.8 9.7 0.0

OUTLYING AREAS 197 173 110 192 127 5.0 4.5 2.9 5.1 3.4

TOTAL 19,608 21,992 23,651 26,362 30,803 6.2 6.9 7.3 8.1 9.5

* Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, and late syphilis with clinical manifestations (including late benign 

syphilis and cardiovascular syphilis).
104

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

Table 39. Late and Late Latent Syphilis* — Reported Cases and Rates of Reported Cases in Selected Metropolitan 

Statistical Areas (MSAs)† in Alphabetical Order, United States, 2012–2016

Cases Rates per 100,000 Population

MSAs 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Atlanta-Sandy Springs-Roswell, GA 573 782 804 926‡ 1,135 10.5 14.2 14.3 16.2‡ 19.9

Austin-Round Rock, TX 154 134 246 175 212 8.4 7.1 12.7 8.7 10.6

Baltimore-Columbia-Towson, MD 203 218 225 306 321 7.4 7.9 8.1 10.9 11.5

Birmingham-Hoover, AL 79 96 53 62 52‡ 7.0 8.4 4.6 5.4 4.5‡

Boston-Cambridge-Newton, MA-NH 207 211 158‡ 303‡ 267‡ 4.5 4.5 3.3‡ 6.3‡ 5.6‡

Buffalo-Cheektowaga-Niagara Falls, NY 32 62 62 51 49 2.8 5.5 5.5 4.5 4.3

Charlotte-Concord-Gastonia, NC-SC 122 151 180 190 199 5.3 6.5 7.6 7.8 8.2

Chicago-Naperville-Elgin, IL-IN-WI 853 963 988 1,169 1,529 9.0 10.1 10.3 12.2 16.0

Cincinnati, OH-KY-IN 275 191 124 129 105 12.9 8.9 5.8 6.0 4.9

Cleveland-Elyria, OH 82 64 88 120 157 4.0 3.1 4.3 5.8 7.6

Columbus, OH 101 98 101 105 109 5.2 5.0 5.1 5.2 5.4

Dallas-Fort Worth-Arlington, TX 1,132 1,081 1,065 837 1,069 16.9 15.9 15.3 11.8 15.1

Denver-Aurora-Lakewood, CO 74 81 0 59 150 2.8 3.0 0.0 2.1 5.3

Detroit-Warren-Dearborn, MI 252 277 299 274 282 5.9 6.4 7.0 6.4 6.6

Hartford-West Hartford-East Hartford, CT 3 10‡ 10 8 3 0.2 0.8‡ 0.8 0.7 0.2

Houston-The Woodlands-Sugar Land, TX 1,265 1,154 1,430 1,592 1,805 20.5 18.3 22.0 23.9 27.1

Indianapolis-Carmel-Anderson, IN 84 90 83 93 87 4.4 4.6 4.2 4.7 4.4

Jacksonville, FL 73 75 128 179 181 5.3 5.4 9.0 12.3 12.5

Kansas City, MO-KS 38 54 54 40 87 1.9 2.6 2.6 1.9 4.2

Las Vegas-Henderson-Paradise, NV 98 54 133 102 315 4.9 2.7 6.4 4.8 14.9

Los Angeles-Long Beach-Anaheim, CA 1,091 1,705 1,678 1,901 2,529 8.4 13.0 12.7 14.3 19.0

Louisville-Jefferson County, KY-IN 48 52 70 92 112 3.8 4.1 5.5 7.2 8.8

Memphis, TN-MS-AR 291 283 236 256 334 21.7 21.1 17.6 19.0 24.8

Miami-Fort Lauderdale-West Palm Beach, FL 1,032 1,075 1,370 1,519 1,859 17.9 18.4 23.1 25.3 30.9

Milwaukee-Waukesha-West Allis, WI 59 56 63 42 70 3.8 3.6 4.0 2.7 4.4

Minneapolis-St. Paul-Bloomington, MN-WI 105 175 187 192 251 3.1 5.1 5.4 5.4 7.1

Nashville-Davidson-Murfreesboro-Franklin, TN 133 120 148 161 196 7.7 6.8 8.3 8.8 10.7

New Orleans-Metairie, LA 386 442 370 362 357 31.5 35.6 29.6 28.7 28.3

New York-Newark-Jersey City, NY-NJ-PA 2,679 2,707 3,052 2,909 3,521 13.5 13.6 15.2 14.4 17.4

Oklahoma City, OK 15‡ 11 31 32 47 1.2‡ 0.8 2.3 2.4 3.5

Orlando-Kissimmee-Sanford, FL 192 250 362 343 416 8.6 11.0 15.6 14.4 17.4

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 338 439 311 314 265 5.6 7.3 5.1 5.2 4.4

Phoenix-Mesa-Scottsdale, AZ 332 335 397 393 534 7.7 7.6 8.8 8.6 11.7

Pittsburgh, PA 21 11 13 11 11 0.9 0.5 0.6 0.5 0.5

Portland-Vancouver-Hillsboro, OR-WA 99 118 140 154 158 4.3 5.1 6.0 6.4 6.6

Providence-Warwick, RI-MA 32 45 47‡ 71‡ 102‡ 2.0 2.8 2.9‡ 4.4‡ 6.3‡

Raleigh, NC 63 68 109 124 106 5.3 5.6 8.8 9.7 8.3

Richmond, VA 51 58 9 36 35 4.1 4.7 0.7 2.8 2.8

Riverside-San Bernardino-Ontario, CA 465 433 432 508 707 10.7 9.9 9.7 11.3 15.7

Sacramento-Roseville-Arden-Arcade, CA 59 107 134 203 197 2.7 4.8 6.0 8.9 8.7

Salt Lake City, UT 33 34 39 50 75 2.9 3.0 3.4 4.3 6.4

San Antonio-New Braunfels, TX 366 457 448 483 531 16.4 20.1 19.2 20.3 22.3

San Diego-Carlsbad, CA 144 245 310 366 425 4.5 7.6 9.5 11.1 12.9

San Francisco-Oakland-Hayward, CA 321 421 497 550 621 7.2 9.3 10.8 11.8 13.3

San Jose-Sunnyvale-Santa Clara, CA 84 69 125 128 142 4.4 3.6 6.4 6.5 7.2

Seattle-Tacoma-Bellevue, WA 169 161 211 224 268 4.8 4.5 5.7 6.0 7.2

St. Louis, MO-IL 95 104 119 165 160 3.4 3.7 4.2 5.9 5.7

Tampa-St. Petersburg-Clearwater, FL 171 227 254 297 326 6.0 7.9 8.7 10.0 11.0

Virginia Beach-Norfolk-Newport News, VA-NC 100 86 45 90 65 5.9 5.0 2.6 5.2 3.8

Washington-Arlington-Alexandria, DC-VA-MD-WV 517 599 295 500 473 8.8 10.1 4.9 8.2 7.8

SELECTED MSAs TOTAL 15,191 16,739 17,733 19,196 23,007 8.9 9.7 10.1 10.9 13.0

* Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, and late syphilis with clinical manifestations (including late benign 

syphilis and cardiovascular syphilis).

†

 MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

‡

 The variable used to identify county, which is used to classify cases into MSAs, was complete for ≤95% of cases in a state contributing data to this MSA. See 

Appendix A1.4 for more information.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

105

Table 40. Congenital Syphilis — Reported Cases and Rates of Reported Cases by State†, Ranked by Rates, 

United States, 2016

Rank* State† Cases Rate per 100,000 Live Births

1 Louisiana 48 74.4

2 California 206 41.0

3 Nevada 12 33.5

4 Florida 59 26.8

5 Maryland 16 21.6

6 Texas 71 17.8

7 Arizona 15 17.3

8 South Dakota 2 16.3

9 Georgia 21 16.0

U.S. TOTAL‡ 628 15.7

10 South Carolina 9 15.6

11 Arkansas 6 15.6

12 North Carolina 16 13.2

13 Oregon 6 13.2

14 New Jersey 12 11.6

15 New Mexico 3 11.5

16 Michigan 13 11.4

17 Illinois 18 11.4

18 Missouri 8 10.6

19 Minnesota 7 10.0

20 West Virginia 2 9.9

21 Tennessee 8 9.8

22 Indiana 8 9.5

HP 2020 TARGET 9.1

23 Ohio 11 7.9

24 Alabama 4 6.7

25 Colorado 4 6.1

26 Oklahoma 3 5.6

27 Massachusetts 4 5.6

28 New York 13 5.4

29 Hawaii 1 5.4

30 Kentucky 3 5.3

31 Mississippi 2 5.2

32 Virginia 5 4.8

33 Pennsylvania 5 3.5

34 Washington 3 3.4

35 Kansas 1 2.5

36 Iowa 1 2.5

37 Wisconsin 1 1.5

Alaska 0 0.0

Connecticut 0 0.0

Delaware 0 0.0

Idaho 0 0.0

Maine 0 0.0

Montana 0 0.0

Nebraska 0 0.0

New Hampshire 0 0.0

North Dakota 0 0.0

Rhode Island 0 0.0

Utah 0 0.0

Vermont 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 1 case, but excludes outlying areas (Guam with 0 cases, Puerto Rico with 4 cases, and Virgin Islands 

with 0 cases).
106

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

Table 41. Congenital Syphilis — Reported Cases and Rates of Reported Cases by Year of Birth, State/Area*, and 

Region in Alphabetical Order, United States and Outlying Areas, 2012–2016

Cases Rates per 100,000 Live Births

State/Area* 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Alabama 4 2 3 3 4 6.8 3.4 5.0 5.0 6.7

Alaska 1 1 0 0 0 8.9 8.7 0.0 0.0 0.0

Arizona 14 13 13 14 15 16.2 15.2 15.0 16.1 17.3

Arkansas 11 12 7 5 6 28.7 31.7 18.2 13.0 15.6

California 35 58 102 140 206 6.9 11.7 20.3 27.8 41.0

Colorado 0 0 0 0 4 0.0 0.0 0.0 0.0 6.1

Connecticut 0 0 0 1 0 0.0 0.0 0.0 2.8 0.0

Delaware 1 1 0 1 0 9.1 9.2 0.0 9.1 0.0

District of Columbia 0 2 0 1 1 0.0 21.5 0.0 10.5 10.5

Florida 37 35 48 38 59 17.4 16.2 21.8 17.3 26.8

Georgia 16 20 17 21 21 12.3 15.5 13.0 16.0 16.0

Hawaii 0 0 0 2 1 0.0 0.0 0.0 10.8 5.4

Idaho 1 0 0 0 0 4.4 0.0 0.0 0.0 0.0

Illinois 28 23 27 31 18 17.6 14.7 17.0 19.6 11.4

Indiana 0 0 8 5 8 0.0 0.0 9.5 5.9 9.5

Iowa 0 0 1 0 1 0.0 0.0 2.5 0.0 2.5

Kansas 0 0 0 0 1 0.0 0.0 0.0 0.0 2.5

Kentucky 2 4 3 1 3 3.6 7.2 5.3 1.8 5.3

Louisiana 33 40 46 54 48 52.7 63.3 71.3 83.7 74.4

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 12 14 16 18 16 16.5 19.5 21.6 24.4 21.6

Massachusetts 1 4 3 4 4 1.4 5.6 4.2 5.6 5.6

Michigan 7 9 15 11 13 6.2 7.9 13.1 9.6 11.4

Minnesota 1 0 0 2 7 1.5 0.0 0.0 2.9 10.0

Mississippi 0 0 1 0 2 0.0 0.0 2.6 0.0 5.2

Missouri 1 3 1 4 8 1.3 4.0 1.3 5.3 10.6

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 1 0 1 0 0 3.9 0.0 3.7 0.0 0.0

Nevada 1 2 5 8 12 2.9 5.7 13.9 22.3 33.5

New Hampshire 1 0 0 0 0 8.1 0.0 0.0 0.0 0.0

New Jersey 1 0 0 0 12 1.0 0.0 0.0 0.0 11.6

New Mexico 1 2 1 2 3 3.7 7.6 3.8 7.7 11.5

New York 8 11 22 12 13 3.3 4.6 9.2 5.0 5.4

North Carolina 2 4 6 9 16 1.7 3.4 5.0 7.4 13.2

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 19 18 15 17 11 13.7 13.0 10.8 12.2 7.9

Oklahoma 0 0 6 7 3 0.0 0.0 11.2 13.1 5.6

Oregon 1 0 2 6 6 2.2 0.0 4.4 13.2 13.2

Pennsylvania 6 3 4 7 5 4.2 2.1 2.8 4.9 3.5

Rhode Island 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

South Carolina 7 1 5 3 9 12.2 1.8 8.7 5.2 15.6

South Dakota 0 0 3 0 2 0.0 0.0 24.4 0.0 16.3

Tennessee 2 2 2 5 8 2.5 2.5 2.5 6.1 9.8

Texas 78 74 74 52 71 20.4 19.1 18.5 13.0 17.8

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 3 2 3 5 1.0 2.9 1.9 2.9 4.8

Washington 0 0 2 5 3 0.0 0.0 2.3 5.6 3.4

West Virginia 0 0 0 0 2 0.0 0.0 0.0 0.0 9.9

Wisconsin 0 0 0 0 1 0.0 0.0 0.0 0.0 1.5

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 334 361 461 492 628 8.4 9.2 11.6 12.3 15.7

Northeast 17 18 29 24 34 2.7 2.9 4.6 3.8 5.4

Midwest 57 53 71 70 70 6.8 6.4 8.5 8.4 8.4

South 206 214 236 221 274 13.7 14.2 15.3 14.4 17.8

West 54 76 125 177 250 5.5 7.9 12.8 18.1 25.6

Guam 0 1 0 2 0 0.0 30.4 0.0 58.9 0.0

Puerto Rico 1 2 0 5 4 2.6 5.5 0.0 14.5 11.6

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 1 3 0 7 4 2.3 7.3 0.0 17.9 10.2

TOTAL 335 364 461 499 632 8.4 9.2 11.4 12.4 15.7

* Mother’s state of residence was used to assign case.
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

107

Table 42. Congenital Syphilis — Reported Cases and Rates of Reported Cases per 100,000 Live Births by Year of 

Birth and Race/Ethnicity of Mother, United States, 2012–2016

Year of Birth

Whites Blacks Hispanics

Asians/

Pacific 

Islanders

American 

Indians/

Alaska Natives

Other Unknown Total

Cases Rates Cases Rates Cases Rates Cases Rates Cases Rates Cases Rates Cases Rates Cases Rates

2012 50 2.3 189 32.1 80 8.8 6 2.3 2 5.1 3 NA 4 NA 334 8.4

2013 62 2.9 185 31.4 93 10.3 9 3.5 5 12.8 3 NA 4 NA 361 9.2

2014 79 3.6 227 38.2 112 12.3 18 6.6 5 13.2 9 NA 11 NA 461 11.6

2015 97 4.5 207 34.9 143 15.6 15 5.5 4 10.5 7 NA 19 NA 492 12.3

2016 116 5.3 256 43.1 187 20.5 25 9.2 12 31.6 7 NA 25 NA 628 15.7

NA = Not applicable.
108

Tables Centers for Disease Control and Prevention: STD Surveillance 2016

Table 43. Chancroid — Reported Cases and Rates of Reported Cases by State/Area in Alphabetical Order, 

United States and Outlying Areas, 2012–2016

Cases Rates per 100,000 Population

State/Area 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Alabama 1 1 0 0 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 0 1 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 7 6 4 2 2 0.0 0.0 0.0 0.0 0.0

Colorado 0 0 0 0 1 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 0 0 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 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Massachusetts 1 2 1 3 1 0.0 0.0 0.0 0.0 0.0

Michigan 2 0 0 0 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 1 0 0 0 1 0.0 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 0 0 0 0 1 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 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Texas 0 1 1 2 0 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 0 0 0.0 0.0 0.0 0.0 0.0

Washington 0 0 0 1 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 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wyoming 0 0 0 1 0 0.0 0.0 0.0 0.2 0.0

U.S. TOTAL 15 10 6 11 7 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 15 10 6 11 7 0.0 0.0 0.0 0.0 0.0
Centers for Disease Control and Prevention: STD Surveillance 2016 Tables

109

Table 44. Selected STDs and Complications — Initial Visits to Physicians’ Offices, National Disease 

and Therapeutic Index, United States, 1966–2015

Year

Trichomonas vaginalis 

Infections*

Other 

Vaginal 

Infections*

Pelvic 

Inflammatory

Disease†

1966 579,000 1,155,000 NA

1967 515,000 1,277,000 NA

1968 463,000 1,460,000 NA

1969 421,000 1,390,000 NA

1970 529,000 1,500,000 NA

1971 484,000 1,281,000 NA

1972 574,000 1,810,000 NA

1973 466,000 1,858,000 NA

1974 427,000 1,907,000 NA

1975 500,000 1,919,000 NA

1976 473,000 1,690,000 NA

1977 324,000 1,713,000 NA

1978 329,000 2,149,000 NA

1979 363,000 1,662,000 NA

1980 358,000 1,670,000 423,000

1981 369,000 1,742,000 283,000

1982 268,000 1,859,000 374,000

1983 424,000 1,932,000 424,000

1984 381,000 2,450,000 381,000

1985 291,000 2,728,000 425,000

1986 338,000 3,118,000 457,000

1987 293,000 3,087,000 403,000

1988 191,000 3,583,000 431,000

1989 165,000 3,374,000 413,000

1990 213,000 4,474,000 358,000

1991 198,000 3,822,000 377,000

1992 182,000 3,428,000 335,000

1993 207,000 3,755,000 407,000

1994 199,000 4,123,000 332,000

1995 141,000 3,927,000 262,000

1996 245,000 3,472,000 286,000

1997 176,000 3,100,000 260,000

1998 164,000 3,200,000 233,000

1999 171,000 3,077,000 250,000

2000 222,000 3,470,000 254,000

2001 210,000 3,365,000 244,000

2002 150,000 3,315,000 197,000

2003 179,000 3,516,000 123,000

2004 221,000 3,602,000 132,000

2005 165,000 4,071,000 176,000

2006 200,000 3,891,000 106,000

2007 205,000 3,723,000 146,000

2008 204,000 3,571,000 104,000

2009 216,000 3,063,000 100,000

2010 149,000 3,192,000 113,000

2011 168,000 3,102,000 90,000

2012 219,000 3,452,000 106,000

2013 225,000 3,278,000 88,000

2014 155,000 3,419,000 51,000

2015 139,000 3,215,000 68,000

* Females only. 

† Females 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, Integrated Promotional Services. IMS Health report, 1966–2015. The 2016 data 

were not obtained in time to include them in this report. See Section A2.5 in the Appendix for more information.
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Centers for Disease Control and Prevention: STD Surveillance 2016 Appendix

111

Appendix

A. Interpreting STD Surveillance Data

Sexually Transmitted Disease Surveillance 2016 presents surveillance information derived from the official statistics for 

the reported occurrence of nationally notifiable STDs in the United States, including data from sentinel surveillance and 

national surveys. 

A1. 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, United States 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.

A1.1 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).
112

Appendix Centers for Disease Control and Prevention: STD Surveillance 2016

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 (P&S) 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 1995 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 1995, 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 continues to be used 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 (41 reporting areas submitted 

congenital syphilis surveillance data through NETSS in 2016). 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.

Surveillance data and updates sent to CDC through NETSS and on hard copy forms through June 7, 2017, are included 

in this report. The data presented in the figures and tables in this report supersede those in all earlier publications.

A1.2 Population Denominators and Rate Calculations

2000–2016 Rates and Population

For those figures and tables presenting race using the 1997 Office of Management and Budget (OMB) standards, nonbridged-race data provided directly by the United States Census Bureau were used to calculate race. The latest available 

year for population estimates at the time this report was written was 2015. Thus, 2015 population estimates were used to 

calculate 2016 rates.

Once published, the 2016 population estimates will be used to calculate 2016 rates in the Sexually Transmitted Disease 

Surveillance 2017.
Centers for Disease Control and Prevention: STD Surveillance 2016 Appendix

113

Population estimates for Puerto Rico were obtained from the U.S. Census Bureau Web site at:

https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml.

Population estimates for Guam and the Virgin Islands were obtained from the U.S. Census Bureau International 

Programs Web site at: https://www.census.gov/population/international/data/idb/informationGateway.php.

The 2016 rates by age and sex for Guam and the Virgin Islands were calculated using 2010 population estimates 

available at: https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml.

Because of the use of the updated population data, rates for 2000–2015 may be different from those presented in 

previous STD surveillance reports.

Several figures throughout this report depict state- or county-specific rates of reported cases of STDs. Rates were 

grouped and displayed by quintiles in Figures 3, 4, 15, 16, 32, D, E, H, I, J, K, L, M, N, O, P, Q, and Y. Rates were 

grouped and displayed in 4 categories – zero cases and tertiles – in Figure 33.

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.

1941–2016 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 1941–2016. 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 of 1941 through 2016, 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 2014 were 

calculated by using live birth data based on information coded by the states and provided to the National Center for 

Health Statistics (NCHS) through the Vital Statistics Cooperative Program. Rates for 2015 and 2016 were calculated by 

using live birth data for 2014.

2010–2015 Gay, Bisexual, and Other Men Who Have Sex with Men Rates and Population

Figures BB and Y show rates of reported cases of gonorrhea and P&S syphilis among gay, bisexual, and other men 

who have sex with men (collectively referred to as MSM). Population estimates of MSM are based on a method that 

combines published estimates of the prevalence of same-sex behavior among adult men with housing and population 

data from the American Community Survey 5-year summary file (2011–2015).4-7 County-specific estimates begin with 

MSM prevalence estimates that are determined by their urbanicity according to the NCHS urban-rural classification 

scheme for counties and their United States region.8

 Estimates are then multiplied by a modified ratio of each county’s 

percentage of male same-sex households to the total percentage of male same-sex households among all counties at the 

same level of urbanicity and within the same region. Thus, the final estimate for each county reflects what would be 

expected based on the county’s geography, urban-rural classification, and observed concentration of households with a 

male head of household and a male partner.
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A1.3 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 (CSTE) 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.

A1.4 Reporting of Surveillance Data by Metropolitan Statistical Area

Sexually Transmitted Disease Surveillance 2016 continues the presentation of STD incidence data and rates for the 50 

metropolitan statistical areas (MSA) with the largest populations according to 2010 United States census 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.9

 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.

Reported cases are assigned to MSAs based on the reported county; cases reported with a missing a value for the county 

variable cannot be assigned to an MSA. Consequently, if a jurisdiction reports cases missing values for the county 

variable, reported rates for MSAs in their jurisdiction may be incomplete. Additionally, relative rankings of case counts 

by counties may be impacted by completeness of the variable used to identify county. Table A1 reports the percentage of 

cases reported with missing county information in each state for P&S syphilis, chlamydia, and gonorrhea.

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:

https://www.census.gov/programs-surveys/metro-micro.html.

A1.5 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. The OMB standards were first issued in 1997.10 Beginning with the 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 

or Other Pacific Islander, White and Multirace. For this report, jurisdictions are considered to be OMB compliant for a 

condition if ≥97% of cases for that condition are reported using current OMB standards. As of reporting year 2016, all 

jurisdictions were compliant with the current OMB race/ethnicity standards for chlamydia, gonorrhea, and P&S syphilis. 

For chlamydia and gonorrhea figures showing trends for 2012–2016, data are included for all jurisdictions except five 

not consistently reporting race/ethnicity data according to the current standard categories for the five consecutive years 

(Alaska, Maryland, Michigan, New York, and the District of Columbia). For P&S syphilis figures showing trends for 

2012– 2016, data are included for all jurisdictions except five not consistently reporting race/ethnicity data according 

to the current standard categories for the five consecutive years (Alaska, Maryland, New York, Utah, and the District of 

Columbia).
Centers for Disease Control and Prevention: STD Surveillance 2016 Appendix

115

A1.6 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 2016.

As a result, rate data that are stratified by one or more of these variables reflect rates based on reported data only.

A1.7 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 (HMOs), 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. Figures 7, 8, 21, 

and 22 display trends in the proportion of cases reported in 2016 categorized by reporting source. Categories displayed 

vary across these figures and include the five most commonly reported sources for the population included in the figure, 

along with trends for all other reporting sources combined into the “All Other” category, and trends in the proportion of 

cases with unknown reporting source.

A1.8 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. 

During 2000–2011, the expanded use of more sensitive diagnostic tests (e.g., nucleic acid amplification tests [NAATs]) 

likely increased the number of infections identified and reported independently of increases in incidence. Also, 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. 

The increased use of electronic laboratory reporting over the last decade or so also likely increased the proportion of 

diagnosed cases reported. Consequently, an increasing chlamydia case rate over time 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.

A1.9 Syphilis Morbidity Reporting

The category of “total syphilis” or “all stages of syphilis” includes primary syphilis, secondary syphilis, early latent 

syphilis, late latent syphilis, late syphilis with clinical manifestations (including late benign syphilis and cardiovascular 

syphilis), and congenital syphilis.

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.
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A1.10 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.11 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 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. Similarly, since 1995, congenital 

syphilis cases are reported by state and city of residence of the mother.

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.

A2. Other Sources of Surveillance Data

A2.1 National Job Training Program

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 

Department of Labor. Prevalence data are presented in figures N, O, P, and Q.

A2.2 STD Surveillance Network

In 2005, CDC established the STD Surveillance Network (SSuN) as a collaborative network of state, county and/or city 

health departments following protocols to conduct sentinel and enhanced STD surveillance activities. The purpose of 

SSuN is to improve the capacity of national, state and local STD programs to detect, monitor, and respond to trends in 

STDs through enhanced collection, reporting, analysis, visualization, and interpretation of disease information.

Cycle 3 (2013–2018) of SSuN provides funding to 10 jurisdictions to conduct two core STD surveillance activities 

including; (1) sentinel facility component, providing clinical and demographic information on

a full census of patients attending categorical STD clinics and women aged 15–44 years presenting for care in 

reproductive health settings, and, (2) population component, conducting enhanced health department look-back, 

provider, and patient investigations on a probability sample of all persons diagnosed and reported with gonorrhea. 

Funded jurisdictions for both core activities in SSuN Cycle 3 include Baltimore City (Maryland), California (excluding 

San Francisco County), Florida, Massachusetts, Minnesota, Multnomah County (Oregon), Philadelphia City 

(Pennsylvania), New York City (New York), San Francisco County (California), and Washington State.

In both the facility and population components of SSuN Cycle 3, unique patients can be anonymously identified using 

non-identifying IDs to provide longitudinal information. In the facility component, the primary unit of analysis is 

the patient visit, which is merged with multiple laboratory, diagnostic, and treatment observations. In the population 

component, the primary unit of analysis is a reported episode of gonorrhea for a unique person merged with multiple 

laboratory observations, health department disease registry history, provider-based clinical information, and patient 

demographic and behavioral interview data. For analysis in the population component, cases in the probability sample 

are weighted to reflect study design and to adjust for non-response by demographic category of the patient. Weighted 

analyses provide estimates of case and person characteristics representative of all reported cases in the collaborating 

jurisdictions.
Centers for Disease Control and Prevention: STD Surveillance 2016 Appendix

117

MSM are defined in all SSuN data collection activities as men who either reported having sex with another man in the 

preceding 2–3 months, reported current history of male sex partners, and/or those who reported that they considered 

themselves gay/homosexual or bisexual. Men who have sex with women (MSW) are defined as men who reported 

having sex with women only or who did not report the sex of their sex partners but reported that they considered 

themselves to be straight/heterosexual.

Data presented in this report from the facility component of SSuN are from nine participating jurisdictions (Baltimore 

City [Maryland], California [excluding San Francisco County], Massachusetts, Minnesota, Multnomah County 

[Oregon], New York City [New York], Philadelphia City [Pennsylvania], San Francisco County [California] and 

Washington State). Figures 11, 24, CC, DD, EE, and FF are based on STD clinic data and Figure F is based on data from 

facilities that provide family planning and reproductive health services. Data presented in this report from the population 

component of SSuN include Figures 23 and BB. Figure 23 presents data collected January–December 2016 showing the 

proportion of cases attributable to MSM, men who have sex with both men and women (MSMW), MSW, and women 

for all SSuN jurisdictions. Figure BB presents data collected January 2010–June 2013 and June–December 2015 for 

six SSuN jurisdictions collaborating in both SSuN Cycle 2 and SSuN Cycle 3 (Baltimore City [Maryland], California 

[excluding San Francisco County], New York City [New York], Philadelphia City [Pennsylvania], San Francisco County 

[California], and Washington State).

A2.3 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 regional 

laboratories in the United States. For more details on findings from GISP, go to: https://www.cdc.gov/std/GISP/.

For 2016, the antimicrobial agents tested by GISP were ceftriaxone, cefixime, azithromycin, ciprofloxacin, penicillin, 

tetracycline, and gentamicin.

The antimicrobial susceptibility criteria used in GISP for 2016 are as follows:

• Ceftriaxone, minimum inhibitory concentration (MIC) ≥0.5 μg/ml (decreased susceptibility)*

• Ceftriaxone, MIC ≥0.125 μg/ml (elevated MICs)*

• Cefixime, MIC ≥0.5 μg/ml (decreased susceptibility)*

• Cefixime, MIC ≥0.25 μg/ml (elevated MICs)*

• Azithromycin, MIC ≥2.0 μg/ml (elevated MICs)*

• Ciprofloxacin, MIC ≥1.0 μg/ml (resistance)

• Ciprofloxacin, MIC 0.125–0.5 μg/ml (intermediate resistance)

• Penicillin, MIC ≥2.0 μg/ml (resistance)

• Tetracycline, MIC ≥2.0 μg/ml (resistance)

• Gentamicin (MIC values correlated with susceptibility and resistance have not been established).

The majority of these criteria are also recommended by the Clinical and Laboratory Standards Institute (CLSI).12

* The CLSI criteria for decreased susceptibility and resistance to ceftriaxone, cefixime, gentamicin, and azithromycin and for susceptibility to azithromycin have not 

been established for N. gonorrhoeae.

A2.4 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 

two years. The sampling plan of the survey is a stratified, multistage, probability cluster design that selects a sample 

representative of the United States civilian, non-institutionalized population. For more information,

see: https://www.cdc.gov/nchs/nhanes.htm.
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A2.5 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 2015; the 2016 NDTI data were not obtained in time to include them in this report). 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.

References

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. American Community Survey. 5-year summary file, 2011–2015. US Census Bureau: 2016.

5. Grey JA, Bernstein KT, Sullivan PS, et al. Estimating the population sizes of men who have sex with men in US states and counties using data from the 

American Community Survey. JMIR Public Health Surveill 2016; 2(1):e14.

6. Oster AM, Sternberg M, Lansky A, et al. Population size estimates for men who have sex with men and persons who inject drugs. J Urban Health 2015; 

92(4):733–743.

7. Purcell DW, Johnson CH, Lansky A, et al. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. 

Open AIDS J 2012; 6(Suppl 1):98–107.

8. Ingram DD, Franco SJ. 2013 NCHS urban-rural classification scheme for counties. National Center for Health Statistics. Vital Health Stat 2014; 2(166):1–81. 

9. Office of Management and Budget. Standards for defining metropolitan and micropolitan statistical areas. Federal Register 2000; 65(249):82228–82238.

10. Office of Management and Budget. Revisions to the Standards for Classification of Federal Data on Race and Ethnicity. Federal Register Notice. October 30, 

1997.

11. Kaufman RE, Jones OG, Blount JH, et al. Questionnaire survey of reported early congenital syphilis: problems in diagnosis, prevention, and treatment. Sex 

Transm Dis 1977; 4(4):135–139.

12. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty-fifth informational supplement. M100-S25, 

35(3). Wayne (PA): Clinical and Laboratory Standards Institute; 2015.
Centers for Disease Control and Prevention: STD Surveillance 2016 Appendix

119

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

by State and by Nationally Notifiable STD, 2016

Primary and Secondary Syphilis

State

Percentage

Unknown

Race/

Ethnicity

Percentage

Unknown

Age

Percentage

Unknown

Sex

Percentage

Unknown

Sex

Partner

Percentage

Unknown

County

Alabama 0.3 8.8 0.0 32.2 4.5

Alaska* 0.0 0.0 0.0 12.5 0.0

Arizona 1.9 0.0 0.0 6.8 0.0

Arkansas 1.3 0.0 0.0 4.7 0.0

California 6.2 0.0 0.1 16.0 0.0

Colorado 3.6 0.0 0.0 6.4 0.0

Connecticut 0.0 0.0 0.0 20.0 0.9

Delaware 6.9 0.0 0.0 84.5 0.0

District of Columbia 30.4 0.0 2.5 26.7 NA

Florida 2.6 0.0 0.0 12.1 0.0

Georgia 1.4 0.0 0.0 28.4 0.0

Hawaii 5.4 0.0 0.0 19.6 0.0

Idaho 8.0 0.0 0.0 22.0 0.0

Illinois 1.8 0.0 0.0 26.8 0.0

Indiana 0.3 0.0 0.0 6.1 0.0

Iowa 1.1 0.0 0.0 9.0 0.0

Kansas 0.0 0.0 0.0 6.5 0.0

Kentucky 0.0 0.0 0.0 16.0 0.0

Louisiana 0.0 0.0 0.0 4.4 0.0

Maine 0.0 0.0 0.0 28.6 0.0

Maryland 1.8 0.0 0.0 12.4 0.0

Massachusetts 4.7 0.0 0.2 13.5 9.2

Michigan 1.6 0.0 0.0 5.2 0.0

Minnesota 3.3 0.0 0.7 4.9 0.0

Mississippi 3.4 0.0 0.0 4.0 0.0

Missouri 0.0 0.0 0.0 6.3 0.0

Montana 0.0 0.0 0.0 14.3 0.0

Nebraska 7.5 0.0 0.0 43.3 0.0

Nevada 1.4 0.0 0.0 7.4 0.2

New Hampshire 10.0 0.0 0.0 2.5 0.0

New Jersey 4.4 0.0 0.0 30.5 0.0

New Mexico 14.8 0.0 0.0 7.9 0.0

New York 7.7 0.1 0.9 31.6 0.0

North Carolina 0.1 0.0 0.0 6.2 0.0

North Dakota 9.1 0.0 0.0 12.1 0.0

Ohio 0.0 0.0 0.0 8.2 0.0

Oklahoma 0.0 0.0 0.0 0.4 0.0

Oregon 4.6 0.0 0.0 16.8 0.0

Pennsylvania 6.5 0.0 0.0 9.4 0.0

Rhode Island 13.3 0.0 0.0 41.1 0.0

South Carolina 3.8 0.0 0.0 2.8 0.0

South Dakota 0.0 0.0 0.0 3.8 0.0

Tennessee 0.0 0.0 0.0 58.7 0.0

Texas 0.6 0.0 0.0 6.0 0.1

Utah 0.0 0.0 0.0 5.4 0.0

Vermont 0.0 0.0 0.0 4.3 0.0

Virginia 8.7 0.0 2.0 12.9 0.0

Washington 5.8 0.0 0.0 4.2 0.0

West Virginia 0.0 0.0 0.0 5.7 0.0

Wisconsin 7.6 0.0 0.0 50.0 0.0

Wyoming* 14.3 0.0 0.0 100.0 0.0

U.S. TOTAL 3.8 0.1 0.1 15.9 0.2

Continued on next page.
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Table A1. Selected STDs — Percentage of Unknown, Missing, or Invalid Values for Selected Variables by State 

and by Nationally Notifiable STD, 2016 (continued)

Gonorrhea Chlamydia

State

Percentage

Unknown

Race/

Ethnicity

Percentage

Unknown

Age

Percentage

Unknown

Sex

Percentage 

Unknown 

County

Percentage

Unknown

Race/

Ethnicity

Percentage

Unknown

Age

Percentage

Unknown

Sex

Percentage 

Unknown 

County

Alabama 31.3 14.2 0.7 26.5 38.6 13.1 0.7 25.4

Alaska* 0.1 0.0 0.0 0.3 0.1 0.0 0.0 0.4

Arizona 17.8 0.0 0.0 0.0 29.3 0.0 0.0 0.0

Arkansas 0.6 0.0 0.0 0.0 0.4 0.0 0.0 0.0

California 21.8 0.2 0.6 0.0 41.5 0.2 0.3 0.0

Colorado 30.1 0.0 0.0 0.1 46.2 0.0 0.0 0.2

Connecticut 30.9 0.1 0.1 5.7 66.4 0.1 1.1 3.0

Delaware 4.1 0.0 0.0 0.0 4.8 0.0 0.0 0.0

District of Columbia 69.9 0.6 2.2 NA 76.6 0.7 2.1 NA

Florida 9.7 0.0 0.0 0.0 15.4 0.0 0.1 0.0

Georgia 26.5 0.1 0.1 3.7 38.0 0.1 0.1 3.9

Hawaii 36.1 0.1 0.1 0.1 47.9 0.1 0.0 0.1

Idaho 24.7 0.0 0.3 0.0 39.4 0.0 0.1 0.0

Illinois 18.8 0.0 0.1 0.0 20.4 0.0 0.1 0.0

Indiana 7.4 0.0 0.0 0.0 11.5 0.0 0.0 0.0

Iowa 3.4 0.0 0.0 0.0 6.0 0.0 0.0 0.0

Kansas 9.6 0.0 0.0 0.0 33.3 0.0 0.0 0.0

Kentucky 24.6 0.1 1.5 0.0 35.1 0.1 1.9 0.0

Louisiana 0.2 0.0 0.0 0.2 0.2 0.0 0.0 0.3

Maine 1.8 0.9 0.2 0.9 31.6 0.0 0.1 1.4

Maryland 23.4 0.0 0.1 0.0 40.0 0.0 0.1 0.0

Massachusetts 36.1 0.1 0.3 14.4 67.4 0.1 0.3 17.2

Michigan 24.2 0.1 0.0 0.0 28.6 0.1 0.0 0.0

Minnesota 17.3 0.1 0.2 2.9 24.4 0.1 0.1 4.0

Mississippi 19.6 0.0 0.1 0.0 25.9 0.0 0.2 0.0

Missouri 8.9 0.0 0.0 0.0 13.8 0.0 0.0 0.0

Montana 1.3 0.0 0.0 0.0 1.4 0.1 0.0 0.0

Nebraska 16.2 0.0 0.2 0.0 26.5 0.1 0.3 0.0

Nevada 36.6 0.0 0.1 0.5 44.9 0.0 0.2 0.9

New Hampshire 21.1 0.0 0.0 0.0 25.5 0.0 0.0 0.0

New Jersey 38.8 0.6 0.2 1.1 52.1 0.4 0.2 1.0

New Mexico 21.3 0.0 0.1 0.0 27.1 0.0 0.1 0.0

New York 24.9 0.1 0.2 0.0 38.4 0.1 0.1 0.0

North Carolina 15.5 0.0 0.0 0.0 20.3 0.0 0.0 0.0

North Dakota 3.0 0.0 0.0 0.0 9.6 0.0 0.0 0.0

Ohio 18.6 0.0 0.0 2.0 25.0 0.1 0.0 2.5

Oklahoma 9.9 0.0 0.0 0.0 13.6 0.0 0.0 0.0

Oregon 9.7 0.0 0.0 0.1 27.2 0.0 0.0 0.0

Pennsylvania 22.8 0.0 0.1 0.0 33.3 0.0 0.1 0.0

Rhode Island 14.4 0.1 0.0 1.3 23.1 0.0 0.0 0.5

South Carolina 20.7 0.0 0.5 0.0 27.3 0.0 0.4 0.0

South Dakota 1.8 0.0 0.0 0.0 10.5 0.0 0.0 0.0

Tennessee 1.1 0.0 0.0 0.0 1.8 0.0 0.0 0.0

Texas 17.0 0.1 0.2 0.4 22.3 0.1 0.2 0.4

Utah 6.4 0.0 0.0 0.1 6.4 0.0 0.0 0.1

Vermont 0.8 0.0 0.0 0.0 4.0 0.0 0.1 0.0

Virginia 26.1 0.1 0.3 0.3 36.0 0.2 0.3 0.2

Washington 13.1 0.1 0.0 0.0 19.2 0.1 0.0 0.0

West Virginia 11.8 0.0 0.0 0.0 26.6 0.0 0.0 0.0

Wisconsin 23.8 0.0 0.1 0.0 19.6 0.0 0.1 0.0

Wyoming* 26.2 0.0 0.0 0.0 37.1 0.0 0.0 0.0

U.S. TOTAL 19.0 0.3 0.2 1.0 28.8 0.3 0.2 1.1

* Percentages for primary and secondary syphilis are based on less than 10 cases.

NA = Not applicable.

NOTE: For all categories, unknown included cases reported as unknown or missing. In addition, unknown race/ethnicity included cases reported in non-OMB 

compliant categories.
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Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2016

Non-STD Clinic STD Clinic Total

Disease Male Female Total* Male Female Total* Male† Female† Total‡

Chlamydia 385,522 868,276 1,255,933 57,357 44,552 102,022 522,870 1,072,719 1,598,354

Gonorrhea 196,422 156,304 353,487 35,286 13,909 49,248 270,033 197,499 468,514

Primary Syphilis 5,969 608 6,584 1,784 108 1,894 8,565 793 9,369

Secondary Syphilis 11,691 1,757 13,465 2,903 320 3,226 16,159 2,256 18,445

Early Latent Syphilis 18,547 2,969 21,571 3,815 561 4,382 24,919 3,939 28,924

Late and Late Latent Syphilis§ 16,489 5,861 22,386 2,245 648 2,895 22,785 7,850 30,676

Chancroid 4 1 5 0 0 0 6 1 7

* 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 and late syphilis with clinical manifestations (including late benign syphilis and cardiovascular syphilis).
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B. National Objectives and Goals

B1. 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.1

 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 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 to drive action that 

will support its four overarching goals:

• Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.

• Achieve health equity, eliminate disparities, and improve the health of all groups.

• Create social and physical environments that promote good health for all.

• 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 B1. The year 2020 targets for the diseases addressed 

in this report are as follows: primary and secondary (P&S) syphilis (males), 6.8 cases per 100,000 males; P&S syphilis 

(females), 1.4 cases per 100,000 females; congenital syphilis, 9.1 cases per 100,000 live births; gonorrhea (females aged 

15–44 years), 257.0 cases per 100,000 females and gonorrhea (males aged 15–44 years), 198.0 cases per 100,000 males. 

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.”

B2. 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 pelvic inflammatory disease (PID) and eliminating congenital syphilis. Each of these goals has specific 

measures of progress, which are outlined in Table B2.

References

1. U.S. Department of Health and Human Services. Healthy People 2020 (Healthy People 2020 Web site). Available at https://www.healthypeople.gov/2020/default.

Accessed on August 4, 2017.
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Table B1. Healthy People 2020 (HP 2020) Sexually Transmitted Diseases Objectives

HP2020 Objectives Baseline 

Year Baseline 2014 2015 2016 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% N/A 8.6% 8.4% 6.7%

b. Among females aged 24 years and under enrolled in a National Job 

 Training Program 2008 12.8% 12.8% 12.7% 11.4% 11.5%

c. Among males aged 24 years and under enrolled in a National Job 

 Training Program 2008 7.0% 7.0% 7.5% 7.1% 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% 52.3% 51.2% N/A 70.9%

b. Females aged 21 to 24 years 2008 59.4% 62.0% 60.1% 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% 42.7% 42.4% N/A 61.3%

b. Females aged 21 to 24 years 2008 43.5% 52.1% 52.4% N/A 74.6%

4 Reduce the proportion of females aged 15 to 44 years who have ever 

required treatment for pelvic inflammatory disease (PID) 2006–2010 4.2% N/A 3.0% N/A 3.8%

5 Reduce gonorrhea rates

a. Females aged 15 to 44 years 2008 279.9 248.1 263.4 297.1 251.9

b. Males aged 15 to 44 years 2008 216.5 262.8 307.6 370.2 194.8

6 Reduce sustained domestic transmission of primary and 

secondary syphilis 

a. Among females 2008 1.4 1.1 1.4 1.9 1.3

b. Among males 2008 7.4 11.6 13.7 15.6 6.7

7 Reduce congenital syphilis 2008 10.7 11.6 12.4 15.7 9.6

8 Reduce the proportion of young adults with genital herpes 

infection due to herpes simplex type 2 2005–2008 10.5% 8.3%* N/A N/A 9.5%

HP2020 

Objective Data Source

1a STD Surveillance Network (SSuN), CDC

1b, 1c National Job Training Program (NJTP)

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 National Survey of Family Growth (NSFG), CDC

5a, 5b National Notifiable Disease Surveillance System (NNDSS), CDC

6a, 6b National Notifiable Disease Surveillance System (NNDSS), CDC

7 National Notifiable Disease Surveillance System (NNDSS), CDC

8 National Health and Nutrition Examination Survey (NHANES), CDC

NOTE: Data presented in this table reflect data reported to HP2020 in current and prior years. Data for years prior to 2016 may not match estimates presented in 

other sections of this report. More information about HP2020 is available at: https://www.healthypeople.gov/

* 2011–2012
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Table B2. Government Performance and Results Act (GPRA) Sexually Transmitted Diseases Goals, Measures, 

and Target

GPRA Goals

Actual Target

2014 2015 2016 2017

Goal 1: Reduction in PID (as measured by initial visits to physicians in women 15–44 years of age) 98,800 68,000 N/A 86,423

a. Proportion of high-risk women aged 16–20 infected with chlamydia* 13.9% 13.4% 12.3% 11.7%

b. Proportion of high-risk women aged 21–24 infected with chlamydia*† 7.3% 8.5% 7.4% 8.3%

c. Rate of gonorrhea/100,000 population in women aged 16–20 523.9 537.0 586.0 523.9

d. Rate of gonorrhea/100,000 population in women aged 21–24 508.1 523.9 573.0 511.8

e. Black: white ratio of gonorrhea in women aged 16–24 10.3 9.5 8.4 10.1

f. Proportion of sexually active females aged 16–20 years enrolled in Medicaid who are screened for 

 chlamydia infections 52.3% 51.2% N/A 62.5%

g. Proportion of sexually active females aged 21–24 years enrolled in Medicaid who are screened for 

 chlamydia infections 62.0% 60.1% N/A 66.0%

h. Proportion of sexually active females aged 16–20 years enrolled in commercial health insurance plans 

 who are screened for chlamydia infections 42.7% 42.4% N/A 43.5%

i. Proportion of sexually active females aged 21–24 years enrolled in commercial health insurance plans 

 who are screened for chlamydia infections 52.1% 52.4% N/A 52.7%

Goal 2: Elimination of Congenital Syphilis

a. Incidence of P&S syphilis/100,000 population in women aged 15–44 2.6 3.2 4.2 0.8

b. Incidence of congenital syphilis/100,000 live births 11.5 12.4 15.7 6.2

c. Proportion of pregnant women that are screened for syphilis at least one month before delivery 85.9% 84.0% N/A 84.0%

GPRA Goals Data Source

1 National Disease and Therapeutic Index (IMS Health)

1a, 1b National Job Training Program (NJTP)

1c, 1d, 1e National Notifiable Disease Surveillance System (NNDSS), CDC

1f, 1g, 1h, 1i Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)

2a, 2b National Notifiable Disease Surveillance System (NNDSS),CDC

2c MarketScan Commercial Claims and Encounters Database, Truven Health Analytics

NOTE: Data presented in this table reflect data reported to GPRA in current and prior years. Data for years prior to 2016 may not match estimates presented in 

other sections of this report.

* 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.
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C. STD Surveillance Case Definitions

C1. Case Definitions For Nationally Notifiable Infectious Diseases

The Council of State and Territorial Epidemiologists (CSTE) recommends that state health departments report cases 

of selected diseases to CDC’s National Notifiable Diseases Surveillance System (NNDSS). Case definitions are 

periodically revised using CSTE’s Position Statements and provide uniform criteria of nationally notifiable conditions 

for reporting purposes. The most current surveillance case definitions for nationally notifiable STDs are listed below. 

Please see the NNDSS website (https://wwwn.cdc.gov/nndss/case-definitions.html) for historical case definitions.

C1.1 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

• 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.

C1.2 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

• Isolation of C. trachomatis by culture or

• Demonstration of C. trachomatis in a clinical specimen by detection of antigen or nucleic acid

Case classification

Confirmed: a case that is laboratory confirmed.
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C1.3 Gonorrhea (Effective 1/14)

Clinical description

A sexually transmitted infection commonly manifested by urethritis, cervicitis, proctitis, salpingitis, or pharyngitis. 

Infection may be asymptomatic.

Laboratory criteria for diagnosis

• Observation of gram-negative intracellular diplococci in a urethral smear obtained from a male or an endocervical 

smear obtained from a female, or

• Isolation of typical gram-negative, oxidase-positive diplococci by culture (presumptive Neisseria gonorrhoeae) 

from a clinical specimen, or

• Demonstration of N. gonorrhoeae in a clinical specimen by detection of antigen or nucleic acid

Case classification

Probable: demonstration of gram-negative intracellular diplococci in a urethral smear obtained from a male or an 

endocervical smear obtained from a female.

Confirmed: a person with laboratory isolation of typical gram-negative, oxidase-positive diplococci by culture 

(presumptive Neisseria gonorrhoeae) from a clinical specimen, or demonstration of N. gonorrhoeae in a clinical 

specimen by detection of antigen or detection of nucleic acid via nucleic acid amplification (e.g., PCR) or hybridization 

with a nucleic acid probe.

C1.4 Syphilis (Effective 1/14)

Syphilis is a complex sexually transmitted disease that has a highly variable clinical course. Adherence to the following 

surveillance case definitions will facilitate understanding the epidemiology of this disease across the U.S.

Syphilis, primary (Effective 1/14)

Clinical description

A stage of infection with Treponema pallidum characterized by one or more ulcerative lesions (e.g. chancre), which 

might differ considerably in clinical appearance.

Laboratory criteria for diagnosis

Demonstration of T. pallidum in clinical specimens by darkfield microscopy, or by polymerase chain reaction (PCR) or 

equivalent direct molecular methods.

Case classification

Probable: a case that meets the clinical description of primary syphilis with a reactive serologic test (nontreponemal: 

Venereal Disease Research Laboratory [VDRL], rapid plasma reagin [RPR], or equivalent serologic methods; 

treponemal: fluorescent treponemal antibody absorbed [FTA-ABS], T. pallidum particle agglutination [TP-PA], enzyme 

immunoassay [EIA], chemiluminescence immunoassay [CIA], or equivalent serologic methods). These treponemal tests 

supersede older testing technologies, including microhemagglutination assay for antibody to T. pallidum [MHA-TP].

Confirmed: a case that meets the clinical description of primary syphilis that is laboratory confirmed.
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Syphilis, secondary (Effective 1/14)

Clinical description

A stage of infection caused by T. pallidum characterized by localized or diffuse mucocutaneous lesions (e.g., rash – 

such as non-pruritic macular, maculopapular, popular, or pustular lesions), often with generalized lymphadenopathy. 

Other symptoms can include mucous patches, condyloma lata, and alopecia. The primary ulcerative lesion may still be 

present. Because of the wide array of symptoms possibly indicating secondary syphilis, serologic tests for syphilis and a 

thorough sexual history and physical examination are crucial to determining if a case should be classified as secondary 

syphilis.

Laboratory criteria for diagnosis

Demonstration of T. pallidum in clinical specimens by darkfield microscopy, or by polymerase chain reaction (PCR) or 

equivalent direct molecular methods.

Case classification

Probable: a case that meets the clinical description of secondary syphilis with a nontreponemal (VDRL, RPR, or 

equivalent serologic methods) titer ≥4 and a reactive treponemal test (FTA-ABS, TP-PA, EIA, CIA, or equivalent 

serologic methods).

Confirmed: a case that meets the clinical description of secondary syphilis (with at least one sign or symptom) that is 

laboratory confirmed.

Syphilis, early latent (Effective 1/14)

Clinical description

A subcategory of latent syphilis (a stage of infection caused by T. pallidum in which organisms persist in the body of the 

infected person without causing symptoms or signs) when initial infection has occurred within the previous 12 months.

Case classification

Probable: A person with no clinical signs or symptoms of syphilis who has one of the following:

• No past diagnosis of syphilis, and a reactive nontreponemal test (e.g., VDRL, RPR, or equivalent serologic 

methods), and a reactive treponemal test (e.g., FTA-ABS, TP-PA, EIA, CIA, or equivalent serologic methods), or

• A current nontreponemal test titer demonstrating fourfold or greater increase from the last nontreponemal test titer

AND evidence of having acquired the infection within the previous 12 months based on one or more of the following 

criteria:

• Documented seroconversion or fourfold or greater increase in titer of a nontreponemal test during the previous 12 

months

• Documented seroconversion of a treponemal test during the previous 12 months

• A history of symptoms consistent with primary or secondary syphilis during the previous 12 months

• A history of sexual exposure to a partner within the previous 12 months who had primary, secondary, or early latent 

syphilis (documented independently as duration <12 months)

• Only sexual contact was within the last 12 months (sexual debut). 

There is no confirmed case classification for early latent syphilis.
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Syphilis, late latent (Effective 1/14)

Clinical description

A subcategory of latent syphilis (a stage of infection caused by T. pallidum in which organisms persist in the body of the 

infected person without causing symptoms or signs) when initial infection has occurred >12 months previously.

Case classification

Probable: a person with no clinical signs or symptoms of syphilis who has one of the following:

• No past diagnosis of syphilis, and a reactive nontreponemal test (e.g., VDRL, RPR, or equivalent serologic 

methods), and a reactive treponemal test (e.g., FTA-ABS, TP-PA, EIA, CIA, or equivalent serologic methods), or

• A past history of syphilis therapy and a current nontreponemal test titer demonstrating fourfold or greater increase 

from the last nontreponemal test titer.

AND who has no evidence of having acquired the disease within the preceding 12 months (see Syphilis, early latent). 

There is no confirmed case classification for late latent syphilis.

Neurosyphilis (Effective 1/14)

Neurosyphilis can occur at any stage of syphilis. If the patient has neurologic manifestations of syphilis, the case should 

be reported with the appropriate stage of infection (as if neurologic manifestations were not present) and neurologic 

manifestations should be noted in the case report data. If no other stage is appropriate, the case should be staged as “late, 

with clinical manifestations”.

Neurosyphilis can apply to all stages of infection of syphilis listed, including: primary syphilis, secondary syphilis, early 

latent syphilis, late latent syphilis, and late syphilis with clinical manifestations.

Clinical description

Infection of the central nervous system with T. pallidum, as evidenced by manifestations including syphilitic meningitis, 

meningovascular syphilis, optical involvement including interstitial keratitis and uveitis, general paresis, including 

dementia, and tabes dorsalis.

Laboratory criteria for diagnosis

• A reactive VDRL in cerebrospinal fluid (CSF) and either (1) a reactive treponemal serologic test for syphilis (e.g., 

FTA- ABS, TP-PA, EIA, CIA, or equivalent serologic methods) or (2) a reactive nontreponemal serologic test for 

syphilis (VDRL, RPR, or equivalent serologic method).

Case classification

Probable: syphilis of any stage with a negative VDRL test in CSF specimen and either (1) a reactive treponemal 

serologic test for syphilis (e.g., FTA-ABS, TP-PA, EIA, CIA, or equivalent serologic methods) or (2) a reactive nontreponemal serologic test for syphilis (VDRL, RPR, or equivalent serologic method), and both of the following:

• Elevated CSF protein (>50 mg/dL2) or leukocyte count (>5 white blood cells/cubic millimeter CSF) in the absence 

of other known causes of these abnormalities, and

• 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.
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Syphilis, late with clinical manifestations (including late benign syphilis and cardiovascular 

syphilis) (Effective 1/14)

Clinical description

Clinical manifestations of late syphilis may include inflammatory lesions of the cardiovascular system (e.g., aortitis, 

coronary vessel disease), skin (e.g., gummatous lesions) bone (e.g., osteitis) or other tissue. 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. If only neurologic manifestations of syphilis (e.g., tabes dorsalis, dementia) are present and 

infection occurred more than 12 months ago, the case should be reported as “late syphilis”.

Laboratory criteria for diagnosis

Demonstration of T. pallidum in late lesions by special stains (although organisms are rarely visualized in late lesions), 

or equivalent methods, or by polymerase chain reaction (PCR) or equivalent direct molecular methods.

Case classification

Probable: characteristic abnormalities or lesions of the cardiovascular system (e.g., aortitis, coronary vessel disease), 

skin (e.g., gummatous lesions), bone (e.g., osteitis), or other tissue and a reactive treponemal test (e.g., FTA-ABS, 

TP-PA, EIA, CIA, or equivalent serologic methods), in the absence of other known causes of these abnormalities. CSF 

abnormalities and clinical symptoms or signs consistent with neurologic manifestations of syphilis might be present.

Confirmed: a case that meets the clinical description of late syphilis that is laboratory confirmed.

Syphilis, Congenital (Revised 1/15)

Clinical description

A condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, from inapparent 

infection to severe cases that are clinically apparent at birth. An infant or child (aged less than 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

• Demonstration of T. pallidum by darkfield microscopy of lesions, body fluids, or neonatal nasal discharge, or

• Polymerase chain reaction (PCR) or other equivalent direct molecular methods of lesions, placenta, umbilical cord, 

or autopsy material, or

• Immunohistochemistry (IHC), or special stains (e.g., silver staining) of specimens from lesions, neonatal nasal 

discharge, 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 non-treponemal test for syphilis (Venereal 

Disease Research Laboratory [VDRL], rapid plasma reagin [RPR], or equivalent serologic methods) AND any one of 

the following:

• Any evidence of congenital syphilis on physical examination (see Clinical description)

• Any evidence of congenital syphilis on radiographs of long bones

• A reactive cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL) test

• In a nontraumatic lumbar puncture, an elevated CSF leukocyte (white blood cell, WBC) count or protein (without 

other cause):

* Adequate treatment is defined as completion of a penicillin-based regimen, in accordance with CDC treatment guidelines, appropriate for stage of infection, 

initiated 30 or more days before delivery.
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Suggested parameters for abnormal CSF WBC and protein values:

• During the first 30 days of life, a CSF WBC count of >15 WBC/mm3 or a CSF protein >120 mg/dL.

• After the first 30 days of life, a CSF WBC count of >5 WBC mm3 or a CSF protein >40 mg/dL, regardless of 

CSF serology.

• The treating clinician should be consulted to interpret the CSF values for the specific patient.

Confirmed: a case that is laboratory confirmed.

Syphilitic Stillbirth

Clinical case definition

A fetal death that occurs after a 20-week gestation or in which the fetus weighs greater than 500 g and the mother had 

untreated or inadequately treated* syphilis at delivery.

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, 

WBC cell count, and protein 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. While maternal antibodies can complicate interpretation of serologic tests in an infant, 

reactive tests past 18 months of age are considered to reflect the status of the child. 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.

* Adequate treatment is defined as completion of a penicillin-based regimen, in accordance with CDC treatment guidelines, appropriate for stage of infection, 

initiated 30 or more days before delivery.

C2. Case Definitions For Non-Notifiable Infectious Diseases

Although the conditions below are not currently nationally notifiable, they may be reportable in some jurisdictions. To 

provide uniform criteria for those jurisdictions, case definitions are provided by CSTE. Case definitions are periodically 

revised. The most current surveillance case definitions for non-notifiable STDs are listed below. Please see the NNDSS 

website (https://wwwn.cdc.gov/nndss/case-definitions.html) for historical case definitions.

C2.1 Genital Herpes (Herpes Simplex Virus) (Revised 9/96)

Clinical description

A condition characterized by visible, painful genital or anal lesions.

Laboratory criteria for diagnosis

• Isolation of herpes simplex virus from cervix, urethra, or anogenital lesion, or

• Demonstration of virus by antigen detection technique in clinical specimens from cervix, urethra, or anogenital 

lesion, or

• Demonstration of multinucleated giant cells on a Tzanck smear of scrapings from an anogenital lesion.
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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.

C2.2 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

• Histopathologic changes characteristic of human papillomavirus infection in specimens obtained by biopsy or 

exfoliative cytology or

• 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.

Comment

Genital warts should be reported only once per patient. The first diagnosis for a patient with no previous diagnosis 

should be reported.

C2.3 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

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.
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C2.4 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

Isolation of C. trachomatis, serotype L1, L2, or L3 from clinical specimen, or

• Demonstration by immunofluorescence of inclusion bodies in leukocytes of an inguinal lymph node (bubo) 

aspirate, or

• 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.

C2.5 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:

• Mucopurulent secretion (from the endocervix) that is yellow or green when viewed on a white, cotton-tipped swab 

(positive swab test)

• Induced endocervical bleeding (bleeding when the first swab is placed in the endocervix).

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). 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.
Centers for Disease Control and Prevention: STD Surveillance 2016 Appendix

135

C2.6 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:

• A visible abnormal urethral discharge, or

• 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

• Microscopic evidence of urethritis (≥5 white blood cells per high-power field) on a Gram stain of a urethral smear.

Laboratory criteria for diagnosis

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). 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.

C2.7 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:

• Lower abdominal tenderness, and

• Tenderness with motion of the cervix, and

• Adnexal tenderness.

In addition to the preceding criteria, at least one of the following findings must also be present:

• Meets the surveillance case definition of C. trachomatis infection or gonorrhea

• Temperature >100.4 F (>38.0 C)

• Leukocytosis >10,000 white blood cells/mm3

• Purulent material in the peritoneal cavity obtained by culdocentesis or laparoscopy

• Pelvic abscess or inflammatory complex detected by bimanual examination or by sonography

• 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.
136

Appendix Centers for Disease Control and Prevention: STD Surveillance 2016
Centers for Disease Control and Prevention: STD Surveillance 2016 Contributors

137

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 August 24, 2017.

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 Rene Montgomery Brandi Roberts Dirk Haselow Glen Baker

California Heidi Bauer Romni Neiman Gilberto Chavez Paul Kimsey

 Los Angeles Michael Green Sonali Kulkarni Gilberto Chavez Nicole Green

 San Francisco Susan Philip Trang Nguyen Gilberto Chavez Severin Gose (Acting)

Colorado Melanie Mattson Rebecca Jordan-Yehle Lisa Miller Hugh Maguire (Acting)

Connecticut Lynn Sosa Heidi Jenkins Matthew Cartter Jafar Razeq

Delaware Catherine Mosley Catherine Mosley Tabatha Offutt-Powell Sergio Huerta

District of Columbia Michael Kharfen Travis Gayles John Davies-Cole Morris Blaylock (Acting)

Florida Craig Wilson Lisa Thompson Anna Likos Carina Blackmore

Georgia Michelle Allen LaTasha Terry Cherie Drenzek Elizabeth Franko

Hawaii Peter Whiticar Gerald “Luke” Hasty, Jr. Sarah Park A. Christian Whelen

Idaho Aimee Shipman Kimberly Matulonis Christine Hahn Christopher Ball

Illinois Danny Brikshavana Danny Brikshavana Constance Austin E. Matt Charles (Acting)

 Chicago Irina Tabidze Irina Tabidze Constance Austin Massimo Pacilli (QA Manager)

Indiana Dennis L. Stover Caitlin Conrad Pamela Pontones Judith Lovchik

Iowa Randy Mayer George Walton Patricia Quinlisk Christopher Atchison

Kansas Stephanie Green Stephanie Green Charles Hunt N. Myron Gunsalus

Kentucky Robert Brawley Chang Lee Doug Thoroughman Jeremy Hart

Louisiana DeAnn Gruber Chaquetta Johnson Raoult Ratard Stephen Martin

Maine Jayson Hunt Emer Smith Siiri Bennett Kenneth Pote

Maryland Kenneth Ruby Marcia Pearlowitz David Blythe Robert Myers

 Baltimore Glen Olthoff Hilda Ndirangu David Blythe n/a

Massachusetts Kathleen Roosevelt David Goudreau Alfred DeMaria Michael Pentella

Michigan Patricia Villegas Kristine Judd-Tuinier Sarah Lyon-Callo Sandip Shah

Minnesota Krissie Guerard Krissie Guerard Ruth Lynfield Joanne Bartkus

Mississippi James Stewart David Peyton Thomas Dobbs Daphne Ware

Missouri Nicole Massey Craig Highfill George Turabelidze Bill Whitmar

Montana Cara Murolo Cara Murolo Carol Ballew Ron Paul

Nebraska Jeri Weberg-Bryce Jeri Weberg-Bryce Thomas Safranek Peter Iwen

Nevada Andrea Rivers Elizabeth Kessler Ihsan Azzam Yashpal Agrawal (Interim)

New Hampshire Lindsay Pierce Lisa Ouellette Benjamin Chan Christine Bean

New Jersey Connie Meyers Amelia Hamarman Christina Tan Onesia Bishop

New Mexico Andrew Gans Janine Waters Michael Landen Lixia Liu

New York Alison Muse Margaret Carroll Debra Blog Jill Taylor

 New York City Susan Blank Kate Washburn Debra Blog Jennifer Rakeman

North Carolina Jacquelyn Clymore Roger Follas Scott Zimmerman

North Dakota Lindsey VanderBusch Lindsey VanderBusch Tracy Miller Myra Kosse

Ohio Amanda Dennison Amanda Dennison Mary DiOrio Quanta Brown (Acting)

Oklahoma Jan Fox Kristen Eberly Kristy Bradley S. Terrance Dunn

Oregon Annick Benson-Scott Ruth Helsley Katrina Hedberg John Fontana

Pennsylvania Beth Butler Kristine King Sharon Watkins James Lute (Acting)

 Philadelphia Greta Anschuetz Cherie Walker-Baban Sharon Watkins Kerry Buchs
138

Contributors Centers for Disease Control and Prevention: STD Surveillance 2016

State/City/Outlying Area STD Project Directors STD Program Managers State Epidemiologists Laboratory Directors

Rhode Island Thomas Bertrand Valentina Adamova Utpala Bandy Ewa King

South Carolina Ali B. Mansaray Bernard Gilliard Linda Bell Shahiedy Shahied

South Dakota Amanda Gill Amanda Gill Lon Kightlinger Timothy Southern

Tennessee Carolyn Wester Parul Patel Tim Jones Richard Steece

Texas Shelley Lucas Tammy Foskey Linda Gaul Grace Kubin

Utah Erin Fratto Ameila Self Allyn Nakashima Robyn Atkinson-Dunn

Vermont Daniel Daltry Daniel Daltry Patsy Kelso/Lori Cragin Mary Celotti

Virginia Jeff Stover Oana Vasiliu Laurie Forlano Denise Toney

Washington Mark Aubin Mark Aubin Scott Lindquist/Cathy Wasserman Romesh Gautom

West Virginia Pamela Reynolds Pamela Reynolds Loretta Haddy Sharon Lee Cibrik

Wisconsin Stephanie Smiley Anthony Wade Jeffrey Davis Peter Shult (Acting)

Wyoming Debi Nelson-Anderson Brittany Wardle Tracy Murphy Sarah Buss

American Samoa Fara M. Utu Fetaui V. Saelua Scott Anesi Mary Matau

Federated States of Micronesia Mayleen Ekiek Mayleen Ekiek Afeke Kambui

Kessler Lakutak/

Herbert Johnny/ 

Kasian Otoko/

Maria Marfel

Government of the Marshall Islands Francyne Wase-Jacklick Adela Sibok Lokkas Lakmij Anne Chang Gum

Northern Marianas (CNMI) John Dax Moreno John Dax Moreno Paul White Philip Dauterman

Guam Josephine O’Mallan Bernadette P. Schumann Robert Haddock Josephine O’Mallan

Puerto Rico Sandra Miranda de Leon Raymond Perez Rivera Brenda Rivera-Garcia Myriam Garcia-Negron

Republic of Palau Sherilynn Madraisau Columbo Sakuma Tmong Cheryl Udui Francis Termeteet

Virgin Islands Vanessa Farrell Vanessa Farrell Esther Ellis Joseph Mark
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