Sexually

Transmitted

Disease

Surveillance

2014

Division of STD Prevention

November 2015

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention 

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

Division of STD Prevention

Atlanta, Georgia 30333
ii STD Surveillance 2014

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 

Delicia Carey

Darlene Davis

Elaine Flagg 

Alison Footman

LaZetta Grier

Alesia Harvey

Sarah Kidd

Robert Kirkcaldy

Eloisa Llata

Rob Nelson

Marc Pitasi 

Rodney Presley

Fred Rivers

Charnetta Smith

Mark Stenger

John Su

Elizabeth Torrone

Hillard Weinstock

Others contributing to the production and dissemination of this publication

Office of the Director

Division of STD Prevention

Gail Bolan

Keith Davis

Suzanne Haecker

Rachel Powell 

Raul Romaguera 

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.
STD Surveillance 2014 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 2014. Atlanta: U.S. Department of

Health and Human Services; 2015.

Web Site

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

Selected STD Surveillance and Prevention References and Web Sites

STD Surveillance Reports 1993–2013

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

STD Data in the NCHHSTP Atlas

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

STD Data on Wonder

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

STD Data Management & Information Technology

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

STD Fact Sheets

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

STD Treatment Guidelines

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

STD Program Evaluation Guidelines

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

STD Program Operation Guidelines

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

Recommendations for Public Health Surveillance of Syphilis in the United States

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

Behavioral Surveillance

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

National Survey of Family Growth

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

STD Surveillance 2014 v

Foreword

“STDs are hidden epidemics of enormous health and 

economic consequence in the United States. They are 

hidden because many Americans are reluctant to address 

sexual health issues in an open way and because of the 

biologic and social characteristics of these diseases. 

All Americans have an interest in STD prevention 

because all communities are impacted by STDs and all 

individuals directly or indirectly pay for the costs of these 

diseases. STDs are public health problems that lack easy 

solutions because they are rooted in human behavior and 

fundamental societal problems. Many of the strongest 

predictors of health, including sexual health, are social, 

economic, and environmental. Providing information 

about personal health and health services can empower 

people to make healthier choices to protect their health. 

Indeed, there are many obstacles to effective prevention 

efforts. The first hurdle will be to confront the reluctance 

of American society to openly confront issues surrounding 

sexuality and STDs. Despite the barriers, there are existing 

individual- and community-based interventions that are 

effective and can be implemented immediately. That is why 

a multifaceted approach is necessary at both the individual 

and community levels.

To successfully prevent STDs, many stakeholders need 

to redefine their mission, refocus their efforts, modify 

how they deliver services, and accept new responsibilities. 

In this process, strong leadership, innovative thinking, 

partnerships, and adequate resources will be required. The 

additional investment required to effectively prevent STDs 

may be considerable, but it is negligible when compared 

with the likely return on the investment. The process of 

preventing STDs must be a collaborative one. No one 

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

members of the community must do their part. A successful 

national initiative to confront and prevent STDs requires 

widespread public awareness and participation and bold 

national leadership from the highest levels.”1

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

Washington (DC): National Academy Press; 1997. p. 43.
vi STD Surveillance 2014

Preface

Sexually Transmitted Disease Surveillance 2014 presents 

statistics and trends for sexually transmitted diseases (STDs) 

in the United States through 2014. This annual publication 

is intended as a reference document for policy makers, 

program managers, health planners, researchers, and others 

who are concerned with the public health implications of 

these diseases. The figures and tables in this edition supersede 

those in earlier publications of these data.

The surveillance information in this report is based 

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

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

that monitor STD positivity and prevalence in various 

settings, including the National Job Training Program, 

the STD Surveillance Network, and the Gonococcal 

Isolate Surveillance Project; and (3) other national surveys 

implemented by federal and private organizations.

The STD surveillance systems operated by state and local 

STD control programs, which provide the case report data 

for chlamydia, gonorrhea, syphilis, and chancroid, are the 

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

tables in this publication. These systems are an integral part 

of program management at all levels of STD prevention 

and control in the United States. Because of incomplete 

diagnosis and reporting, the number of STD cases reported 

to the Centers for Disease Control and Prevention is less 

than the actual number of cases occurring in the U.S. 

population. National summary data of case reports for 

other STDs are not available because they are not nationally 

notifiable diseases.

Beginning with the publication of Sexually Transmitted 

Disease Surveillance 2010, redistribution methodology is 

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

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

are summations of all valid data reported in reporting year 

2014. Because missing data are excluded from calculations 

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

by these characteristics, particularly by race/ethnicity for 

chlamydia and gonorrhea, appear somewhat lower than in 

reports released for data prior to 2010.

The collection of information on race/ethnicity has been 

standardized since 1997 in the United States from the 

Office of Management and Budget (OMB). Following a 

revision in the National Electronic Telecommunication 

System for Surveillance (NETSS) implementation guide 

in April 2008, jurisdictions reporting STD data were to 

collect race according to the OMB standard categories: 

American Indian or Alaska Native, Asian, black or African 

American, Hispanic or Latino, Native Hawaiian/Other 

Pacific Islander, white and multirace. While 49 states collect 

and report data for at least one STD in formats compliant 

with these standards as of 2014, some jurisdictions 

only recently adopted this standard and used previous 

standards to report their case data to CDC in past years. 

In 2014, one jurisdiction reported data for syphilis cases in 

compliance with OMB standards, but reported chlamydia 

and gonorrhea using an outdated standard. Consequently, 

historical trend and rate data by race/ethnicity displayed in 

figures and interpreted in this report for 2010–2014 include 

only those jurisdictions reporting in the current standard 

consistently for 2010 through 2014.

Sexually Transmitted Disease Surveillance 2014 consists of 

four sections: the National Profile, the Special Focus Profiles, 

the Tables, and the Appendix. The National Profile section 

contains figures that provide an overview of STD morbidity 

in the United States. The accompanying text identifies 

major findings and trends for selected STDs. The Special 

Focus Profiles section contains figures and text that describe 

STDs in selected populations that are a focus of national 

and state prevention efforts. The Tables section provides 

statistical information about STDs at county, metropolitan 

statistical area, regional, state, and national levels. The 

Appendix includes information on how to interpret the 

STD surveillance data used to produce this report, as well 

as information about Healthy People 2020 STD objectives 

and progress toward meeting these objectives, Government 

Performance and Results Act goals and progress toward 

meeting these goals, and STD surveillance case definitions.

Any comments and suggestions that would improve future 

publications are appreciated and should be sent to:

Director, Division of STD Prevention

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

TB Prevention

Centers for Disease Control and Prevention

1600 Clifton Road, Mailstop E-02

Atlanta, Georgia 30333
STD Surveillance 2014 vii

Guide to Acronyms

CDC Centers for Disease Control and Prevention 

CI confidence interval 

CIA chemiluminescence immunoassay

CSF cerebrospinal fluid

EIA enzyme immunoassay

EP ectopic pregnancy

FTA-ABS fluorescent treponemal antibody absorbed

GISP Gonococcal Isolate Surveillance Project

HEDIS Healthcare Effectiveness Data and Information 

HMOs health maintenance organizations

HIV human immunodeficiency virus

HP2020 Healthy People 2020

HPV human papillomavirus

HSV herpes simplex virus

MHA-TP microhemagglutination assay for antibody to T. pallidum

MICs minimum inhibitory concentrations

MPC mucopurulent cervicitis 

MSA metropolitan statistical area

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

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

NDTI National Disease and Therapeutic Index

NGU nongonococcal urethritis

NHANES National Health and Nutrition Examination Survey

NJTP National Job Training Program 

OMB Office of Management and Budget 

P&S primary and secondary

PCR polymerase chain reaction

PID pelvic inflammatory disease

RPR rapid plasma reagin

SSuN STD Surveillance Network

STD sexually transmitted disease

TP-PA T. pallidum particle agglutination

VDRL Venereal Disease Research Laboratory
viii STD Surveillance 2014
STD Surveillance 2014 ix

Contents

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

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

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

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

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

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

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

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

National Overview of Sexually Transmitted Diseases (STDs), 2014 .................................................................1

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

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

Gonorrhea .............................................................................................................................................15

Syphilis..................................................................................................................................................29

Other Sexually Transmitted Diseases ......................................................................................................41

Special Focus Profiles ....................................................................................................................51

STDs in Women and Infants .................................................................................................................52

STDs in Adolescents and Young Adults .................................................................................................60

STDs in Racial and Ethnic Minorities ...................................................................................................65

STDs in Men Who Have Sex with Men ................................................................................................73

Tables

National Summary ................................................................................................................................79

Chlamydia .............................................................................................................................................81

Gonorrhea .............................................................................................................................................93

Syphilis................................................................................................................................................105

Chancroid ...........................................................................................................................................127

Selected STDs .....................................................................................................................................128

Appendix

A. Interpreting STD Surveillance Data ................................................................................................129

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

Variables by State and by Nationally Notifiable STD, 2014 ........................................... 135

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2014.................. 136

B. National Objectives and Goals .......................................................................................................137

Table B1. Healthy People 2020 (HP 2020) Sexually Transmitted Diseases Objectives ..................... 138

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

Goals, Measures, and Target........................................................................................... 139

C. STD Surveillance Case Definitions.................................................................................................140

Contributors........................................................................................................................................149
x STD Surveillance 2014

Figures in the National Profile

Chlamydia

Figure 1. Chlamydia — Rates of Reported Cases by Sex, United States, 1994–2014......................... 8 

Figure 2. Chlamydia — Rates of Reported Cases by Region, United States, 2005–2014................... 8

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

Outlying Areas, 2014......................................................................................................... 9

Figure 4. Chlamydia — Rates of Reported Cases by County, United States, 2014 ............................ 9

Figure 5. Chlamydia — Rates of Reported Cases by Age and Sex, United States, 2014................... 10

Figure 6. Chlamydia — Rates of Reported Cases by Race/Ethnicity, United States, 2010–2014..... 10

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

2005–2014 ...................................................................................................................... 11

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

United States, 2014.......................................................................................................... 11

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

and Sexual Behavior, STD Surveillance Network (SSuN), 2014....................................... 12

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

Ethnicity, or Age, National Health and Nutrition Examination Survey, 2007–2012 ........ 12

Figure 11. Chlamydia — Prevalence Among Sexually-Active Women Aged 14–39 Years by 

Race/Ethnicity and Age, National Health and Nutrition Examination Survey, 

2007–2012 ...................................................................................................................... 13

Gonorrhea

Figure 12. Gonorrhea — Rates of Reported Cases by Year, United States, 1941–2014...................... 19

Figure 13. Gonorrhea — Rates of Reported Cases by Sex, United States, 1994–2014 ...................... 19

Figure 14. Gonorrhea — Rates of Reported Cases by Region, United States, 2005–2014................. 20

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

Outlying Areas, 2014....................................................................................................... 20

Figure 16. Gonorrhea — Rates of Reported Cases by County, United States, 2014 .......................... 21

Figure 17. Gonorrhea — Rates of Reported Cases by Age and Sex, United States, 2014................... 21

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

Age, United States, 2005–2014........................................................................................ 22

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

United States, 2005–2014................................................................................................ 22

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

United States, 2010–2014................................................................................................ 23

Figure 21. Gonorrhea — Reported Cases by Reporting Source and Sex, United States, 

2005–2014 ...................................................................................................................... 23

Figure 22. Gonorrhea — Percentage of Reported Cases by Sex and Reporting Sources, 

United States, 2014.......................................................................................................... 24

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

Site, STD Surveillance Network (SSuN), 2013 ................................................................ 24

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

and Sexual Behavior, STD Surveillance Network (SSuN), 2014....................................... 25

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

Isolate Surveillance Project (GISP), United States, 2014 .................................................. 25

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

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

Isolate Surveillance Project (GISP), 2006–2014............................................................... 26
STD Surveillance 2014 xi

Figure 27. Neisseria gonorrhoeae — Percentage of Isolates with Elevated Cefixime Minimum 

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

Surveillance Project (GISP), 2006–2014.......................................................................... 26

Figure 28. Neisseria gonorrhoeae — Distribution of Azithromycin Minimum Inhibitory 

Concentrations (MICs), Gonococcal Isolate Surveillance Project (GISP), 2010–2014 ..... 27

Figure 29. Neisseria gonorrhoeae — Percentage of Isolates with Penicillin, Tetracycline, and/

or Ciprofloxacin Resistance, Gonococcal Isolate Surveillance Project (GISP), 2014 ......... 27

Figure 30. Primary Antimicrobial Drugs Used to Treat Gonorrhea Among Participants, 

Gonococcal Isolate Surveillance Project (GISP), 1988–2014............................................ 28

Syphilis

Figure 31. Syphilis — Reported Cases by Stage of Infection, United States, 1941–2014................... 33

Figure 32. Primary and Secondary Syphilis — Reported Cases by Sex and Sexual Behavior, 

27 areas, 2007–2014........................................................................................................ 33

Figure 33. Primary and Secondary Syphilis — Rates of Reported Cases by Sex and Male-toFemale Rate Ratios, United States, 1990–2014................................................................ 34

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

States, 2005–2014 ........................................................................................................... 34

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

States and Outlying Areas, 2014 ...................................................................................... 35

Figure 36. Primary and Secondary Syphilis — Rates of Reported Cases by County, United 

States, 2014 ..................................................................................................................... 35

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

United States, 2014.......................................................................................................... 36

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

Aged 15–44 Years by Age, United States, 2005–2014 ...................................................... 36

Figure 39 Primary and Secondary Syphilis — Rates of Reported Cases Among Men Aged 

15–44 Years by Age, United States, 2005–2014 ............................................................... 37

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

United States, 2010–2014................................................................................................ 37

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

Behavior, 2014................................................................................................................. 38

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

Race/Ethnicity, United States, 2014................................................................................. 38

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

HIV Status (Positive or Negative), 26 areas, 2014 ............................................................ 39

Figure 44. Primary and Secondary Syphilis — Reported Cases by Reporting Source and Sex, 

United States, 2005–2014................................................................................................ 39

Figure 45. Primary and Secondary Syphilis — Percentage of Reported Cases by Sex, Sexual 

Behavior, and Selected Reporting Sources, 2014 .............................................................. 40

Figure 46. Congenital Syphilis — Reported Cases by Year of Birth and Rates of Primary and 

Secondary Syphilis Among Women, United States, 2005–2014....................................... 40
xii STD Surveillance 2014

Other Sexually Transmitted Diseases

Figure 47. Chancroid — Reported Cases by Year, United States, 1981–2014 ................................... 45

Figure 48. Human Papillomavirus — Cervicovaginal Prevalence of High-Risk and Low-Risk 

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

Nutrition Examination Survey, 2003–2006 ..................................................................... 45

Figure 49. Human Papillomavirus — Cervicovaginal Prevalence of Types 6, 11, 16, and 18 

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

Health and Nutrition Examination Survey, 2003–2006 and 2007–2010 ......................... 46

Figure 50. Genital Warts — Initial Visits to Physicians’ Offices, United States, 1966–2013.............. 46

Figure 51. Genital Warts — Prevalence per 1000 Person-Years Among Participants In 

Private Health Plans Aged 10–39 Years by Sex, Age Group, and Year, 2003–2010 ........... 47

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

and Site, STD Surveillance Network (SSuN), 2014 ......................................................... 47

Figure 53. Genital Herpes — Initial Visits to Physicians’ Offices, United States, 1966–2013............ 48

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

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

Examination Surveys, 1988–1994, 1999–2002, 2003–2006, and 2007–2010................. 48

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

Physicians’ Offices, United States, 1966–2013 ................................................................. 49
STD Surveillance 2014 xiii

Figures in the Special Focus Profiles

STDs in Women and Infants

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

and Outlying Areas, 2014 ................................................................................................ 56

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

and Outlying Areas, 2014 ................................................................................................ 56

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

State, United States and Outlying Areas, 2014 ................................................................. 57

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

and State, United States and Outlying Areas, 2014 .......................................................... 57

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

Women Aged 15–44 Years, United States, 2004–2013 ..................................................... 58

Figure F. Pelvic Inflammatory Disease — Trends in Lifetime Prevalence of Treatment 

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

National Survey of Family Growth, 1995, 2002, 2006–2010 ........................................... 58

Figure G. Ectopic Pregnancy — Rates Among Commercially Insured Pregnant Women 

Aged 15–44 Years by Age, 2003–2013 ............................................................................. 59

STDs in Adolescents and Young Adults

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

State, United States and Outlying Areas, 2014 ................................................................. 62

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

State, United States and Outlying Areas, 2014 ................................................................. 62

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

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

Outlying Areas, 2013 ....................................................................................................... 63

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

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

Outlying Areas, 2013 ....................................................................................................... 63

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

National Job Training Program by State of Residence, United States and Outlying 

Areas, 2013 ...................................................................................................................... 64

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

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

Outlying Areas, 2013 ....................................................................................................... 64

STDs in Racial and Ethnic Minorities

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

United States, 2014 .......................................................................................................... 69

Figure O. Gonorrhea —Rate Ratios by Race/Ethnicity, United States, 2010–2014 .......................... 69

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

United States, 2014 .......................................................................................................... 70

Figure Q. Gonorrhea — Rate Ratios by Race/Ethnicity and Region, United States, 2014 ................ 70

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

and Sex, United States, 2014 ............................................................................................ 71

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

Aged 15–19 Years, by Race/Ethnicity, United States, 2010–2014 ..................................... 71
xiv STD Surveillance 2014

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

15–19 Years, by Race/Ethnicity, United States, 2010–2014.............................................. 72

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

and Mother’s Race/Ethnicity, United States, 2005–2014 .................................................. 72

STDs in Men Who Have Sex with Men

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

Testing Positive for Gonorrhea and Chlamydia, STD Surveillance 

Network (SSuN), 2014 .................................................................................................... 75

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

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

HIV, STD Surveillance Network (SSuN), 2014 ............................................................... 75

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

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

(SSuN), 2014 ................................................................................................................... 76

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

Attending STD Clinics, Gonococcal Isolate Surveillance (GISP), 1990–2014 ................. 76

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

Minimum Inhibitory Concentrations (MICs) (≥0.125 μg/ml) by Reported Sex of 

Sex Partner, Gonococcal Isolate Surveillance Project (GISP), 2007–2014 ........................ 77
STD Surveillance 2014 xv

Tables in the National Profile

National Summary

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

per 100,000 Population, United States, 1941–2014......................................................... 79

Chlamydia

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

Rates, United States, 2014 ............................................................................................... 81

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

Area and Region in Alphabetical Order, United States and 

Outlying Areas, 2010–2014............................................................................................. 82

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, 

2010–2014 ...................................................................................................................... 83

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, 2010–2014............................................................................................. 84

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

(MSAs) in Alphabetical Order, United States, 2010–2014 ............................................... 85

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

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

States, 2010–2014 ........................................................................................................... 86

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

Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2010–2014................................................................................................ 87

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

Independent Cities Ranked by Number of Reported Cases, United States, 2014 ............. 88

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

Sex, United States, 2010–2014 ........................................................................................ 89

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

States, 2014 ..................................................................................................................... 90

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

Ethnicity, Age Group, and Sex, United States, 2014......................................................... 91

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

Reported Cases by Age, United States, 2010–2014 .......................................................... 92

Gonorrhea

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

Rates, United States, 2014 ............................................................................................... 93

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

Region in Alphabetical Order, United States and Outlying Areas, 2010–2014................. 94

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, 

2010–2014 ...................................................................................................................... 95

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

Area and Region in Alphabetical Order, United States and 

Outlying Areas, 2010–2014............................................................................................. 96
xvi STD Surveillance 2014

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

Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2010–2014................................................................................................ 97

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

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

States, 2010–2014 ........................................................................................................... 98

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

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

States, 2010–2014 ........................................................................................................... 99

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

Independent Cities, Ranked by Number of Reported Cases, United States, 2014 .......... 100

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

Sex, United States, 2010–2014 ...................................................................................... 101

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

States, 2014 ................................................................................................................... 102

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

Ethnicity, Age Group, and Sex, United States, 2014....................................................... 103

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

Reported Cases by Age, United States, 2010–2014 ........................................................ 104

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, 2010–2014........................................................................................... 105

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

Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2010–2014.............................................................................................. 106

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

by State, Ranked by Rates, United States, 2014 ............................................................. 107

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, 2010–2014.......................................................................................................... 108

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, 2010–2014 .................................................................................... 109

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, 2010–2014 .................................................................................... 110

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

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

States, 2010–2014 ......................................................................................................... 111

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, 2010–2014 .................................................................................. 112

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

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

United States, 2010–2014.............................................................................................. 113

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, 2014........................................................................................................ 114
STD Surveillance 2014 xvii

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

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

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

in 2014, United States, 2013–2014 ............................................................................... 115

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

by Age Group and Sex, United States, 2010–2014......................................................... 116

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

Group, and Sex, United States, 2014 ............................................................................. 118

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

Population by Race/Ethnicity, Age Group, and Sex, United States, 2014 ....................... 119

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

Area and Region in Alphabetical Order, United States and 

Outlying Areas, 2010–2014........................................................................................... 120

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

Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2010–2014.............................................................................................. 121

Table 39. Late and Late Latent Syphilis — Reported Cases and Rates of Cases by State/Area 

and Region in Alphabetical Order, United States and Outlying Areas, 2010–2014 ........ 122

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

Selected Metropolitan Areas (MSAs) in Alphabetical Order, 

United States, 2010–2014.............................................................................................. 123

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

Ranked by Rates, United States, 2014............................................................................ 124

Table 42. Congenital Syphilis — Reported Cases and Rates of Reported Cases by Year of 

Birth, by State/Area and Region in Alphabetical Order, United States, 2010–2014........ 125

Table 43. 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, 2010–2014.............................................................................................. 126

Chancroid

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

Alphabetical Order, United States and Outlying Areas, 2010–2014 ............................... 127

Selected STDs

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

National Disease and Therapeutic Index, United States, 1966–2013.............................. 128

Appendix

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

Variables by State and by Nationally Notifiable STD, 2014 ........................................... 135

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2014.................. 136

Table B1. Healthy People 2020 (HP2020) Sexually Transmitted Diseases Objectives ...................... 138

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

Goals, Measures, and Target........................................................................................... 139
xviii STD Surveillance 2014
STD Surveillance 2014 xix

Census Regions of the United States

West Midwest Northeast

South

West Midwest South Northeast

Alaska Illinois Alabama Connecticut

Arizona Indiana Arkansas Maine

California Iowa Delaware Massachusetts

Colorado Kansas District of Columbia New Hampshire

Hawaii Michigan Florida New Jersey

Idaho Minnesota Georgia New York

Montana Missouri Kentucky Pennsylvania

Nevada Nebraska Louisiana Rhode Island

New Mexico North Dakota Maryland Vermont

Oregon Ohio Mississippi

Utah South Dakota North Carolina

Washington Wisconsin Oklahoma

Wyoming South Carolina

Tennessee

Texas

Virginia

West Virginia
xx STD Surveillance 2014
STD Surveillance 2014 Overview 1

National Overview of Sexually 

Transmitted Diseases (STDs), 2014

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 

2014 on the three notifiable diseases for which there are 

federally funded control programs: chlamydia, gonorrhea, 

and syphilis. 

Chlamydia

In 2014, a total of 1,441,789 cases of Chlamydia trachomatis 

infection were reported to the CDC (Table 1). This case 

count corresponds to a rate of 456.1 cases per 100,000 

population, an increase of 2.8% compared with the rate 

in 2013. This overall increase follows the first time since 

nationwide reporting for chlamydia began that the overall 

rate of reported cases of chlamydia decreased from 2011 to 

2013. While the rate in women from 2013–2014 increased 

1.3% and the rate in men increased 6.8%, the rate among 

women aged 15-19 years decreased 4.2%, continuing a 

decline in that group since 2011. 

In 2014, the overall rate of chlamydial infection in the 

United States among women (627.2 cases per 100,000 

females) based on reported cases was over two times the rate 

among men (278.4 cases per 100,000 males) (Tables 4 and 

5), reflecting the larger number of women screened for this 

infection. However, with the increased availability of urine 

testing, men are increasingly being tested for chlamydial 

infection. During 2010–2014, the chlamydia rate in men 

increased 22%, compared with a 6% increase in women 

during this period. 

Rates varied among different racial and ethnic minority 

populations. In 2014, the chlamydia rate in blacks was 

6 times the rate in whites, and the rate among American 

Indians/Alaska Natives was almost 4 times the rate among 

whites.

Gonorrhea

In 2009, the national rate of reported gonorrhea cases 

reached an historic low of 98.1 cases per 100,000 

population (Figure 12 and Table 1). However, during 

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

cases per 100,000 population in 2012. In 2013, the rate 

decreased to 105.3 cases per 100,000 population. But in 

2014, a total of 350,062 gonorrhea cases were reported, 

and the national gonorrhea rate increased to 110.7 cases per 

100,000 population.

The increase in gonorrhea rate during 2013–2014 was 

observed primarily among men (Figure 13). Gonorrhea 

rates among men increased in every region of the United 

States, while gonorrhea rates among women increased in 

the South and West but decreased in the Northeast and 

Midwest (Tables 15 and 16). 

In 2014, the rate of reported gonorrhea cases remained 

highest among blacks (405.4 cases per 100,000 population) 

(Table 22B). The rate among blacks was 10.6 times the rate 

among whites (38.3 cases per 100,000 population). The 

gonorrhea rate among American Indians/Alaska Natives 

(159.4 cases per 100,000 population) was 4.2 times that 

of whites. While rates of gonorrhea during 2010-2014 

have been declining among blacks, they have increased in 

all other racial/ethnic groups. In American Indian/Alaska 

Natives, they have increased 104% during this time period. 

Antimicrobial resistance remains an important 

consideration in the treatment of gonorrhea. With 

increased resistance to the fluoroquinolones and declining 

susceptibility to cefixime, dual therapy with ceftriaxone 

and azithromycin is now the only CDC recommended 

treatment for gonorrhea.2 In 2014, increases in minimum 

inhibitory concentrations (MICs) of cephalosporins 

(cefixime and ceftriaxone) were observed after decreases in 

2012 and 2013 (Figures 26 and 27). While the percentage 

of isolates with reduced azithromycin susceptibility has 

remained stable (between 0.3% and 0.6% of all isolates 

tested) in previous years, between 2013 and 2014, this 
2 Overview STD Surveillance 2014

In 2014, men accounted for 91% of all cases of P&S 

syphilis. And, of those male cases for whom sex of sex 

partner was known, 83% were MSM. Reported cases of 

P&S syphilis continued to be characterized by a high rate 

of HIV co-infection, particularly among MSM. In 2014, 

26 states reported both sex of sex partner and HIV status 

(HIV-positive or HIV-negative) for at least 70% of P&S 

syphilis cases (Figure 43). Among P&S syphilis cases with 

known HIV-status in these states, 51% of cases among 

MSM were HIV-positive, compared with 11% of cases 

among MSW, and 6% of cases among women.

Rates in women remained unchanged between 2011 and 

2013 but increased 22% between 2013 and 2014. In 

2014, 1,840 cases of P&S syphilis were reported in women 

compared with 1,500 in 2013. The 2013 rate of congenital 

syphilis (9.1 cases per 100,000 live births) marked the first 

increase in congenital syphilis since 2008. During 2013–

2014, the rate increased 27.5%. There were 458 cases of 

congenital syphilis reported in 2014 compared with 359 in 

2013 (Figure 46).

Significant racial and ethnic disparities in STD rates 

persist. In 2014, the P&S syphilis rate among blacks was 

5.4 times the rate among whites (Figure 40). In some 

subgroups, however, disparities were even higher. The 2014 

P&S syphilis rates among black and American Indian/

Alaska Native women were between 9-10 times the rates 

for whites. (Table 36B). While rates of congenital syphilis 

increased in most race/ethnicity groups during 2013-2014, 

they were 10 times higher in blacks than in whites and over 

3 times higher in Hispanics and in American Indian/Alaska 

Natives than in whites (Table 43).

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

hidden epidemic: confronting sexually transmitted diseases. 

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

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.

percentage jumped up to 2.5% (Figure 28). 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 (Figure 31, Table 1). However, the P&S syphilis 

rate has increased almost every year since 2000–2001. In 

2014, a total of 19,999 P&S syphilis cases were reported, 

and the national P&S syphilis rate increased to 6.3 cases per 

100,000 population, the highest rate since 1994.

During 2000–2014, the rise in the P&S syphilis rate 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 32 

and 33). However, during 2013–2014, the rate increased 

both among men (14.4%) and among women (22.7%) 

(Tables 28 and 29). This increase among women is of 

particular concern because congenital syphilis cases tend to 

increase as the rate of P&S syphilis among women increases 

(Figure 46). 

During 2013–2014, the overall male and female P&S 

syphilis rates increased in every region of the country 

(Figure 34, Tables 27–29). Nationally, P&S syphilis rates 

increased in every 5-year age group of those 15–44 years of 

age (Table 35) and in every race/ethnicity group except for 

Native Hawaiians/Other Pacific Islanders during 2013–

2014 (Figure 40). 
NATIONAL PROFILE
NATIONAL PROFILE
STD Surveillance 2014 National Profile 3

National Profile

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

(chlamydia, gonorrhea, syphilis, and chancroid) by age, sex, race/ethnicity, and location for the United States.
4 National Profile: Chlamydia STD Surveillance 2014

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.1,2

Chlamydial infections in women are usually asymptomatic. 

However, untreated infection can result in pelvic 

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

infertility, ectopic pregnancy, and chronic pelvic pain. Data 

from randomized controlled trials of chlamydia screening 

suggested that screening programs can lead to a reduction in 

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

chlamydial infection might facilitate the transmission 

of human immunodeficiency virus (HIV) infection.5 In 

addition, pregnant women infected with chlamydia can pass 

the infection to their infants during delivery, potentially 

resulting in neonatal ophthalmia and pneumonia. Because 

of the large burden of disease and risks associated with 

infection, CDC recommends that all sexually active women 

younger than age 25 years receive annual chlamydia 

screening.6

The Healthcare Effectiveness Data and Information Set 

(HEDIS) contains a measure which assesses chlamydia 

screening coverage of sexually active young women who 

receive medical care through commercial or Medicaid 

managed care organizations. Among sexually-active 

women aged 16–24 years in commercial plans, chlamydia 

screening increased from 23.1% in 2001 to 46.2% in 

2013. 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 54.9% in 

2013.7 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. Expanded use of more sensitive diagnostics tests 

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

number of infections identified and reported independent 

of increases in incidence. Although chlamydia has been 

a nationally notifiable condition since 1994, it was not 

until 2000 that all 50 states and the District of Columbia 

required reporting of chlamydia cases. National case rates 

prior to 2000 reflect incomplete reporting. Additionally, 

increasing use of electronic laboratory reporting has 

likely increased the proportion of diagnosed cases that are 

reported. Consequently, an increasing chlamydia case rate 

may reflect increases in incidence of infection, screening 

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

complete reporting. Likewise, decreases in chlamydia case 

rates may suggest decreases in incidence of infection or 

screening coverage.

Chlamydia — United States

In 2014, a total of 1,441,789 chlamydial infections were 

reported to CDC in 50 states and the District of Columbia 

(Table 1). This case count corresponds to a rate of 456.1 

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

of reported chlamydial infection increased from 178.0 to 

453.4 cases per 100,000 population (Figure 1, Table 1). 

During 2011–2013, the rate of reported cases decreased to 

443.5 cases per 100,000. During 2013–2014, the national 

rate of reported cases increased 2.8% to 456.1 cases per 

100,000.

Chlamydia by Region

In 2014, rates of reported chlamydia were highest in the 

South (492.3 per 100,000 population), followed by the 

Midwest (448.9), the West (441.8), and the Northeast 

(406.9) (Table 3). Between 2005–2012, 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 2013–2014, rates increased in all regions with 

the largest increase in the West (421.1 to 441.8 cases per 

100,000) (Table 3).
STD Surveillance 2014 National Profile: Chlamydia 5

Chlamydia by State

In 2014, rates of reported cases of chlamydia by state ranged 

from 254.5 cases per 100,000 population in West Virginia 

to 787.5 cases in Alaska (Figure 3, Table 2); the rate in 

the District of Columbia was 818.8 cases per 100,000 

(Table 3). During 2013–2014, rates of reported chlamydia 

increased in 40 states.

Chlamydia by Metropolitan

Statistical Area

In 2014, the rate of reported cases of chlamydia per 

100,000 population in the 50 most populous metropolitan 

statistical areas (MSAs) increased 3.6% from the rate in 

2013 (458.3 and 474.6 cases per 100,000, respectively) 

(Table 6). In 2014, 56.9% of chlamydia cases were reported 

by these MSAs. In these MSAs, the rate among women 

increased 1.7% during 2013–2014 (623.8 to 634.5 cases 

per 100,000) (Table 7) and the rate among men increased 

8.1% (283.8 to 306.8 cases per 100,000) (Table 8). 

Chlamydia by County

Counties in the United States with the highest rates of 

reported cases of chlamydia were located primarily in the 

South and West, including Alaska (Figure 4). In 2014, 785 

(25.0%) of 3,142 counties had rates higher than 439 cases 

per 100,000 population. Seventy counties and independent 

cities reported 43% of all chlamydia cases in 2014 (Table 

9).

Chlamydia by Sex

In 2014, 1,006,441 cases of chlamydia were reported 

among females for a case rate of 627.2 per 100,000 females. 

During 1995–2011, the rate among females increased each 

year (Figure 1). During 2011–2013, the rate decreased 

from 643.4 to 619.0 cases per 100,000 females and during 

2013–2014, the rate increased 1.3% to 627.2 cases per 

100,000 (Table 4).

After remaining stable during 2012–2013, the overall case 

rate among males increased (6.8%) during 2013–2014 

(260.6 to 278.4 cases per 100,000 males). As in previous 

years, the reported case rate among females was about two 

times the case rate among males in 2014, likely reflecting a 

larger number of women screened for this infection (Figure 

1, Tables 4 and 5). The lower rate among men also suggests 

that many of the sex partners of women with chlamydia are 

not receiving a diagnosis of chlamydia or being reported as 

having chlamydia.

However, with the advent of highly sensitive nucleic acid 

amplification tests (NAATs) that can be performed on 

urine, chlamydial infection is increasingly being diagnosed 

in symptomatic and asymptomatic men. During 2010–

2014, the rate of reported cases among men increased 

22.4% (from 233.2 to 278.4 cases per 100,000 males) 

compared with a 6.0% increase among women during 

the same period (from 605.1 to 627.2 cases per 100,000 

females).

Chlamydia by Age

Rates of reported cases of chlamydia are highest among 

adolescents and young adults aged 15–24 years (Table 

10). In 2014, the rate among 15–19 year olds was 1,804.0 

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

2,484.6 cases per 100,000.

Among women, the highest age-specific rates of reported 

chlamydia in 2014 were among those aged 15–19 years 

(2,941.0 cases per 100,000 females) and 20–24 years 

(3,651.1 cases per 100,000 females) (Figure 5, Table 10). 

Within these age ranges, reported rates were highest among 

women aged 19 years (4,640.4 cases per 100,000 females) 

and aged 20 years (4,567.5 cases per 100,000 females) 

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

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

during 2011–2012, decreased 8.7% during 2012–2013, 

and decreased 4.2% during 2013–2014. The rate increased 

among women aged 20–24 years during 2011–2014 

(3,630.0 to 3,651.1 per 100,000 females) (Table 10). 

Age-specific rates among men, although substantially lower 

than the rates among women, were highest in those aged 

20–24 years (1,368.3 cases per 100,000 males) (Figure 5, 

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

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

years decreased 5.1% during 2011–2012 and decreased 9.0% 

during 2012–2013. Rates among men aged 15–19 years 

decreased slightly during 2013–2014 (722.9 to 718. 3 per 

100,000 males). Among men aged 20–24 years, the reported 

case rate increased 4.4% during 2013–2014 (1,310.9 to 

1,368.3 cases per 100,000 males).

Chlamydia by Race/Ethnicity

Among the 48 states that submitted data in the race 

and ethnicity categories in 2014 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 non-Hispanic black men and women 

(Figure L, Table 11B). The rate of chlamydia among nonHispanic blacks was 6.2 times the rate among non-Hispanic 

whites (1,117.9 and 180.6 cases per 100,000 population, 
6 National Profile: Chlamydia STD Surveillance 2014

respectively). The rate among American Indians/Alaska 

Natives (668.8 cases per 100,000) was 3.7 times the rate 

among whites. The rate among Hispanics (380.6 cases 

per 100,000) was 2.1 times the rate among whites. The 

rate among Native Hawaiians/Other Pacific Islanders 

(625.1 cases per 100,000) was 3.5 times the rate among 

whites. The rate among Asians was lower than the rate 

among whites (112.0 cases and 180.6 cases per 100,000, 

respectively).

During 2010–2014, 43 states submitted chlamydia case 

report data in the race and ethnicity categories according 

to the OMB standards (see Section A1.5 in the Appendix). 

Between 2010–2014, rates increased among all races and 

ethnicities, except blacks (Figure 6). During 2013–2014, 

rates increased among whites (2.1%) and Asians (5.2%), 

and decreased 2.4% among American Indians/Alaska 

Natives. Rates were stable among blacks, Hispanics, Native 

Hawaiians/Other Pacific Islanders during 2013–2014 

(Figure 6). 

More information on chlamydia rates among race/ethnicity 

groups can be found in the Special Focus Profiles.

Chlamydia by Reporting Source

Most chlamydia cases reported in 2014 were from venues 

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

time, the proportion of cases reported from non-STD 

clinic sites has continued to increase (Figure 7). In 2014, 

among women, only 4.9% of chlamydia cases were reported 

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

women were reported from private physicians/health 

maintenance organizations (HMOs) (33.6%). Among 

men, 14.9% of chlamydia cases were reported from an 

STD clinic in 2014 and 25.0% were reported from private 

physicians/HMOs.

Chlamydia Prevalence in the

Population

The National Health and Nutrition Examination Survey 

(NHANES; see Section A2.4 in the Appendix for more 

information) is a nationally representative survey of the 

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

years that provides an important measure of chlamydia 

disease burden. 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 10). 

Among sexually active females aged 14–24 years, the 

population targeted for screening, prevalence was 4.7% 

(95% CI: 3.2–6.1), with highest prevalence among black 

females (13.5%, 95% CI: 9.2–17.7) (Figure 11).1

Chlamydia Positivity in Selected

Populations

The STD Surveillance Network (SSuN) is an ongoing 

collaboration of states and independently funded cities 

collecting enhanced clinical and behavioral information 

among patients attending STD clinics in the SSuN 

jurisdictions. Due to a transition from SSuN Cycle 2 to 

Cycle 3, data for this report include information from 

patients attending STD clinics during 2014 in the 6 

jurisdictions that overlap cycles. See Section A2.2 of the 

Appendix for more information about SSuN methodology.

In 2014, the proportion of STD clinic patients testing 

positive for chlamydia varied by age, sex, and sexual 

behavior. Adolescent men who have sex with women 

(MSW) had the highest prevalence (28.4%), either 

reflecting disproportionate testing of men with urethritis 

or targeted testing of partners of females diagnosed with 

chlamydia. Prevalence among all those tested decreased with 

age, though the variation in prevalence by age was not as 

pronounced for gay, bisexual, and other men who have sex 

with men (MSM) (Figure 9).

Chlamydia Among Special Populations

More information on chlamydia among women of 

reproductive age, adolescents and young adults, MSM, 

and minority populations is presented in the Special Focus 

Profiles.

Chlamydia Summary

Chlamydia continues to be the most commonly reported 

nationally notifiable disease with 1,441,789 cases reported 

in 2014. During 2013–2014, rates of reported chlamydia 

increased 2.8% overall, but decreased 4.2% among females 

aged 15–19 years. However, both test positivity and the 

number of reported cases of C. trachomatis infections 

remain high among most age groups, racial/ethnic groups, 

geographic areas, and both sexes. Racial differences also 

persist; reported case rates and prevalence estimates among 

blacks continue to be substantially higher than among other 

racial/ethnic groups.
STD Surveillance 2014 National Profile: Chlamydia 7

1 Torrone E, Papp J, Weinstock H; Centers for Disease Control 

and Prevention (CDC). Prevalence of Chlamydia trachomatis

genital infection among persons aged 14-39 years--United 

States, 2007-2012. MMWR Morb Mortal Wkly Rep. 2014 Sep 

26;63(38):834-8. 

2 Hogben M, Leichliter JS. Social determinants and sexually 

transmitted disease disparities. Sex Transm Dis. 2008 Dec;35(12 

Suppl):S13-8. 

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

KK, Stamm WE. Prevention of pelvic inflammatory disease 

by screening for cervical chlamydial infection. N Engl J Med 

1996;34(21):1362-6.

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

Chlamydia trachomatis to prevent pelvic inflammatory disease: the 

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

doi: 10.1136/bmj.c1642.

5 Fleming DT, Wasserheit JN. From epidemiological synergy 

to public health policy and practice: the contribution of other 

sexually transmitted diseases to sexual transmission of HIV 

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

6 Centers for Disease Control and Prevention. Sexually transmitted 

diseases treatment guidelines, MMWR Morb Mortal Wkly 

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

Rep. 2011;60(1):18.

7 National Committee for Quality Assurance. The state of 

healthcare quality 2014. Washington (DC): National Committee 

for Quality Assurance; 2014. p. 68-69.
8 National Profile: Chlamydia STD Surveillance 2014

Figure 1. Chlamydia — Rates of Reported Cases by Sex, United States, 1994–2014 

NOTE: As of January 2000, all 50 states and the District of Columbia have regulations that require the reporting of chlamydia cases.

 0

150

300

450

600

750

Year

1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

Rate (per 100,000 population)

Men

Women

Total

Figure 2. Chlamydia — Rates of Reported Cases by Region, United States, 2005–2014

 0

100

200

300

400

500

Year

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rate (per 100,000 population)

West

Midwest

Northeast

South
STD Surveillance 2014 National Profile: Chlamydia 9

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

Outlying Areas, 2014

NOTE: The total rate of reported cases of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 452.6 per 

100,000 population.

Rate per 100,000

population

Guam 523 

Puerto Rico 136 

Virgin Islands 755 

<=382

383-442

443-503

>=504

(n= 14)

(n= 13)

(n= 14)

(n= 13)

VT 357

NH 271

MA 318

RI 414

CT 372

NJ 336

DE 483

MD 463

DC 819

600

788

489 527

460 415

431

520

457

338

517 434

382

384 402

626

266

447

367

655

463

413

401 424

554

503

479

477

474

537

395

396

588

493

474

496

284

436

381

255

403

338

Figure 4. Chlamydia — Rates of Reported Cases by County, United States, 2014

Rate per 100,000

population

<=192 (n= 797)

193-285 (n= 780)

286-439 (n= 780)

>439 (n= 785)
10 National Profile: Chlamydia STD Surveillance 2014

Figure 5. Chlamydia — Rates of Reported Cases by Age and Sex, United States, 2014

Men Rate (per 100,000 population) Women

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

12.7 9 10-14 9.4

718.3 2 15-19 941.0

1368.3 20-24 3651.1

837.0 25-29 1523.4

430.6 6 30-34 33.7

234.0 3 35-39 00.9

132.3 40-44 130.3

66.4 45-54 47.0

20.6 1 55-64 2.8

4.4 2 65+ .3

278.4 6 Total 27.2

Figure 6. Chlamydia — Rates of Reported Cases by Race/Ethnicity, United States, 2010–2014 

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

NOTE: Includes 43 states reporting race/ethnicity data in Oce of Management and Budget compliant formats during 2010–2014 (see Section A1.5 in 

the Appendix).

Year

 0

 300

 600

 900

1200

1500

2010 2011 2012 2013 2014

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

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace
STD Surveillance 2014 National Profile: Chlamydia 11

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

2005–2014 

 0

 200

 400

 600

 800

1,000

Year

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Cases (in thousands) Non-STD Clinic, Men

Non-STD Clinic, Women

STD Clinic, Men

STD Clinic, Women

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

United States, 2014 

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

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

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

Percentage Private Physician/HMO*

STD Clinic

Other HD* Clinic

Family Planning Clinic

Emergency Room

All Other

Missing/Unknown

 0

 10

 20

 30

 40

Men Women
12 National Profile: Chlamydia STD Surveillance 2014

Figure 10. Chlamydia — Prevalence Among Persons Aged 14–39 Years by Sex, 

Race/Ethnicity, or Age, National Health and Nutrition Examination Survey,

2007–2012 

NOTE: Error bars indicate 95% condence intervals.

SOURCE: Torrone E, Papp J, Weinstock H; Centers for Disease Control and Prevention (CDC). Prevalence of Chlamydia trachomatis genital infection

among persons aged 14-39 years —United States, 2007-2012. MMWR Morb Mortal Wkly Rep. 2014 Sep 26;63(38):834-8.

Prevalence, %

0

2

4

6

8

Overall Men

 Sex

Women

NonHispanic

Whites

NonHispanic

Blacks

Race/Ethnicity

Mexican

Americans 14-19 20-24

 Age Group (Years)

25-39

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

Sexual Behavior, STD Surveillance Network (SSuN), 2014

* Only includes patients tested for chlamydia. †

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

NOTE: Includes the six jurisdictions (Baltimore, Los Angeles, New York City, Philadelphia, San Francisco and Seattle) that contributed data for all of 2014.

Percentage

Age Group

Women

0

10

20

30

40

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

MSM†

MSW†
STD Surveillance 2014 National Profile: Chlamydia 13

Figure 11. Chlamydia — Prevalence Among Sexually-Active Women Aged 14–39 Years by

Race/Ethnicity and Age, National Health and Nutrition Examination Survey, 2007–2012 

NOTE: Error bars indicate 95% condence intervals.

SOURCE: Torrone E, Papp J, Weinstock H; Centers for Disease Control and Prevention (CDC). Prevalence of Chlamydia trachomatis genital infection

among persons aged 14-39 years—United States, 2007-2012. MMWR Morb Mortal Wkly Rep. 2014 Sep 26;63(38):834-8.

Prevalence, %

0

5

10

15

20

14-19 20-24

 Age Group (Years)

25-39 All

NonHispanic

Whites

NonHispanic

Blacks

Among 14-24 Year Olds

Mexican

Americans
14 National Profile: Chlamydia STD Surveillance 2014
STD Surveillance 2014 National Profile: Gonorrhea 15

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 an historic low of 98.1 cases per 100,000 

population (Figure 12 and Table 1). However, during 

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

cases per 100,000 population in 2012. In 2013, the rate 

decreased slightly to 105.3 cases per 100,000 population. 

In 2014, a total of 350,062 gonorrhea cases were reported, 

and the national gonorrhea rate increased to 110.7 cases per 

100,000 population.

The increase in gonorrhea rate during 2013–2014 was 

observed primarily among men (Figure 13). Overall, the 

gonorrhea rate increased in the South and the West, but 

decreased in the Northeast and Midwest (Figure 14). The rate 

increased among persons aged 20–24 years and in older age 

groups, but decreased among younger age groups (Table 21).

N. gonorrhoeae has progressively developed resistance to 

each of the antimicrobials used for treatment of gonorrhea. 

Most recently, 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 CDC-recommended treatment regimen for 

gonorrhea.3 The emerging threat of cephalosporin resistance 

highlights the need for continued surveillance of N. 

gonorrhoeae antimicrobial susceptibility.

The combination of persistently high gonorrhea morbidity 

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

the epidemiology of gonorrhea.

Interpreting Rates of Reported Cases 

of Gonorrhea

Although gonorrhea case reporting is useful for monitoring 

disease trends, the number of gonorrhea cases reported 

to CDC is affected by many factors in addition to the 

actual occurrence of the infection within the population. 

Changes in the burden of gonorrhea may be masked by 

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

with tests that also detect N. gonorrhoeae infections or 

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

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

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

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

reporting of gonorrhea cases to CDC is incomplete.4 For 

these reasons, supplemental data on gonorrhea prevalence 

in persons screened in a variety of settings are useful in 

assessing the burden of disease in selected populations.

Gonorrhea — United States

In 2014, a total of 350,062 cases of gonorrhea were 

reported in the United States, yielding a rate of 110.7 cases 

per 100,000 population (Table 1). The rate increased 5.1% 

since 2013, and increased 10.5% since 2010.

Gonorrhea by Region

In 2014, as in previous years, the South had the highest 

rate of reported gonorrhea cases (131.4 cases per 100,000 

population) among the four regions of the United States, 

followed by the Midwest (106.6 cases per 100,000 

population), West (101.1 cases per 100,000 population), 

and Northeast (84.7 cases per 100,000 population) (Table 

14). During 2013–2014, the gonorrhea rate increased 

22.2% in the West and 3.1% in the South, but decreased 

1.5% in the Midwest and 0.6% in the Northeast (Figure 

14, Table 14).

Gonorrhea by State

In 2014, rates of reported gonorrhea cases per 100,000 

population ranged by state from 13.4 in Vermont to 194.6 

in Louisiana; the gonorrhea rate in the District of Columbia 

was 291.3 per 100,000 population (Figure 15, Table 13). 

During 2013–2014, gonorrhea rates increased in 70% 

(35/50) of states, and decreased in 30% (15/50) of states 

and the District of Columbia (Table 14).
16 National Profile: Gonorrhea STD Surveillance 2014

Gonorrhea by Metropolitan 

Statistical Area

The overall rate of reported gonorrhea cases in the 50 

most populous metropolitan statistical areas (MSAs) was 

122.8 cases per 100,000 population in 2014 (Table 17), 

representing a 5.0% increase compared with 2013 (117.0 

cases per 100,000 population). In 2014, 60.6% of reported 

gonorrhea cases were reported by these MSAs. Since 2010, 

the gonorrhea rate among women in the 50 most populous 

MSAs has been lower than the rate among men (Tables 18 

and 19). In 2014, the rate among women in these MSAs 

was 102.0 cases per 100,000 females, while the rate among 

men was 144.1 cases per 100,000 males.

Gonorrhea by County

In 2014, 50% of reported gonorrhea cases occurred in just 

70 counties or independent cities (Table 20). In 2014, 792 

counties (25.2%) in the United States had a rate less than 

or equal to 13 cases per 100,000 population (Figure 16). 

The rate ranged from 14 to 36 per 100,000 population in 

791 counties (25.2%), ranged from 37 to 91 per 100,000 

population in 777 counties (24.7%), and was more than 91 

cases per 100,000 population in 782 counties (24.9%). As 

in previous years, counties with the highest gonorrhea rates 

were concentrated in the South.

Gonorrhea by Sex

As was observed in 2013, in 2014 the rate of reported 

gonorrhea cases among men (120.1 cases per 100,000 

males) was higher than the rate among women (101.3 

cases per 100,000 females) (Figure 13, Tables 15 and 

16). During 2013–2014, the gonorrhea rate among men 

increased 10.5%, and the rate among women decreased 

0.4%. During 2010–2014, the rate among men increased 

27.9%, while the rate among women decreased 4.1%. 

The magnitude of the increase among men compared 

with a decrease among women suggests either increased 

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

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

other men who have sex with men (collectively referred to 

as MSM). However, most jurisdictions do not routinely 

report sex of sex partner or site of infection for gonorrhea 

cases, so trends in gonorrhea rates among MSM over time 

cannot be assessed.

Gonorrhea by Region and Sex

During 2013–2014 in the West, the rate of reported 

gonorrhea cases increased among men (25.7%) and among 

women (16.9%) (Tables 15 and 16). Similarly, in the 

South, the rate of reported gonorrhea cases increased both 

among men (6.2%) and among women (0.6%). In contrast, 

in the Northeast and Midwest, the gonorrhea rate increased 

among men (increased 8.9% in the Northeast, 4.2% in the 

Midwest), but decreased among women (decreased 12.0% 

in the Northeast, 6.5% in the Midwest).

Gonorrhea by Age

In 2014, rates of reported gonorrhea cases continued to be 

highest among adolescents and young adults (Figure 17, 

Table 21). In 2014, the highest rates among women were 

observed among those aged 20–24 years (533.7 cases per 

100,000 females) and 15–19 years (430.5 cases per 100,000 

females). Among men, the rate was highest among those 

aged 20–24 years (485.6 cases per 100,000 males) and 

25–29 years (370.5 cases per 100,000 males).

In 2014, persons aged 15–44 years accounted for 93.2% 

of reported gonorrhea cases with known age. During 

2013–2014, the gonorrhea rate decreased 5.0% among 

those aged 15–19 years (Table 21). However, the gonorrhea 

rate increased 2.8% among those aged 20–24 years, 12.1% 

among those aged 25–29 years, 12.7% among those aged 

30–34 years, 15.3% among those aged 35–39 years, and 

7.4% among those aged 40–44 years.

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

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

older age groups during 2013–2014 (Figure 18). Among 

men aged 15–44 years, the rate decreased among those aged 

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

older age groups during 2013–2014 (Figure 19).

Gonorrhea by Race/Ethnicity

In 2014, among the 48 states 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 (405.4 cases per 100,000 

population) (Table 22B). The rate among blacks was 10.6 

times the rate among whites (38.3 cases per 100,000 

population). The gonorrhea rate among American Indians/

Alaska Natives (159.4 cases per 100,000 population) 

was 4.2 times that of whites, the rate among Native 

Hawaiians/Other Pacific Islanders (102.1 cases per 100,000 

population) was 2.7 times that of whites, the rate among 

Hispanics (73.3 cases per 100,000 population) was 1.9 

times that of whites, and the rate among Asians (19.3 cases 

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

During 2010–2014, among the 43 states that submitted 

race and ethnicity data according to OMB standards (see 

Section A1.5 in the Appendix) for all five years during 
STD Surveillance 2014 National Profile: Gonorrhea 17

that period, the gonorrhea rate increased among American 

Indians/Alaska Natives (100.3%), whites (59.3%), 

Hispanics (51.2%), Asians (45.3%), and Native Hawaiians/

Other Pacific Islanders (44.2%) (Figure 20). During this 

same time period, the gonorrhea rate decreased 8.2% 

among blacks.

More information on gonorrhea rates among race/ethnicity 

groups can be found in the Special Focus Profiles.

Gonorrhea by Reporting Source

The number of gonorrhea cases reported by STD clinics 

declined during 2005–2014 (Figure 21). In 2014, 15.1% 

of gonorrhea cases with known reporting source were 

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

2013, when 16.3% of gonorrhea cases were reported by 

STD clinics. In 2014, among women, private physicians 

or health maintenance organizations (HMOs) (25.1%) 

were the most common reporting source, followed by 

family planning clinics (8.5%), STD clinics (8.2%), other 

health department clinics (6.6%), and emergency rooms 

(5.5%) (Figure 22). Among men, private physicians/HMOs 

(20.5%) and STD clinics (17.2%) were the most common 

reporting sources. Other reporting sources for men included 

other health department clinics (8.7%), emergency rooms 

(5.9%), and family planning clinics (4.7%).

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 this report were obtained from Cycle 2 of 

SSuN, which included 12 sites collecting data through 

June 2013. These data for 2014 are not yet available due to 

transition to SSuN Cycle 3, which includes different sites 

and new data collection protocols. Subsequent cycles of 

SSuN will continue to provide more complete estimates of 

case characteristics often missing on routine case reports, 

such as gender of sex partners, which is essential for better 

targeting of gonorrhea control efforts. Between January 1 

and June 30, 2013, SSuN cycle 2 collaborators interviewed 

3,121 gonorrhea cases representing 8.1% of total morbidity 

reported from participating jurisdictions during that time 

period. The estimated burden of disease represented by 

MSM, men who have sex with women only (MSW), and 

women varied substantially across collaborating sites (Figure 

23). San Francisco County had the highest proportion of 

estimated MSM cases (82.6%), while the lowest proportion 

of morbidity estimated to be attributed to MSM was found 

in Virginia at 13.0%. Across collaborating jurisdictions 

in 2013, 27.4% of gonorrhea cases were estimated to be 

among MSM, 30.5% among MSW, and 42.1% among 

women.

Enhanced clinical and behavioral information is also 

collected among patients attending STD clinics in SSuN 

jurisdictions. Clinic data for this report include information 

from patients attending STD clinics during 2014 in the 

6 SSuN jurisdictions that were in both Cycle 2 and Cycle 

3. In 2014, the proportion of STD clinic patients who 

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

of sex partner (Figure 24). Among those attending these 

clinics, MSM disproportionately have higher positivity rates 

when compared to MSW and women, especially among 

adolescent MSM ≤19 years of age (29.0%). Positivity rates 

decline with increasing age for MSM, MSW, and women. 

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 the Section A2.3 in the Appendix. 

More information about GISP and additional data can be 

found at http://www.cdc.gov/std/GISP.

Ceftriaxone Susceptibility

Susceptibility testing for ceftriaxone began in 1987. During 

2006–2014, the percentage of GISP isolates that exhibited 

elevated ceftriaxone MICs, defined as ≥0.125 μg/ml, 

fluctuated between 0.1% and 0.4% (Figure 26).

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 
18 National Profile: Gonorrhea STD Surveillance 2014

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 Dec; 35(12 

Suppl):S13-8.

3 Centers for Disease Control and Prevention. Sexually transmitted 

diseases treatment guidelines, 2015. MMWR Morb Mortal Wkly 

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.

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

sexually transmitted diseases treatment guidelines, 2006: 

fluoroquinolones no longer recommended for treatment of 

gonococcal infections. MMWR Morb Mortal Wkly Rep 2007; 

56: 332–336. 

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: 1413–1417.

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 2010 and 2011 to 0.4% in 2013 

(Figure 27); in 2014, the percentage was 0.8%. 

Azithromycin Susceptibility

Susceptibility testing for azithromycin began in 1992. 

Figure 28 displays the distribution of azithromycin MICs 

among GISP isolates collected during 2010–2014. Most 

isolates had MICs of 0.125–0.5 μg/ml. From 2010–2013, 

the percentage of isolates with reduced azithromycin 

susceptibility (MICs ≥ 2 μg/ml) ranged from 0.3% to 0.6%; 

between 2013 and 2014, the percentage increased from 

0.6% to 2.5%. 

Spectinomycin Susceptibility

All isolates were susceptible to spectinomycin in 2014. A 

spectinomycin-resistant isolate was last identified in GISP 

in 1994 (West Palm Beach, Florida).

Ciprofloxacin Susceptibility

During 1999–2007, the prevalence of ciprofloxacin 

increased from 0.4% to 14.8%. The prevalence declined 

in 2008 and 2009 and then increased. In 2014, 19.2% of 

GISP isolates were resistant to ciprofloxacin. Among isolates 

from MSM, 29.7% were resistant; 12.7% of isolates from 

MSW exhibited ciprofloxacin resistance.

Susceptibility to Other Antimicrobials

In 2014, 37.0% of isolates collected from GISP sites were 

resistant to penicillin, tetracycline, ciprofloxacin, or some 

combination of those antimicrobials (Figure 29). Although 

these antimicrobials are no longer recommended for 

treatment of gonorrhea, the resistance phenotypes remain 

common. Conversely, 63.0% 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 30. The proportion 

of patients treated with ceftriaxone 250 mg increased 

from 84.0% in 2011 to 96.9% in 2013. In 2014, 93.7% 

of patients were treated with ceftriaxone 250 mg, 1.9% 

of patients were treated with azithromycin 2 grams as 

monotherapy, and 1 patient (<0.1%) was treated with 

cefixime.

Gonorrhea Among Special Populations

More information about gonorrhea in race/ethnicity 

groups, women of reproductive age, adolescents, and MSM 

can be found in the Special Focus Profiles.

Gonorrhea Summary

The national rate of reported gonorrhea cases reached an 

historic low in 2009, but increased each year during 2009–

2012. After a temporary decrease in 2013, the gonorrhea 

rate increased again in 2014. This increase was largely 

attributable to an increase 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.
STD Surveillance 2014 National Profile: Gonorrhea 19

Figure 13. Gonorrhea — Rates of Reported Cases by Sex, United States, 1994–2014 

 0

 50

100

150

200

250

Year

1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

Rate (per 100,000 population)

Men

Women

Total

Figure 12. Gonorrhea — Rates of Reported Cases by Year, United States, 1941–2014 

 0

100

200

300

400

500

Year

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

Rate (per 100,000 population)
20 National Profile: Gonorrhea STD Surveillance 2014

Figure 14. Gonorrhea — Rates of Reported Cases by Region, United States, 2005–2014

 0

 50

100

150

200

250

Year

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rate (per 100,000 population)

West

Midwest

Northeast

South

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

Outlying Areas, 2014

NOTE: The total rate of reported cases of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 109.6 per 

100,000 population.

Rate per 100,000

population

Guam 62 

Puerto Rico 13 

Virgin Islands 80 

<=60

61-99

100-124

>=125

(n= 14)

(n= 13)

(n= 14)

(n= 13)

VT 13

NH 17

MA 57

RI 56

CT 65

NJ 75

DE 138

MD 103

DC 291

159

182

117 153

119 60

107

138

73

28

124 111

53

89 99

195

18

98

75

188

122

43

78 114

108

106

146

96

140

159

59

100

173

106

111

134

50

100

89

45

71

20
STD Surveillance 2014 National Profile: Gonorrhea 21

Figure 17. Gonorrhea — Rates of Reported Cases by Age and Sex, United States, 2014 

Men Rate (per 100,000 population) Women

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

4.2 1 10-14 9.9

221.1 4 15-19 30.5

485.6 20-24 533.7

370.5 2 25-29 72.1

228.0 30-34 132.2

144.4 6 35-39 7.8

90.2 40-44 31.7

57.4 45-54 13.1

20.4 3 55-64 .3

4.0 0 65+ .5

120.1 1 Total 01.3

Figure 16. Gonorrhea — Rates of Reported Cases by County, United States, 2014

Rate per 100,000

population

<=13 (n= 792)

14-36 (n= 791)

37-91 (n= 777)

>91 (n= 782)
22 National Profile: Gonorrhea STD Surveillance 2014

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

United States, 2005–2014

 0

 150

 300

 450

 600

 750

Year

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

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, United 

States, 2005–2014 

 0

 120

 240

 360

 480

 600

Year

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rate (per 100,000 population) Age Group

15-19

20-24

25-29

30-34

35-39

40-44
STD Surveillance 2014 National Profile: Gonorrhea 23

Figure 21. Gonorrhea — Reported Cases by Reporting Source and Sex, United States, 

2005–2014 

 0

 40

 80

120

160

200

Year

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Cases (in thousands) Non-STD Clinic, Men

Non-STD Clinic, Women

STD Clinic, Men

STD Clinic, Women

Figure 20. Gonorrhea — Rates of Reported Cases by Race/Ethnicity, United States, 2010–2014 

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

NOTE: Includes 43 states reporting race/ethnicity data in Oce of Management and Budget compliant formats during 2010–2014 (see Section A1.5 in 

the Appendix).

 0

 100

 200

 300

 400

 500

Year

2010 2011 2012 2013 2014

Rate (per 100,000 population)

AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace
24 National Profile: Gonorrhea STD Surveillance 2014

Figure 22. Gonorrhea — Percentage of Reported Cases by Sex and Reporting Sources, United 

States, 2014 

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

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

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

Percentage Private Physician/HMO*

STD Clinic

Other HD* Clinic

Family Planning Clinic

Emergency Room

All Other

Missing/Unknown

 0

 10

 20

 30

 40

Men Women

Figure 23. Gonorrhea — Estimated Proportion of MSM*, MSW*, and Women Among 

Gonorrhea Cases† by Site, STD Surveillance Network (SSuN), 2013

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

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

during January to June 2013. ‡

 California data excludes San Francisco County (shown separately).

NOTE: See Section A2.2 in the Appendix for STD Surveillance Network (SSuN) methods and jurisdictions included in each project area.

Percentage

MSM*

MSW*

Women

 0

 20

 40

 60

 80

100

San FranciscoNew York

City Colorado

WashingtonChicagoCalifornia‡

Baltimore

Philadelphia

Connecticut

Louisiana

Alabama

Virginia
STD Surveillance 2014 National Profile: Gonorrhea 25

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

Isolate Surveillance Project (GISP), United States, 2014

NOTE: Austin is a regional laboratory only.

Sentinel Sites

Sites and 

Regional Labs

 Birmingham Phoenix

 Los Angeles

 Orange Co.

 San Diego

 San Francisco

 Atlanta

 Honolulu

 Tripler AMC

 Chicago

 Indianapolis

 New Orleans

 Baltimore

 Boston

 Pontiac Minneapolis

 Kansas City

 Las Vegas

 Albuquerque

 Buffalo

 New York City

 Greensboro

 Cleveland

 Columbus

 Portland

 Philadelphia

 Austin

 Dallas

 Seattle

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

Sexual Behavior, STD Surveillance Network (SSuN), 2014 

* Only includes patients tested for gonorrhea. †

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

NOTE: Includes the six jurisdictions (Baltimore, Los Angeles, New York City, Philadelphia, San Francisco and Seattle) that contributed data for all of 2014.

Percentage

Age Group

Women

0

10

20

30

40

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

MSM†

MSW†
26 National Profile: Gonorrhea STD Surveillance 2014

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

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

Project (GISP), 2006–2014 

Percentage

Year

 0.0

 0.1

 0.2

 0.3

 0.4

 0.5

2006 2007 2008 2009 2010 2011 2012 2013 2014

Figure 27. Neisseria gonorrhoeae — Percentage of Isolates with Elevated Cefixime Minimum 

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

Project (GISP), 2006–2014 

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

Percentage

Year

 0.0

 0.3

 0.6

 0.9

 1.2

 1.5

2006 2007* 2008* 2009 2010 2011 2012 2013 2014
STD Surveillance 2014 National Profile: Gonorrhea 27

Figure 29. Neisseria gonorrhoeae — Percentage of Isolates with Penicillin, Tetracycline, and/or 

Ciprofloxacin Resistance, Gonococcal Isolate Surveillance Project (GISP), 2014

NOTE: PenR = penicillinase-producing Neisseria gonorrhoeae and chromosomally-mediated penicillin-resistant N. gonorrhoeae; TetR = chromosomallyand plasmid-mediated tetracycline-resistant N. gonorrhoeae; and QRNG = quinolone-resistant N. gonorrhoeae.

Susceptible

PenR

TetR

QRNG

PenR/TetR

PenR/QRNG

TetR/QRNG

PenR/TetR/QRNG

62.9%

5.0%

10.5%

5.2%

2.4%

1.6%

5.1%

7.3%

Figure 28. Neisseria gonorrhoeae — Distribution of Azithromycin Minimum Inhibitory 

Concentrations (MICs), Gonococcal Isolate Surveillance Project (GISP), 2010–2014

Percentage

MICs (μg/ml)

2010

2011

2012

2013

2014

 0

 10

 20

 30

 40

 50

≤0.03 0.06 0.125 0.25 0.5 1 248 ≥16
28 National Profile: Gonorrhea STD Surveillance 2014

Figure 30. Primary Antimicrobial Drugs Used to Treat Gonorrhea Among Participants, 

Gonococcal Isolate Surveillance Project (GISP), 1988–2014 

NOTE: For 2014, “Other” includes clinical trial study drugs (2.9%), azithromycin 2g (1.9%), no therapy (0.7%), and other less frequently used drugs (0.1%).

0

20

40

60

80

100

Year

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

Other Cephalosporins

Ceftriaxone 125 mg

Spectinomycin

Ceftriaxone 250 mg

Cexime

Penicillins

Ciprooxacin

Tetracyclines

Ooxacin

Other

Percentage
STD Surveillance 2014 National Profile: Syphilis 29

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 may result in perinatal 

death of the infant in up to 40% of cases and, if acquired 

during the 4 years before pregnancy, can lead to infection of 

the fetus in 80% of cases.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 31, Table 1). However, the P&S syphilis 

rate has increased almost every year since 2000–2001. In 

2014, a total of 19,999 P&S syphilis cases were reported, 

and the national P&S syphilis rate increased to 6.3 cases per 

100,000 population, the highest rate reported since 1994.

During 2000–2014, the rise in the P&S syphilis rate 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 32 

and 33). However, during 2013–2014, the rate increased 

both among men (14.4%) and among women (22.7%) 

(Tables 28 and 29). This increase among women is of 

particular concern because congenital syphilis cases tend to 

increase as the rate of P&S syphilis among women increases 

(Figure 46). During 2013–2014, the overall, male, and 

female P&S syphilis rates increased in every region of the 

country (Figure 34, Tables 27–29). Nationally, P&S syphilis 

rates increased in every age group 15–44 years of age (Table 

35) and in every race/ethnicity group except for Native 

Hawaiians/Other Pacific Islanders during 2013–2014 

(Figure 40).

As in recent years, MSM accounted for the majority of P&S 

syphilis cases in 2014 (Figures 32 and 41). Nationally, the 

highest rates of P&S syphilis in 2014 were observed among 

men aged 20–24 years and 25–29 years (Figure 37, Table 

35), among men in the West and in the South (Table 29), 

and among black men (Table 36B).

Interpreting Rates of Reported Cases 

of Syphilis

Left untreated, infection with syphilis can span decades. 

Primary and secondary syphilis are the earliest stages of 

infection, reflect symptomatic disease, and are indicators 

of incident infection.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 2014, a total of 19,999 cases of P&S syphilis were 

reported in the United States, yielding a rate of 6.3 cases 

per 100,000 population (Table 1). This rate represents a 

15.1% increase compared with 2013 (5.5 cases per 100,000 

population), and a 40.0% increase compared with 2010 

(4.5 cases per 100,000 population).

P&S Syphilis by Region

In 2014, the West had the highest rate of reported P&S 

syphilis cases (7.9 cases per 100,000 population), followed 

by the South (6.9 cases per 100,000 population), the 

Northeast (5.5 cases per 100,000 population), and the 

Midwest (4.4 cases per 100,000 population) (Table 27). 

During 2013–2014, the P&S syphilis rate increased in 

every region: 17.9% in the West, 16.9% in the South, 

14.6% in the Northeast, and 10.0% in the Midwest 

(Figure 34, Table 27).
30 National Profile: Syphilis STD Surveillance 2014

P&S Syphilis by State

In 2014, rates of reported P&S syphilis cases per 100,000 

population ranged by state from 0.7 in Wyoming to 12.8 in 

Nevada; the P&S syphilis rate in the District of Columbia 

was 17.9 cases per 100,000 population (Figure 35, Table 

26). During 2013–2014, P&S syphilis rates increased in 

70% (35/50) of states and in the District of Columbia, and 

decreased in 30% (15/50) 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 

8.7 cases per 100,000 population in 2014, which represents 

a 13.0% increase since 2013 (7.7 cases per 100,000 

population) (Table 30). In 2014, 74.9% of reported P&S 

syphilis cases (76.5% of male cases and 59.5% of female 

cases) were reported by these 50 MSAs. In 2014, the rate 

among women in these MSAs was 1.2 cases per 100,000 

females, while the rate among men was 16.4 cases per 

100,000 males (Tables 31 and 32).

P&S Syphilis by County

In 2014, 67% of reported P&S syphilis cases occurred in 

just 70 counties or independent cities (Table 33). Of 3,142 

counties in the United States, 411 (13.1%) had a rate 

greater than 5.4 cases per 100,000 population, 400 (12.7%) 

reported a rate from 2.5 to 5.4 cases per 100,000 population, 

389 (12.4%) reported a rate between 0.3 and 2.4 cases per 

100,000 population, and 1,942 (61.8%) counties reported 

no cases of P&S syphilis in 2014 (Figure 36).

P&S Syphilis by Sex and Sex Behavior

As has been observed in previous years, in 2014 the rate 

of reported P&S syphilis cases among men (11.7 cases 

per 100,000 males) was much higher than the rate among 

women (1.1 cases per 100,000 females), and men account 

for a large majority (90.8%) of P&S syphilis cases with 

known sex (Figure 37, Tables 28 and 29). Among men, the 

rate of P&S syphilis has increased every year since 2000, 

and during 2013–2014 the rate among men increased 

14.4% (Figure 33). In contrast, the P&S syphilis rate 

among women has fluctuated between 0.8 and 1.7 cases per 

100,000 females since 2000. During 2013–2014, the P&S 

syphilis rate among women increased 22.7%. 

These increases in male and female P&S syphilis rates were 

observed in every region of the country during 2013–2014. 

Among men, the rate increased 17.0% in the South, 15.9% 

in the West, 15.1% in the Northeast, and 6.8% in the 

Midwest (Table 29). Among women, the largest increases 

were observed in the West (50%), followed by the Midwest 

(28.5%), Northeast (25.0%), and South (7.1%).

MSM continued to account for the majority of P&S 

syphilis cases in 2014 (Figures 32 and 41). Of 19,999 

P&S reported syphilis cases in 2014, 12,226 (61.1%) 

were among MSM, 2,513 (12.6%) were among men who 

have sex with women only (MSW), 1,840 (9.2%) were 

among women, 3,407 (17.0%) were among men without 

information about sex of sex partner, and 13 (0.1%) were 

cases reported with unknown sex (Figure 41). Among 

male cases with information on sex of sex partner, 82.9% 

occurred among MSM. 

This same pattern was observed across race/ethnicity groups: 

the majority of P&S syphilis cases among whites, blacks, 

and Hispanics in 2014 occurred among MSM (Figure 

42). Among MSM, the largest proportion of P&S syphilis 

cases in 2014 occurred among whites (37.6%), followed 

by blacks (31.8%) and Hispanics (21.8%). In contrast, 

the largest proportion of cases among MSW and women 

occurred among blacks (48.4% of cases among MSW and 

50.0% of cases among women).

A total of 27 states reported sex of sex partner data for at 

least 70% of reported P&S cases each year during 2007–

2014. In these states during 2013–2014, the number of 

cases increased 8.8% among MSM, 16.3% among MSW, 

and 28.1% among women. (Figure 32).

P&S Syphilis by Age

As in previous years, in 2014 rates of reported P&S syphilis 

cases were highest among persons aged 20–24 years and 

25–29 years (Figure 37, Table 35). In 2014, the highest 

rates were observed among men aged 25–29 years (34.0 

cases per 100,000 males) and 20–24 years (31.1 cases per 

100,000 males). Similarly, the highest rates among women 

were among those aged 25–29 years (4.5 cases per 100,000 

women) and those aged 20–24 years (2.5 cases per 100,000 

women).
STD Surveillance 2014 National Profile: Syphilis 31

During 2013–2014, the P&S syphilis rate increased among 

all age groups aged 15–64 years (Table 35). Rates increased 

11.6% among persons aged 15–19 years, 13.1% among 

persons aged 20–24 years, 23.4% among those aged 25–29 

years, 18.3% among those aged 30–34 years, 13.0% among 

those aged 35–39 years, 3.7% among those aged 40–44 

years, 13.3% among those aged 45–54 years, and 21.1% 

among those aged 55–64 years (Table 35).

In 2014, persons aged 15–44 years accounted for 79.7% of 

reported P&S syphilis cases with known age. Among men, 

the P&S syphilis rate increased during 2013–2014 among 

all age groups 15–44 years of age (Figure 39). Among 

women, the P&S syphilis rate remained stable among 

those aged 40–44 years, but increased among all age groups 

15–39 years of age (Figure 38).

P&S Syphilis by Race/Ethnicity

In 2014, among the 49 states 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 P&S syphilis 

cases remained highest among blacks (18.9 cases per 

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

was 5.4 times the rate among whites (3.5 cases per 100,000 

population). The P&S syphilis rates among American 

Indians/Alaska Natives (7.6 cases per 100,000 population) 

and Hispanics (7.6 cases per 100,000 population) were 

2.2 times the rate among whites, the rate among Native 

Hawaiians/Other Pacific Islanders (6.5 cases per 100,000 

population) was 1.9 times the rate among whites, and the 

rate among Asians (2.8 cases per 100,000 population) was 

0.8 times the rate among whites.

During 2010–2014, among the 44 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). During 2013–2014, rates 

increased in every race/ethnicity group except for Native 

Hawaiians/Other Pacific Islanders. The greatest increases 

during 2013–2014 were observed among American 

Indians/Alaska Natives (68.8%) and those who identified as 

multiracial (47.3%), followed by Hispanics (15.7%), whites 

(14.3%), Asians (12.8%), and blacks (11.4%). 

More information on P&S syphilis rates among race/

ethnicity 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. In 2014, 26 states reported both sex of sex partner 

and HIV status (HIV-positive or HIV-negative) for at 

least 70% of P&S syphilis cases (Figure 43). Among P&S 

syphilis cases with known HIV-status in these states, 51.2% 

of cases among MSM were HIV-positive, compared with 

10.7% of cases among MSW, and 5.9% of cases among 

women.

P&S Syphilis by Reporting Source

The number of P&S syphilis cases reported by STD clinics 

and by non-STD clinic settings increased during 2005–

2014 (Figure 44). However, the proportion of P&S syphilis 

cases that were reported by STD clinics declined during this 

period, from 31.3% of cases with known reporting source 

in 2005 to 24.9% of cases in 2014 (Table A2). In 2014, 

STD clinics and private physicians or health maintenance 

organizations (HMOs) were the most common reporting 

sources among MSM (28.7% and 28.2%, respectively), 

MSW (25.7% and 23.3% of cases, respectively), and 

women (18.7% and 24.3%, respectively)(Figure 45). 

Congenital Syphilis

After decreasing during 2008–2012 (from 10.5 to 8.4 

reported cases per 100,000 live births), the rate of reported 

congenital syphilis increased in 2013 to 9.1 cases per 

100,000 live births (Table 1). During 2013–2014, the 

rate increased 27.5% to 11.6 cases per 100,000 live births 

in 2014. As has been observed historically, this increase 

paralleled a similar increase (22.2%) in P&S syphilis among 

women during 2013–2014 (Figure 46). 

In 2014, the highest congenital syphilis rates continued to 

be reported from the South (15.5 cases per 100,000 live 

births), followed by the West (12.6 cases per 100,000 live 

births, Midwest (8.5 cases per 100,000 live births), and 

the Northeast (4.7 cases per 100,000 live births). During 

2013–2014, the congenital syphilis rate increased in every 

region, with the largest increases occurring in the Northeast 

(74.1%) and West (63.6%) compared with the Midwest 

(32.8%) and South (9.2%) (Table 42). Increased congenital 

syphilis rates were also observed among most race/ethnicity 

groups during 2013–2014, including whites (32.1%), 

blacks (21.6%), Hispanics (19.6%), and Asians/Pacific 

Islanders (102.9%) (Table 43).
32 National Profile: Syphilis STD Surveillance 2014

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 FHDHANRS CO4 cohort. Arch Intern Med 2012; 172: 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; 18:2075–2079.

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: 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, Ortiz-Rios E, Furness 

BW, Blank S, et al. Misclassification of the stages of syphilis: 

implications for surveillance. Sex Transm Dis. 2005;32(3):144-9.

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

Late, Late Latent, and Congenital)

Total case counts and rates for syphilis were the highest 

recorded since 1995. The total number of cases of syphilis 

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

to CDC increased 12.3% during 2013–2014 (from 56,482 

cases to 63,450 cases) (Table 1). The number of cases of 

early latent syphilis reported to CDC increased 14.8% 

(from 16,929 cases to 19,452 cases), and the number of 

cases of late and late latent syphilis increased 7.9% (from 

21,819 cases to 23,541 cases) (Tables 1, 37, and 39).

Syphilis among Special Populations

More information about syphilis and congenital syphilis 

in race/ethnicity groups, women of reproductive age, 

adolescents, and MSM can be found in the Special Focus 

Profiles.

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 2013–2014, rates increased among both 

men and women in every region of the country. Rates of 

reported congenital syphilis cases also increased in every 

region of the country during 2013–2014.

MSM continued to account for the majority of P&S 

syphilis cases in 2014. Nationally, the highest rates of P&S 

syphilis in 2014 were observed among men aged 20–24 

years and 25–29 years, among men in the West and in the 

South, and among black men.
STD Surveillance 2014 National Profile: Syphilis 33

* 27 states reported sex of partner data for ≥70% of reported cases of primary and secondary syphilis for each year during 2007–2014. †

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

Figure 32. Primary and Secondary Syphilis — Reported Cases by Sex and Sexual Behavior, 

27 Areas*, 2007–2014

 0

 2,000

 4,000

 6,000

 8,000

10,000

Year

2007 2008 2009 2010 2011 2012 2013 2014

Cases

†

†

MSM

MSW

Women

Figure 31. Syphilis — Reported Cases by Stage of Infection, United States, 1941–2014 

 0

120

240

360

480

600

Year

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

Cases (in thousands)

Primary and Secondary

Early Latent

Total Syphilis
34 National Profile: Syphilis STD Surveillance 2014

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

Male-to-Female Rate Ratios, United States, 1990–2014 

 0

 5

 10

 15

 20

 25

Year

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

1:1

2:1

4:1

8:1

16:1

Rate (per 100,000 population) Rate Ratio (log scale)

Male Rate

Female Rate

Total Rate

Male-to-Female Rate Ratio

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

United States, 2005–2014

0

2

4

6

8

10

Year

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rate (per 100,000 population)

West

Midwest

Northeast

South
STD Surveillance 2014 National Profile: Syphilis 35

* In 2014, 1,942 (61.8%) of 3,142 counties in the United States reported no cases of primary and secondary syphilis.

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

United States, 2014 

Rate per 100,000

population

0* (n= 1,942)

>0-2.4 (n= 389)

2.5-5.4 (n= 400)

>5.4 (n= 411)

Figure 35. Primary and Secondary Syphilis — Rates of Reported Cases by State, United States 

and Outlying Areas, 2014 

NOTE: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 6.4 per 

100,000 population.

Rate per 100,000

population

Guam 4.4 

Puerto Rico 13.4 

Virgin Islands 1.9 

<=2.4

2.5-4.4

4.5-6.7

>=6.8

(n= 14)

(n= 14)

(n= 13)

(n= 13)

VT 0.8

NH 2.7

MA 4.5

RI 6.8

CT 2.4

NJ 3.3

DE 5.1

MD 7.6

DC 17.9

3.3

2.0

8.7 4.1

10.0 3.5

8.9

12.3

4.8

0.7

6.7 2.6

2.3

2.1 3.6

12.4

1.2

4.3

4.7

6.3

5.8

0.8

2.7 12.8

6.0

8.8

7.4

1.8

4.9

3.9

6.9

4.2

5.2

6.3

3.6

6.2

1.6

3.5

4.9

1.5

1.5

0.7
36 National Profile: Syphilis STD Surveillance 2014

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

United States, 2014 

Men Rate (per 100,000 population) Women

40 32 24 16 8 0 Age 0 8 16 24 32 40

0.0 0 10-14 .1

7.0 2 15-19 .5

31.1 4 20-24 .5

34.0 3 25-29 .4

24.7 2 30-34 .3

19.1 35-39 1.8

16.0 40-44 1.0

13.1 45-54 0.6

4.5 0 55-64 .2

0.9 0 65+ .0

11.7 1 Total .1

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

15–44 Years by Age, United States, 2005–2014 

 0

 2

 4

 6

 8

 10

Year

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rate (per 100,000 population)

Age Group

15-19

20-24

25-29

30-34

35-39

40-44
STD Surveillance 2014 National Profile: Syphilis 37

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

United States, 2010–2014 

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

NOTE: Includes 44 states reporting race/ethnicity data in Oce of Management and Budget compliant formats during 2010–2014 (see Section A1.5 in 

the Appendix).

 0

 4

 8

 12

 16

 20

Year

2010 2011 2012 2013 2014

Rate (per 100,000 population)

AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

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

Years by Age, United States, 2005–2014 

 0

 8

 16

 24

 32

 40

Year

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rate (per 100,000 population)

Age Group

15-19

20-24

25-29

30-34

35-39

40-44
38 National Profile: Syphilis STD Surveillance 2014

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

Behavior, 2014 

* Of the reported male cases of primary and secondary syphilis, 18.8% were missing sex of sex partner information. †

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

Cases

†

Primary

Secondary

 0

 2250

 4500

 6750

 9000

MSW Women MSM†

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

Race/Ethnicity, United States, 2014

* Of the reported male cases of primary and secondary syphilis, 18.8% were missing sex of sex partner information; 3.3% of reported male cases with sex 

of sex partner data were missing race/ethnicity data. †

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

Cases

†

Whites

Blacks

Hispanics

Other

 0

 1250

 2500

 3750

 5000

MSW Women MSM†
STD Surveillance 2014 National Profile: Syphilis 39

Figure 44. Primary and Secondary Syphilis — Reported Cases by Reporting Source and Sex, 

United States, 2005–2014

 0

 3

 6

 9

 12

 15

Year

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Cases (in thousands)

Non-STD Clinic, Men

Non-STD Clinic, Women

STD Clinic, Men

STD Clinic, Women

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

Status (Positive or Negative), 26 Areas*, 2014

* 26 states reported both sex of sex partner and HIV status for ≥70% of reported cases of primary and secondary syphilis during 2014. †

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

Cases

†

HIVHIV+

 0

 1000

 2000

 3000

 4000

MSW Women MSM†
40 National Profile: Syphilis STD Surveillance 2014

Figure 45. Primary and Secondary Syphilis — Percentage of Reported Cases* by Sex, Sexual 

Behavior, and Selected Reporting Sources, 2014

* Of all primary and secondary syphilis cases, 6.7% had a missing or unknown reporting source. Among all cases with a known reporting

source the reporting source categories presented represent 62.0% of cases; 38.0% were reported from sources other than those shown. †

 HMO = health maintenance organization; MSM = men who have sex with men; MSW = men who have sex with women only.

Percentage

†

Correctional Facility

HIV Counseling and Testing Site

Private Physician/HMO

STD Clinic

 0

 10

 20

 30

 40

MSW Women MSM†

Figure 46. Congenital Syphilis — Reported Cases by Year of Birth and Rates of Primary and 

Secondary Syphilis Among Women, United States, 2005–2014 

*CS = congenital syphilis; P&S = primary and secondary syphilis.

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

P&S Rate

CS Cases

0.0

0.2

0.4

0.6

0.8

Year

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

0

1

2

3

4

 
STD Surveillance 2014 National Profile: Other Sexually Transmitted Diseases 41

Other Sexually Transmitted Diseases 

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. Since then, the number of reported cases has 

fluctuated somewhat, while still appearing to decline overall 

(Figure 47, Table 1). In 2014, a total of 6 cases of chancroid 

were reported in the United States. Only 3 states reported 

one or more cases of chancroid in 2014 (Table 44).

Although the overall decline in reported chancroid cases 

most likely reflects a decline in the incidence of this disease, 

these data should be interpreted with caution because 

Haemophilus ducreyi, the causative organism of chancroid, 

is difficult to culture; as a result, this condition may be 

underdiagnosed.2,3

Human Papillomavirus

Human papillomavirus (HPV) is the most common 

sexually transmitted infection in the United States.4 Over 

40 distinct types can infect the genital tract;5 about 90% 

of infections are asymptomatic and resolve spontaneously 

within two years.6 However, persistent infection with some 

HPV types can cause cancer and genital warts. HPV types 

16 and 18 account for approximately 70% of cervical 

cancers worldwide,7,8 while HPV 6 and 11 are responsible 

for approximately 90% of genital warts.9,10

A quadrivalent HPV vaccine that protects against HPV 

types 6, 11, 16 and 18 has been licensed in the United 

States for use in females since June 2006,11 and in males 

since October 2009.12 In October 2009, a bivalent 

HPV vaccine that protects against HPV types 16 and 

18 was licensed for use in females.13 Either vaccine is 

recommended for routine use in females aged 11 or 

12 years and in females who have not been vaccinated 

previously through age 26 years.11 The quadrivalent vaccine 

is recommended for routine use in males aged 11 or 12 

years and is recommended through age 21 years for males 

who have not been vaccinated previously.11 Quadrivalent 

vaccination of gay, bisexual, and other men who have 

sex with men (collectively referred to as MSM) through 

age 26 is recommended; other males aged 22–26 years 

may also be vaccinated.11 Vaccination is recommended 

through age 26 years for immunocompromised persons 

(including those infected with HIV) who have not been 

vaccinated previously.11 In December 2014, a 9-valent 

vaccine that protects against the HPV types included in 

the quadrivalent vaccine, as well as five additional cancer 

causing types (HPV 31, 33, 45, 52, and 58), was licensed 

for use in the United States.14

HPV vaccine uptake in the United States remains lower

than the Healthy People 2020 goal of 80% coverage.15 In

2014, a national survey found that 60% of girls aged 13–

17 years had received at least 1 dose of the HPV vaccine, 

and 40% had received all 3 doses in the series.16 HPV 

vaccine uptake is lower among boys; 42% aged 13–17 years

received at least 1 dose, but only 22% received all 3 doses.16

National population-based data were obtained from the 

National Health and Nutrition Examination Survey 

(NHANES; see Section A2.4 in the Appendix for 

more information) to examine the prevalence of HPV 

vaccine types in the civilian, non-institutionalized female 

population during 2003–2006. HPV detection and 

typing were performed on self-collected cervicovaginal 

swab samples using the Research Use Only Linear Array 

genotyping assay (Roche Diagnostics). In the pre-vaccine 

era (2003–2006), the overall prevalence of any HPV was 

42.5% (95% Confidence Interval [CI]: 40.3–44.7) among 

females aged 14–59 years.17 Prevalence varied significantly 

by age, peaking in young women 20–24 years of age 

(Figure 48).

Despite low vaccine coverage in the United States, 

prevalence of quadrivalent HPV vaccine types 6, 11, 

16, and/or 18 in cervicovaginal specimens decreased 

from 11.5% (95% CI: 9.2–14.4) in the pre-vaccine era 

(2003–2006) to 5.1% (95% CI: 3.8–6.6) in the vaccine 

era (2007–2010) among females aged 14–19 years, the 

age group most likely to benefit from HPV vaccination 

(Figure 49).18 Among other age groups, vaccine-type HPV 

prevalence did not differ significantly between the two time 

periods.

Data from the National Disease and Therapeutic Index 

(NDTI; see Section A2.5 in the Appendix for more 

information) suggest that cases of genital warts (Figure 50, 

Table 45), as measured by initial visits to physicians’ offices, 

may have increased during the late 1990s through 2011. 

Although the number of cases appears to have decreased 

in 2012 and 2013, compared to 2011, more years of data 

are needed to discern whether genital warts are declining, 

particularly since 2013 cases exceed those reported in 2012. 

The 2014 NDTI data were not obtained in time to include 

them in this report.
42 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2014

Prevalence of genital warts in a large United States cohort 

of individuals with private health insurance significantly 

declined in 2007 through 2010 among girls aged 15–19 

years.19 Among women aged 20–24 years, genital wart 

prevalence, which had been increasing from 2003 through 

2007, was stable from 2007 to 2009 and then decreased in 

2010. Prevalence in women aged 25–29 increased through 

2009, but decreases in genital warts were also observed for 

this group in 2010 (Figure 51).19 These declines are what 

would be expected several years after initiating routine 

HPV vaccination for girls aged 11 to 12 years, with catchup vaccination through age 26 years. Although genital wart 

prevalence in women aged 30–34 and 35–39 years did not 

continue to increase between 2009 and 2010, more years 

of data are needed to interpret these observations, as well 

as the observed decline in prevalence in 2010 for men aged 

20–24 years. The NHANES data for 1999–2004 indicated 

that 5.6% (95% CI: 4.9–6.4) of sexually active adults 

aged 18–59 years self-reported a history of a genital wart 

diagnosis.20 

For data reported in Figure 52, enhanced behavioral and 

demographic information on patients who presented for 

care in 2014 in the 6 jurisdictions that contributed data 

for all of 2014 to the STD Surveillance Network (SSuN) 

was used. See Section A2.2 in the Appendix for more 

information about the SSuN. Genital warts were identified 

by provider diagnosis or by documentation from the 

physical examination. MSM and men who have sex with 

women only (MSW) were defined by self-report or by sex 

of reported sex partners. The prevalence of genital warts in 

2014 is presented separately for MSM, MSW, and women 

by SSuN jurisdiction in the figure. Among women the 

median prevalence of genital warts was 1.1% (range 0.8 to 

2.3) across all jurisdictions, compared to 4.0% (range 2.9 

to 4.7) for MSM and 4.9% (range 3.3 to 5.5) for MSW.

Pelvic Inflammatory Disease

For data 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 

sexually transmitted infections;4,21 although most infections 

are subclinical,22 clinical manifestations are characterized by 

recurrent, painful genital and/or anal lesions.23 Most genital 

herpes infections in the United States are caused by HSV2; however genital HSV-1 infections are increasing among 

college students and other populations.24,25 Case reporting 

data for genital HSV are not available. Data on initial visits 

to physicians’ offices for this condition are available from the 

NDTI (Figure 53, Table 45), however, the 2014 NDTI data 

were not obtained in time to include them in this report.

National trend data on the gender-specific seroprevalence of 

HSV-2 among those aged 14–49 years from the NHANES 

were compared across survey years 1988–1994, 1999–

2002, 2003–2006, and 2007–2010 (Figure 54). Overall, 

HSV-2 seroprevalence decreased between 1988–1994 

and 2007–2010, from 21.2% to 15.5%.26 Among nonHispanic white females, HSV-2 seroprevalence decreased 

from 19.5% (1988–1994) to 15.3% (2007–2010; 

P<0.001); HSV-2 seroprevalence remained stable among 

non-Hispanic black or African American (hereinafter 

referred to as black) females, from 52.5% (1988–1994) to 

49.9% (2007–2010; P=0.1).26 These data, along with data 

from the NHANES survey years 1976–1980,27 indicate 

that blacks had higher seroprevalence than whites for each 

survey period and age group.

Although HSV-2 seroprevalence is decreasing, most persons 

with HSV-2 have not received a diagnosis. The overall 

percentage of HSV-2 seropositive NHANES participants 

who reported never being told by a doctor or health care 

professional that they had genital herpes did not change 

significantly between 1988–1994 and 2007–2010, 

and remained high (90.7% and 87.4%, respectively).26 

However, an overall increase in the number of visits 

for genital herpes over time, as suggested by the NDTI 

data, may indicate increased use of serologic testing and 

increased recognition of infection.

Neonatal HSV infections, although relatively rare, cause 

significant morbidity and mortality.28 Most neonatal HSV 

infections result from vertical transmission from mother to 

neonate.29 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 2006.30 Rates did not vary significantly by region 

or race/ethnicity; however, prevalence was significantly 

higher among cases for which the expected primary payer 

was Medicaid (15.1 per 100,000; 95% CI: 12.1–18.1) 

compared with private insurance or managed health care 

(5.4 per 100,000; 95% CI: 4.0–6.8).

Trichomoniasis

Trichomonas vaginalis infection is a common sexually 

transmitted protozoal infection associated with adverse 

health outcomes such as preterm birth and symptomatic 

vaginitis.4,31,32 Trend data for this infection are limited to 

estimates of initial physician office visits from the NDTI 

(Figure 55, Table 45); however, the 2014 NDTI data were 
STD Surveillance 2014 National Profile: Other Sexually Transmitted Diseases 43

not obtained in time to include them in this report. The 

NHANES data from 2001–2004 indicated an overall 

trichomoniasis prevalence of 3.1% (95% CI: 2.3–4.3), 

with the highest prevalence observed among blacks (13.3%; 

95% CI: 10.0–17.7).32

1 Lewis DA. Chancroid: clinical manifestations, 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 1992;41(SS-3):57–61.

3 Mertz KJ, Trees D, Levine WC, Lewis JS, Litchfield B, Pettus 

KS, et al. Etiology of genital ulcers and prevalence of human 

immunodeficiency virus coinfection in 10 US cities. J Infect Dis 

1998;178(6):1795–8.

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

Banez Ocfemia MC, et al. Sexually transmitted infections among 

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

Sex Transm Dis 2013;40(3):187–93.

5 de Villiers E-M, Fauquet C, Broker TR, Bernard H-U, 

zur Hausen H. Classification of papillomaviruses. Virol 

2004;324:17–27.

6 Ho GYF, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural 

history of cervicovaginal papillomavirus infection in young 

women. N Engl J Med 1998;338(7);423–8.

7 Clifford GM, Smith JS, Plummer M, Munoz N, Franceschi 

S. Human papillomavirus types in invasive cervical cancer 

worldwide: a meta-analysis. Br J Cancer 2003;88(1):63–73.

8 Bosch FX, Manos MM, Munoz N, Sherman M, Jansen AM, Peto 

J, et al. Prevalence of human papillomavirus in cervical cancer: a 

worldwide perspective. J Natl Cancer Inst 1995;87(11):796–802.

9 Garland SM, Steben M, Sings HL, James M, Lu S, Railkar R, 

et al. Natural history of genital warts: analysis of the placebo 

arm of 2 randomized phase III trials of a quadrivalent human 

papillomavirus (types 6, 11, 16, and 18) vaccine. J Infect Dis 

2009;199(6):805–14.

10 Gissmann L, Wolnik L, Ikenberg H, Koldovsky U, Schnurch 

HG, zur Hausen H. Human papillomavirus types 6 and 11 

DNA sequences in genital and laryngeal papillomas and in some 

cervical cancers. Proc Natl Acad Sci USA. 1983;80(2):560–3.

11 Markowitz LE, Dunne EF, Saraiya M, Chesson HW, Curtis 

CR, Gee J, et al. Human papillomavirus vaccination: 

recommendations of the Advisory Committee on Immunization 

Practices (ACIP). MMWR Morb Mortal Wkly Rep 

2014;63(RR05):1–30.

12 Centers for Disease Control and Prevention. FDA licensure of 

quadrivalent human papillomavirus vaccine (HPV4, Gardasil) 

for use in males and guidance from the Advisory Committee on 

Immunization Practices (ACIP). MMWR Morb Mortal Wkly 

Rep 2010;59(20):630–2.

13 Centers for Disease Control and Prevention. FDA licensure of 

bivalent human papillomavirus vaccine (HPV2, Cervarix) for 

use in females and updated HPV vaccination recommendations 

from the Advisory Committeee on Immunization Practices 

(ACIP). MMWR Morb Mortal Wkly Rep 2010;59(20):626–9.

14 Petrosky E, Bocchini JA, Hariri S, Chesson H, Curtis CR, 

Saraiya M, 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.

15 HealthyPeople.gov. Healthy People 2020 Topics & Objectives. 

Immunization and Infectious Diseases. Objective IID–11.4. 

Increase the vaccination coverage level of 3 doses of human 

papillomavirus (HPV) vaccine for females by age 13 to 15 years. 

Objective IID–11.5. Increase the vaccination coverage level 

of 3 doses of human papillomavirus (HPV) vaccine for males 

by age 13 to 15 years. http://www.healthypeople.gov/2020/

topicsobjectives2020/objectiveslist.aspx?topicId=23, Accessed 

August 7, 2015.

16 Reagan-Steiner S, Yankey D, Jeyarajah J, Elam-Evans LD, 

Singleton JA, Curtis CR, et al. National, regional, state, and 

selected local area vaccination coverage among adolescents aged 

13–17 years — United States, 2014. MMWR Morb Mortal 

Wkly Rep 2015;64(29):784–92.

17 Hariri S, Unger ER, Sternberg M, Dunne EF, Swan D, 

Patel S, et al. Prevalence of genital human papillomavirus 

among females in the United States, the National Health 

and Nutrition Examination Survey, 2003–2006. J Infect Dis 

2011;204(4):566–73.

18 Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, 

McQuillan G, et al. Reduction in human papillomavirus 

(HPV) prevalence among young women following HPV 

vaccine introduction in the United States, National Health 

and Nutrition Examination Surveys, 2003–2010. J Infect Dis 

2013;208(3):385–93.

19 Flagg EW, Schwartz R, Weinstock H. Prevalence of anogenital 

warts among participants in private health plans in the United 

States, 2003–2010: potential impact of human papillomavirus 

vaccination. Am J Public Health 2013;103(8):1428–35.

20 Dinh TH, Sternberg M, Dunne EF, Markowitz LE. Genital 

warts among 18- to 59-year-olds in the United States, National 

Health and Nutrition Examination Survey, 1999–2004. Sex 

Transm Dis 2008;35(4):357–60.

21 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.

22 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.

23 Kimberlin DW, Rouse DJ. Clinical practice: genital herpes. N 

Engl J Med 2004;350(19):1970–7.

24 Lafferty WE, Downey L, Celum C, Wald A. Herpes simplex 

virus type 1 as a cause of genital herpes: impact on surveillance 

and prevention. J Infect Dis 2000;181(4):1454–7. 
44 National Profile: Gonorrhea STD Surveillance 2014

25 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. 

26 Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz 

L. Trends in seroprevalence of herpes simplex virus type 2 

among non-Hispanic blacks and non-Hispanic whites aged 14 

to 49 years — United States, 1988 to 2010. Sex Transm Dis 

2013;40(11):860–4.

27 Xu F, Sternberg MR, Kottiri BJ, McQuillan GM, Lee FK, 

Nahmias AJ, et al. Trends in herpes simplex virus type 1 

and type 2 seroprevalence in the United States. JAMA 

2006;296(8):964–73.

28 Kimberlin DW. Herpes simplex virus infections of the newborn. 

Semin Perinatol 2007;31:19–25.

29 Corey L, Wald A. Maternal and neonatal herpes simplex virus 

infections. N Engl J Med 2009;361(14):1376–85.

30 Flagg EW, Weinstock H. Incidence of neonatal herpes 

simplex virus infections in the United States, 2006. Pediatrics 

2011;172(1):e1–8.

31 French JI, McGregor JA, Parker R. Readily treatable 

reproductive tract infections and preterm birth among black 

women. Am J Obstet Gynecol 2006;194:1717–27.

32 Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman 

S, Markowitz L. The prevalence of Trichomonas vaginalis 

infection among reproductive-age women in the United States, 

2001–2004. Clin Infect Dis 2007;45(10):1319–26.
STD Surveillance 2014 National Profile: Other Sexually Transmitted Diseases 45

Figure 47. Chancroid — Reported Cases by Year, United States, 1981–2014 

0

1

2

3

4

5

Year

1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

Cases (in thousands)

Figure 48. Human Papillomavirus — Cervicovaginal Prevalence of High-Risk and Low-Risk 

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

Nutrition Examination Survey, 2003–2006 

* HPV = human papillomavirus.

NOTE: Error bars indicate 95% condence interval. Both high-risk and low-risk HPV types were detected in some females.

SOURCE: Hariri S, Unger ER, Sternberg M, Dunne EF, Swan D, Patel S, et al. Prevalence of genital human papillomavirus among females in the United 

States, the National Health and Nutrition Examination Survey, 2003–2006. J Infect Dis 2011;204(4):566–73.

Prevalence, %

Age Group

Low-risk HPV*

High-risk HPV*

0

10

20

30

40

50

60

14-19 20-24 25-29 30-39 40-49 50-59
46 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2014

Figure 50. Genital Warts — Initial Visits to Physicians’ Offices, United States, 1966–2013

NOTE: The relative standard errors for genital warts estimates of more than 100,000 range from 18% to 23%. See Section A2.5 in the Appendix 

and Table 45.

SOURCE: National Disease and Therapeutic Index, IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966–2013. The 2014 data

were not obtained in time to include them in this report.

 0

100

200

300

400

500

Year

1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Visits (in thousands)

Figure 49. Human Papillomavirus — Cervicovaginal Prevalence of Types 6, 11, 16 and 18 

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

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

NOTE: Error bars indicate 95% condence interval.

SOURCE: Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, McQuillan G, et al. Reduction in human papillomavirus (HPV) prevalence among young

women following HPV vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003–2010. J Infect Dis 

2013;208(3):385–93.

Prevalence, %

Age Group

2003-2006

2007-2010

0

5

10

15

20

25

30

14-19 20-24 25-29 30-39 40-49 50-59
STD Surveillance 2014 National Profile: Other Sexually Transmitted Diseases 47

Figure 51. Genital Warts — Prevalence per 1000 Person-Years Among Participants in Private 

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

SOURCE: Flagg EW, Schwartz R, Weinstock H. Prevalence of anogenital warts among participants in private health plans in the United States, 

2003–2010: potential impact of human papillomavirus vaccination. Am J Public Health 2013;103(8):1428–35.

 0

 2

 4

 6

 8

 10

Year

2003 2004 2005 2006 2007 2008 2009 2010

Prevalence

Females

 0

 2

 4

 6

 8

 10

Year

2003 2004 2005 2006 2007 2008 2009 2010

Prevalence

Males

10-14

15-19

20-24

25-29

30-34

35-39

Age Group

Figure 52. Genital Warts — Prevalence among STD Clinic Patients by Sex, Sex of Partners, 

and Site, STD Surveillance Network (SSuN), 2014

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

NOTE: Includes the six jurisdictions (Baltimore, Los Angeles, New York City, Philadelphia, San Francisco and Seattle) which contributed data for 

all of 2014.

Prevalence, %

MSM*

MSW*

Women

 0

 3

 6

 9

 12

 15

Seattle San

Francisco

Los

Angeles

Baltimore   Philadelphia New York

City
48 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2014

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

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

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

NOTE: Error bars indicate 95% condence interval.

SOURCE: Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz L. Trends in seroprevalence of herpes simplex virus type 2 among non-Hispanic blacks 

and non-Hispanic whites aged 14 to 49 years — United States, 1988 to 2010. Sex Transm Dis 2013;40(11):860–4.

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

Figure 53. Genital Herpes — Initial Visits to Physicians’ Offices, United States, 1966–2013

NOTE: The relative standard errors for genital herpes estimates of more than 100,000 range from 19% to 23%. See Section A2.5 in the

Appendix and Table 45.

SOURCE: National Disease and Therapeutic Index, IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966–2013. The 2014 

data were not obtained in time to include them in this report.

 0

 80

160

240

320

400

Year

1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Visits (in thousands)
STD Surveillance 2014 National Profile: Other Sexually Transmitted Diseases 49

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

Physicians’ Offices, United States, 1966–2013

NOTE: The relative standard errors for trichomoniasis estimates range from 16% to 21% and for other vaginitis estimates range from 8% to 13%. See 

Section A2.5 in the Appendix and Table 45.

SOURCE: National Disease and Therapeutic Index, IMS Health, Integrated Promotional ServicesTM, IMS Health Report, 1966–2013. The 2014 data were

not obtained in time to include them in this report.

 0

 900

1,800

2,700

3,600

4,500

Year

1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Visits (in thousands)

Trichomoniasis

Other Vaginitis
50 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2014
SPECIAL FOCUS PROFILES
SPECIAL FOCUS PROFILES
STD Surveillance 2014 Special Focus Profiles 51

Special Focus Profiles 

The Special Focus Profiles highlight trends and distribution of STDs in populations of particular interest to STD and HIV 

prevention programs in state and local health departments: women and infants, adolescents and young adults, racial and 

ethnic minority groups, and gay and bisexual men and other men who have sex with men (MSM). These populations are 

most vulnerable to STDs and their consequences and often lack adequate access to healthcare services. In 2013, in the 

U.S., age was strongly associated with having health insurance. Older adults (65 years and older) and children (19 years and 

under) were most likely to have health insurance. Working adults (19 years to 64 years) had higher uninsured rates. The 

rates of non-insured for whites, blacks, and Hispanics were: 9.8%, 15.9%, and 24.3% respectively.1 The Patient Protection 

and Affordable Care Act (ACA) aims to increase access to sexual and reproductive health services through reforms based on 

the U.S. Preventive Services Task Force recommendations that include: chlamydia and gonorrhea screening (for sexually 

active women under 25 and all higher risk women), HIV screening (everyone 15–65 years old, pregnant, and higher risk), 

STD counseling (for all sexually active adolescents and higher-risk adults), and syphilis screening (for pregnant women and 

adults at higher risk).2 However, although health insurance coverage has been expanded for most groups, including both 

men and women, and for most race and ethnic groups, evidence suggests that disparities in health insurance coverage and 

access to STD services remain.3-4

1 Smith, J and Medalia, Carla. U.S. Census Bureau, Current Population Reports, P60-250, Health Insurance Coverage in the United States: 

2013, U.S. Government Printing Office, Washington, DC, 2014.

2 Oglesby, WH. Perceptions of and preferences for federally-funded family planning clinics. Reproductive Health 2014; 11(50)1-9.

HYPERLINK http://www.reproductive-health-journal.com/content/11/1/50

3 O’Hara, B and Brault, MW. The disparate impact of the ACA-dependent expansion across population subgroups. Health Serv Res. 2013 

Oct;48(5):1581-92.

4 Drainoni, M, Sullivan, M, Sequeira, S, Bacic, J, and Hsu, K. Health reform and shifts in funding for sexually transmitted infection 

services. Sexually Transmitted Diseases 41(7), July 2014, p 455–460
52 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2014

STDs in Women and Infants

Public Health Impact

Women and infants are at significant risk for long-term 

consequences of STDs. A woman’s relationship status with 

her male partner, in particular, has been identified as an 

important predictor of her sexual health.1 In addition to 

social factors such as poverty and lack of access to quality 

STD services, a woman may be unable to negotiate 

safer sexual practices, such as condom use, which can 

significantly affect her sexual and reproductive health, as 

well as the health of her unborn baby.2,3 

As an example of how social factors can impact women’s 

health, a perceived shortage of available men in a 

community can cause women to be more accepting of 

their partners’ concurrent sexual relationships, and partner 

concurrency is a factor associated with increased risk for 

STDs.4 Because it may be her male partner’s risk, rather 

than the woman’s that increases a woman’s risk for STDs, 

even a woman who has only one partner may be obliged 

to practice safer sex such as using condoms.5 A number of 

studies have found significant associations between condom 

use and socio-demographic characteristics, including age, 

income, education, and acculturation.6 

Women infected with C. trachomatis or N. gonorrhoeae 

can develop pelvic inflammatory disease (PID), which, in 

turn, can lead to reproductive morbidity such as ectopic 

pregnancy and tubal factor infertility. An estimated 10%–

20% of women with chlamydia or gonorrhea may develop 

PID if they do not receive adequate treatment.7,8 Among 

women with PID, tubal scarring can cause infertility in 8% 

of women, ectopic pregnancy in 9%, and chronic pelvic 

pain in 18%.9

About 80%–90% of chlamydial infections10 and up to 80% 

of gonococcal infections11 in women are asymptomatic. 

These infections are detected primarily through screening. 

Because the symptoms associated with PID can be 

nonspecific, up to 85% of women with PID delay seeking 

medical care, thereby increasing the risk for infertility and 

ectopic pregnancy.12 Data from two randomized controlled 

trials of chlamydia screening suggest that such screening 

programs reduce PID incidence. 13,14

Human papillomavirus (HPV) infections are highly 

prevalent in the United States, especially among young 

sexually active women. Although most HPV infections in 

women resolve within 2 years, they are a major concern 

because persistent infection with specific types of the 

virus can cause abnormal cervical cells to be noted on 

a Papanicolaou (Pap) smear. These abnormal cells can 

progress to cervical cancer. Other types cause genital warts, 

low-grade Pap smear abnormalities, and, rarely, recurrent 

respiratory papillomatosis in infants born to infected 

mothers.15 

Impact on Pregnancy Outcomes

Chlamydia and gonorrhea can result in adverse outcomes 

of pregnancy, including neonatal ophthalmia and, in the 

case of chlamydia, neonatal pneumonia. Although topical 

prophylaxis of infants at delivery is effective for prevention 

of gonococcal ophthalmia neonatorum, prevention of 

neonatal pneumonia requires prenatal detection and 

treatment.

Genital infections with herpes simplex virus (HSV) are 

extremely common, can cause painful outbreaks, and can 

have serious consequences for pregnant women and their 

infants.16

When a woman has a syphilis infection during pregnancy, 

she can transmit the infection to the fetus in utero. 

Transmission can result in fetal death or an infant born with 

physical and mental developmental disabilities. Most cases 

of congenital syphilis are easily preventable if women are 

screened for syphilis and treated early during prenatal care.17

Observations

Chlamydia — United States

Chlamydial infections in women are usually asymptomatic 

and screening is necessary to identify most infections.18 

Routine chlamydia screening of sexually-active young 

women has been recommended by CDC since 1993.19 

Rates of reported cases among women increased steadily 

from the early 1990s likely reflecting expanded screening 

coverage and use of more sensitive diagnostic tests (Figure 

1). During 2011–2013, rates decreased from 643.4 to 

619.0 cases per 100,000 females and then increased 1.3% 

to 627.2 per 100,000 in 2014 (Table 4).

Chlamydia rates are highest among young women, the 

population targeted for screening (Figure 5, Table 10). 

During 2013–2014, rates of reported chlamydia decreased 

4.2% among females aged 15–19 years and increased 1.6% 

among females aged 20–24 years. Regionally, chlamydia 

case rates are highest among women in the South, with a 
STD Surveillance 2014 Special Focus Profiles: STDs in Women and Infants 53

rate of 694.4 per 100,000 females in 2014 (Table 4). Rates 

of reported chlamydia exceeded gonorrhea rates among 

women in all regions (Figures A and B, Tables 4 and 15).

Gonorrhea — United States

Like chlamydia, gonorrhea is often asymptomatic in 

women. Thus, gonorrhea screening is an important strategy 

for the identification of gonorrhea among women. Largescale screening programs for gonorrhea in women began in 

the 1970s. After an initial increase in cases detected through 

screening, rates of reported gonorrhea cases for both women 

and men declined steadily throughout the 1980s and early 

1990s and then declined more gradually in the late 1990s 

and the 2000s (Figure 12). After reaching a 40-year low in 

2009 (104.5 cases per 100,000 females), the gonorrhea rate 

for women increased slightly each year during 2009–2011, 

but then decreased each year during 2012–2014. In 2014, 

the gonorrhea rate among women decreased to 101.3 cases 

per 100,000 females (Figure 13, Table 15).

The gonorrhea rate among women was slightly higher than 

the rate among men during 2001–2012, but the rate among 

men was higher than the rate among women in 2013 and 

2014 (Figure 13, Tables 15 and 16). Gonorrhea rates are 

highest among young women (Figure 17, Table 21). Among 

young women and adolescents, rates were highest in 2014 

among 19-year old females (643.9 per 100,000 females) 

(Table 23).

Congenital Syphilis

Trends in congenital syphilis usually follow trends in primary 

and secondary syphilis (P&S) among women, with a lag 

of 1–2 years (Figure 46). The rate of reported P&S syphilis 

cases among women declined 95.4% (from 17.3 to 0.8 cases 

per 100,000 females) during 1990–2004 (Figure 33). Since 

2004, the rate has fluctuated. It increased during 2005–2008 

to 1.5 cases per 100,000 females in 2008, decreased during 

2009–2011 to 0.9 cases per 100,000 females in 2011, 

and plateaued at 0.9 cases per 100,000 females during 

2012–2013. In 2014, the P&S syphilis rate among women 

increased to 1.1 cases per 100,000 females (Table 28). This 

represents a 22.2% increase relative to 2013.

Similarly, the reported rate of congenital syphilis cases 

declined by 92.4% during 1991–2005, from a peak of 

107.6 cases per 100,000 live births in 1991 to 8.2 cases per 

100,000 live births in 2005, but has fluctuated since 2005 

(Table 1). The congenital syphilis rate increased during 

2006–2008 to 10.5 cases per 100,000 live births in 2008, 

decreased during 2009–2012 to 8.4 cases per 100,000 live 

births in 2012, and subsequently increased each year in 

2013 and 2014, to 11.6 cases per 100,000 live births in 

2014. This increase in 2014 represents a 27.5% increase 

relative to 2013 and a 19.6% increase relative to 2010 

(Table 42). 

As in previous years, the highest rates of P&S syphilis 

among women and the highest rates of congenital syphilis 

were observed in the South (Figures C and D, Table 28 and 

42). However, all regions experienced an increase in the rate 

of P&S syphilis among women and the rate of congenital 

syphilis during 2013–2014. The largest increases in the 

rate of P&S syphilis among women were seen in the West 

(50.0%), followed by the Midwest (28.5%), Northeast 

(25%), and South (7.1%). The largest increases in the rate 

of congenital syphilis were seen in the Northeast (74.1%), 

followed by the West (63.6%), the Midwest (32.8%), and 

the South (9.2%).

Although most cases of congenital syphilis occur among 

infants whose mothers have had some prenatal care, 

late or limited prenatal care has been associated with 

congenital syphilis. Failure of health care providers to 

adhere to maternal syphilis screening recommendations also 

contributes to the occurrence of congenital syphilis.20

Pelvic Inflammatory Disease

Accurate estimates of PID and tubal factor infertility 

resulting from chlamydial and gonococcal infections are 

difficult to obtain, in part because definitive diagnoses of 

these conditions can be complex. Published data suggest 

overall declining rates of women diagnosed with PID 

in the United States in both hospital and ambulatory 

settings.21-23 The National Disease and Therapeutic Index 

(NDTI) provides estimates of initial visits to office-based, 

private physicians for PID (NDTI; see Section A2.5 in the 

Appendix for more information). NDTI estimated that 

from 2004–2013 the number of visits to such physicians for 

PID among women aged 15–44 decreased (39.8%) from 

123,000 to 88,000 visits (Figure E). The 2014 NDTI data 

were not obtained in time to include them in this report. 

Several suggestions have been put forth as factors that could 

influence PID rates, including increases in chlamydia and 

gonorrhea screening coverage, more sensitive diagnostic 

technologies, and availability of single-dose therapies 

that increase adherence to treatment.22-24 While PID is 

declining nationally, it still causes an enormous amount of 

unnecessary and expensive morbidity.

Differences in PID diagnoses or treatment by race/ethnicity 

have been observed in earlier research.21 Using data from the 

National Survey of Family Growth, the overall proportion 

of sexually experienced women who have been treated for 

PID declined from 8.6% in 1995 to 5.7% in 2002 and 

leveled off to 5.0% in 2006–2010 (Figure F).25 While this 
54 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2014

pattern was observed across all racial/ethnic groups, the 

proportion who had received PID treatment was higher 

among non-Hispanic blacks than those among Hispanics 

or non-Hispanic whites. These disparities are consistent 

with the marked racial disparities observed for chlamydia 

and gonorrhea. However, because of the subjective methods 

by which PID is diagnosed, racial disparity data should be 

interpreted with caution.

Ectopic Pregnancy

Ectopic pregnancy (EP) is a potentially life-threatening 

adverse pregnancy outcome that requires prompt evaluation 

and treatment, and an important cause of pregnancy related 

mortality. Past studies have found that it affects 1–2% of 

all pregnancies.26-27 Fallopian tube pathology is the most 

common etiology of EP.28

In the past, the National Hospital Discharge Survey, which 

collects information on discharged hospital in-patients in 

the United States, was used to estimate trends in the rate 

of EP. However, medical and surgical treatment of EP is 

currently provided in both inpatient and outpatient settings, 

making the task of tracking reliable estimates at the national 

level difficult.29 More recent attempts to estimate EP 

incidence use data from surveys or administrative databases 

of public and private insurance and managed care systems.30

Data from a large administrative claims database suggests 

the rate of EP increases with age among pregnancies in girls 

and women aged 15–44 years during the period of 2003 

to 2013 (Figure G). In 2013, EP rates were highest among 

women aged 35–44 years. During 2012–2013, the EP rate 

decreased among all age groups, most notably in the 25–29 

age group (21%). 

1 El-Bassel N, Gilbert L, Krishnan S, Schilling R, Gaeta T, Purpura 

S, et al. Partner violence and sexual HIV-Risk behaviors among 

women in an inner-city emergency department. Violence 

Vict.1998;13(4):377-393.

2 Pulerwitz J, Amaro H, De Jong W, Gortmaker SL, Rudd R. 

Relationship power, condom use and HIV risk among women in 

the USA. AIDS Care. 2002;14(6):789-800

3 McCree DH, Rompalo A. Biological and behavioral risk factors 

associated with STDs/HIV in women: implications for behavioral 

interventions, In: Aral SO, Douglas JM,Lipshutz JA (editors). 

Behavioral Interventions for Prevention and Control of Sexually 

Transmitted Diseases (p. 310-324). New York, NY: Springer.

4

 Hogben M, Leichliter JS. Social determinants and 

sexually transmitted disease disparities. Sex Transm Dis. 

2008;35(12):S13-S18.

5 O’Leary A. A woman’s risk for HIV from a primary partner: 

balancing risk and intimacy. Annu Rev Sex Res. 2000; 11:191-234.

6 Manderson L, Chang T, Tye LC, Rajanayagam K. Condom use in 

heterosexual sex: a review of research, 1985–1994. In: Catalan J, 

Sherr L, Hedge B (editors). The impact of AIDS: psychological and 

social aspects of HIV Infection. p. 1-26. The Netherlands: Harwood 

Academic Publishers.

7 Paavonen J, Westrom L, Eschenbach. Pelvic Inflammatory 

Disease. In: Holmes KK, Sparling PF, Stamm WE, Piot P, 

Wasserheit JN, Corey L, Cohen, MS, Watts DH, (editors). Sex 

Transm Dis. 4th ed. New York: McGraw-Hill; 2008:1017-1050.

8 Hook EW III, Handsfield HH. Gonococcal infections in the 

adult. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit 

JN, Corey L, et al, (editors). Sex Transm Dis. 4th ed. New York: 

McGraw-Hill; 2008:627-45.

9 Westrom L, Joesoef R, Reynolds G, Hagdu A, Thompson SE. 

Pelvic inflammatory disease and fertility: a cohort study of 1,844 

women with laparoscopically verified disease and 657 control 

women with normal laparoscopy. Sex Transm Dis. 1992;9:185-92.

10 Stamm WE. Chlamydia trachomatis infections in the adult. In: 

Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, 

Corey L, et al, (editors). Sex Transm Dis. 4th ed. New York: 

McGraw-Hill; 2008:575-93.

11 Marrazzo JM, Handsfield HH, Sparling PF. Neisseria gonorrhoeae 

In: Mandell GL, Bennett JE, Dolin R (editors). Principles 

and practice of Infectious Diseases, 7th ed. Philadelphia, PA: 

Churchill Livingstone; 2010: 2753-2770.

12 Hillis SD, Joesoef R, Marchbanks PA, Wasserheit JN, Cates 

W Jr, Westrom L. Delayed care of pelvic inflammatory 

disease as a risk factor for impaired fertility. Am J Obstet 

Gynecol.1993;168:1503-9.

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

KK, Stamm WE. Prevention of pelvic inflammatory disease 

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

1996;34(21):1362-6.

14 Oakeschott, P, Kerry S, Aghaizu A, Atherton H, Hay S, et 

al. Randomised controlled trial of screening for Chlamydia 

trachomatis to prevent pelvic inflammatory disease: the POPI 

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

15 Centers for Disease Control and Prevention. Prevention of genital 

HPV infection and sequelae: report of an external consultants’ 

meeting. Atlanta: U.S. Department of Health and Human 

Services; 1999.

16 Kimberlin DW. Herpes simplex virus infections of the newborn. 

Semin Perinatol. 2007;31(1):19-25.

17 Centers for Disease Control and Prevention. Guidelines for 

prevention and control of congenital syphilis. MMWR Morb 

Mortal Wkly Rep. 1988;37(No. SS-1).

18 Farley TA, Cohen DA, Elkins W. Asymptomatic sexually 

transmitted diseases: the case for screening. preventive medicine. 

2003;36:502-9.
STD Surveillance 2014 Special Focus Profiles: STDs in Women and Infants 55

25 Leichliter JS. Chandra A. Aral SO. Correlates of self-reported 

pelvic inflammatory disease treatment in sexually experienced 

reproductive-aged women in the United States, 1995 and 2006-

2010. Sex Transm Dis. 2013;40(5):413-8.

26 Ectopic pregnancy–United States, 1990–1992. MMWR Morb 

Mortal Wkly Rep 1995;44:46–8.

27 Van Den Eeden SK, Shan J, Bruce C, Glasser M. Ectopic 

pregnancy rate and treatment utilization in a large managed care 

organization. Obstet Gynecol 2005;105:1052–7.

28 Medical management of ectopic pregnancy. ACOG Practice 

Bulletin No. 94. American College of Obstetricians and 

Gynecologists.Obstet Gynecol 2008;111:1479–85.

29 Zane SB, Kieke BA Jr, Kendrick JS, Bruce C. Surveillance in 

a time of changing health care practices: estimating ectopic 

pregnancy incidence in the United States. Matern Child Health J 

2002;6:227–36

30 Hoover KW, Tao G, Kent CK. Trends in the diagnosis and 

treatment of ectopic pregnancy in the United States. Obstet 

Gynecol. 2010;3(115):495-502.

19 Centers for Disease Control and Prevention. Recommendations 

for the prevention and management of Chlamydia trachomatis 

infections. 1993 Aug 6;42(RR-12):1-39.

20 Centers for Disease Control and Prevention. Congenital syphilis 

— United States, 2003–2008. MMWR Morb Mortal Wkly Rep. 

2010;59:413-17.

21 Sutton MY, Sternberg M, Zaidi A, St. Louis ME, Markowitz LE. 

Trends in pelvic inflammatory disease hospital discharges and 

ambulatory visits, United States, 1985–2001. Sex Transm Dis. 

2005;32(12):778-84.

22 Bohm MK, Newman L, Satterwhite CL, et al. Pelvic 

inflammatory disease among privately insured women, United 

States, 2001–2005. Sex Transm Dis 2010;37:131–136.

23 Whiteman MK, Kuklina E, Jamieson DJ, et al. Inpatient 

hospitalization for gynecologic disorders in the United States. Am 

J Obstet Gynecol 2010;202:541 e1–6.

24 Owusu-Edusei, Kwame Jr. Bohm, Michele K. Chesson, Harrell W. 

Kent, Charlotte K. Chlamydia screening and pelvic inflammatory 

disease: Insights from exploratory time-series analyses. Am J Prev 

Med. 2010;38(6):652-7.
56 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2014

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

Outlying Areas, 2014

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 

622.4 per 100,000 female population.

Rate per 100,000

population

Guam 753 

Puerto Rico 200 

Virgin Islands 1057 

<=523

524-608

609-710

>=711

(n= 14)

(n= 13)

(n= 14)

(n= 13)

VT 508

NH 366

MA 406

RI 560

CT 516

NJ 473

DE 646

MD 627

DC 1090

829

1127

683 772

599 569

589

721

644

484

710 617

539

570 556

902

365

625

494

912

635

570

544 581

798

644

703

623

660

764

531

523

840

700

637

729

376

590

522

358

556

474

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

and Outlying Areas, 2014

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 

100.2 per 100,000 female population.

Rate per 100,000

population

Guam 60 

Puerto Rico 9 

Virgin Islands 97 

<=50

51-93

94-128

>=129

(n= 14)

(n= 14)

(n= 13)

(n= 13)

VT 11

NH 14

MA 35

RI 40

CT 60

NJ 68

DE 145

MD 92

DC 252

164

190

107 168

83 50

92

128

50

24

115 115

55

101 102

214

15

102

66

194

118

44

82 93

91

70

154

109

148

178

40

94

185

133

103

130

39

104

72

49

71

21
STD Surveillance 2014 Special Focus Profiles: STDs in Women and Infants 57

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

State, United States and Outlying Areas, 2014

NOTE: The total rate of primary and secondary syphilis among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands)

was 1.2 per 100,000 female population.

Rate per 100,000

population

Guam 2.5 

Puerto Rico 1.6 

Virgin Islands 1.8 

<=0.4

0.5-0.9

1.0-1.4

>=1.5

(n= 17)

(n= 12)

(n= 12)

(n= 13)

VT 0.0

NH 0.6

MA 0.7

RI 0.9

CT 0.4

NJ 0.4

DE 0.4

MD 1.6

DC 1.5

0.7

0.3

1.5 1.5

1.7 0.2

1.4

1.9

0.3

0.0

1.2 0.3

0.4

1.0 1.0

5.6

0.4

0.6

0.8

1.1

1.1

0.4

0.4 1.7

1.3

0.5

1.3

1.4

1.3

0.8

1.1

0.7

0.9

8.1

1.0

1.8

0.1

0.4

0.5

0.6

0.2

0.0

Figure D. Congenital Syphilis — Rates of Reported Cases by Year of Birth and State, United 

States and Outlying Areas, 2014

NOTE: The total rate of congenital syphilis for infants by year of birth for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands)

was 11.5 per 100,000 live births.

Rate per 100,000

live births

Guam 0.0 

Puerto Rico 0.0 

Virgin Islands 0.0 

0.0

0.1-2.6

2.7-10.8

>=10.9

(n= 23)

(n= 6)

(n= 12)

(n= 13)

VT 0.0

NH 0.0

MA 4.1

RI 0.0

CT 0.0

NJ 0.0

DE 0.0

MD 22.0

DC 0.0

5.1

0.0

15.0 15.6

19.7 0.0

22.1

13.0

0.0

0.0

17.0 9.6

2.6

0.0 5.4

73.4

0.0

13.3

0.0

2.6

1.3

0.0

3.9 17.2

3.7

9.1

5.0

0.0

10.8

11.4

4.4

3.5

8.7

24.8

2.5

19.3

0.0

1.9

2.3

0.0

0.0

0.0
58 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2014

Figure F. Pelvic Inflammatory Disease — Trends in Lifetime Prevalence of Treatment 

Among Sexually Experienced Women Aged 15–44 by Race/Ethnicity, National 

Survey of Family Growth, 1995, 2002, 2006–2010

SOURCE: Leichliter, Jami. Chandra Anjani, Aral SO. Correlates of Self-Reported Pelvic Inammatory Disease Treatment in Sexually

Experienced Reproductive-Aged Women in the United States, 1995, 2002, and 2006-2010. Sex Transm Dis. 2013;40(5):413-418.

Prevalence, %

1995

2002

2006-2010

 0

 5

 10

 15

 20

Hispanic Non-Hispanic

Whites

Non-Hispanic

Blacks

Total

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

Aged 15–44 Years, United States, 2004–2013

NOTE: The relative standard errors for these estimates are 16%–23%. See Section A2.5 in the Appendix and Table 45.

SOURCE: National Disease and Therapeutic Index, IMS Health, Integrated Promotional ServicesTM, IMS Health Report, 2004–2013. The 2014 data

were not obtained in time to include them in this report.

 0

 40

 80

120

160

200

Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Visits (in thousands)
STD Surveillance 2014 Special Focus Profiles: STDs in Women and Infants 59

Figure G Ectopic Pregnancy — Rates Among Commercially Insured Pregnant Women Aged 

15–44 Years by Age, 2003–2013

SOURCE: MarketScan Commercial Claims and Encounters Database, Truven Health Analytics, Ann Arbor, MI, 2003-2013.

0.0

0.4

0.8

1.2

1.6

2.0

Year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Age Group

15-19

20-24

25-29

30-34

35-39

40-44

Rate (per 100,000)
60 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2014

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 1 

in 4 sexually active adolescent females have an STD, such 

as chlamydia or human papillomavirus (HPV).2 Compared 

with older adults, sexually active adolescents aged 15–19 

years and young adults aged 20–24 years are at higher risk of 

acquiring STDs for a combination of behavioral, biological, 

and cultural reasons. For some STDs, such as chlamydia, 

adolescent females may have increased susceptibility to 

infection because of increased cervical ectopy. Cervical 

ectopy refers to columnar cells, which are typically located 

within the cervical canal, being located on the outer surface 

of the cervix. Although this is a normal finding in adolescent 

and young women, these cells are more susceptible 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, conflicts between 

clinic hours and work and school schedules, embarrassment 

attached to seeking STD services, method of specimen 

collection, and concerns about confidentiality.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 that affect 

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 2014, there were 948,102 reported cases of chlamydial 

infection among persons aged 15–24 years of age, 

representing 66% of all reported chlamydia cases. Among 

those aged 15–19 years, the rate of reported cases of 

chlamydia decreased 3.5% during 2013–2014 (1,869.7 

to 1,804.0 per 100,000) (Table 10). Among those aged 

20–24 years, the rate increased 2.3% during 2013–2014 

(2,428.8.8 to 2,484.6 per 100,000) (Table 10).

Among women aged 15–24 years of age, the population 

targeted for chlamydia screening, the overall rate of reported 

cases of chlamydia was 3,309.4 per 100,000 females. Rates 

varied by state, with highest reported case rates in the South 

(Figure H). 

15- to 19-Year Old Women — In 2014, the chlamydia case 

rate among women aged 15–19 years was 2,941.0 cases per 

100,000 females, a 4.2% decrease from the 2013 rate of 

3,068.4 cases per 100,000 females (Table 10). Decreases in 

rates of reported cases were largest among 15-, 16-, and 17- 

year old females (Table 12).

20- to 24-Year Old Women — In 2014, women aged 

20–24 years had the highest rate of chlamydia (3,651.1 cases 

per 100,000 females) compared with any other age and sex 

group (Figure 5). The overall chlamydia case rate among 

women in this age group increased 1.6% during 2013–2014 

(Table 10). However, increases in rates of reported cases 

were largest among 23- and 24-year old females (Table 12).

15- to 19-Year Old Men — During 2013-2014, the 

chlamydia case rate for men aged 15–19 years decreased 

0.6% (722.9 to 718.3 cases per 100,000 males) (Table 10).

20- to 24-Year Old Men — In 2014, as in previous years, 

men aged 20–24 years had the highest rate of chlamydia 

among men (1,368.3 cases per 100,000 males). The 

chlamydia rate for men in this age group increased 4.4% 

during 2013–2014 (Table 10).

Gonorrhea

During 2013–2014, the rate of reported gonorrhea cases 

decreased 5.0% for persons aged 15–19 years and increased 

2.8% for persons aged 20–24 years (Table 21). Among 

women aged 15–24 years, the overall rate was 484.0 

per 100,000 females. Rates varied by state, with highest 

reported case rates in the South (Figure I).

15- to 19-Year Old Women — In 2014, women aged 15–

19 years had the second highest rate of gonorrhea (430.5 

cases per 100,000 females) compared with other females 

(Figure 17, Table 21). During 2013–2014, the gonorrhea 

rate for women in this age group decreased 7.0%.

20- to 24-Year Old Women — In 2014, women aged 20–

24 years had the highest rate of gonorrhea (533.7 cases per 

100,000 females) compared with any other age or sex group 

(Figure 17, Table 21). During 2013–2014, the gonorrhea 

rate for women in this age group decreased 0.7%.
STD Surveillance 2014 Special Focus Profiles: STDs in Adolescents and Young Adults 61

15- to 19-Year Old Men — In 2014, the gonorrhea rate 

among men aged 15–19 years was 221.1 cases per 100,000 

males (Figure 17, Table 21). During 2013–2014, the 

gonorrhea rate for men in this age group decreased 0.9%.

20- to 24-Year Old Men — In 2014, as in previous years, 

men aged 20–24 years had the highest rate of gonorrhea 

(485.6 cases per 100,000 males) compared with other males 

(Figure 17, Table 21). During 2013–2014, the gonorrhea 

rate for men in this age group increased 6.9%.

Primary and Secondary Syphilis

During 2013–2014, the rate of reported primary and 

secondary (P&S) syphilis cases increased 11.6% among 

persons aged 15–19 years and 13.1% among persons aged 

20–24 years (Table 35).

15- to 19-Year Old Women — The rate of reported P&S 

syphilis cases among women aged 15–19 years decreased 

each year during 2009–2013 (from 3.3 cases to 1.9 cases 

per 100,000 females) (Figure 38, Table 35). However, 

during 2013–2014, the rate increased 31.6%, to 2.5 cases 

per 100,000 females.

20- to 24-Year Old Women — In 2014, women aged 20–

24 years had the highest rate of P&S syphilis (4.5 cases per 

100,000 females) compared with other female age groups 

(Figure 37, Table 35). During 2013–2014, the P&S syphilis 

rate for women in this age group increased 15.4%.

15- to 19-Year Old Men — In 2014, the P&S syphilis rate 

among men aged 15–19 years was 7.0 cases per 100,000 

males (Figure 37). During 2013–2014, the P&S syphilis 

rate for men in this age group increased 7.7% (Figure 39, 

Table 35).

20- to 24-Year Old Men — In 2014, men aged 20–24 

years had the second highest rate of P&S syphilis compared 

with any other age group for either sex (Figure 37). During 

2013–2014, the P&S syphilis rate for men in this age group 

increased 13.5% (Figure 39, Table 35).

National Job Training Program

The National Job Training Program (NJTP) is 

an educational program for socioeconomically 

disadvantaged youth aged 16–24 years and is 

administered at more than 100 sites throughout the 

country. The NJTP screens participants for chlamydia 

and gonorrhea within two days of entry to the program. 

All of NJTP’s chlamydia screening tests and the majority 

of gonorrhea screening tests are conducted by a single 

national contract laboratory*, which provides these 

data to CDC. To increase the stability of the estimates, 

chlamydia or gonorrhea prevalence data are presented 

when valid test results for 100 or more students per year 

are available for the population subgroup and state. The 

2014 data were not available for inclusion in this report. 

Additional information about NJTP can be found in 

Section A2.1 in the Appendix.

Among women entering the program in 40 states, the 

District of Columbia, and Puerto Rico, the median 

state- specific chlamydia prevalence in 2013 was 11.7% 

(range: 4.1% to 19.0%) (Figure J). Among men entering 

the program in 47 states, the District of Columbia, 

and Puerto Rico, the median state-specific chlamydia 

prevalence was 7.4% (range: 1.8% to 14.6%) (Figure K).

Among women entering the program in 39 states and 

Puerto Rico, the median state-specific gonorrhea prevalence 

in 2013 was 2.1% (range: 0.0% to 5.6%) (Figure L). 

Among men entering the program in 36 states and Puerto 

Rico, the median state-specific gonorrhea prevalence was 

0.7% (range: 0.0% to 2.6%) (Figure M).

* Laboratory data are provided by the Center for Disease Detection, 

LLC San Antonio, Texas.

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

Ocfemia MC, et al. Sexually transmitted infections among US 

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

Transm Dis. 2013;40(3):187-93.

2 Forhan SE, Gottlieb SL, Sternberg MR, Xu F, Datta SD, 

McQuillan GM, et al. Prevalence of sexually transmitted infections 

among female adolescents aged 14 to 19 in the United States. 

Pediatrics. 2009;124(6):1505-12 doi: 10.1542/peds.2009-0674. 

Epub 2009 Nov 23.

3 Tilson EC, Sanchez V, Ford CL, Smurzynski M, Leone PA, Fox 

KK et al. Barriers to asymptomatic screening and other STD 

services for adolescents and young adults: focus group discussions, 

2004. BMC Public Health 2004, (4):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, Oliphant J, Pettingell S, 

Plowman S, et al. A clinic-based youth development program to 

reduce sexual risk behaviors among adolescent girls: prime time 

pilot study. Health Promot Pract. 2012;13(4):462-71.

6 Upchurch DM, Mason W, Kusunoki Y, Kriechbaum MJ. Social 

and behavioral determinants of self-reported STD among 

adolescents. Perspect Sex Reprod Health. 2004;36(6):276-287.
62 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2014

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

State, United States and Outlying Areas, 2014

NOTE: Rates for Guam and the Virgin Islands were calculated by using the 2010 population estimates (see Section A1.2 in the Appendix).

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

State, United States and Outlying Areas, 2014

NOTE: Rates for Guam and the Virgin Islands were calculated by using the 2010 population estimates (see Section A1.2 in the Appendix).

Rate per 100,000

population

Guam 182 

Puerto Rico 40 

Virgin Islands 587 

<=223

224-432

433-596

>=597

(n= 14)

(n= 13)

(n= 14)

(n= 13)

VT 39

NH 53

MA 147

RI 143

CT 259

NJ 366

DE 660

MD 467

DC 1239

840

564

423 855

314 223

472

640

213

107

633 559

249

440 495

1101

62

516

329

1017

596

167

365 387

344

333

792

440

729

812

137

484

936

526

535

604

110

526

273

247

375

99

Rate per 100,000

population

Guam 2659 

Puerto Rico 959 

Virgin Islands 5582 

<=2772

2773-3169

3170-3748

>=3749

(n= 14)

(n= 13)

(n= 14)

(n= 13)

VT 2788

NH 2004

MA 2032

RI 2808

CT 2772

NJ 2578

DE 3574

MD 3527

DC 5426

4681

5047

3335 4314

2755 3026

3360

3851

3305

2616

3919 3287

2865

3002 3081

4837

2285

3434

2750

5000

3555

3151

2836 3049

3870

3222

3915

2865

3748

4104

2866

2960

4630

3544

3581

3618

1639

3187

2697

2211

3046

2575
STD Surveillance 2014 Special Focus Profiles: STDs in Adolescents and Young Adults 63

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

Job Training Program by State of Residence, United States and Outlying Areas, 2013

Prevalence, %

Puerto Rico 10.8 

Virgin Islands 

*

<10.0

10.0-14.9

>=15.0

(n= 11)

(n= 16)

(n= 20)

(n= 6)

VT

NH

MA 5.0

RI

CT 12.1

NJ 14.8

DE 13.3

MD 12.7

DC 7.6

14.8

8.0 17.1

6.5

14.4

19.0

6.8

12.7 14.5

9.1

11.2 9.9

18.2

8.7

12.5

5.7

15.3

11.0

9.6

9.5

15.5

9.3

11.3

13.5

12.5

13.4

5.9

9.1

10.7

16.3

8.5

12.5

4.1

12.2

14.8

* Fewer than 100 women who resided in these states/areas and entered the National Job Training Program were screened for chlamydia in 2013.

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

Training Program by State of Residence, United States and Outlying Areas, 2013

Prevalence, %

Puerto Rico 5.3 

Virgin Islands 

*

<10.0

>=10.0

(n= 4)

(n= 38)

(n= 11)

VT 3.0

NH

MA 4.5

RI

CT 4.5

NJ 8.3

DE 8.3

MD 6.7

DC 8.5

11.6

3.5

4.0 14.6

4.3 4.4

7.5

11.6

5.4

4.0

12.2 8.8

7.7

10.6 8.8

13.3

4.8

11.0

2.0

10.8

8.6

6.0

2.8 7.2

8.1

6.2

10.6

5.2

10.7

8.9

2.6

7.2

10.5

1.8

7.6

9.4

3.0

7.4

3.9

5.8

7.7

* Fewer than 100 men who resided in these states/areas and entered the National Job Training Program were screened for chlamydia in 2013.
64 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2014

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

Job Training Program, by State of Residence, United States and Outlying Areas, 2013

Prevalence, %

Puerto Rico 1.1 

Virgin Islands 

*

<2.0

>=2.0

(n= 13)

(n= 19)

(n= 21)

VT

NH

MA 0.2

RI

CT 3.0

NJ 4.3

DE 1.6

MD 0.9

DC

2.6

1.3 3.0

0.5

2.0

4.4

3.0 3.6

0.9

2.7 1.7

2.8

0.9

2.2

0.0

3.6

4.2

0.6

1.8

0.0

1.2

2.8

2.4

5.6

3.2

0.4

2.1

2.5

3.1

0.0

1.2

0.0

3.4

0.5

* Fewer than 100 women who resided in these states/areas and entered the National Job Training Program were screened for gonorrhea in 2013.

NOTE: Many training centers use local laboratories to test female students for gonorrhea; these results are not available to CDC. For this map, gonorrhea

test results for students at centers that submitted specimens to the national contract laboratory were included if the numbers of gonorrhea tests 

submitted was greater than the 90% of the number of chlamydia tests submitted.

Prevalence, %

Puerto Rico 0.0 

Virgin Islands 

*

<2.0

>=2.0

(n= 16)

(n= 34)

(n= 3)

VT 0.0

NH

MA 0.0

RI

CT 0.8

NJ 0.0

DE

MD 1.0

DC

1.3

0.0

0.6 2.6

0.0

0.7

1.5

1.2

0.0

1.2

0.5

0.0

1.3

0.0

2.1

1.3

0.6

0.0 0.7

0.9

0.7

0.9

0.6

0.7

1.9

0.7

2.4

1.4

0.4

0.3

0.0

* Fewer than 100 men who resided in these states/areas and entered the National Job Training Program were screened for gonorrhea in 2013.

NOTE: Many training centers use local laboratories to test female students for gonorrhea; these results are not available to CDC. For this map, gonorrhea

test results for students at centers that submitted specimens to the national contract laboratory were included if the numbers of gonorrhea tests 

submitted was greater than the 90% of the number of chlamydia tests submitted.

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

Training Program, by State of Residence, United States and Outlying Areas, 2013
STD Surveillance 2014 Special Focus Profiles: STDs in Racial and Ethnic Minorities 65

STDs in Racial and Ethnic Minorities

Public Health Impact

Surveillance data show higher rates of reported STDs 

among some racial or ethnic minority groups when 

compared with rates among whites.1,2 Race and ethnicity 

in the United States are population characteristics that are 

correlated with other fundamental determinants of health 

status such as high rates of poverty, income inequality, 

unemployment and low educational attainment.3-5People 

who struggle financially are often experiencing life 

circumstances that potentially increase their risk for STDs.6

Those who cannot afford basic necessities may have trouble 

accessing and affording quality sexual health services.7 

The overall U.S. poverty rate in 2013 was 14.5 (or 46.7 

million) and remained the same in 2014 (the most recent 

year for which poverty statistics are available). Although 

the poverty rate did not change, many Americans continue 

to face economic challenges. For example, the poverty 

rate for whites was 10.1% (19.7 million), for blacks it was 

26.2% (or 10.8 million), and for Hispanics it was 23.6% 

(or 13.1 million).3,8 Although the overall proportion of 

adults without health insurance decreased from 13.3% in 

2013 to 10.4% (or 316 million) in 2014, many people in 

the U.S. may still not have access to health care.9 Among 

all races and ethnicities in the U.S., Hispanics had the 

lowest rate of health insurance coverage in 2014 at 80.1% 

(or 55.6 million).9,10 Non-U.S. citizens (i.e., immigrants 

or undocumented persons) may face additional barriers in 

accessing care. In 2014, 31.2% (or 7 million) of persons not 

U.S. citizens did not have health insurance coverage. 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.11 Moreover, the quality of care may differ 

substantially for minority patients.12 These 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 inequalities, individuals may have a more difficult 

time reducing their risk for infection. With each sexual 

encounter, they face a greater chance of encountering an 

infected partner than those in lower prevalence settings.2 

Acknowledging the inequity in STD rates by race or 

ethnicity is one of the first steps in empowering affected 

communities to organize and focus on this problem.

STD Reporting Practices

Surveillance data are based on cases of STDs reported to 

state and local health departments (see Section A.1 in the 

Appendix). In many state and local health jurisdictions, 

electronic laboratory reporting is increasingly a primary 

source of initial case notifications. These reports are often 

missing race and ethnicity of the patient; ascertainment 

of information on race and Hispanic ethnicity is often a 

function of active follow-up or dependent on previous 

information available about the patient in existing health 

department surveillance databases. Prevalence data from 

population-based surveys, such as 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.13, 14

Method of Classifying Race & 

Hispanic Ethnicity

Interpretation of racial and ethnic disparities among persons 

with STDs is influenced by data collection methods, and 

by the categories by which these data are displayed. Race/

ethnicity data are presented in Office of Management and 

Budget (OMB) race and ethnic categories, according to the 

1997 revised OMB standards. However, NCHS bridgedrace categories are used where OMB categories are not 

available (congenital syphilis).15 Forty-eight states collect 

and report data in formats compliant with these standards 

as of 2014. One additional jurisdiction reported cases of 

primary & secondary (P&S) syphilis by the appropriate 

standard, but did not report chlamydia and gonorrhea cases 

by this standard. Historical trend and rate data by race and 

Hispanic ethnicity displayed in figures and interpreted in 

this report for 2010–2014 include only those jurisdictions 

(43 states for chlamydia/gonorrhea and 44 states for 

syphilis) reporting in the current standard consistently for 

years 2010 through 2014. Please refer to Section A1.5 of 

the Appendix for additional information on reporting data 

for race and Hispanic ethnicity.

Completeness of Race/Ethnicity Data

Chlamydia — In 2014, 27.1% of chlamydia case 

reports were missing race or ethnicity data, ranging by 

state from 0.5% to 65.9% (Table A1).

Gonorrhea — In 2014, 19.3% of gonorrhea case reports 

were missing information on race or ethnicity, ranging by 

state from 0.0% to 64.0% (Table A1).
66 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2014

Syphilis — In 2014, 4.5% of P&S syphilis case reports 

were missing information on race or ethnicity, ranging from 

0.0% to 31.3% among states with 10 or more cases of P&S 

syphilis (Table A1).

Observations

Chlamydia

Among the 43 states that submitted data on race and 

Hispanic ethnicity for each year during 2010–2014 

according to the OMB standards, rates of reported cases of 

chlamydia increased during 2010–2014 among all racial 

and ethnic groups except among blacks (Figure 6). During 

2010–2014, chlamydia rates increased 12.6% among 

American Indians/Alaska Natives, 5.6% among Hispanics, 

11.5% among Asians, 34.5% among Native Hawaiians/

Other Pacific Islanders, and 26.9% among whites. During 

2010–2014, rates of reported cases of chlamydia decreased 

6.2% among blacks.

In 2014, 48 states submitted data on race and Hispanic 

ethnicity according to the OMB standards. The following 

data pertain to those jurisdictions:

Blacks — In 2014, the overall rate among blacks in the 

United States was 1,117.9 cases per 100,000 population 

(Table 11B). The rate of reported cases of chlamydia among 

black women was 5.7 times the rate among white women 

(1,432.6 and 253.3 per 100,000 females, respectively) 

(Table 11B and Figure N). The chlamydia rate among black 

men was 7.3 times the rate among white men (772.0 and 

105.5 cases per 100,000 males, respectively).

Rates of reported cases of chlamydia were highest for blacks 

aged 15–19 and 20–24 years in 2014 (Table 11B). The 

chlamydia rate among black females aged 15–19 years was 

6,371.5 cases per 100,000 females, which was 4.9 times the 

rate among white females in the same age group (1,291.6 

per 100,000 females). The rate among black women aged 

20–24 years was 4.1 times the rate among white women in 

the same age group (Table 11B).

Similar racial disparities in reported chlamydia rates 

exist among men. Among males aged 15–19 years, the 

rate among blacks was nine times the rate among whites 

(Table 11B). The chlamydia rate among black men aged 

20–24 years was 5.4 times the rate among white men 

of the same age group (3,241.2 and 603.5 cases per 

100,000 males, respectively).

American Indians/Alaska Natives — In 2014, the 

chlamydia rate among American Indians/Alaska Natives was 

668.8 cases per 100,000 population (Table 11B). Overall, the 

rate of chlamydia among American Indians/Alaska Natives in 

the United States was 3.7 times the rate among whites.

Native Hawaiians/Other Pacific Islanders — In 2014, 

the chlamydia rate among Native Hawaiians/Other Pacific 

Islanders was 625.1 cases per 100,000 population (Table 

11B). The overall rate among Native Hawaiians/Other 

Pacific Islanders was 5.6 times the rate among whites and 

3.5 times the rate among Asians.

Hispanics — In 2014, the chlamydia rate among Hispanics 

was 380.6 cases per 100,000 population (Table 11B) which 

is 2.1 times the rate among whites.

Asians — In 2014, the chlamydia rate among Asians was 

112.0 cases per 100,000 population (Table 11B). The overall 

rate among whites is 1.6 times the rate among Asians.

Gonorrhea

During 2010–2014, among the 43 states that submitted 

data for each year according to the OMB standards, rates 

of reported gonorrhea cases increased 100.4% among 

American Indians/Alaska Natives (84.7 to 169.7 per 

100,000 population), 59.8% among whites (25.1 to 40.1 

per 100,000), 51.1% among Hispanics (49.1 to 74.2 per 

100,000), 44.8% among Asians (14.3 to 20.7 per 100,000), 

and 44.1% among Native Hawaiians/Other Pacific 

Islanders (74.3 to 107.1 per 100,000) (Figure 20). The 

gonorrhea rate decreased 8.2% among blacks (466.4 to 

428.1 per 100,000).

In 2014, 48 states submitted data in race and ethnicity 

categories according to the OMB standards. The 

following data pertain to those jurisdictions:

Blacks — In 2014, 55.4% of reported gonorrhea cases with 

known race/ethnicity occurred among blacks (excluding 

cases with missing information on race or ethnicity, and 

cases whose reported race or ethnicity was other) (Table 

22A). The rate of gonorrhea among blacks in 2014 was 

405.4 cases per 100,000 population, which was 10.6 times 

the rate among whites (38.3 per 100,000) (Table 22B). 

Although the calculated rate ratio for 2014 differs when 

considering the 43 jurisdictions that submitted data in race 

and ethnic categories according to the OMB standards for 

each year during 2010–2014, this disparity has decreased 

slightly in recent years (Figure O). In 2014, this disparity was 

similar for black men (10.6 times the rate among white men) and 

black women (10.7 times the rate among white women) (Figure 

P, Table 22B).

As in previous years, the disparity in gonorrhea rates for 

blacks in 2014 was larger in the Midwest and Northeast 

than in the West or the South (Figure Q).

Considering all racial/ethnic and age categories, gonorrhea 

rates were highest for blacks aged 20–24, 15–19, and 25–

29 years in 2014 (Table 22B). Black women aged 20–24 

had a gonorrhea rate of 1,799.9 cases per 100,000 women. 
STD Surveillance 2014 Special Focus Profiles: STDs in Racial and Ethnic Minorities 67

This rate was 9.5 times the rate among white women in 

the same age group (188.7 per 100,000). Black women 

aged 15–19 years had a gonorrhea rate of 1,541.0 cases per 

100,000 women, which was 12.7 times the rate among 

white women in the same age group (121.3 per 100,000).

Black men aged 20–24 years had a gonorrhea rate of 1,670.4 

cases per 100,000 men, which was 10.7 times the rate among 

white men in the same age group (155.4 per 100,000). Black 

men aged 25–29 years had a gonorrhea rate of 1,291.6 cases 

per 100,000 men, which was 8.9 times the rate among white 

men in the same age group (145.5 per 100,000).

American Indians/Alaska Natives — In 2014, the 

gonorrhea rate among American Indians/Alaska Natives 

was 159.4 cases per 100,000 population, which was 4.2 

times the rate among whites (Table 22B). The disparity 

between gonorrhea rates for American Indians/Alaska 

Natives and whites was larger for American Indian/Alaska 

Native women (5.6 times the rate among white women) 

than for American Indian/Alaska Native men (2.9 times 

the rate among white men) (Figure P, Table 22 B). The 

disparity in gonorrhea rates for American Indians/Alaska 

Natives in 2014 was larger in the Midwest than in the 

West, Northeast, and South (Figure Q).

Native Hawaiians/Other Pacific Islanders — In 2014, 

the gonorrhea rate among Native Hawaiians/Other Pacific 

Islanders was 102.1 cases per 100,00 population, which 

was 2.7 times the rate among whites (Table 22B). The 

disparity between gonorrhea rates for Native Hawaiians/

Other Pacific Islanders and whites was the similar for 

Native Hawaiian/Other Pacific Islander women (2.9 times 

the rate among white women) and Native Hawaiian/Other 

Pacific Islander men (2.4 times the rate among white men) 

(Figure P, Table 22B). The disparity in gonorrhea rates for 

Native Hawaiians/Other Pacific Islanders in 2014 was 

lower in the West than in the Midwest, Northeast, and

South (Figure Q).

Hispanics — In 2014, the gonorrhea rate among Hispanics 

was 73.3 cases per 100,000 population, which was 1.9 

times the rate among whites (Table 22B). This disparity 

was similar for Hispanic women (1.8 times the rate among 

white women) and Hispanic men (2.0 times the rate 

among white men) (Figure P, Table 22B). The disparity in 

gonorrhea rates for Hispanics was highest in the Northeast 

and lowest in the West and Midwest (Figure Q).

Asians — In 2014, the gonorrhea rate among Asians 

was 19.3 cases per 100,000 population, which was lower 

than (0.5 times) the rate among whites (Table 22B). This 

difference is larger for Asian women than for Asian men 

(Figure P, Table 22B). In 2014, rates among Asians were 

lower than rates among whites in all four regions of the 

United States (Figure Q).

Primary and Secondary (P&S) Syphilis

During 2010–2014, 44 states submitted syphilis data for 

each year according to the OMB standards. Among these 

states during 2010–2014, rates of reported P&S syphilis 

cases increased 152.6% among American Indians/Alaska 

Natives (3.1 to 7.9 per 100,000 population), 135.2% among 

Asians (1.2 to 2.9 per 100,000), 80.2% among Hispanics 

(4.2 to 7.5 per 100,000 population), 56.7% among whites 

(2.2 to 3.5 per 100,000), 38.2% among Native Hawaiians/

Other Pacific Islanders (5.1 to 7.1 per 100,000), and 7.8% 

among blacks (17.8 to 19.2 per 100,000) (Figure 40).

In 2014, 49 states submitted syphilis data by race and 

ethnicity according to the OMB standards. The following 

data pertain to those jurisdictions:

Blacks — In 2014, 38.1% of reported P&S syphilis 

cases with known race/ethnicity occurred among blacks 

(excluding cases with missing information on race or 

ethnicity, and cases whose reported race or ethnicity was 

other) (Table 36A). The P&S syphilis rate among blacks in 

2014 was 18.9 cases per 100,000 population, which was 

5.4 times the rate among whites (3.5 per 100,000) (Table 

36B). This disparity was higher for black women (9.2 times 

the rate among white women) than for black men (5.3 times 

the rate among white men) (Figure R, Table 36B).

Considering all race/ethnicity, sex, and age categories, 

P&S syphilis rates were highest among black men aged 

20–24 years and 25–29 years in 2014 (Table 36B). 

Black men aged 20–24 years had a P&S syphilis rate of 

106.3 cases per 100,000 men. This rate was 8.5 times 

the rate among white men in the same age group (12.5 

per 100,000). Black men aged 25–29 years had a P&S 

syphilis rate of 121.3 cases per 100,000 men, which was 

7.9 times the rate among white men in the same age 

group (15.4 per 100,000).

American Indians/Alaska Natives — In 2014, the P&S 

syphilis rate among American Indians/Alaska Natives was 

7.6 cases per 100,000 population, 2.2 times the rate among 

whites (Table 36B). This disparity was larger for American 

Indian/Alaska Native women (9.6 times the rate among 

white women) than for American Indian/Alaska Native 

men (1.6 times the rate among white men).

Native Hawaiians/Other Pacific Islanders — In 2014, the 

P&S syphilis rate among Native Hawaiians/Other Pacific 

Islanders was 6.5 cases per 100,000 population, which was 

1.9 times the rate among whites (Table 36B). This disparity 

was similar for Native Hawaiian/Other Pacific Islander 

women (1.6 times the rate among white women) and 

Native Hawaiian/Other Pacific Islander men (1.8 times the 

rate among white men).
68 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2014

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African American Communities. Sex Transm Dis. 2008;35(12):S4-

S12.

2 Hogben M, Leichliter JS. Social determinants and sexually 

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Washington, DC, 2015.

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Disparities and Inequalities Report - United States 2013 MMWR 

Morb Mortal Wkly. Rep. 2013;62(Suppl 3).

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prevalence of sexually transmitted diseases in the United States: a 

network explanation. Sex Transm Dis. 1999;26(5):250-61.

7 Institute of Medicine. The Hidden Epidemic: Confronting 

Sexually Transmitted Diseases. Washington, DC: National 

Academy Press; 1997.

8 Bureau of Labor Statistics Report, August 2014 http://www.bls.gov.

Hispanics — In 2014, the P&S syphilis rate among 

Hispanics was 7.6 cases per 100,000 population, which was 

2.2 times the rate among whites (Table 36B). This disparity 

was similar for Hispanic women (2.2 times the rate among 

white women) and Hispanic men (2.1 times the rate among 

white men).

Asians — In 2014, the P&S syphilis rate among Asians was 

2.8 cases per 100,000 population, which was 0.8 times the 

rate among whites (Table 36B). This difference is larger for 

Asian women (0.4 times the rate among white women) than 

for Asian men (0.9 times the rate among white men).

Congenital Syphilis

Race/ethnicity for cases of congenital syphilis is based 

on the mother’s race/ethnicity. During 2013–2014, rates 

of reported congenital syphilis cases increased 102.9% 

among Asians/Pacific Islanders, 32.1% among whites, 

21.7% among blacks, and 19.8% among Hispanics (Table 

43, Figure U). The congenital syphilis rate did not change 

among American Indians/Alaska Natives.

In 2014, 50.6% of congenital syphilis cases with known 

race/ethnicity occurred among blacks (excluding cases with 

missing information on race or ethnicity, and cases whose 

reported race or ethnicity was other) (Table 43). The rate 

of congenital syphilis among blacks in 2014 was 38.2 cases 

per 100,000 live births, which was 10.3 times the rate 

among whites (3.7 per 100,000 live births). The rate of 

congenital syphilis was 12.7 cases per 100,000 live births 

among American Indians/Alaska Natives (3.4 times the rate 

among whites), 12.1 cases per 100,000 live births among 

Hispanics (3.3 times the rate among whites), and 6.9 cases 

per 100,000 births among Asians/Pacific Islanders (1.9 

times the rate among whites).

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 Smith, Jessica C and Carla Medalia, U.S. Census Bureau, 

Current Population Reports, P60-253, Health Insurance Coverage 

in the United States: 2014, U.S. Government Printing Office, 

Washington, DC, 2015.

11 Berk ML, Schur CL. The effect of fear on access to care 

among undocumented Latino immigrants. J Immigr Health. 

2001;3(3):151-156.

12 Institute of Medicine. Unequal Treatment: Confronting Racial 

and Ethnic Disparities in Health Care. Washington, DC: National 

Academies Press; 2002.

13 Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, 

McQuillan G, et al. Gonorrhea and chlamydia in the United 

States among persons 14 to 39 years of age, 1999 to 2002. Ann 

Intern Med. 2007;147(2):89-96.

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

Hobbs MM, et al. Prevalence of chlamydial and gonococcal 

infections among young adults in the United States. JAMA. 

2004;291(18):2229-36.

15 Office of Management and Budget. Provisional guidance on the 

implementation of the 1997 standards for federal data on race 

and ethnicity. 1999. [Accessed July 29, 2013]. Available at: http:// 

www.whitehouse.gov/omb/fedreg_1997standards/.
STD Surveillance 2014 Special Focus Profiles: STDs in Racial and Ethnic Minorities 69

Figure O. Gonorrhea — Rate Ratios* by Race/Ethnicity, United States, 2010–2014

* Rate ratios are calculated as the rate of reported gonorrhea cases per 100,000 population for a given racial or ethnic minority population divided by the 

rate of reported gonorrhea cases per 100,000 population for non-Hispanic whites. Any population with a lower rate of reported cases of gonorrhea than 

the non-Hispanic white population will have a rate ratio of less than 1:1.

†

 Y-axis is log scale. ‡ AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacic Islanders.

NOTE: Includes 43 states reporting race/ethnicity data in Oce of Management and Budget compliant formats during 2010–2014 (see Section A1. 5 in

the Appendix).

1:4

1:2

1:1

2:1

4:1

8:1

16:1

32:1

Year

2010 2011 2012 2013 2014

Rate Ratio†

‡

‡

AI/AN

Asians

Blacks

Hispanics

NHOPI

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

2014

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

NOTE: Includes 48 states reporting race/ethnicity data in Oce of Management and Budget compliant formats in 2014 (see Section A1.5 in the

Appendix).

Men Rate (per 100,000 population) Women

Race/Ethnicity

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

303.0 1 AI/AN* 022.9

67.9 Asians 151.6

772.0 Blacks 1432.6

207.1 5 Hispanics 59.0

284.5 NHOPI* 970.8

105.5 2 Whites 53.3

80.9 Multirace 174.1

278.4 6 Total 27.2
70 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2014

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

United States, 2014

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

NOTE: Includes 48 states reporting race/ethnicity data in Oce of Management and Budget compliant formats in 2014 (see Section A1.5 in the

Appendix).

Men Rate (per 100,000 population) Women

Race/Ethnicity

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

120.9 1 AI/AN* 96.5

28.0 Asians 11.3

440.1 3 Blacks 73.3

84.1 6 Hispanics 1.9

100.5 1 NHOPI* 02.9

41.7 Whites 34.9

54.3 4 Multirace 1.4

120.1 1 Total 01.3

Figure Q. Gonorrhea — Rate Ratios* by Race/Ethnicity and Region, United States, 2014

* Rate ratios are calculated as the rate of reported gonorrhea cases per 100,000 population for a given racial or ethnic minority population divided by the 

rate of reported gonorrhea cases per 100,000 population for non-Hispanic whites. Any population with a lower rate of reported cases of gonorrhea than 

the non-Hispanic white population will have a rate ratio of less than 1:1.

†

 Y-axis is log scale. ‡

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

NOTE: Includes 48 states reporting race/ethnicity data in Oce of Management and Budget compliant formats in 2014 (see Section A1.5 in the Appendix).

Rate Ratio†

‡

West

Midwest

Northeast

South

1:4

1:2

1:1

2:1

4:1

8:1

16:1

32:1

AI/AN Asians Blacks Hispanics NHOPI ‡
STD Surveillance 2014 Special Focus Profiles: STDs in Racial and Ethnic Minorities 71

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

Sex, United States, 2014

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

NOTE: Includes 49 states reporting race/ethnicity data in Oce of Management and Budget compliant formats in 2014 (see Section A1.5 in the Appendix).

Men Rate (per 100,000 population) Women

Race/Ethnicity

40 32 24 16 8 0 0 8 16 24 32 40

10.5 AI/AN* 4.8

5.6 0 Asians .2

34.5 4 Blacks .6

13.9 Hispanics 1.1

12.0 NHOPI* 0.8

6.5 0 Whites .5

9.5 0 Multirace .5

11.7 Total 1.1

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

15–19 Years by Race/Ethnicity, United States, 2010–2014

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

NOTE: Includes 44 states reporting race/ethnicity data in Oce of Management and Budget compliant formats during 2010–2014 

(see Section A1.5 in the Appendix).

 0

 4

 8

 12

 16

 20

Year

2010 2011 2012 2013 2014

Rate (per 100,000 population)

AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace
72 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2014

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

Aged 15–19 Years, by Race/Ethnicity, United States, 2010–2014

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

NOTE: Includes 44 states reporting race/ethnicity data in Oce of Management and Budget compliant formats during 2010–2014 

(see Section A1.5 in the Appendix).

 0

 10

 20

 30

 40

 50

Year

2010 2011 2012 2013 2014

Rate (per 100,000 population)

AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

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

and Mother’s Race/Ethnicity, United States, 2005–2014

* AI/AN = American Indians/Alaska Natives.

NOTE: National Center for Health Statistics bridged race categories are presented to allow the display of data across several years. Cases missing

maternal race/ethnicity information were excluded (< 1% of cases).

 0

 10

 20

 30

 40

 50

Year

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rate (per 100,000 live births)

AI/AN*

Asians/Pacic Islanders

Blacks

Hispanics

Whites
STD Surveillance 2014 Special Focus Profiles: STDs in Men Who Have Sex with Men 73

STDs in Men Who Have Sex with Men

Public Health Impact

Gay, bisexual, and other men who have sex with men 

(MSM) are at increased risk for STDs, including emergence 

of antimicrobial resistance when compared to women and 

exclusively heterosexual men.1–4 Because STDs, and the 

behaviors associated with acquiring them, increase the 

likelihood of acquiring and transmitting HIV infection,

STD incidence among MSM may also be an indicator of 

higher risk for subsequent HIV infection.5, 6

Population-level factors such as limited or overlapping 

social and sexual networks are associated with higher rates 

of STDs, including HIV among MSM.7 Additionally, 

individual-level risk behaviors, such as number of lifetime 

sex partners, rate of partner exchange and frequency of 

unprotected sex, may contribute to rates of STDs.

MSM of lower economic status may be particularly 

vulnerable to poor health outcomes, especially if they belong 

to racial and ethnic minority populations.8, 9 Among black 

MSM, factors such as community isolation and limited 

social support may influence sexual risk-taking. Similarly, 

for Hispanic men, the relationship between individual 

experiences of oppression (e.g., social discrimination 

and financial hardship) and risk for sexually transmitted 

infections in the United States has been documented.10

With the exception of reported syphilis cases, most 

nationally notifiable STD surveillance data do not include 

information on sexual behaviors; therefore, trends in STDs 

among MSM in the United States are based on findings 

from sentinel surveillance systems. Testing strategies are also 

evolving to include more extragenital 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.11 Data 

from sentinel surveillance projects are presented in this 

section to provide information on STDs in MSM.

STD Surveillance Network (SSuN) — 

Monitoring Trends in Prevalence of 

STDs Among MSM Who Visit STD 

Clinics, 2014

The STD Surveillance Network (SSuN), established 

in 2005, is an ongoing collaboration of states and 

independently funded cities collecting enhanced clinical 

and behavioral information among patients attending 

participating SSuN STD clinics.12 Data for 2014 were 

obtained from 6 jurisdictions (including 26 STD clinics) 

continuously participating in SSuN since 2008. For data 

reported in this section, 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. Additional information about SSuN 

can be found in Section A2.2 of the Appendix. 

Gonorrhea and Chlamydial Infection

In 2014, the proportion of MSM who tested positive for 

gonorrhea and chlamydia at STD clinics varied by SSuN 

site (Figure V). A larger proportion of MSM who visited 

STD clinics tested positive for gonorrhea than tested 

positive for chlamydia.

Across the participating STD clinics, 18,568 MSM were 

tested for gonorrhea and 18,414 MSM were tested for 

chlamydia. The median site-specific gonorrhea prevalence 

among those tested was 19.2% (range by site: 14.5%–

25.3%). The median site-specific chlamydia prevalence 

among those tested was 14.9% (range by site: 7.0%–

17.9%). For this report, a person who tested positive for 

gonorrhea or chlamydia more than one time in a year was 

counted only once for each infection.

Co-infection of Primary and Secondary 

(P&S) Syphilis and HIV

Among MSM who presented to participating STD clinics 

with P&S syphilis infection in 2014, the proportion who 

were also infected with HIV ranged from 9.1% in Los 

Angeles to 53.2% in Baltimore (Figure W). The median 

site-specific proportion of MSM co-infected with HIV 

(41.9%) was similar to the proportion of co-infection in 

MSM observed in 2014 case report data (51.6%). P&S 

syphilis was identified by provider diagnosis, and HIV 

status was identified by laboratory report, self-report, or 

provider diagnosis.

HIV status and STDs

Among MSM visiting SSuN STD clinics, prevalence of 

STDs was higher among MSM living with HIV than 

among HIV-negative MSM (Figure X). The prevalence 

of P&S syphilis was 10.4% among MSM living with 

HIV and 3.5% among HIV-negative MSM. Among 

MSM living with HIV, urethral gonorrhea positivity 
74 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2014

was 11.4%, pharyngeal gonorrhea positivity was 6.7%, 

and rectal gonorrhea positivity was 12.4% (compared 

to 8.6%, 7.4%, and 5.5%, respectively, among HIVnegative MSM). Among MSM living with HIV, urethral 

chlamydia positivity was 6.1% and rectal chlamydia 

positivity was 12.1% (compared to 5.7% and 7.5%, 

respectively, among HIV-negative MSM).

Nationally Notifiable Syphilis 

Surveillance Data

The number of reported cases of P&S syphilis among MSM 

has been increasing since at least 2000.3,14 Twenty-seven 

states reported sex of sex partner data for at least 70% of 

all cases of P&S syphilis each year during 2007–2014. 

Among these states, cases among MSM increased 8.8% 

during 2013–2014, and 47.9% during 2010–2014 (Figure 

32). In 2014, MSM accounted for 82.9% of all male P&S 

syphilis cases with known information about sex of sex 

partners (Figure 41), and MSM accounted for more cases 

than MSW or women in all racial and ethnic groups (Figure 

42). More information about syphilis can be found in the 

Syphilis section of the National Profile.

Gonococcal Isolate Surveillance Project 

(GISP)

GISP is a national sentinel surveillance system designed 

to monitor trends in antimicrobial susceptibilities of N. 

gonorrhoeae strains in the United States.15 Overall, the 

proportion of isolates from MSM in selected STD clinics 

from GISP sentinel sites has increased steadily, from 

4.6% in 1990 to 37.1% in 2014 (Figure Y). The reason 

for this increase 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.4 During 2007–2014, the prevalence of elevated 

ceftriaxone MICs (≥0.125 μg/ml) was higher in isolates 

from MSM than from MSW (Figure Z).

More information on GISP can be found in the Gonorrhea 

section of the National Profile.

1 Brewer TH, Schillinger J, Lewis FM, Blank S, Pathela P, Jordahl L, 

et al. Infectious syphilis among adolescent and young adult men: 

implications for human immunodeficiency virus transmission and 

public health interventions. Sex Transm Dis. 2011;38(5):367-71.

2 Centers for Disease Control and Prevention. Trends in HIV/AIDS 

diagnoses among men who have sex with men — 33 States, 2000–

2006. MMWR Morb Mortal Wkly Rep. 2008; 57:681–686.

3 Su JR, Beltrami JF, Zaidi AA, Weinstock HS. Primary and 

secondary syphilis among black and Hispanic men who have sex 

with men: case report data from 27 States. Ann Intern Med. 2011; 

155(3):145-51.

4 Kirkcaldy RD, Zaidi A, Hook EW 3rd, Holmes KK, Soge O, del 

Rio C, et al. Neisseria gonorrhoeae antimicrobial resistance among 

men who have sex with men and men who have sex exclusively 

with women: The Gonococcal Isolate Surveillance Project, 

2005–2010. Ann Intern Med. 2013; 158(5 Pt 1):321–8.

5 Fleming DT, Wasserheit JN. From epidemiologic synergy to public 

health policy and practice: the contribution of other sexually 

transmitted diseases to sexual transmission of HIV infection. Sex 

Transm Infect. 1999;75:3-17.

6 Hall HI, Song R, Rhodes P, Prejean J, An Q, Lee LM, et al, for the 

HIV Incidence Surveillance Group. Estimation of HIV incidence 

in the United States. JAMA. 2008;6;300(5):520-9.

7 Koblin BA, Husnik MJ, Marla JB, Colfax GC, Huang Y, Madison 

ME, et al. Risk factors for HIV infection among men who have

sex with men. AIDS. 2006;20(5):731-739.

8 Alvy LM , McKirnan DJ, Du Bois SN , Jones K, Ritchie N, 

Fingerhut D. Health Care Disparities and Behavioral Health 

Among Men Who Have Sex with Men. J Gay Lesbian Soc Serv. 

2011;23(4): 507-522.

9 McKirnan DJ, Du Bois SN, Alvy LM, Jones K. Health Care 

Access and Health Behaviors Among Men Who Have Sex 

With Men: The Cost of Health Disparities. Health Educ Behav. 

2013;40(1):32-41.

10 Díaz RM, Ayala G, Bein E. Sexual risk as an outcome of social 

oppression: data from a probability sample of Latino gay men 

in three U.S. cities. Cultur Divers Ethnic Minor Psychol. 

2004;10(3):255-267.

11 Patton ME, Kidd S, Llata E, Stenger M, Braxton J, et al. 

Extragenital gonorrhea and chlamydia testing and infection among 

men who have sex with men--STD Surveillance Network, United 

States, 2010-2012. Clin Infect Dis. 2014;58(11):1564-70.

12 Rietmeijer K, Donnelly J, Bernstein K, Bissette J, Martins S, 

Pathela P, et al. Here comes the SSuN—early experiences with the 

STD Surveillance Network. Pub Health Rep. 2009;124(Suppl 

2):72-77.

13 Centers for Disease Control and Prevention. Sexually Transmitted 

Disease Surveillance 2011. Atlanta: U.S. Department of Health 

and Human Services; 2012.

14 Heffelfinger JD, Swint EB, Berman SM, Weinstock HS. Trends 

in primary and secondary syphilis among men who have sex 

with men in the United States. Am J Public Health. 2007 

Jun;97(6):1076-83.

15 Schwarcz S, Zenilman J, Schnell D, Knapp JS, Hook EW III, 

Thompson S, et al. National surveillance of antimicrobial resistance 

in Neisseria gonorrhoeae. JAMA. 1990;264(11):1413-7.
STD Surveillance 2014 Special Focus Profiles: STDs in Men Who Have Sex with Men 75

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

Positive for Gonorrhea and Chlamydia, STD Surveillance Network (SSuN), 2014

* Among men who have who sex with men who were tested for gonorrhea and/or chlamydia.

NOTE: Includes the six jurisdictions (Baltimore, Los Angeles, New York City, Philadelphia, San Francisco and Seattle) that contributed data

for all of 2014.

Percentage

Gonorrhea

Chlamydia

 0

 7

 14

 21

 28

 35

Seattle San

Francisco

Los

Angeles

Baltimore Philadelphia New York

City

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

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

Surveillance Network (SSuN), 2014

* MSM = men who have sex with men.

NOTE: Includes the six jurisdictions (Baltimore, Los Angeles, New York City, Philadelphia, San Francisco and Seattle) that contributed data

for all of 2014.

Percentage

 0

 20

 40

 60

 80

100

Seattle San

Francisco

Los

Angeles

Baltimore   Philadelphia New York

City
76 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2014

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

Gonorrhea or Chlamydia by HIV Status†, STD Surveillance Network (SSuN), 2014

* MSM = men who have sex with men; P&S = primary and secondary syphilis; GC = gonorrhea; CT = chlamydia. †

 Excludes all persons for whom there was no laboratory documentation or self-report of HIV status. ‡

 GC urethral and CT urethral include results from both urethral and urine specimens.

NOTE: Includes the six jurisdictions (Baltimore, Los Angeles, New York City, Philadelphia, San Francisco and Seattle) that contributed data for all of 2014.

Percentage

‡

HIVHIV+

 0

 4

 8

 12

 16

 20

P&S 

syphilis

GC 

urethral

GC 

pharyngeal

GC

rectal

CT

urethral

CT

rectal ‡

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

Attending STD Clinics, Gonococcal Isolate Surveillance Project (GISP), 1990–2014 

* MSM = men who have sex with men.

 0

 8

 16

 24

 32

 40

Year

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

Percentage
STD Surveillance 2014 Special Focus Profiles: STDs in Men Who Have Sex with Men 77

Figure Z. Neisseria gonorrhoeae — Percentage of Urethral Isolates with Elevated Ceftriaxone Minimum Inhibitory Concentrations (MICs) (≥0.125 μg/ml) by Reported Sex 

of Sex Partner, Gonococcal Isolate Surveillance Project (GISP), 2007–2014

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

Percentage

MSM

MSW

0.0

0.5

1.0

1.5

2.0

2007 2008 2009 2010 2011 2012 2013 2014

*

*
78 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2014
TABLES
TABLES
STD Surveillance 2014 National Summary Tables 79

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

100,000 Population, United States, 1941–2014

Syphilis

Year*

All Stages†

Primary and 

Secondary Early Latent

Late and Late 

Latent‡ Congenital Chlamydia Gonorrhea Chancroid

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

1941 485,560 368.2 68,231 51.7 109,018 82.6 202,984 153.9 17,600 651.1 NR — 193,468 146.7 3,384 2.5

1942 479,601 363.4 75,312 57.0 116,245 88.0 202,064 153.1 16,918 566.0 NR — 212,403 160.9 5,477 4.1

1943 575,593 447.0 82,204 63.8 149,390 116.0 251,958 195.7 16,164 520.7 NR — 275,070 213.6 8,354 6.4

1944 467,755 367.9 78,443 61.6 123,038 96.7 202,848 159.6 13,578 462.0 NR — 300,676 236.5 7,878 6.1

1945 359,114 282.3 77,007 60.5 101,719 79.9 142,187 111.8 12,339 431.7 NR — 287,181 225.8 5,515 4.3

1946 363,647 271.7 94,957 70.9 107,924 80.6 125,248 93.6 12,106 354.9 NR — 368,020 275.0 7,091 5.2

1947 355,592 252.3 93,545 66.4 104,124 73.9 122,089 86.6 12,200 319.6 NR — 380,666 270.0 9,515 6.7

1948 314,313 218.2 68,174 47.3 90,598 62.9 123,312 85.6 13,931 383.0 NR — 345,501 239.8 7,661 5.3

1949 256,463 175.3 41,942 28.7 75,045 51.3 116,397 79.5 13,952 382.4 NR — 317,950 217.3 6,707 4.6

1950 217,558 146.0 23,939 16.7 59,256 39.7 113,569 70.2 13,377 368.3 NR — 286,746 192.5 4,977 3.3

1951 174,924 116.1 14,485 9.6 43,316 28.7 98,311 65.2 11,094 290.4 NR — 254,470 168.9 4,233 2.8

1952 167,762 110.2 10,449 6.9 36,454 24.0 105,238 69.1 8,553 218.8 NR — 244,957 160.8 3,738 2.5

1953 148,573 95.9 8,637 5.6 28,295 18.3 98,870 63.8 7,675 193.9 NR — 238,340 153.9 3,338 2.2

1954 130,697 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

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
80 National Summary Tables STD Surveillance 2014

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

100,000 Population, United States, 1941–2014 (continued)

Syphilis

Year*

All Stages†

Primary and 

Secondary Early Latent

Late and Late 

Latent‡ Congenital Chlamydia Gonorrhea Chancroid

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

1990 135,590 54.3 50,578 20.3 55,397 22.2 25,750 10.3 3,865 92.9 323,663 160.2 690,042 276.4 4,212 1.7

1991 128,719 50.9 42,950 17.0 53,855 21.3 27,490 10.9 4,424 107.6 381,228 179.7 621,918 245.8 3,476 1.4

1992 114,730 44.7 34,009 13.3 49,929 19.5 26,725 10.4 4,067 100.0 409,694 182.3 502,858 196.0 1,906 0.7

1993 102,612 39.5 26,527 10.2 41,919 16.1 30,746 11.8 3,420 85.5 405,332 178.0 444,649 171.1 1,292 0.5

1994 82,713 31.4 20,641 7.8 32,017 12.2 27,603 10.5 2,452 62.0 451,785 192.5 419,602 163.9 782 0.3

1995 69,359 26.0 16,543 6.2 26,657 10.0 24,296 9.1 1,863 47.8 478,577 187.8 392,651 147.5 607 0.2

1996 53,240 19.8 11,405 4.2 20,187 7.5 20,366 7.6 1,282 32.9 492,631 190.6 328,169 121.8 386 0.1

1997 46,716 17.1 8,556 3.1 16,631 6.1 20,447 7.5 1,082 27.9 537,904 205.5 327,665 120.2 246 0.1

1998 38,289 13.9 7,007 2.5 12,696 4.6 17,743 6.4 843 21.4 614,250 231.8 356,492 129.2 189 0.1

1999 35,386 12.7 6,617 2.4 11,534 4.1 16,655 6.0 580 14.6 662,647 247.2 360,813 129.3 110 0.0

2000 31,618 11.2 5,979 2.1 9,465 3.4 15,594 5.5 580 14.3 709,452 251.4 363,136 128.7 78 0.0

2001 32,286 11.3 6,103 2.1 8,701 3.0 16,976 5.9 506 12.6 783,242 274.5 361,705 126.8 38 0.0

2002 32,919 11.4 6,862 2.4 8,429 2.9 17,168 6.0 460 11.4 834,555 289.4 351,852 122.0 48 0.0

2003 34,289 11.8 7,177 2.5 8,361 2.9 18,319 6.3 432 10.6 877,478 301.7 335,104 115.2 54 0.0

2004 33,423 11.4 7,980 2.7 7,768 2.6 17,300 5.9 375 9.1 929,462 316.5 330,132 112.4 30 0.0

2005 33,288 11.2 8,724 2.9 8,176 2.8 16,049 5.4 339 8.2 976,445 329.4 339,593 114.6 17 0.0

2006 36,958 12.3 9,756 3.3 9,186 3.1 17,644 5.9 372 8.7 1,030,911 344.3 358,366 119.7 19 0.0

2007 40,925 13.6 11,466 3.8 10,768 3.6 18,256 6.1 435 10.1 1,108,374 367.5 355,991 118.0 23 0.0

2008 46,292 15.2 13,500 4.4 12,401 4.1 19,945 6.6 446 10.5 1,210,523 398.1 336,742 110.7 25 0.0

2009 44,832 14.6 13,997 4.6 13,066 4.3 17,338 5.6 431 10.4 1,244,180 405.3 301,174 98.1 28 0.0

2010 45,844 14.8 13,774 4.5 13,604 4.4 18,079 5.9 387 9.7 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 56,482 17.9 17,375 5.5 16,929 5.4 21,819 6.9 359 9.1 1,401,906 443.5 333,004 105.3 10 0.0

2014 63,450 20.1 19,999 6.3 19,452 6.2 23,541 7.4 458 11.6 1,441,789 456.1 350,062 110.7 6 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 10, 2015. 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.
STD Surveillance 2014 Chlamydia Tables 81

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

United States, 2014

Rank* State Cases Rate per 100,000 Population

1 Alaska 5,789 787.5

2 Mississippi 19,605 655.4

3 Louisiana 28,955 626.0

4 Alabama 29,010 600.2

5 South Carolina 28,087 588.2

6 New Mexico 11,558 554.3

7 Oklahoma 20,662 536.6

8 Arkansas 15,605 527.3

9 Georgia 51,945 519.9

10 Illinois 66,536 516.5

11 New York 98,814 502.8

12 Texas 131,219 496.1

13 South Dakota 4,166 493.1

14 Arizona 32,397 488.9

15 Delaware 4,473 483.2

16 North Carolina 47,147 478.7

17 North Dakota 3,451 477.1

18 Ohio 54,858 474.1

19 Tennessee 30,793 474.0

20 Missouri 27,981 462.9

21 Maryland 27,424 462.6

22 California 176,308 459.9

23 Hawaii 6,419 457.2

U.S. TOTAL† 1,441,789 456.1

24 Michigan 44,256 447.2

25 Virginia 36,048 436.4

26 Indiana 28,519 434.0

27 Florida 84,194 430.6

28 Nevada 11,841 424.4

29 Colorado 21,863 415.0

30 Rhode Island 4,349 413.6

31 Montana 4,193 413.0

32 Wisconsin 23,154 403.2

33 Kentucky 17,664 401.9

34 Nebraska 7,499 401.3

35 Pennsylvania 50,536 395.6

36 Oregon 15,508 394.6

37 Kansas 11,116 384.1

38 Iowa 11,804 382.0

39 Washington 26,577 381.2

40 Connecticut 13,382 372.1

41 Minnesota 19,907 367.3

42 Vermont 2,237 357.0

43 Wyoming 1,972 338.4

44 Idaho 5,442 337.6

45 New Jersey 29,904 336.0

46 Massachusetts 21,271 317.8

47 Utah 8,223 283.5

48 New Hampshire 3,586 271.0

49 Maine 3,530 265.8

50 West Virginia 4,719 254.5

* 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 5,293 cases and a rate of 818.8, but excludes outlying areas (Guam with 839 cases and rate of 

523.1, Puerto Rico with 4,899 cases and rate of 135.5, and Virgin Islands with 791 cases and rate of 755.2).
82 Chlamydia Tables STD Surveillance 2014

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

Alphabetical Order, United States and Outlying Areas, 2010–2014

Cases Rates per 100,000 Population

State/Area 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Alabama 27,041 29,626 30,621 29,464 29,010 565.7 616.9 635.0 609.6 600.2

Alaska 6,019 5,739 5,462 5,774 5,789 847.5 794.1 746.7 785.4 787.5

Arizona 26,861 29,251 30,444 30,564 32,397 420.2 451.2 464.6 461.2 488.9

Arkansas 15,424 16,052 16,611 15,447 15,605 529.0 546.4 563.3 522.0 527.3

California 150,443 166,773 167,695 167,346 176,308 403.8 442.5 440.8 436.6 459.9

Colorado 19,447 21,811 21,631 20,386 21,863 386.7 426.3 417.0 387.0 415.0

Connecticut 12,649 13,649 13,065 12,775 13,382 353.9 381.2 363.9 355.2 372.1

Delaware 4,464 4,508 4,438 5,213 4,473 497.1 496.9 483.9 563.1 483.2

District of Columbia 5,589 6,585 6,808 6,414 5,293 928.8 1,065.5 1,076.7 992.2 818.8

Florida 74,744 76,033 77,644 80,182 84,194 397.5 399.0 401.9 410.1 430.6

Georgia 45,147 54,403 52,418 51,070 51,945 466.0 554.3 528.4 511.1 519.9

Hawaii 6,015 6,001 6,340 6,640 6,419 442.2 436.5 455.4 472.9 457.2

Idaho 4,208 4,699 4,550 5,428 5,442 268.4 296.5 285.1 336.7 337.6

Illinois 60,672 64,939 67,701 63,797 66,536 472.9 504.6 525.8 495.2 516.5

Indiana 22,825 27,801 29,505 28,023 28,519 352.0 426.6 451.3 426.5 434.0

Iowa 10,542 10,705 11,377 10,953 11,804 346.1 349.6 370.1 354.4 382.0

Kansas 9,601 10,598 11,135 11,012 11,116 336.5 369.1 385.8 380.5 384.1

Kentucky 16,376 16,629 17,273 17,134 17,664 377.4 380.6 394.3 389.8 401.9

Louisiana 29,151 31,614 27,353 28,739 28,955 643.0 691.0 594.4 621.3 626.0

Maine 2,586 3,094 3,413 3,438 3,530 194.7 232.9 256.8 258.8 265.8

Maryland 26,192 27,212 26,534 26,723 27,424 453.7 466.9 450.9 450.7 462.6

Massachusetts 21,080 22,764 23,550 23,210 21,271 321.9 345.6 354.3 346.8 317.8

Michigan 49,478 49,568 47,566 44,835 44,256 500.6 501.9 481.3 453.1 447.2

Minnesota 15,294 16,902 18,056 18,742 19,907 288.4 316.2 335.7 345.8 367.3

Mississippi 21,417 21,216 23,054 17,464 19,605 721.8 712.3 772.3 583.8 655.4

Missouri 26,049 27,887 27,835 27,328 27,981 435.0 464.0 462.2 452.1 462.9

Montana 3,082 3,406 3,827 3,818 4,193 311.5 341.2 380.7 376.1 413.0

Nebraska 5,114 6,780 6,748 7,301 7,499 280.0 368.0 363.7 390.7 401.3

Nevada 9,666 10,507 11,137 11,781 11,841 357.9 385.8 403.7 422.2 424.4

New Hampshire 2,462 3,010 3,072 3,119 3,586 187.0 228.3 232.6 235.7 271.0

New Jersey 26,142 26,209 27,271 28,327 29,904 297.3 297.1 307.6 318.3 336.0

New Mexico 11,706 11,374 11,898 12,249 11,558 568.5 546.2 570.5 587.4 554.3

New York 99,920 102,763 100,546 95,803 98,814 515.6 527.9 513.8 487.5 502.8

North Carolina 42,048 54,819 50,596 48,416 47,147 441.0 567.7 518.8 491.6 478.7

North Dakota 2,404 2,445 2,908 2,932 3,451 357.4 357.5 415.6 405.3 477.1

Ohio 51,150 52,653 53,141 53,121 54,858 443.4 456.1 460.3 459.1 474.1

Oklahoma 14,302 14,596 16,843 18,278 20,662 381.2 385.0 441.5 474.7 536.6

Oregon 12,352 13,643 13,454 14,181 15,508 322.4 352.4 345.0 360.8 394.6

Pennsylvania 47,518 52,884 54,993 52,056 50,536 374.1 415.0 430.9 407.5 395.6

Rhode Island 3,480 4,146 4,313 4,312 4,349 330.6 394.4 410.6 410.1 413.6

South Carolina 26,525 28,932 27,149 25,594 28,087 573.5 618.3 574.7 536.0 588.2

South Dakota 3,192 3,409 3,924 3,927 4,166 392.1 413.7 470.9 464.8 493.1

Tennessee 28,327 31,105 32,525 30,370 30,793 446.4 485.8 503.8 467.5 474.0

Texas 119,872 124,882 127,036 129,861 131,219 476.7 486.4 487.5 491.0 496.1

Utah 6,690 7,086 7,615 7,535 8,223 242.1 251.5 266.7 259.7 283.5

Vermont 1,257 1,483 1,724 1,842 2,237 200.9 236.7 275.4 294.0 357.0

Virginia 30,797 36,314 34,963 33,316 36,048 384.9 448.5 427.1 403.3 436.4

Washington 21,348 23,280 24,596 24,950 26,577 317.5 340.8 356.6 357.9 381.2

West Virginia 3,876 4,295 4,790 5,139 4,719 209.2 231.5 258.2 277.1 254.5

Wisconsin 23,236 24,619 23,726 23,572 23,154 408.6 431.0 414.3 410.5 403.2

Wyoming 2,113 2,092 2,102 2,005 1,972 374.9 368.2 364.7 344.1 338.4

U.S. TOTAL 1,307,893 1,412,791 1,422,976 1,401,906 1,441,789 423.6 453.4 453.3 443.5 456.1

Northeast 217,094 230,002 231,947 224,882 227,609 392.5 414.3 416.0 402.0 406.9

Midwest 279,557 298,306 303,622 295,543 303,247 417.7 444.2 451.0 437.5 448.9

South 531,292 578,821 576,656 568,824 582,843 463.8 498.8 491.8 480.5 492.3

West 279,950 305,662 310,751 312,657 328,090 389.1 419.5 422.3 421.1 441.8

Guam 899 1,071 1,031 937 839 563.9 671.1 644.7 584.2 523.1

Puerto Rico 5,960 5,634 6,227 5,969 4,899 160.0 152.0 169.8 165.1 135.5

Virgin Islands 609 820 802 775 791 573.1 775.2 761.8 739.9 755.2

OUTLYING AREAS 7,468 7,525 8,060 7,681 6,529 187.1 189.4 205.0 198.0 168.3

TOTAL 1,315,361 1,420,316 1,431,036 1,409,587 1,448,318 420.6 450.1 450.2 440.5 452.6
STD Surveillance 2014 Chlamydia Tables 83

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, 2010–2014

Cases Rates per 100,000 Population

State/Area 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Alabama 20,030 21,217 22,099 21,096 20,619 814.4 857.9 889.8 847.8 828.6

Alaska 3,960 3,801 3,670 3,899 3,940 1,162.6 1,093.7 1,047.9 1,115.4 1,127.1

Arizona 19,529 21,196 22,087 21,950 22,747 607.2 650.5 670.4 658.9 682.8

Arkansas 11,303 11,921 12,247 11,334 11,625 761.5 797.3 816.1 752.7 772.0

California 102,645 114,657 114,396 112,460 115,339 547.8 605.3 598.2 583.7 598.6

Colorado 14,188 15,751 15,476 14,336 14,906 565.6 617.8 598.9 546.8 568.5

Connecticut 9,223 9,824 9,464 9,210 9,512 502.8 535.1 514.2 500.0 516.4

Delaware 3,296 3,191 3,181 3,714 3,084 711.9 682.9 672.9 777.3 645.5

District of Columbia 3,782 4,357 4,426 3,992 3,709 1,191.2 1,337.4 1,328.0 1,173.4 1,090.2

Florida 53,318 54,262 55,628 56,688 58,800 554.7 557.3 563.6 567.4 588.6

Georgia 32,863 39,829 37,456 36,559 36,871 662.8 794.6 738.9 715.3 721.4

Hawaii 4,340 4,314 4,452 4,646 4,469 639.1 629.8 644.9 669.0 643.5

Idaho 3,014 3,345 3,206 3,885 3,895 385.3 422.7 402.2 482.6 483.8

Illinois 44,598 46,728 48,575 45,764 46,516 682.1 712.9 740.9 698.1 709.6

Indiana 16,344 20,065 21,633 20,307 20,586 496.2 606.2 651.8 609.0 617.3

Iowa 7,612 7,647 8,194 7,895 8,385 494.9 495.0 528.7 507.1 538.5

Kansas 7,449 8,158 8,440 8,323 8,276 518.1 564.4 581.8 573.2 570.0

Kentucky 11,859 11,990 12,366 12,086 12,404 538.0 540.2 556.3 541.5 555.8

Louisiana 20,564 23,390 20,507 21,258 21,297 888.6 1,001.1 872.7 900.2 901.8

Maine 1,814 2,149 2,420 2,404 2,478 267.4 316.9 356.5 354.5 365.4

Maryland 19,827 20,004 19,295 19,049 19,162 664.9 665.1 635.9 623.7 627.4

Massachusetts 14,753 15,744 16,319 15,851 14,000 436.4 463.3 476.4 459.7 406.0

Michigan 36,431 36,367 34,510 32,056 31,470 723.5 723.0 685.7 636.5 624.9

Minnesota 10,965 11,827 12,568 12,950 13,484 410.4 439.7 464.3 474.9 494.4

Mississippi 15,958 15,697 16,771 12,676 14,008 1,045.7 1,024.6 1,092.1 824.9 911.6

Missouri 18,867 20,097 19,745 19,303 19,549 617.5 655.4 643.0 626.7 634.7

Montana 2,194 2,390 2,655 2,701 2,878 445.3 480.9 530.8 534.5 569.5

Nebraska 3,561 4,783 4,628 4,945 5,110 387.0 515.7 495.9 526.8 544.4

Nevada 6,897 7,215 7,628 8,183 8,039 515.9 534.9 557.7 591.0 580.6

New Hampshire 1,808 2,184 2,150 2,187 2,452 271.0 327.3 321.6 326.5 366.1

New Jersey 20,128 19,886 20,231 20,771 21,556 446.1 439.9 445.5 456.0 473.2

New Mexico 8,718 8,309 8,724 9,033 8,395 836.9 789.7 828.6 858.9 798.2

New York 68,693 70,466 68,337 64,454 65,114 686.9 702.3 677.9 637.2 643.7

North Carolina 33,836 42,992 39,140 37,146 35,494 691.9 868.1 782.9 735.9 703.2

North Dakota 1,577 1,603 1,898 1,923 2,202 474.0 474.7 551.9 544.2 623.1

Ohio 38,636 38,914 38,879 38,293 39,033 654.4 658.9 658.8 647.8 660.3

Oklahoma 10,297 10,349 12,341 13,065 14,855 543.6 540.8 641.1 672.3 764.4

Oregon 8,565 9,489 9,425 9,932 10,545 442.6 485.3 478.8 500.2 531.1

Pennsylvania 33,175 36,463 37,569 35,657 34,170 509.4 558.5 575.0 545.9 523.2

Rhode Island 2,478 2,984 3,091 3,044 3,037 455.4 549.5 570.3 561.5 560.2

South Carolina 20,842 22,278 20,497 19,103 20,581 877.5 927.2 844.7 779.2 839.5

South Dakota 2,300 2,491 2,801 2,793 2,942 565.4 606.2 674.9 664.2 699.6

Tennessee 20,559 22,200 22,732 21,057 21,203 632.1 676.3 687.3 632.6 636.9

Texas 92,847 95,326 96,405 96,923 96,959 732.6 737.1 735.3 728.7 728.9

Utah 4,473 4,821 5,149 5,050 5,414 325.2 343.9 362.8 350.2 375.5

Vermont 910 1,106 1,296 1,319 1,613 286.6 348.3 408.5 415.5 508.1

Virginia 22,348 26,283 24,670 23,167 24,754 548.4 637.9 592.4 551.8 589.6

Washington 15,634 16,641 17,271 17,452 18,193 463.3 486.5 499.8 500.2 521.5

West Virginia 2,832 3,092 3,405 3,624 3,356 301.5 328.8 362.2 386.1 357.5

Wisconsin 16,657 17,402 16,727 16,448 16,063 581.5 605.1 580.1 569.0 555.7

Wyoming 1,305 1,357 1,492 1,387 1,352 472.5 487.4 528.8 486.0 473.8

U.S. TOTAL 949,802 1,018,552 1,018,272 993,348 1,006,441 605.1 643.4 638.7 619.0 627.2

Northeast 152,982 160,806 160,877 154,897 153,932 537.8 563.8 562.0 539.7 536.4

Midwest 204,997 216,082 218,598 211,000 213,616 602.9 633.7 639.9 615.9 623.6

South 396,361 428,378 423,166 412,537 418,781 678.5 724.2 708.3 684.1 694.4

West 195,462 213,286 215,631 214,914 220,112 541.5 583.9 584.6 577.5 591.5

Guam 664 783 726 700 595 846.8 996.9 921.9 885.8 752.9

Puerto Rico 4,878 4,528 5,102 4,766 3,770 251.4 234.3 267.1 252.7 199.9

Virgin Islands 427 591 592 579 590 757.7 1,051.7 1,056.8 1,037.1 1,056.8

OUTLYING AREAS 5,969 5,902 6,420 6,045 4,955 287.6 285.5 314.0 299.1 245.2

TOTAL 955,771 1,024,454 1,024,692 999,393 1,011,396 601.0 638.8 634.6 615.0 622.4

NOTE: Cases reported with unknown sex are not included in this table.
84 Chlamydia Tables STD Surveillance 2014

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, 2010–2014

Cases Rates per 100,000 Population

State/Area 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Alabama 6,877 7,648 8,295 8,201 8,318 296.4 328.3 354.7 349.7 354.7

Alaska 2,058 1,938 1,792 1,875 1,849 556.8 516.5 470.0 486.3 479.6

Arizona 7,331 8,052 8,354 8,610 9,650 230.8 249.8 256.4 261.3 292.9

Arkansas 4,112 4,125 4,360 4,104 3,964 287.2 285.9 301.0 282.3 272.7

California 47,239 51,554 52,983 54,679 60,687 255.1 275.0 280.1 286.8 318.3

Colorado 5,259 6,057 6,155 6,050 6,957 208.6 235.9 236.4 228.6 262.9

Connecticut 3,426 3,825 3,524 3,481 3,757 196.9 219.2 201.4 198.4 214.2

Delaware 1,168 1,317 1,257 1,499 1,389 268.5 299.4 282.9 334.6 310.1

District of Columbia 1,789 2,225 2,345 2,400 1,555 629.4 761.4 784.2 783.7 507.8

Florida 21,362 21,685 22,009 23,300 25,239 232.5 232.6 233.0 243.7 263.9

Georgia 11,965 13,978 14,521 14,063 14,736 253.0 291.0 299.3 288.1 301.9

Hawaii 1,675 1,687 1,888 1,994 1,950 245.9 244.6 269.0 281.0 274.8

Idaho 1,183 1,347 1,344 1,528 1,547 150.6 169.7 168.3 189.3 191.7

Illinois 15,957 18,083 18,977 17,943 19,908 253.6 286.4 300.3 283.6 314.7

Indiana 6,451 7,681 7,850 7,708 7,921 202.2 239.5 243.9 238.2 244.8

Iowa 2,930 3,058 3,183 3,058 3,419 194.3 201.5 208.8 199.4 223.0

Kansas 2,152 2,440 2,695 2,689 2,840 152.0 171.1 187.8 186.5 197.0

Kentucky 4,488 4,577 4,851 4,989 5,194 210.2 212.9 224.8 230.6 240.1

Louisiana 6,658 7,568 6,846 7,481 7,655 300.0 338.1 304.0 330.4 338.1

Maine 768 944 990 1,031 1,050 118.1 145.2 152.2 158.6 161.5

Maryland 6,336 7,197 7,193 7,654 8,237 227.0 255.2 252.4 266.2 286.5

Massachusetts 6,302 7,000 7,193 7,341 7,197 199.0 219.5 223.4 226.2 221.8

Michigan 12,926 13,095 12,962 12,683 12,723 266.6 270.2 267.2 261.0 261.8

Minnesota 4,329 5,075 5,430 5,791 6,414 164.5 191.2 203.2 215.0 238.1

Mississippi 5,459 5,519 6,281 4,788 5,588 378.8 381.5 433.4 329.2 384.2

Missouri 7,182 7,790 8,090 8,025 8,432 244.8 264.6 274.1 270.8 284.5

Montana 888 1,016 1,172 1,116 1,314 178.8 202.7 232.1 218.9 257.7

Nebraska 1,548 1,987 2,093 2,196 2,357 170.8 217.1 226.9 236.2 253.5

Nevada 2,768 3,290 3,508 3,590 3,786 203.0 239.3 252.2 255.4 269.4

New Hampshire 654 826 922 932 1,130 100.7 126.9 141.4 142.6 172.9

New Jersey 5,874 6,231 6,958 7,476 8,272 137.3 144.9 160.9 172.1 190.4

New Mexico 2,986 3,054 3,170 3,209 3,148 293.5 296.5 307.0 310.5 304.6

New York 31,224 32,126 32,147 31,273 33,634 333.0 340.6 338.8 327.9 352.7

North Carolina 8,030 11,585 11,354 11,254 11,638 172.9 246.3 238.9 234.4 242.4

North Dakota 822 841 1,010 1,009 1,249 241.9 242.9 283.9 272.7 337.6

Ohio 12,320 13,731 14,262 14,828 15,825 218.7 243.5 252.8 262.0 279.6

Oklahoma 3,997 3,851 4,498 5,213 5,802 215.2 205.1 238.0 273.3 304.2

Oregon 3,786 4,154 4,028 4,243 4,953 199.7 216.7 208.6 218.2 254.7

Pennsylvania 14,297 16,364 17,388 16,360 16,315 231.0 263.3 279.1 262.1 261.4

Rhode Island 1,002 1,162 1,222 1,268 1,312 197.1 228.6 240.4 248.9 257.5

South Carolina 5,653 6,585 6,588 6,432 7,376 251.2 289.2 286.8 276.9 317.5

South Dakota 883 914 1,123 1,134 1,224 216.8 221.2 268.5 267.2 288.4

Tennessee 7,748 8,905 9,754 9,311 9,587 250.5 285.3 309.8 294.0 302.7

Texas 26,966 29,533 30,532 31,980 34,110 216.2 231.8 235.8 243.2 259.5

Utah 2,215 2,265 2,466 2,485 2,808 159.5 160.0 171.7 170.3 192.5

Vermont 347 377 428 523 622 112.6 122.1 138.6 169.2 201.2

Virginia 8,397 9,929 10,247 10,112 11,244 213.9 249.7 254.8 248.9 276.8

Washington 5,711 6,639 7,325 7,498 8,384 170.5 194.7 212.8 215.3 240.7

West Virginia 1,044 1,203 1,385 1,514 1,363 114.3 131.5 151.3 165.4 148.9

Wisconsin 6,573 7,203 6,999 7,114 7,077 232.9 254.0 246.2 249.4 248.1

Wyoming 808 734 610 617 619 281.1 253.3 207.3 207.5 208.2

U.S. TOTAL 353,923 389,970 402,557 405,652 433,325 233.2 254.4 260.6 260.6 278.4

Northeast 63,894 68,855 70,772 69,685 73,289 237.8 255.0 260.8 255.8 269.0

Midwest 74,073 81,898 84,674 84,178 89,389 225.0 247.7 255.4 252.9 268.5

South 132,049 147,430 152,316 154,295 162,995 235.2 259.1 264.8 265.7 280.7

West 83,907 91,787 94,795 97,494 107,652 234.1 252.6 258.3 263.2 290.6

Guam 235 288 305 234 244 290.1 355.3 375.8 287.6 299.9

Puerto Rico 1,076 1,106 1,125 1,203 1,126 60.3 62.3 64.0 69.6 65.1

Virgin Islands 182 229 210 196 201 364.7 461.8 426.3 400.7 411.0

OUTLYING AREAS 1,493 1,623 1,640 1,633 1,571 77.9 85.2 86.9 87.8 84.5

TOTAL 355,416 391,593 404,197 407,285 434,896 231.2 252.3 258.5 258.6 276.1

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2014 Chlamydia Tables 85

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

Statistical Areas (MSAs)* in Alphabetical Order, United States, 2010–2014

Cases Rates per 100,000 Population

MSAs 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Atlanta-Sandy Springs-Roswell, GA 22,203 27,372 26,470 16,429 25,744 420.0 509.0 485.0 297.5 466.1

Austin-Round Rock, TX 8,511 9,360 9,810 10,138 10,920 495.9 524.8 534.8 538.4 579.9

Baltimore-Columbia-Towson, MD 13,988 14,399 13,578 13,749 14,095 516.1 527.6 493.2 496.2 508.7

Birmingham-Hoover, AL 6,126 6,834 6,868 6,552 6,309 543.1 603.6 604.2 574.6 553.3

Boston-Cambridge-Newton, MA-NH 14,291 15,703 16,339 16,127 14,264 313.9 342.0 352.1 344.3 304.5

Buffalo-Cheektowaga-Niagara Falls, NY 5,938 5,965 6,010 5,724 5,841 522.9 526.0 529.9 504.7 515.0

Charlotte-Concord-Gastonia, NC-SC 9,060 13,257 11,548 11,418 11,766 408.7 587.2 502.8 488.9 503.8

Chicago-Naperville-Elgin, IL-IN-WI 45,726 49,590 51,329 47,837 51,457 483.3 521.7 539.0 501.6 539.5

Cincinnati, OH-KY-IN 9,791 10,044 10,234 10,207 10,516 463.0 473.2 480.8 477.5 492.0

Cleveland-Elyria, OH 11,608 12,348 12,339 12,126 11,363 558.8 597.0 598.0 587.3 550.3

Columbus, OH 9,625 9,031 8,946 9,734 10,258 506.1 469.3 460.2 494.8 521.5

Dallas-Fort Worth-Arlington, TX 29,430 32,002 31,697 30,684 30,549 458.0 486.2 473.0 450.5 448.5

Denver-Aurora-Lakewood, CO 14,320 12,710 12,764 12,131 13,346 563.0 488.9 482.5 449.7 494.8

Detroit-Warren-Dearborn, MI 27,751 26,237 24,229 22,567 21,012 645.9 612.2 564.5 525.4 489.2

Hartford-West Hartford-East Hartford, CT 4,616 4,837 4,562 4,311 4,713 380.7 398.7 375.7 354.8 387.8

Houston-The Woodlands-Sugar Land, TX 27,462 26,508 26,807 29,120 30,554 463.9 437.4 434.0 461.3 484.0

Indianapolis-Carmel-Anderson, IN 8,797 11,117 12,714 11,835 11,952 466.0 582.1 659.1 605.7 611.7

Jacksonville, FL 7,093 7,264 6,813 7,138 7,391 527.1 534.0 494.5 511.8 530.0

Kansas City, MO-KS 9,372 10,038 10,152 9,513 9,866 466.4 495.3 498.0 463.0 480.2

Las Vegas-Henderson-Paradise, NV 7,614 8,337 8,587 9,286 9,485 390.2 423.2 429.2 457.9 467.7

Los Angeles-Long Beach-Anaheim, CA 56,033 58,552 60,231 59,386 64,263 436.8 452.3 461.4 452.2 489.4

Louisville/Jefferson County, KY-IN 6,157 6,483 6,658 6,384 6,751 498.3 520.6 532.1 505.8 534.8

Memphis, TN-MS-AR 12,486 11,720 12,744 10,763 10,554 942.5 878.3 949.8 802.2 786.6

Miami-Fort Lauderdale-West Palm Beach, FL 19,095 19,561 20,933 22,821 24,599 343.1 345.0 363.2 391.6 422.1

Milwaukee-Waukesha-West Allis, WI 11,512 11,712 10,929 10,754 10,303 739.9 749.7 697.5 685.1 656.4

Minneapolis-St. Paul-Bloomington, MN-WI 10,975 12,143 12,144 12,227 13,589 327.7 358.5 354.9 353.5 392.8

Nashville-Davidson-Murfreesboro-Franklin, TN 6,026 6,990 7,151 7,356 7,878 360.6 411.5 414.1 418.5 448.1

New Orleans-Metairie, LA 7,050 8,124 7,118 8,134 8,595 592.5 669.8 580.1 655.5 692.6

New York-Newark-Jersey City, NY-NJ-PA 92,464 95,088 92,763 89,211 93,515 472.5 483.0 467.7 447.2 468.8

Oklahoma City, OK 4,704 5,087 5,640 6,190 7,293 375.4 398.0 435.0 469.1 552.6

Orlando-Kissimmee-Sanford, FL 9,491 9,545 9,928 10,230 11,001 444.7 439.6 446.5 451.1 485.1

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 33,050 34,799 35,513 34,741 33,376 554.0 580.7 590.0 575.7 553.1

Phoenix-Mesa-Scottsdale, AZ 16,519 17,746 20,358 20,164 21,576 394.0 416.3 470.2 458.4 490.5

Pittsburgh, PA 7,096 8,436 8,994 8,605 8,059 301.2 357.5 381.0 364.5 341.4

Portland-Vancouver-Hillsboro, OR-WA 7,415 8,509 7,797 8,536 9,283 333.1 376.1 340.5 368.8 401.1

Providence-Warwick, RI-MA 4,759 5,559 5,941 5,828 5,695 297.3 347.4 371.0 363.3 355.0

Raleigh, NC 5,122 5,693 5,373 4,966 5,126 453.1 489.3 452.1 408.9 422.1

Richmond, VA 6,911 7,698 7,224 6,817 7,817 572.1 631.5 586.4 547.2 627.5

Riverside-San Bernardino-Ontario, CA 12,263 20,749 20,994 19,819 19,560 290.3 482.0 482.6 452.4 446.5

Sacramento-Roseville-Arden-Arcade, CA 8,084 10,866 9,852 9,771 9,674 376.2 499.3 448.5 441.0 436.6

Salt Lake City, UT 3,653 3,767 4,041 3,947 4,423 335.8 339.9 359.6 346.1 387.8

San Antonio-New Braunfels, TX 12,430 13,066 13,023 13,335 11,573 580.2 595.3 582.9 585.5 508.1

San Diego-Carlsbad, CA 15,341 15,346 16,524 14,706 15,754 495.6 488.7 520.1 458.0 490.6

San Francisco-Oakland-Hayward, CA 17,686 18,745 17,171 18,254 20,377 407.9 426.9 385.4 404.2 451.2

San Jose-Sunnyvale-Santa Clara, CA 5,691 5,965 4,676 6,717 6,278 309.8 319.8 246.8 349.9 327.0

Seattle-Tacoma-Bellevue, WA 11,510 12,329 12,965 12,971 13,861 334.6 352.3 365.0 359.3 384.0

St. Louis, MO-IL 14,660 15,517 14,843 14,783 14,711 525.9 555.7 530.9 527.8 525.2

Tampa-St. Petersburg-Clearwater, FL 12,158 12,595 12,274 12,752 12,952 436.8 445.9 431.7 444.2 451.2

Virginia Beach-Norfolk-Newport News, VA-NC 11,387 13,674 12,409 11,852 12,192 679.1 811.5 730.0 694.2 714.1

Washington-Arlington-Alexandria, DC-VA-MD-WV 20,027 22,839 23,872 23,531 18,342 355.3 396.6 407.3 395.5 308.3

SELECTED MSAs TOTAL 755,077 811,856 811,879 792,177 820,371 450.9 479.2 474.2 458.3 474.6

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.
86 Chlamydia Tables STD Surveillance 2014

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

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2010–2014

Cases Rates per 100,000 Population

MSAs 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Atlanta-Sandy Springs-Roswell, GA 15,556 19,507 18,298 11,221 17,564 573.1 707.7 652.7 395.0 618.3

Austin-Round Rock, TX 6,212 6,644 6,909 6,691 7,513 725.5 746.6 755.2 712.3 799.8

Baltimore-Columbia-Towson, MD 10,744 10,668 9,933 9,848 9,780 764.4 754.3 696.7 686.9 682.1

Birmingham-Hoover, AL 4,525 4,834 4,866 4,486 4,300 775.0 824.1 826.1 759.2 727.7

Boston-Cambridge-Newton, MA-NH 9,937 10,747 11,234 10,791 9,243 422.9 454.1 469.9 447.5 383.3

Buffalo-Cheektowaga-Niagara Falls, NY 4,386 4,370 4,317 4,024 4,077 746.5 745.7 737.4 688.0 697.1

Charlotte-Concord-Gastonia, NC-SC 7,101 10,024 8,731 8,605 8,633 624.2 864.7 740.1 717.0 719.3

Chicago-Naperville-Elgin, IL-IN-WI 33,360 35,360 36,701 34,216 35,696 689.5 728.0 754.3 702.5 732.9

Cincinnati, OH-KY-IN 7,740 7,763 7,750 7,527 7,724 716.1 715.9 713.0 690.0 708.1

Cleveland-Elyria, OH 8,556 9,065 8,877 8,550 7,914 793.1 844.7 829.5 799.4 739.9

Columbus, OH 6,947 6,266 6,280 6,749 6,895 717.8 640.2 635.3 674.7 689.3

Dallas-Fort Worth-Arlington, TX 22,979 24,221 24,018 22,744 22,213 705.4 726.5 707.6 658.7 643.3

Denver-Aurora-Lakewood, CO 10,458 9,143 9,117 8,447 9,020 817.7 700.4 686.4 624.1 666.4

Detroit-Warren-Dearborn, MI 20,530 19,161 17,460 16,152 14,822 927.2 867.8 789.8 730.5 670.4

Hartford-West Hartford-East Hartford, CT 3,324 3,470 3,301 3,109 3,349 534.2 557.6 529.8 499.0 537.5

Houston-The Woodlands-Sugar Land, TX 21,875 20,956 20,858 22,027 22,832 735.0 688.2 672.3 695.0 720.4

Indianapolis-Carmel-Anderson, IN 5,976 7,579 8,899 8,149 8,398 619.1 776.3 902.5 816.1 841.0

Jacksonville, FL 5,191 5,213 4,812 5,131 5,238 752.4 746.9 680.7 717.4 732.4

Kansas City, MO-KS 6,800 7,278 7,295 6,795 6,991 662.8 703.8 701.5 649.2 667.9

Las Vegas-Henderson-Paradise, NV 5,537 5,777 5,942 6,571 6,486 571.4 590.2 597.1 650.5 642.0

Los Angeles-Long Beach-Anaheim, CA 37,486 38,802 39,470 38,456 40,401 576.7 592.0 597.1 578.5 607.7

Louisville/Jefferson County, KY-IN 4,545 4,745 4,884 4,574 4,827 718.4 744.1 762.7 708.1 747.2

Memphis, TN-MS-AR 9,542 8,767 9,367 7,717 7,758 1,385.5 1,263.3 1,342.7 1,105.5 1,111.3

Miami-Fort Lauderdale-West Palm Beach, FL 13,566 13,815 14,692 15,645 16,473 472.5 473.5 495.4 521.9 549.5

Milwaukee-Waukesha-West Allis, WI 8,376 8,397 7,760 7,463 7,183 1,048.2 1,047.4 964.7 926.6 891.8

Minneapolis-St. Paul-Bloomington, MN-WI 7,788 8,371 8,326 8,293 8,957 459.4 488.7 481.1 474.2 512.2

Nashville-Davidson-Murfreesboro-Franklin, TN 4,250 4,942 4,928 5,084 5,278 497.5 568.7 557.8 565.0 586.6

New Orleans-Metairie, LA 5,134 6,056 5,326 6,062 6,301 840.7 972.3 843.9 948.7 986.1

New York-Newark-Jersey City, NY-NJ-PA 64,520 65,988 63,588 60,539 62,097 636.7 648.2 620.5 587.7 602.8

Oklahoma City, OK 3,292 3,518 3,951 4,430 5,255 517.9 543.3 601.6 662.5 785.8

Orlando-Kissimmee-Sanford, FL 6,777 6,993 7,373 7,503 8,021 621.9 631.1 649.6 648.3 693.1

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 22,863 23,928 24,166 23,532 22,317 740.7 772.0 776.5 754.4 715.4

Phoenix-Mesa-Scottsdale, AZ 11,892 12,696 14,396 14,206 14,841 564.3 592.8 661.6 642.4 671.1

Pittsburgh, PA 5,146 5,963 6,325 6,046 5,509 422.5 489.5 519.7 497.4 453.2

Portland-Vancouver-Hillsboro, OR-WA 5,091 5,824 5,359 5,809 6,158 451.8 508.8 462.8 496.1 525.9

Providence-Warwick, RI-MA 3,433 4,022 4,256 4,124 3,945 415.1 486.9 515.3 498.7 477.1

Raleigh, NC 3,525 3,951 3,691 3,490 3,502 609.5 663.4 606.8 561.5 563.5

Richmond, VA 5,161 5,599 5,083 4,792 5,311 826.7 889.1 798.4 744.7 825.4

Riverside-San Bernardino-Ontario, CA 8,810 15,241 15,296 14,536 13,988 414.8 704.9 700.5 661.1 636.2

Sacramento-Roseville-Arden-Arcade, CA 5,754 7,874 7,122 6,915 6,686 525.2 709.9 635.9 611.8 591.5

Salt Lake City, UT 2,386 2,517 2,679 2,541 2,873 441.3 457.0 479.6 448.0 506.6

San Antonio-New Braunfels, TX 8,972 9,286 9,436 9,576 8,158 823.1 832.0 832.1 829.5 706.7

San Diego-Carlsbad, CA 10,538 10,395 11,102 9,684 10,211 683.6 664.9 702.5 606.3 639.3

San Francisco-Oakland-Hayward, CA 10,940 11,733 10,391 10,845 11,509 497.8 527.7 460.5 474.3 503.4

San Jose-Sunnyvale-Santa Clara, CA 3,951 4,187 3,260 4,530 4,100 431.6 450.7 345.9 474.6 429.6

Seattle-Tacoma-Bellevue, WA 8,000 8,259 8,460 8,411 8,751 463.0 470.9 474.8 465.4 484.2

St. Louis, MO-IL 10,468 11,077 10,351 10,364 10,271 727.9 769.0 717.8 717.6 711.2

Tampa-St. Petersburg-Clearwater, FL 8,527 8,913 8,738 8,948 9,066 593.9 612.5 596.5 604.2 612.1

Virginia Beach-Norfolk-Newport News, VA-NC 8,106 9,798 8,771 8,259 8,425 948.5 1,141.0 1,015.2 952.5 971.6

Washington-Arlington-Alexandria, DC-VA-MD-WV 14,263 15,946 16,349 15,768 12,501 493.1 540.4 544.5 518.1 410.7

SELECTED MSAs TOTAL 540,836 575,649 570,494 549,975 559,361 632.3 665.7 653.1 623.8 634.5

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2014 Chlamydia Tables 87

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

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2010–2014

Cases Rates per 100,000 Population

MSAs 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Atlanta-Sandy Springs-Roswell, GA 6,482 7,563 7,917 5,061 7,979 252.0 288.6 298.3 188.7 297.5

Austin-Round Rock, TX 2,290 2,710 2,890 2,592 3,372 266.2 303.2 314.3 274.7 357.3

Baltimore-Columbia-Towson, MD 3,231 3,723 3,608 3,889 4,294 247.6 283.2 271.8 290.9 321.2

Birmingham-Hoover, AL 1,545 1,852 1,985 2,031 1,990 283.9 339.4 362.5 369.7 362.2

Boston-Cambridge-Newton, MA-NH 4,334 4,946 5,086 5,328 4,988 196.7 222.4 226.0 234.4 219.5

Buffalo-Cheektowaga-Niagara Falls, NY 1,552 1,595 1,693 1,700 1,764 283.2 291.1 308.5 309.5 321.2

Charlotte-Concord-Gastonia, NC-SC 1,948 3,191 2,794 2,804 3,125 180.5 290.5 250.2 247.0 275.3

Chicago-Naperville-Elgin, IL-IN-WI 12,250 14,110 14,518 13,553 15,679 265.0 303.6 311.8 290.4 336.0

Cincinnati, OH-KY-IN 2,017 2,279 2,482 2,676 2,787 195.1 219.5 238.3 255.7 266.3

Cleveland-Elyria, OH 3,016 3,283 3,462 3,576 3,449 302.1 329.9 348.5 359.4 346.6

Columbus, OH 2,646 2,762 2,666 2,985 3,363 283.2 292.2 279.0 308.7 347.8

Dallas-Fort Worth-Arlington, TX 6,445 7,778 7,669 7,916 8,313 203.4 239.5 231.9 235.7 247.6

Denver-Aurora-Lakewood, CO 3,862 3,564 3,647 3,684 4,326 305.4 275.4 276.9 274.1 321.9

Detroit-Warren-Dearborn, MI 7,134 7,011 6,718 6,350 6,153 342.6 337.4 322.8 304.7 295.3

Hartford-West Hartford-East Hartford, CT 1,292 1,367 1,245 1,181 1,333 219.0 231.3 210.5 199.4 225.1

Houston-The Woodlands-Sugar Land, TX 5,550 5,550 5,944 7,078 7,700 188.5 184.1 193.3 225.1 244.9

Indianapolis-Carmel-Anderson, IN 2,814 3,513 3,802 3,681 3,544 305.0 376.3 403.2 385.3 370.9

Jacksonville, FL 1,893 2,047 2,001 1,989 2,138 288.7 309.1 298.2 292.7 314.7

Kansas City, MO-KS 2,572 2,760 2,857 2,718 2,875 261.5 278.1 286.1 269.7 285.3

Las Vegas-Henderson-Paradise, NV 2,076 2,558 2,644 2,708 2,986 211.4 258.1 262.9 266.1 293.4

Los Angeles-Long Beach-Anaheim, CA 18,343 19,577 20,633 20,831 23,766 289.9 306.3 320.3 321.3 366.6

Louisville/Jefferson County, KY-IN 1,601 1,710 1,744 1,781 1,896 265.5 281.4 285.4 289.0 307.7

Memphis, TN-MS-AR 2,938 2,953 3,377 3,046 2,795 461.8 461.1 524.3 473.2 434.2

Miami-Fort Lauderdale-West Palm Beach, FL 5,523 5,721 6,238 7,134 8,086 205.0 207.8 223.0 252.0 285.7

Milwaukee-Waukesha-West Allis, WI 3,134 3,312 3,169 3,284 3,111 414.1 435.5 415.5 429.7 407.1

Minneapolis-St. Paul-Bloomington, MN-WI 3,187 3,772 3,813 3,933 4,623 192.7 225.3 225.4 229.9 270.3

Nashville-Davidson-Murfreesboro-Franklin, TN 1,767 2,048 2,185 2,271 2,598 216.4 246.8 259.1 264.6 302.8

New Orleans-Metairie, LA 1,714 2,043 1,792 2,072 2,294 295.9 346.3 300.7 344.2 381.1

New York-Newark-Jersey City, NY-NJ-PA 27,844 28,877 29,065 28,546 31,310 295.2 303.7 303.3 295.8 324.5

Oklahoma City, OK 1,410 1,457 1,688 1,760 2,036 228.4 231.1 263.8 270.4 312.8

Orlando-Kissimmee-Sanford, FL 2,705 2,539 2,555 2,708 2,964 258.9 238.8 234.7 243.9 266.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 10,146 10,817 11,314 11,178 11,010 352.4 373.9 389.2 383.4 377.7

Phoenix-Mesa-Scottsdale, AZ 4,626 5,047 5,960 5,957 6,735 221.8 237.9 276.8 272.3 307.9

Pittsburgh, PA 1,947 2,471 2,668 2,550 2,541 171.1 216.5 233.3 222.6 221.8

Portland-Vancouver-Hillsboro, OR-WA 2,323 2,685 2,437 2,723 3,124 211.4 240.2 215.3 238.1 273.2

Providence-Warwick, RI-MA 1,325 1,536 1,683 1,702 1,744 171.2 198.4 217.1 218.9 224.3

Raleigh, NC 1,577 1,723 1,673 1,474 1,622 285.6 303.4 288.3 248.6 273.5

Richmond, VA 1,727 2,053 2,129 2,011 2,503 295.8 348.4 357.6 333.9 415.6

Riverside-San Bernardino-Ontario, CA 3,437 5,412 5,683 5,271 5,542 163.6 252.6 262.3 241.5 254.0

Sacramento-Roseville-Arden-Arcade, CA 2,287 2,960 2,712 2,846 2,976 217.1 277.4 251.9 262.2 274.2

Salt Lake City, UT 1,267 1,250 1,362 1,406 1,550 231.5 224.2 241.0 245.2 270.4

San Antonio-New Braunfels, TX 3,458 3,780 3,587 3,757 3,412 328.6 350.4 326.1 334.5 303.8

San Diego-Carlsbad, CA 4,785 4,925 5,418 5,013 5,508 308.0 312.3 339.3 310.6 341.2

San Francisco-Oakland-Hayward, CA 6,645 6,948 6,739 7,370 8,823 310.8 320.5 306.5 330.5 395.7

San Jose-Sunnyvale-Santa Clara, CA 1,649 1,667 1,353 2,186 2,163 179.0 178.0 142.1 226.5 224.1

Seattle-Tacoma-Bellevue, WA 3,509 4,070 4,505 4,560 5,110 205.0 233.1 254.5 253.0 283.5

St. Louis, MO-IL 4,190 4,436 4,474 4,411 4,429 310.5 328.1 330.5 325.1 326.4

Tampa-St. Petersburg-Clearwater, FL 3,601 3,657 3,532 3,752 3,835 267.2 267.0 256.3 270.0 276.0

Virginia Beach-Norfolk-Newport News, VA-NC 3,275 3,857 3,631 3,584 3,748 398.3 466.8 434.3 426.5 446.1

Washington-Arlington-Alexandria, DC-VA-MD-WV 5,720 6,867 7,461 7,725 5,813 208.5 244.6 261.1 265.8 200.0

SELECTED MSAs TOTAL 212,609 234,332 240,208 240,342 259,825 259.6 282.5 286.5 283.8 306.8

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

NOTE: Cases reported with unknown sex are not included in this table.
88 Chlamydia Tables STD Surveillance 2014

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

Independent Cities* Ranked by Number of Reported Cases, United States, 2014

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percentage

1 Los Angeles County, CA 54,881 547.9 3

2 Cook County, IL 37,371 713.1 6

3 Harris County, TX 24,785 571.5 8

4 Maricopa County, AZ 20,219 504.3 9

5 Philadelphia County, PA 18,935 1,219.1 10

6 Kings County, NY 17,785 686.1 12

7 Bronx County, NY 16,168 1,139.6 13

8 San Diego County, CA 15,754 490.6 14

9 Dallas County, TX 14,945 602.5 15

10 Wayne County, MI 14,278 804.3 16

11 New York County, NY 12,551 771.8 17

12 Queens County, NY 12,063 525.4 18

13 San Bernardino County, CA 10,753 514.9 18

14 Miami-Dade County, FL 10,725 409.8 19

15 Bexar County, TX 10,335 568.6 20

16 Marion County, IN 9,512 1,024.7 20

17 Clark County, NV 9,485 467.7 21

18 Orange County, CA 9,382 301.2 22

19 Milwaukee County, WI 9,290 971.7 22

20 Cuyahoga County, OH 9,072 718.2 23

21 Broward County, FL 9,045 491.9 24

22 Riverside County, CA 8,807 384.2 24

23 Tarrant County, TX 8,652 452.6 25

24 Franklin County, OH 8,171 674.0 25

25 Shelby County, TN 8,074 859.4 26

26 Sacramento County, CA 7,736 529.1 26

27 Hillsborough County, FL 7,465 578.0 27

28 King County, WA 7,424 363.1 27

29 Baltimore (City), MD 7,345 1,180.7 28

30 Travis County, TX 7,322 653.2 29

31 Alameda County, CA 7,214 456.9 29

32 Orange County, FL 7,213 588.7 30

33 Fulton County, GA 6,575 668.0 30

34 Hamilton County, OH 6,526 811.2 30

35 Hennepin County, MN 6,426 536.0 31

36 Kern County, CA 6,345 734.3 31

37 Mecklenburg County, NC 6,313 637.0 32

38 Santa Clara County, CA 6,133 329.4 32

39 Prince George's County, MD 6,130 688.7 33

40 San Francisco County, CA 6,041 721.4 33

41 Denver County, CO 5,919 911.3 33

42 Duval County, FL 5,770 651.3 34

43 Fresno County, CA 5,730 599.8 34

44 Allegheny County, PA 5,710 463.7 35

45 Pima County, AZ 5,615 563.4 35

46 Essex County, NJ 5,542 701.9 35

47 St. Louis County, MO 5,360 535.2 36

48 Jefferson County, KY 5,200 687.1 36

49 Jackson County, MO 5,071 745.7 36

50 Jefferson County, AL 5,040 764.2 37

51 Erie County, NY 5,004 544.0 37

52 Oklahoma County, OK 4,994 661.2 38

53 Honolulu County, HI 4,994 507.8 38

54 El Paso County, TX 4,987 602.5 38

55 Palm Beach County, FL 4,829 351.9 39

56 DeKalb County, GA 4,583 642.5 39

57 Pierce County, WA 4,415 538.6 39

58 Wake County, NC 4,383 449.9 39

59 Orleans Parish, LA 4,296 1,134.4 40

60 Davidson County, TN 4,291 651.5 40

61 Salt Lake County, UT 4,280 396.4 40

62 Contra Costa County, CA 4,250 388.4 41

63 Multnomah County, OR 4,216 550.3 41

64 Hartford County, CT 4,154 462.4 41

65 Monroe County, NY 4,140 552.3 42

66 Bernalillo County, NM 4,074 604.3 42

67 Tulsa County, OK 4,070 653.9 42

68 St. Louis (City), MO 3,996 1,255.0 42

69 New Haven County, CT 3,963 459.6 43

70 Douglas County, NE 3,944 734.1 43

* Accounting for 43% of reported chlamydia cases.

† Counties and independent cities were ranked in descending order by number of cases reported then by rate in 2014.
STD Surveillance 2014 Chlamydia Tables 89

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

United States, 2010–2014 

Age

Group

Cases Rates*

Total Male Female Unknown Sex Total Male Female

0–4 964 327 619 18 4.8 3.2 6.3

2010

5–9 188 26 158 4 0.9 0.3 1.6

10–14 14,531 1,590 12,860 81 70.3 15.0 127.4

15–19 441,342 85,570 354,252 1,520 2,002.4 757.0 3,299.5

20–24 488,996 131,686 355,994 1,316 2,265.3 1,195.6 3,367.4

25–29 197,525 66,470 130,561 494 936.1 625.0 1,247.4

30–34 83,408 31,230 51,925 253 417.8 312.4 521.0

35–39 38,384 15,861 22,421 102 190.2 157.9 221.2

40–44 19,614 9,594 9,931 89 93.9 92.3 94.6

45–54 16,106 8,635 7,423 48 35.8 39.0 32.5

55–64 3,523 1,834 1,674 15 9.7 10.4 8.9

65+ 954 464 481 9 2.4 2.7 2.1

Unknown Age 2,358 636 1,503 219

TOTAL 1,307,893 353,923 949,802 4,168 423.6 233.2 605.1

0–4 747 284 458 5 3.7 2.8 4.6

2011

5–9 143 24 118 1 0.7 0.2 1.2

10–14 15,405 1,743 13,588 74 74.4 16.5 134.3

15–19 459,029 90,764 366,818 1,447 2,120.8 816.3 3,485.2

20–24 542,947 147,948 393,534 1,465 2,450.8 1,307.8 3,630.0

25–29 214,534 73,357 140,628 549 1,008.2 681.7 1,337.0

30–34 91,787 34,971 56,562 254 447.5 340.1 553.0

35–39 40,734 16,911 23,711 112 207.9 173.2 241.1

40–44 21,654 10,460 11,120 74 102.9 100.0 105.2

45–54 18,136 9,910 8,182 44 40.6 45.0 36.0

55–64 4,210 2,300 1,903 7 11.1 12.5 9.7

65+ 1,064 569 486 9 2.6 3.2 2.1

Unknown Age 2,401 729 1,444 228

TOTAL 1,412,791 389,970 1,018,552 4,269 453.4 254.4 643.4

0–4 774 272 495 7 3.9 2.7 5.1

2012

5–9 151 17 134 0 0.7 0.2 1.3

10–14 14,355 1,655 12,673 27 69.5 15.7 125.5

15–19 433,239 86,150 346,430 659 2,028.2 785.8 3,331.7

20–24 554,173 152,772 400,629 772 2,453.9 1,322.8 3,630.9

25–29 224,014 77,666 146,037 311 1,046.9 716.2 1,383.8

30–34 97,736 38,011 59,594 131 467.4 362.2 572.1

35–39 43,660 18,274 25,313 73 224.0 188.1 259.0

40–44 23,882 11,596 12,245 41 113.6 110.9 115.9

45–54 20,321 11,332 8,961 28 45.9 52.0 39.9

55–64 4,950 2,783 2,161 6 12.8 15.0 10.8

65+ 1,134 602 525 7 2.6 3.2 2.2

Unknown Age 4,587 1,427 3,075 85

TOTAL 1,422,976 402,557 1,018,272 2,147 453.3 260.6 638.7

0–4 681 266 402 13 3.4 2.6 4.1

2013

5–9 145 20 123 2 0.7 0.2 1.2

10–14 12,585 1,554 11,001 30 60.9 14.7 108.9

15–19 395,612 78,404 316,438 770 1,869.7 722.9 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 99.4

15–19 381,717 77,908 303,294 515 1,804.0 718.3 2,941.0

20–24 566,385 159,804 405,876 705 2,484.6 1,368.3 3,651.1

25–29 253,825 91,729 161,793 303 1,176.2 837.0 1,523.4

30–34 113,208 45,990 67,060 158 532.4 430.6 633.7

35–39 52,536 22,894 29,545 97 268.0 234.0 300.9

40–44 27,426 13,711 13,662 53 131.5 132.3 130.3

45–54 24,773 14,318 10,424 31 56.6 66.4 47.0

55–64 6,527 3,911 2,603 13 16.6 20.6 12.8

65+ 1,449 871 570 8 3.2 4.4 2.3

Unknown Age 1,753 621 1,033 99

TOTAL 1,441,789 433,325 1,006,441 2,023 456.1 278.4 627.2

* 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.
90 Chlamydia Tables STD Surveillance 2014

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

United States*, 2014

Age

Group

American Indians/

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 4 2 2 8 2 6 130 46 84

5–9 2 0 2 1 0 1 47 9 38

10–14 166 18 148 49 1 47 4,573 651 3,916

15–19 3,754 675 3,078 2,420 342 2,076 124,318 30,538 93,695

20–24 5,217 1,174 4,041 6,110 1,451 4,654 164,078 51,501 112,497

25–29 2,717 656 2,061 3,891 1,273 2,610 68,020 27,052 40,939

30–34 1,375 331 1,042 2,103 773 1,328 27,794 12,666 15,116

35–39 582 171 411 1,069 410 658 12,114 6,229 5,877

40–44 296 93 203 674 314 357 5,763 3,423 2,332

45–54 191 60 131 609 287 322 5,071 3,223 1,844

55–64 48 15 33 165 69 96 1,358 821 536

65+ 8 5 3 28 13 15 224 142 82

Unknown Age 7 4 3 26 7 19 226 94 129

TOTAL 14,367 3,204 11,158 17,153 4,942 12,189 413,716 136,395 277,085

Age

Group

Native Hawaiians/

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 3 1 2 108 31 77 8 5 3

5–9 0 0 0 31 3 26 0 0 0

10–14 11 0 11 1,747 95 1,652 68 0 68

15–19 698 94 604 83,923 12,892 70,995 2,293 378 1,914

20–24 1,244 264 980 140,813 37,474 103,275 2,756 742 2,012

25–29 660 195 464 62,605 22,473 40,109 1,227 494 732

30–34 312 86 226 26,710 11,060 15,641 517 285 231

35–39 136 33 103 11,635 5,239 6,387 227 150 77

40–44 53 24 29 6,127 3,284 2,837 130 99 29

45–54 51 27 24 6,305 4,237 2,067 132 108 24

55–64 9 5 4 1,663 1,248 414 32 22 10

65+ 1 1 0 345 258 87 3 0 3

Unknown Age 5 0 5 210 74 135 6 1 5

TOTAL 3,183 730 2,452 342,222 98,368 243,702 7,399 2,284 5,108

Age

Group

Hispanics Other/Unknown

Total† Male Female Total† Male Female

0–4 52 14 36 241 81 149

5–9 28 1 26 59 9 50

10–14 1,405 145 1,259 2,753 351 2,387

15–19 49,005 9,127 39,845 96,431 19,932 76,183

20–24 75,538 19,172 56,318 144,494 40,593 103,446

25–29 37,674 12,607 25,043 66,725 23,180 43,347

30–34 18,309 6,670 11,620 31,766 12,320 19,340

35–39 8,876 3,383 5,481 15,850 6,371 9,415

40–44 4,383 1,871 2,507 8,920 4,045 4,847

45–54 3,257 1,654 1,601 8,240 4,168 4,048

55–64 619 332 286 2,354 1,241 1,104

65+ 116 63 53 642 348 287

Unknown Age 201 63 131 941 333 530

TOTAL 199,463 55,102 144,206 379,416 112,972 265,133

* Includes 48 states reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2014.

† Total includes cases reported with unknown sex.

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 3–5 for total and sex-specific 

cases and rates.

Cases in the 0–4 age group may include cases due to perinatal transmission.
STD Surveillance 2014 Chlamydia Tables 91

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

Group, and Sex, United States*, 2014

Age

Group

American Indians/

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 2.5 2.5 2.6 0.9 0.4 1.4 4.9 3.4 6.5

5–9 1.2 0.0 2.5 0.1 0.0 0.2 1.8 0.7 2.9

10–14 99.2 21.1 180.1 5.5 0.2 10.5 164.6 46.1 286.5

15–19 2,148.5 756.0 3,602.5 261.3 72.5 456.4 4,151.3 2,003.6 6,371.5

20–24 2,851.9 1,255.6 4,518.7 533.1 250.0 822.8 5,178.6 3,241.2 7,122.5

25–29 1,734.5 835.5 2,638.0 305.5 206.6 396.8 2,547.8 2,081.8 2,987.7

30–34 948.8 459.0 1,431.4 161.4 127.2 191.0 1,079.7 1,032.5 1,121.6

35–39 437.0 260.5 608.5 82.7 67.6 95.8 513.7 560.5 471.4

40–44 212.8 135.8 287.3 53.6 53.4 53.3 230.0 289.7 176.2

45–54 63.8 41.7 84.3 28.8 29.1 28.5 98.1 132.6 67.3

55–64 20.4 13.4 26.6 9.8 9.1 10.4 33.8 44.9 24.5

65+ 4.2 5.8 2.8 1.8 1.9 1.7 6.4 10.3 3.9

Unknown Age

TOTAL 668.8 303.0 1,022.9 112.0 67.9 151.6 1,117.9 772.0 1,432.6

Age

Group

Native Hawaiians/

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 7.8 5.1 10.6 1.1 0.6 1.6 0.9 1.1 0.7

5–9 0.0 0.0 0.0 0.3 0.1 0.5 0.0 0.0 0.0

10–14 29.2 0.0 60.6 16.3 1.7 31.6 10.0 0.0 20.2

15–19 1,778.8 469.3 3,144.5 741.6 221.5 1,291.6 385.0 126.0 647.2

20–24 2,619.3 1,080.5 4,249.8 1,155.6 603.5 1,728.2 561.9 310.3 800.5

25–29 1,423.1 822.6 2,046.7 529.4 375.5 686.6 321.5 273.5 364.3

30–34 730.3 393.9 1,081.8 231.2 189.7 273.3 154.2 180.8 130.0

35–39 368.6 175.4 569.6 107.8 96.4 119.1 82.5 116.0 52.8

40–44 153.1 137.8 168.6 49.2 52.5 45.7 50.8 81.7 21.5

45–54 78.2 83.1 73.2 22.0 29.7 14.3 29.0 49.8 10.1

55–64 19.5 22.2 17.0 6.1 9.4 3.0 9.7 14.0 5.8

65+ 2.8 6.1 0.0 1.0 1.8 0.5 1.1 0.0 1.9

Unknown Age

TOTAL 625.1 284.5 970.8 180.6 105.5 253.3 128.6 80.9 174.1

Age

Group

Hispanics

Total† Male Female

0–4 1.0 0.5 1.4

5–9 0.6 0.0 1.1

10–14 30.3 6.1 55.5

15–19 1,084.1 391.6 1,820.0

20–24 1,669.7 802.6 2,637.3

25–29 873.3 549.0 1,241.2

30–34 430.7 299.6 574.0

35–39 225.3 167.2 286.0

40–44 120.8 100.9 141.2

45–54 55.8 56.3 55.3

55–64 17.2 19.2 15.3

65+ 3.7 4.7 3.0

Unknown Age

TOTAL 380.6 207.1 559.0

* Includes 48 states reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2014.

† 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.
92 Chlamydia Tables STD Surveillance 2014

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

Reported Cases by Age, United States, 2010–2014

Age Cases Rate per 100,000 Population

2010

15 25,432 1,231.1

16 48,233 2,296.7

17 73,089 3,428.0

18 100,399 4,573.2

19 107,099 4,774.3

20 99,175 4,485.9

21 84,674 3,973.3

22 69,755 3,342.6

23 56,264 2,734.2

24 46,126 2,212.0

25 37,155 1,768.4

2011

15 25,792 1,272.2

16 48,942 2,368.5

17 75,143 3,569.5

18 104,501 4,902.9

19 112,440 5,122.9

20 107,958 4,804.7

21 95,195 4,236.2

22 77,799 3,605.2

23 62,339 2,953.3

24 50,243 2,417.5

25 40,711 1,943.9

2012

15 24,453 1,207.2

16 45,041 2,212.8

17 69,465 3,346.4

18 99,459 4,699.5

19 108,012 5,036.6

20 104,425 4,727.7

21 96,456 4,266.0

22 81,292 3,593.9

23 65,473 3,011.7

24 52,983 2,489.8

25 41,911 1,999.6

2013

15 21,680 1,070.3

16 40,528 1,994.3

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

25 44,330 2,068.5

2014

15 20,096 992.1

16 38,507 1,894.8

17 58,940 2,885.1

18 87,040 4,174.8

19 98,711 4,640.4

20 98,480 4,567.5

21 94,204 4,241.9

22 82,581 3,631.2

23 71,535 3,142.5

24 59,076 2,698.8

25 47,696 2,225.6

NOTE: This table should be used only for age comparisons. Cases reported with unknown sex are not included in this table.
STD Surveillance 2014 Gonorrhea Tables 93

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

United States, 2014

Rank* State Cases Rate per 100,000 Population

1 Louisiana 9,002 194.6

2 Mississippi 5,625 188.1

3 Alaska 1,341 182.4

4 South Carolina 8,253 172.8

5 Oklahoma 6,137 159.4

6 Alabama 7,677 158.8

7 Arkansas 4,539 153.4

8 North Carolina 14,415 146.4

9 Ohio 16,237 140.3

10 Delaware 1,279 138.2

11 Georgia 13,770 137.8

12 Texas 35,322 133.6

13 Illinois 15,970 124.0

14 Missouri 7,387 122.2

15 California 45,408 118.5

16 Arizona 7,750 117.0

17 Nevada 3,188 114.3

18 Indiana 7,289 110.9

19 Tennessee 7,199 110.8

U.S. TOTAL† 350,062 110.7

20 New Mexico 2,246 107.7

21 Florida 20,944 107.1

22 New York 20,758 105.6

23 South Dakota 892 105.6

24 Maryland 6,108 103.0

25 Virginia 8,250 99.9

26 Pennsylvania 12,710 99.5

27 Kentucky 4,353 99.0

28 Michigan 9,688 97.9

29 North Dakota 694 95.9

30 Washington 6,221 89.2

31 Kansas 2,568 88.7

32 Nebraska 1,459 78.1

33 Minnesota 4,073 75.1

34 New Jersey 6,636 74.6

35 Hawaii 1,020 72.6

36 Wisconsin 4,078 71.0

37 Connecticut 2,333 64.9

38 Colorado 3,170 60.2

39 Oregon 2,320 59.0

40 Massachusetts 3,817 57.0

41 Rhode Island 590 56.1

42 Iowa 1,641 53.1

43 Utah 1,441 49.7

44 West Virginia 841 45.4

45 Montana 434 42.8

46 Idaho 443 27.5

47 Wyoming 116 19.9

48 Maine 237 17.8

49 New Hampshire 226 17.1

50 Vermont 84 13.4

* States were ranked by rate, then case count, then in alphabetical order, with rates shown rounded to the nearest tenth.

† Total includes cases reported by the District of Columbia with 1,883 cases and a rate of 291.3, but excludes outlying areas (Guam with 99 cases and rate of 61.7, 

Puerto Rico with 454 cases and rate of 12.6, and Virgin Islands with 84 cases and rate of 80.2)
94 Gonorrhea Tables STD Surveillance 2014

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

Alphabetical Order, United States and Outlying Areas, 2010–2014

Cases Rates per 100,000 Population

State/Area 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Alabama 7,933 9,132 9,270 8,377 7,677 166.0 190.1 192.2 173.3 158.8

Alaska 1,273 984 726 1,128 1,341 179.2 136.2 99.3 153.4 182.4

Arizona 3,249 4,564 5,809 6,412 7,750 50.8 70.4 88.6 96.8 117.0

Arkansas 4,769 4,687 4,307 4,007 4,539 163.6 159.5 146.0 135.4 153.4

California 26,441 27,516 33,579 38,166 45,408 71.0 73.0 88.3 99.6 118.5

Colorado 2,787 2,363 2,822 2,820 3,170 55.4 46.2 54.4 53.5 60.2

Connecticut 2,569 2,449 2,133 2,860 2,333 71.9 68.4 59.4 79.5 64.9

Delaware 1,010 827 899 1,390 1,279 112.5 91.2 98.0 150.1 138.2

District of Columbia 2,104 2,569 2,402 2,478 1,883 349.7 415.7 379.9 383.3 291.3

Florida 20,163 19,689 19,462 20,818 20,944 107.2 103.3 100.7 106.5 107.1

Georgia 15,852 16,428 15,326 14,252 13,770 163.6 167.4 154.5 142.6 137.8

Hawaii 759 685 815 718 1,020 55.8 49.8 58.5 51.1 72.6

Idaho 147 162 167 211 443 9.4 10.2 10.5 13.1 27.5

Illinois 15,777 17,037 18,149 16,464 15,970 123.0 132.4 141.0 127.8 124.0

Indiana 6,496 6,569 7,338 7,144 7,289 100.2 100.8 112.2 108.7 110.9

Iowa 1,803 1,920 2,006 1,472 1,641 59.2 62.7 65.3 47.6 53.1

Kansas 2,084 2,209 2,228 2,161 2,568 73.0 76.9 77.2 74.7 88.7

Kentucky 4,345 4,521 4,283 4,315 4,353 100.1 103.5 97.8 98.2 99.0

Louisiana 8,912 9,169 8,873 8,669 9,002 196.6 200.4 192.8 187.4 194.6

Maine 162 272 456 245 237 12.2 20.5 34.3 18.4 17.8

Maryland 7,413 6,458 5,686 5,989 6,108 128.4 110.8 96.6 101.0 103.0

Massachusetts 2,483 2,353 2,628 3,106 3,817 37.9 35.7 39.5 46.4 57.0

Michigan 13,627 12,901 12,584 10,569 9,688 137.9 130.6 127.3 106.8 97.9

Minnesota 2,119 2,284 3,082 3,873 4,073 40.0 42.7 57.3 71.5 75.1

Mississippi 6,195 5,814 6,875 5,096 5,625 208.8 195.2 230.3 170.4 188.1

Missouri 7,159 7,802 7,889 7,546 7,387 119.5 129.8 131.0 124.8 122.2

Montana 102 85 108 224 434 10.3 8.5 10.7 22.1 42.8

Nebraska 1,187 1,352 1,429 1,385 1,459 65.0 73.4 77.0 74.1 78.1

Nevada 1,728 2,000 2,264 2,714 3,188 64.0 73.4 82.1 97.3 114.3

New Hampshire 151 130 147 121 226 11.5 9.9 11.1 9.1 17.1

New Jersey 5,872 7,348 7,486 7,014 6,636 66.8 83.3 84.4 78.8 74.6

New Mexico 1,229 1,839 1,883 1,918 2,246 59.7 88.3 90.3 92.0 107.7

New York 18,320 20,706 22,571 19,919 20,758 94.5 106.4 115.3 101.4 105.6

North Carolina 14,111 17,454 14,318 13,666 14,415 148.0 180.8 146.8 138.8 146.4

North Dakota 204 251 335 492 694 30.3 36.7 47.9 68.0 95.9

Ohio 16,496 16,726 16,493 16,619 16,237 143.0 144.9 142.9 143.6 140.3

Oklahoma 4,369 4,215 4,441 5,303 6,137 116.5 111.2 116.4 137.7 159.4

Oregon 1,076 1,489 1,464 1,729 2,320 28.1 38.5 37.5 44.0 59.0

Pennsylvania 12,883 13,770 15,390 13,874 12,710 101.4 108.1 120.6 108.6 99.5

Rhode Island 291 360 507 454 590 27.6 34.2 48.3 43.2 56.1

South Carolina 7,970 8,350 7,638 7,194 8,253 172.3 178.4 161.7 150.7 172.8

South Dakota 468 602 707 784 892 57.5 73.1 84.8 92.8 105.6

Tennessee 7,121 7,667 9,098 7,376 7,199 112.2 119.7 140.9 113.5 110.8

Texas 31,788 30,930 32,473 33,835 35,322 126.4 120.5 124.6 127.9 133.6

Utah 310 277 479 951 1,441 11.2 9.8 16.8 32.8 49.7

Vermont 58 48 99 97 84 9.3 7.7 15.8 15.5 13.4

Virginia 7,402 6,518 6,885 6,952 8,250 92.5 80.5 84.1 84.2 99.9

Washington 2,864 2,737 3,238 4,369 6,221 42.6 40.1 46.9 62.7 89.2

West Virginia 579 796 831 1,063 841 31.2 42.9 44.8 57.3 45.4

Wisconsin 5,091 4,789 4,704 4,599 4,078 89.5 83.8 82.1 80.1 71.0

Wyoming 40 46 44 66 116 7.1 8.1 7.6 11.3 19.9

U.S. TOTAL 309,341 321,849 334,826 333,004 350,062 100.2 103.3 106.7 105.3 110.7

Northeast 42,789 47,436 51,417 47,690 47,391 77.4 85.4 92.2 85.2 84.7

Midwest 72,511 74,442 76,944 73,108 71,976 108.3 110.8 114.3 108.2 106.6

South 152,036 155,224 153,067 150,780 155,597 132.7 133.8 130.5 127.4 131.4

West 42,005 44,747 53,398 61,426 75,098 58.4 61.4 72.6 82.7 101.1

Guam 97 96 92 92 99 60.8 60.2 57.5 57.4 61.7

Puerto Rico 312 341 345 356 454 8.4 9.2 9.4 9.8 12.6

Virgin Islands 151 139 136 58 84 142.1 131.4 129.2 55.4 80.2

OUTLYING AREAS 560 576 573 506 637 14.0 14.5 14.6 13.0 16.4

TOTAL 309,901 322,425 335,399 333,510 350,699 99.1 102.2 105.5 104.2 109.6
STD Surveillance 2014 Gonorrhea Tables 95

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, 2010–2014

Cases Rates per 100,000 Population

State/Area 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Alabama 4,432 5,103 5,187 4,668 4,090 180.2 206.3 208.9 187.6 164.4

Alaska 698 515 385 589 665 204.9 148.2 109.9 168.5 190.2

Arizona 1,553 2,212 2,827 3,102 3,564 48.3 67.9 85.8 93.1 107.0

Arkansas 2,729 2,687 2,432 2,160 2,527 183.9 179.7 162.1 143.4 167.8

California 10,546 10,811 13,045 14,258 16,009 56.3 57.1 68.2 74.0 83.1

Colorado 1,514 1,285 1,362 1,243 1,318 60.4 50.4 52.7 47.4 50.3

Connecticut 1,449 1,378 1,153 1,419 1,108 79.0 75.1 62.6 77.0 60.2

Delaware 621 471 496 763 693 134.1 100.8 104.9 159.7 145.0

District of Columbia 1,073 1,209 1,006 953 858 338.0 371.1 301.8 280.1 252.2

Florida 10,240 9,999 9,570 9,718 9,228 106.5 102.7 97.0 97.3 92.4

Georgia 8,297 8,589 7,921 7,060 6,552 167.3 171.4 156.3 138.1 128.2

Hawaii 314 273 299 264 350 46.2 39.9 43.3 38.0 50.4

Idaho 68 79 63 87 196 8.7 10.0 7.9 10.8 24.3

Illinois 8,924 9,500 9,837 8,574 7,559 136.5 144.9 150.1 130.8 115.3

Indiana 3,598 3,690 4,139 3,796 3,819 109.2 111.5 124.7 113.8 114.5

Iowa 1,179 1,217 1,170 812 862 76.7 78.8 75.5 52.2 55.4

Kansas 1,235 1,360 1,339 1,222 1,464 85.9 94.1 92.3 84.2 100.8

Kentucky 2,487 2,596 2,328 2,331 2,270 112.8 117.0 104.7 104.4 101.7

Louisiana 4,824 5,263 5,080 4,927 5,049 208.5 225.3 216.2 208.6 213.8

Maine 75 122 240 119 98 11.1 18.0 35.4 17.5 14.5

Maryland 4,028 3,461 2,878 2,841 2,793 135.1 115.1 94.9 93.0 91.5

Massachusetts 1,004 1,083 1,076 1,168 1,215 29.7 31.9 31.4 33.9 35.2

Michigan 7,971 7,599 7,194 5,865 5,129 158.3 151.1 142.9 116.5 101.8

Minnesota 1,248 1,294 1,676 2,037 1,802 46.7 48.1 61.9 74.7 66.1

Mississippi 3,602 3,344 3,834 2,726 2,987 236.0 218.3 249.7 177.4 194.4

Missouri 3,951 4,195 4,209 3,944 3,620 129.3 136.8 137.1 128.0 117.5

Montana 56 51 58 127 221 11.4 10.3 11.6 25.1 43.7

Nebraska 675 823 784 694 770 73.4 88.7 84.0 73.9 82.0

Nevada 830 879 982 1,203 1,294 62.1 65.2 71.8 86.9 93.4

New Hampshire 59 59 61 52 91 8.8 8.8 9.1 7.8 13.6

New Jersey 3,115 3,916 3,798 3,484 3,082 69.0 86.6 83.6 76.5 67.7

New Mexico 610 925 857 823 961 58.6 87.9 81.4 78.3 91.4

New York 8,718 9,716 10,021 8,020 7,077 87.2 96.8 99.4 79.3 70.0

North Carolina 8,314 10,076 8,093 7,547 7,759 170.0 203.4 161.9 149.5 153.7

North Dakota 140 149 207 301 385 42.1 44.1 60.2 85.2 108.9

Ohio 10,034 10,009 9,706 9,176 8,735 169.9 169.5 164.5 155.2 147.8

Oklahoma 2,493 2,395 2,652 3,000 3,451 131.6 125.1 137.8 154.4 177.6

Oregon 477 602 528 566 786 24.7 30.8 26.8 28.5 39.6

Pennsylvania 7,268 7,687 8,360 7,206 6,164 111.6 117.7 128.0 110.3 94.4

Rhode Island 121 167 232 192 218 22.2 30.8 42.8 35.4 40.2

South Carolina 4,905 4,981 4,416 4,050 4,527 206.5 207.3 182.0 165.2 184.6

South Dakota 290 399 446 464 557 71.3 97.1 107.5 110.3 132.5

Tennessee 3,884 4,112 4,721 3,617 3,419 119.4 125.3 142.7 108.7 102.7

Texas 17,246 16,476 17,151 17,206 17,253 136.1 127.4 130.8 129.4 129.7

Utah 75 66 132 373 565 5.5 4.7 9.3 25.9 39.2

Vermont 24 24 54 46 35 7.6 7.6 17.0 14.5 11.0

Virginia 4,146 3,693 3,734 3,678 4,361 101.7 89.6 89.7 87.6 103.9

Washington 1,044 1,066 1,230 1,704 2,504 30.9 31.2 35.6 48.8 71.8

West Virginia 326 467 438 539 461 34.7 49.7 46.6 57.4 49.1

Wisconsin 3,164 2,907 2,640 2,455 2,046 110.5 101.1 91.6 84.9 70.8

Wyoming 19 25 19 39 61 6.9 9.0 6.7 13.7 21.4

U.S. TOTAL 165,693 171,005 172,066 163,208 162,608 105.6 108.0 107.9 101.7 101.3

Northeast 21,833 24,152 24,995 21,706 19,088 76.7 84.7 87.3 75.6 66.5

Midwest 42,409 43,142 43,347 39,340 36,748 124.7 126.5 126.9 114.8 107.3

South 83,647 84,922 81,937 77,784 78,278 143.2 143.6 137.1 129.0 129.8

West 17,804 18,789 21,787 24,378 28,494 49.3 51.4 59.1 65.5 76.6

Guam 45 44 46 43 47 57.4 56.0 58.4 54.4 59.5

Puerto Rico 141 140 157 120 161 7.3 7.2 8.2 6.4 8.5

Virgin Islands 96 94 92 41 54 170.3 167.3 164.2 73.4 96.7

OUTLYING AREAS 282 278 295 204 262 13.6 13.4 14.4 10.1 13.0

TOTAL 165,975 171,283 172,361 163,412 162,870 104.4 106.8 106.7 100.6 100.2

NOTE: Cases reported with unknown sex are not included in this table.
96 Gonorrhea Tables STD Surveillance 2014

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, 2010–2014

Cases Rates per 100,000 Population

State/Area 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Alabama 3,430 3,825 4,034 3,680 3,563 147.8 164.2 172.5 156.9 151.9

Alaska 575 469 341 539 676 155.6 125.0 89.4 139.8 175.3

Arizona 1,696 2,350 2,981 3,310 4,186 53.4 72.9 91.5 100.5 127.0

Arkansas 2,038 1,996 1,873 1,843 2,007 142.4 138.3 129.3 126.8 138.1

California 15,773 16,598 20,431 23,849 29,310 85.2 88.5 108.0 125.1 153.7

Colorado 1,273 1,078 1,460 1,577 1,852 50.5 42.0 56.1 59.6 70.0

Connecticut 1,120 1,071 978 1,440 1,219 64.4 61.4 55.9 82.1 69.5

Delaware 389 356 403 627 586 89.4 80.9 90.7 140.0 130.8

District of Columbia 1,028 1,360 1,386 1,519 1,011 361.7 465.4 463.5 496.0 330.1

Florida 9,906 9,675 9,892 11,049 11,686 107.8 103.8 104.7 115.5 122.2

Georgia 7,421 7,684 7,301 7,075 7,137 156.9 160.0 150.5 144.9 146.2

Hawaii 445 412 516 454 669 65.3 59.7 73.5 64.0 94.3

Idaho 78 83 104 124 247 9.9 10.5 13.0 15.4 30.6

Illinois 6,824 7,513 8,283 7,872 8,386 108.5 119.0 131.1 124.4 132.6

Indiana 2,884 2,867 3,188 3,347 3,465 90.4 89.4 99.1 103.4 107.1

Iowa 624 703 836 660 779 41.4 46.3 54.8 43.0 50.8

Kansas 849 849 889 939 1,104 60.0 59.5 61.9 65.1 76.6

Kentucky 1,854 1,913 1,948 1,966 2,068 86.8 89.0 90.3 90.9 95.6

Louisiana 3,540 3,739 3,793 3,742 3,953 159.5 167.0 168.4 165.3 174.6

Maine 86 150 216 126 137 13.2 23.1 33.2 19.4 21.1

Maryland 3,377 2,992 2,806 3,145 3,304 121.0 106.1 98.4 109.4 114.9

Massachusetts 1,479 1,269 1,551 1,932 2,590 46.7 39.8 48.2 59.5 79.8

Michigan 5,634 5,281 5,372 4,694 4,551 116.2 109.0 110.8 96.6 93.7

Minnesota 871 990 1,395 1,835 2,260 33.1 37.3 52.2 68.1 83.9

Mississippi 2,593 2,470 3,039 2,370 2,637 179.9 170.8 209.7 162.9 181.3

Missouri 3,208 3,607 3,680 3,602 3,767 109.4 122.5 124.7 121.5 127.1

Montana 46 34 50 97 213 9.3 6.8 9.9 19.0 41.8

Nebraska 512 528 641 674 686 56.5 57.7 69.5 72.5 73.8

Nevada 898 1,121 1,280 1,509 1,892 65.9 81.6 92.0 107.4 134.6

New Hampshire 92 71 86 69 135 14.2 10.9 13.2 10.6 20.7

New Jersey 2,727 3,400 3,673 3,514 3,544 63.7 79.1 85.0 80.9 81.6

New Mexico 619 914 1,025 1,095 1,284 60.8 88.7 99.3 105.9 124.2

New York 9,601 10,977 12,529 11,844 13,624 102.4 116.4 132.0 124.2 142.9

North Carolina 5,712 7,300 6,180 6,113 6,652 123.0 155.2 130.0 127.3 138.6

North Dakota 64 101 127 191 309 18.8 29.2 35.7 51.6 83.5

Ohio 6,421 6,717 6,787 7,443 7,502 114.0 119.1 120.3 131.5 132.6

Oklahoma 1,873 1,708 1,789 2,303 2,685 100.9 91.0 94.7 120.7 140.8

Oregon 599 887 936 1,163 1,532 31.6 46.3 48.5 59.8 78.8

Pennsylvania 5,615 6,078 7,025 6,659 6,543 90.7 97.8 112.8 106.7 104.8

Rhode Island 170 193 275 262 372 33.4 38.0 54.1 51.4 73.0

South Carolina 3,056 3,351 3,196 3,133 3,689 135.8 147.2 139.1 134.9 158.8

South Dakota 177 202 259 320 335 43.4 48.9 61.9 75.4 78.9

Tennessee 3,235 3,555 4,368 3,758 3,778 104.6 113.9 138.7 118.7 119.3

Texas 14,524 14,448 15,286 16,410 18,035 116.5 113.4 118.1 124.8 137.2

Utah 235 211 347 578 876 16.9 14.9 24.2 39.6 60.0

Vermont 33 24 45 51 49 10.7 7.8 14.6 16.5 15.8

Virginia 3,248 2,814 3,145 3,272 3,879 82.7 70.8 78.2 80.5 95.5

Washington 1,818 1,671 2,008 2,665 3,717 54.3 49.0 58.3 76.5 106.7

West Virginia 253 329 393 524 380 27.7 36.0 42.9 57.2 41.5

Wisconsin 1,926 1,880 2,064 2,140 2,027 68.2 66.3 72.6 75.0 71.1

Wyoming 21 21 25 27 55 7.3 7.2 8.5 9.1 18.5

U.S. TOTAL 142,470 149,835 162,235 169,130 186,943 93.9 97.7 105.0 108.7 120.1

Northeast 20,923 23,233 26,378 25,897 28,213 77.9 86.1 97.2 95.1 103.6

Midwest 29,994 31,238 33,521 33,717 35,171 91.1 94.5 101.1 101.3 105.6

South 67,477 69,515 70,832 72,529 77,050 120.2 122.2 123.2 124.9 132.7

West 24,076 25,849 31,504 36,987 46,509 67.2 71.1 85.9 99.9 125.6

Guam 52 52 46 49 52 64.2 64.2 56.7 60.2 63.9

Puerto Rico 171 201 188 236 293 9.6 11.3 10.7 13.6 16.9

Virgin Islands 55 45 44 17 30 110.2 90.7 89.3 34.8 61.3

OUTLYING AREAS 278 298 278 302 375 14.5 15.6 14.7 16.2 20.2

TOTAL 142,748 150,133 162,513 169,432 187,318 92.9 96.7 103.9 107.6 118.9

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2014 Gonorrhea Tables 97

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

Statistical Areas (MSAs)* in Alphabetical Order, United States, 2010–2014

MSAs

Cases Rates per 100,000 Population

2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Atlanta-Sandy Springs-Roswell, GA 8,351 8,577 8,299 5,452 7,256 158.0 159.5 152.1 98.7 131.4

Austin-Round Rock, TX 1,932 2,009 2,204 2,570 2,860 112.6 112.6 120.2 136.5 151.9

Baltimore-Columbia-Towson, MD 4,369 3,634 2,974 3,233 3,459 161.2 133.2 108.0 116.7 124.8

Birmingham-Hoover, AL 2,363 2,550 2,340 2,130 1,957 209.5 225.2 205.9 186.8 171.6

Boston-Cambridge-Newton, MA-NH 1,881 1,671 1,995 2,372 2,716 41.3 36.4 43.0 50.6 58.0

Buffalo-Cheektowaga-Niagara Falls, NY 1,227 1,543 2,172 1,232 1,342 108.1 136.1 191.5 108.6 118.3

Charlotte-Concord-Gastonia, NC-SC 3,060 3,832 3,172 3,058 3,645 138.0 169.7 138.1 130.9 156.1

Chicago-Naperville-Elgin, IL-IN-WI 12,380 13,188 14,304 12,793 12,630 130.9 138.8 150.2 134.1 132.4

Cincinnati, OH-KY-IN 3,378 3,515 3,227 3,229 3,346 159.7 165.6 151.6 151.1 156.5

Cleveland-Elyria, OH 3,608 3,930 4,203 4,155 3,802 173.7 190.0 203.7 201.2 184.1

Columbus, OH 3,354 3,038 2,859 3,220 3,260 176.3 157.9 147.1 163.7 165.7

Dallas-Fort Worth-Arlington, TX 8,771 8,743 7,842 8,354 9,195 136.5 132.8 117.0 122.7 135.0

Denver-Aurora-Lakewood, CO 2,344 1,662 2,055 1,828 2,016 92.2 63.9 77.7 67.8 74.7

Detroit-Warren-Dearborn, MI 9,160 8,924 8,062 6,564 5,311 213.2 208.2 187.8 152.8 123.7

Hartford-West Hartford-East Hartford, CT 1,126 1,036 744 1,065 894 92.9 85.4 61.3 87.6 73.6

Houston-The Woodlands-Sugar Land, TX 7,645 6,861 7,582 7,783 8,299 129.1 113.2 122.7 123.3 131.5

Indianapolis-Carmel-Anderson, IN 3,140 3,128 3,738 3,616 3,759 166.3 163.8 193.8 185.1 192.4

Jacksonville, FL 2,128 2,040 1,948 2,321 2,608 158.1 150.0 141.4 166.4 187.0

Kansas City, MO-KS 3,202 2,913 2,919 2,696 2,642 159.4 143.7 143.2 131.2 128.6

Las Vegas-Henderson-Paradise, NV 1,604 1,740 1,968 2,256 2,653 82.2 88.3 98.4 111.2 130.8

Los Angeles-Long Beach-Anaheim, CA 11,156 11,105 13,102 14,449 17,130 87.0 85.8 100.4 110.0 130.5

Louisville/Jefferson County, KY-IN 2,243 2,400 2,040 2,063 1,962 181.5 192.7 163.0 163.4 155.4

Memphis, TN-MS-AR 4,094 3,852 4,498 3,086 2,625 309.0 288.7 335.2 230.0 195.6

Miami-Fort Lauderdale-West Palm Beach, FL 5,506 5,352 5,291 5,801 6,128 98.9 94.4 91.8 99.5 105.1

Milwaukee-Waukesha-West Allis, WI 3,425 3,349 3,277 3,179 2,584 220.1 214.4 209.1 202.5 164.6

Minneapolis-St. Paul-Bloomington, MN-WI 1,670 1,889 2,534 3,188 3,341 49.9 55.8 74.0 92.2 96.6

Nashville-Davidson--Murfreesboro--Franklin, TN 1,362 1,681 1,900 1,806 1,922 81.5 99.0 110.0 102.7 109.3

New Orleans-Metairie, LA 2,022 2,099 2,198 2,448 2,667 169.9 173.1 179.1 197.3 214.9

New York-Newark-Jersey City, NY-NJ-PA 17,724 21,153 21,310 19,319 20,054 90.6 107.4 107.5 96.8 100.5

Oklahoma City, OK 1,700 1,845 1,947 2,352 2,366 135.7 144.4 150.2 178.2 179.3

Orlando-Kissimmee-Sanford, FL 2,495 2,277 2,328 2,514 2,571 116.9 104.9 104.7 110.9 113.4

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 9,694 10,123 11,026 10,557 9,618 162.5 168.9 183.2 174.9 159.4

Phoenix-Mesa-Scottsdale, AZ 2,335 3,340 4,526 4,918 5,944 55.7 78.3 104.5 111.8 135.1

Pittsburgh, PA 2,069 2,473 3,048 2,827 2,602 87.8 104.8 129.1 119.7 110.2

Portland-Vancouver-Hillsboro, OR-WA 926 1,318 1,183 1,199 1,499 41.6 58.3 51.7 51.8 64.8

Providence-Warwick, RI-MA 382 475 643 593 913 23.9 29.7 40.2 37.0 56.9

Raleigh, NC 1,388 1,606 1,532 1,384 1,408 122.8 138.0 128.9 114.0 115.9

Richmond, VA 1,701 1,419 1,671 1,658 2,173 140.8 116.4 135.6 133.1 174.4

Riverside-San Bernardino-Ontario, CA 1,924 2,330 3,031 3,273 4,292 45.5 54.1 69.7 74.7 98.0

Sacramento--Roseville--Arden-Arcade, CA 1,676 1,913 2,324 2,597 2,616 78.0 87.9 105.8 117.2 118.1

Salt Lake City, UT 202 197 342 690 1,026 18.6 17.8 30.4 60.5 90.0

San Antonio-New Braunfels, TX 3,729 3,731 3,672 3,352 3,155 174.0 170.0 164.4 147.2 138.5

San Diego-Carlsbad, CA 2,021 2,173 2,620 2,825 3,420 65.3 69.2 82.5 88.0 106.5

San Francisco-Oakland-Hayward, CA 4,867 5,009 5,263 5,681 7,110 112.3 114.1 118.1 125.8 157.4

San Jose-Sunnyvale-Santa Clara, CA 586 680 1,020 1,145 1,552 31.9 36.5 53.8 59.6 80.8

Seattle-Tacoma-Bellevue, WA 2,189 1,971 2,323 2,990 3,931 63.6 56.3 65.4 82.8 108.9

St. Louis, MO-IL 4,136 5,014 4,810 4,492 4,346 148.4 179.6 172.0 160.4 155.2

Tampa-St. Petersburg-Clearwater, FL 3,516 3,655 3,422 3,660 3,455 126.3 129.4 120.4 127.5 120.4

Virginia Beach-Norfolk-Newport News, VA-NC 3,431 2,813 2,630 2,581 3,206 204.6 166.9 154.7 151.2 187.8

Washington-Arlington-Alexandria, DC-VA-MD-WV 5,250 5,503 5,369 5,616 2,974 93.1 95.6 91.6 94.4 50.0

SELECTED MSAs TOTAL 190,442 197,279 205,487 202,170 212,240 113.7 116.4 120.0 117.0 122.8

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

NOTE: Cases reported with unknown sex are not included in this table.
98 Gonorrhea Tables STD Surveillance 2014

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

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2010–2014

Cases Rates per 100,000 Population

MSAs 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Atlanta-Sandy Springs-Roswell, GA 3,964 4,141 3,907 2,458 3,030 146.0 150.2 139.4 86.5 106.7

Austin-Round Rock, TX 910 935 993 1,078 1,213 106.3 105.1 108.5 114.8 129.1

Baltimore-Columbia-Towson, MD 2,397 1,941 1,527 1,542 1,608 170.5 137.2 107.1 107.5 112.2

Birmingham-Hoover, AL 1,323 1,417 1,280 1,099 970 226.6 241.6 217.3 186.0 164.2

Boston-Cambridge-Newton, MA-NH 708 730 738 828 844 30.1 30.8 30.9 34.3 35.0

Buffalo-Cheektowaga-Niagara Falls, NY 669 828 1,173 594 664 113.9 141.3 200.4 101.6 113.5

Charlotte-Concord-Gastonia, NC-SC 1,754 2,117 1,778 1,700 1,962 154.2 182.6 150.7 141.7 163.5

Chicago-Naperville-Elgin, IL-IN-WI 6,741 7,015 7,464 6,374 5,662 139.3 144.4 153.4 130.9 116.2

Cincinnati, OH-KY-IN 2,331 2,264 2,051 1,932 1,913 215.7 208.8 188.7 177.1 175.4

Cleveland-Elyria, OH 2,082 2,371 2,426 2,328 2,021 193.0 220.9 226.7 217.6 188.9

Columbus, OH 1,919 1,561 1,514 1,500 1,473 198.3 159.5 153.2 150.0 147.3

Dallas-Fort Worth-Arlington, TX 4,791 4,653 4,157 3,921 4,153 147.1 139.6 122.5 113.6 120.3

Denver-Aurora-Lakewood, CO 1,261 885 965 724 780 98.6 67.8 72.7 53.5 57.6

Detroit-Warren-Dearborn, MI 5,217 5,114 4,406 3,614 2,698 235.6 231.6 199.3 163.5 122.0

Hartford-West Hartford-East Hartford, CT 633 596 422 543 425 101.7 95.8 67.7 87.2 68.2

Houston-The Woodlands-Sugar Land, TX 4,170 3,803 4,039 4,033 4,151 140.1 124.9 130.2 127.2 131.0

Indianapolis-Carmel-Anderson, IN 1,638 1,674 1,957 1,761 1,828 169.7 171.5 198.5 176.4 183.1

Jacksonville, FL 1,152 1,121 983 1,121 1,288 167.0 160.6 139.1 156.7 180.1

Kansas City, MO-KS 1,804 1,592 1,585 1,424 1,361 175.8 153.9 152.4 136.0 130.0

Las Vegas-Henderson-Paradise, NV 779 742 847 1,015 1,039 80.4 75.8 85.1 100.5 102.8

Los Angeles-Long Beach-Anaheim, CA 3,947 3,944 4,359 4,578 5,029 60.7 60.2 65.9 68.9 75.6

Louisville/Jefferson County, KY-IN 1,246 1,375 1,096 1,079 992 196.9 215.6 171.2 167.0 153.6

Memphis, TN-MS-AR 2,288 2,192 2,418 1,550 1,371 332.2 315.9 346.6 222.0 196.4

Miami-Fort Lauderdale-West Palm Beach, FL 2,480 2,361 2,198 2,225 2,123 86.4 80.9 74.1 74.2 70.8

Milwaukee-Waukesha-West Allis, WI 2,070 1,980 1,814 1,655 1,298 259.0 247.0 225.5 205.5 161.2

Minneapolis-St. Paul-Bloomington, MN-WI 953 1,035 1,322 1,641 1,388 56.2 60.4 76.4 93.8 79.4

Nashville-Davidson--Murfreesboro--Franklin, TN 642 776 858 838 790 75.2 89.3 97.1 93.1 87.8

New Orleans-Metairie, LA 1,027 1,131 1,186 1,317 1,339 168.2 181.6 187.9 206.1 209.6

New York-Newark-Jersey City, NY-NJ-PA 8,248 9,826 9,157 7,615 6,544 81.4 96.5 89.3 73.9 63.5

Oklahoma City, OK 962 1,034 1,081 1,305 1,310 151.3 159.7 164.6 195.1 195.9

Orlando-Kissimmee-Sanford, FL 1,171 1,090 1,087 1,114 1,109 107.5 98.4 95.8 96.3 95.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 5,125 5,361 5,581 5,052 4,461 166.0 173.0 179.3 162.0 143.0

Phoenix-Mesa-Scottsdale, AZ 1,071 1,568 2,118 2,318 2,658 50.8 73.2 97.3 104.8 120.2

Pittsburgh, PA 1,274 1,501 1,857 1,715 1,415 104.6 123.2 152.6 141.1 116.4

Portland-Vancouver-Hillsboro, OR-WA 371 482 393 325 382 32.9 42.1 33.9 27.8 32.6

Providence-Warwick, RI-MA 159 232 294 261 325 19.2 28.1 35.6 31.6 39.3

Raleigh, NC 738 868 807 677 638 127.6 145.7 132.7 108.9 102.7

Richmond, VA 967 797 908 957 1,194 154.9 126.6 142.6 148.7 185.6

Riverside-San Bernardino-Ontario, CA 976 1,196 1,562 1,576 1,966 46.0 55.3 71.5 71.7 89.4

Sacramento--Roseville--Arden-Arcade, CA 907 990 1,212 1,323 1,246 82.8 89.3 108.2 117.0 110.2

Salt Lake City, UT 40 41 88 263 376 7.4 7.4 15.8 46.4 66.3

San Antonio-New Braunfels, TX 1,886 1,835 1,865 1,624 1,445 173.0 164.4 164.5 140.7 125.2

San Diego-Carlsbad, CA 535 609 847 827 1,038 34.7 39.0 53.6 51.8 65.0

San Francisco-Oakland-Hayward, CA 1,710 1,531 1,493 1,491 1,836 77.8 68.9 66.2 65.2 80.3

San Jose-Sunnyvale-Santa Clara, CA 249 243 372 446 557 27.2 26.2 39.5 46.7 58.4

Seattle-Tacoma-Bellevue, WA 686 649 732 988 1,412 39.7 37.0 41.1 54.7 78.1

St. Louis, MO-IL 2,187 2,699 2,467 2,313 2,087 152.1 187.4 171.1 160.2 144.5

Tampa-St. Petersburg-Clearwater, FL 1,834 1,887 1,701 1,774 1,619 127.7 129.7 116.1 119.8 109.3

Virginia Beach-Norfolk-Newport News, VA-NC 1,856 1,563 1,402 1,341 1,711 217.2 182.0 162.3 154.7 197.3

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,685 2,709 2,355 2,278 1,163 92.8 91.8 78.4 74.8 38.2

SELECTED MSAs TOTAL 96,533 99,005 98,842 92,055 89,905 112.9 114.5 113.1 104.4 102.0

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2014 Gonorrhea Tables 99

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

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2010–2014

 Cases Rates per 100,000 Population

MSAs 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Atlanta-Sandy Springs-Roswell, GA 4,310 4,343 4,329 2,952 4,177 167.5 165.7 163.1 110.1 155.7

Austin-Round Rock, TX 1,022 1,073 1,196 1,295 1,635 118.8 120.1 130.1 137.2 173.3

Baltimore-Columbia-Towson, MD 1,968 1,690 1,447 1,690 1,840 150.8 128.5 109.0 126.4 137.6

Birmingham-Hoover, AL 1,024 1,094 1,057 1,029 979 188.2 200.5 193.0 187.3 178.2

Boston-Cambridge-Newton, MA-NH 1,173 940 1,257 1,541 1,870 53.2 42.3 55.9 67.8 82.3

Buffalo-Cheektowaga-Niagara Falls, NY 558 715 999 638 678 101.8 130.5 182.1 116.2 123.4

Charlotte-Concord-Gastonia, NC-SC 1,299 1,704 1,384 1,356 1,683 120.3 155.1 123.9 119.4 148.3

Chicago-Naperville-Elgin, IL-IN-WI 5,610 6,150 6,819 6,407 6,947 121.4 132.3 146.4 137.3 148.9

Cincinnati, OH-KY-IN 1,041 1,250 1,176 1,297 1,431 100.7 120.4 112.9 123.9 136.7

Cleveland-Elyria, OH 1,517 1,559 1,777 1,827 1,781 151.9 156.7 178.9 183.6 179.0

Columbus, OH 1,432 1,477 1,345 1,720 1,787 153.3 156.2 140.8 177.9 184.8

Dallas-Fort Worth-Arlington, TX 3,977 4,089 3,682 4,426 5,033 125.5 125.9 111.4 131.8 149.9

Denver-Aurora-Lakewood, CO 1,083 777 1,090 1,104 1,236 85.6 60.0 82.8 82.1 92.0

Detroit-Warren-Dearborn, MI 3,924 3,794 3,642 2,942 2,606 188.5 182.6 175.0 141.2 125.0

Hartford-West Hartford-East Hartford, CT 493 440 322 522 466 83.5 74.5 54.5 88.1 78.7

Houston-The Woodlands-Sugar Land, TX 3,462 3,055 3,543 3,749 4,146 117.6 101.3 115.2 119.3 131.9

Indianapolis-Carmel-Anderson, IN 1,499 1,447 1,772 1,854 1,927 162.5 155.0 187.9 194.0 201.7

Jacksonville, FL 973 919 965 1,198 1,316 148.4 138.8 143.8 176.3 193.7

Kansas City, MO-KS 1,398 1,321 1,334 1,272 1,281 142.2 133.1 133.6 126.2 127.1

Las Vegas-Henderson-Paradise, NV 825 998 1,119 1,239 1,612 84.0 100.7 111.3 121.8 158.4

Los Angeles-Long Beach-Anaheim, CA 7,156 7,124 8,712 9,849 12,071 113.1 111.5 135.2 151.9 186.2

Louisville/Jefferson County, KY-IN 995 1,020 940 969 961 165.0 167.9 153.8 157.2 155.9

Memphis, TN-MS-AR 1,805 1,660 2,080 1,536 1,254 283.7 259.2 323.0 238.6 194.8

Miami-Fort Lauderdale-West Palm Beach, FL 3,024 2,987 3,093 3,564 3,999 112.3 108.5 110.6 125.9 141.3

Milwaukee-Waukesha-West Allis, WI 1,354 1,368 1,463 1,521 1,281 178.9 179.9 191.8 199.0 167.6

Minneapolis-St. Paul-Bloomington, MN-WI 717 854 1,209 1,546 1,942 43.4 51.0 71.5 90.4 113.5

Nashville-Davidson--Murfreesboro--Franklin, TN 719 905 1,034 968 1,130 88.0 109.1 122.6 112.8 131.7

New Orleans-Metairie, LA 937 962 1,012 1,131 1,328 161.8 163.0 169.8 187.9 220.6

New York-Newark-Jersey City, NY-NJ-PA 9,451 11,291 12,124 11,639 13,448 100.2 118.7 126.5 120.6 139.4

Oklahoma City, OK 736 775 866 1,047 1,056 119.2 122.9 135.3 160.8 162.2

Orlando-Kissimmee-Sanford, FL 1,320 1,186 1,241 1,399 1,461 126.4 111.5 114.0 126.0 131.6

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 4,565 4,756 5,439 5,501 5,152 158.6 164.4 187.1 188.7 176.7

Phoenix-Mesa-Scottsdale, AZ 1,264 1,770 2,407 2,600 3,286 60.6 83.4 111.8 118.9 150.2

Pittsburgh, PA 795 971 1,191 1,110 1,187 69.8 85.1 104.1 96.9 103.6

Portland-Vancouver-Hillsboro, OR-WA 555 836 790 874 1,116 50.5 74.8 69.8 76.4 97.6

Providence-Warwick, RI-MA 223 243 349 331 587 28.8 31.4 45.0 42.6 75.5

Raleigh, NC 648 735 724 707 770 117.4 129.4 124.8 119.2 129.9

Richmond, VA 732 617 761 701 978 125.4 104.7 127.8 116.4 162.4

Riverside-San Bernardino-Ontario, CA 944 1,126 1,467 1,695 2,321 44.9 52.5 67.7 77.7 106.4

Sacramento--Roseville--Arden-Arcade, CA 756 917 1,104 1,271 1,362 71.8 85.9 102.6 117.1 125.5

Salt Lake City, UT 162 156 254 427 650 29.6 28.0 44.9 74.5 113.4

San Antonio-New Braunfels, TX 1,843 1,896 1,807 1,728 1,710 175.1 175.8 164.3 153.9 152.3

San Diego-Carlsbad, CA 1,482 1,552 1,766 1,995 2,354 95.4 98.4 110.6 123.6 145.8

San Francisco-Oakland-Hayward, CA 3,127 3,454 3,746 4,167 5,261 146.3 159.4 170.4 186.9 235.9

San Jose-Sunnyvale-Santa Clara, CA 333 430 626 699 995 36.1 45.9 65.8 72.4 103.1

Seattle-Tacoma-Bellevue, WA 1,501 1,322 1,591 2,002 2,519 87.7 75.7 89.9 111.1 139.7

St. Louis, MO-IL 1,949 2,315 2,340 2,178 2,256 144.4 171.2 172.8 160.5 166.3

Tampa-St. Petersburg-Clearwater, FL 1,678 1,761 1,721 1,871 1,823 124.5 128.6 124.9 134.6 131.2

Virginia Beach-Norfolk-Newport News, VA-NC 1,572 1,248 1,226 1,239 1,489 191.2 151.0 146.7 147.5 177.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,558 2,791 3,001 3,330 1,811 93.2 99.4 105.0 114.6 62.3

SELECTED MSAs TOTAL 93,489 97,863 106,339 109,653 121,989 114.1 118.0 126.8 129.5 144.1

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

NOTE: Cases reported with unknown sex are not included in this table.
100 Gonorrhea Tables STD Surveillance 2014

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

Independent Cities* Ranked by Number of Reported Cases, United States, 2014 

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percentage

1 Los Angeles County, CA 15,316 152.9 4

2 Cook County, IL 10,387 198.2 7

3 Harris County, TX 7,126 164.3 9

4 Philadelphia County, PA 5,961 383.8 11

5 Maricopa County, AZ 5,642 140.7 12

6 Dallas County, TX 5,034 203.0 14

7 New York County, NY 4,550 279.8 15

8 Wayne County, MI 4,140 233.2 16

9 Kings County, NY 4,091 157.8 17

10 San Diego County, CA 3,420 106.5 18

11 Marion County, IN 3,374 363.5 19

12 San Francisco County, CA 3,328 397.4 20

13 Cuyahoga County, OH 3,213 254.4 21

14 Bronx County, NY 3,093 218.0 22

15 Bexar County, TX 2,919 160.6 23

16 Franklin County, OH 2,897 239.0 24

17 Tarrant County, TX 2,673 139.8 24

18 Clark County, NV 2,653 130.8 25

19 San Bernardino County, CA 2,607 124.8 26

20 Broward County, FL 2,585 140.6 27

21 Fulton County, GA 2,560 260.1 27

22 Milwaukee County, WI 2,477 259.1 28

23 Miami-Dade County, FL 2,427 92.7 29

24 Hamilton County, OH 2,309 287.0 29

25 Alameda County, CA 2,306 146.1 30

26 Mecklenburg County, NC 2,284 230.5 31

27 King County, WA 2,233 109.2 31

28 Duval County, FL 2,229 251.6 32

29 Sacramento County, CA 2,227 152.3 33

30 Travis County, TX 2,206 196.8 33

31 Baltimore (City), MD 2,194 352.7 34

32 Queens County, NY 2,169 94.5 35

33 Shelby County, TN 2,155 229.4 35

34 Allegheny County, PA 2,084 169.2 36

35 Hennepin County, MN 1,997 166.6 36

36 Orange County, FL 1,893 154.5 37

37 Oklahoma County, OK 1,853 245.4 37

38 Hillsborough County, FL 1,844 142.8 38

39 Orange County, CA 1,814 58.2 38

40 Jackson County, MO 1,757 258.4 39

41 St. Louis County, MO 1,729 172.7 39

42 Riverside County, CA 1,685 73.5 40

43 Tulsa County, OK 1,665 267.5 40

44 Jefferson County, KY 1,665 220.0 41

45 Jefferson County, AL 1,660 251.7 41

46 Orleans Parish, LA 1,607 424.3 42

47 St. Louis (City), MO 1,548 486.2 42

48 Kern County, CA 1,548 179.1 43

49 Santa Clara County, CA 1,530 82.2 43

50 Fresno County, CA 1,519 159.0 44

51 Essex County, NJ 1,513 191.6 44

52 DeKalb County, GA 1,402 196.5 44

53 Pinellas County, FL 1,329 143.0 45

54 Pierce County, WA 1,288 157.1 45

55 Davidson County, TN 1,284 195.0 45

56 Prince George's County, MD 1,276 143.4 46

57 Guilford County, NC 1,259 248.5 46

58 Wake County, NC 1,215 124.7 47

59 Pulaski County, AR 1,192 304.6 47

60 Monroe County, NY 1,158 154.5 47

61 Erie County, NY 1,155 125.6 48

62 Palm Beach County, FL 1,116 81.3 48

63 Suffolk County, MA 1,090 144.3 48

64 Cumberland County, NC 1,083 332.3 49

65 Denver County, CO 1,080 166.3 49

66 Bell County, TX 1,079 330.1 49

67 Pima County, AZ 1,057 106.1 49

68 Douglas County, NE 1,052 195.8 50

69 Sedgwick County, KS 1,037 205.2 50

70 Contra Costa County, CA 1,028 93.9 50

* Accounting for 50% of reported gonorrhea cases.

† Counties and independent cities were ranked in descending order by number of cases reported then by rate in 2014.
STD Surveillance 2014 Gonorrhea Tables 101

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

Sex, United States, 2010–2014

Age

Group

Cases Rates*

Total Male Female Unknown Sex Total Male Female

0–4 247 70 167 10 1.2 0.7 1.7

2010

5–9 64 10 53 1 0.3 0.1 0.5

10–14 3,016 486 2,498 32 14.6 4.6 24.7

15–19 88,250 28,002 59,867 381 400.4 247.7 557.6

20–24 105,619 46,708 58,574 337 489.3 424.1 554.1

25–29 50,890 26,818 23,907 165 241.2 252.2 228.4

30–34 25,401 14,809 10,510 82 127.2 148.1 105.5

35–39 13,769 8,812 4,907 50 68.2 87.8 48.4

40–44 9,262 6,745 2,495 22 44.3 64.9 23.8

45–54 9,555 7,490 2,043 22 21.2 33.8 8.9

55–64 2,194 1,852 338 4 6.0 10.5 1.8

65+ 520 411 105 4 1.3 2.4 0.5

Unknown Age 554 257 229 68

TOTAL 309,341 142,470 165,693 1,178 100.2 93.9 105.6

0–4 182 43 136 3 0.9 0.4 1.4

2011

5–9 82 15 66 1 0.4 0.1 0.7

10–14 3,223 548 2,648 27 15.6 5.2 26.2

15–19 88,139 28,102 59,747 290 407.2 252.7 567.7

20–24 111,730 49,633 61,756 341 504.3 438.7 569.6

25–29 53,245 28,288 24,821 136 250.2 262.9 236.0

30–34 27,157 16,044 11,044 69 132.4 156.0 108.0

35–39 14,109 8,972 5,096 41 72.0 91.9 51.8

40–44 9,686 6,955 2,708 23 46.1 66.5 25.6

45–54 10,473 8,222 2,222 29 23.4 37.3 9.8

55–64 2,747 2,270 471 6 7.2 12.4 2.4

65+ 587 485 99 3 1.4 2.7 0.4

Unknown Age 489 258 191 40

TOTAL 321,849 149,835 171,005 1,009 103.3 97.7 108.0

0–4 198 72 122 4 1.0 0.7 1.2

2012

5–9 68 16 52 0 0.3 0.2 0.5

10–14 3,136 573 2,559 4 15.2 5.4 25.3

15–19 81,548 26,578 54,852 118 381.8 242.4 527.5

20–24 115,224 52,351 62,711 162 510.2 453.3 568.4

25–29 58,441 31,631 26,722 88 273.1 291.7 253.2

30–34 31,420 18,936 12,436 48 150.3 180.4 119.4

35–39 16,193 10,493 5,670 30 83.1 108.0 58.0

40–44 10,965 7,858 3,089 18 52.1 75.1 29.2

45–54 12,383 9,773 2,594 16 28.0 44.8 11.5

55–64 3,230 2,642 586 2 8.4 14.2 2.9

65+ 644 537 105 2 1.5 2.9 0.4

Unknown Age 1,376 775 568 33

TOTAL 334,826 162,235 172,066 525 106.7 105.0 107.9

0–4 172 60 111 1 0.9 0.6 1.1

2013

5–9 75 11 64 0 0.4 0.1 0.6

10–14 2,637 508 2,122 7 12.8 4.8 21.0

15–19 72,092 24,212 47,749 131 340.7 223.2 463.0

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 19.9

15–19 68,468 23,981 44,399 88 323.6 221.1 430.5

20–24 116,200 56,714 59,329 157 509.8 485.6 533.7

25–29 69,587 40,602 28,899 86 322.5 370.5 272.1

30–34 38,393 24,349 13,988 56 180.6 228.0 132.2

35–39 20,803 14,129 6,654 20 106.1 144.4 67.8

40–44 12,687 9,349 3,320 18 60.9 90.2 31.7

45–54 15,322 12,388 2,917 17 35.0 57.4 13.1

55–64 4,549 3,859 680 10 11.6 20.4 3.3

65+ 911 790 121 0 2.0 4.0 0.5

Unknown Age 485 288 145 52

TOTAL 350,062 186,943 162,608 511 110.7 120.1 101.3

* 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.
102 Gonorrhea Tables STD Surveillance 2014

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

United States*, 2014

Age

Group

American Indians/

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 2 1 1 0 0 0 56 19 37

5–9 1 0 1 0 0 0 23 3 20

10–14 25 3 22 6 1 5 1,264 217 1,046

15–19 576 162 414 263 122 141 35,115 12,437 22,661

20–24 1,112 377 735 768 461 305 55,003 26,542 28,429

25–29 753 312 441 717 530 186 28,434 16,784 11,627

30–34 472 176 296 473 343 130 13,505 8,869 4,633

35–39 214 99 115 298 236 62 6,872 4,824 2,045

40–44 121 56 64 176 140 36 3,758 2,899 859

45–54 121 73 48 186 153 33 4,386 3,735 649

55–64 14 9 5 50 39 11 1,349 1,196 150

65+ 9 8 1 12 9 3 209 191 18

Unknown Age 4 3 1 2 2 0 66 43 21

TOTAL 3,424 1,279 2,144 2,951 2,036 912 150,040 77,759 72,195

Age

Group

Native Hawaiians/

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 0 0 0 19 6 13 1 0 1

5–9 0 0 0 8 3 5 1 0 1

10–14 2 0 2 258 29 229 21 1 20

15–19 82 22 60 9,327 2,650 6,670 552 143 409

20–24 172 84 87 20,934 9,647 11,274 842 391 449

25–29 109 62 47 16,029 8,707 7,317 590 396 193

30–34 68 39 29 9,942 5,982 3,957 339 254 85

35–39 37 17 20 5,487 3,569 1,914 152 123 29

40–44 20 12 7 3,673 2,638 1,032 113 95 18

45–54 21 15 6 5,025 4,096 928 118 110 8

55–64 6 4 2 1,478 1,261 216 17 16 1

65+ 2 2 0 303 267 36 3 2 1

Unknown Age 1 1 0 51 26 25 1 0 1

TOTAL 520 258 260 72,534 38,881 33,616 2,750 1,531 1,216

Age

Group

Hispanics Other/Unknown

Total† Male Female Total† Male Female

0–4 14 5 9 43 11 30

5–9 5 0 5 13 1 12

10–14 216 50 166 514 116 394

15–19 6,542 2,517 4,018 12,892 4,928 7,911

20–24 12,232 6,644 5,575 20,160 10,369 9,705

25–29 8,343 5,259 3,072 11,950 7,074 4,836

30–34 4,960 3,341 1,610 7,264 4,468 2,759

35–39 2,726 1,931 793 4,200 2,809 1,381

40–44 1,519 1,142 375 2,827 2,025 792

45–54 1,437 1,165 271 3,393 2,553 827

55–64 290 251 39 1,156 925 226

65+ 61 45 16 269 225 44

Unknown Age 50 29 21 269 158 63

TOTAL 38,395 22,379 15,970 64,950 35,662 28,980

* Includes 48 states reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2014.

† Total includes cases reported with unknown sex.

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 21 for age-specific cases and rates and Tables 14–16 for total and sex-specific 

cases and rates.

Cases in the 0–4 age group may include cases due to perinatal transmission.
STD Surveillance 2014 Gonorrhea Tables 103

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

Group, and Sex, United States*, 2014

Age

Group

American Indians/

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 1.3 1.3 1.3 0.0 0.0 0.0 2.1 1.4 2.8

5–9 0.6 0.0 1.2 0.0 0.0 0.0 0.9 0.2 1.5

10–14 14.9 3.5 26.8 0.7 0.2 1.1 45.5 15.4 76.5

15–19 329.7 181.4 484.6 28.4 25.9 31.0 1,172.6 816.0 1,541.0

20–24 607.9 403.2 821.9 67.0 79.4 53.9 1,736.0 1,670.4 1,799.9

25–29 480.7 397.4 564.5 56.3 86.0 28.3 1,065.0 1,291.6 848.5

30–34 325.7 244.1 406.6 36.3 56.4 18.7 524.6 723.0 343.8

35–39 160.7 150.8 170.3 23.0 38.9 9.0 291.4 434.1 164.0

40–44 87.0 81.8 90.6 14.0 23.8 5.4 150.0 245.3 64.9

45–54 40.4 50.8 30.9 8.8 15.5 2.9 84.8 153.7 23.7

55–64 5.9 8.1 4.0 3.0 5.1 1.2 33.6 65.4 6.9

65+ 4.7 9.3 0.9 0.8 1.3 0.3 6.0 13.8 0.9

Unknown Age

TOTAL 159.4 120.9 196.5 19.3 28.0 11.3 405.4 440.1 373.3

Age

Group

Native Hawaiians/

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 0.0 0.0 0.0 0.2 0.1 0.3 0.1 0.0 0.2

5–9 0.0 0.0 0.0 0.1 0.1 0.1 0.1 0.0 0.3

10–14 5.3 0.0 11.0 2.4 0.5 4.4 3.1 0.3 5.9

15–19 209.0 109.8 312.4 82.4 45.5 121.3 92.7 47.7 138.3

20–24 362.2 343.8 377.3 171.8 155.4 188.7 171.7 163.5 178.6

25–29 235.0 261.5 207.3 135.5 145.5 125.3 154.6 219.2 96.0

30–34 159.2 178.6 138.8 86.1 102.6 69.2 101.1 161.1 47.8

35–39 100.3 90.3 110.6 50.8 65.7 35.7 55.3 95.1 19.9

40–44 57.8 68.9 40.7 29.5 42.1 16.6 44.1 78.4 13.4

45–54 32.2 46.2 18.3 17.5 28.8 6.4 25.9 50.8 3.4

55–64 13.0 17.8 8.5 5.4 9.5 1.6 5.1 10.2 0.6

65+ 5.6 12.1 0.0 0.9 1.8 0.2 1.1 1.6 0.6

Unknown Age

TOTAL 102.1 100.5 102.9 38.3 41.7 34.9 47.8 54.3 41.4

Age

Group

Hispanics

Total† Male Female

0–4 0.3 0.2 0.4

5–9 0.1 0.0 0.2

10–14 4.7 2.1 7.3

15–19 144.7 108.0 183.5

20–24 270.4 278.1 261.1

25–29 193.4 229.0 152.3

30–34 116.7 150.1 79.5

35–39 69.2 95.4 41.4

40–44 41.9 61.6 21.1

45–54 24.6 39.7 9.4

55–64 8.1 14.5 2.1

65+ 2.0 3.4 0.9

Unknown Age

TOTAL 73.3 84.1 61.9

* Includes 48 states reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2014.

† 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.
104 Gonorrhea Tables STD Surveillance 2014

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

Reported Cases by Age, United States, 2010–2014

Age Cases Rate per 100,000 Population

2010

15 4,502 217.9

16 8,286 394.6

17 12,397 581.4

18 16,743 762.6

19 17,939 799.7

20 16,320 738.2

21 14,015 657.6

22 11,087 531.3

23 9,329 453.4

24 7,823 375.1

25 6,546 311.6

2011

15 4,466 220.3

16 8,128 393.4

17 12,308 584.7

18 16,973 796.3

19 17,872 814.3

20 16,865 750.6

21 14,559 647.9

22 12,202 565.4

23 9,861 467.2

24 8,269 397.9

25 6,804 324.9

2012

15 4,241 209.4

16 7,316 359.4

17 11,006 530.2

18 15,580 736.2

19 16,709 779.1

20 15,849 717.5

21 15,029 664.7

22 12,800 565.9

23 10,449 480.6

24 8,584 403.4

25 7,343 350.3

2013

15 3,776 186.4

16 6,503 320.0

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

25 7,446 347.4

2014

15 3,487 172.2

16 6,188 304.5

17 8,830 432.2

18 12,196 585.0

19 13,698 643.9

20 13,801 640.1

21 13,324 600.0

22 12,031 529.0

23 10,746 472.1

24 9,427 430.7

25 7,966 371.7

NOTE: This table should be used only for age comparisons. Cases reported with unknown sex are not included in this table.
STD Surveillance 2014 Syphilis Tables 105

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, 2010–2014

Cases Rates per 100,000 Population

State/Area 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Alabama 781 758 705 679 475 16.3 15.8 14.6 14.0 9.8

Alaska 15 11 34 35 45 2.1 1.5 4.6 4.8 6.1

Arizona 905 907 787 962 1,459 14.2 14.0 12.0 14.5 22.0

Arkansas 534 464 468 527 389 18.3 15.8 15.9 17.8 13.1

California 6,115 6,782 8,016 9,972 11,440 16.4 18.0 21.1 26.0 29.8

Colorado 342 367 503 475 355 6.8 7.2 9.7 9.0 6.7

Connecticut 234 189 121 133 169 6.5 5.3 3.4 3.7 4.7

Delaware 44 124 106 146 110 4.9 13.7 11.6 15.8 11.9

District of Columbia 495 552 589 609 281 82.3 89.3 93.1 94.2 43.5

Florida 4,070 4,143 4,483 5,022 6,102 21.6 21.7 23.2 25.7 31.2

Georgia 2,347 1,895 2,434 2,990 3,384 24.2 19.3 24.5 29.9 33.9

Hawaii 73 32 43 87 106 5.4 2.3 3.1 6.2 7.5

Idaho 20 42 54 42 46 1.3 2.6 3.4 2.6 2.9

Illinois 2,236 2,426 2,424 2,661 2,796 17.4 18.9 18.8 20.7 21.7

Indiana 412 468 531 543 475 6.4 7.2 8.1 8.3 7.2

Iowa 68 70 143 226 239 2.2 2.3 4.7 7.3 7.7

Kansas 110 76 129 196 200 3.9 2.6 4.5 6.8 6.9

Kentucky 311 335 390 395 447 7.2 7.7 8.9 9.0 10.2

Louisiana 2,484 2,043 1,780 2,006 2,173 54.8 44.7 38.7 43.4 47.0

Maine 41 24 22 21 23 3.1 1.8 1.7 1.6 1.7

Maryland 1,015 1,278 1,243 1,361 1,475 17.6 21.9 21.1 23.0 24.9

Massachusetts 639 770 806 990 813 9.8 11.7 12.1 14.8 12.1

Michigan 683 764 786 1,068 1,095 6.9 7.7 8.0 10.8 11.1

Minnesota 350 367 335 541 631 6.6 6.9 6.2 10.0 11.6

Mississippi 823 748 456 293 642 27.7 25.1 15.3 9.8 21.5

Missouri 512 414 426 609 771 8.5 6.9 7.1 10.1 12.8

Montana 5 9 3 8 9 0.5 0.9 0.3 0.8 0.9

Nebraska 33 36 35 95 96 1.8 2.0 1.9 5.1 5.1

Nevada 412 430 445 523 894 15.3 15.8 16.1 18.7 32.0

New Hampshire 43 33 65 79 79 3.3 2.5 4.9 6.0 6.0

New Jersey 947 971 883 968 1,172 10.8 11.0 10.0 10.9 13.2

New Mexico 151 212 234 247 283 7.3 10.2 11.2 11.8 13.6

New York 4,860 4,786 5,312 6,173 7,129 25.1 24.6 27.1 31.4 36.3

North Carolina 1,233 1,255 1,037 1,153 1,998 12.9 13.0 10.6 11.7 20.3

North Dakota 6 5 14 25 51 0.9 0.7 2.0 3.5 7.1

Ohio 1,076 954 1,141 1,096 1,229 9.3 8.3 9.9 9.5 10.6

Oklahoma 272 270 256 383 414 7.3 7.1 6.7 9.9 10.8

Oregon 173 252 424 527 582 4.5 6.5 10.9 13.4 14.8

Pennsylvania 1,007 1,125 1,349 1,485 1,524 7.9 8.8 10.6 11.6 11.9

Rhode Island 79 84 93 94 160 7.5 8.0 8.9 8.9 15.2

South Carolina 580 639 624 753 750 12.5 13.7 13.2 15.8 15.7

South Dakota 12 14 29 61 95 1.5 1.7 3.5 7.2 11.2

Tennessee 1,193 1,025 1,068 980 977 18.8 16.0 16.5 15.1 15.0

Texas 6,413 6,161 7,057 7,044 7,804 25.5 24.0 27.1 26.6 29.5

Utah 133 64 101 172 149 4.8 2.3 3.5 5.9 5.1

Vermont 4 10 12 10 12 0.6 1.6 1.9 1.6 1.9

Virginia 800 726 906 1,001 702 10.0 9.0 11.1 12.1 8.5

Washington 535 712 709 711 854 8.0 10.4 10.3 10.2 12.3

West Virginia 26 9 24 39 55 1.4 0.5 1.3 2.1 3.0

Wisconsin 186 203 268 257 285 3.3 3.6 4.7 4.5 5.0

Wyoming 6 6 12 9 6 1.1 1.1 2.1 1.5 1.0

U.S. TOTAL 45,844 46,040 49,915 56,482 63,450 14.8 14.8 15.9 17.9 20.1

Northeast 7,854 7,992 8,663 9,953 11,081 14.2 14.4 15.5 17.8 19.8

Midwest 5,684 5,797 6,261 7,378 7,963 8.5 8.6 9.3 10.9 11.8

South 23,421 22,425 23,626 25,381 28,178 20.4 19.3 20.1 21.4 23.8

West 8,885 9,826 11,365 13,770 16,228 12.3 13.5 15.4 18.5 21.9

Guam 11 26 27 24 13 6.9 16.3 16.9 15.0 8.1

Puerto Rico 723 671 704 811 960 19.4 18.1 19.2 22.4 26.6

Virgin Islands 4 7 2 9 6 3.8 6.6 1.9 8.6 5.7

OUTLYING AREAS 738 704 733 844 979 18.5 17.7 18.6 21.8 25.2

TOTAL 46,582 46,744 50,648 57,326 64,429 14.9 14.8 15.9 17.9 20.1

* See Section A1.9 in the Appendix for definition.
106 Syphilis Tables STD Surveillance 2014

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

Metropolitan Statistical Areas (MSAs)† in Alphabetical Order, United States, 2010–2014

MSAs

Cases Rates per 100,000 Population

2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Atlanta-Sandy Springs-Roswell, GA 1,916 1,549 1,822 2,257 2,668 36.2 28.8 33.4 40.9 48.3

Austin-Round Rock, TX 362 425 478 500 680 21.1 23.8 26.1 26.6 36.1

Baltimore-Columbia-Towson, MD 531 710 726 732 815 19.6 26.0 26.4 26.4 29.4

Birmingham-Hoover, AL 234 276 226 236 157 20.7 24.4 19.9 20.7 13.8

Boston-Cambridge-Newton, MA-NH 544 607 570 758 596 11.9 13.2 12.3 16.2 12.7

Buffalo-Cheektowaga-Niagara Falls, NY 43 48 70 115 130 3.8 4.2 6.2 10.1 11.5

Charlotte-Concord-Gastonia, NC-SC 314 372 310 360 530 14.2 16.5 13.5 15.4 22.7

Chicago-Naperville-Elgin, IL-IN-WI 2,085 2,266 2,269 2,499 2,559 22.0 23.8 23.8 26.2 26.8

Cincinnati, OH-KY-IN 483 436 529 437 381 22.8 20.5 24.9 20.4 17.8

Cleveland-Elyria, OH 182 151 140 111 199 8.8 7.3 6.8 5.4 9.6

Columbus, OH 248 237 316 342 441 13.0 12.3 16.3 17.4 22.4

Dallas-Fort Worth-Arlington, TX 1,958 1,816 2,141 2,093 2,231 30.5 27.6 32.0 30.7 32.8

Denver-Aurora-Lakewood, CO 293 319 434 382 298 11.5 12.3 16.4 14.2 11.0

Detroit-Warren-Dearborn, MI 459 522 607 830 791 10.7 12.2 14.1 19.3 18.4

Hartford-West Hartford-East Hartford, CT 85 55 21 43 52 7.0 4.5 1.7 3.5 4.3

Houston-The Woodlands-Sugar Land, TX 1,891 1,870 2,246 1,891 2,316 31.9 30.9 36.4 30.0 36.7

Indianapolis-Carmel-Anderson, IN 236 270 336 340 285 12.5 14.1 17.4 17.4 14.6

Jacksonville, FL 228 188 177 189 269 16.9 13.8 12.8 13.6 19.3

Kansas City, MO-KS 145 141 164 320 406 7.2 7.0 8.0 15.6 19.8

Las Vegas-Henderson-Paradise, NV 389 402 403 438 830 19.9 20.4 20.1 21.6 40.9

Los Angeles-Long Beach-Anaheim, CA 3,003 3,247 3,540 4,537 4,737 23.4 25.1 27.1 34.6 36.1

Louisville/Jefferson County, KY-IN 196 186 201 210 239 15.9 14.9 16.1 16.6 18.9

Memphis, TN-MS-AR 760 587 591 578 475 57.4 44.0 44.0 43.1 35.4

Miami-Fort Lauderdale-West Palm Beach, FL 2,259 2,315 2,591 2,740 3,313 40.6 40.8 45.0 47.0 56.8

Milwaukee-Waukesha-West Allis, WI 121 117 159 153 184 7.8 7.5 10.1 9.7 11.7

Minneapolis-St. Paul-Bloomington, MN-WI 309 326 313 487 585 9.2 9.6 9.1 14.1 16.9

Nashville-Davidson--Murfreesboro--Franklin, TN 267 229 271 239 305 16.0 13.5 15.7 13.6 17.4

New Orleans-Metairie, LA 688 668 547 634 723 57.8 55.1 44.6 51.1 58.3

New York-Newark-Jersey City, NY-NJ-PA 5,379 5,303 5,670 6,506 7,476 27.5 26.9 28.6 32.6 37.5

Oklahoma City, OK 148 114 148 213 231 11.8 8.9 11.4 16.1 17.5

Orlando-Kissimmee-Sanford, FL 391 485 499 631 782 18.3 22.3 22.4 27.8 34.5

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 930 1,029 1,119 1,333 1,273 15.6 17.2 18.6 22.1 21.1

Phoenix-Mesa-Scottsdale, AZ 645 676 624 713 1,065 15.4 15.9 14.4 16.2 24.2

Pittsburgh, PA 72 92 128 95 154 3.1 3.9 5.4 4.0 6.5

Portland-Vancouver-Hillsboro, OR-WA 153 220 410 475 470 6.9 9.7 17.9 20.5 20.3

Providence-Warwick, RI-MA 95 111 125 138 204 5.9 6.9 7.8 8.6 12.7

Raleigh, NC 154 151 150 179 315 13.6 13.0 12.6 14.7 25.9

Richmond, VA 210 154 194 204 145 17.4 12.6 15.7 16.4 11.6

Riverside-San Bernardino-Ontario, CA 428 527 775 803 950 10.1 12.2 17.8 18.3 21.7

Sacramento--Roseville--Arden-Arcade, CA 183 258 249 289 371 8.5 11.9 11.3 13.0 16.7

Salt Lake City, UT 94 48 74 136 109 8.6 4.3 6.6 11.9 9.6

San Antonio-New Braunfels, TX 730 736 983 1,167 1,017 34.1 33.5 44.0 51.2 44.7

San Diego-Carlsbad, CA 607 609 717 791 986 19.6 19.4 22.6 24.6 30.7

San Francisco-Oakland-Hayward, CA 1,150 1,271 1,595 1,892 2,106 26.5 28.9 35.8 41.9 46.6

San Jose-Sunnyvale-Santa Clara, CA 183 159 233 276 304 10.0 8.5 12.3 14.4 15.8

Seattle-Tacoma-Bellevue, WA 439 589 559 539 590 12.8 16.8 15.7 14.9 16.3

St. Louis, MO-IL 403 271 280 338 412 14.5 9.7 10.0 12.1 14.7

Tampa-St. Petersburg-Clearwater, FL 503 516 582 632 806 18.1 18.3 20.5 22.0 28.1

Virginia Beach-Norfolk-Newport News, VA-NC 237 212 296 302 220 14.1 12.6 17.4 17.7 12.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 1,191 1,316 1,374 1,543 811 21.1 22.9 23.4 25.9 13.6

SELECTED MSAs TOTAL 34,554 35,182 38,982 43,646 47,992 20.6 20.8 22.8 25.3 27.8

* 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.
STD Surveillance 2014 Syphilis Tables 107

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

State, Ranked by Rates, United States, 2014

Rank* State Cases Rate per 100,000 Population

1 Nevada 357 12.8

2 Louisiana 575 12.4

3 Georgia 1,234 12.3

4 California 3,835 10.0

5 Florida 1,740 8.9

6 New York 1,727 8.8

7 Arizona 577 8.7

8 Maryland 449 7.6

9 North Carolina 733 7.4

10 Oregon 272 6.9

11 Rhode Island 71 6.8

12 Illinois 863 6.7

U.S. TOTAL† 19,999 6.3

13 Mississippi 189 6.3

14 South Dakota 53 6.3

15 Texas 1,636 6.2

16 New Mexico 126 6.0

17 Missouri 352 5.8

18 South Carolina 250 5.2

19 Delaware 47 5.1

20 Washington 344 4.9

21 Ohio 568 4.9

22 Hawaii 68 4.8

23 Minnesota 257 4.7

24 Massachusetts 301 4.5

25 Michigan 421 4.3

26 Pennsylvania 532 4.2

27 Arkansas 121 4.1

28 Oklahoma 151 3.9

29 Tennessee 237 3.6

30 Kentucky 158 3.6

31 Colorado 186 3.5

32 Virginia 289 3.5

33 New Jersey 297 3.3

34 Alabama 161 3.3

35 New Hampshire 36 2.7

36 Nebraska 50 2.7

37 Indiana 168 2.6

38 Connecticut 86 2.4

39 Iowa 72 2.3

40 Kansas 60 2.1

41 Alaska 15 2.0

42 North Dakota 13 1.8

43 Utah 47 1.6

44 West Virginia 28 1.5

45 Wisconsin 86 1.5

46 Maine 16 1.2

47 Vermont 5 0.8

48 Montana 8 0.8

49 Idaho 12 0.7

50 Wyoming 4 0.7

* 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 116 cases and a rate of 17.9, but excludes outlying areas (Guam with 7 cases and rate of 4.4, Puerto 

Rico with 484 cases and rate of 13.4, and Virgin Islands with 2 cases and rate of 1.9).
108 Syphilis Tables STD Surveillance 2014

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, 2010–2014

State/Area

Cases Rates per 100,000 Population

2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Alabama 260 228 216 183 161 5.4 4.7 4.5 3.8 3.3

Alaska 3 5 11 23 15 0.4 0.7 1.5 3.1 2.0

Arizona 230 274 202 287 577 3.6 4.2 3.1 4.3 8.7

Arkansas 205 182 173 177 121 7.0 6.2 5.9 6.0 4.1

California 2,065 2,443 2,953 3,532 3,835 5.5 6.5 7.8 9.2 10.0

Colorado 138 133 208 163 186 2.7 2.6 4.0 3.1 3.5

Connecticut 98 65 55 56 86 2.7 1.8 1.5 1.6 2.4

Delaware 9 27 38 52 47 1.0 3.0 4.1 5.6 5.1

District of Columbia 134 165 165 168 116 22.3 26.7 26.1 26.0 17.9

Florida 1,184 1,257 1,369 1,513 1,740 6.3 6.6 7.1 7.7 8.9

Georgia 795 678 937 1,017 1,234 8.2 6.9 9.4 10.2 12.3

Hawaii 35 14 23 46 68 2.6 1.0 1.7 3.3 4.8

Idaho 6 13 26 15 12 0.4 0.8 1.6 0.9 0.7

Illinois 908 881 804 798 863 7.1 6.8 6.2 6.2 6.7

Indiana 175 173 224 215 168 2.7 2.7 3.4 3.3 2.6

Iowa 19 20 70 106 72 0.6 0.7 2.3 3.4 2.3

Kansas 19 24 24 51 60 0.7 0.8 0.8 1.8 2.1

Kentucky 139 129 150 122 158 3.2 3.0 3.4 2.8 3.6

Louisiana 546 447 339 423 575 12.0 9.8 7.4 9.1 12.4

Maine 32 12 17 10 16 2.4 0.9 1.3 0.8 1.2

Maryland 328 452 431 456 449 5.7 7.8 7.3 7.7 7.6

Massachusetts 285 266 316 360 301 4.4 4.0 4.8 5.4 4.5

Michigan 235 286 295 487 421 2.4 2.9 3.0 4.9 4.3

Minnesota 149 139 118 193 257 2.8 2.6 2.2 3.6 4.7

Mississippi 228 191 150 78 189 7.7 6.4 5.0 2.6 6.3

Missouri 152 136 157 251 352 2.5 2.3 2.6 4.2 5.8

Montana 3 7 2 5 8 0.3 0.7 0.2 0.5 0.8

Nebraska 12 10 8 41 50 0.7 0.5 0.4 2.2 2.7

Nevada 130 136 113 205 357 4.8 5.0 4.1 7.3 12.8

New Hampshire 22 18 36 28 36 1.7 1.4 2.7 2.1 2.7

New Jersey 244 232 229 233 297 2.8 2.6 2.6 2.6 3.3

New Mexico 53 71 101 78 126 2.6 3.4 4.8 3.7 6.0

New York 1,098 1,083 1,224 1,459 1,727 5.7 5.6 6.3 7.4 8.8

North Carolina 396 431 347 404 733 4.2 4.5 3.6 4.1 7.4

North Dakota 3 1 4 12 13 0.4 0.1 0.6 1.7 1.8

Ohio 528 440 425 436 568 4.6 3.8 3.7 3.8 4.9

Oklahoma 92 84 83 118 151 2.5 2.2 2.2 3.1 3.9

Oregon 71 97 212 267 272 1.9 2.5 5.4 6.8 6.9

Pennsylvania 369 373 494 471 532 2.9 2.9 3.9 3.7 4.2

Rhode Island 41 46 44 45 71 3.9 4.4 4.2 4.3 6.8

South Carolina 155 221 225 271 250 3.4 4.7 4.8 5.7 5.2

South Dakota 4 0 18 44 53 0.5 0.0 2.2 5.2 6.3

Tennessee 277 278 266 214 237 4.4 4.3 4.1 3.3 3.6

Texas 1,230 1,169 1,627 1,475 1,636 4.9 4.6 6.2 5.6 6.2

Utah 65 14 42 74 47 2.4 0.5 1.5 2.6 1.6

Vermont 4 9 6 3 5 0.6 1.4 1.0 0.5 0.8

Virginia 279 213 285 315 289 3.5 2.6 3.5 3.8 3.5

Washington 266 328 302 284 344 4.0 4.8 4.4 4.1 4.9

West Virginia 6 4 8 15 28 0.3 0.2 0.4 0.8 1.5

Wisconsin 49 65 91 95 86 0.9 1.1 1.6 1.7 1.5

Wyoming 0 0 4 1 4 0.0 0.0 0.7 0.2 0.7

U.S. TOTAL 13,774 13,970 15,667 17,375 19,999 4.5 4.5 5.0 5.5 6.3

Northeast 2,193 2,104 2,421 2,665 3,071 4.0 3.8 4.3 4.8 5.5

Midwest 2,253 2,175 2,238 2,729 2,963 3.4 3.2 3.3 4.0 4.4

South 6,263 6,156 6,809 7,001 8,114 5.5 5.3 5.8 5.9 6.9

West 3,065 3,535 4,199 4,980 5,851 4.3 4.9 5.7 6.7 7.9

Guam 1 5 6 6 7 0.6 3.1 3.8 3.7 4.4

Puerto Rico 228 254 306 385 484 6.1 6.9 8.3 10.6 13.4

Virgin Islands 0 0 0 2 2 0.0 0.0 0.0 1.9 1.9

OUTLYING AREAS 229 259 312 393 493 5.7 6.5 7.9 10.1 12.7

TOTAL 14,003 14,229 15,979 17,768 20,492 4.5 4.5 5.0 5.6 6.4
STD Surveillance 2014 Syphilis Tables 109

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, 2010–2014

State/Area

Cases Rates per 100,000 Population

2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Alabama 75 54 38 22 17 3.0 2.2 1.5 0.9 0.7

Alaska 0 1 1 2 1 0.0 0.3 0.3 0.6 0.3

Arizona 20 15 16 27 50 0.6 0.5 0.5 0.8 1.5

Arkansas 82 76 49 44 23 5.5 5.1 3.3 2.9 1.5

California 74 103 116 210 318 0.4 0.5 0.6 1.1 1.7

Colorado 2 4 3 4 6 0.1 0.2 0.1 0.2 0.2

Connecticut 5 5 9 8 7 0.3 0.3 0.5 0.4 0.4

Delaware 1 1 2 3 2 0.2 0.2 0.4 0.6 0.4

District of Columbia 2 7 6 19 5 0.6 2.1 1.8 5.6 1.5

Florida 147 134 134 137 137 1.5 1.4 1.4 1.4 1.4

Georgia 82 58 66 87 96 1.7 1.2 1.3 1.7 1.9

Hawaii 7 0 2 0 2 1.0 0.0 0.3 0.0 0.3

Idaho 0 1 2 0 0 0.0 0.1 0.3 0.0 0.0

Illinois 108 81 73 66 81 1.7 1.2 1.1 1.0 1.2

Indiana 20 13 22 18 11 0.6 0.4 0.7 0.5 0.3

Iowa 3 5 7 10 6 0.2 0.3 0.5 0.6 0.4

Kansas 1 0 2 4 14 0.1 0.0 0.1 0.3 1.0

Kentucky 8 19 13 17 22 0.4 0.9 0.6 0.8 1.0

Louisiana 251 179 127 115 132 10.8 7.7 5.4 4.9 5.6

Maine 0 0 2 1 3 0.0 0.0 0.3 0.1 0.4

Maryland 26 49 45 61 49 0.9 1.6 1.5 2.0 1.6

Massachusetts 16 23 15 17 23 0.5 0.7 0.4 0.5 0.7

Michigan 23 26 30 29 31 0.5 0.5 0.6 0.6 0.6

Minnesota 9 5 7 12 21 0.3 0.2 0.3 0.4 0.8

Mississippi 69 45 34 19 17 4.5 2.9 2.2 1.2 1.1

Missouri 3 6 12 19 34 0.1 0.2 0.4 0.6 1.1

Montana 0 1 0 1 2 0.0 0.2 0.0 0.2 0.4

Nebraska 3 1 1 4 4 0.3 0.1 0.1 0.4 0.4

Nevada 7 7 4 14 23 0.5 0.5 0.3 1.0 1.7

New Hampshire 1 1 0 1 4 0.1 0.1 0.0 0.1 0.6

New Jersey 16 13 19 13 16 0.4 0.3 0.4 0.3 0.4

New Mexico 3 2 9 20 14 0.3 0.2 0.9 1.9 1.3

New York 47 37 45 44 49 0.5 0.4 0.4 0.4 0.5

North Carolina 55 31 37 36 68 1.1 0.6 0.7 0.7 1.3

North Dakota 1 0 0 1 5 0.3 0.0 0.0 0.3 1.4

Ohio 132 107 85 63 76 2.2 1.8 1.4 1.1 1.3

Oklahoma 16 12 6 13 15 0.8 0.6 0.3 0.7 0.8

Oregon 1 0 6 12 22 0.1 0.0 0.3 0.6 1.1

Pennsylvania 36 34 34 26 47 0.6 0.5 0.5 0.4 0.7

Rhode Island 2 3 1 1 5 0.4 0.6 0.2 0.2 0.9

South Carolina 9 24 34 39 23 0.4 1.0 1.4 1.6 0.9

South Dakota 0 0 1 15 34 0.0 0.0 0.2 3.6 8.1

Tennessee 49 34 31 22 34 1.5 1.0 0.9 0.7 1.0

Texas 333 255 269 179 242 2.6 2.0 2.1 1.3 1.8

Utah 2 0 0 2 1 0.1 0.0 0.0 0.1 0.1

Vermont 2 0 0 0 0 0.6 0.0 0.0 0.0 0.0

Virginia 20 18 21 17 17 0.5 0.4 0.5 0.4 0.4

Washington 5 6 9 13 18 0.1 0.2 0.3 0.4 0.5

West Virginia 0 0 2 4 6 0.0 0.0 0.2 0.4 0.6

Wisconsin 6 5 11 9 7 0.2 0.2 0.4 0.3 0.2

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 1,780 1,501 1,458 1,500 1,840 1.1 0.9 0.9 0.9 1.1

Northeast 125 116 125 111 154 0.4 0.4 0.4 0.4 0.5

Midwest 309 249 251 250 324 0.9 0.7 0.7 0.7 0.9

South 1,225 996 914 834 905 2.1 1.7 1.5 1.4 1.5

West 121 140 168 305 457 0.3 0.4 0.5 0.8 1.2

Guam 1 2 1 5 2 1.3 2.5 1.3 6.3 2.5

Puerto Rico 18 17 20 35 30 0.9 0.9 1.0 1.9 1.6

Virgin Islands 0 0 0 1 1 0.0 0.0 0.0 1.8 1.8

OUTLYING AREAS 19 19 21 41 33 0.9 0.9 1.0 2.0 1.6

TOTAL 1,799 1,520 1,479 1,541 1,873 1.1 0.9 0.9 0.9 1.2

NOTE: Cases reported with unknown sex are not included in this table.
110 Syphilis Tables STD Surveillance 2014

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, 2010–2014

State/Area

Cases Rates per 100,000 Population

2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Alabama 185 174 178 161 144 8.0 7.5 7.6 6.9 6.1

Alaska 3 4 10 21 14 0.8 1.1 2.6 5.4 3.6

Arizona 210 257 186 260 527 6.6 8.0 5.7 7.9 16.0

Arkansas 123 106 124 133 98 8.6 7.3 8.6 9.1 6.7

California 1,990 2,327 2,823 3,319 3,515 10.7 12.4 14.9 17.4 18.4

Colorado 136 129 205 159 180 5.4 5.0 7.9 6.0 6.8

Connecticut 93 60 46 48 79 5.3 3.4 2.6 2.7 4.5

Delaware 8 26 36 49 45 1.8 5.9 8.1 10.9 10.0

District of Columbia 132 158 159 149 106 46.4 54.1 53.2 48.7 34.6

Florida 1,037 1,123 1,235 1,376 1,602 11.3 12.0 13.1 14.4 16.8

Georgia 713 620 870 930 1,138 15.1 12.9 17.9 19.1 23.3

Hawaii 28 14 21 46 66 4.1 2.0 3.0 6.5 9.3

Idaho 6 12 24 15 12 0.8 1.5 3.0 1.9 1.5

Illinois 800 800 731 731 782 12.7 12.7 11.6 11.6 12.4

Indiana 155 160 202 197 157 4.9 5.0 6.3 6.1 4.9

Iowa 16 15 63 96 66 1.1 1.0 4.1 6.3 4.3

Kansas 18 24 22 47 46 1.3 1.7 1.5 3.3 3.2

Kentucky 131 110 137 105 136 6.1 5.1 6.3 4.9 6.3

Louisiana 284 268 212 308 443 12.8 12.0 9.4 13.6 19.6

Maine 32 12 15 9 13 4.9 1.8 2.3 1.4 2.0

Maryland 302 403 386 395 400 10.8 14.3 13.5 13.7 13.9

Massachusetts 269 243 301 343 277 8.5 7.6 9.3 10.6 8.5

Michigan 212 260 265 458 390 4.4 5.4 5.5 9.4 8.0

Minnesota 140 134 111 178 235 5.3 5.0 4.2 6.6 8.7

Mississippi 159 146 116 59 172 11.0 10.1 8.0 4.1 11.8

Missouri 149 130 145 232 318 5.1 4.4 4.9 7.8 10.7

Montana 3 6 2 4 6 0.6 1.2 0.4 0.8 1.2

Nebraska 9 9 7 37 46 1.0 1.0 0.8 4.0 4.9

Nevada 123 129 109 191 334 9.0 9.4 7.8 13.6 23.8

New Hampshire 21 17 36 27 32 3.2 2.6 5.5 4.1 4.9

New Jersey 228 219 210 220 281 5.3 5.1 4.9 5.1 6.5

New Mexico 50 69 92 58 112 4.9 6.7 8.9 5.6 10.8

New York 1,051 1,045 1,175 1,408 1,675 11.2 11.1 12.4 14.8 17.6

North Carolina 341 400 310 368 665 7.3 8.5 6.5 7.7 13.9

North Dakota 2 1 4 11 8 0.6 0.3 1.1 3.0 2.2

Ohio 396 333 340 373 492 7.0 5.9 6.0 6.6 8.7

Oklahoma 76 72 77 105 136 4.1 3.8 4.1 5.5 7.1

Oregon 70 97 206 255 250 3.7 5.1 10.7 13.1 12.9

Pennsylvania 333 339 460 445 485 5.4 5.5 7.4 7.1 7.8

Rhode Island 39 43 43 44 66 7.7 8.5 8.5 8.6 13.0

South Carolina 146 197 191 232 227 6.5 8.7 8.3 10.0 9.8

South Dakota 4 0 17 29 19 1.0 0.0 4.1 6.8 4.5

Tennessee 228 244 235 192 203 7.4 7.8 7.5 6.1 6.4

Texas 896 914 1,358 1,296 1,394 7.2 7.2 10.5 9.9 10.6

Utah 63 14 42 72 46 4.5 1.0 2.9 4.9 3.2

Vermont 2 9 6 3 5 0.6 2.9 1.9 1.0 1.6

Virginia 259 195 264 298 272 6.6 4.9 6.6 7.3 6.7

Washington 261 322 293 271 326 7.8 9.4 8.5 7.8 9.4

West Virginia 6 4 6 11 22 0.7 0.4 0.7 1.2 2.4

Wisconsin 43 60 80 86 79 1.5 2.1 2.8 3.0 2.8

Wyoming 0 0 4 1 4 0.0 0.0 1.4 0.3 1.3

U.S. TOTAL 11,981 12,453 14,190 15,861 18,146 7.9 8.1 9.2 10.2 11.7

Northeast 2,068 1,987 2,292 2,547 2,913 7.7 7.4 8.4 9.3 10.7

Midwest 1,944 1,926 1,987 2,475 2,638 5.9 5.8 6.0 7.4 7.9

South 5,026 5,160 5,894 6,167 7,203 9.0 9.1 10.2 10.6 12.4

West 2,943 3,380 4,017 4,672 5,392 8.2 9.3 10.9 12.6 14.6

Guam 0 3 5 1 5 0.0 3.7 6.2 1.2 6.1

Puerto Rico 210 237 286 350 454 11.8 13.4 16.3 20.2 26.3

Virgin Islands 0 0 0 1 1 0.0 0.0 0.0 2.0 2.0

OUTLYING AREAS 210 240 291 352 460 11.0 12.6 15.4 18.9 24.7

TOTAL 12,191 12,693 14,481 16,213 18,606 7.9 8.2 9.3 10.3 11.8

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2014 Syphilis Tables 111

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

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

2010–2014

Cases Rates per 100,000 Population

MSAs 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Atlanta-Sandy Springs-Roswell, GA 651 581 745 789 996 12.3 10.8 13.7 14.3 18.0

Austin-Round Rock, TX 107 114 154 145 227 6.2 6.4 8.4 7.7 12.1

Baltimore-Columbia-Towson, MD 212 308 307 288 282 7.8 11.3 11.2 10.4 10.2

Birmingham-Hoover, AL 82 89 73 69 58 7.3 7.9 6.4 6.1 5.1

Boston-Cambridge-Newton, MA-NH 240 191 204 268 227 5.3 4.2 4.4 5.7 4.8

Buffalo-Cheektowaga-Niagara Falls, NY 11 14 27 38 49 1.0 1.2 2.4 3.4 4.3

Charlotte-Concord-Gastonia, NC-SC 116 152 116 134 220 5.2 6.7 5.1 5.7 9.4

Chicago-Naperville-Elgin, IL-IN-WI 881 853 759 763 811 9.3 9.0 8.0 8.0 8.5

Cincinnati, OH-KY-IN 272 228 166 166 153 12.9 10.7 7.8 7.8 7.2

Cleveland-Elyria, OH 82 55 44 32 80 3.9 2.7 2.1 1.5 3.9

Columbus, OH 123 122 159 167 250 6.5 6.3 8.2 8.5 12.7

Dallas-Fort Worth-Arlington, TX 342 317 391 445 508 5.3 4.8 5.8 6.5 7.5

Denver-Aurora-Lakewood, CO 120 116 183 135 153 4.7 4.5 6.9 5.0 5.7

Detroit-Warren-Dearborn, MI 146 203 235 394 317 3.4 4.7 5.5 9.2 7.4

Hartford-West Hartford-East Hartford, CT 32 15 9 14 26 2.6 1.2 0.7 1.2 2.1

Houston-The Woodlands-Sugar Land, TX 330 322 537 363 414 5.6 5.3 8.7 5.7 6.6

Indianapolis-Carmel-Anderson, IN 109 91 150 146 109 5.8 4.8 7.8 7.5 5.6

Jacksonville, FL 49 47 44 40 69 3.6 3.5 3.2 2.9 4.9

Kansas City, MO-KS 43 57 65 155 220 2.1 2.8 3.2 7.5 10.7

Las Vegas-Henderson-Paradise, NV 125 126 97 164 318 6.4 6.4 4.8 8.1 15.7

Los Angeles-Long Beach-Anaheim, CA 766 876 1,049 1,299 1,407 6.0 6.8 8.0 9.9 10.7

Louisville/Jefferson County, KY-IN 104 92 81 71 83 8.4 7.4 6.5 5.6 6.6

Memphis, TN-MS-AR 166 120 110 105 94 12.5 9.0 8.2 7.8 7.0

Miami-Fort Lauderdale-West Palm Beach, FL 652 630 705 762 821 11.7 11.1 12.2 13.1 14.1

Milwaukee-Waukesha-West Allis, WI 29 35 43 54 52 1.9 2.2 2.7 3.4 3.3

Minneapolis-St. Paul-Bloomington, MN-WI 140 127 116 181 243 4.2 3.7 3.4 5.2 7.0

Nashville-Davidson--Murfreesboro--Franklin, TN 76 85 88 57 74 4.5 5.0 5.1 3.2 4.2

New Orleans-Metairie, LA 93 101 66 103 221 7.8 8.3 5.4 8.3 17.8

New York-Newark-Jersey City, NY-NJ-PA 1,228 1,169 1,315 1,491 1,721 6.3 5.9 6.6 7.5 8.6

Oklahoma City, OK 55 39 54 78 91 4.4 3.1 4.2 5.9 6.9

Orlando-Kissimmee-Sanford, FL 103 174 168 201 239 4.8 8.0 7.6 8.9 10.5

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 307 302 369 396 446 5.1 5.0 6.1 6.6 7.4

Phoenix-Mesa-Scottsdale, AZ 161 213 162 219 416 3.8 5.0 3.7 5.0 9.5

Pittsburgh, PA 36 49 61 39 78 1.5 2.1 2.6 1.7 3.3

Portland-Vancouver-Hillsboro, OR-WA 66 90 209 240 206 3.0 4.0 9.1 10.4 8.9

Providence-Warwick, RI-MA 47 55 58 65 93 2.9 3.4 3.6 4.1 5.8

Raleigh, NC 44 47 56 70 129 3.9 4.0 4.7 5.8 10.6

Richmond, VA 88 50 64 70 68 7.3 4.1 5.2 5.6 5.5

Riverside-San Bernardino-Ontario, CA 157 182 166 203 288 3.7 4.2 3.8 4.6 6.6

Sacramento--Roseville--Arden-Arcade, CA 57 131 151 147 162 2.7 6.0 6.9 6.6 7.3

Salt Lake City, UT 54 9 34 65 39 5.0 0.8 3.0 5.7 3.4

San Antonio-New Braunfels, TX 183 188 329 310 247 8.5 8.6 14.7 13.6 10.8

San Diego-Carlsbad, CA 274 293 331 333 371 8.9 9.3 10.4 10.4 11.6

San Francisco-Oakland-Hayward, CA 543 626 744 814 767 12.5 14.3 16.7 18.0 17.0

San Jose-Sunnyvale-Santa Clara, CA 91 68 105 146 120 5.0 3.6 5.5 7.6 6.3

Seattle-Tacoma-Bellevue, WA 236 276 248 211 235 6.9 7.9 7.0 5.8 6.5

St. Louis, MO-IL 118 92 95 108 153 4.2 3.3 3.4 3.9 5.5

Tampa-St. Petersburg-Clearwater, FL 183 199 230 226 320 6.6 7.0 8.1 7.9 11.1

Virginia Beach-Norfolk-Newport News, VA-NC 92 64 106 102 85 5.5 3.8 6.2 6.0 5.0

Washington-Arlington-Alexandria, DC-VA-MD-WV 311 360 358 418 226 5.5 6.3 6.1 7.0 3.8

SELECTED MSAs TOTAL 10,533 10,743 12,136 13,299 14,982 6.3 6.3 7.1 7.7 8.7

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.
112 Syphilis Tables STD Surveillance 2014

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, 2010–2014

MSAs

Cases Rates per 100,000 Population

2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Atlanta-Sandy Springs-Roswell, GA 44 40 33 52 58 1.6 1.5 1.2 1.8 2.0

Austin-Round Rock, TX 18 12 8 6 14 2.1 1.3 0.9 0.6 1.5

Baltimore-Columbia-Towson, MD 19 39 39 46 42 1.4 2.8 2.7 3.2 2.9

Birmingham-Hoover, AL 21 10 7 5 5 3.6 1.7 1.2 0.8 0.8

Boston-Cambridge-Newton, MA-NH 12 14 5 10 14 0.5 0.6 0.2 0.4 0.6

Buffalo-Cheektowaga-Niagara Falls, NY 0 2 1 2 1 0.0 0.3 0.2 0.3 0.2

Charlotte-Concord-Gastonia, NC-SC 6 14 15 6 6 0.5 1.2 1.3 0.5 0.5

Chicago-Naperville-Elgin, IL-IN-WI 107 77 77 65 76 2.2 1.6 1.6 1.3 1.6

Cincinnati, OH-KY-IN 107 99 63 31 33 9.9 9.1 5.8 2.8 3.0

Cleveland-Elyria, OH 6 3 5 2 5 0.6 0.3 0.5 0.2 0.5

Columbus, OH 13 10 14 18 34 1.3 1.0 1.4 1.8 3.4

Dallas-Fort Worth-Arlington, TX 103 63 56 41 63 3.2 1.9 1.6 1.2 1.8

Denver-Aurora-Lakewood, CO 0 1 3 3 4 0.0 0.1 0.2 0.2 0.3

Detroit-Warren-Dearborn, MI 9 20 27 25 23 0.4 0.9 1.2 1.1 1.0

Hartford-West Hartford-East Hartford, CT 3 2 3 0 2 0.5 0.3 0.5 0.0 0.3

Houston-The Woodlands-Sugar Land, TX 77 69 97 59 64 2.6 2.3 3.1 1.9 2.0

Indianapolis-Carmel-Anderson, IN 12 5 10 9 5 1.2 0.5 1.0 0.9 0.5

Jacksonville, FL 11 11 4 5 9 1.6 1.6 0.6 0.7 1.3

Kansas City, MO-KS 1 4 1 9 23 0.1 0.4 0.1 0.9 2.2

Las Vegas-Henderson-Paradise, NV 6 4 2 6 17 0.6 0.4 0.2 0.6 1.7

Los Angeles-Long Beach-Anaheim, CA 17 16 26 50 67 0.3 0.2 0.4 0.8 1.0

Louisville/Jefferson County, KY-IN 4 7 9 11 14 0.6 1.1 1.4 1.7 2.2

Memphis, TN-MS-AR 33 22 22 17 22 4.8 3.2 3.2 2.4 3.2

Miami-Fort Lauderdale-West Palm Beach, FL 55 47 63 65 44 1.9 1.6 2.1 2.2 1.5

Milwaukee-Waukesha-West Allis, WI 5 5 5 5 6 0.6 0.6 0.6 0.6 0.7

Minneapolis-St. Paul-Bloomington, MN-WI 5 5 7 9 19 0.3 0.3 0.4 0.5 1.1

Nashville-Davidson--Murfreesboro--Franklin, TN 11 3 1 4 5 1.3 0.3 0.1 0.4 0.6

New Orleans-Metairie, LA 31 17 9 10 18 5.1 2.7 1.4 1.6 2.8

New York-Newark-Jersey City, NY-NJ-PA 53 39 57 46 52 0.5 0.4 0.6 0.4 0.5

Oklahoma City, OK 12 6 1 5 7 1.9 0.9 0.2 0.7 1.0

Orlando-Kissimmee-Sanford, FL 7 10 15 9 8 0.6 0.9 1.3 0.8 0.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 33 28 30 24 39 1.1 0.9 1.0 0.8 1.3

Phoenix-Mesa-Scottsdale, AZ 12 9 14 22 42 0.6 0.4 0.6 1.0 1.9

Pittsburgh, PA 2 4 5 2 6 0.2 0.3 0.4 0.2 0.5

Portland-Vancouver-Hillsboro, OR-WA 2 0 9 9 9 0.2 0.0 0.8 0.8 0.8

Providence-Warwick, RI-MA 3 3 1 3 8 0.4 0.4 0.1 0.4 1.0

Raleigh, NC 5 1 5 9 6 0.9 0.2 0.8 1.4 1.0

Richmond, VA 6 10 10 4 2 1.0 1.6 1.6 0.6 0.3

Riverside-San Bernardino-Ontario, CA 1 8 3 7 15 0.0 0.4 0.1 0.3 0.7

Sacramento--Roseville--Arden-Arcade, CA 12 7 5 10 11 1.1 0.6 0.4 0.9 1.0

Salt Lake City, UT 0 0 0 1 1 0.0 0.0 0.0 0.2 0.2

San Antonio-New Braunfels, TX 28 39 59 44 47 2.6 3.5 5.2 3.8 4.1

San Diego-Carlsbad, CA 3 13 12 10 20 0.2 0.8 0.8 0.6 1.3

San Francisco-Oakland-Hayward, CA 20 27 28 40 34 0.9 1.2 1.2 1.7 1.5

San Jose-Sunnyvale-Santa Clara, CA 3 4 3 9 12 0.3 0.4 0.3 0.9 1.3

Seattle-Tacoma-Bellevue, WA 2 3 6 10 10 0.1 0.2 0.3 0.6 0.6

St. Louis, MO-IL 3 3 9 6 17 0.2 0.2 0.6 0.4 1.2

Tampa-St. Petersburg-Clearwater, FL 33 26 29 31 41 2.3 1.8 2.0 2.1 2.8

Virginia Beach-Norfolk-Newport News, VA-NC 3 7 5 5 8 0.4 0.8 0.6 0.6 0.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 13 16 15 35 7 0.4 0.5 0.5 1.2 0.2

SELECTED MSAs TOTAL 992 884 933 912 1,095 1.2 1.0 1.1 1.0 1.2

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2014 Syphilis Tables 113

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, 2010–2014

MSAs

Cases Rates per 100,000 Population

2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Atlanta-Sandy Springs-Roswell, GA 607 541 712 737 938 23.6 20.6 26.8 27.5 35.0

Austin-Round Rock, TX 89 102 146 139 213 10.3 11.4 15.9 14.7 22.6

Baltimore-Columbia-Towson, MD 193 269 268 242 240 14.8 20.5 20.2 18.1 18.0

Birmingham-Hoover, AL 61 79 66 64 53 11.2 14.5 12.1 11.6 9.6

Boston-Cambridge-Newton, MA-NH 228 177 199 258 213 10.4 8.0 8.8 11.4 9.4

Buffalo-Cheektowaga-Niagara Falls, NY 11 12 26 36 48 2.0 2.2 4.7 6.6 8.7

Charlotte-Concord-Gastonia, NC-SC 110 138 101 128 214 10.2 12.6 9.0 11.3 18.9

Chicago-Naperville-Elgin, IL-IN-WI 774 776 682 697 735 16.7 16.7 14.6 14.9 15.7

Cincinnati, OH-KY-IN 165 129 103 135 120 16.0 12.4 9.9 12.9 11.5

Cleveland-Elyria, OH 76 52 39 30 75 7.6 5.2 3.9 3.0 7.5

Columbus, OH 110 112 145 149 216 11.8 11.8 15.2 15.4 22.3

Dallas-Fort Worth-Arlington, TX 239 254 335 404 445 7.5 7.8 10.1 12.0 13.3

Denver-Aurora-Lakewood, CO 120 115 180 132 149 9.5 8.9 13.7 9.8 11.1

Detroit-Warren-Dearborn, MI 137 183 208 369 294 6.6 8.8 10.0 17.7 14.1

Hartford-West Hartford-East Hartford, CT 29 13 6 14 24 4.9 2.2 1.0 2.4 4.1

Houston-The Woodlands-Sugar Land, TX 253 253 440 304 350 8.6 8.4 14.3 9.7 11.1

Indianapolis-Carmel-Anderson, IN 97 86 140 137 104 10.5 9.2 14.8 14.3 10.9

Jacksonville, FL 38 36 40 35 60 5.8 5.4 6.0 5.2 8.8

Kansas City, MO-KS 42 53 64 146 197 4.3 5.3 6.4 14.5 19.5

Las Vegas-Henderson-Paradise, NV 119 122 95 158 301 12.1 12.3 9.4 15.5 29.6

Los Angeles-Long Beach-Anaheim, CA 749 858 1,019 1,248 1,340 11.8 13.4 15.8 19.2 20.7

Louisville/Jefferson County, KY-IN 100 85 72 60 69 16.6 14.0 11.8 9.7 11.2

Memphis, TN-MS-AR 133 98 88 88 72 20.9 15.3 13.7 13.7 11.2

Miami-Fort Lauderdale-West Palm Beach, FL 597 583 642 697 777 22.2 21.2 23.0 24.6 27.5

Milwaukee-Waukesha-West Allis, WI 24 30 38 49 46 3.2 3.9 5.0 6.4 6.0

Minneapolis-St. Paul-Bloomington, MN-WI 135 122 109 169 223 8.2 7.3 6.4 9.9 13.0

Nashville-Davidson--Murfreesboro--Franklin, TN 65 82 87 53 69 8.0 9.9 10.3 6.2 8.0

New Orleans-Metairie, LA 55 84 57 93 203 9.5 14.2 9.6 15.4 33.7

New York-Newark-Jersey City, NY-NJ-PA 1,175 1,129 1,254 1,438 1,666 12.5 11.9 13.1 14.9 17.3

Oklahoma City, OK 43 33 53 73 84 7.0 5.2 8.3 11.2 12.9

Orlando-Kissimmee-Sanford, FL 96 164 153 192 231 9.2 15.4 14.1 17.3 20.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 274 274 339 372 407 9.5 9.5 11.7 12.8 14.0

Phoenix-Mesa-Scottsdale, AZ 149 202 148 197 374 7.1 9.5 6.9 9.0 17.1

Pittsburgh, PA 34 45 56 37 72 3.0 3.9 4.9 3.2 6.3

Portland-Vancouver-Hillsboro, OR-WA 64 90 200 231 197 5.8 8.0 17.7 20.2 17.2

Providence-Warwick, RI-MA 44 52 57 62 84 5.7 6.7 7.4 8.0 10.8

Raleigh, NC 39 46 51 61 123 7.1 8.1 8.8 10.3 20.7

Richmond, VA 82 40 54 66 66 14.0 6.8 9.1 11.0 11.0

Riverside-San Bernardino-Ontario, CA 156 171 163 196 273 7.4 8.0 7.5 9.0 12.5

Sacramento--Roseville--Arden-Arcade, CA 45 122 144 137 151 4.3 11.4 13.4 12.6 13.9

Salt Lake City, UT 54 9 34 64 38 9.9 1.6 6.0 11.2 6.6

San Antonio-New Braunfels, TX 155 149 270 266 200 14.7 13.8 24.5 23.7 17.8

San Diego-Carlsbad, CA 271 279 318 323 351 17.4 17.7 19.9 20.0 21.7

San Francisco-Oakland-Hayward, CA 523 596 713 773 731 24.5 27.5 32.4 34.7 32.8

San Jose-Sunnyvale-Santa Clara, CA 88 64 102 137 108 9.5 6.8 10.7 14.2 11.2

Seattle-Tacoma-Bellevue, WA 234 273 242 201 225 13.7 15.6 13.7 11.2 12.5

St. Louis, MO-IL 115 89 86 102 136 8.5 6.6 6.4 7.5 10.0

Tampa-St. Petersburg-Clearwater, FL 150 173 201 195 278 11.1 12.6 14.6 14.0 20.0

Virginia Beach-Norfolk-Newport News, VA-NC 89 57 101 97 77 10.8 6.9 12.1 11.5 9.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 298 344 343 383 219 10.9 12.3 12.0 13.2 7.5

SELECTED MSAs TOTAL 9,534 9,845 11,189 12,374 13,879 11.6 11.9 13.3 14.6 16.4

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.

NOTE: Cases reported with unknown sex are not included in this table.
114 Syphilis Tables STD Surveillance 2014

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, 2014

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percentage

1 Los Angeles County, CA 1,204 12.0 6

2 Cook County, IL 724 13.8 9

3 New York County, NY 497 30.6 12

4 San Francisco County, CA 470 56.1 14

5 Miami-Dade County, FL 434 16.6 16

6 Fulton County, GA 429 43.6 18

7 Maricopa County, AZ 412 10.3 20

8 San Diego County, CA 371 11.6 22

9 Harris County, TX 366 8.4 24

10 Kings County, NY 348 13.4 26

11 Broward County, FL 323 17.6 27

12 Clark County, NV 318 15.7 29

13 Philadelphia County, PA 308 19.8 31

14 Dallas County, TX 299 12.1 32

15 Bronx County, NY 283 19.9 33

16 DeKalb County, GA 242 33.9 35

17 Franklin County, OH 232 19.1 36

18 Bexar County, TX 227 12.5 37

19 Hillsborough County, FL 218 16.9 38

20 Wayne County, MI 213 12.0 39

21 Orange County, CA 203 6.5 40

22 Travis County, TX 193 17.2 41

23 Baltimore (City), MD 192 30.9 42

24 Riverside County, CA 188 8.2 43

25 Orange County, FL 186 15.2 44

26 Queens County, NY 185 8.1 45

27 Mecklenburg County, NC 181 18.3 46

28 King County, WA 176 8.6 47

29 Jackson County, MO 173 25.4 47

30 Hennepin County, MN 167 13.9 48

31 Tarrant County, TX 164 8.6 49

32 Orleans Parish, LA 148 39.1 50

33 Alameda County, CA 145 9.2 51

34 Pima County, AZ 144 14.4 51

35 Multnomah County, OR 140 18.3 52

36 Kern County, CA 140 16.2 53

37 Sacramento County, CA 137 9.4 53

38 Hamilton County, OH 121 15.0 54

39 Santa Clara County, CA 119 6.4 55

40 Fresno County, CA 118 12.4 55

41 Wake County, NC 115 11.8 56

42 Prince George's County, MD 111 12.5 56

43 San Bernardino County, CA 100 4.8 57

44 Gwinnett County, GA 96 11.2 57

45 Marion County, IN 96 10.3 58

46 Denver County, CO 90 13.9 58

47 San Joaquin County, CA 88 12.5 59

48 Suffolk County, MA 86 11.4 59

49 Cobb County, GA 84 11.7 60

50 Contra Costa County, CA 83 7.6 60

51 St. Louis (City), MO 82 25.8 60

52 Clayton County, GA 80 30.3 61

53 Pinellas County, FL 79 8.5 61

54 Shelby County, TN 78 8.3 62

55 Oklahoma County, OK 77 10.2 62

56 Richland County, SC 76 19.0 62

57 Jefferson County, KY 74 9.8 63

58 Caddo Parish, LA 73 28.6 63

59 East Baton Rouge Parish, LA 73 16.4 63

60 Hudson County, NJ 72 10.9 64

61 Oakland County, MI 72 5.8 64

62 Cuyahoga County, OH 72 5.7 64

63 Allegheny County, PA 68 5.5 65

64 Middlesex County, MA 67 4.3 65

65 Bernalillo County, NM 66 9.8 65

66 Stanislaus County, CA 65 12.4 66

67 Duval County, FL 65 7.3 66

68 Palm Beach County, FL 64 4.7 66

69 Cumberland County, NC 59 18.1 67

70 Davidson County, TN 58 8.8 67

* Accounting for 67% of reported primary and secondary syphilis cases.

† Counties and independent cities were ranked in descending order by number of cases reported then by rate in 2014.
STD Surveillance 2014 Syphilis Tables 115

Table 34. Primary and Secondary Syphilis Among Men and Women — Reported Cases and Rates 

of Reported Cases per 100,000 population, and Male-To-Female Rate Ratios in the 

Counties and Independent Cities Ranked in the Top 30 for Cases in 2014, United States, 

2013–2014

Male Female Male-to-Female

2013 2014 2013 2014 Rate Ratio

County/Independent City* Cases Rates Cases Rates Cases Rates Cases Rates 2013 2014

Maricopa County, AZ 191 9.6 371 18.7 21 1.0 41 2.0 9.6 9.4

Los Angeles County, CA 1,055 21.3 1,151 23.3 40 0.8 53 1.0 26.6 23.3

Orange County, CA 193 12.5 189 12.3 10 0.6 14 0.9 20.8 13.7

Riverside County, CA 126 11.0 182 15.9 2 0.2 6 0.5 55.0 31.8

San Diego County, CA 323 20.0 351 21.7 10 0.6 20 1.3 33.3 16.7

San Francisco County, CA 489 115 464 109 13 3.2 4 1.0 35.8 109

Broward County, FL 242 27.1 310 34.7 23 2.4 13 1.4 11.3 24.8

Hillsborough County, FL 137 21.8 187 29.7 26 3.9 30 4.5 5.6 6.6

Miami-Dade County, FL 382 30.0 410 32.2 31 2.3 24 1.8 13.0 17.9

Orange County, FL 141 23.4 180 29.8 6 1.0 6 1.0 23.4 29.8

DeKalb County, GA 186 54.6 229 67.2 12 3.2 13 3.5 17.1 19.2

Fulton County, GA 358 74.7 408 85.2 21 4.2 21 4.2 17.8 20.3

Cook County, IL 635 25.0 654 25.7 58 2.1 70 2.6 11.9 9.9

Baltimore (City), MD 177 60.3 162 55.2 34 10.3 30 9.1 5.9 6.1

Wayne County, MI 267 31.3 194 22.7 19 2.1 19 2.1 14.9 10.8

Hennepin County, MN 125 21.2 152 25.8 6 1.0 14 2.3 21.2 11.2

Jackson County, MO 105 31.9 157 47.7 7 2.0 16 4.6 16.0 10.4

Clark County, NV 158 15.5 301 29.6 6 0.6 17 1.7 25.8 17.4

Bronx County, NY 226 33.8 270 40.4 8 1.1 11 1.5 30.7 26.9

Kings County, NY 278 22.6 339 27.6 5 0.4 9 0.7 56.5 39.4

New York County, NY 477 62.1 491 63.9 7 0.8 6 0.7 77.6 91.3

Queens County, NY 139 12.5 179 16.1 6 0.5 6 0.5 25.0 32.2

Mecklenburg County, NC 103 21.6 178 37.3 5 1.0 3 0.6 21.6 62.2

Franklin County, OH 141 23.9 201 34.0 15 2.4 31 5.0 10.0 6.8

Philadelphia County, PA 262 35.7 279 38.0 16 2.0 29 3.5 17.9 10.9

Bexar County, TX 251 28.0 182 20.3 42 4.6 45 4.9 6.1 4.1

Dallas County, TX 222 18.1 267 21.8 22 1.8 32 2.6 10.1 8.4

Harris County, TX 269 12.4 311 14.4 50 2.3 55 2.5 5.4 5.8

Travis County, TX 122 21.6 183 32.3 6 1.1 10 1.8 19.6 17.9

King County, WA 165 16.2 168 16.4 6 0.6 8 0.8 27.0 20.5

* Counties and independent cities are in alphabetical order by state.
116 Syphilis Tables STD Surveillance 2014

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

Cases by Age Group and Sex, United States, 2010–2014

Age

Group

Cases Rates*

Total Male Female Unknown Sex Total Male Female

2010

0–4 1 0 1 0 0.0 0.0 0.0

5–9 0 0 0 0 0.0 0.0 0.0

10–14 18 7 11 0 0.1 0.1 0.1

15–19 932 617 313 2 4.2 5.5 2.9

20–24 2,907 2,429 474 4 13.5 22.1 4.5

25–29 2,455 2,131 322 2 11.6 20.0 3.1

30–34 1,794 1,597 197 0 9.0 16.0 2.0

35–39 1,454 1,313 140 1 7.2 13.1 1.4

40–44 1,553 1,448 104 1 7.4 13.9 1.0

45–54 2,056 1,877 176 3 4.6 8.5 0.8

55–64 493 457 36 0 1.4 2.6 0.2

65+ 107 102 5 0 0.3 0.6 0.0

Unknown Age 4 3 1 0

TOTAL 13,774 11,981 1,780 13 4.5 7.9 1.1

2011

0–4 9 5 4 0 0.0 0.0 0.0

5–9 1 1 0 0 0.0 0.0 0.0

10–14 15 6 9 0 0.1 0.1 0.1

15–19 864 606 258 0 4.0 5.5 2.5

20–24 2,987 2,582 403 2 13.5 22.8 3.7

25–29 2,546 2,277 268 1 12.0 21.2 2.5

30–34 1,846 1,657 187 2 9.0 16.1 1.8

35–39 1,382 1,265 115 2 7.1 13.0 1.2

40–44 1,503 1,408 91 4 7.1 13.5 0.9

45–54 2,123 1,999 120 4 4.7 9.1 0.5

55–64 554 510 43 1 1.5 2.8 0.2

65+ 138 135 3 0 0.3 0.8 0.0

Unknown Age 2 2 0 0

TOTAL 13,970 12,453 1,501 16 4.5 8.1 0.9

2012

0–4 1 1 0 0 0.0 0.0 0.0

5–9 0 0 0 0 0.0 0.0 0.0

10–14 9 5 4 0 0.0 0.0 0.0

15–19 880 640 238 2 4.1 5.8 2.3

20–24 3,280 2,859 418 3 14.5 24.8 3.8

25–29 2,911 2,641 266 4 13.6 24.4 2.5

30–34 2,209 2,023 182 4 10.6 19.3 1.7

35–39 1,563 1,443 120 0 8.0 14.9 1.2

40–44 1,618 1,544 70 4 7.7 14.8 0.7

45–54 2,439 2,310 128 1 5.5 10.6 0.6

55–64 614 586 27 1 1.6 3.2 0.1

65+ 123 121 2 0 0.3 0.6 0.0

Unknown Age 20 17 3 0

TOTAL 15,667 14,190 1,458 19 5.0 9.2 0.9

2013

0–4 5 2 3 0 0.0 0.0 0.0

5–9 0 0 0 0 0.0 0.0 0.0

10–14 23 14 9 0 0.1 0.1 0.1

15–19 900 700 200 0 4.3 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

2014

0–4 0 0 0 0 0.0 0.0 0.0

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 4.8 7.0 2.5

20–24 4,137 3,632 503 2 18.1 31.1 4.5

25–29 4,092 3,727 361 4 19.0 34.0 3.4

30–34 2,887 2,635 248 4 13.6 24.7 2.3

35–39 2,045 1,868 177 0 10.4 19.1 1.8

40–44 1,758 1,654 103 1 8.4 16.0 1.0

45–54 2,966 2,830 135 1 6.8 13.1 0.6

55–64 897 860 36 1 2.3 4.5 0.2

65+ 176 169 7 0 0.4 0.9 0.0

Unknown Age 6 6 0 0

TOTAL 19,999 18,146 1,840 13 6.3 11.7 1.1

* No population data are available for unknown sex and age; therefore, rates are not calculated.

NOTE: This table should be used only for age comparisons.

Cases in the 0–4 and 5–9 age groups may include cases due to congenital transmission.
STD Surveillance 2014 Syphilis Tables 117

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118 Syphilis Tables STD Surveillance 2014

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

Sex, United States*, 2014

Age

Group

American Indians/

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 0 0 0 0 0 0 0 0 0

5–9 0 0 0 0 0 0 0 0 0

10–14 0 0 0 0 0 0 7 2 5

15–19 20 8 12 8 8 0 532 375 157

20–24 32 23 9 84 82 2 2,066 1,756 309

25–29 35 25 10 101 98 3 1,798 1,628 169

30–34 29 24 5 67 66 1 1,036 918 116

35–39 22 12 10 59 56 3 579 512 67

40–44 14 12 2 48 46 2 431 394 37

45–54 15 9 6 51 49 2 584 531 53

55–64 1 1 0 10 9 1 189 177 12

65+ 0 0 0 2 2 0 28 28 0

Unknown Age 0 0 0 0 0 0 3 3 0

TOTAL 168 114 54 430 416 14 7,253 6,324 925

Age

Group

Native Hawaiians/

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 0 0 0 0 0 0 0 0 0

5–9 0 0 0 0 0 0 0 0 0

10–14 0 0 0 0 0 0 1 0 1

15–19 2 2 0 158 115 43 11 10 1

20–24 11 11 0 904 811 93 56 53 3

25–29 6 5 1 1,052 958 94 53 50 3

30–34 7 7 0 934 865 69 56 52 4

35–39 2 2 0 742 688 54 43 41 2

40–44 2 2 0 771 733 38 29 29 0

45–54 2 2 0 1,584 1,537 47 31 30 1

55–64 1 0 1 542 530 11 12 11 1

65+ 0 0 0 111 106 5 0 0 0

Unknown Age 0 0 0 2 2 0 0 0 0

TOTAL 33 31 2 6,800 6,345 454 292 276 16

Age

Group

Hispanics Other/Unknown

Total† Male Female Total† Male Female

0–4 0 0 0 0 0 0

5–9 0 0 0 0 0 0

10–14 3 2 1 1 0 1

15–19 240 202 38 45 36 9

20–24 844 772 72 126 110 15

25–29 853 787 65 163 149 14

30–34 607 565 42 127 117 10

35–39 495 465 30 91 81 10

40–44 386 365 20 63 59 4

45–54 495 477 18 171 163 8

55–64 92 84 8 41 40 1

65+ 17 15 2 14 14 0

Unknown Age 0 0 0 1 1 0

TOTAL 4,032 3,734 296 843 770 72

* Includes 49 states reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2014.

† Total includes cases reported with unknown sex.

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 35 for age-specific cases and rates and Tables 27–29 for total and sex-specific 

cases and rates.

Cases in the 0–4 and 5–9 age groups may include cases due to congenital transmission.
STD Surveillance 2014 Syphilis Tables 119

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

Race/Ethnicity, Age Group, and Sex, United States*, 2014

Age

Group

American Indians/

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 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 0.2 0.1 0.4

15–19 11.1 8.7 13.7 0.8 1.7 0.0 17.1 23.7 10.3

20–24 17.1 24.0 9.8 7.2 13.8 0.3 62.7 106.3 18.8

25–29 21.9 31.1 12.5 7.8 15.7 0.4 65.2 121.3 11.9

30–34 19.5 32.5 6.7 5.1 10.7 0.1 39.0 72.4 8.3

35–39 16.1 17.8 14.4 4.5 9.1 0.4 23.7 44.4 5.2

40–44 9.8 17.0 2.8 3.8 7.7 0.3 16.6 32.1 2.7

45–54 4.9 6.1 3.8 2.4 4.9 0.2 10.9 21.1 1.9

55–64 0.4 0.9 0.0 0.6 1.2 0.1 4.5 9.3 0.5

65+ 0.0 0.0 0.0 0.1 0.3 0.0 0.8 1.9 0.0

Unknown Age

TOTAL 7.6 10.5 4.8 2.8 5.6 0.2 18.9 34.5 4.6

Age

Group

Native Hawaiians/

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

5–9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

10–14 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.3

15–19 5.1 9.9 0.0 1.3 1.9 0.7 1.8 3.2 0.3

20–24 23.1 44.8 0.0 7.1 12.5 1.5 11.0 21.4 1.2

25–29 12.9 21.0 4.4 8.6 15.4 1.6 13.5 26.9 1.5

30–34 16.3 31.9 0.0 7.8 14.3 1.2 16.2 32.1 2.2

35–39 5.4 10.6 0.0 6.6 12.2 1.0 15.2 30.8 1.3

40–44 5.7 11.4 0.0 5.9 11.3 0.6 11.0 23.2 0.0

45–54 3.1 6.1 0.0 5.3 10.4 0.3 6.6 13.4 0.4

55–64 2.2 0.0 4.2 1.9 3.8 0.1 3.5 6.8 0.6

65+ 0.0 0.0 0.0 0.3 0.7 0.0 0.0 0.0 0.0

Unknown Age

TOTAL 6.5 12.0 0.8 3.5 6.5 0.5 4.9 9.5 0.5

Age

Group

Hispanics

Total† Male Female

0–4 0.0 0.0 0.0

5–9 0.0 0.0 0.0

10–14 0.1 0.1 0.0

15–19 5.3 8.6 1.7

20–24 18.5 32.0 3.3

25–29 19.6 34.0 3.2

30–34 14.2 25.2 2.1

35–39 12.5 22.8 1.6

40–44 10.6 19.5 1.1

45–54 8.4 16.1 0.6

55–64 2.5 4.8 0.4

65+ 0.5 1.1 0.1

Unknown Age

TOTAL 7.6 13.9 1.1

* Includes 49 states reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2014.

† Total includes cases reported with unknown sex.

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 35 for age-specific cases and rates and Tables 27–29 for total and sex-specific 

cases and rates.

Cases in the 0–4 and 5–9 age groups may include cases due to congenital transmission.

No population data exist for unknown sex, unknown age, or unknown race; therefore rates are not calculated.
120 Syphilis Tables STD Surveillance 2014

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

Region in Alphabetical Order, United States and Outlying Areas, 2010–2014

Cases Rates per 100,000 Population

State/Area 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Alabama 277 268 237 202 144 5.8 5.6 4.9 4.2 3.0

Alaska 5 3 8 8 25 0.7 0.4 1.1 1.1 3.4

Arizona 166 187 147 207 311 2.6 2.9 2.2 3.1 4.7

Arkansas 202 167 152 163 152 6.9 5.7 5.2 5.5 5.1

California 1,788 2,030 2,519 2,844 3,396 4.8 5.4 6.6 7.4 8.9

Colorado 129 154 194 195 164 2.6 3.0 3.7 3.7 3.1

Connecticut 51 57 52 55 62 1.4 1.6 1.4 1.5 1.7

Delaware 14 49 38 30 33 1.6 5.4 4.1 3.2 3.6

District of Columbia 239 222 244 243 142 39.7 35.9 38.6 37.6 22.0

Florida 1,294 1,212 1,384 1,540 1,886 6.9 6.4 7.2 7.9 9.6

Georgia 636 436 639 863 1,078 6.6 4.4 6.4 8.6 10.8

Hawaii 15 5 9 22 25 1.1 0.4 0.6 1.6 1.8

Idaho 4 11 21 6 12 0.3 0.7 1.3 0.4 0.7

Illinois 502 581 690 809 819 3.9 4.5 5.4 6.3 6.4

Indiana 103 95 148 157 129 1.6 1.5 2.3 2.4 2.0

Iowa 4 11 15 63 82 0.1 0.4 0.5 2.0 2.7

Kansas 63 34 54 84 92 2.2 1.2 1.9 2.9 3.2

Kentucky 88 109 139 167 169 2.0 2.5 3.2 3.8 3.8

Louisiana 742 488 343 276 372 16.4 10.7 7.5 6.0 8.0

Maine 6 8 2 6 7 0.5 0.6 0.2 0.5 0.5

Maryland 279 332 361 387 529 4.8 5.7 6.1 6.5 8.9

Massachusetts 195 233 231 350 282 3.0 3.5 3.5 5.2 4.2

Michigan 121 132 150 204 243 1.2 1.3 1.5 2.1 2.5

Minnesota 73 121 96 139 159 1.4 2.3 1.8 2.6 2.9

Mississippi 386 313 253 184 336 13.0 10.5 8.5 6.2 11.2

Missouri 133 124 135 220 240 2.2 2.1 2.2 3.6 4.0

Montana 2 1 0 2 1 0.2 0.1 0.0 0.2 0.1

Nebraska 1 3 8 14 19 0.1 0.2 0.4 0.7 1.0

Nevada 178 166 214 232 389 6.6 6.1 7.8 8.3 13.9

New Hampshire 5 5 9 21 22 0.4 0.4 0.7 1.6 1.7

New Jersey 386 452 410 539 612 4.4 5.1 4.6 6.1 6.9

New Mexico 41 56 68 67 76 2.0 2.7 3.3 3.2 3.6

New York 1,358 1,254 1,413 1,945 2,307 7.0 6.4 7.2 9.9 11.7

North Carolina 328 333 244 236 468 3.4 3.4 2.5 2.4 4.8

North Dakota 0 1 0 2 22 0.0 0.1 0.0 0.3 3.0

Ohio 189 160 171 211 265 1.6 1.4 1.5 1.8 2.3

Oklahoma 149 145 146 237 198 4.0 3.8 3.8 6.2 5.1

Oregon 33 63 94 127 149 0.9 1.6 2.4 3.2 3.8

Pennsylvania 355 412 484 581 641 2.8 3.2 3.8 4.5 5.0

Rhode Island 20 20 24 22 49 1.9 1.9 2.3 2.1 4.7

South Carolina 344 345 336 415 467 7.4 7.4 7.1 8.7 9.8

South Dakota 0 0 3 5 23 0.0 0.0 0.4 0.6 2.7

Tennessee 363 256 255 267 236 5.7 4.0 3.9 4.1 3.6

Texas 1,874 1,581 1,767 1,902 1,984 7.5 6.2 6.8 7.2 7.5

Utah 20 8 8 47 41 0.7 0.3 0.3 1.6 1.4

Vermont 0 1 6 2 7 0.0 0.2 1.0 0.3 1.1

Virginia 275 289 303 354 274 3.4 3.6 3.7 4.3 3.3

Washington 109 146 181 204 198 1.6 2.1 2.6 2.9 2.8

West Virginia 4 0 10 10 23 0.2 0.0 0.5 0.5 1.2

Wisconsin 52 57 86 62 91 0.9 1.0 1.5 1.1 1.6

Wyoming 3 0 2 1 1 0.5 0.0 0.3 0.2 0.2

U.S. TOTAL 13,604 13,136 14,503 16,929 19,452 4.4 4.2 4.6 5.4 6.2

Northeast 2,376 2,442 2,631 3,521 3,989 4.3 4.4 4.7 6.3 7.1

Midwest 1,241 1,319 1,556 1,970 2,184 1.9 2.0 2.3 2.9 3.2

South 7,494 6,545 6,851 7,476 8,491 6.5 5.6 5.8 6.3 7.2

West 2,493 2,830 3,465 3,962 4,788 3.5 3.9 4.7 5.3 6.4

Guam 0 4 1 3 1 0.0 2.5 0.6 1.9 0.6

Puerto Rico 191 211 222 270 375 5.1 5.7 6.1 7.5 10.4

Virgin Islands 3 0 0 2 0 2.8 0.0 0.0 1.9 0.0

OUTLYING AREAS 194 215 223 275 376 4.9 5.4 5.7 7.1 9.7

TOTAL 13,798 13,351 14,726 17,204 19,828 4.4 4.2 4.6 5.4 6.2
STD Surveillance 2014 Syphilis Tables 121

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

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2010–2014

Cases Rates per 100,000 Population

MSAs 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Atlanta-Sandy Springs-Roswell, GA 529 352 491 672 863 10.0 6.5 9.0 12.2 15.6

Austin-Round Rock, TX 137 137 170 220 207 8.0 7.7 9.3 11.7 11.0

Baltimore-Columbia-Towson, MD 148 198 206 216 296 5.5 7.3 7.5 7.8 10.7

Birmingham-Hoover, AL 67 90 74 71 46 5.9 7.9 6.5 6.2 4.0

Boston-Cambridge-Newton, MA-NH 161 176 158 278 208 3.5 3.8 3.4 5.9 4.4

Buffalo-Cheektowaga-Niagara Falls, NY 0 7 11 15 19 0.0 0.6 1.0 1.3 1.7

Charlotte-Concord-Gastonia, NC-SC 101 103 70 74 129 4.6 4.6 3.0 3.2 5.5

Chicago-Naperville-Elgin, IL-IN-WI 476 531 630 751 734 5.0 5.6 6.6 7.9 7.7

Cincinnati, OH-KY-IN 87 67 78 70 98 4.1 3.2 3.7 3.3 4.6

Cleveland-Elyria, OH 20 25 13 14 31 1.0 1.2 0.6 0.7 1.5

Columbus, OH 42 37 49 71 82 2.2 1.9 2.5 3.6 4.2

Dallas-Fort Worth-Arlington, TX 647 500 604 550 644 10.1 7.6 9.0 8.1 9.5

Denver-Aurora-Lakewood, CO 109 139 177 166 145 4.3 5.3 6.7 6.2 5.4

Detroit-Warren-Dearborn, MI 76 82 113 152 163 1.8 1.9 2.6 3.5 3.8

Hartford-West Hartford-East Hartford, CT 18 18 9 19 16 1.5 1.5 0.7 1.6 1.3

Houston-The Woodlands-Sugar Land, TX 370 351 419 348 444 6.2 5.8 6.8 5.5 7.0

Indianapolis-Carmel-Anderson, IN 70 66 102 104 91 3.7 3.5 5.3 5.3 4.7

Jacksonville, FL 91 50 57 73 69 6.8 3.7 4.1 5.2 4.9

Kansas City, MO-KS 59 40 61 111 132 2.9 2.0 3.0 5.4 6.4

Las Vegas-Henderson-Paradise, NV 174 162 207 218 375 8.9 8.2 10.3 10.8 18.5

Los Angeles-Long Beach-Anaheim, CA 991 1,132 1,393 1,520 1,619 7.7 8.7 10.7 11.6 12.3

Louisville/Jefferson County, KY-IN 46 41 72 85 82 3.7 3.3 5.8 6.7 6.5

Memphis, TN-MS-AR 257 180 188 188 143 19.4 13.5 14.0 14.0 10.7

Miami-Fort Lauderdale-West Palm Beach, FL 749 682 831 885 1,094 13.5 12.0 14.4 15.2 18.8

Milwaukee-Waukesha-West Allis, WI 35 33 57 43 69 2.2 2.1 3.6 2.7 4.4

Minneapolis-St. Paul-Bloomington, MN-WI 68 112 91 131 155 2.0 3.3 2.7 3.8 4.5

Nashville-Davidson--Murfreesboro--Franklin, TN 72 37 50 62 83 4.3 2.2 2.9 3.5 4.7

New Orleans-Metairie, LA 195 109 90 81 122 16.4 9.0 7.3 6.5 9.8

New York-Newark-Jersey City, NY-NJ-PA 1,605 1,569 1,668 2,299 2,681 8.2 8.0 8.4 11.5 13.4

Oklahoma City, OK 76 65 79 124 107 6.1 5.1 6.1 9.4 8.1

Orlando-Kissimmee-Sanford, FL 138 142 136 175 180 6.5 6.5 6.1 7.7 7.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 348 398 408 497 512 5.8 6.6 6.8 8.2 8.5

Phoenix-Mesa-Scottsdale, AZ 126 153 120 150 240 3.0 3.6 2.8 3.4 5.5

Pittsburgh, PA 27 30 46 45 63 1.1 1.3 1.9 1.9 2.7

Portland-Vancouver-Hillsboro, OR-WA 33 58 101 117 124 1.5 2.6 4.4 5.1 5.4

Providence-Warwick, RI-MA 26 26 35 28 64 1.6 1.6 2.2 1.7 4.0

Raleigh, NC 44 35 31 41 77 3.9 3.0 2.6 3.4 6.3

Richmond, VA 76 68 78 75 68 6.3 5.6 6.3 6.0 5.5

Riverside-San Bernardino-Ontario, CA 86 144 138 159 223 2.0 3.3 3.2 3.6 5.1

Sacramento--Roseville--Arden-Arcade, CA 43 51 38 33 74 2.0 2.3 1.7 1.5 3.3

Salt Lake City, UT 12 7 7 37 31 1.1 0.6 0.6 3.2 2.7

San Antonio-New Braunfels, TX 305 252 269 381 308 14.2 11.5 12.0 16.7 13.5

San Diego-Carlsbad, CA 177 162 236 211 299 5.7 5.2 7.4 6.6 9.3

San Francisco-Oakland-Hayward, CA 373 396 528 656 839 8.6 9.0 11.9 14.5 18.6

San Jose-Sunnyvale-Santa Clara, CA 29 35 44 60 58 1.6 1.9 2.3 3.1 3.0

Seattle-Tacoma-Bellevue, WA 91 134 142 167 143 2.6 3.8 4.0 4.6 4.0

St. Louis, MO-IL 106 84 89 125 139 3.8 3.0 3.2 4.5 5.0

Tampa-St. Petersburg-Clearwater, FL 117 139 176 176 227 4.2 4.9 6.2 6.1 7.9

Virginia Beach-Norfolk-Newport News, VA-NC 84 108 90 112 90 5.0 6.4 5.3 6.6 5.3

Washington-Arlington-Alexandria, DC-VA-MD-WV 441 403 497 520 286 7.8 7.0 8.5 8.7 4.8

SELECTED MSAs TOTAL 10,158 9,916 11,427 13,376 14,992 6.1 5.9 6.7 7.7 8.7

* MSAs were selected on the basis of the largest population in the 2010 U.S. Census.
122 Syphilis Tables STD Surveillance 2014

Table 39. Late and Late Latent Syphilis* — Reported Cases and Rates of Reported Cases by State/

Area and Region in Alphabetical Order, United States and Outlying Areas, 2010–2014

Cases Rates per 100,000 Population

State/Area 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Alabama 235 252 248 292 167 4.9 5.2 5.1 6.0 3.5

Alaska 7 3 14 3 5 1.0 0.4 1.9 0.4 0.7

Arizona 493 431 424 455 558 7.7 6.6 6.5 6.9 8.4

Arkansas 116 100 132 175 110 4.0 3.4 4.5 5.9 3.7

California 2,223 2,269 2,509 3,539 4,110 6.0 6.0 6.6 9.2 10.7

Colorado 75 80 101 117 5 1.5 1.6 1.9 2.2 0.1

Connecticut 83 67 14 22 21 2.3 1.9 0.4 0.6 0.6

Delaware 19 48 29 63 30 2.1 5.3 3.2 6.8 3.2

District of Columbia 121 164 180 196 23 20.1 26.5 28.5 30.3 3.6

Florida 1,572 1,641 1,693 1,934 2,429 8.4 8.6 8.8 9.9 12.4

Georgia 898 771 842 1,090 1,055 9.3 7.9 8.5 10.9 10.6

Hawaii 23 13 11 19 13 1.7 0.9 0.8 1.4 0.9

Idaho 9 18 6 21 22 0.6 1.1 0.4 1.3 1.4

Illinois 799 946 902 1,031 1,087 6.2 7.4 7.0 8.0 8.4

Indiana 134 200 159 171 170 2.1 3.1 2.4 2.6 2.6

Iowa 45 39 58 57 84 1.5 1.3 1.9 1.8 2.7

Kansas 28 18 51 61 48 1.0 0.6 1.8 2.1 1.7

Kentucky 84 95 99 102 117 1.9 2.2 2.3 2.3 2.7

Louisiana 1,163 1,090 1,065 1,267 1,180 25.7 23.8 23.1 27.4 25.5

Maine 3 4 3 5 0 0.2 0.3 0.2 0.4 0.0

Maryland 386 470 439 504 481 6.7 8.1 7.5 8.5 8.1

Massachusetts 158 271 258 276 227 2.4 4.1 3.9 4.1 3.4

Michigan 322 338 334 368 416 3.3 3.4 3.4 3.7 4.2

Minnesota 128 107 120 209 215 2.4 2.0 2.2 3.9 4.0

Mississippi 200 238 53 31 116 6.7 8.0 1.8 1.0 3.9

Missouri 225 153 133 135 178 3.8 2.5 2.2 2.2 2.9

Montana 0 1 1 1 0 0.0 0.1 0.1 0.1 0.0

Nebraska 20 23 18 40 26 1.1 1.2 1.0 2.1 1.4

Nevada 99 125 117 84 142 3.7 4.6 4.2 3.0 5.1

New Hampshire 16 10 19 30 21 1.2 0.8 1.4 2.3 1.6

New Jersey 314 282 243 196 263 3.6 3.2 2.7 2.2 3.0

New Mexico 57 85 64 100 80 2.8 4.1 3.1 4.8 3.8

New York 2,387 2,436 2,667 2,758 3,073 12.3 12.5 13.6 14.0 15.6

North Carolina 499 485 444 509 791 5.2 5.0 4.6 5.2 8.0

North Dakota 3 3 10 11 16 0.4 0.4 1.4 1.5 2.2

Ohio 349 341 526 431 381 3.0 3.0 4.6 3.7 3.3

Oklahoma 31 39 27 28 59 0.8 1.0 0.7 0.7 1.5

Oregon 69 92 117 133 159 1.8 2.4 3.0 3.4 4.0

Pennsylvania 280 335 365 431 346 2.2 2.6 2.9 3.4 2.7

Rhode Island 18 18 25 27 40 1.7 1.7 2.4 2.6 3.8

South Carolina 80 73 56 66 28 1.7 1.6 1.2 1.4 0.6

South Dakota 8 14 8 12 16 1.0 1.7 1.0 1.4 1.9

Tennessee 542 483 545 497 502 8.5 7.5 8.4 7.7 7.7

Texas 3,204 3,312 3,585 3,593 4,110 12.7 12.9 13.8 13.6 15.5

Utah 47 42 51 51 61 1.7 1.5 1.8 1.8 2.1

Vermont 0 0 0 5 0 0.0 0.0 0.0 0.8 0.0

Virginia 245 224 317 329 137 3.1 2.8 3.9 4.0 1.7

Washington 159 236 226 223 310 2.4 3.5 3.3 3.2 4.4

West Virginia 16 5 6 14 4 0.9 0.3 0.3 0.8 0.2

Wisconsin 84 80 91 100 108 1.5 1.4 1.6 1.7 1.9

Wyoming 3 6 6 7 1 0.5 1.1 1.0 1.2 0.2

U.S. TOTAL 18,079 18,576 19,411 21,819 23,541 5.9 6.0 6.2 6.9 7.4

Northeast 3,259 3,423 3,594 3,750 3,991 5.9 6.2 6.4 6.7 7.1

Midwest 2,145 2,262 2,410 2,626 2,745 3.2 3.4 3.6 3.9 4.1

South 9,411 9,490 9,760 10,690 11,339 8.2 8.2 8.3 9.0 9.6

West 3,264 3,401 3,647 4,753 5,466 4.5 4.7 5.0 6.4 7.4

Guam 10 17 20 14 5 6.3 10.7 12.5 8.7 3.1

Puerto Rico 302 204 175 154 101 8.1 5.5 4.8 4.3 2.8

Virgin Islands 1 7 2 5 4 0.9 6.6 1.9 4.8 3.8

OUTLYING AREAS 313 228 197 173 110 7.8 5.7 5.0 4.5 2.8

TOTAL 18,392 18,804 19,608 21,992 23,651 5.9 6.0 6.2 6.9 7.4

* 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).
STD Surveillance 2014 Syphilis Tables 123

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

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

2010–2014

Cases Rates per 100,000 Population

MSAs 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Atlanta-Sandy Springs-Roswell, GA 723 611 573 782 804 13.7 11.4 10.5 14.2 14.6

Austin-Round Rock, TX 118 168 154 134 246 6.9 9.4 8.4 7.1 13.1

Baltimore-Columbia-Towson, MD 162 196 203 218 225 6.0 7.2 7.4 7.9 8.1

Birmingham-Hoover, AL 84 95 79 96 53 7.4 8.4 7.0 8.4 4.6

Boston-Cambridge-Newton, MA-NH 142 240 207 211 158 3.1 5.2 4.5 4.5 3.4

Buffalo-Cheektowaga-Niagara Falls, NY 32 27 32 62 62 2.8 2.4 2.8 5.5 5.5

Charlotte-Concord-Gastonia, NC-SC 97 116 122 151 180 4.4 5.1 5.3 6.5 7.7

Chicago-Naperville-Elgin, IL-IN-WI 703 866 853 963 988 7.4 9.1 9.0 10.1 10.4

Cincinnati, OH-KY-IN 117 131 275 191 124 5.5 6.2 12.9 8.9 5.8

Cleveland-Elyria, OH 79 70 82 64 88 3.8 3.4 4.0 3.1 4.3

Columbus, OH 82 76 101 98 101 4.3 3.9 5.2 5.0 5.1

Dallas-Fort Worth-Arlington, TX 944 982 1,132 1,081 1,065 14.7 14.9 16.9 15.9 15.6

Denver-Aurora-Lakewood, CO 64 64 74 81 0 2.5 2.5 2.8 3.0 0.0

Detroit-Warren-Dearborn, MI 232 229 252 277 299 5.4 5.3 5.9 6.4 7.0

Hartford-West Hartford-East Hartford, CT 34 22 3 10 10 2.8 1.8 0.2 0.8 0.8

Houston-The Woodlands-Sugar Land, TX 1,149 1,166 1,265 1,154 1,430 19.4 19.2 20.5 18.3 22.7

Indianapolis-Carmel-Anderson, IN 57 113 84 90 83 3.0 5.9 4.4 4.6 4.2

Jacksonville, FL 87 89 73 75 128 6.5 6.5 5.3 5.4 9.2

Kansas City, MO-KS 43 44 38 54 54 2.1 2.2 1.9 2.6 2.6

Las Vegas-Henderson-Paradise, NV 85 111 98 54 133 4.4 5.6 4.9 2.7 6.6

Los Angeles-Long Beach-Anaheim, CA 1,238 1,222 1,091 1,705 1,678 9.7 9.4 8.4 13.0 12.8

Louisville/Jefferson County, KY-IN 46 51 48 52 70 3.7 4.1 3.8 4.1 5.5

Memphis, TN-MS-AR 326 279 291 283 236 24.6 20.9 21.7 21.1 17.6

Miami-Fort Lauderdale-West Palm Beach, FL 853 984 1,032 1,075 1,370 15.3 17.4 17.9 18.4 23.5

Milwaukee-Waukesha-West Allis, WI 57 49 59 56 63 3.7 3.1 3.8 3.6 4.0

Minneapolis-St. Paul-Bloomington, MN-WI 101 87 105 175 187 3.0 2.6 3.1 5.1 5.4

Nashville-Davidson--Murfreesboro--Franklin, TN 119 107 133 120 148 7.1 6.3 7.7 6.8 8.4

New Orleans-Metairie, LA 392 457 386 442 370 32.9 37.7 31.5 35.6 29.8

New York-Newark-Jersey City, NY-NJ-PA 2,526 2,550 2,679 2,707 3,052 12.9 13.0 13.5 13.6 15.3

Oklahoma City, OK 17 10 15 11 31 1.4 0.8 1.2 0.8 2.3

Orlando-Kissimmee-Sanford, FL 149 166 192 250 362 7.0 7.6 8.6 11.0 16.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 271 325 338 439 311 4.5 5.4 5.6 7.3 5.2

Phoenix-Mesa-Scottsdale, AZ 345 299 332 335 397 8.2 7.0 7.7 7.6 9.0

Pittsburgh, PA 9 13 21 11 13 0.4 0.6 0.9 0.5 0.6

Portland-Vancouver-Hillsboro, OR-WA 54 72 99 118 140 2.4 3.2 4.3 5.1 6.0

Providence-Warwick, RI-MA 22 30 32 45 47 1.4 1.9 2.0 2.8 2.9

Raleigh, NC 65 68 63 68 109 5.7 5.8 5.3 5.6 9.0

Richmond, VA 46 36 51 58 9 3.8 3.0 4.1 4.7 0.7

Riverside-San Bernardino-Ontario, CA 185 201 465 433 432 4.4 4.7 10.7 9.9 9.9

Sacramento--Roseville--Arden-Arcade, CA 81 69 59 107 134 3.8 3.2 2.7 4.8 6.0

Salt Lake City, UT 28 32 33 34 39 2.6 2.9 2.9 3.0 3.4

San Antonio-New Braunfels, TX 232 286 366 457 448 10.8 13.0 16.4 20.1 19.7

San Diego-Carlsbad, CA 148 154 144 245 310 4.8 4.9 4.5 7.6 9.7

San Francisco-Oakland-Hayward, CA 230 244 321 421 497 5.3 5.6 7.2 9.3 11.0

San Jose-Sunnyvale-Santa Clara, CA 62 54 84 69 125 3.4 2.9 4.4 3.6 6.5

Seattle-Tacoma-Bellevue, WA 112 177 169 161 211 3.3 5.1 4.8 4.5 5.8

St. Louis, MO-IL 177 94 95 104 119 6.3 3.4 3.4 3.7 4.2

Tampa-St. Petersburg-Clearwater, FL 195 175 171 227 254 7.0 6.2 6.0 7.9 8.8

Virginia Beach-Norfolk-Newport News, VA-NC 60 40 100 86 45 3.6 2.4 5.9 5.0 2.6

Washington-Arlington-Alexandria, DC-VA-MD-WV 425 536 517 599 295 7.5 9.3 8.8 10.1 5.0

SELECTED MSAs TOTAL 13,605 14,283 15,191 16,739 17,733 8.1 8.4 8.9 9.7 10.3

* 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).

† MSAs were selected on the basis of the largest population in the 2010 U.S. Census.
124 Syphilis Tables STD Surveillance 2014

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

Ranked by Rates, United States, 2014

Rank* State† Cases Rate per 100,000 Live Births

1 Louisiana 46 73.4

2 South Dakota 3 24.8

3 Florida 47 22.1

4 Maryland 16 22.0

5 California 99 19.7

6 Texas 74 19.3

7 Nevada 6 17.2

8 Illinois 27 17.0

9 Arkansas 6 15.6

10 Arizona 13 15.0

11 Michigan 15 13.3

12 Georgia 17 13.0

U.S. TOTAL‡ 458 11.6

13 Oklahoma 6 11.4

14 Ohio 15 10.8

15 Indiana 8 9.6

16 New York 22 9.1

HP 2020 TARGET 9.1

17 South Carolina 5 8.7

18 Kentucky 3 5.4

19 Alabama 3 5.1

20 North Carolina 6 5.0

21 Oregon 2 4.4

22 Massachusetts 3 4.1

23 Nebraska 1 3.9

24 New Mexico 1 3.7

25 Pennsylvania 5 3.5

26 Mississippi 1 2.6

27 Iowa 1 2.6

28 Tennessee 2 2.5

29 Washington 2 2.3

30 Virginia 2 1.9

31 Missouri 1 1.3

Alaska 0 0.0

Colorado 0 0.0

Connecticut 0 0.0

Delaware 0 0.0

Hawaii 0 0.0

Idaho 0 0.0

Kansas 0 0.0

Maine 0 0.0

Minnesota 0 0.0

Montana 0 0.0

New Hampshire 0 0.0

New Jersey 0 0.0

North Dakota 0 0.0

Rhode Island 0 0.0

Utah 0 0.0

Vermont 0 0.0

West Virginia 0 0.0

Wisconsin 0 0.0

Wyoming 0 0.0

* States were ranked by rate, then by case count, then in alphabetical order, with rates shown rounded to the nearest tenth.

† Mother’s state of residence was used to assign case.

‡ Total includes cases reported by the District of Columbia, with 0 cases, but excludes outlying areas (Guam with 0 cases, Puerto Rico with 0 cases, and Virgin 

Islands with 0 cases).
STD Surveillance 2014 Syphilis Tables 125

Table 42. Congenital Syphilis — Reported Cases and Rates of Reported Cases by Year of Birth, by 

State/Area and Region in Alphabetical Order, United States and Outlying Areas, 2010–2014

State/Area*

Cases Rates per 100,000 Live Births

2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Alabama 9 10 4 2 3 15.0 16.8 6.8 3.4 5.1

Alaska 0 0 1 1 0 0.0 0.0 8.9 8.9 0.0

Arizona 16 15 14 13 13 18.3 17.5 16.2 15.0 15.0

Arkansas 11 15 11 12 6 28.5 38.7 28.7 31.3 15.6

California 39 40 35 57 99 7.6 8.0 6.9 11.3 19.7

Colorado 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Connecticut 2 0 0 0 0 5.3 0.0 0.0 0.0 0.0

Delaware 2 0 1 1 0 17.6 0.0 9.1 9.1 0.0

District of Columbia 1 1 0 2 0 10.9 10.8 0.0 21.3 0.0

Florida 20 33 37 35 47 9.3 15.5 17.4 16.4 22.1

Georgia 18 10 16 20 17 13.4 7.6 12.3 15.4 13.0

Hawaii 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Idaho 1 0 1 0 0 4.3 0.0 4.4 0.0 0.0

Illinois 27 18 28 23 27 16.3 11.2 17.6 14.5 17.0

Indiana 0 0 0 0 8 0.0 0.0 0.0 0.0 9.6

Iowa 0 0 0 0 1 0.0 0.0 0.0 0.0 2.6

Kansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kentucky 0 2 2 4 3 0.0 3.6 3.6 7.2 5.4

Louisiana 33 18 33 40 46 52.9 29.1 52.7 63.9 73.4

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 22 24 12 14 16 29.8 32.8 16.5 19.2 22.0

Massachusetts 1 0 1 4 3 1.4 0.0 1.4 5.5 4.1

Michigan 5 8 7 9 15 4.4 7.0 6.2 8.0 13.3

Minnesota 0 0 1 0 0 0.0 0.0 1.5 0.0 0.0

Mississippi 9 6 0 0 1 22.5 15.1 0.0 0.0 2.6

Missouri 2 1 1 3 1 2.6 1.3 1.3 4.0 1.3

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 0 0 1 0 1 0.0 0.0 3.9 0.0 3.9

Nevada 5 3 1 2 6 13.9 8.5 2.9 5.7 17.2

New Hampshire 0 0 1 0 0 0.0 0.0 8.1 0.0 0.0

New Jersey 3 5 1 0 0 2.8 4.7 1.0 0.0 0.0

New Mexico 0 0 1 2 1 0.0 0.0 3.7 7.4 3.7

New York 17 13 8 11 22 7.0 5.4 3.3 4.6 9.1

North Carolina 10 6 2 4 6 8.2 5.0 1.7 3.3 5.0

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 10 13 19 18 15 7.2 9.4 13.7 13.0 10.8

Oklahoma 0 2 0 0 6 0.0 3.8 0.0 0.0 11.4

Oregon 0 0 1 0 2 0.0 0.0 2.2 0.0 4.4

Pennsylvania 3 5 6 2 5 2.1 3.5 4.2 1.4 3.5

Rhode Island 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

South Carolina 1 0 7 1 5 1.7 0.0 12.2 1.7 8.7

South Dakota 0 0 0 0 3 0.0 0.0 0.0 0.0 24.8

Tennessee 11 8 2 2 2 13.8 10.1 2.5 2.5 2.5

Texas 105 99 78 74 74 27.2 26.2 20.4 19.3 19.3

Utah 1 0 0 0 0 1.9 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 1 3 2 1.0 0.0 1.0 2.9 1.9

Washington 1 2 0 0 2 1.2 2.3 0.0 0.0 2.3

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wisconsin 1 1 0 0 0 1.5 1.5 0.0 0.0 0.0

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 387 358 334 359 458 9.7 9.1 8.4 9.1 11.6

Northeast 26 23 17 17 30 4.0 3.6 2.7 2.7 4.7

Midwest 45 41 57 53 71 5.3 4.9 6.8 6.4 8.5

South 253 234 206 214 234 16.6 15.5 13.7 14.2 15.5

West 63 60 54 75 123 6.4 6.2 5.5 7.7 12.6

Guam 0 0 0 1 0 0.0 0.0 0.0 27.9 0.0

Puerto Rico 2 2 1 2 0 4.7 4.9 2.6 5.1 0.0

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 2 2 1 3 0 4.2 4.4 2.3 6.8 0.0

TOTAL 389 360 335 362 458 9.6 9.0 8.4 9.1 11.5

* Mother’s state of residence was used to assign case.
126 Syphilis Tables STD Surveillance 2014

Table 43. 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, 2010–2014

Year of Birth

Whites, Non-Hispanic Blacks, Non-Hispanic Hispanics

Cases Rate Cases Rate Cases Rate

2010 63 2.9 216 36.3 91 9.6

2011 50 2.3 211 35.9 73 8.0

2012 50 2.3 189 32.1 80 8.8

2013 61 2.8 185 31.4 92 10.1

2014 80 3.7 225 38.2 110 12.1

Year of Birth

Asians/Pacific Islanders American Indians/Alaska Natives Multirace

Cases Rate Cases Rate Cases Rate

2010 9 3.8 1 2.5 2 NA

2011 14 5.7 2 5.0 0 NA

2012 6 2.3 2 5.1 0 NA

2013 9 3.4 5 12.7 1 NA

2014 18 6.9 5 12.7 7 NA

Year of Birth

Other Unknown Total

Cases Rate Cases Rate Cases Rate

2010 1 NA 4 NA 387 9.7

2011 3 NA 5 NA 358 9.1

2012 3 NA 4 NA 334 8.4

2013 2 NA 4 NA 359 9.1

2014 2 NA 11 NA 458 11.6

NA = Not applicable.
STD Surveillance 2014 Chancroid 127

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

Order, United States and Outlying Areas, 2010–2014

Cases Rates per 100,000 Population

State/Area 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Alabama 1 0 1 1 0 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 1 0 0 0 0.0 0.0 0.0 0.0 0.0

Arkansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

California 5 1 7 6 4 0.0 0.0 0.0 0.0 0.0

Colorado 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Connecticut 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Delaware 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

District of Columbia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Florida 1 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 0 0 1 0 0 0.0 0.0 0.0 0.0 0.0

Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kentucky 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Louisiana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 0 0 1 0 0 0.0 0.0 0.0 0.0 0.0

Massachusetts 1 2 1 2 1 0.0 0.0 0.0 0.0 0.0

Michigan 0 1 2 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 1 0 0 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 1 2 0 0 0 0.0 0.0 0.0 0.0 0.0

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Texas 12 1 0 1 1 0.0 0.0 0.0 0.0 0.0

Utah 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 0 0 1 0 0 0.0 0.0 0.0 0.0 0.0

Washington 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wisconsin 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 24 8 15 10 6 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 24 8 15 10 6 0.0 0.0 0.0 0.0 0.0
128 Selected STDs STD Surveillance 2014

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

Disease and Therapeutic Index, United States, 1966–2013

Year Genital Herpes Genital Warts

Vaginal 

Trichomoniasis* Other Vaginitis*

Pelvic Inflammatory 

Disease†

1966 19,000 56,000 579,000 1,155,000 NA

1967 15,000 72,000 515,000 1,277,000 NA

1968 16,000 87,000 463,000 1,460,000 NA

1969 15,000 61,000 421,000 1,390,000 NA

1970 17,000 119,000 529,000 1,500,000 NA

1971 49,000 128,000 484,000 1,281,000 NA

1972 26,000 165,000 574,000 1,810,000 NA

1973 51,000 198,000 466,000 1,858,000 NA

1974 75,000 202,000 427,000 1,907,000 NA

1975 36,000 181,000 500,000 1,919,000 NA

1976 57,000 217,000 473,000 1,690,000 NA

1977 116,000 221,000 324,000 1,713,000 NA

1978 76,000 269,000 329,000 2,149,000 NA

1979 83,000 200,000 363,000 1,662,000 NA

1980 57,000 218,000 358,000 1,670,000 423,000

1981 133,000 191,000 369,000 1,742,000 283,000

1982 134,000 256,000 268,000 1,859,000 374,000

1983 106,000 203,000 424,000 1,932,000 424,000

1984 157,000 224,000 381,000 2,450,000 381,000

1985 124,000 263,000 291,000 2,728,000 425,000

1986 136,000 275,000 338,000 3,118,000 457,000

1987 102,000 351,000 293,000 3,087,000 403,000

1988 163,000 290,000 191,000 3,583,000 431,000

1989 148,000 220,000 165,000 3,374,000 413,000

1990 172,000 275,000 213,000 4,474,000 358,000

1991 235,000 282,000 198,000 3,822,000 377,000

1992 139,000 218,000 182,000 3,428,000 335,000

1993 172,000 167,000 207,000 3,755,000 407,000

1994 142,000 239,000 199,000 4,123,000 332,000

1995 160,000 253,000 141,000 3,927,000 262,000

1996 208,000 191,000 245,000 3,472,000 286,000

1997 176,000 145,000 176,000 3,100,000 260,000

1998 188,000 211,000 164,000 3,200,000 233,000

1999 224,000 240,000 171,000 3,077,000 250,000

2000 179,000 220,000 222,000 3,470,000 254,000

2001 157,000 233,000 210,000 3,365,000 244,000

2002 216,000 266,000 150,000 3,315,000 197,000

2003 203,000 264,000 179,000 3,516,000 123,000

2004 269,000 316,000 221,000 3,602,000 132,000

2005 266,000 357,000 165,000 4,071,000 176,000

2006 371,000 422,000 200,000 3,891,000 106,000

2007 317,000 312,000 205,000 3,723,000 146,000

2008 292,000 385,000 204,000 3,571,000 104,000

2009 306,000 357,000 216,000 3,063,000 100,000

2010 232,000 376,000 149,000 3,192,000 113,000

2011 227,000 453,000 168,000 3,102,000 90,000

2012 228,000 353,000 219,000 3,452,000 106,000

2013 306,000 404,000 225,000 3,278,000 88,000

* Women only.

† Women aged 15-44 years only.

NA = Not available.

NOTE: Standard errors for estimates under 100,000 are not available. The relative standard errors for estimates 100,000–299,999 are from 19% to 23%; 

300,000–599,999 are from 16% to 19%; 600,000–999,999 are from 13% to 16%; and 1,000,000–5,000,000 are from 7% to 13%.

SOURCE: National Disease and Therapeutic Index, IMS Health, Integrated Promotional Services. IMS Health Report, 1966–2013. The 2014 data were not 

obtained in time to include them in this report. See Section A2.5 in the Appendix for more information.
APPENDIX
APPENDIX
STD Surveillance 2014 Appendix: Interpreting STD Surveillance Data 129

A. Interpreting STD Surveillance Data

Sexually Transmitted Disease Surveillance 2014 presents 

surveillance information derived from the official statistics 

for the reported occurrence of nationally notifiable sexually 

transmitted diseases (STDs) in the United States, test 

positivity and prevalence data from numerous prevalence 

monitoring initiatives, sentinel surveillance, and national 

health care services surveys.

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, U.S. dependencies and 

possessions, and independent nations in free association 

with the United States to the Division of STD Prevention, 

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

TB Prevention, Centers for Disease Control and Prevention 

(CDC). Included among the dependencies, possessions, and 

independent nations are Guam, Puerto Rico, and the Virgin 

Islands. These entities are identified as “outlying areas” of the 

United States in selected figures and tables.

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).

Summary Report Forms

The following hard copy forms were used to report national 

STD morbidity data:

1. FORM CDC 73.998: Monthly Surveillance Report of 

Early Syphilis. This monthly hard copy reporting form 

was used during 1984–2002 to report summary data for 

primary and secondary syphilis and early latent syphilis 

by county and state.

2. FORM CDC 73.688: Sexually Transmitted Disease 

Morbidity Report. This quarterly hard copy reporting 

form was used during 1963–2002 to report summary 

data for all stages of syphilis, congenital syphilis, 

gonorrhea, chancroid, chlamydia, and other STDs by 

sex and source of report (private versus public) for all 

50 states, the District of Columbia, 64 selected cities 

(including San Juan, Puerto Rico), and outlying areas of 

the United States.

Note: Chlamydial infection became a nationally 

notifiable condition in 1996, and the form was 

modified to support reporting of chlamydia that year. 

Congenital syphilis was dropped from this aggregate 

form in 1995 and replaced by the case-specific CDC 

73.126 form described later in this section.

3. FORM CDC 73.2638: Report of Civilian Cases 

of Primary & Secondary Syphilis, Gonorrhea, and 

Chlamydia by Reporting Source, Sex, Race/Ethnicity, 

and Age Group. This annual hard copy form was used 

during 1981–2002 to report summary data for P&S 

syphilis, gonorrhea, and chlamydia by age, race, sex, 

and source (public versus private) for all 50 states, 

seven large cities (Baltimore, Chicago, New York 

City, Los Angeles, Philadelphia, San Francisco, and 

the District of Columbia), and outlying areas of the 

United States.

Note: Chlamydial infection became a nationally 

notifiable condition in 1996, and the form was 

modified to support reporting of chlamydia that year.

4. FORM CDC 73.126: Congenital Syphilis (CS) Case 

Investigation and Reporting. This case-specific hard copy 

form was first used in 1983 and continued to be used 

through 2014 to report detailed case-specific data for 

congenital syphilis in some areas.

National Electronic Telecommunications System 

for Surveillance (NETSS)

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 2014). 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 10, 

2015, are included in this report. Data received after 

this date will appear in subsequent STD surveillance 

reports. The data presented in the figures and tables in 

this report supersede those in all earlier publications.
130 Appendix: Interpreting STD Surveillance Data STD Surveillance 2014

A1.2 Population Denominators and 

Rate Calculations

2000–2014 Rates and Population

(Excluding OMB-compliant Race)

CDC’s National Center for Health Statistics (NCHS) 

released bridged-race population counts for the 2000–2013 

U.S. resident populations that are based on counts from 

the 2000 and 2010 U.S. Censuses. These estimates resulted 

from bridging the 31 race categories first used in the 2000 

census, as specified in the 1997 Office of Management and 

Budget (OMB) standards, to the five race/ethnicity groups 

specified in the 1977 OMB standards. This report uses the 

first published population estimate for a given year. The latest 

available year for population estimates at the time this report 

was written was 2013. Thus 2013 population estimates 

were used to calculate 2014 rates. Once published, the 2014 

population estimates will be used to calculate rates in the 

upcoming 2015 STD Surveillance Report. 

2000-2014 Rates and Population (including 

OMB-compliant Race)

For those figures and tables presenting race using the 1997 

OMB race standards, non-bridged-race data provided 

directly by the U.S. Census Bureau were used to calculate 

race. The latest available year for population estimates at 

the time this report was written was 2013. Thus, 2013 

population estimates were used to calculate 2014 rates. 

Once published, the 2014 population estimates will 

be used to calculate rates in the upcoming 2015 STD 

Surveillance Report.

Population estimates for Puerto Rico were obtained from 

the U.S. Census Bureau Web site at http://factfinder2.

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 http://www.census.gov/population/

international/data/idb/informationGateway.php

The 2014 rates by age and sex for Guam and the Virgin 

Islands were calculated using 2010 population estimates 

available at: http://factfinder2.census.gov/faces/nav/jsf/

pages/index.xhtml.

Because of the use of the updated population data, rates 

for 2000–2013 may be different from those presented in 

previous STD surveillance reports.

Several figures throughout this report depict state-specific 

rates of reported cases of STDs. Rates were grouped and 

displayed by quartiles in Figures 3, 4, 15, 16, 35, A, B, C, 

H, and I. Rates were grouped and displayed in 4 categories 

– zero cases and tertiles – in Figure 36 and Figure D. 

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.

1941–2014 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 1941–2014. 

Previous publications presented congenital syphilis rates per 

100,000 population during 1941–1994 and rates for cases 

diagnosed at younger than 1 year of age per 100,000 live 

births during 1995–2005. To allow for trends in congenital 

syphilis rates to be compared for the period 1941 through 

2014, live births now are used as the denominator for 

congenital syphilis, and case counts are no longer limited 

to those diagnosed within the first year of life. Congenital 

syphilis morbidity is assigned by year of birth. Rates of 

congenital syphilis for 1963 through 1988 were calculated 

by using published live birth data.3 Congenital syphilis rates 

for 1989 through 2012 were calculated by using live birth 

data based on information coded by the states and provided 

to the NCHS through the Vital Statistics Cooperative 

Program. Rates for 2013 and 2014 were calculated by using 

live birth data for 2012.

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 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, 
STD Surveillance 2014 Appendix: Interpreting STD Surveillance Data 131

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 2014 continues 

the presentation of STD incidence data and rates for 

the 50 metropolitan statistical areas (MSAs) with the 

largest populations according to 2010 census data. STD 

surveillance reports published before 2005 presented data 

by selected cities; these data were derived from county 

data, which were used to estimate city-specific disease rates. 

Because county data were used to estimate city-specific 

morbidity and because current STD project areas’ reporting 

practices do not support direct identification of city-specific 

morbidity reports, MSAs were chosen as a geographic unit 

smaller than a state or territory for presentation of STD 

morbidity data.

MSAs are defined by the OMB to provide nationally 

consistent definitions for collecting, tabulating, and 

publishing federal statistics for a set of geographic areas.4 

An MSA is associated with at least one urbanized area that 

has a population of at least 50,000. The MSA comprises the 

central county or counties containing the central county, 

plus adjacent, outlying counties that have a high degree of 

social and economic integration with the central county 

as measured through commuting. The title of an MSA 

includes the name of the principal city with the largest 2010 

census population. If there are multiple principal cities, the 

names of the second largest and third largest principal cities 

appear in the title in order of descending population size.

The MSA concept has been used as a statistical representation 

of the social and economic links between urban cores and 

outlying, integrated areas. However, MSAs do not equate to 

an urban-rural classification; all counties included in MSAs 

and many other counties contain both urban and rural 

territory and populations. STD programs that treat all parts 

of an MSA as if they were as urban as the densely settled 

core ignore the rural conditions that may exist in some parts 

of the area. In short, MSAs are not intended to be a general 

purpose geographic framework for nonstatistical activities or 

for use in program funding formulas.

For more information on the MSA definitions used in this 

report, go to: http://www.census.gov/population/metro/

data/metrodef.html.

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.5 The OMB standards were first 

issued in 1997. Beginning with publication of Sexually 

Transmitted Disease Surveillance 2012, the race/ethnicity data 

are presented according to the current standard categories: 

American Indian or Alaska Native, Asian, black or African 

American, Hispanic or Latino, Native Hawaiian/Other 

Pacific Islander, white and multirace. As of reporting year 

2014, 3 jurisdictions (Alaska, Michigan, and the District 

of Columbia) were not compliant with the current OMB 

race/ethnicity standards when reporting chlamydia and 

gonorrhea. Only two jurisdictions (Alaska and the District 

of Columbia) were not compliant with the current OMB 

race/ethnicity standards when reporting primary and 

secondary syphilis. 

For chlamydia and gonorrhea figures showing trends 

for 2010–2014, data are included for all jurisdictions 

except eight not consistently reporting race/ethnicity data 

according to the current standard categories for the five 

consecutive years (Alaska, Maryland, Michigan, New 

Jersey, New York, North Carolina, Utah, and the District 

of Columbia). For primary and secondary syphilis figures 

showing trends for 2010–2014, data are presented for 44 

states excluding seven not consistently reporting race/

ethnicity data according to the current standard categories 

for the five consecutive years (Alaska, Maryland, New 

Jersey, New York, North Carolina, Utah, and the District of 

Columbia).

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, 
132 Appendix: Interpreting STD Surveillance Data STD Surveillance 2014

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 2014.

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, hospitals (inpatient), emergency rooms, 

correctional facilities, laboratories, blood banks, the 

National Job Training Program (NJTP), school-based clinics, 

mental health providers, the military, the Indian Health 

Service, and other unspecified sources.

Analysis of the data reported electronically after 1996 

confirmed that the new STD clinic source of report 

data corresponded to the earlier public source category. 

Therefore, source of case report data during 1984–2014 

are presented as STD clinic or non-STD clinic only 

(Table A2).

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. Expanded use of more sensitive 

diagnostics tests (e.g., nucleic acid amplification tests) 

can also increase the number of infections identified and 

reported independent of increases in incidence. Although 

chlamydia has been a nationally notifiable condition 

since 1994, it was not until 2000 that all 50 states and 

the District of Columbia required reporting of chlamydia 

cases. National case rates prior to 2000 reflect incomplete 

reporting. Additionally, increasing use of electronic 

laboratory reporting has likely increased the proportion 

of diagnosed cases that are reported. Consequently, an 

increasing chlamydia case rate may reflect increases in 

incidence of infection, screening coverage, and use of 

more sensitive tests, as well as more complete reporting. 

Likewise, decreases in chlamydia case rates may suggest 

decreases in incidence of infection or screening coverage.

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, and 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.

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.6 In addition, many 

state and local STD programs have greatly enhanced active 

case finding for congenital syphilis since 1988. For these 

reasons, as well as because of increasing morbidity, the 

number of reported cases increased dramatically during 

1989–1991. All reporting areas had implemented the new 

case definition for reporting congenital syphilis by January 

1, 1992.

In addition to changing the case definition for congenital 

syphilis, CDC introduced a new data collection form 

(CDC 73.126) in 1990 (revised February 2013). Since 

1995, the data collected on this form have been used 

for reporting congenital syphilis cases and associated 

rates. This form is used to collect individual case 

information, which allows more thorough analysis of case 

characteristics. For the purpose of analyzing race/ethnicity, 

cases are classified by the race/ethnicity of the mother. 

Congenital syphilis cases were reported by state and city 

of residence of the mother during 1995–2014.

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.
STD Surveillance 2014 Appendix: Interpreting STD Surveillance Data 133

A2. Other Sources of Surveillance Data

A2.1 National Job Training Program 

(NJTP)

Chlamydia and gonorrhea prevalence was calculated 

for men and women entering the NJTP. To increase the 

stability of the estimates, chlamydia or gonorrhea prevalence 

data are presented when valid test results for 100 or more 

students per year are available for the population subgroup 

and state. The majority of NJTP’s chlamydia screening 

tests are conducted by a single national contract laboratory, 

which provides these data to CDC. Gonorrhea screening 

tests for male and female students in many training centers 

are conducted by local laboratories; these data are not 

available to CDC. Test results for students at centers that 

submit specimens to the national contract laboratory are 

included only if the number of gonorrhea tests submitted 

is greater than 90% of the number of chlamydia tests 

submitted from the same center for the same period. 

Prevalence data for state-specific figures were published with 

permission from the NJTP. Prevalence data presented in 

Figures J, K, L, and M are grouped and displayed by chosen 

cut-off values rather than quantiles.

A2.2 STD Surveillance Network (SSuN)

In 2005, CDC established the STD Surveillance Network 

(SSuN) as a dynamic network comprised of state and 

local STD surveillance units following enhanced STD 

surveillance protocols. The purpose of SSuN is to improve 

the capacity of national, state, and local STD programs 

to detect, monitor, and respond rapidly to trends in 

STDs through enhanced collection, reporting, analysis, 

visualization, and interpretation of disease information.

Twelve collaborating local or state health departments 

contributed data through Cycle 2 of the network through 

June of 2013. These include Alabama Department of Public 

Health, Baltimore City Health Department, Chicago 

Department of Public Health, Colorado Department of 

Public Health and Environment, Connecticut Department 

of Public Health, County of Los Angeles Department 

of Public Health (in collaboration with California State 

Department of Public Health), Louisiana Office of Public 

Health, New York City Department of Health and Mental 

Hygiene, Philadelphia Department of Public Health, 

San Francisco Department of Public Health, Virginia 

Department of Health, and Washington State Department 

of Health. Cycle 3 of the network was funded in 2013 and 

includes Baltimore City Health Department, California 

State Department of Public Health, Florida Department 

of Health, Massachusetts Department of Public Health, 

Minnesota Department of Health, Multnomah County 

Health Department, New York City Department of Health 

and Mental Hygiene, Philadelphia Department of Public 

Health, San Francisco Department of Public Health, 

Utah Department of Health and the Washington State 

Department of Health.

The SSuN data contained in this report include 

demographic, behavioral, clinical, and laboratory 

information collected from patients at STD clinics within 

the jurisdictions of SSuN health state and/or local health 

departments. These clinics are located in San Francisco, 

CA (San Francisco City Clinic); Los Angeles, CA (12 

STD clinics in Los Angeles County); Seattle, WA (SeattleKing County Clinic); Denver, CO (Denver Metro Health 

Clinic); Chicago, IL (7 public STD clinics in Cook 

County); New Orleans, LA (Delgado Personal Health 

Center); Birmingham, AL (Jefferson County STD Clinic); 

Richmond, VA (Richmond City, Henrico County and 

Chesterfield County Clinics); Baltimore, MD (Druid 

STD Clinic and Eastern STD Clinic); Philadelphia, PA 

(Philadelphia STD Clinics 1 and 5); New York City, NY (9 

public STD clinics in 5 boroughs); Hartford, CT (Hartford 

STD Clinic); and New Haven, CT (New Haven STD 

Clinic). 

Collaborators in SSuN jurisdictions also identified a 

probability sample of all gonorrhea cases reported to the 

health department for enhanced investigation including 

administration of a standardized behavioral interview. 

Information including number, gender and demographics 

of recent partners was collected directly from patients. 

Gay, bisexual, and other men who have sex with men 

(MSM) were defined as men who either reported having 

sex with another man ever before STD testing (asked at 

all SSuN sites) or who did not report sex with men but 

reported that they considered themselves gay/homosexual 

or bisexual (asked at 10 of the 12 sites). Men who have sex 

with women (MSW) were defined as men who reported 

having sex with women only before STD testing or who did 

not report the sex of their sex partner, but reported that they 

considered themselves straight/heterosexual (asked at 10 of 

the 12 sites). Data from the probability sample are weighted 

to reflect differing sample fractions across jurisdictions and 

to adjust for non-response. Weighted analyses provides 

estimates of these characteristics representative of all 

reported cases in the collaborating jurisdictions.

Data points presented in this report for 2014 from the STD 

clinic component of SSuN (Figures 9, 24, 52, V, W, X) are 

based on data from six jurisdictions (Baltimore City, Los 
134 Appendix: Interpreting STD Surveillance Data STD Surveillance 2014

Angeles, New York City, Philadelphia, San Francisco and 

Washington State) continuing collaboration across Cycles 

2 & 3. For the enhanced gonorrhea component of SSuN, 

new protocols are being implemented in Cycle 3 and data 

will not be available until 2015. Figure 23 presents data 

collected through June of 2013 showing the proportion of 

cases attributable to MSM, MSW and women. 

A2.3 Gonococcal Isolate Surveillance 

Project (GISP)

Data on antimicrobial susceptibility in Neisseria gonorrhoeae 

were collected through the Gonococcal Isolate Surveillance 

Project (GISP), a sentinel system of selected STD clinics 

located at 25–30 GISP sentinel sites and 4–5 regional 

laboratories in the United States. For more details on 

findings from GISP, go to: http://www.cdc.gov/std/GISP.

For 2014, the antimicrobial agents tested by GISP were 

ceftriaxone, cefixime, azithromycin, spectinomycin, 

ciprofloxacin, penicillin, and tetracycline.

The antimicrobial susceptibility criteria used in GISP for 

2014 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 (decreased 

susceptibility)*

• Spectinomycin, MIC ≥128.0 μg/ml (resistance)

• 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).

The majority of these criteria are also recommended by the 

Clinical and Laboratory Standards Institute (CLSI).7

A2.4 National Health and Nutrition 

Examination Survey (NHANES)

The National Health and Nutrition Examination Survey 

(NHANES) is a series of cross-sectional surveys designed 

to provide national statistics on the health and nutritional 

status of the general household population in the United 

States. Data are collected through household interviews, 

standardized physical examinations, and the collection of 

biological samples in special mobile examination centers. 

In 1999, NHANES became a continuous survey with data 

released every 2 years. The sampling plan of the survey 

is a stratified, multistage, probability cluster design that 

selects a sample representative of the U.S. civilian, noninstitutionalized population. For more information, see: 

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

A2.5 National Disease and Therapeutic 

Index (NDTI)

The information on the number of initial visits to private 

physicians’ offices for STDs was based on analysis of data 

from the National Disease and Therapeutic Index (NDTI) 

(machine-readable files or summary statistics for 1966 

through 2013; the 2014 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.

1 U.S. Census Bureau. United States population estimates by age, 

sex and race: 1980–1988. In: Current population reports [Series 

P-25, No. 1045]. Washington, DC: U.S. Government Printing 

Office; 1990.

2 U.S. Census Bureau. United States population estimates by age, 

sex and race: 1989. In: Current population reports [Series P-25, 

No. 1057]. Washington, DC: U.S. Government Printing Office; 

1990.

3 Centers for Disease Control and Prevention. Vital statistics of 

the United States 1988. vol.1 - natality. Hyattsville (MD): U.S. 

Department of Health and Human Services; 1990.

4 Office of Management and Budget. Standards for defining 

metropolitan and micropolitan statistical areas. Federal Register. 

2000;65(249):82228-38.

5 Office of Management and Budget. Revisions to the Standards 

for Classification of Federal Data on Race and Ethnicity. Federal 

Register Notice. October 30, 1997.

6 Kaufman RE, Jones OG, Blount JH, Wiesner PJ. Questionnaire 

survey of reported early congenital syphilis: problems in diagnosis, 

prevention, and treatment. Sex Transm Dis. 1977;4:135-9.

7 Clinical and Laboratory Standards Institute. Performance 

standards for antimicrobial susceptibility testing; twenty-fifth 

informational supplement. M100-S25, 35(3). Wayne (PA): 

Clinical and Laboratory Standards Institute; 2015.

* The Clinical Laboratory Standards Institute criteria for decreased susceptibility and resistance to ceftriaxone, cefixime, and azithromycin 

and for susceptibility to azithromycin have not been established for N. gonorrhoeae.
135 Appendix: Percentage Unknown STD Surveillance 2014

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

Variables by State and by Nationally Notifiable STD, 2014

State

Primary and Secondary Syphilis Gonorrhea Chlamydia

Percentage 

Unknown 

Race/

Ethnicity

Percentage 

Unknown 

Age

Percentage 

Unknown 

Sex

Percentage 

Unknown 

Sex Partner

Percentage 

Unknown 

Race/

Ethnicity

Percentage 

Unknown 

Age

Percentage 

Unknown 

Sex

Percentage 

Unknown 

Race/

Ethnicity

Percentage 

Unknown 

Age

Percentage 

Unknown 

Sex

Alabama 7.5 0.0 0.0 30.4 25.5 0.1 0.3 30.5 0.0 0.3

Alaska 0.0 0.0 0.0 100.0 0.0 0.0 0.0 0.5 0.0 0.0

Arizona 0.7 0.0 0.0 4.3 22.7 0.0 0.0 30.9 0.0 0.0

Arkansas 0.8 0.0 0.0 14.0 10.4 0.2 0.1 14.8 0.1 0.1

California 7.6 0.1 0.1 11.8 24.9 0.6 0.2 37.1 0.5 0.2

Colorado 6.5 0.0 0.0 2.7 22.7 0.0 0.0 41.4 0.0 0.0

Connecticut 2.3 2.3 0.0 9.3 45.5 0.3 0.3 64.3 0.1 0.8

Delaware 0.0 0.0 0.0 80.9 2.6 0.0 0.0 5.2 0.0 0.0

District of Columbia 29.3 0.0 4.3 100.0 64.0 0.6 0.7 65.9 0.8 0.5

Florida 4.7 0.0 0.1 9.0 15.2 0.0 0.1 20.6 0.0 0.2

Georgia 1.7 0.0 0.0 30.2 29.9 0.1 0.6 39.1 0.1 0.7

Hawaii 5.9 0.0 0.0 16.2 38.3 0.3 0.1 48.0 0.0 0.0

Idaho 8.3 0.0 0.0 16.7 28.2 0.0 0.0 41.5 0.0 0.0

Illinois 2.4 0.0 0.0 25.5 20.4 0.0 0.2 21.4 0.0 0.2

Indiana 0.0 0.0 0.0 4.2 2.9 0.0 0.1 5.2 0.0 0.0

Iowa 0.0 0.0 0.0 6.9 5.8 0.0 0.0 8.6 0.0 0.0

Kansas 1.7 0.0 0.0 10.0 19.6 0.0 0.0 42.7 0.0 0.0

Kentucky 0.0 0.0 0.0 4.4 20.4 0.3 0.3 30.2 0.3 0.4

Louisiana 8.3 0.0 0.0 9.0 1.9 0.0 0.0 2.4 0.0 0.0

Maine 31.3 0.0 0.0 31.3 30.0 0.4 0.8 40.7 0.2 0.1

Maryland 2.4 0.0 0.0 46.8 19.1 0.1 0.2 30.4 0.2 0.1

Massachusetts 7.3 0.3 0.3 33.2 39.0 0.1 0.3 46.5 0.2 0.3

Michigan 0.0 0.0 0.0 6.9 23.5 0.3 0.1 28.2 0.2 0.1

Minnesota 1.2 0.0 0.4 6.2 19.3 0.0 0.3 26.5 0.0 0.0

Mississippi 3.2 0.0 0.0 9.0 10.9 0.0 0.0 15.3 0.1 0.0

Missouri 2.0 0.0 0.0 10.5 8.9 0.0 0.0 14.9 0.0 0.0

Montana* 12.5 0.0 0.0 12.5 5.5 0.5 0.0 6.3 0.6 0.0

Nebraska 12.0 0.0 0.0 28.0 19.5 0.0 0.2 32.9 0.0 0.4

Nevada 2.5 0.0 0.0 19.6 26.1 0.0 0.1 32.0 0.0 0.1

New Hampshire 13.9 0.0 0.0 11.1 14.6 0.0 0.0 21.3 0.0 0.1

New Jersey 5.7 0.0 0.0 25.6 32.7 0.3 0.2 48.1 0.3 0.3

New Mexico 14.3 0.0 0.0 5.6 25.3 0.0 0.0 30.1 0.0 0.1

New York 6.6 0.0 0.2 26.5 24.7 0.1 0.3 37.2 0.2 0.1

North Carolina 0.0 0.0 0.0 13.0 12.1 0.0 0.0 16.4 0.0 0.0

North Dakota 7.7 0.0 0.0 7.7 13.3 0.0 0.0 17.4 0.0 0.0

Ohio 0.2 0.0 0.0 7.6 20.2 0.1 0.0 27.0 0.1 0.0

Oklahoma 0.0 0.0 0.0 2.6 6.6 0.0 0.0 7.8 0.0 0.0

Oregon 6.6 0.0 0.0 21.7 14.9 0.0 0.1 29.5 0.1 0.1

Pennsylvania 2.4 0.0 0.0 12.4 27.6 0.0 0.0 37.4 0.0 0.1

Rhode Island 1.4 0.0 0.0 7.0 5.3 0.0 0.0 17.6 0.0 0.0

South Carolina 0.0 0.0 0.0 1.2 27.8 0.1 0.4 34.1 0.1 0.5

South Dakota 0.0 0.0 0.0 47.2 2.4 0.0 0.0 13.3 0.0 0.0

Tennessee 0.8 0.0 0.0 3.4 1.4 0.0 0.0 2.1 0.0 0.0

Texas 0.6 0.0 0.0 3.5 13.0 0.1 0.1 17.2 0.0 0.1

Utah 0.0 0.0 0.0 31.9 1.9 0.0 0.0 3.6 0.0 0.0

Vermont* 0.0 0.0 0.0 20.0 0.0 0.0 0.0 3.6 0.0 0.1

Virginia 0.0 0.0 0.0 7.6 18.1 0.0 0.1 28.7 0.1 0.1

Washington 24.7 0.0 0.0 4.4 18.8 0.0 0.0 23.1 0.1 0.0

West Virginia 0.0 0.0 0.0 7.1 12.6 0.0 0.0 22.5 0.0 0.0

Wisconsin 15.1 0.0 0.0 70.9 19.6 0.0 0.1 21.4 0.0 0.1

Wyoming* 25.0 0.0 0.0 75.0 19.0 0.0 0.0 21.8 0.0 0.1

U.S. TOTAL 4.5 0.0 0.1 15.5 19.3 0.1 0.1 27.1 0.1 0.1

* Percentages for primary and secondary syphilis are based on less than 10 cases.

NOTE: Unknown includes cases reported with unknown, missing, or invalid data values.
STD Surveillance 2014 Appendix: STD Reporting Source 136

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2014

Disease

Non-STD Clinic STD Clinic Total

Male Female Total* Male Female Total* Male† Female† Total‡

Chlamydia 307,845 818,255 1,127,566 64,479 49,702 114,258 433,325 1,006,441 1,441,789

Gonorrhea 129,529 127,049 256,917 32,179 13,347 45,555 186,943 162,608 350,062

Primary Syphilis 3,806 278 4,086 1,525 80 1,606 5,680 412 6,095

Secondary Syphilis 8,811 1,102 9,916 2,803 238 3,042 12,466 1,428 13,904

Early Latent Syphilis 12,215 2,014 14,249 3,186 475 3,664 16,733 2,687 19,452

Late and Late Latent Syphilis§ 11,679 4,959 16,669 2,204 608 2,814 16,872 6,634 23,541

Chancroid 4 0 4 0 0 0 4 2 6

* Total includes cases reported with unknown sex.

† Total includes cases reported with unknown reporting source.

‡ Total includes cases reported with unknown sex and reporting source.

§ Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, late syphilis with clinical manifestations other than 

neurosyphilis, and late syphilis with clinical manifestations (including late benign syphilis and cardiovascular syphilis).
STD Surveillance 2014 Appendix: National Objectives and Goals 137

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 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: P&S syphilis 

(males), 6.8 cases per 100,000 population; P&S syphilis 

(females), 1.4 cases per 100,000 population; congenital 

syphilis, 9.1 cases per 100,000 live births; gonorrhea 

(females aged 15–44 years), 257.0 cases per 100,000 

population and gonorrhea (males aged 15–44 years), 198.0 

cases per 100,000 population. The majority of the STDrelated 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 PID and eliminating congenital 

syphilis. Each of these goals has specific measures of 

progress, which are outlined in Table B2.

1 U.S. Department of Health and Human Services. Healthy People 2020 Web site. [Accessed on 9/8/2015] http://healthypeople. gov/2020/

default.aspx.
138 Appendix: Healthy People 2020 STD Surveillance 2014

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

HP2020 Objectives Baseline 

Year Baseline 2012 2013 2014 HP 2020 Target

1 Reduce the proportion of adolescents and young adults with 

Chlamydia trachomatis infections

a. Among females aged 15 to 24 years attending family planning 

clinics

2008 7.4% N/A N/A N/A 6.7%

b. Among females aged 24 years and under enrolled in a National 

Job Training Program

2008 12.8% 11.0% 11.7% N/A 11.5%

c. Among males aged 24 years and under enrolled in a National 

Job Training Program

2008 7.0% 7.0% 7.4% N/A 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% 53.5% 53.0% N/A 70.9%

b. Females aged 21 to 24 years 2008 59.4% 63.6% 64.1% 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% 41.4% 42.3% N/A 61.3%

b. Females aged 21 to 24 years 2008 43.5% 49.2% 51.2% N/A 74.6%

4 Reduce the proportion of females aged 15 to 44 who have 

ever required treatment for pelvic inflammatory disease (PID)

2006-2008 4.0% N/A N/A N/A 3.6%

5 Reduce gonorrhea rates

a. Females aged 15 to 44 years 2008 285.0 264.7 250.6 248.8 257.0

b. Males aged 15 to 44 years 2008 220.4 232.1 239.4 263.0 198.0

6 Reduce sustained domestic transmission of primary and 

secondary syphilis 

a. Among females 2008 1.5 0.9 0.9 1.2 1.4

b. Among males 2008 7.6 9.3 10.3 11.8 6.8

7 Reduce congenital syphilis 2008 10.1 8.4 9.1 11.6 9.1

8 Reduce the proportion of females with human papillomavirus 

(HPV) Infection (DEVELOPMENTAL)

a. Females with types 6 and 11 2003-2006 3.2 2.0* N/A N/A N/A

b. Females with types 16 and 18 2003-2006 6.2 6.1* N/A N/A N/A

c. Females with other types 2003-2006 40.3 38.3* N/A N/A N/A

9 Reduce the proportion of young adults with genital herpes 

infection due to herpes simplex type 2

2005-2008 10.5% 8.8%**

8.3 

(2011-2012)

N/A 9.5%

HP2020 

Objectives Data Source

1a STD Surveillance System (STDSS), NCHHSTP, CDC

1b, 1c National Job Training Program, STD Surveillance System (STDSS), NCHHSTP, CDC

2a, 2b Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)

3a, 3b Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)

4 2006-2010 National Survey of Family Growth (NSFG), NCHS, CDC

5a, 5b STD Surveillance System (STDSS), NCHHSTP, CDC

6a, 6b STD Surveillance System (STDSS), NCHHSTP, CDC

7 STD Surveillance System (STDSS), NCHHSTP, CDC

8a, 8b NHANES, CDC, NCHS and the National Health Interview Survey (NHIS), CDC

8c NHANES, CDC, NCHS

9 NHANES, CDC, NCHS

*2007-2010 

**2009-2010 data among 20-29 year olds
STD Surveillance 2014 Appendix: GPRA Goals 139

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

Measures, and Target

GPRA Goals

Actual Target

2012 2013 2014 2015

Goal 1: Reduction in PID (as measured by initial visits to physicians 

in women 15–44 years of age) 106,000 88,000 98,800 87,208

a. Proportion of high-risk women aged 16-20 infected with chlamydia* 12.4† 13.3 N/A 11.9

b. Proportion of high-risk women aged 21-24 infected with chlamydia* 8.9† 9.4† N/A 8.5

c. Rate of gonorrhea/100,000 population in women aged 16-20 618.5 551.9 523.9 538.1

d. Rate of gonorrhea/100,000 population in women aged 21-24 545.3 513.8 508.1 512.8

e. Black: white ratio of gonorrhea in women 16-24 12.4 11.1 10.3 10.6

f. Proportion of sexually active females 16-20 enrolled in Medicaid 

who are screened for chlamydia infections 53.5 53.0 N/A 61.1

g. Proportion of sexually active females 21-24 enrolled in Medicaid 

who are screened for chlamydia infections 63.6 64.1 N/A 65.4

h. Proportion of sexually active females 16-20 enrolled in commercial 

health insurance plans who are screened for chlamydia infections 41.1 42.3 N/A 43.1

i. Proportion of sexually active females 21-24 enrolled in commercial 

health insurance plans who are screened for chlamydia infections 49.2 51.2 N/A 52.2

Goal 2: Elimination of Congenital Syphilis

a. Incidence of P&S syphilis/100,000 population in women aged 15-44 2.1 2.1 2.6 1.7

b. Incidence of congenital syphilis/100,000 live births 8.4 8.7 11.5 6.7

c. Proportion of pregnant women that are screened for syphilis at least 

one month before delivery 85.0 85.1 N/A 84

GPRA Goals Data Source

1 National Disease and Therapeutic Index (IMS Health)

1a, 1b National Job Training Program

1c, 1d, 1e STD Surveillance System (STDSS), NCHHSTP, CDC

1f, 1g, 1h, 1i Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)

2a, 2b STD Surveillance System (STDSS), NCHHSTP, CDC

2c Marketscan. Thomson Reuters (Healthcare) Inc.

* Median state-specific chlamydia prevalence/positivity among states with >100 females in this age group entering the National Job Training Program. 

† In FY 2013 CDC improved the calculation of these data to increase the stability of estimate over time. Data for 2010 and later years reflect this improved 

calculation method.

GPRA= Government Performance and Results Act; PID= pelvic inflammatory disease; P&S= primary and secondary; N/A = Not available.
140 Appendix: STD Surveillance Case Definitions STD Surveillance 2014

C. STD Surveillance Case Definitions

C1. CASE DEFINITIONS1 FOR NATIONALLY NOTIFIABLE INFECTIOUS 

DISEASES

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

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.

1 Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance, 1997. MMWR 

Morb Mortal Wkly Rep. 1997;46(No. RR-10).
STD Surveillance 2014 Appendix: STD Surveillance Case Definitions 141

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.

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.
142 Appendix: STD Surveillance Case Definitions STD Surveillance 2014

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.

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.
STD Surveillance 2014 Appendix: STD Surveillance Case Definitions 143

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., FTAABS, 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 non-treponemal 

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

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.
144 Appendix: STD Surveillance Case Definitions STD Surveillance 2014

Syphilitic Stillbirth

Clinical description

A fetal death that occurs after a 20-week gestation or in which the fetus weighs >500 g and the mother had untreated or 

inadequately* treated syphilis at delivery

Comment

For reporting purposes, syphilitic stillbirths should be reported as cases of congenital syphilis.

Syphilis, Congenital (Revised 9/96)

Clinical description

A condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, and only severe 

cases are clinically apparent at birth. An infant or child (aged <2 years) may have signs such as hepatosplenomegaly, rash, 

condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or 

malnutrition). An older child may have stigmata (e.g., interstitial keratitis, nerve deafness, anterior bowing of shins, frontal 

bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints).

Laboratory criteria for diagnosis

• Demonstration of T. pallidum by darkfield microscopy, fluorescent antibody, or other specific stains in specimens 

from lesions, placenta, umbilical cord, or autopsy material

Case classification

Probable: a condition affecting an infant whose mother had untreated or inadequately treated* syphilis at delivery, regardless 

of signs in the infant, or an infant or child who has a reactive treponemal test for syphilis and any one of the following:

• Any evidence of congenital syphilis on physical examination

• Any evidence of congenital syphilis on radiographs of long bones

• A reactive cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL)

• An elevated CSF cell count or protein (without other cause)

• A reactive fluorescent treponemal antibody absorbed—19S-IgM antibody test or IgM enzyme-linked immunosorbent 

assay

Confirmed: a case that is laboratory confirmed

Comment

Congenital and acquired syphilis may be difficult to distinguish when a child is seropositive after infancy. Signs of 

congenital syphilis may not be obvious, and stigmata may not yet have developed. Abnormal values for CSF VDRL, 

cell count, and protein, as well as IgM antibodies, may be found in either congenital or acquired syphilis. Findings on 

radiographs of long bones may help because radiographic changes in the metaphysis and epiphysis are considered classic 

signs of congenitally acquired syphilis. The decision may ultimately be based on maternal history and clinical judgment. 

In a young child, the possibility of sexual abuse should be considered as a cause of acquired rather than congenital syphilis, 

depending on the clinical picture. For reporting purposes, congenital syphilis includes cases of congenitally acquired 

syphilis among infants and children as well as syphilitic stillbirths.

* Inadequate treatment consists of any nonpenicillin therapy or penicillin administered < 30 days before delivery.
STD Surveillance 2014 Appendix: STD Surveillance Case Definitions 145

C2. CASE DEFINITIONS1 FOR NON-NOTIFIABLE INFECTIOUS 

DISEASES

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

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.

1 Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance, 1997. MMWR 

Morb Mortal Wkly Rep. 1997;46(No. RR-10).
146 Appendix: STD Surveillance Case Definitions STD Surveillance 2014

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

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
STD Surveillance 2014 Appendix: STD Surveillance Case Definitions 147

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.

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
148 Appendix: STD Surveillance Case Definitions STD Surveillance 2014

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.
STD Surveillance 2014 Appendix: Contributors 149

Contributors

We gratefully acknowledge the contributions of state STD project directors, STD program managers, state and territorial 

epidemiologists, and laboratory directors. The persons listed were in the positions shown as of September 15, 2015.

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 Vacant Brandi Roberts Dirk Haselow Glen Baker

California Heidi Bauer Romni Neiman Gilberto Chavez Paul Kimsey

Los Angeles Michael Green Vacant Gilberto Chavez Nicole Green (Acting)

San Francisco Trang Nguyen Nora Macias Gilberto Chavez 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 Michael Kharfen John Davies-Cole Morris Blaylock (Acting)

Florida Vacant Kisha Gaines Anna Likos Carina Blackmore

Georgia Michelle Allen Michelle Allen Cherie Drenzek Elizabeth Franko

Hawaii Peter Whiticar Gerald “Luke” Hasty, Jr. Sarah Park A. Christian Whelen

Idaho Rafe Hewitt Deane Gardner Christine Hahn Christopher Ball

Illinois Danny Brikshavana Vacant Constance Austin Tom Johnson

Chicago Vacant Vacant Constance Austin Massimo Pacilli

Indiana Jeremy Roseberry Jeremy Roseberry Pamela Pontones Judith Lovchik

Iowa Randy Mayer George Walton Patricia Quinlisk Christopher Atchison

Kansas Jennifer VandeVelde Jennifer VandeVelde Charles Hunt Myron Gunsalus

Kentucky Vacant Chang Lee Kraig Humbaugh Paul Bachner

Louisiana DeAnn Gruber Vacant Raoult Ratard Stephen Martin

Maine Jayson Hunt Emer Smith Siiri Bennett Kenneth Pote

Maryland Sandra Matus Sandra Matus David Blythe Robert Myers

Baltimore Glen Olthoff Hilda Ndirangu David Blythe

Massachusetts Kathleen Roosevelt David Goudreau Alfred DeMaria Michael Pentella

Michigan Karen Krzanowski Karen Krzanowski Corrine Miller Sandip Shah

Minnesota Marcie Babcock Marcie Babcock Ruth Lynfield Joanne Bartkus

Mississippi Nicholas Mosca David Peyton Thomas Dobbs Daphne Ware

Missouri Ken Palermo Ken Palermo 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 Sandi Larson Chelsi Cheatom Daniel Mackie/ Ihsan Azzam Yashpal Agrawal (Interim)

New Hampshire Christine Adamski Lindsay Pierce Benjamin Chan Christine Bean

New Jersey Connie F. Calisti-Meyers Patricia Mason Christina Tan Onesia Bishop

New Mexico Andrew Gans Janine Waters Michael Landen Lizia 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 Pete Moore Megan Davies Scott Zimmerman

North Dakota Kirby Kruger Lindsey VanderBusch Tracy Miller Myra Kosse

Ohio Amanda Dennison Vacant Mary DiOrio Rosemarie Gearhart

Oklahoma Jan Fox Kristen Eberly Kristy Bradley S. Terrance Dunn

Oregon Veda Latin Ruth Helsley Katrina Hedberg John Fontana

Pennsylvania Beth Butler Beth Butler Kirsten Waller James Lute (Acting)

Philadelphia Greta Anschuetz Melinda Salmon Kirsten Waller Kerry Buchs

Rhode Island Thomas Bertrand Jaime Comella Utpala Bandy Ewa King

South Carolina Vacant Bernard Gilliard Linda Bell Shahiedy Shahied

South Dakota Amanda Gill Amanda Gill Lon Kightlinger Timothy Southern

Tennessee Brad Beasely Vacant Tim Jones Richard Steece

Texas Feipe Rocha Shelley Lucas Linda Gaul Grace Kubin

Utah Lynn Meinor Lynn Meinor Allyn Nakashima Robyn Atkinson-Dunn

Vermont Daniel Daltry Daniel Daltry Patsy Kelso/ Lori Cragin Mary Celotti

Virginia Diana Jordan Oana Vasiliu Laurie Forlano Denise Toney

Washington David Kern David Kern Scott Lindquist/ Cathy Wasserman Romesh Gautom

West Virginia Susan Hall Ken Gould Loretta Haddy Sharon Lee Cibrik

Wisconsin Vacant Anthony Wade Henry Anderson/ Jeffrey Davis Charles Brokopp

Wyoming Tai Wright Debi Anderson Tracy Murphy Sarah Buss

American Samoa Fara M. Utu Fetaui V. Saelua Scott Anesi Mary Matau

Federated States of Micronesia Vita Akapito Skilling Mayleen Ekiek Vita Akapito Skilling Lisa Barrow

Government of the Marshall Islands Julia Alfred Adela Sibok Edlen Anzures Anne Chang Gum

Northern Marianas (CNMI) John Dax Moreno John Dax Moreno Ginny Monteiro Philip Dauterman

Guam James W. Gillan Bernadette P. Schumann Josephine O’Mallan Vacant

Puerto Rico Trinidad Garcia Vargan Raymond Perez Rivera Brenda Rivera-Garcia Myriam Garcia-Negron

Republic of Palau Berrymoon Watson Sherilynn Madraisau Dawn Fitzgibbons Francis Termeteet

Virgin Islands Gritell Martinez Jasper Lettsome Esther Ellis Joseph Mark