Sexually 

Transmitted 

Disease 

Surveillance 

2004 

Division of STD Prevention 

September 2005 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for HIV, STD, and TB Prevention 

Division of STD Prevention 

Atlanta, Georgia 30333 

Centers for Disease Control and 

Prevention........................................Julie Louise Gerberding, M.D., M.P.H. 

Director 

Coordinating Center for 

Infectious Diseases ...............................................Mitchell L. Cohen, M.D. 

Director 

National Center for 

HIV, STD, and TB Prevention .......................Ron Valdiserri, M.D., M.P.H. 

Acting Director 

Division of STD Prevention ............................John M. Douglas, Jr., M.D. 

Director 

Epidemiology and Surveillance 

Branch ...............................................Stuart M. Berman, M.D., Sc.M. 

Chief 

Surveillance and Special Studies 

Team ......................................Hillard S. Weinstock, M.D., M.P.H. 

Lead 

Statistics and Data Management 

Branch ....................................Samuel L. Groseclose, D.V.M., M.P.H. 

Chief 

Melinda L. Flock, M.S.P.H. 

Deputy Chief 

Rose Horsley 

Team Lead 

iii 
Copyright Information 

All material contained in this report is in the public domain and may be used and reprinted 

without special permission; citation to source, however, is appreciated. 

Suggested Citation 

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2004. 

Atlanta, GA: U.S. Department of Health and Human Services, September 2005. 

Copies can be obtained from the National Center for HIV, STD, and TB Prevention, Centers for 

Disease Control and Prevention, 1600 Clifton Road, Mailstop E-07, Atlanta, Georgia 30333. 

Printed copies can also be obtained through the Internet on-line ordering system at the web site 

listed below. 

This report is also available by Internet via the CDC home page at: http://www.cdc.gov/std/stats/ 

Related Websites 

The following is a list of suggested websites related to information in this report: 

• STD Surveillance 1993-2004: 

http://www.cdc.gov/nchstp/dstd/Stats_Trends/Stats_and_Trends.htm 

• STD Data on WONDER: http://wonder.cdc.gov/sexu00.html 

• STD Fact Sheets: http://www.cdc.gov/std/healthcomm/fact_sheets.htm 

• STD Treatment Guidelines: http://www.cdc.gov/STD/treatment/ 

Supplemental Reports 

• 2004 Chlamydia Prevalence Monitoring Project: http://www.cdc.gov/std/chlamydia2004/ 

(available first quarter 2006) 

• 2004 Gonococcal Isolate Surveillance Project: http://www.cdc.gov/std/GISP2004/ 

(available first quarter 2006) 

• 2004 Syphilis Surveillance Project: http://www.cdc.gov/std/Syphilis2004/ (available 

first quarter 2006) 

iv 
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. 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 to 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 Concluding statement from the Institute of Medicine’s Summary Report, The Hidden Epidemic: 

Confronting Sexually Transmitted Diseases, National Academy Press, Washington, DC, 1997, p.43. 

v 
Preface 

Sexually Transmitted Disease Surveillance, 2004 presents statistics and trends for sexually transmitted diseases (STDs) in the United States through 2004. 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) case 

reports from state and local STD programs; (2) prevalence data from the Regional Infertility Prevention 

Projects, the National Job Training Program (formerly the Job Corps), the Corrections STD Prevalence 

Monitoring Project, and the Men Who Have Sex With Men (MSM) Prevalence Monitoring Project; (3) sentinel surveillance of gonococcal antimicrobial resistance from the Gonococcal Isolate Surveillance Project 

(GISP); and (4) 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 sources of many of the 

figures and all 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 CDC is less than the actual 

number of cases occurring in the United States population. Case report data for other STDs are not 

available because they are not nationally notifiable diseases. 

Sexually Transmitted Disease Surveillance, 2004 consists of four parts. The National Profile 

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 contain 

figures and text describing STDs in selected subgroups and populations that are a focus of national 

and state prevention efforts. The Detailed Tables provide statistical information about STDs at 

the city, county, state, and national levels. The Appendix includes information on interpreting the 

STD Surveillance data used to produce this report, Healthy People 2010 STD objectives, GPRA 

goals, and STD surveillance case definitions. 

Selected figures and tables in this document identify goals that reflect progress towards some 

of the Healthy People 2010 (HP2010) national health status objectives for STDs.1 Appendix 

Table A3 displays progress made towards the HP2010 targets for STDs. These targets are used 

as reference points throughout this edition of Sexually Transmitted Disease Surveillance, 2004. 

Any comments and suggestions that would improve the usefulness of future publications are 

appreciated and should be sent to Director, Division of STD Prevention, National Center for 

HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, 

Mailstop E-02, Atlanta, Georgia, 30333. 

1 U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and 

Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government 

Printing Office, November 2000. 

vi 
Acknowledgments 

Publication of this report would not have been possible without the contributions of the State 

and Territorial Health Departments and the Sexually Transmitted Disease Control Programs 

and the Regional Infertility Prevention Projects, which provided surveillance data to the Centers 

for Disease Control and Prevention. 

This report was prepared by the following staff and contractors of the Division of STD Prevention, 

National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention: Stuart 

Berman, Susan Bradley, Jim Braxton, Sharon Clanton, Deblina Datta, Darlene Davis, Linda Webster 

Dicker, John Douglas, Melinda Flock, LaZetta Grier, Samuel Groseclose, Alesia Harvey, Donna 

Helms, Rose Horsley, Riduan Joesoef, Heather Lindstrom, Elvin Magee, Catherine McLean, Debra 

Mosure, Rob Nelson, Lori Newman, Katrina Park, Amy Pulver, LuEtta Schneider, Maya Sternberg, 

Emmett Swint, Hillard Weinstock, Jennifer Wright, and Akbar Zaidi. 

vii 
Contents 

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

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

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
 

Figures in the National Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
 

Figures in the Special Focus Profiles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x
 

Tables in the National Profile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
 

Geographic Divisions of the United States. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi
 

National Overview of Sexually Transmitted Diseases, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
 

National Profile 

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
 

Chlamydia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
 

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

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

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

Special Focus Profiles 

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
 

STDs in Women and Infants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
 

STDs in Adolescents and Young Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
 

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

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

STDs in Persons Entering Corrections Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
 

Tables 

National Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
 

Chlamydia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 
 

Gonorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
 

Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
 

Chancroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
 

Selected STDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
 

Appendix 

Interpreting STD Surveillance Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
 

Table A1. Selected STDs — Percentage of unknown, missing, or invalid values
 

Table A2. Reported cases of sexually transmitted disease by sex and reporting source:
 

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

for selected demographic variables by state, 2004 . . . . . . . . . . . . . . . . . . . . . 147
 

United States, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
 

Table A3. Healthy People 2010 Sexually Transmitted Diseases Objective Status . . . . . . 149
 

Diseases Goals and Measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
 

STD Surveillance Case Definitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
 

Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
 

viii 
Figures in the National Profile 

Chlamydia 

Figure 1. Chlamydia — Rates: United States, 1984–2004. . . . . . . . . . . . . . . . . . . . . . . . 10
 

Figure 2. Chlamydia — Rates by state: United States and outlying areas, 2004 . . . . . . . 10
 

Figure 3. Chlamydia — Rates by county: United States, 2004 . . . . . . . . . . . . . . . . . . . . 11
 

Figure 4. Chlamydia — Rates by region: United States, 1984–2004 . . . . . . . . . . . . . . . . 11
 

Figure 5. Chlamydia — Rates by sex: United States, 1984–2004 . . . . . . . . . . . . . . . . . . 12
 

Figure 6. Chlamydia — Age- and sex-specific rates: United States, 2004 . . . . . . . . . . . . 12
 

Figure 7. Chlamydia — Positivity among 15- to 24-year-old women tested in
 

family planning clinics by state: United States and outlying areas, 2004. . . . . . 13
 

Figure 8. Chlamydia — Trends in positivity among 15- to 24-year-old women
 

tested in family planning clinics by HHS region, 1988–2004 . . . . . . . . . . . . . . 13
 

Gonorrhea 

Figure 9. Gonorrhea — Rates: United States, 1970–2004 and the Healthy People
 

2010 target. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
 

Figure 10. Gonorrhea — Reported cases by reporting source: United States,
 

Figure 13. Gonorrhea — Rates by region: United States, 1981–2004 and the
 

Figure 14. Gonorrhea — Rates by sex: United States, 1981–2004 and the Healthy
 

Figure 15. Gonorrhea — Rates by race and ethnicity: United States, 1981–2004
 

Figure 17. Gonorrhea — Age-specific rates among women 10 to 44 years of age:
 

Figure 18. Gonorrhea — Age-specific rates among men 10 to 44 years of age:
 

Figure 19. Gonorrhea — Positivity among 15- to 24-year-old women tested in family
 

Figure 20. Gonococcal Isolate Surveillance Project (GISP) — Location of
 

Figure 21. Gonococcal Isolate Surveillance Project (GISP) — Penicillin and
 

1984-2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
 

Figure 11. Gonorrhea — Rates by state: United States and outlying areas, 2004 . . . . . . . 21
 

Figure 12. Gonorrhea — Rates by county: United States, 2004 . . . . . . . . . . . . . . . . . . . . 21
 

Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
 

People 2010 target. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
 

and the Healthy People 2010 target. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
 

Figure 16. Gonorrhea — Age- and sex-specific rates: United States, 2004 . . . . . . . . . . . . 23
 

United States, 1981–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
 

United States, 1981–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
 

planning clinics by state: United States and outlying areas, 2004 . . . . . . . . . . . 25
 

participating clinics and regional laboratories: United States, 2004. . . . . . . . . . 25
 

tetracycline resistance among GISP isolates, 2004 . . . . . . . . . . . . . . . . . . . . . . 26
 

Figure 22. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria
 

gonorrhoeae isolates with resistance or intermediate resistance to
 

ciprofloxacin, 1990–2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
 

Figure 23. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria
 

gonorrhoeae isolates with resistance to ciprofloxacin by sexual behavior,
 

2001–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
 

ix 
Syphilis 

Figure 24. Syphilis — Reported cases by stage of infection: United States, 1941–2004. . . 33
 

Figure 25. Primary and secondary syphilis — Reported cases by reporting source: 

United States, 1984–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
 

Figure 26. Primary and secondary syphilis — Rates: United States, 1970–2004 and 

the Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
 

Figure 27. Primary and secondary syphilis — Rates by state: United States and 

outlying areas, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
 

Figure 28. Primary and secondary syphilis — Rates by county: United States, 2004. . . . . 35
 

Figure 29. Primary and secondary syphilis — Rates by region: United States, 

1981–2004 and the Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . 35
 

Figure 30. Primary and secondary syphilis — Rates by sex: United States, 

1981–2004 and the Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . 36
 

Figure 31. Primary and secondary syphilis — Rates by race and ethnicity: 

United States, 1981–2004 and the Healthy People 2010 target . . . . . . . . . . . . 36
 

Figure 32. Primary and secondary syphilis — Male-to-female rate ratios: 

United States, 1981–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
 

Figure 33. Primary and secondary syphilis — Age- and sex-specific rates: 

United States, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
 

Figure 34. Primary and secondary syphilis — Age-specific rates among women 

10 to 44 years of age: United States, 1981–2004. . . . . . . . . . . . . . . . . . . . . . . 38
 

Figure 35. Primary and secondary syphilis — Age-specific rates among men 

10 to 44 years of age: United States, 1981–2004. . . . . . . . . . . . . . . . . . . . . . . 38
 

Figure 36. Congenital syphilis — Reported cases for infants <1 year of age 

and rates of primary and secondary syphilis among women: United States, 

1970–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
 

Figure 37. Congenital syphilis — Rates for infants <1 year of age: United States, 

1981–2004 and the Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . 39
 

Other Sexually Transmitted Diseases 

Figure 38. Chancroid — Reported cases: United States, 1981–2004. . . . . . . . . . . . . . . . . 43
 

Figure 39. Genital herpes — Initial visits to physicians’ offices: United States,
 

1966–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
 

Figure 40. Genital warts — Initial visits to physicians’ offices: United States,
 

Figure 41. Trichomoniasis and other vaginal infections in women — Initial visits
 

1966–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
 

to physicians’ offices: United States, 1966–2004 . . . . . . . . . . . . . . . . . . . . . . . 44
 

Figures in the Special Focus Profiles 

STDs in Women and Infants 

Figure A. Chlamydia — Rates among women by state: United States and outlying
 

areas, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
 

Figure B. Gonorrhea — Rates among women by state: United States and outlying
 

areas, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
 

x
Figure C. Primary and secondary syphilis — Rates for women by state: United States
 

and outlying areas, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
 

Figure D. Congenital syphilis — Rates for infants < 1 year of age by state: United States
 

Figure E. Chlamydia — Positivity in 15- to 24-year-old women tested in prenatal
 

Figure F. Gonorrhea — Positivity among 15- to 24-year-old women tested in prenatal
 

Figure G. Ectopic pregnancy — Hospitalizations of women 15 to 44 years of age:
 

Figure H. Pelvic inflammatory disease — Hospitalizations of women 15 to 44 years
 

and outlying areas, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
 

clinics by state: United States and outlying areas, 2004 . . . . . . . . . . . . . . . . . . 53
 

clinics by state: United States and outlying areas, 2004 . . . . . . . . . . . . . . . . . . 53
 

United States, 1980-2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
 

of age: United States, 1980–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
 

Figure I. Pelvic inflammatory disease — Initial visits to physicians’ offices by women
 

15 to 44 years of age: United States, 1980–2004. . . . . . . . . . . . . . . . . . . . . . . 55
 

STDs in Adolescents and Young Adults 

Figure J. Chlamydia — Trends in positivity among 15- to 19-year-old women tested 

in family planning clinics by HHS regions, 1988–2004. . . . . . . . . . . . . . . . . . . 60
 

Figure K. Chlamydia — Positivity among women tested in family planning clinics by 

age group: Region X, 1988–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
 

Figure L. Chlamydia — Prevalence among 16- to 24-year-old women entering the 

National Job Training Program by state of residence: United States and 

outlying areas, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
 

Figure M. Chlamydia — Prevalence among 16- to 24-year-old men entering the 

National Job Training Program by state of residence: United States and 

outlying areas, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
 

Figure N. Gonorrhea — Prevalence among 16- to 24-year-old women entering the 

National Job Training Program by state of residence: United States and 

outlying areas, 2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
 

Figure O. Gonorrhea — Prevalence among 16- to 24-year-old men entering the 

National Job Training Program by state of residence: United States and 

outlying areas, 2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
 

STDs in Racial and Ethnic Minorities 

Figure P. Chlamydia — Positivity among women tested in family planning clinics
 

by race and ethnicity: Region X, 1988–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . 66
 

Figure R. Gonorrhea — Rates among 15- to 19-year-old females by race and
 

Figure S. Gonorrhea — Rates among 15- to 19-year-old males by race and
 

Figure T. Primary and secondary syphilis — Rates by race/ethnicity and sex:
 

Figure U. Primary and secondary syphilis — Rates among 15- to 19-year-old
 

Figure Q. Gonorrhea — Rates by race/ethnicity and sex, 2004 . . . . . . . . . . . . . . . . . . . . 66
 

ethnicity: United States, 1981–2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
 

ethnicity: United States, 1981–2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
 

United States, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
 

females by race and ethnicity: United States, 1981–2004. . . . . . . . . . . . . . . . . 68
 

Figure V. Primary and secondary syphilis — Rates among 15- to 19-year-old males
 

by race and ethnicity: United States, 1981–2004 . . . . . . . . . . . . . . . . . . . . . . . 69
 

Figure W. Congenital syphilis — Rates among infants <1 year of age by 

mother’s race and ethnicity: United States, 1991–2004 and the 

Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
 

xi
STDs in Men Who Have Sex with Men 

Figure X. MSM Prevalence Monitoring Project — Syphilis serologic reactivity
 

among men who have sex with men, STD clinics, 1999-2004 . . . . . . . . . . . . . 75
 

Figure Y. MSM Prevalence Monitoring Project — Gonorrhea positivity among
 

men who have sex with men, STD clinics, 1999-2004 . . . . . . . . . . . . . . . . . . . 75
 

Figure Z.	 MSM Prevalence Monitoring Project — Test positivity for gonorrhea,
 

chlamydia, and HIV among men who have sex with men, by race/ethnicity,
 

STD clinics, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
 

Figure AA. MSM Prevalence Monitoring Project — Positivity for gonorrhea and chlamydia
 

among men who have sex with men, by HIV status, STD clinics, 2004 . . . . . . . 76
 

Figure BB. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria
 

gonorrhoeae isolates obtained from men who sex with men attending
 

STD clinics, 1988-2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
 

Figure CC. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria
 

gonorrhoeae isolates obtained from men who sex with men attending
 

STD clinics, 2001-2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
 

STDs in Persons Entering Corrections Facilities 

Figure DD. Chlamydia — Positivity by age, juvenile corrections facilities, 2004 . . . . . . . . . 82
 

Figure EE. Chlamydia — Positivity by age, adult corrections facilities, 2004 . . . . . . . . . . . 82
 

Figure FF. Gonorrhea — Positivity by age, juvenile corrections facilities, 2004 . . . . . . . . . 83
 

Figure GG.Gonorrhea — Positivity by age, adult corrections facilities, 2004 . . . . . . . . . . . 83
 

Table AA. Chlamydia — Positivity among men and women in juvenile corrections
 

facilities, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
 

Table BB. Chlamydia — Positivity among men and women in adult corrections
 

Table CC. Gonorrhea — Positivity among men and women in juvenile corrections
 

Table DD. Gonorrhea — Positivity among men and women in adult corrections
 

Table EE. Syphilis — Reactive syphilis among men and women in juvenile
 

Table FF. Syphilis — Reactive syphilis among men and women in adult
 

facilities, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
 

facilities, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
 

facilities, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
 

corrections facilities, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
 

corrections facilities, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
 

xii 
Tables in the National Profile 

National Summary 

Table 1.	 Cases of sexually transmitted diseases reported by state health departments
 

and rates per 100,000 civilian population: United States, 1941–2004 . . . . . . 87
 

Chlamydia 

Table 2. Chlamydia — Reported cases and rates by state, ranked by rates:
 

United States, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
 

Table 3. Chlamydia — Reported cases and rates by state/area and region listed
 

Table 4. Chlamydia — Women – Reported cases and rates by state/area and region
 

Table 5. Chlamydia — Men – Reported cases and rates by state/area and region
 

Table 6. Chlamydia — Reported cases and rates in selected cities ranked by rates:
 

Table 7. Chlamydia — Reported cases and rates in selected cities listed in
 

Table 8. Chlamydia — Women – Reported cases and rates in selected cities listed
 

Table 9. Chlamydia — Men – Reported cases and rates in selected cities listed in
 

Table 10. Chlamydia — Reported cases and rates per 100,000 population by age
 

Table 11A. Chlamydia — Reported cases by race/ethnicity, age group and sex:
 

Table 11B. Chlamydia — Rates per 100,000 population by race/ethnicity, age group
 

in alphabetical order: United States and outlying areas, 2000–2004 . . . . . . . . 90
 

listed in alphabetical order: United States and outlying areas, 2000–2004 . . . . 91
 

listed in alphabetical order: United States and outlying areas, 2000–2004 . . . . 92
 

United States, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
 

alphabetical order: United States and outlying areas, 2000–2004 . . . . . . . . . . 94
 

in alphabetical order: United States and outlying areas, 2000–2004 . . . . . . . . 95
 

alphabetical order: United States and outlying areas, 2000–2004 . . . . . . . . . . 96
 

and sex: United States, 2000–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
 

United States, 2000–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
 

and sex: United States, 2000–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
 

Gonorrhea 

Table 12. Gonorrhea — Reported cases and rates by state/area, ranked by rates:
 

United States, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
 

Table 13. Gonorrhea — Reported cases and rates by state/area and region listed
 

Table 14. Gonorrhea — Women – Reported cases and rates by state/area and region
 

Table 15. Gonorrhea — Men – Reported cases and rates by state/area and region
 

Table 16. Gonorrhea — Reported cases and rates in selected cities ranked by rates:
 

Table 17. Gonorrhea — Reported cases and rates in selected cities listed in
 

Table 18. Gonorrhea — Women – Reported cases and rates in selected cities listed
 

Table 19. Gonorrhea — Men – Reported cases and rates in selected cities listed in
 

in alphabetical order: United States and outlying areas, 2000–2004 . . . . . . . 101
 

listed in alphabetical order: United States and outlying areas, 2000–2004 . . . 102
 

listed in alphabetical order: United States and outlying areas, 2000–2004 . . . 103
 

United States, 2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
 

alphabetical order: United States and outlying areas, 2000–2004 . . . . . . . . . 105
 

in alphabetical order: United States and outlying areas, 2000–2004 . . . . . . . 106
 

alphabetical order: United States and outlying areas, 2000–2004 . . . . . . . . . 107
 

xiii 
Table 20. Gonorrhea — Reported cases and rates per 100,000 population by age 

and sex: United States, 2000–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
 

Table 21A. Gonorrhea — Reported cases by race/ethnicity, age group and sex:
 

United States, 2000–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
 

Table 21B. Gonorrhea — Rates per 100,000 population by race/ethnicity, age group
 

and sex: United States, 2000–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
 

Syphilis 

Table 22. All stages of syphilis — Reported cases and rates by state/area and region
 

listed in alphabetical order: United States and outlying areas, 2000–2004 . . . 112
 

Table 23. All stages of syphilis — Reported cases and rates in selected cities listed
 

Table 24. Primary and secondary syphilis — Reported cases and rates by state/area,
 

Table 25. Primary and secondary syphilis — Counties and independent cities ranked by
 

in alphabetical order: United States and outlying areas, 2000–2004 . . . . . . . 113
 

ranked by rates: United States, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
 

* 

number of reported cases: United States, 2004 . . . . . . . . . . . . . . . . . . . . . . . 115
 

Table 26. Primary and secondary syphilis — Reported cases and rates by
 

state/area and region listed in alphabetical order: United States and
 

Table 27. Primary and secondary syphilis — Women – Reported cases and rates
 

by state/area and region listed in alphabetical order: United States and
 

Table 28. Primary and secondary syphilis — Men – Reported cases and rates
 

by state/area and region listed in alphabetical order: United States and
 

Table 29. Primary and secondary syphilis — Reported cases and rates in selected
 

Table 30. Primary and secondary syphilis — Reported cases and rates in selected cities
 

Table 31. Primary and secondary syphilis — Women – Reported cases and rates
 

in selected cities listed in alphabetical order: United States and outlying
 

Table 32. Primary and secondary syphilis — Men – Reported cases and rates
 

in selected cities listed in alphabetical order: United States and outlying
 

Table 33. Primary and secondary syphilis — Reported cases and rates per 100,000
 

Table 34A. Primary and secondary syphilis — Reported cases by race/ethnicity,
 

Table 34B. Primary and secondary syphilis — Rates per 100,000 population by
 

Table 35. Early latent syphilis — Reported cases and rates by state/area
 

and region listed in alphabetical order: United States and outlying areas,
 

Table 36. Early latent syphilis — Reported cases and rates in selected cities listed
 

Table 37. Late and late latent syphilis — Reported cases and rates by
 

state/area and region listed in alphabetical order: United States and
 

outlying areas, 2000–2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
 

outlying areas, 2000–2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
 

outlying areas, 2000–2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
 

cities, ranked by rates: United States, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . 119
 

listed in alphabetical order: United States and outlying areas, 2000–2004 . . . 120
 

areas, 2000–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
 

areas, 2000–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
 

population by age and sex: United States, 2000–2004. . . . . . . . . . . . . . . . . . 123
 

age group and sex: United States, 2000–2004 . . . . . . . . . . . . . . . . . . . . . . . . 124
 

race/ethnicity, age group and sex: United States, 2000–2004. . . . . . . . . . . . . 125
 

2000–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
 

in alphabetical order: United States and outlying areas, 2000–2004 . . . . . . . 127
 

outlying areas, 2000–2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
 

xiv 
Table 38.	 Late and late latent syphilis — Reported cases and rates in selected cities 

listed in alphabetical order: United States and outlying areas, 2000–2004 . . . 129
 

Table 39.	 Congenital syphilis — Reported cases and rates in infants < 1 year of age: 

United States (excluding outlying areas), 1963–2004. . . . . . . . . . . . . . . . . . . 130
 

Table 40.	 Congenital syphilis — Reported cases and rates in infants < 1 year of 

age by state, ranked by rates: United States, 2004 . . . . . . . . . . . . . . . . . . . . . 131
 

Table 41.	 Congenital syphilis — Reported cases and rates in infants < 1 year of age 

by state/area and region listed in alphabetical order: United States and 

outlying areas, 2000–2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
 

Table 42.	 Congenital syphilis — Reported cases and rates in infants < 1 year of age 

in selected cities, ranked by rates: United States, 2004. . . . . . . . . . . . . . . . . . 133
 

Table 43.	 Congenital syphilis — Reported cases and rates in infants < 1 year of age 

in selected cities listed in alphabetical order: United States and outlying 

areas, 2000–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
 

Table 44.	 Congenital syphilis — Reported cases and rates in infants <1 year of age 

by race/ethnicity of mother: United States, 2000–2004 . . . . . . . . . . . . . . . . . 135
 

Chancroid 

Table 45. Chancroid — Reported cases and rates by state/area listed in alphabetical
 

order: United States and outlying areas, 2000–2004 . . . . . . . . . . . . . . . . . . . 136
 

Table 46. Chancroid — Reported cases and rates in selected cities listed in alphabetical
 

order: United States and outlying areas, 2000–2004 . . . . . . . . . . . . . . . . . . . 137
 

Selected STDs 

Table 47.	 Selected STDs and complications — Initial visits to physicians' offices:
 

United States, 1966–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
 

Interpreting STD Surveillance Data 

Table A1. Selected STDs — Percentage of unknown, missing, or invalid values
 

for selected demographic variables by state, 2004 . . . . . . . . . . . . . . . . . . . . . 147
 

Table A2. Reported cases of sexually transmitted disease by sex and reporting source:
 

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

United States, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
 

Table A3. Healthy People 2010 Sexually Transmitted Diseases Objective Status . . . . . . 149
 

Diseases Goals and Measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
 

xv 
Geographic Divisions 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 

xvi 
National Overview of Sexually Transmitted Diseases, 2004

The logo on the cover of Sexually Transmitted Disease Surveillance, 2004 is a reminder of the 

multifaceted, national dimensions of the morbidity, mortality, and costs that result from sexually 

transmitted diseases (STDs) in the United States. It highlights the central role of STD prevention in 

improving health among women and infants and in promoting HIV prevention. Organized collaboration among interested, committed public and private organizations is the key to reducing STDs 

and their related health burdens in our population. As noted in the report of the Institute of Medicine, The Hidden Epidemic: Confronting Sexually Transmitted Diseases,1 surveillance is a key component of our efforts to prevent and control these diseases. 

This overview summarizes national surveillance data on the three diseases for which there are 

federally-funded control programs: chlamydia, gonorrhea, and syphilis. Several observations for 

2004 are worthy of note. 

Chlamydia

In 2004, 929,462 cases of genital Chlamydia trachomatis infection were reported to CDC (Table 

1). This case count corresponds to a rate of 319.6 cases per 100,000 population, an increase of 

5.9% compared with the rate in 2003. Rates of reported chlamydia infections among women have 

been increasing annually since the late 1980s when public programs for screening and treatment of 

women were first established to avert pelvic inflammatory disease and related complications. 

Chlamydia screening and reporting are likely to continue to expand further in response to the 

Health Plan Employer Data and Information Set (HEDIS) measure for chlamydia screening of sexually active women 15 to 25 years of age who are provided medical care through managed care organizations.2 The continued increase in chlamydia case reports in 2004 most likely represents a 

continued increase in screening for this infection and also increased use of more sensitive chlamydia 

screening tests than in prior years. 

Chlamydia Screening and Prevalence Monitoring in Special Populations

Data from multiple sources on prevalence of chlamydia infection in defined populations have 

been useful in monitoring disease burden and guiding chlamydia screening programs: 

• In 2004, the median state-specific chlamydia test positivity among women 15 to 

24 years of age who were screened at selected family planning clinics in all states, 

the District of Columbia, Puerto Rico, and the Virgin Islands was 6.3% (range 

3.2% to 16.3%) (Figure 8). 

• In 2004, the median state-specific chlamydia test positivity among 15- to 24- year 

old women who were screened at selected prenatal clinics in 25 states, Puerto 

Rico, and the Virgin Islands was 6.8% (range 3.1% to 17.6%) (Figure 7). 

• For economically-disadvantaged women 16 to 24 years of age who entered the 

National Job Training Program in 2004 from 38 states and Puerto Rico, the 

STD Surveillance 2004 Overview 1 
median state-specific prevalence was 9.7% (range 4.4% to 17.3%) (Figure M). 

Among men entering the program in 2004 from 47 states and Puerto Rico the 

median state-specific chlamydia prevalence was 7.3% (range 0.8% to 13.0%) 

(Figure N). 

• For adolescent women entering 56 juvenile detention centers, the median 

chlamydia positivity by facility was 14.0% (range 2.4% to 26.5%) (Table AA). 

Among adolescent men entering 81 juvenile detention centers, the median 

chlamydia positivity was 5.8% by facility (range 1.0% to 27.5%) (Table AA). 

Although these data on prevalence are not entirely comparable because of differences in the populations screened, in the performance characteristics of the screening tests, and variations in screening criteria, they provide important information on the continuing high burden of disease in the 

United States. 

Gonorrhea

In 2004, 330,132 cases of gonorrhea were reported in the United States. Following a 74.3% decline in the rate of reported gonorrhea from 1975 (467.7 cases per 100,000 population) to 1997 

(120.2 cases per 100,000 population), overall rates appeared to plateau. Since 2000, however, the 

gonorrhea rate has decreased 15.2% to the current rate of 113.5 per 100,000 population (Table 1). 

Although this is the lowest gonorrhea rate the United States has ever reported, the 2004 rate for 

gonorrhea considerably exceeds the Healthy People 2010 (HP2010) target of 19 cases per 100,000 

population. 

The rate among women was slightly higher (116.5 per 100,000 population) than the rate 

among men (110.0 per 100,000 population) for the third straight year (Figure 14). As with 

chlamydia, rates of gonorrhea in women are particularly high in 15- to 19-year-olds, and in 

men, are highest in the 20- to 24-year age group (Figure 16 and Table 20). Since 2000, the overall rate of gonorrhea among 15- to 19-year-olds has decreased by 15.4%. Similar to previous 

years, in 2004, African-American 15- to 19-year-old females had the highest gonorrhea rate of 

any age and race/ethnic group (2,790.5 cases per 100,000 population) (Table 21B). However, 

gonorrhea rates among both African-American men and women decreased from 2000 through 

2004 (22.2% and 15.6%, respectively). In contrast, gonorrhea rates among both white men and 

women have increased between 2000 and 2004 (20.2% and 19.0%, respectively). 

Gonorrhea in Special Populations

In 2004, data on gonorrhea prevalence in defined populations were available from several 

sources. These data showed a continuing high burden of disease in adolescents and young adults in 

some parts of the United States. 

• For 16- to 24-year-old women entering the National Job Training Program in 33 

states and Puerto Rico in 2004, the median state-specific gonorrhea prevalence 

was 2.4% (range 0% to 6.4%). Among men entering the program from 8 states, 

the median state-specific gonorrhea prevalence was 3.7% (range 1.0% to 5.5%). 

• Among women entering 34 juvenile corrections facilities the median prevalence 

was 4.5% (range 0% to 16.6%); the median prevalence for men entering 49 

juvenile corrections facilities was 0.8% (range 0% to 18.2%). 

2 Overview STD Surveillance 2004 
• Among women entering 26 adult corrections facilities, the median positivity was 

3.0% (range 0% to 8.4%). In men, the median positivity was 2.6% (range 0% to 

33.8%) in 27 adult corrections facilities. 

• Among men who have sex with men attending 7 STD clinics, the median 

positivity was 15% (range 11-17%). 

Antimicrobial Resistance

The Gonococcal Isolate Surveillance Project (GISP) was established in 1986 to monitor trends in 

antimicrobial susceptibilities of strains of Neisseria gonorrhoeae in the United States. Isolates are 

collected from the first 25 men with urethral gonorrhea attending selected STD clinics each month in 

28 cities. 

There is considerable geographic variation in the prevalence of fluoroquinolone-resistance 

within the United States. Outside of Hawaii and California, 3.6% of N. gonorrhoeae isolates demonstrated resistance. In Honolulu, California and Washington the proportion of GISP isolates that 

were resistant to ciprofloxacin stayed relatively steady or increased during 2004, while increases in 

resistance were seen in other areas of the continental U.S., most notably in Denver, Miami, 

Minneapolis, and Phoenix. 

The proportion of GISP isolates among men who have sex with men (MSM) that were resistant to 

ciprofloxacin increased again in 2004 to 23.9%, up from 15% in 2003. The proportion of resistant 

isolates among heterosexuals nearly doubled in 2004, increasing from 1.5% in 2003 to 2.9% in 

2004. In 2004 CDC recommended that fluoroquinolones no longer be used to treat gonorrhea 

among MSM.3 See Appendix for more information on GISP. 

Syphilis

The rate of primary and secondary (P&S) syphilis reported in the United States decreased during 

the 1990s and in 2000 was the lowest since reporting began in 1941. The low rate of syphilis and the 

concentration of the majority of syphilis cases in a small number of geographic areas led to the development of the National Plan to Eliminate Syphilis from the United States, which was announced 

by the Surgeon General in October 1999.4 The rate of P&S syphilis in the United States declined by 

89.2% from 1990 through 2000. However, the rate of P&S syphilis has increased each year since 

2001, primarily among men. In 2004, P&S syphilis cases reported to CDC increased to 7,980 from 

7,177 in 2003, an increase of 11.2%. The number of cases in women increased for the first time in 

over a decade, though only slightly. Cases of congenital syphilis continued to decline; 353 cases of 

congenital syphilis were reported in 2004, down from 432 in 2003. 

Despite national progress toward syphilis elimination among women and African-Americans, 

syphilis remains an important problem in the South and in areas with large populations of MSM. Between 2003 and 2004 the rate of P&S syphilis among men increased from 4.2 to 4.7 cases per 

100,000 population. The overall rate in women remained the same, 0.8 cases per 100,000 

population. 

While syphilis elimination efforts have successfully focused on heterosexual minority populations 

at risk for syphilis, recent increases in syphilis among MSM highlight the importance of continually 

reassessing and refining surveillance, prevention, and control strategies. 

STD Surveillance 2004 Overview 3 
Although wide disparities exist in the rates of STDs among racial and ethnic groups, there has 

been a reduction in these differences for syphilis over the past five years. The P&S syphilis rate for 

2004 among African-Americans was 5.6 times the rate among whites, reflecting a substantial decline from 1999, when the rate among African-Americans was 29 times greater than that among 

whites (Table 34B). While this has reflected decreasing rates among African-Americans, it also reflects significant increases among white men during the past 4 years. In 2004, however, increases 

were observed among both African-American men (14.1 cases per 100,000 population, up from 

11.5 in 2003) and African-American women (4.3 cases per 100,000 population, up from 4.2 in 

2003) for the first time in over a decade. Increases were also observed among white men and 

women. 

1	 Institute of Medicine. The Hidden Epidemic: Confronting Sexually Transmitted Diseases, Committee on 

Prevention and Control of Sexually Transmitted Diseases, National Academy Press, Washington, DC, 

1997. 

2	 National Committee for Quality Assurance (NCQA). HEDIS 2000: Technical Specifications, Washington, 

DC, 1999, pp. 68-70, 285-286. 

3	 Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. 

MMWR 2002;51 (No. RR-6). 

4	 Division of STD Prevention. The National Plan to Eliminate Syphilis from the United States. National 

Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1999. 

4 Overview	 STD Surveillance 2004 
NATIONALPROFILE 

National Profile 

The National Profile section contains figures showing trends and the distribution of nationally 

reportable sexually transmitted diseases (chlamydia, gonorrhea, syphilis and chancroid) by age, sex, 

race/ethnicity, and location for the United States. Where relevant, the figures illustrate progress towards 

specific targets* for the nation published in U.S. Department of Health and Human Services. Healthy 

People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 

2 vols. Washington, DC: U.S. Government Printing Office, November 2000. 

* See the Appendix for a listing of the Healthy People 2010 objectives for the diseases addressed in this report. 

STD Surveillance 2004 National Profile 5 

Chlamydia 

Chlamydia trachomatis infections are the most commonly reported notifiable disease in the 

United States. They are among the most prevalent of all STDs and, since 1994, have comprised the 

largest proportion of all STDs reported to CDC (Table 1). In women, chlamydia infections, which 

are usually asymptomatic, may result in pelvic inflammatory disease (PID), which is a major cause 

of infertility, ectopic pregnancy, and chronic pelvic pain. Data from a randomized controlled trial of 

chlamydia screening in a managed care setting suggest that screening programs can lead to a reduction in the incidence of PID by as much as 60%.1 As with other inflammatory STDs, chlamydia infection can facilitate the transmission of HIV infection. In addition, pregnant women infected with 

chlamydia can pass the infection to their infants during delivery, potentially resulting in neonatal 

ophthalmia and pneumonia. 

The increase in reported chlamydia infections during the last 10 years reflects the expansion of 

chlamydia screening activities, use of increasingly sensitive diagnostic tests, an increased emphasis 

on case reporting from providers and laboratories, and improvements in the information systems 

for reporting. However, many women who are at risk are still not being tested, reflecting, in part, lack 

of awareness among some health care providers and the limited resources available to support 

screening. Chlamydia screening and reporting are likely to expand further in response to the recently implemented Health Plan Employer Data and Information Set (HEDIS) measure for 

chlamydia screening of sexually active women 15 through 25 years of age who receive medical care 

through managed care organizations.2 To better monitor trends in disease burden in defined populations during the expansion of chlamydia screening activities, data on chlamydia positivity among 

persons screened in a variety of settings are used; in most instances, test positivity serves as a 

reasonable approximation of prevalence.3 

• In 2000, for the first time, all 50 states and the District of Columbia had regulations 

requiring the reporting of chlamydia cases to CDC. 

• In 2004, 929,462 chlamydia infections were reported to CDC from 50 states and 

the District of Columbia (Table 1). This case count corresponds to a rate of 319.6 

cases per 100,000 population, an increase of 5.9% compared with the rate of 

301.7 in 2003. The reported number of chlamydia infections was more than two 

and one half times the number of reported cases of gonorrhea (330,132 

gonorrhea cases were reported in 2004) (Table 1). 

• From 1987 through 2004, the rates of reported chlamydia infection increased 

from 50.8 to 319.6 cases per 100,000 population (Figure 1, Table 1). The 

continuing increase in reported cases likely represents the further expansion of 

screening for this infection, the development and use of more sensitive screening 

tests, and more complete national reporting. 

• For the years 1996-2001, the chlamydia rates in the Southern region of the 

United States were higher than the rates in any other region of the country 

(Figures 2-4, Table 3). Before 1996, chlamydia rates were highest in the West and 

Midwest, where substantial public resources had been committed for screening 

STD Surveillance 2004 National Profile Chlamydia 7 
programs in family planning clinics. For the years 2002-2004, overall rates were 

highest in the Midwest although rates among women remained highest in the 

South. Rates have remained lowest in the Northeast. 

• In 2004, the overall rate of reported chlamydia infection among women in the 

United States (485.0 cases per 100,000 females) was over 3 times higher than the 

rate among men (147.1 cases per 100,000 males), likely reflecting a greater 

number of women screened for this infection (Tables 4 and 5). The lower rates 

among men suggest that many of the sex partners of women with chlamydia are 

not diagnosed or reported. However, with the advent of highly sensitive nucleic 

acid amplification tests that can be performed on urine, symptomatic and 

asymptomatic men are increasingly being diagnosed with chlamydia infection. 

From 2000 through 2004, the chlamydia infection rate in men increased by 

47.7% (from 99.6 to 147.1 cases per 100,000 males) compared with a 22.4% 

increase in women over this period (from 396.3 to 485.0 cases per 100,000 

females) (Tables 4 and 5). 

• Among women, the highest age-specific rates of reported chlamydia in 2004 were 

among 15- to 19-year-olds (2,761.5 per 100,000 females) and 20- to 24-yearolds (2,630.7 per 100,000 females). These increased rates in women may be, in 

part, due to increased screening in this group. Age-specific rates among men, 

while substantially lower than the rates in women, were highest in the 20- to 

24-year-olds (Figure 6, Table 10). 

• In 2004, the rate of chlamydia among African-American females in the United 

States was more than seven and a half times higher than the rate among white 

females (1,722.3 and 226.6 per 100,000, respectively) (Table 11B). The 

chlamydia rate among African-American males was 11 times higher than that 

among white males (645.2 and 57.3 per 100,000 respectively). 

Chlamydia Screening and Prevalence Monitoring Project 

• Chlamydia screening and prevalence monitoring activities were initiated in Health 

and Human Services (HHS) Region X (Alaska, Idaho, Oregon, Washington) in 

1988 as a CDC-supported demonstration project. From 1988 through 1996, the 

screening programs in HHS Region X family planning clinics demonstrated a 68% 

decline in chlamydia positivity from 15.1% to 4.9% among 15- to 24-year-old 

women (Figure 8). Since that time, there has been a 57% increase from 4.9% to 

7.7%; chlamydia positivity was adjusted for changes in laboratory test methods and 

associated test sensitivity.4,5 

• In 1993, chlamydia screening services for women were expanded to three 

additional HHS regions (III, VII, and VIII) and, in 1995, to the remaining HHS 

regions (I, II, IV, V, VI, and IX). In some regions, federally-funded chlamydia 

screening supplements local- and state-funded screening programs. 

• In 2004, the median state-specific chlamydia test positivity among 15- to 

24-year-old women who were screened during visits to selected family planning 

clinics in all states and outlying areas was 6.3% (range 3.2% to 16.3%) (Figure 7). 

In all states chlamydia positivity was greater than the HP2010 target of 3%.6 See 

Appendix (Chlamydia, Gonorrhea, and Syphilis Prevalence Monitoring) for 

details. 

8 Chlamydia National Profile STD Surveillance 2004 
• After adjusting trends in chlamydia positivity to account for changes in laboratory 

test methods and associated increases in test sensitivity (see Appendix), 

chlamydia test positivity decreased in 2 of 10 HHS regions from 2003 through 

2004, increased in 6 regions, and remained the same in 2 regions (Figure 8). 

• Additional information on chlamydia screening programs for women of 

reproductive age and chlamydia among adolescents and minority populations 

can be found in the Special Focus Profiles. 

1 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): 1362-66. 

2 National Committee for Quality Assurance (NCQA). HEDIS 2000: Technical Specifications, Washington, 

DC, 1999, pp. 68-70, 285-286. 

3 Dicker LW, Mosure DJ, Levine WC. Chlamydia positivity versus prevalence: what's the difference? 

Sexually Transmitted Diseases 1998;25:251-3. 

4 Dicker LW, Mosure DJ, Levine WC, et al. Impact of switching laboratory tests on reported trends in 

Chlamydia trachomatis infections. Am J Epidemiol 2000;51:430-5. 

5 Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2004 

Supplement: Chlamydia Prevalence Monitoring Project Annual Report 2004. Atlanta, GA: U.S. 

Department of Health and Human Services (available first quarter 2006). 

6 U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and 

Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government 

Printing Office, November 2000. 

STD Surveillance 2004 National Profile Chlamydia 9 
Figure 1. Chlamydia — Rates: United States, 1984–2004 

Rate (per 100,000 population)
 

350
 

280
 

210
 

140
 

70
 

0
 

Note: As of January 2000, all 50 states and the District of Columbia had regulations requiring the 

reporting of chlamydia cases. 

Figure 2. Chlamydia — Rates by state: United States and outlying areas, 2004
 

1984 86 88 90 92 94 96 98 2000 02 04
 

Rate per 100,000 

population 

<=150.0 

150.1-300.0 

>300.0 

VT 183.6 

NH 134.8 

MA 205.8 

RI 319.8 

CT 274.2 

NJ 202.0 

DE 361.3 

MD 362.2 

Guam 457.2 

Puerto Rico 92.5 

Virgin Is. 278.5 

(n= 2) 

(n= 25) 

(n= 26) 

295.8 

609.4 

300.8 288.5 

344.4 311.0 

250.0 

394.7 

422.0 

203.8 

372.9 297.6 

236.3 

275.1 157.1 

485.7 

161.8 

409.2 

229.3 

654.7 

373.7 

284.2 

301.2 298.5 

482.0 

308.0 

344.5 

285.6 

344.3 

295.2 

244.1 

307.5 

444.2 

331.3 

385.4 

317.5 

164.0 

292.9 

287.6 

152.3 

351.2 

215.9 

Note: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico and 

Virgin Islands) was 316.7 per 100,000 population. For further information on chlamydia 

reporting, see Appendix (Chlamydia Morbidity Reporting). 

10 Chlamydia National Profile STD Surveillance 2004
 
Figure 3. Chlamydia — Rates by county: United States, 2004 

Rate per 100,000 

population 

<=150.0 (N= 1,415) 

150.1-300.0 (N= 985) 

>300.0 (N= 739) 

Figure 4. Chlamydia — Rates by region: United States, 1984–2004 

Rate (per 100,000 population) 

350 

280 

210 

70 

140 West 

Midwest 

Northeast 

South 

0 

1984 86 88 90 92 94 96 98 2000 02 04 

STD Surveillance 2004 National Profile Chlamydia 11 
Figure 5. Chlamydia — Rates by sex: United States, 1984–2004 

Rate (per 100,000 population) 

Men 

Women 

0 

100 

200 

300 

400 

500 

1984 86 88 90 92 94 96 98 2000 02 04 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10.8 10-14

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

458.3 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

744.7 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

402.9 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

185.2 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

99.3 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

56.1 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

23.0 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

7.4 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

2.2 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

147.5 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14 132.0 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

2,761.5 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

2,630.7 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

1,039.5 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

364.8 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

148.3 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

62.6 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

22.4 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

6.2 

Men Rate (per 100,000 population) Women

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

2.0 

Men Rate (per 100,000 population) Women 

3,000 2,400 1,800 1,200 600 0 Age 0 600 1,200 1,800 2,400 3,000 

Total 

65+ 

55-64 

45-54 

40-44 

35-39 

30-34 

25-29 

20-24 

15-19 

10-14 

486.2 

Figure 6. Chlamydia — Age- and sex-specific rates: United States, 2004 

Note: See Table 10 and Appendix (Chlamydia Morbidity Reporting) for more information. 

12 Chlamydia National Profile STD Surveillance 2004 
Figure 7. Chlamydia — Positivity among 15- to 24-year-old women tested in family planning 

clinics by state: United States and outlying areas, 2004 

7.1 

6.1 5.9 4.1 

4.3 7.1 

4.6 5.7 8.5 6.0 VT 4.0 

5.4 7.4 NH 4.0 

3.9 4.9 4.9 

7.6 

6.1 MA 

RI 

CT 

5.4 

6.4 

5.1 9.3 7.2 7.7 NJ 7.8 6.3 6.4 5.7 7.2 4.1 

3.2 7.5 DE 

MD 

6.5 

6.1 

DC 3.9 

7.3 6.6 7.2 5.6 9.5 6.1 11.8 

Positivity (%) 

16.3 6.9 9.5 

<4.0 (n= 3) 

4.7 

8.6 

9.0 

4.9 

4.0-4.9 

>=5.0 

(n= 10) 

(n= 40) 

8.7 

Puerto Rico 5.9 

Virgin Is. 14.9 

Note: Includes states and outlying areas that reported chlamydia positivity data on at least 500 

women aged 15-24 years screened during 2004. 

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers 

for Disease Control and Prevention 

Figure 8.	 Chlamydia — Trends in positivity among 15- to 24-year-old women tested in family 

planning clinics by HHS region, 1988–2004 

15.1 11.811.4 9.5	 10.2 8.2	 9.2 8.8 8.2 8.7 8.8 9.0 7.5 7.7 7.5 8.0 6.1 5.7 5.1 4.9 4.9	 5.6 6.0 6.1 6.2 6.7	 6.0 5.9 5.2 6.2 6.4 6.1 5.5 5.4 

88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 97 98 99 00 01 02 03 04 96 97 98 99 00 01 02 03 04 

Region X	 Region V Region I

9.8 10.2 9.7 8.1 9.3 8.7 8.8 8.0	 8.5 8.5 8.8 8.3 8.6 9.1 7.0 7.6 X 7.8

I V II 96 97 98 99 00	 01 02 03 04 97 98 99 00 01 02 03 04 VIII Region IX Region II

VII III IX

10.1 7.6 6.5 6.2 5.9 6.6	 6.7 6.6 7.1 7.4 7.3 7.6 8.1 7.3 7.7 8.0 8.4 7.9 7.2 6.8 6.9 7.5 IV VI 94 95 96 97 98	 99 00 01 02 03 04 94 95 96 97 98 99 00 01 02 03 04 

Region VIII Region III

12.6 12.8	 13.6 12.0 12.0 12.7 11.5 11.8 11.7 11.7 11.2 11.7 10.5 10.4 10.1 10.9 9.6 6.1 5.8 6.3 6.1 6.3	 6.1 6.5 6.5 6.8 

96 97 98 99 00	 01 02 03 04 96 97 98 99 00 01 02 03 04 97 98 99 00 01 02 03 04 

Region VII	 Region VI Region IV

Note: Annual positivity adjusted for changes in laboratory test method and associated increases in 

test sensitivity. See Appendix (Chlamydia, Gonorrhea, and Syphilis Prevalence Monitoring) 

for more information. See Appendix for definition of Health and Human Services (HHS) 

regions. 

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; 

Centers for Disease Control and Prevention 

STD Surveillance 2004 National Profile	 Chlamydia 13 

Gonorrhea 

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 

such as tubal infertility, ectopic pregnancy, and chronic pelvic pain. In addition, epidemiologic and 

biologic studies provide strong evidence that gonococcal infections facilitate the transmission of 

HIV infection.1 

From 1975 through 1997, the national gonorrhea rate declined 74.3% following implementation 

of the national gonorrhea control program in the mid-1970s (Table 1). Gonorrhea rates subsequently appeared to plateau for several years; however, the gonorrhea rate has decreased 11.8% 

from 2000 to 2004. (Figure 9 and Table 1). True increases or decreases may be masked by changes 

in screening practices (affected by simultaneous testing for chlamydia), use of diagnostic tests with 

different sensitivities, and changes in reporting practices.2 

For most areas, the number of gonorrhea cases reported to CDC is affected by many factors, in 

addition to the occurrence of the infection within the population. As with reporting of other STDs, 

reporting of gonorrhea cases to CDC is incomplete.3 In addition, reporting practices for gonococcal 

infections may have been biased towards reporting of infections in persons of minority race or ethnicity, who are more likely to attend public STD clinics.2,4 For such reasons, supplemental data on 

gonorrhea prevalence in persons screened in a variety of different settings are useful in assessing disease burden in selected populations. 

• In 2004, 330,132 cases of gonorrhea were reported in the United States. The rate 

of reported gonorrhea in the United States was 113.5 cases per 100,000 

population in 2004 (Figure 9 and Table 1), which was the lowest rate of reported 

gonorrhea ever. 

• In 2004, 29.7% of gonorrhea cases were reported by STD clinics. This is a change 

from 1984, when 73.6% of gonorrhea cases were reported by STD clinics (Figure 

10 and Table A2). In 2004, similar to previous years, a higher proportion of male 

gonorrhea cases were reported from STD clinics than were female cases (42.7% 

and 17.9% respectively). 

• In 2004, only 7 states and Puerto Rico had gonorrhea rates below the Healthy 

People 2010 (HP2010) national target of 19 cases per 100,000 population 

(Figure 11 and Table 12).5 

• In 2004, 1,330 (42.4%) of 3,139 counties in the United States had gonorrhea 

rates at or below the HP2010 national target of 19 cases per 100,000 population. 

Rates per 100,000 population were between 19 and 100 in 1,139 counties 

(36.3%), and greater than 100 in 670 counties (21.3%). The majority of counties 

with greater than 100 cases per 100,000 population were located in the South 

(Figure 12). 

STD Surveillance 2004 National Profile Gonorrhea 15 
• As in previous years, in 2004 the South had the highest gonorrhea rate among the 

four regions of the country. However, the gonorrhea rate in the South has 

declined by 22% from a rate of 184.0 per 100,000 population in 2000 to 143.5 in 

2004. In contrast, the gonorrhea rate in the West has increased by 27.3% from 

57.2 cases per 100,000 population in 2000 to 72.8 in 2004. Rates in the 

Northeast (80.6 in 2004) and the Midwest (134.3 in 2004) have shown minimal 

change since 2000 (Figure 13 and Table 13). 

• Prior to 1996, rates of gonorrhea among men were higher than rates among 

women. For the third straight year, however, gonorrhea rates in women are 

slightly higher than in men (Figure 14). In 2004 the gonorrhea rate among 

women was 116.5 and the rate among men was 110.0 cases per 100,000 

population (Tables 14 and 15). 

• From 2000 to 2004, gonorrhea rates among women increased 31.3% in the 

West, and decreased 18.6% in the South. Over the same time period, gonorrhea 

rates among men increased 24.1% in the West, and decreased 25.2% in the 

South (Figure 13 and Tables 14 and 15). 

• The overall gonorrhea rate in selected large cities was 196.9 cases per 100,000 

population in 2004. This rate has decreased 19.5% since 2000 when it was 244.7 

cases per 100,000 population. All of these cities had rates higher than the 

HP2010 target of 19 cases per 100,000 population (Table 16). In 2004, 42.5% of 

gonorrhea cases were reported by these selected cities (Table 17). Similar to 

previous years, in 2004 the total gonorrhea rate among males in these selected 

large cities (204.0) remained higher than that among females (189.4) (Tables 18 

and 19). 

• Changes in gonorrhea rates from 2000 through 2004 differed by racial/ethnic 

group. Gonorrhea rates decreased by 19.1% during this time period for 

African-Americans from 778.1 to 629.6 cases per 100,000 population. 

Gonorrhea rates also decreased by 19.9% among Asian/Pacific Islanders from 

26.7 to 21.4 cases per 100,000 population. Since 2000, the gonorrhea rate 

among whites increased 19.8% (33.3 per 100,000 in 2004), American 

Indian/Alaska Natives increased 19.4% (117.7 per 100,000 in 2004), and 

Hispanics increased 3.8% (71.3 per 100,000 in 2004) (Figure 15 and Table 21B). 

In 2004, the gonorrhea rate among African-Americans was 19 times greater than 

the rate for whites, down from 28 times greater in 2000. 

• In 2004, the overall gonorrhea rate was highest for 20- to 24-year-olds (497.8). 

Among females in 2004, 15- to 19- and 20- to 24-year-olds had the highest rates 

of gonorrhea (610.9 and 569.1, respectively); among males, 20- to 24-year-olds 

had the highest rate (430.6) (Figure 16 and Table 20). Since 2000 there has been 

a 15.4% decrease in the rate of gonorrhea among 15- to 19-year-olds, and a 

15.2% decrease among 20- to 24-year olds, greater than in any other age group. 

Decreases over this time period were greater among male 15- to 19-year olds and 

20- to 24-year olds (21.1% and 22.3% respectively) than among female 15- to 

19-year olds and 20- to 24-year olds (12.7% and 18.4%, respectively) (Table 20). 

• The overall rate in African-American men decreased 22.2% from 862.0 per 

100,000 population in 2000 to 670.3 in 2004. Decreases were seen in all age 

groups of African-American men in this time period. The overall rate in white 

males increased 20.2% from 21.8 per 100,000 population in 2000 to 26.2 in 

16 Gonorrhea National Profile STD Surveillance 2004 
678

2004. Rates among Hispanic, Asian/Pacific Islander, and American Indian/ 

Alaska Native men showed no consistent trends over this time period (Table 

21B). 

• The overall rate among African-American women decreased 15.6% from 702.1 

per 100,000 population in 2000 to 592.5 in 2004. Decreases were noted in 15- to 

19-year-old African-American women (19.7% from 2000 through 2004). 

However, 15- to 19-year-old African-American women still have the highest 

gonorrhea rate of any group (2,790.5 per 100,000 population). Rates among 

white women increased 19% from 33.6 per 100,000 population in 2000 to 40.0 

in 2004. Increases among white women were seen in nearly all age groups (Table 

21B). 

• In summary, in those populations where rates are highest, African-Americans and 

adolescents, significant decreases were observed. Increases were observed in 

whites; other groups showed no change. 

Gonorrhea Prevalence Monitoring Projects 

• Gonorrhea test positivity data are available from a variety of settings. In 2004, the 

median state-specific gonorrhea test positivity among 15- to 24-year-old women 

screened in selected family planning clinics in 38 states, Puerto Rico, the District of 

Columbia, and the Virgin Islands was 0.88% (range 0.1% to 4.2%) (Figure 19). 

• For women in this age group attending selected prenatal clinics in 19 states, 

Puerto Rico, and the Virgin Islands, the median positivity was 1% (range 0% to 

3.5%) (Figure F). 

• For 16- to 24-year-old women entering the National Job Training Program in 33 

states in 2004, the median state-specific gonorrhea prevalence was 2.4% (range 

0% to 6.4%) in 2004 (Figure N). Among men entering the program from 8 states 

in 2004, the median state-specific gonorrhea positivity was 3.7% (range 1% to 

5.5%) (Figure O). 

• The median positivity for gonorrhea in women entering 34 juvenile corrections 

facilities was 4.5% (range 0% to 16.6%), and in men entering 49 juvenile 

corrections facilities was 0.8% (range 0% to 18.2%) (Table CC). 

Gonococcal Isolate Surveillance Project 

• Antimicrobial resistance remains an important consideration in the treatment of 

6-8 gonorrhea. Overall, 15.9% of isolates collected in 2004 in 28 STD clinics by the 

Gonococcal Isolate Surveillance Project (GISP) were resistant to penicillin, 

tetracycline, or both (Figure 21). 

• Resistance to ciprofloxacin (a fluoroquinolone) was first identified in GISP in 

1991. From 1991 through 1998, fewer than nine ciprofloxacin-resistant isolates 

were identified each year and such isolates were identified in only a few GISP 

clinics. In 2000, similar to 1999, 19 (0.4%) ciprofloxacin-resistant GISP isolates 

were identified in 7 GISP clinics. In 2001, 38 (0.7%) ciprofloxacin-resistant GISP 

isolates were identified in 6 clinics; in 2002, 116 (2.2%) such isolates were 

identified in 13 clinics (Figure 22) and in 2003, 270 (4.1%) were identified in 21 

clinics. In 2004, 429 (6.8%) isolates submitted to GISP demonstrated resistance 

to ciprofloxacin. 

STD Surveillance 2004 National Profile Gonorrhea 17 
• In Honolulu, the prevalence of ciprofloxacin-resistance identified remained high. 

In 2004, 21 (22.8%) of 92 isolates submitted from Honolulu demonstrated 

ciprofloxacin-resistance, up from 16 (13.3%) of 120 isolates in 2003. At Tripler Army 

Medical Center, in Hawaii, 2 (28.6%) of 7 isolates tested in 2004 demonstrated 

resistance to ciprofloxacin. This high proportion of ciprofloxacin-resistant isolates in 

Hawaii continues to reinforce the recommendation made by CDC in 2000 that 

fluoroquinolones not be used to treat gonococcal infections acquired in 

Hawaii.6 

• In California, increases in the number of isolates resistant to ciprofloxacin were 

identified in 4 of 5 GISP sites, while one site, Orange County, experienced a 

decrease from 31.5% in 2003 to 20.5% in 2004. In Long Beach, 25% of isolates 

were ciprofloxacin-resistant compared with 19.4% in 2003; in San Francisco, 

24.3% were resistant in 2004 compared to 19.2% in 2003; in San Diego, 20.6% 

were resistant in 2004 compared to 13.2% in 2003; in Los Angeles, 13.8% were 

resistant compared to 12.4% in 2003. The high prevalence in California 

reinforces the CDC and California STD Program recommendations that 

fluoroquinolones no longer be used for gonorrhea treatment in California. 

• In other west coast states, GISP sites experienced large increases in ciprofloxacinresistance. In Seattle the prevalence of resistant isolates submitted to GISP 

doubled from 18 (7%) of 258 in 2003 to 38 (16.2%) of 235 in 2004, while in 

Portland the prevalence nearly quadrupled, from 4 (3%) of 132 in 2003 to 22 

(11.5%) of 191 in 2004. 

• Prevalence of ciprofloxacin-resistance also increased in many GISP sites 

outside California, Hawaii, Washington and Oregon in 2004. Substantial 

increases occurred in Denver, Miami, Minneapolis and Phoenix, while smaller 

increases occurred in 8 other GISP sites. In Denver, ciprofloxacin-resistance 

increased from 0.7% in 2003 to 8.3% in 2004. In Miami resistance increased 

from 2.1% in 2003 to 6.8% in 2004; in Minneapolis it increased from 2.3% in 

2003 to 9.3% in 2004; in Phoenix it increased from 2.6% in 2003 to 6.6% in 

2004. Atlanta, Baltimore, Chicago, Dallas, Greensboro, New Orleans, 

Oklahoma City and Philadelphia saw increases in fluoroquinolone-resistant 

Neisseria gonorrhoeae (QRNG) prevalence, but to a lesser extent. Sites that 

saw ciprofloxacin-resistant isolates for the first time in 2004 included Atlanta, 

Greensboro, and Oklahoma City. 

• The prevalence of ciprofloxacin-resistance did not change from 2003 in several GISP 

sites: Cincinnati – 0.3%, Cleveland – 0.4%, and Las Vegas – 2.4%. Only Albuquerque, 

Birmingham, Detroit and St. Louis did not identify ciprofloxacin-resistant isolates 

during 2004. 

• Overall, outside of Hawaii and California, 3.6% of isolates were ciprofloxacinresistant in 2004. Looking at sites outside Hawaii, California and Washington, 

areas where fluoroquinolones are no longer recommended for treatment of any 

gonococcal cases, 3% of isolates were resistant. Additional information on 

antimicrobial susceptibility data and treatment recommendations from state and 

local health departments may be found in the 2004 GISP report7 or the GISP 

website (http://www.cdc.gov/std/GISP). 

• The number of fluoroquinolone-resistant Neisseria gonorrhoeae (QRNG) isolates 

from men who have sex with men (MSM) continued to increase in 2004 to 286 

18 Gonorrhea National Profile STD Surveillance 2004 
(23.8%). During the same time period, the number of these isolates from 

heterosexuals increased from 79 (1.5%) in 2003 to 136 (2.9%) (Figure 23). In 

2004, CDC recommended that fluoroquinolones no longer be used to treat 

gonorrhea among MSM.9 

• To date, cephalosporin resistance has not been identified in GISP and the 

proportion of GISP isolates demonstrating decreased susceptibility to ceftriaxone 

or cefixime has remained very low over time. In 2001, three GISP isolates with 

decreased susceptibility to cefixime were also found to be resistant to penicillin, 

tetracycline, and ciprofloxacin; such multi-drug resistance in combination with 

decreased susceptibility to cefixime had not previously been identified in the 

United States.10 In 2004, two GISP isolates had decreased susceptibility to 

cefixime; one of those isolates demonstrated the same resistance pattern as the 

2001 isolates described above. In 2004, no GISP isolates had decreased 

susceptibility to ceftriaxone. 

• The proportion of GISP isolates demonstrating elevated minimum inhibitory 

concentrations (MICs) to azithromycin has been increasing since GISP began 

monitoring azithromycin susceptibility in 1992. In 1992, there were no isolates 

with azithromycin MIC ≥ 1.0 1g/ml but in 2004 there were 57 (0.9%) such isolates, 

compared with 26 (0.4%) in 2003. 

• Additional information about gonorrhea in racial and ethnic minority 

populations, adolescents, men who have sex with men, and other at risk 

populations can be found in the Special Focus Profiles. 

1	 Cohen MS, Hoffman IF, Royce RA, et al. Reduction of concentration of HIV-1 in semen after treatment of 

urethritis: implications for prevention of sexual transmission of HIV-1. Lancet 1997;349:1868-73. 

2 Centers for Disease Control and Prevention. Gonorrhea – United States, 1998. MMWR 2000;49:538-42. 

3	 Sexually Transmitted Diseases in America: How Many Cases and At What Cost? Prepared for the Kaiser 

Family Foundation by: American Social Health Association, December 1998, ASHA: Research Triangle 

Park, NC, Kaiser Family Foundation: Menlo Park, CA 94025. 

4	 Fox KK, Whittington W, Levine WC, Moran JS, Zaidi AA, Nakashima AN. Gonorrhea in the United States, 

1981-1996: demographic and geographic trends. Sexually Transmitted Diseases 1998;25(7):386-93. 

5	 U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and 

Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government 

Printing Office, November 2000. 

6	 Centers for Disease Control and Prevention. Fluoroquinolone-resistance in Neisseria gonorrhoeae, 

Hawaii, 1999, and decreased susceptibility to azithromycin in N. gonorrhoeae, Missouri, 1999. MMWR 

2000;49:833-837. 

7	 Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2004 

Supplement: Gonococcal Isolate Surveillance Project (GISP) Annual Report 2004. Atlanta, GA: U.S. 

Department of Health and Human Services (available first quarter 2006). 

8 Centers for Disease Control and Prevention. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae 

– Hawaii and California, 2001 MMWR 2002;51:1041-1044. 

STD Surveillance 2004 National Profile	 Gonorrhea 19 
9 Centers for Disease Control and Prevention. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae 

among men who have sex with men – United States, 2003, and revised recommendations for gonorrhea 

treatment, 2004. MMWR 2004;53:335-338. 

10Wang SA, Lee MV, Iverson CJ, Ohye RG, Whiticar PM, Hale JA, Trees DL, Knapp JS, Effler PV, Weinstock 

HS. Multi-drug resistant Neisseria gonorrhoeae with decreased susceptibility to cefixime, Hawaii, 2001. 

CID 2003;37:849-52. 

20 Gonorrhea National Profile STD Surveillance 2004 
Figure 9.	 Gonorrhea — Rates: United States, 1970–2004 and the Healthy People 2010 

target 

Rate (per 100,000 population) 

500 

400 

300 

200 

100 

0 

Gonorrhea 

2010 Target 

1970 73 76 79 82 85 88 91 94 97 2000 03 

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population. 

Figure 10. Gonorrhea — Reported cases by reporting source: United States, 1984-2004 

Cases (in thousands) 

750 

600 

450 

300 

150 

0 

non-STD Clinic 

STD Clinic 

1984 86 88 90 92 94 96 98 2001 02 04 

Note: Prior to 1996, the STD clinic source of report corresponded to public (clinic) source of 

report, and the non-STD clinic category corresponded to private source of report. See 

Appendix (Reporting Sources, Table A2). After 1996, as states began reporting morbidity 

data electronically, the specific source of report (i.e., STD clinic) began to be reported from 

an increasing number of states. 

STD Surveillance 2004 National Profile	 Gonorrhea 21 
Figure 11. Gonorrhea — Rates by state: United States and outlying areas, 2004 

45.8 

9.6 17.4 16.1 

36.6 58.4 

7.5 39.8 92.3 97.6 VT 13.9 11.8 172.4 NH 10.3 

137.3 

25.6 

65.9 42.4 

162.8 110.6 179.0 

90.9 MA 

RI 

CT 

47.5 

75.8 

82.2 

85.0 67.1 93.3 161.6 67.0 

49.3 116.0 NJ 

DE 

MD 

77.5 

109.4 

150.6 

180.7 145.1 72.8 69.7 126.8 151.8 221.1 Rate per 100,000 

Guam 69.7 population 

248.6 182.3 181.7 

<=19.0 (n= 8) 110.2 19.1-100.0 (n= 25) 234.4 87.4 >100.0 (n= 20) 109.2 

94.9 

Puerto Rico 6.9 

Virgin Is. 68.9 

Note: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico and 

Virgin Islands) was 112.1 per 100,000 population. The Healthy People 2010 target is 19.0 

cases per 100,000 population. 

Figure 12. Gonorrhea — Rates by county: United States, 2004 

Rate per 100,000 

population 

<=19.0 (N= 1,330) 

19.1-100.0 (N= 1,139) 

>100.0 (N= 670) 

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population. 

22 Gonorrhea National Profile STD Surveillance 2004 
Figure 13. Gonorrhea — Rates by region: United States, 1981–2004 and the Healthy 

People 2010 target 

Rate (per 100,000 population) 

600 

480 

360 

240 

120 

0 

West 

Midwest 

Northeast 

South 

2010 Target 

1981 83 85 87 89 91 93 95 97 99 2001 03 

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population. 

Figure 14. Gonorrhea — Rates by sex: United States, 1981–2004 and the Healthy 

People 2010 target 

Rate (per 100,000 population) 

600 

480 

360 

240 

120 

0 

Male 

Female 

2010 Target 

1981 83 85 87 89 91 93 95 97 99 2001 03 

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population. 

STD Surveillance 2004 National Profile Gonorrhea 23 
Figure 15. Gonorrhea — Rates by race and ethnicity: United States, 1981–2004 and the 

Healthy People 2010 target 

Rate (per 100,000 population) 

White 

Black 

Hispanic 

Asian/Pac Isl 

Am Ind/AK Nat 

2010 Target 

0 

500 

1,000 

1,500 

2,000 

2,500 

1981 83 85 87 89 91 93 95 97 99 2001 03 

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population. 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

5.8 10-14

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

252.9 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

430.6 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

302.1 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

178.6 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

124.5 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

89.6 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

48.1 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

17.0 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

4.1 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

110.2 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14 36.9 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

610.9 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

569.1 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

269.7 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

114.2 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

60.3 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

32.9 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

11.7 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

2.5 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

0.6 

Men Rate (per 100,000 population) Women 

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

Total 

65+ 

55-64 

45-54 

40-44 

35-39 

30-34 

25-29 

20-24 

15-19 

10-14 

116.7 

Figure 16. Gonorrhea — Age- and sex-specific rates: United States, 2004 

24 Gonorrhea National Profile STD Surveillance 2004 
Figure 17. Gonorrhea — Age-specific rates among women 10 to 44 years of age: 

United States, 1981–2004 

Rate (per 100,000 population) 

1,500 

1,200 

900 

600 

300 

0 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

1981 83 85 87 89 91 93 95 97 99 2001 03 

Figure 18. Gonorrhea — Age-specific rates among men 10 to 44 years of age: United 

States, 1981–2004 

Rate (per 100,000 population)
 

2,000
 

1,600
 

1,200
 

800
 

400
 

0
 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

1981 83 85 87 89 91 93 95 97 99 2001 03 

STD Surveillance 2004 National Profile Gonorrhea 25 
Figure 19. Gonorrhea — Positivity among 15- to 24-year-old women tested in family planning 

clinics by state: United States and outlying areas, 2004 

Positivity (%) 

See* 

<1.0 

1.0-1.9 

>=2.0 

VT 

NH 

MA 

RI 

CT 

NJ 

DE 

MD 

DC 

Puerto Rico 0.2 

Virgin Is. 3.2 

1.1 

0.1 

1.4 

1.0 0.3 

0.5 

2.1 

0.9 

1.4 0.9 

0.4 

0.7 0.6 

2.0 

0.1 

1.8 

0.9 

3.0 

1.0 

0.7 

0.4 0.9 

1.0 

0.5 

1.7 

0.7 2.0 

0.8 

1.3 

0.8 

1.1 

0.3 

4.2 

0.2 

0.3 

0.2 

0.6 

1.5 

0.9 

(n= 12) 

(n= 24) 

(n= 11) 

(n= 6) 

*States/areas reported gonorrhea positivity data on less than 500 women aged 15-24 years during 2004. 

Note: Includes states that reported gonorrhea positivity data on at least 500 women aged 15-24 years 

screened during 2004 except for Maine, which submitted gonorrhea positivity data for AprilDecember 2004, and Minnesota which submitted gonorrhea positivity data for January-March 

and July-December 2004. 

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers for Disease Control and Prevention 

Figure 20. Gonococcal Isolate Surveillance Project (GISP) — Location of participating 

clinics and regional laboratories: United States, 2004 

STD Clinics 

Clinics and 

Birmingham Phoenix 

Long Beach Los Angeles 

Orange Co. 

San Diego 

San Francisco Denver 

Miami 

Atlanta 

Honolulu 

Tripler AMC 

Chicago 

New Orleans 

Baltimore 

Detroit Minneapolis 

St. Louis Las Vegas 

Albuquerque 

Greensboro 

Cincinnati 

Cleveland 

Oklahoma City 

Portland 

Philadelphia 

Dallas 

Seattle 

Regional Labs 

. 

26 Gonorrhea National Profile STD Surveillance 2004 
Note: Resistant isolates have ciprofloxacin MICs ≥ 1g/ml. Isolates with intermediate resistance have 

 ciprofloxacin MICs of 0.125 - 0.5 1g/ml. Susceptibility to ciprofloxacin was first measured in GISP 

 in 1990.

Figure 21. Gonococcal Isolate Surveillance Project (GISP) — Penicillin and tetracycline 

resistance among GISP isolates, 2004 

Susceptible 

PPNG 

TRNG 

PPNG/TRNG 

PenR 

TetR 

CMRNG 

84.1% 

0.6% 

3.4% 

0.5% 

1.1% 

6.1% 

4.3% 

Note: PPNG=penicillinase-producing N. gonorrhoeae; TRNG=plasmid-mediated tetracyclineresistant N. gonorrhoeae; PPNG-TRNG=plasmid-mediated penicillin and tetracycline-resistant 

N. gonorrhoeae; PenR=chromosomally mediated penicillin-resistant N. gonorrhoeae; TetR= 

chromosomally mediated tetracycline-resistant N. gonorrhoeae; CMRNG=chromosomally 

mediated penicillin- and tetracycline-resistant N. gonorrhoeae. 

Figure 22. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria 

gonorrhoeae isolates with resistance or intermediate resistance to 

ciprofloxacin, 1990–2004 

Percent 

10.0 

8.0 

6.0 

4.0 

2.0 

0.0 

Resistance 

Intermediate resistance 

1990 91 92 93 94 95 96 97 98 99 2000 01 02 03 04 

STD Surveillance 2004 National Profile Gonorrhea 27 
Figure 23. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria 

gonorrhoeae isolates with resistance to ciprofloxacin by sexual behavior, 

2001–2004 

Percent Ciprofloxacin Resistant 

Heterosexual 

Men who have sex with men (MSM) 

0 

5 

10 

15 

20 

25 

2001 2002 2003 2004
 

28 Gonorrhea National Profile STD Surveillance 2004
 
4567891011

Syphilis 

Syphilis, a genital ulcerative disease, facilitates the transmission of HIV and may be important in 

contributing to HIV transmission in those parts of the country where rates of both infections are high. 

Untreated early syphilis in pregnant women results in perinatal death in up to 40% of cases and, if 

acquired during the four years preceding pregnancy, may lead to infection of the fetus in over 70% 

of cases.1 

The rate of primary and secondary (P&S) syphilis reported in the United States decreased during 

the 1990s; in 2000, the rate was the lowest since reporting began in 1941 (Figure 24). The low rate 

of infectious syphilis and the concentration of the majority of syphilis cases in a small number of geographic areas in the United States led to the development of the CDC’s National Plan to Eliminate 

Syphilis, which was announced by Surgeon General David Satcher in October 1999.2 Collaboration with diverse organizations, public health professionals, the private medical community, and 

other partners working in the fields of STD and HIV is essential for the successful elimination of 

syphilis in the United States.3 

Although the rate of P&S syphilis in the United States declined by 90% during 1990-2000, the 

rate of P&S syphilis increased from 2000 to 2004. Overall increases in rates during 2000-2004 were 

observed only among men. In 2004, for the first time in over ten years, the rate of primary and secondary syphilis among women did not decrease; it remained the same between 2003 and 2004 at 

0.8 cases per 100,000 population. 

Despite national progress toward syphilis elimination syphilis remains an important problem in 

the South and in urban areas in other regions of the country. Increases among men who have sex 

with men have occurred at least since 2000 and continue through 2004. These men have been characterized by high rates of HIV co-infection and high-risk sexual behavior. 4-11 

• In 2004, P&S syphilis cases reported to CDC increased to 7,980 from 7,177 in 

2003, an increase of 11.2%. The rate of P&S syphilis in the United States in 2004 

(2.7 cases per 100,000 population) was 8% higher than the rate in 2003 (2.5 

cases per 100,000 population), and it is greater than the Healthy People 2010 

(HP2010) target of 0.2 case per 100,000 population (Figure 26, Table 1).12 

• During 2003-2004, the number of cases of early latent syphilis reported to CDC 

decreased 7.1% (from 8,361 to 7,768) while the number of cases of late and late 

latent syphilis decreased 5.6% (from 18,319 to 17,300) (Table 1). The total 

number of cases of syphilis (all stages: P&S, early latent, late latent, and 

congenital syphilis) reported to CDC decreased 2.6% (from 34,289 to 33,401) 

during 2003-2004 (Table 1). 

• The rate of P&S syphilis increased 11.9% among men (from 4.2 cases to 4.7 cases 

per 100,000 men) between 2003 and 2004 (Figure 30, Table 28). During this 

time, the rate remained unchanged among women (0.8 cases per 100,000 

women) (Figure 30, Table 27). 

STD Surveillance 2004 National Profile Syphilis 29 
• The male-to-female rate ratio for P&S syphilis has risen steadily since 1996 when 

it was 1.2 (Figure 32), suggesting an increase in syphilis among MSM during this 

time. The male-to-female rate ratio in 2002 was 3.4; in 2003 it was 5.2, and in 

2004 it was 5.9. 

• Between 2003 and 2004, the male-to-female rate ratio for P&S syphilis 

decreased among whites (from 14 to 10), among Asian/Pacific Islanders (from 19 

to 11) and among American Indians/Alaska Natives (from 2.8 to 1.2). The 

male-to-female rate ratio increased among African-Americans (from 2.7 to 3.3) 

and among Hispanics (from 6.1 to 7.9). (Table 34B). 

• An increase in the male-to-female rate ratio for P&S syphilis occurred in the 

District of Columbia, Puerto Rico and in 23 (68%) of 34 states that reported at 

least 25 cases in 2004. 

• In 2004, syphilis rates increased for men and women in almost all racial and 

ethnic groups. African-Americans accounted for 41% of cases of P&S syphilis in 

2004 and 39.2% in 2003. During 2003-2004, the rate of P&S syphilis increased 

16.9% among African-Americans, reflecting a 22.2% increase in the number of 

cases among men (from 2,005 to 2,450) and a 1% increase among women (from 

805 to 813). The rate among non-Hispanic whites increased 6.7%; cases among 

men increased 5.9% (from 2,783 to 2,947) and cases among women increased 

12.8% (from 227 to 256). The rate among Hispanics increased 10.3%; cases 

among men increased 13.9% (from 1,001 to 1,140), and cases among women 

decreased 13.2% (from 159 to 138). The rate among Asian/Pacific Islanders 

increased 20%; cases among men increased (from 119 to 142) and increased 

among women (from 8 to 11). The rate among American Indian/Alaska Natives 

increased 14.3%; cases among men decreased (from 50 to 42), but increased 

among women (from 19 to 35). (Figure 31, Tables 34A and 34B). 

• In 2004, the rate of P&S syphilis reported among African-Americans (9.0 cases 

per 100,000 population) was 6 times greater than the rate among non-Hispanic 

whites (1.6 cases per 100,000 population). This differential was more than that in 

2003, when the rate of P&S syphilis among African-Americans was 5 times 

greater than the rate among non-Hispanic whites (Table 34B) and reflects an 

increase in syphilis among African-Americans for the first time in over a decade. 

• The incidence of P&S syphilis was highest among women aged 20-24 years (3.0 

cases per 100,000 population) and among men aged 35-39 (12.4 cases per 

100,000 population) in 2004 (Figure 33, Table 33). 

• The South accounted for 48% of P&S syphilis in 2004 and 45% in 2003. During 

2003-2004, rates increased in all U.S. regions except the Midwest; rates increased 

16.1% in the South (from 3.1 to 3.6 cases per 100,000 population), 4.8% in the 

Northeast (from 2.1 to 2.2), and 7.4% in the West (from 2.7 to 2.9); the rate 

remained the same in the Midwest at 1.6. The 2004 rates in all regions were 

greater than the HP2010 target of 0.2 case per 100,000 population (Figure 29, 

Table 26). 

• In 2004, P&S syphilis rates in 6 states and one outlying area were less than or 

equal to the HP2010 national target of 0.2 case per 100,000 population (Figure 

27, Table 24). Nine states and two outlying areas reported five or fewer cases of 

P&S syphilis in 2004 (Tables 24 and 26). 

30 Syphilis National Profile STD Surveillance 2004 
• In 2004, 2,488 (79.3%) of 3,139 counties in the United States reported no cases 

of P&S syphilis compared with 2,530 (80.6%) counties reporting no cases in 

2003. Of 651 counties reporting at least one case of P&S syphilis in 2004, 5 

(0.8%) had rates at or below the HP2010 target of 0.2 case per 100,000 

population. Rates of P&S syphilis were above the HP2010 target for 646 counties 

in 2004 (Figure 28). These 646 counties (20.6% of the total number of counties in 

the United States) accounted for 99.2% of the total P&S syphilis cases reported in 

2004. 

• In 2004, half of the total number of P&S syphilis cases were reported from 19 

counties and 1 city (Table 25). 

• The overall rate of P&S syphilis in 2004 for 63 selected large U.S. cities (6.7 cases 

per 100,000 population) increased 9.8% from the rate in 2003 (Table 30). Rates 

exceeded the HP2010 target of 0.2 case per 100,000 population in all but 1 of the 

63 cities in 2004 (Table 29). 

• During 1990-2004, the proportion of P&S syphilis cases reported from sources 

other than STD clinics increased from 25.6% to 64.4% (Figure 25). During 

2000-2004, the number of cases reported from non-STD clinic sources increased 

each year and the number of cases reported from STD clinics decreased each 

year. 

Congenital Syphilis 

• Between 2003 and 2004, the overall rate of congenital syphilis decreased 17.8% 

in the United States, from 10.7 to 8.8 cases per 100,000 live births (Figure 37, 

Table 39). The continuing decline in the rate of congenital syphilis (Figure 37) 

likely reflects the substantial reduction in the rate of P&S syphilis among women 

that has occurred during the last decade (Figure 36).13,14 

• During 1991-2004, the average yearly percentage decrease in the congenital 

syphilis rate was 17.2% (Table 39). The average yearly percentage decrease in 

the rate of P&S syphilis among women during 1991-2004 was 21.4%. Overall, 

there has been a 92% decrease in cases of congenital syphilis since 1991. 

• In 2004, 31 states and one outlying area had rates of congenital syphilis that 

exceeded the HP2010 target of 1.0 case per 100,000 live births (Tables 40-41). 

• Thirty-two (51%) of 63 selected cities in the United States had congenital syphilis 

rates greater than the HP2010 target of 1.0 case per 100,000 live births in 2004 

(Table 42). All of these cities had rates that were more than eight times the 

HP2010 target. 

• Additional information about syphilis and congenital syphilis in racial and ethnic 

minority populations, adolescents, men who have sex with men, and other at risk 

populations can be found in the Special Focus Profiles. 

1 Ingraham NR. The value of penicillin alone in the prevention and treatment of congenital syphilis. Acta 

Derm Venereol 31 (suppl 24):60,1951. 

2 Division of STD Prevention. The National Plan to Eliminate Syphilis from the United States. National 

Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1999. 

STD Surveillance 2004 National Profile Syphilis 31 
3 Centers for Disease Control and Prevention. Primary and secondary syphilis – United States, 1999. 

MMWR 2000;50:113-117. 

4 Centers for Disease Control and Prevention. Resurgent bacterial sexually transmitted disease among men 

who have sex with men – King County, Washington, 1997-1999. MMWR 1999;48:773-777. 

5 Centers for Disease Control and Prevention. Outbreak of syphilis among men who have sex with men – 

Southern California, 2000. MMWR 2001;50(7):117-20. 

6 Bronzan R, Echavarria L, Hermida J, Trepka M, Burns T, Fox, K. Syphilis among men who have sex with 

men (MSM) in Miami – Dade County, Florida [Abstract no. P135]. In: Program and abstracts of the 2002 

National STD Prevention Conference, San Diego, California, March 4-7, 2002. 

7 Centers for Disease Control and Prevention. Primary and secondary syphilis among men who have sex 

with men – New York City, 2001. MMWR 2002;51:853-6. 

8 Chen SY, Gibson S, Katz MH, Klausner JD, Dilley JW, Schwarcz SK, Kellogg TA, McFarland W. 

Continuing increases in sexual risk behavior and sexually transmitted diseases among men who have sex 

with men: San Francisco, California, 1999-2001 [Letter]. Am J Public Health 2002;92:1387-8. 

9 Ciesielski CA, Boghani S. HIV infection among men with infectious syphilis in Chicago, 1998-2000 

[Abstract no. 12]. In: Program and abstracts of the 9th Conference on Retroviruses and Opportunistic 

Infections, Seattle, Washington, February 24-28, 2002. 

10D'Souza G, Lee JH, Paffel JM. Outbreak of syphilis among men who have sex with men in Houston, 

Texas. Sexually Transmitted Diseases 2003;30:872-3. 

11Robinson BC, Chiliade PA, Lee C, Bautista J, Saenz G. Redirecting elimination efforts in response to the 

changing epidemiology of syphilis [Abstract 167]. In: Program and abstracts of the 2004 National STD 

Prevention Conference, Philadelphia, Pennsylvania, March 8-11, 2004. 

12U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and 

Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government 

Printing Office, November 2000. 

13Centers for Disease Control and Prevention. Congenital syphilis – United States, 2002. MMWR 

2004;53:716-9. 

14Centers for Disease Control and Prevention. Primary and secondary syphilis – United States, 2002. 

MMWR 2003;52(46):1117-20. 

32 Syphilis National Profile STD Surveillance 2004 
Figure 24. Syphilis — Reported cases by stage of infection: United States, 1941–2004 

Cases (in thousands) 

600 

480 

360 

240 

120 

0 

P&S 

Early Latent 

Total Syphilis 

1941 46 51 56 61 66 71 76 81 86 91 96 2001 

Figure 25. Primary and secondary syphilis — Reported cases by reporting source: 

United States, 1984–2004 

Cases (in thousands) 

50 

40 

30 

20 

10 

0 

non-STD Clinic 

STD Clinic 

1984 86 88 90 92 94 96 98 2001 02 

Note: Prior to 1996, the STD clinic source of report corresponded to public (clinic) source of 

report, and the non-STD clinic category corresponded to private source of report. See 

Appendix (Reporting Sources, Table A2). After 1996, as states began reporting morbidity 

data electronically, the specific source of report (i.e., STD clinic) began to be reported from 

an increasing number of states. 

STD Surveillance 2004 National Profile Syphilis 33 

04 
Figure 26. Primary and secondary syphilis — Rates: United States, 1970–2004 and the 

Healthy People 2010 target 

Rate (per 100,000 population) 

25 

20 

15 

10 

5 

0 

P&S Syphilis 

2010 Target 

1970 73 76 79 82 85 88 91 94 97 2000 03 

Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population. 

Figure 27. Primary and secondary syphilis — Rates by state: United States and outlying 

areas, 2004 

Rate per 100,000 

population 

<=0.2 

0.21-4.0 

>4.0 

VT 0.2 

NH 0.4 

MA 1.8 

RI 2.4 

CT 1.3 

NJ 1.7 

DE 1.1 

MD 6.9 

Guam 0.0 

(n= 7) 

(n= 39) 

(n= 7) 

3.7 

1.2 

2.8 1.7 

3.8 1.4 

4.3 

6.3 

0.6 

1.8 

3.1 1.0 

0.2 

0.9 1.1 

7.4 

0.2 

1.9 

0.5 

2.0 

1.6 

0.4 

0.4 1.8 

4.4 

3.8 

2.3 

0.0 

2.1 

0.7 

0.8 

1.0 

2.8 

0.0 

2.2 

3.7 

0.6 

1.6 

2.4 

0.2 

0.5 

0.6 

Puerto Rico 4.7 

Virgin Is. 4.6 

Note: The total rate of P&S syphilis for the United States and outlying areas (Guam, Puerto Rico and 

Virgin Islands) was 2.8 per 100,000 population. The Healthy People 2010 target is 0.2 case per 

100,000 population. 

34 Syphilis National Profile STD Surveillance 2004 
Figure 28. Primary and secondary syphilis — Rates by county: United States, 2004 

Rate per 100,000 

population 

<=0.2 (N= 2,493) 

0.3-4.0 (N= 472) 

>4.0 (N= 174) 

Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population. In 2004, 

2,488 (79.3%) of 3,139 counties in the U.S. reported no cases of P&S syphilis. 

Figure 29. Primary and secondary syphilis — Rates by region: United States, 1981–2004 

and the Healthy People 2010 target 

Rate (per 100,000 population) 

50 

West 

Midwest 

40 Northeast 

South 

2010 Target 

30 

20 

10 

0 

1981 83 85 87 89 91 93 95 97 99 2001 03 

Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population. 

STD Surveillance 2004 National Profile Syphilis 35 
Figure 30. Primary and secondary syphilis — Rates by sex: United States, 1981–2004 

and the Healthy People 2010 target 

Rate (per 100,000 population) 

25 

20 

15 

10 

5 

0 

Male 

Female 

2010 Target 

1981 83 85 87 89 91 93 95 97 99 2001 03 

Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population. 

Figure 31. Primary and secondary syphilis — Rates by race and ethnicity: United States, 

1981–2004 and the Healthy People 2010 target 

Rate (per 100,000 population) 

150 

120 

90 

60 

30 

0 

White 

Black 

Hispanic 

Asian/Pac Isl 

Am Ind/AK Nat 

2010 Target 

1981 83 85 87 89 91 93 95 97 99 2001 03 

Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population. 

36 Syphilis National Profile STD Surveillance 2004 
Figure 32. Primary and secondary syphilis — Male-to-female rate ratios: United States, 

1981–2004 

Male-Female rate ratio 

10:1 

8:1 

6:1 

4:1 

2:1 

0 

1981 83 85 87 89 91 93 95 97 99 2001 03 

Figure 33. Primary and secondary syphilis — Age- and sex-specific rates: United States, 2004 

Men Rate (per 100,000 100,000 population) population) Women 

12.0 9.6 7.2 4.8 2.4 0.0 Age 0.0 2.4 4.8 7.2 9.6 12.0 

12.4 

0.0 

1.8 

7.0 

9.7 

10.8 

10.6 

4.6 

1.9 

0.4 

4.7 

0.1 

1.5 

3.0 

2.0 

1.6 

1.5 

1.3 

0.6 

0.2 

0.0 

0.9 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

Total 

Note: See Table 33. 

STD Surveillance 2004 National Profile Syphilis 37 
Figure 34. Primary and secondary syphilis — Age-specific rates among women 10 to 44 

years of age: United States, 1981–2004 

Rate (per 100,000 population) 

75 

60 

45 

30 

15 

0 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

1981 83 85 87 89 91 93 95 97 99 2001 03 

Figure 35. Primary and secondary syphilis — Age-specific rates among men 10 to 44 years 

of age: United States, 1981–2004 

Rate (per 100,000 population) 

75 

60 

45 

30 

15 

0 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

1981 83 85 87 89 91 93 95 97 99 2001 03 

38 Syphilis National Profile STD Surveillance 2004 
Figure 36. Congenital syphilis — Reported cases for infants <1 year of age and rates of 

primary and secondary syphilis among women: United States, 1970–2004 

P&S rate (per 100,000 population) CS cases (in thousands) 

20 

16 

12 

8 

4 

0 

Kaufman Criteria 

CDC Surveillance 

Definition 

P&S Syphilis 

Congenital 

Syphilis 

7.5 

6.0 

4.5 

3.0 

1.5 

0.0 

1970 75 80 85 90 95 2000 

Note: The surveillance case definition for congenital syphilis changed in 1988. See Appendix 

(Congenital Syphilis Morbidity Reporting). Case counts for congenital syphilis shown in this 

graph correspond to those listed in Table 39. 

Figure 37. Congenital syphilis — Rates for infants <1 year of age: United States, 

1981–2004 and the Healthy People 2010 target 

Rate (per 100,000 live births) 

Cong. Syphilis 

2010 Target 

0 

25 

50 

75 

100 

125 

1981 83 85 87 89 91 93 95 97 99 2001 03 

Note: The Healthy People 2010 target for congenital syphilis is 1.0 case per 100,000 live births. 

The surveillance case definition for congenital syphilis changed in 1988. See Appendix 

(Congenital Syphilis Morbidity Reporting). 

STD Surveillance 2004 National Profile Syphilis 39 

Other Sexually Transmitted Diseases
 

Chancroid 

Since 1987, reported cases of chancroid had declined steadily until 2001 when 38 cases were reported (Figure 38, Table 1). In 2004, 30 cases of chancroid were reported in the United States. Only 

16 states and one outlying area reported one or more cases of chancroid in 2004 (Table 45). 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 in view of the fact that Haemophilus 

ducreyi, the causative organism of chancroid, is difficult to culture and, as a result, this condition 

may be substantially under diagnosed.1,2 

Human Papillomavirus 

Sentinel surveillance for cervical infection with high-risk human papillomavirus (HR-HPV types 

16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) is being conducted in 29 STD, family planning and 

primary care clinics in six locations (Boston, MA; Baltimore, MD; New Orleans, LA; Denver, CO; 

Seattle, WA; and Los Angeles, CA) as part of an effort to estimate national burden of disease and inform prevention efforts in the U.S. Testing was performed using a commercially available test for 

HR-HPV testing (Digene Hybrid Capture 2, Gaithersburg, MD). Interim results from 2003-2004 

document an overall HR-HPV prevalence of 22.5%. Prevalence in STD clinics was 28%, 24% in 

Family Planning clinics, and 16% in Primary Care clinics. Prevalence by age group was: 14-19 years 

35%; 20-29 years 29%; 30-39 years 14%; 40-49 years 12%; and 50-65 years 6%.3 

Lymphogranuloma Venereum 

Lymphogranuloma venereum (LGV) is a systemic, sexually transmitted disease caused by a type 

of Chlamydia trachomatis. Prevalent in developing countries, LGV has been relatively rare in industrialized countries. However, beginning in late 2003 and continuing to the present time, outbreaks of 

LGV proctitis among men who have sex with men (MSM), the majority of whom were HIV infected, 

have been reported in Europe.4,5 There is no national surveillance for LGV in the United States. In 

1995, LGV was removed from the list of nationally notifiable diseases. However, reporting is mandated in 24 states, and some of these states continue to report cases of LGV to the CDC. In 2004, 27 

cases of LGV were reported to the CDC. Studies are underway to identify LGV throughout the 

United States through genotypic confirmation.6 See www.cdc.gov/std for additional information. 

Pelvic Inflammatory Disease 

For data on Pelvic Inflammatory Disease (PID), see the Special Focus Profile on Women and 

Infants. 

STD Surveillance 2004 National Profile Other Sexually Transmitted Diseases 41 
Other Sexually Transmitted Diseases 

Case reporting data for genital herpes simplex virus (HSV), genital warts or other human 

papillomavirus infections, and trichomoniasis are not available. Trend data are limited to estimates 

of the office visits in physicians’ office practices provided by the National Disease and Therapeutic 

Index (NDTI) (Figures 39-41 and Table 47). 

1 Schulte JM, Martich FA, Schmid GP. Chancroid in the United States, 1981-1990: Evidence for 

underreporting of cases. MMWR 1992;41(no. SS-3):57-61. 

2 Mertz KJ, Trees D, Levine WC, et al. Etiology of genital ulcers and prevalence of human immunodeficiency 

virus coinfection in 10 US cities. J Infect Dis 1998;178:1795-8. 

3 Datta SD, Koutsky L, Douglas J, et al. Sentinel surveillance for human papillomavirus among women in 

the United States, 2003-2004. Program and abstracts of the 16th Biennial Meeting of the International 

Society for Sexually Transmitted Diseases Research; July 10-13, 2005; Amsterdam, The Netherlands. 

Abstract MO-306. 

4 Centers for Disease Control and Prevention. Lymphogranuloma venereum among men who have sex 

with men – Netherlands, 2003-2004. MMWR 2004; 53:985-988. 

5 Nieuwenhuis RF, Ossewaarde JM, Götz HM, Dees J, Thio HB, Thomeer MG, et al. Resurgence of 

lymphogranuloma venereum in Western Europe: an outbreak of Chlamydia trachomatis serovar L2 

proctitis in the Netherlands among men who have sex with men. Clin Infect Dis 2004;39:996-1003. 

6 McLean C, Lindstrom H, Wendt A, et al. Lymphogranuloma venereum in the United States, November 

2004 through March 2005. Program and abstracts of the 16th Biennial Meeting of the International 

Society for Sexually Transmitted Diseases Research; July 10-13, 2005; Amsterdam, The Netherlands. 

Poster MP-138. 

42 Other Sexually Transmitted Diseases National Profile STD Surveillance 2004 
 

Figure 38. Chancroid — Reported cases: United States, 1981–2004 

Cases (in thousands) 

5 

4 

3 

2 

1 

0 

1981 83 85 87 89 91 93 95 97 99 2001 03 

Figure 39. Genital herpes — Initial visits to physicians’ offices: United States, 1966–2004 

Visits (in thousands) 

300 

240 

180 

120 

60 

0 

1966 69 72 75 78 81 84 87 90 93 96 99 2002 

Note: See Appendix (Other Data Sources) and Table 47. The relative standard error for these 

estimates range from 45% to 60%. 

SOURCE: National Disease and Therapeutic Index (IMS Health) 

STD Surveillance 2004 National Profile Other Sexually Transmitted Diseases 43 
Figure 40. Genital warts — Initial visits to physicians’ offices: United States, 1966–2004 

Visits (in thousands) 

400 

320 

240 

160 

80 

0 

1966 69 72 75 78 81 84 87 90 93 96 99 2002 

Note: See Appendix (Other Data Sources) and Table 47. The relative standard error for these 

estimates range from 40% to 60%. 

SOURCE: National Disease and Therapeutic Index (IMS Health) 

Figure 41. Trichomoniasis and other vaginal infections in women — Initial visits to 

physicians’ offices: United States, 1966–2004 

Visits (in thousands)
 

4,500
 

3,600
 

2,700
 

1,800
 

900
 

0
 

Trichomoniasis 

Other Vaginitis 

1966 69 72 75 78 81 84 87 90 93 96 99 2002 

Note: See Appendix (Other Data Sources) and Table 47. The relative standard error for these 

estimates range from 16% to 30% and for other vaginitis estimates range from 30% to 

60%. 

SOURCE: National Disease and Therapeutic Index (IMS Health) 

44 Other Sexually Transmitted Diseases National Profile STD Surveillance 2004 
SPECIALFOCUSPROFILES 

Special Focus Profiles 

The Special Focus Profiles highlight trends and distribution of sexually transmitted diseases 

(STDs) in populations of particular interest for STD and HIV prevention programs in state and local 

health departments. These populations are most vulnerable to STDs and their consequences: women 

and infants, adolescents and young adults, minorities, men who have sex with men (MSM), and 

persons entering corrections facilities. The Special Focus Profiles refer to figures located in disease-specific sections in the National Profile and additional figures and tables (Figures A-GG and 

Tables AA-FF) that highlight specific points made in the text. 

STD Surveillance 2004 Special Focus Profiles 45 

456

STDs in Women and Infants
 

Public Health Impact 

Women and infants disproportionately bear the long term consequences of STDs. Women infected with Neisseria gonorrhoeae or Chlamydia trachomatis can develop pelvic inflammatory disease (PID), which, in turn, may lead to reproductive system morbidity such as ectopic pregnancy 

and tubal factor infertility. If not adequately treated, 20% to 40% of women infected with 

chlamydia1 and 10% to 40% of women infected with gonorrhea2 may develop PID. Among women 

with PID, tubal scarring will cause involuntary infertility in 20%, ectopic pregnancy in 9%, and 

chronic pelvic pain in 18%.3 Approximately 70% of chlamydia infections and 50% of gonococcal 

infections in women are asymptomatic. 4-6 These infections are detected primarily through screening 

programs. The vague symptoms associated with chlamydial and gonococcal PID cause 85% of 

women to delay seeking medical care, thereby increasing the risk of infertility and ectopic pregnancy.7 Data from a randomized controlled trial of chlamydia screening in a managed care setting 

suggest that such screening programs can reduce the incidence of PID by as much as 60%.8 

Gonorrhea and chlamydia can also 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 ophthalmia neonatorum, prevention of neonatal pneumonia requires prenatal detection and treatment. 

Human papillomavirus (HPV) infections are highly prevalent, especially among young sexually 

active women. While the great majority of HPV infections in women resolve within one year, they 

are a major concern because persistent infection with specific types (e.g., types 16, 18, 31, 33, 35, 

and 45), are causally related to cervical cancer; these types also cause Pap smear abnormalities. 

Other types (e.g., types 6 and 11) cause genital warts, low grade Pap smear abnormalities and, 

rarely, recurrent respiratory papillomatosis in infants born to infected mothers.9 

Genital infections with herpes simplex virus are extremely common, may cause painful outbreaks, and may have serious consequences for pregnant women including potentially fatal neonatal infections.10 

When a woman has a syphilis infection during pregnancy, she may transmit the infection to the fetus in utero. This may 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.11 

STD Surveillance 2004 Special Focus Profiles STDs in Women and Infants 47 
Observations 

Chlamydia and Gonorrhea 

• Between 2003 and 2004, the rate of chlamydia infections in women increased 

from 463.6 to 485.0 per 100,000 females (Figure 5, Table 4). Chlamydia rates 

exceed gonorrhea rates among women in all states (Figures A and B, Tables 4 and 

14). 

• In 2004, the median state-specific chlamydia test positivity among 15- to 

24-year-old women screened in selected prenatal clinics in 25 states, Puerto Rico, 

and the Virgin Islands was 6.8% (range 3.1% to 17.6%) (Figure E). 

• In 2004, the median state-specific chlamydia test positivity among 15- to 

24-year-old women who were screened during visits to selected family planning 

clinics in all states and outlying areas was 6.3% (range 3.2% to 16.3%) (Figure 7). 

• Gonorrhea rates among women were higher than the overall HP 2010 target of 

19.0 cases per 100,000 population12 in 44 states and two outlying areas in 2004 

(Figure B, Table 14). 

• Like chlamydia, gonorrhea is often asymptomatic in women and can only be 

identified through screening. Large-scale screening programs for gonorrhea in 

women began in the 1970s. After an initial increase in cases detected through 

screening, gonorrhea rates for both women and men declined steadily 

throughout the 1980s and early 1990s (Figure 14 and Tables 14-15). The 

gonorrhea rate for women in 2004 (116.5 per 100,000 females) showed a slight 

decline since 2000. Although the gonorrhea rate in men has been historically 

higher than the rate in women, the gonorrhea rate among women has been 

higher than the rate among men for four consecutive years (Figure 14 and Tables 

14-15). 

• In 2004, the median state-specific gonorrhea test positivity among 15- to 24-yearold women screened in selected prenatal clinics in 19 states, Puerto Rico, and the 

Virgin Islands was 0.9% (range 0% to 3.5%) (Figure F). 

• In 2004, the median state-specific gonorrhea test positivity among 15- to 24-yearold women screened in selected family planning clinics in 38 states, Puerto Rico, 

the District of Columbia, and the Virgin Islands was 1% (range 0.1%-4.2%). 

Primary and Secondary Syphilis 

• The HP2010 target for primary and secondary (P&S) syphilis is 0.2 case per 

100,000 population. In 2004, 31 states, the District of Columbia, and two 

outlying areas had rates of P&S syphilis for women that were greater than 0.2 

case per 100,000 population (Tables 27 and 31). 

Congenital Syphilis 

• The HP2010 target for congenital syphilis is 1.0 case per 100,000 live births. In 

2004, 31 states and Puerto Rico had rates higher than this target (Figure 37, 

Tables 40-42). 

• The number of congenital syphilis cases closely follows the trend of P&S syphilis 

among women (Figure 36). Peaks in congenital syphilis usually occur one year 

48 STDs in Women and Infants Special Focus Profiles STD Surveillance 2004 
after peaks in P&S syphilis among women. The congenital syphilis rate peaked in 

1991 at 107.3 cases per 100,000 live births, and declined by 92% to 8.8 cases per 

100,000 live births in 2004 (Figure 36, Table 39). The rate of P&S syphilis among 

women declined 95.4% (from 17.3 to 0.8 cases per 100,000 females) during 

1990-2004 (Figure 30). 

• The 2004 rate of congenital syphilis for the United States is currently 9 times 

higher than the HP2010 target of 1.0 case per 100,000 live births. This target is 

many times greater than the rate of congenital syphilis of most industrialized 

countries where syphilis and congenital syphilis have nearly been eliminated. 

• While 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.13 

Pelvic Inflammatory Disease 

• Accurate estimates of pelvic inflammatory disease (PID) and tubal factor infertility 

resulting from gonococcal and chlamydia infections are difficult to obtain. 

Definitive diagnosis of these conditions can be complex. 

• Hospitalizations for PID have declined steadily throughout the 1980s and early 

1990s, but have remained relatively constant between 1995 and 2003 (Figure H). 

A greater proportion of women diagnosed with PID in the 1990s have been 

treated in outpatient instead of inpatient settings when compared to women 

diagnosed with PID in the 1980s.14 

• The reported number of initial visits to physicians’ offices for PID through the 

National Disease and Therapeutic Index (NDTI) has generally declined from 

1993 through 2004 (Figure I and Table 47). 

• In 2002, an estimated 189,662 cases of PID were diagnosed in emergency 

departments among women 15 to 44 years of age. In 2003 this estimate 

decreased to 168,837 (National Hospital Ambulatory Medical Care Survey, 

NCHS). As of the date of publication of this report, 2004 data are not available. 

Ectopic Pregnancy 

• Evidence suggests that health care practices associated with ectopic pregnancy 

changed in the late 1980s and early 1990s. Before that time, treatment of ectopic 

pregnancy usually required admission to a hospital. Hospitalization statistics were 

therefore useful for monitoring trends in ectopic pregnancy. Beginning in 1989, 

hospitalizations for ectopic pregnancy have generally declined over time (Figure 

G). Data suggest that nearly half of all ectopic pregnancies are treated on an 

outpatient basis.15 

1 Stamm WE, Guinan ME, Johnson C. Effect of treatment regimens for Neisseria gonorrhoeae on 

simultaneous infections with Chlamydia trachomatis. N Engl J Med 1984;310:545-9. 

2 Platt R, Rice PA, McCormack WM. Risk of acquiring gonorrhea and prevalence of abnormal adnexal 

findings among women recently exposed to gonorrhea. JAMA 1983;250:3205-9. 

STD Surveillance 2004 Special Focus Profiles STDs in Women and Infants 49 
3 Westrom L, Joesoef R, Reynolds G, et al. Pelvic inflammatory disease and fertility: a cohort study of 

1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopy. 

Sexually Transmitted Diseases 1992;9:185-92. 

4 Hook EW III, Handsfield HH. Gonococcal infections in the adult. In: Holmes KK, Mardh PA, Sparling PF, 

et al, eds. Sexually Transmitted Diseases, 2nd edition. New York City: McGraw-Hill, Inc, 1990:149-65. 

5 Stamm WE, Holmes KK. Chlamydia trachomatis infections in the adult. In: Holmes KK, Mardh PA, 

Sparling PF, et al, eds. Sexually Transmitted Diseases, 2nd edition. New York City: McGraw-Hill, Inc, 

1990:181-93. 

6 Zimmerman HL, Potterat JJ, Dukes RL, et al. Epidemiologic differences between chlamydia and 

gonorrhea. Am J Public Health 1990;80:1338-42. 

7 Hillis SD, Joesoef R, Marchbanks PA, et al. Delayed care of pelvic inflammatory disease as a risk factor for 

impaired fertility. Am J Obstet Gynecol 1993;168:1503-9. 

8 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. 

9 Division of STD Prevention. Prevention of Genital HPV Infection and Sequelae: Report of an External 

Consultants’ Meeting. National Center for HIV, STD, and TB Prevention, Centers for Disease Control 

and Prevention, Atlanta, December 1999. 

10Handsfield HH, Stone KM, Wasserheit JN. Prevention agenda for genital herpes. Sexually Transmitted 

Diseases 1999;26:228-231. 

11Centers for Disease Control. Guidelines for prevention and control of congenital syphilis. MMWR 

1988;37(No.S-1). 

12U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding 

and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government 

Printing Office, November 2000. 

13Centers for Disease Control and Prevention. Congenital syphilis – United States, 2002. MMWR 

2004;53:716-9. 

14Rolfs RT, Galaid EI, Zaidi AA. Pelvic inflammatory disease: trends in hospitalization and office visits, 

1979 through 1988. Am J Obstet Gynecol 1992;166:983-90. 

15Centers for Disease Control and Prevention. Ectopic pregnancy in the United States, 1990-1992. 

MMWR 1995;44:46-8. 

50 STDs in Women and Infants Special Focus Profiles STD Surveillance 2004 
Figure A. Chlamydia — Rates among women by state: United States and outlying areas, 2004 

417.5 

416.4 229.0 380.3 

340.0 334.1 

316.5 474.5 503.2 453.7 VT 273.3 329.4 636.2 NH 193.7 

441.8 

232.3 

433.2 348.1 

558.6 451.5 517.5 

435.0 MA 

RI 

CT 

294.3 

448.6 

412.0 

497.6 455.9 451.1 558.0 239.4 

227.0 441.5 NJ 

DE 

MD 

326.8 

510.3 

566.5 

559.2 543.2 462.3 722.1 462.7 449.2 748.2 Rate per 100,000 

Guam 759.0 population 

1016.6 503.3 628.8 

<=300.0 (n= 8) 

851.9 

517.3 

758.4 

396.5 

300.1-500.0 

>500.0 

(n= 26) 

(n= 19) 

640.9 

Puerto Rico 160.9 

Virgin Is. 408.0 

Note: The total chlamydia infection rate among women in the United States and outlying areas 

(Guam, Puerto Rico and Virgin Islands) was 480.7 per 100,000 female population. 

Figure B. Gonorrhea — Rates among women by state: United States and outlying areas, 2004 

40.0 

11.7 12.6 22.7 

31.7 67.1 

6.2 106.8 46.3 98.0 VT 16.8 15.7 187.5 NH 8.3 

49.2 MA 46.1 98.7 

128.9 74.5 RI 85.7 189.9 22.7 112.7 CT 98.0 178.6 

76.6 73.4 50.7 NJ 81.3 123.8 114.0 175.9 DE 121.1 67.4 MD 152.2 

172.7 144.7 64.1 138.8 78.7 146.0 Rate per 100,000 235.2 

Guam 87.4 population 158.2 184.6 293.7 <=19.0 (n= 7) 111.9 19.1-100.0 (n= 22) 235.5 107.5 >100.0 (n= 24) 107.9 

108.4 

Puerto Rico 7.4 

Virgin Is. 84.4 

Note: The total gonorrhea infection rate among women in the United States and outlying areas 

(Guam, Puerto Rico and Virgin Islands) was 115.0 per 100,000 female population. 

STD Surveillance 2004 Special Focus Profiles STDs in Women and Infants 51 
Figure C. Primary and secondary syphilis — Rates for women by state: United States and 

outlying areas, 2004 

0.2 

0.2 0.0 0.0 

0.1 0.1 

1.6 0.0 0.1 0.3 VT 0.0 0.4 1.2 NH 0.0 

0.7 

0.3 

0.5 0.1 

0.9 0.2 1.0 

0.3 MA 

RI 

CT 

0.2 

1.8 

0.2 

0.4 0.3 0.5 0.4 0.3 

0.1 0.2 NJ 

DE 

MD 

0.9 

0.2 

3.2 

1.1 1.1 1.5 3.8 0.5 1.3 1.2 Rate per 100,000 

Guam 0.0 population 

1.3 2.2 1.0 

<=0.2 (n= 20) 

0.0 

1.6 

5.3 

1.1 

0.21-4.0 

>4.0 

(n= 31) 

(n= 2) 

0.0 

Puerto Rico 3.1 

Virgin Is. 5.3 

Note: The total rate of P&S syphilis among women in the United States and outlying areas (Guam, 

Puerto Rico and Virgin Islands) was 0.9 per 100,000 female population. 

Figure D. Congenital syphilis — Rates for infants < 1 year of age by state: United States and 

outlying areas, 2004 

0.0 

0.0 0.0 0.0 

0.0 1.5 

14.3 0.0 0.0 7.2 VT 0.0 0.0 17.7 NH 0.0 

0.0 MA 0.0 0.0 

0.0 0.0 RI 7.8 1.3 2.0 4.7 CT 0.0 12.7 

12.1 2.9 0.0 NJ 11.3 6.0 5.1 2.7 DE 9.0 1.8 MD 13.6 

7.7 5.2 29.6 4.0 10.8 10.7 Rate per 100,000 16.5 

Guam 0.0 live births 18.7 3.8 7.2 <=1.0 (n= 21) 17.5 1.1-10.0 (n= 18) 27.7 0.0 >10.0 (n= 14) 7.8 

0.0 

Puerto Rico 17.1 

Virgin Is. 0.0 

Note: The total rate of congenital syphilis for infants < 1 year of age for the United States and outlying 

areas (Guam, Puerto Rico and Virgin Islands) was 8.9 per 100,000 live births. The Healthy 

People 2010 target is 1.0 case per 100,000 live births. 

52 STDs in Women and Infants Special Focus Profiles STD Surveillance 2004 
Figure E. Chlamydia — Positivity in 15- to 24-year-old women tested in prenatal 

clinics by state: United States and outlying areas, 2004 

3.1 

VT 

NH 

5.3 5.9 6.3 10.9 MA 

RI 

5.9 6.0 

8.6 5.8 

5.4 

3.7 9.5 

CT 

NJ 

DE 

MD 

14.1 

3.1 

7.4 DC 

6.8 5.9 6.7 7.8 10.4 

Positivity (%) 

14.6 7.7 

See* (n= 26) 9.3 

12.2 <5.0 (n= 3) 

5.3 5.0-9.9 (n= 18) 

>=10.0 (n= 6) 

Puerto Rico 9.6 

Virgin Is. 17.6 

*States not reporting chlamydia positivity data in prenatal clinics. 

Note: Includes states and outlying areas that reported chlamydia positivity data on at least 100 

women aged 15-24 years during 2004 (except for Pennsylvania which submitted data for 

January-September 2004 only). 

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers 

for Disease Control and Prevention 

Figure F.	 Gonorrhea — Positivity among 15- to 24-year-old women tested in prenatal 

clinics by state: United States and outlying areas, 2004 

VT 

NH 

0.0 MA 

0.0 0.5 RI 

1.1 0.8 CT 

NJ 

0.9 0.3 0.7 

1.3 DE 

MD 

DC 

1.1 0.4 0.2 1.2 2.4 

Positivity (%) 

3.1 1.2 

See* (n= 32) 0.9 

2.7 <1.0 (n= 12) 

0.7 1.0-1.9 (n= 5) 

>=2.0 (n= 4) 

Puerto Rico 0.2 

Virgin Is. 3.5 

*States not reporting gonorrhea positivity data in prenatal clinics. 

Note: Includes states and outlying areas that reported gonorrhea positivity data on at least 100 

women aged 15-24 years during 2004. 

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers 

for Disease Control and Prevention 

STD Surveillance 2004 Special Focus Profiles STDs in Women and Infants 53 
Figure G. Ectopic pregnancy — Hospitalizations of women 15 to 44 years of age: United 

States, 1980-2003 

Hospitalizations (in thousands) 

100 

80 

60 

40 

20 

0 

1980 82 84 86 88 90 92 94 96 98 2000 02 

Note: Some variations in 1981 and 1988 estimates may be due to changes in sampling 

procedures. The relative standard error for these estimates ranges from 8% to 12%. Data 

available through 2003. 

SOURCE: National Hospital Discharge Survey (National Center for Health Statistics, CDC) 

Figure H. Pelvic inflammatory disease — Hospitalizations of women 15 to 44 years 

of age: United States, 1980–2003 

Hospitalizations (in thousands) 

200 

160 

120 

80 

40 

0 

Acute, Unspec. 

Chronic 

1980 82 84 86 88 90 92 94 96 98 2000 02 

Note: The relative standard error for these estimates of the total number of acute and chronic PID 

cases ranges from 6% to 18%. Data available through 2003. 

SOURCE: National Hospital Discharge Survey (National Center for Health Statistics, CDC) 

54 STDs in Women and Infants Special Focus Profiles STD Surveillance 2004 
Figure I. Pelvic inflammatory disease — Initial visits to physicians’ offices by women 

15 to 44 years of age: United States, 1980–2004 

Visits (in thousands) 

500
 

400
 

300
 

200
 

100
 

0
 

1980 82 84 86 88 90 92 94 96 98 2000 02 04
 

Note: The relative standard error for these estimates range from 19% to 30%. See Appendix 

(Other Data Sources) and Table 47. 

SOURCE: National Disease and Therapeutic Index (IMS Health) 

STD Surveillance 2004 Special Focus Profiles STDs in Women and Infants 55
 

2,3,4

STDs in Adolescents and Young Adults
 

Public Health Impact 

Compared to older adults, sexually active adolescents (10- to 19-year-olds) and young adults 

(20- to 24-year-olds) are at higher risk for acquiring STDs for a combination of behavioral, biological, and cultural reasons. For some STDs, for example, Chlamydia trachomatis, adolescent women 

may have a physiologically increased susceptibility to infection due to increased cervical ectopy. 

The higher prevalence of STDs among adolescents also reflects multiple barriers to quality STD prevention services, including lack of insurance or other ability to pay, lack of transportation, discomfort with facilities and services designed for adults, and concerns about confidentiality. Recent 

estimates suggest that while representing 25% of the ever sexually active population, 15- to 24-year 

olds acquire nearly one-half of all new STDs.1 

Observations 

Chlamydia and Gonorrhea 

• Numerous prevalence studies in various clinic populations have shown that 

sexually active adolescents have high rates of chlamydia infection. 2-4 The 

Regional Infertility Prevention Projects that routinely perform large scale 

screening for detecting chlamydia infections among women attending family 

planning clinics demonstrate that younger women consistently have higher 

positivity than older women, even when overall prevalence declines. An example 

is the Region X Chlamydia Project, which has screened women in family planning 

clinics since 1988 (Figure K). 

• After adjusting trends in chlamydia positivity to account for changes in laboratory 

test methods and associated increases in test sensitivity (see Appendix), in 15- to 

19-year-old women chlamydia test positivity decreased in 2 of 10 HHS regions 

from 2003 through 2004, increased in 7 regions, and remained the same in 1 

region (Figure J). 

• As in previous years, 15- to 19-year-old women had the highest rates of 

gonorrhea compared to women in all other age categories (Figure 17 and Table 

20). Women aged 20-24 had the highest rates of primary and secondary syphilis 

in 2004, while among men, 35- to 39-year-olds had the highest rates of primary 

and secondary syphilis (Figure 34 and Table 33). Among men, 20- to 

24-year-olds had the highest rate of gonorrhea (Figure 18 and Table 20). 

• In 15- to 19-year-old women, the 2004 gonorrhea rate of 610.9 cases per 

100,000 females was a 12.7% decrease from the 2000 rate of 699.5. Among 

young women in the 20- to 24-year-old group, the rate of gonorrhea in 2004 

decreased 8.4% from 621.0 in 2000 to 569.1 in 2004 (Figure 17, Table 20). 

STD Surveillance 2004 Special Focus Profiles STDs in Adolescents and Young Adults 57 
• Rates of gonorrhea among male adolescents decreased between the years 2000 

and 2004 (Figure 18, Table 20). Among 15- to 19-year-old males, the gonorrhea 

rate declined by 21.1% from 320.6 in 2000 to 252.9 in 2004. Among 20- to 

24-year-old males, the gonorrhea rate declined by 22.3% from 554.1 in 2000 to 

430.6 in 2004. 

Primary and Secondary Syphilis

• Syphilis rates in women are highest in the 20-24 year age group, 3.0 cases per 

100,000 population. Rates among 15-19 year olds have decreased over time and 

remain low (Figure 34, Table 33). 

• In men, increases have been observed in 20- to 24-year-olds (Figure 35), but rates 

among 15-19 year olds are low and remain relatively unchanged (Figure 35, 

Table 33). 

National Job Training Program

• Since 1990, approximately 20,000 female National Job Training Program entrants 

have been screened each year for chlamydia. This program, administered by the 

National Job Training Program at more than 100 sites throughout the country, is a 

job training program for economically- disadvantaged youth aged 16-24 years-old. 

• Chlamydia infection is widespread geographically and highly prevalent among 

economically-disadvantaged young women in the National Job Training 

Program.4Among women entering the program from 38 states and Puerto Rico in 

2004, based on their place of residence before program entry, the median 

state-specific chlamydia prevalence was 9.7% (range 4.4% to 17.3%) (Figure L). 

Among men entering the program from 46 states, the District of Columbia, and 

Puerto Rico in 2004, the median state-specific chlamydia prevalence was 7.3% 

(range 0.8% to 13%) (Figure M). 

• Data from National Job Training Program centers that submit gonorrhea 

specimens from female students aged 16-24 years to a national contract 

laboratory indicates a high prevalence of gonococcal infection in this population. 

Specimens from at least 100 students from each of 33 states were tested by the 

contract laboratory; the median state-specific gonorrhea prevalence was 2.4% 

(range 0% to 6.4%) in 2004 (Figure N). Among men entering the program from 8 

states in 2004, the median state-specific gonorrhea prevalence was 3.7% (range 

1% to 5.5%) (Figure O). 

Corrections Facilities

• Among adolescent women attending juvenile corrections facilities, data from the 

Corrections STD Prevalence Monitoring Project identified a median chlamydia 

positivity of 14% (range 2.4% to 26.5%) (Table AA) and a median gonorrhea 

positivity of 4.5% (range 0% to 16.6%) (Table CC). See Special Focus Profiles

(STDs in Persons Entering Corrections Facilities). 

58 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2004 
1 Weinstock, H, Berman, S, Cates, W, Jr. Sexually Transmitted Diseases among American Youth: Incidence 

and Prevalence Estimates, 2000. Perspect Sex Reprod Health, 2004:36(1):6-10. 

2 Centers for Disease Control and Prevention. Recommendations for the prevention and management of 

Chlamydia trachomatis infections, 1993. MMWR 1993;42(No. RR-12). 

3 Lossick J, DeLisle S, Fine D, Mosure DJ, Lee V, Smith C. Regional program for widespread screening for 

Chlamydia trachomatis in family planning clinics. In: Bowie WR, Caldwell HD, Jones RP, et al., eds. 

Chlamydial Infections: Proceedings of the Seventh International Symposium of Human Chlamydial 

Infections, Cambridge, Cambridge University Press 1990, pp. 575-9. 

4 Mertz KJ, Ransom RL, St. Louis ME, Groseclose SL, Hadgu A, Levine WC, Hayman C. Decline in the 

prevalence of genital chlamydia infection in young women entering a National Job Training Program, 

1990-1997. Am J Pub Health 2001;91(8):1287-1290. 

STD Surveillance 2004 Special Focus Profiles STDs in Adolescents and Young Adults 59 
Figure J. Chlamydia — Trends in positivity among 15- to 19-year-old women tested in family 

planning clinics by HHS regions, 1988–2004 

17.8 14.413.511.710.2 7.7 7.0 5.8 5.8 5.7 6.4 6.8 6.9 7.1 7.6 8.7 9.0 9.5 12.1 10.9 10.2 9.2 9.4 9.9 10.1 10.3 7.3 6.9 6.2 7.0 7.3 6.5 5.9 5.7 

88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 97 98 99 00 01 02 03 04 96 97 98 99 00 01 02 03 04 

Region X Region V Region I

11.7 12.4 11.7 12.9 12.5 10.5 11.0 9.7 10.0 10.6 10.4 10.3 10.0 10.1 9.0 9.5 8.2 X

I V II 96 97 98 99 00 01 02 03 04 97 98 99 00 01 02 03 04 VIII

Region IX Region II

VII III IX

12.8 10.3 9.7 10.1 9.0 8.0 8.4 7.8 9.1 9.4 9.4 8.7 8.3 8.3 9.1 7.4 7.0 6.5 7.2 7.3 6.9 7.8 IV

VI 94 95 96 97 98 99 00 01 02 03 04 94 95 96 97 98 99 00 01 02 03 04 

Region VIII Region III

15.5 15.7 16.2 14.4 14.2 13.9 14.4 13.9 14.1 13.8 14.9 13.5 12.4 12.3 12.2 11.8 13.0 

7.7 7.1 7.4 7.2 7.5 7.2 7.5 7.3 7.9 

96 97 98 99 00 01 02 03 04 96 97 98 99 00 01 02 03 04 97 98 99 00 01 02 03 04 

Region VII Region VI Region IV

Note: Trends adjusted for changes in laboratory test method and associated increases in test 

sensitivity. See Appendix (Chlamydia, Gonorrhea, and Syphilis Prevalence Monitoring) for 

more information. No data on laboratory test method available for Region VII in 1995 and 

Regions IV and V in 1996. See Appendix for definition of Health and Human Services (HHS) 

regions. 

SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers 

for Disease Control and Prevention 

Figure K. Chlamydia — Positivity among women tested in family planning clinics by 

age group: Region X, 1988–2004 

Percent 

15 

<18 Years 

18-19 Years 

12 20-24 Years 

25-29 Years 

30+ Years 

9 

6 

3 

0 

1988 90 92 94 96 98 2000 02 04 

Note: Women who met screening criteria were tested. Trends not adjusted for changes in 

laboratory test method and associated increases in test sensitivity in 1994 and 1999-2004. 

SOURCE: Regional Infertility Prevention Projects: Region X Chlamydia Project 

60 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2004 
Figure L. Chlamydia — Prevalence among 16- to 24-year-old women entering the National 

Job Training Program by state of residence: United States and outlying areas, 2004 

8.2 

5.1 5.3 

4.6 11.9 

6.5 7.7 VT 4.4 

9.7	 NH 

MA 9.4 9.3 5.5 RI 9.7 12.8 CT 10.8 7.3 9.5 14.1 NJ 8.2 9.8 11.5 13.7 DE 10.1 8.1 MD 13.7 

DC 9.2 6.5 13.2	 9.0 11.2	 9.1 

Prevalence (%) 17.3 10.0 14.3 See* (n= 14) 14.3 <10.0 (n= 22) 14.3 

10.0-14.9 (n= 16) 11.2 >=15.0 (n= 1) 

10.6 

Puerto Rico 9.4 

Virgin Is. 

*Fewer than 100 women residing in these states/areas and entering the National Job Training 

Program were screened for chlamydia in 2004. 

Note: The overall chlamydia prevalence among female students entering the National Job Training 

Program in 2004 was 10.3%. 

Figure M. Chlamydia — Prevalence among 16- to 24-year-old men entering the National Job 

Training Program by state of residence: United States and outlying areas, 2004 

4.5 

4.1 2.3 0.8 

2.6 5.4 

3.7 3.3 5.8 8.5 VT 1.6 

10.9 NH 

4.6 

6.3 

3.4 

5.1 7.7 

6.7 2.8 

8.1 

8.9 10.7 

9.7 

12.7 

7.8 

6.7 

11.7 

MA 

RI 

CT 

NJ 

DE 

MD 

4.7 

6.4 

8.1 

10.4 

9.8 DC 9.9 

12.5 5.7 8.9 6.3 9.2 10.4 

Prevalence (%) 

11.2 12.8 13.0 

See* (n= 5) 

6.9 

10.5 

12.2 

8.3 

<10.0 

10.0-14.9 

(n= 36) 

(n= 12) 

>=15.0 

5.5 

Puerto Rico 6.0 

Virgin Is. 

*Fewer than 100 men residing in these states/areas and entering the National Job Training 

Program were screened for chlamydia in 2004. 

Note: The overall chlamydia prevalence among male students entering the National Job Training 

Program was 8.3%. 

STD Surveillance 2004 Special Focus Profiles STDs in Adolescents and Young Adults 61 
Figure N. Gonorrhea — Prevalence among 16- to 24-year-old women entering the National Job 

Training Program by state of residence: United States and outlying areas, 2004 

0.0 0.7 

0.9 0.9 

1.0 1.3 VT 0.6 

3.6 NH 

MA 2.2 

1.4 

1.8 

3.2 

4.3 2.4 

3.1 

6.4 

2.3 

1.8 

3.6 

RI 

CT 

NJ 

DE 

MD 

2.9 

1.9 

3.1 DC 

2.7 1.6 2.6 4.3 

Prevalence (%) 

3.0 3.8 3.6 

See* (n= 20) 2.2 

4.0 <2.0 (n= 13) 

2.8 2.0-4.9 (n= 19) 

>=5.0 (n= 1) 

1.4 

Puerto Rico Virgin Is. 

*Fewer than 100 women residing in these states/areas and entering the National Job Training 

Program were screened for gonorrhea by the national contract laboratory in 2004. 

Note: Many training centers test female students for gonorrhea using local laboratories; these results 

are not available to CDC. For this map, gonorrhea test results for students at centers submitting 

specimens to the national contract laboratory were included if the number of gonorrhea tests 

submitted was greater than 90% of the number of chlamydia tests submitted. The overall 

gonorrhea prevalence among female students entering the National Job Training Program in 

2004 was 2.5%. 

Figure O.	 Gonorrhea — Prevalence among 16- to 24-year-old men entering the National Job 

Training Program by state of residence: United States and outlying areas, 2004 

VT 

4.3	 NH 

MA 

RI 1.0 CT 

NJ 1.1	 1.4 DE 3.8 3.7 MD 

DC 4.1 

Prevalence (%) 5.5 

See* (n= 45) 

<2.0 (n= 3) 

2.0-4.9 (n= 4) 

>=5.0 (n= 1) 

Puerto Rico Virgin Is. 

*Fewer than 100 men residing in these states/areas and entering the National Job Training Program 

were screened for gonorrhea by the national contract laboratory in 2004. 

Note: Many training centers test male students for gonorrhea using local laboratories; these results 

are not available to CDC. For this map, gonorrhea test results for students at centers submitting 

specimens to the national contract laboratory were included if the number of gonorrhea tests 

submitted was greater than 90% of the number of chlamydia tests submitted. The overall 

gonorrhea prevalence among male students entering the National Job Training Program in 

2004 was 3.1%. 

62 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2004 
STDs in Racial and Ethnic Minorities
 

Public Health Impact 

Surveillance data show higher rates of reported STDs among some minority racial or ethnic 

groups when compared with rates among whites. Race and ethnicity in the United States are risk 

markers that correlate with other more fundamental determinants of health status such as poverty, 

access to quality health care, health care seeking behavior, illicit drug use, and living in communities 

with high prevalence of STDs. Acknowledging the disparity in STD rates by race or ethnicity is one 

of the first steps in empowering affected communities to organize and focus on this problem. 

Surveillance data are based on cases of STDs reported to state and local health departments (see 

Appendix). In many areas, reporting from public sources, (for example, STD clinics) is more complete than reporting from private sources. Since minority populations may utilize public clinics more 

than whites, differences in rates between minorities and whites may be increased by this reporting 

bias. 

In 2004, 23.3% of reports on gonorrhea cases were missing information on race or ethnicity, and 

29.3% of reports on chlamydia cases were missing race or ethnicity (Table A1). To adjust for missing 

data, cases in which information is unknown are redistributed according to the distribution of cases 

in which race or ethnicity is known. This process may exacerbate the reporting bias. 

Observations 

Chlamydia 

• Although chlamydia in women is a widely distributed STD among all racial and 

ethnic groups, trends in positivity in women screened in HHS Region X show 

consistently higher chlamydia positivity among minorities (Figure P). 

• In 2004, the rate of chlamydia among African-American females in the United 

States was more than 7 times higher than the rate among white females (1,722.3 

and 226.6 per 100,000, respectively) (Table 11B). The chlamydia rate among 

African-American males was more than 11 times higher than that among white 

males (645.2 and 57.3 per 100,000 population, respectively). 

Gonorrhea 

• In 2004, 69.6% of the total number of cases of gonorrhea reported to CDC 

occurred among African-Americans (Table 21A). In 2004, the rate of gonorrhea 

among African-Americans was 629.6 cases per 100,000 population, among 

American Indian/Alaska Natives the rate was 117.7, and among Hispanics the 

rate was 71.3. These rates are 19, 4, and 2 times higher, respectively, than the rate 

among whites in 2004 of 33.3 cases per 100,000 population. The rate of 

STD Surveillance 2004 Special Focus Profiles STDs in Racial and Ethnic Minorities 63 
gonorrhea among Asian/Pacific Islanders in 2004 was 21.4 cases per 100,000 

population (Figure 15, Table 21B). 

• From 2000 through 2004, gonorrhea rates among African-Americans declined 

by 19.1% (778.1 and 629.6 cases per 100,000 population, respectively). During 

the same period, gonorrhea rates increased by 19.8% among whites, 19.4% 

among American Indian/Alaska Natives, and 3.8% among Hispanics, and 

decreased by 19.9% among Asian/Pacific Islanders (Table 21B). 

• Gonorrhea rates in 2004 among African-American men were 26 times higher 

than among white men. Gonorrhea rates in 2004 among African-American 

women were 15 times higher than among white women (Figure Q). 

• Gonorrhea rates in 2004 were highest for African-Americans aged 15-24 years 

among all racial, ethnic, and age categories. In 2004, African-American women 

aged 15-19 years had a gonorrhea rate of 2,790.5 cases per 100,000 females. 

This rate was 14 times greater than the 2004 rate among white females of similar 

age (201.7). African-American men in the 15- to 19-year-old age category had a 

2004 gonorrhea rate of 1,390.1 cases per 100,000 males, which was 37 times 

higher than the rate among 15- to 19-year-old white males of 37.9 per 100,000. 

Among 20- to 24-year-olds in 2004, the gonorrhea rate among 

African-Americans was 17 times greater than that among whites (2,487.2 and 

149.0 cases per 100,000 population, respectively) (Table 21B). 

• Although gonorrhea rates decreased for most age and race/ethnic groups during 

the 1980s, they did not decrease for African-American adolescents during this 

period; African-American 15- to 19-year-old females did not show a decrease in 

rates until 1991 (Figure R). Decreases among 15- to 19-year old 

African-American males did not begin until 1992 (Figure S). From 2000 to 2004, 

gonorrhea rates among 15- to 19-year-old African-American females and males 

decreased 19.7% and 25.5%, respectively.. 

Primary and Secondary Syphilis 

• The syphilis epidemic in the late 1980s occurred primarily among heterosexual, 

minority populations.1 During the 1990s, the rate of primary and secondary 

(P&S) syphilis declined among all racial and ethnic groups (Figure 31). During 

2000-2004, the rate continued to decline among African-Americans, but the 

overall rate of P&S syphilis and rates among non-Hispanic whites, Hispanics, 

Asian/Pacific Islanders, and American Indian/Alaska Natives increased; increases 

in P&S syphilis occurred only among men and the most rapid rate of increase 

occurred among non-Hispanic white men during this time (Table 34B). 

• Between 2003 and 2004, the rates of primary and secondary syphilis increased 

11% in white men, 17% in African-American men and increased slightly (2%) 

among African-American women (Table 34B). Rates continued to increase 

among Hispanics, Asian/Pacific Islanders, and American Indian/Alaska Natives. 

• In 2004, 41% of all cases of P&S syphilis reported to CDC occurred among 

African-Americans and 40% of all cases occurred among non-Hispanic whites 

(Table 34A). The 2004 rate for African-Americans was 6 times greater than the 

rate among non-Hispanic whites (Table 34B). 

• In 2004, the incidence of P&S syphilis by sex among African-Americans was 

highest among women aged 20-24 years (13.4 cases per 100,000 population) 

64 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Surveillance 2004 
 

and among men aged 25-29 (34.6 cases per 100,000 population) (Table 34B). In 

2003, African-American men in the 35-39 age group had the highest rates. 

• Between 2003 and 2004, P&S syphilis rates for African-Americans in every age 

group increased. (Table 34B). 

• In 2004, 16% of all cases of P&S syphilis reported to CDC occurred among 

Hispanics (Table 34A). The rate of P&S syphilis among Hispanic men increased 

12% (from 4.9 to 5.5 cases per 100,000 population) between 2003 and 2004. 

The rate among Hispanic women remained essentially unchanged (0.7 cases per 

100,000 population). The rate among Hispanics in 2004 was 2 times greater than 

the rate among non-Hispanic whites. 

• The incidence of P&S syphilis among Hispanics was highest among women aged 

20-24 years (1.9 cases per 100,000 population) and among men aged 35-39 

years (14.0 cases per 100,000 population) in 2004 (Table 34B). 

Congenital Syphilis 

• In 2004, the rate of congenital syphilis (based on the mother’s race/ethnicity) was 

26.7 cases per 100,000 live births among African-Americans and 16.2 cases per 

100,000 live births among Hispanics. These rates are 16 and 10 times greater, 

respectively, than the 2004 rate among non-Hispanic whites (1.7 cases per 

100,000 live births), respectively (Figure W, Table 44). 

1 Nakashima AK, Rolfs RT, Flock ML, Kilmarx P, Greenspan JR. Epidemiology of syphilis in the United 

States, 1941 through 1993. Sexually Transmitted Diseases 1996;23:16-23. 

STD Surveillance 2004 Special Focus Profiles STDs in Racial and Ethnic Minorities 65 
Figure P.	 Chlamydia — Positivity among women tested in family planning clinics 

by race and ethnicity: Region X, 1988–2004 

Percent 

15 

12 

9 

6 

3 

0 

White 

Black 

Hispanic 

Asian/Pac Isl 

Am Ind/AK Nat 

1988 90 92 94 96 98 2000 02 04 

Note: Women who met screening criteria were tested. Annual race/ethnicity-specific positivity not 

adjusted for changes in laboratory test method and associated increases in test sensitivity 

in 1994, and 1999-2004. 

SOURCE: Regional Infertility Prevention Projects: Region X Chlamydia Project 

Figure Q. Gonorrhea — Rates by race/ethnicity and sex, 2004 

Men	 Rate (per 100,000 population)population)population)population)population)population)population)population)population)population)population)population) Women 

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

26.2 

670.3 

64.9 

19.4 

79.0 

110.2 

White
 

Black
 

HispanicHispanicHispanicHispanicHispanicHispanicHispanicHispanicHispanicHispanicHispanicHispanic
 

Asian/PIAsian/PIAsian/PIAsian/PIAsian/PIAsian/PIAsian/PIAsian/PIAsian/PIAsian/PIAsian/PIAsian/PI
 

AI/AN
 

Total
 

40.0 

592.5 

78.2 

23.2 

155.3 

116.7 

66 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Surveillance 2004 
Figure R. Gonorrhea — Rates among 15- to 19-year-old females by race and ethnicity: 

United States, 1981–2004 

Rate (per 100,000 population)
 

7,000
 

5,600
 

4,200
 

2,800
 

1,400
 

0
 

White 

Black 

Hispanic 

Asian/Pac Isl 

Am Ind/AK Nat 

1981 83 85 87 89 91 93 95 97 99 2001 03 

Figure S. Gonorrhea — Rates among 15- to 19-year-old males by race and ethnicity: 

United States, 1981–2004 

Rate (per 100,000 population)
 

7,000
 

5,600
 

4,200
 

2,800
 

1,400
 

0
 

White 

Black 

Hispanic 

Asian/Pac Isl 

Am Ind/AK Nat 

1981 83 85 87 89 91 93 95 97 99 2001 03 

STD Surveillance 2004 Special Focus Profiles STDs in Racial and Ethnic Minorities 67 
Figure T. Primary and secondary syphilis — Rates by race/ethnicity and sex: United 

States, 2004 

Men Rate (per 100,000 population)population)population)population)population)population)population)population)population)population)population)population) Women 

15.0 12.0 9.0 6.0 3.0 0.0 Race 0.0 3.0 6.0 9.0 12.0 15.0 

3.1 

14.1 

5.5 

2.3 

3.5 

4.7 

White
 

Black
 

HispanicHispanicHispanicHispanicHispanicHispanicHispanicHispanicHispanicHispanicHispanicHispanic
 

Asian/PIAsian/PIAsian/PIAsian/PIAsian/PIAsian/PIAsian/PIAsian/PIAsian/PIAsian/PIAsian/PIAsian/PI
 

AI/AN
 

Total
 

0.3 

4.3 

0.7 

0.2 

2.9 

0.8 

Figure U. Primary and secondary syphilis — Rates among 15- to 19-year-old females by 

race and ethnicity: United States, 1981–2004 

Rate (per 100,000 population) 

250 

200 

150 

100 

50 

0 

White 

Black 

Hispanic 

Asian/Pac Isl 

Am Ind/AK Nat 

1981 83 85 87 89 91 93 95 97 99 2001 03 

68 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Surveillance 2004 
Figure V.	 Primary and secondary syphilis — Rates among 15- to 19-year-old males by 

race and ethnicity: United States, 1981–2004 

Rate (per 100,000 population) 

125 

100 

75 

50 

25 

0 

White 

Black 

Hispanic 

Asian/Pac Isl 

Am Ind/AK Nat 

1981 83 85 87 89 91 93 95 97 99 2001 03 

Figure W. Congenital syphilis — Rates among infants <1 year of age by mother’s race and 

ethnicity: United States, 1991–2004 and the Healthy People 2010 target 

Rate (per 100,000 live births) 

450 

360 

270 

180 

90 

0 

White 

Black 

Hispanic 

Asian/Pac Isl 

Am Ind/AK Nat 

2010 Target 

1991 92 93 94 95 96 97 98 99 2000 01 02 03 04 

Note: The Healthy People 2010 target for congenital syphilis is 1.0 case per 100,000 live births. 

Less than 5% of cases had missing race/ethnicity information and were excluded. Case 

counts for congenital syphilis shown in this graph correspond to those listed in Table 44. 

STD Surveillance 2004 Special Focus Profiles STDs in Racial and Ethnic Minorities 69 

1,2,3,4,5

STDs in Men Who Have Sex with Men
 

Public Health Impact 

Data from several U.S. cities and projects, including syphilis outbreak investigations and the 

Gonococcal Isolate Surveillance Project (GISP), suggest that an increasing number of men who 

have sex with men (MSM) are acquiring STDs. 1-5 Data also suggest that an increasing number of 

MSM are engaging in sexual behaviors that place them at risk for STDs and HIV infection.6 Several 

factors may be contributing to this change, including the availability of highly active antiretroviral 

therapy (HAART) for HIV infection.7 Because STDs and the behaviors associated with them increase the likelihood of acquiring and transmitting HIV infection,8 the rise in STDs among MSM may 

be associated with an increase in HIV incidence among MSM.9 

Observations 

• Nationally notifiable STD surveillance data reported to CDC do not include 

information regarding sexual behaviors; therefore, national trends in STDs 

among MSM in the United States are not available. Data from enhanced 

surveillance projects are presented in this section to provide information 

regarding STDs in MSM. 

Monitoring Trends in Prevalence of STDs and HIV Risk Behaviors among Men Who Have 

Sex with Men (MSM Prevalence Monitoring Project) 

• From 1999 through 2004, nine U.S. cities participating in the MSM Prevalence 

Monitoring Project submitted syphilis, gonorrhea, chlamydia, and HIV test data 

to CDC from 81,923 MSM visits to STD clinics; data from 68,917 MSM visits were 

submitted from six public STD clinics (Denver, Long Beach, New York City, 

Philadelphia, San Francisco, and Seattle) and 13,006 MSM visits were submitted 

from three STD clinics in community-based, gay men’s health clinics (Chicago, 

the District of Columbia, and Houston). In 2004, eight U.S. cities submitted 

information from 18,186 MSM STD clinic visits. 

• In 2004, Fenway Community Health (Boston), a community-based, gay men’s 

primary care clinic, also participating in the MSM Prevalence Monitoring Project, 

submitted syphilis, gonorrhea, and chlamydia test data to CDC from 22,237 

primary care visits by men. 

• The MSM Prevalence Monitoring Project includes data from culture and 

non-culture tests collected during routine care and reflects testing practices at 

participating clinics. City-specific medians and ranges were calculated for the 

proportion of tests done and STD and HIV test positivity. 

STD Surveillance 2004 Special Focus Profiles STDs in Men Who Have Sex with Men 71 
Syphilis, STD Clinics, 1999-2004 

• In 2004, 85% (range: 63-91%) of MSM visiting participating STD clinics had a 

nontreponemal serologic test for syphilis (STS) [RPR or VDRL] performed 

compared with 69% (range: 54-93%) in 1999. 

• Overall, median syphilis seroreactivity among MSM tested increased from 4% 

(range: 4-13%) in 1999 to 10% (range: 6-4%) in 2004 (Figure X). 

Gonorrhea, STD Clinics, 1999-2004 

• In 2004, overall median clinic gonorrhea positivity in MSM was 15% (range: 

11-17%) at any anatomic site (Figure Y). 

• In 2004, 80% (range: 57-95%) of MSM were tested for urethral gonorrhea, 34% 

(range: 3-65%) were tested for rectal gonorrhea, and 50% (range: 5-92%) were 

tested for pharyngeal gonorrhea. 

• In 2004, median clinic urethral gonorrhea positivity in MSM was 11% (range: 

7-13%), median rectal gonorrhea positivity was 8% (range: 3-19%), and median 

pharyngeal gonorrhea positivity was 5% (range: 3-14%). 

• In 2004, by race/ethnicity, urethral gonorrhea positivity was 11% (range: 8-12%) 

in whites, 16% (range: 9-24%) in African-Americans, and 9% (range: 3-10%) in 

Hispanics. Rectal gonorrhea positivity was 7% (range: 4-12%) in whites, 6% 

(range: 2-8%) in African-Americans, and 5% (range: 3-8%) in Hispanics. 

Pharyngeal gonorrhea positivity was 6% (range: 3-14%) in whites, 7% (range: 

1-10%) in African-Americans, and 4% (range: 2-10%) in Hispanics (Figure Z). 

• In 2004, by HIV status, urethral gonorrhea positivity was 17% (range: 12-25%) in 

HIV-positive MSM and 10% (range 6-12%) in MSM who were HIV-negative or of 

unknown HIV status; rectal gonorrhea positivity was 10% (range: 4-12%) in 

HIV-positive MSM and 7% (range: 3-9%) in MSM who were HIV-negative or of 

unknown HIV status; pharyngeal gonorrhea positivity was 5% (range: 3-10%) in 

HIV-positive MSM and 5% (range: 3-13%) in MSM who were HIV-negative or of 

unknown HIV status (Figure AA). 

HIV Infection, STD Clinics, 2004 

• In 2004, a median of 59% (range: 30-81%) of MSM visiting STD clinics in the 

project and not previously known to be HIV-positive were tested for HIV; median 

HIV positivity was 4% (range: 2-6%). HIV positivity varied by race and ethnicity, 

but was higher in African-American and Hispanic MSM. HIV positivity was 3% 

(range: 2-4%) in whites, 7% (range 3-13%) in African-Americans, and 7% (range: 

3-7%) in Hispanics (Figure Z). 

• In 2004, median HIV prevalence among MSM, including persons previously 

known to be HIV-positive and persons testing HIV-positive at their current visit, 

was 11% (range 6-14%). HIV prevalence was 11% (range: 5-14%) in whites, 

16% (range: 10-20%) in African-Americans, and 11% (range: 6-14%) in 

Hispanics (Figure AA). 

72 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2004 
Chlamydia, STD Clinics, 2004 

• In 2004, a median of 82% (range: 57-95%) of MSM visiting participating STD 

clinics were tested for urethral chlamydia; median urethral chlamydia positivity 

was 6% (range: 5-8%). Urethral chlamydia was 5% (range: 2-8%) in whites; 9% 

(range: 8-11%) in African-Americans, and 6% (range: 3-14%) in Hispanics 

(Figure Z). Median positivity was 6% (range: 5-14%) in HIV-positive MSM and 

6% (range: 5-7%) in MSM who were HIV-negative or of unknown HIV status 

(Figure AA). 

STD Testing and Positivity, Community-based, Gay Men’s Primary Care Clinic, 2004 

• In 2004, among men with a nontreponemal serologic test for syphilis in a gay 

men's primary care clinic, 5% had a reactive syphilis test result and 31% of men 

with reactive syphilis serologies were identified as new syphilis cases. Among men 

tested for gonorrhea, urethral positivity was 9%, rectal positivity was 7%, and 

pharyngeal positivity was 2%. Among men tested for urethral chlamydia, 

positivity was 5%. 

Nationally Reported Syphilis Surveillance Data 

• Primary and secondary (P&S) syphilis increased in the United States during 

2000-2004. Between 2000 and 2004, there was a 90% increase in the number of 

P&S syphilis cases among men and a 49% decrease in the number of cases 

among women (Tables 27 and 28). Trends in the syphilis male-to-female rate 

ratio, which are assumed to reflect syphilis trends among MSM, have been 

increasing in the United States during recent years (Figure 32). In 2004, the rate of 

reported P&S syphilis among men (4.7 cases per 100,000 males) was 6 times 

greater than the rate among women (0.8 cases per 100,000 females) (Figure T). 

The overall male-to-female syphilis rate ratio has risen steadily since 2000 when it 

was 1.5 (Figure 32). The increase in the male-to-female rate ratio occurred 

among all racial and ethnic groups between 2000 and 2004. Additional 

information on syphilis can be found in the Syphilis section. 

Gonococcal Isolate Surveillance Project (GISP) 

• The Gonococcal Isolate Surveillance Project (GISP), a collaborative project 

among selected STD clinics, was established in 1986 to monitor trends in 

antimicrobial susceptibilities of strains of Neisseria gonorrhoeae in the United 

States.10 

• GISP also reports the percentage of Neisseria gonorrhoeae isolates obtained from 

MSM. Overall, the proportion of isolates coming from MSM in GISP clinics 

increased from 4% in 1988 to 20% in 2004, with most of the increase occurring 

after 1993 (Figure BB). Additional information on GISP may be found in the 

Gonorrhea section. 

• The proportion of isolates coming from MSM varies geographically with the 

largest percentage from the west coast (Figure CC). 

STD Surveillance 2004 Special Focus Profiles STDs in Men Who Have Sex with Men 73 
• Due to increases in the proportion of isolates from MSM that are 

fluoroquinolone-resistant (Figure 23), in 2004 CDC recommended that 

fluoroquinolones no longer be used to treat gonorrhea among MSM.11 

1 Centers for Disease Control and Prevention. Gonorrhea among men who have sex with men – selected 

sexually transmitted disease clinics, 1993-1996. MMWR 1997;46:889-92. 

2 Centers for Disease Control and Prevention. Resurgent bacterial sexually transmitted disease among men 

who have sex with men – King County, Washington, 1997-1999. MMWR 1999;48:773-7. 

3 Centers for Disease Control and Prevention. Outbreak of syphilis among men who have sex with men – 

Southern California, 2000. MMWR 2001;50:117-20. 

4 Fox KK, del Rio C, Holmes K, et. al. Gonorrhea in the HIV era: A reversal in trends among men who have 

sex with men. Am J Public Health 2001;91:959-964. 

5 Centers for Disease Control and Prevention. Primary and secondary syphilis among men who have sex 

with men – New York City, 2001. MMWR 2002;51:853-6. 

6 Stall R, Hays R, Waldo C, Ekstrand M, McFarland W. The gay ‘90s: a review of research in the 1990s on 

sexual behavior and HIV risk among men who have sex with men. AIDS 2000;14:S1-S14. 

7 Scheer S, Chu PL, Klausner JD, Katz MH, Schwarcz SK. Effect of highly active antiretroviral therapy on 

diagnoses of sexually transmitted diseases in people with AIDS. Lancet 2001;357:432-5. 

8 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. 

9 Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2003, (Vol. 15). Atlanta: U.S. 

Department of Health and Human Services, Centers for Disease Control and Prevention; 2004. 

10Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2004 

Supplement: Gonococcal Isolate Surveillance Project (GISP) Annual Report 2004. Atlanta, GA: U.S. 

Department of Health and Human Services (available first quarter 2006). 

11Centers for Disease Control and Prevention. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae 

among men who have sex with men – United States, 2003, and revised recommendations for gonorrhea 

treatment, 2004. MMWR 2004;53:335-338. 

74 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2004 
Figure X. MSM Prevalence Monitoring Project — Syphilis serologic reactivity among men 

who have sex with men, STD clinics, 1999-2004 

Seattle, WA New York City, NY 

10.3 10.2 10.6 7.0 5.5 

1999 2000 2001 2002 2003 2004 2002 2003 2004 

4.1 3.9 3.5 3.6 

Philadelphia, PA San Francisco, CA 

13.1 12.1 13.4 13.0 10.4 10.8 8.9	 8.7 7.1	 6.9 3.7 3.2 

1999 2000 2001 2002 2003 2004 1999 2000 2001 2002 2003 2004 

Long Beach, CA* 

District of Columbia 15.8 14.0 10.4 9.5 7.4	 5.9 6.9 4.4 

2000 2001 2002 2003 2000 2001 2002 2003 2004 

3.4 

Houston, TX 

Denver, CO Chicago, IL 16.6 14.0 10.3	 8.5 9.7 5.7 6.7	 7.0 3.7	 4.7	 3.5 4.3 1.5 1.5 

2000 2001 2002 2003 2004 2001 2002 2003 2004 2000 2001 2002 2003 2004 

*Data not reported in 2004. 

Figure Y.	 MSM Prevalence Monitoring Project — Gonorrhea positivity* among men who 

have sex with men, STD clinics, 1999-2004 

Seattle, WA	 New York City, NY 

19.2	 19.5 16.5	 15.3 15.4 15.9 15.8 11.7 13.3

1999 2000 2001 2002 2003 2004	 2002 2003 2004 

Philadelphia, PA San Francisco, CA 

20.7 18.4 17.7	 16.7	 18.9 17.8 18.2 17.3 14.3	 15.6 13.0 13.7

1999 2000 2001 2002 2003 2004	 1999 2000 2001 2002 2003 2004 

Long Beach, Ca† 

District of Columbia† 

16.9 15.5 16.9

10.6	 12.4 10.7 11.6 10.1 

2000 2001 2002 2003	 2000 2001 2002 2003 

Denver, CO Houston, TX Chicago, IL 

22.8 22.4 18.0 19.3	 17.5 19.0 14.2 13.6	 13.0 13.2 12.5 14.0 11.9	 11.4 

2000 2001 2002 2003 2004 2001 2002 2003 2004 2000 2001 2002 2003 2004 

*Includes testing at all anatomic sites. 

†

Data not reported in 2004. 

STD Surveillance 2004 Special Focus Profiles STDs in Men Who Have Sex with Men 75 
Figure Z. MSM Prevalence Monitoring Project — Test positivity for gonorrhea, chlamydia, 

and HIV among men who have sex with men, by race/ethnicity, STD clinics, 2004 

Median positivity 

White 

Black 

Hispanic 

0 

5 

10 

15 

20 

25 

Urethral Rectal Pharyngeal Urethral HIV* 

gonorrhea gonorrhea gonorrhea chlamydia 

*Excludes persons previously known to be HIV-positive. 

Figure AA. MSM Prevalence Monitoring Project — Positivity for gonorrhea and chlamydia 

among men who have sex with men, by HIV status, STD clinics, 2004 

Median positivity 

HIV-positive 

HIV-negative or unknown 

0 

5 

10 

15 

20 

25 

Urethral Rectal Pharyngeal Urethral 

gonorrhea gonorrhea gonorrhea chlamydia 

76 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2004 
 

Figure BB. Gonococcal Isolate Surveillance Project (GISP) — Percent of urethral 

Neisseria gonorrhoeae isolates obtained from men who have sex with men 

attending STD clinics, 1988-2004 

Percent
 

25
 

20
 

15
 

10
 

5
 

0
 

Figure CC. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria 

gonorrhoeae isolates obtained from men who have sex with men attending 

STD clinics, 2001-2004 

1988 90 92 94 96 98 2000 02 04 

0% 

50% 

100% 

'01 '02 '03 '04 

% of Isolates 

from MSM 

BHM PHX 

LBC 

LAX 

ORA 

SDG 

SFO DEN 

ATL 

TRP 

CHI 

NOR 

BAL 

DTR 

MIN 

LVG STL

ALB 

GRB 

CIN 

CLE 

OKC 

POR 

PHI 

DAL 

SEA 

HON	 MIA 

Note:	 Not all clinics participated in GISP for the last 4 years. Clinics include: ALB=Albuquerque, NM; 

ATL=Atlanta, GA; BAL=Baltimore, MD; BHM=Birmingham, AL; CHI=Chicago, IL; CIN=Cincinnati, OH; 

CLE=Cleveland, OH; DAL=Dallas, TX; DEN=Denver, CO; DTR=Detroit, MI; HON=Honolulu, HI; LAX=Los 

Angeles, CA; LBC=Long Beach, CA; LVG=Las Vegas, NV; MIA=Miami, FL; MIN=Minneapolis, MN; 

GRB=Greensboro, NC; NOR=New Orleans, LA; OKC=Oklahoma City, OK; ORA=Orange County, CA; 

PHI=Philadelphia, PA; PHX=Phoenix, AZ; POR=Portland, OR; STL=St Louis, MO (only has data through 

2003); SDG=San Diego, CA; SEA=Seattle, WA; SFO=San Francisco, CA; and TRP=Tripler Army Medical 

Center, HI (does not provide sexual risk behavior data). 

STD Surveillance 2004 Special Focus Profiles STDs in Men Who Have Sex with Men 77 

1,2,3,4

STDs in Persons Entering Corrections Facilities
 

Public Health Impact 

Multiple studies and surveillance projects have demonstrated a high prevalence of STDs in persons entering jails and juvenile corrections facilities. 1-4 Screening for chlamydia, gonorrhea, and 

syphilis at intake offers an opportunity to identify infections, prevent complications, and reduce 

transmission in the general community. For example, one study has suggested that screening and 

treatment of women inmates for syphilis may result in reduction of syphilis in the general community.5 Depending on locale, a substantial proportion of all early syphilis cases are reported from corrections facilities.4 Collecting positivity data and analyzing trends in STD prevalence in the inmate 

population can provide a tool for monitoring trends in STD prevalence in the general community.4 

Description of Population 

• In 2004, STD screening data from corrections facilities were reported from 34 

states for chlamydia, 29 states for gonorrhea, and 10 states for syphilis. These 

data were reported in response to CDC’s request for data, as part of the 

Corrections STD Prevalence Monitoring Project and/or the Regional Infertility 

Prevention Project. 

• The tables and figures shown in this section represent 103,595 chlamydia tests in 

men and 60,466 in women; 77,043 gonorrhea tests in men and 44,161 in 

women; and 235,017 syphilis tests in men and 56,200 in women entering 

corrections facilities during 2004. 

Chlamydia 

• In adolescent men entering 81 juvenile corrections facilities, the median 

chlamydia positivity was 5.8% (range 1% to 27.5%) (Table AA). In adolescent 

women entering 56 juvenile corrections facilities, the median chlamydia positivity 

was 14% (range 2.4% to 26.5%); positivity was greater than 10% in 42 of 56 

facilities reporting data. 

• In men entering juvenile corrections facilities, chlamydia positivity increased from 

1.0% for those aged 12 years to 8.0 % for those aged 17 years (Figure DD). For 

those aged 17 years to 19 years, the rates were similar. In women entering 

juvenile corrections facilities, chlamydia positivity increased from 8.5% for those 

aged 12 years to 16.9% for those aged 15 years. 

• In men entering 35 adult corrections facilities, the median chlamydia positivity 

was 10.2% (range 0.7% to 30%) (Table BB). In women entering 32 adult 

corrections facilities, the median positivity for chlamydia was 7.2% (range 1.2% 

to 22.7%). 

STD Surveillance 2004 Special Focus Profiles STDs in Persons Entering Corrections Facilities 79 
• In men entering adult corrections facilities, chlamydia positivity decreased with 

age from 10.7% for those aged 18-19 years to 1.9% for those aged 35 to 65 years 

(Figure EE). Similar trends were also observed in adult women. Although overall 

chlamydia positivity in women entering adult correction facilities was significantly 

lower than in women entering juvenile corrections facilities, chlamydia positivity 

in women aged 18-19 years attending adult corrections facilities was higher than 

in women attending juvenile corrections facilities. Similar patterns were also 

observed for men aged < 20 years entering adult corrections facilities compared 

to men entering juvenile corrections facilities. 

Gonorrhea

• The median positivity for gonorrhea in adolescent men entering 49 juvenile 

corrections facilities was 0.8% (range 0% to 18.2%) (Table CC). The median 

positivity for gonorrhea in women entering 34 juvenile corrections facilities was 

4.5% (range 0% to 16.6%); positivity was greater than 4% in 20 of 34 juvenile 

corrections facilities. 

• In men entering juvenile corrections facilities, gonorrhea positivity increased from 

0.2% for those aged 12 years to 1.4% for those aged 19 years (Figure FF). This 

trend was not observed in adolescent women. 

• In men entering 27 adult corrections facilities, the median positivity was 2.6% 

(range 0% to 33.8%) (Table DD). In women entering 26 adult facilities, the 

median positivity for gonorrhea was 3.0% (range 0% to 8.4%). 

• In women entering adult corrections facilities, gonorrhea positivity decreased 

with age from 9.5% for those aged 18-19 years to 4.2% for those aged 35 to 65 

years (Figure GG). This trend was not observed in adult men. Women aged 18-19 

years attending adult facilities had higher gonorrhea positivity than women 

attending juvenile detention facilities. This was also true for men. 

Syphilis

• The median reactive syphilis serology was 0.5% (range 0% to 2.4%) in adolescent 

men entering 5 corrections facilities and 0.7% (range 0% to 5.1%) in adolescent 

women entering 5 juvenile corrections facilities (Table EE). 

• In men at 24 adult corrections facilities, the median reactive syphilis serology was 

2.7% (range 0.2% to 5.9%) (Table FF). In women entering 19 adult corrections 

facilities the median percentage of reactive syphilis tests by facility was 5.3% 

(range 0% to 19%). 

1	 Heimberger TS. Chang HG. Birkhead GS. DiFerdinando GD. Greenberg AJ. Gunn R. Morse DL. High 

prevalence of syphilis detected through a jail screening program. A potential public health measure to 

address the syphilis epidemic. Arch Intern Med 1993;153:1799-1804. 

2	 Centers for Disease Control and Prevention. Syphilis screening among women arrestees at the Cook 

County Jail – Chicago, 1996. MMWR 1998;47:432-3. 

80 STDs in Persons Entering Corrections Facilities Special Focus Profiles STDSurveillance 2004 
3	 Mertz KJ, Schwebke JR, Gaydos CA, Beideinger HA, Tulloch SD, Levine WC. Screening women in jails 

for chlamydial and gonococcal infection using urine tests: Feasibility, acceptability, prevalence and 

treatment rates. Sexually Transmitted Diseases 2002;29:271-276. 

4	 Kahn R, Voigt R, Swint E, Weinstock H. Early syphilis in the United States identified in corrections 

facilities, 1999-2002. Sexually Transmitted Diseases 2004;31:360-364. 

5	 Blank S, McDonnell DD, Rubin SR et al., New approaches to syphilis control. Finding opportunities for 

syphilis treatment and congenital syphilis prevention in a women’s correctional setting. Sexually 

Transmitted Diseases 1997; 24:218-26. 

STD Surveillance 2004 Special Focus Profiles STDs in Persons Entering Corrections Facilities 81 
Figure DD. Chlamydia — Positivity by age, juvenile corrections facilities, 2004 

Men PositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivity (%) Women 

22.0 17.6 13.2 8.8 4.4 0.0 Age 0.0 4.4 8.8 13.2 17.6 22.0 

1.0 

1.5 

3.2 

4.7 

6.6 

8.0 

7.9 

8.9 

6.1 

12 

13 

14 

15 

16 

17 

18 

19 

Total 

8.5 

11.5 

16.1 

16.9 

16.2 

16.6 

14.3 

14.3 

15.9 

Note: Percent positivity is presented from facilities reporting > 100 test results. 

Figure EE. Chlamydia — Positivity by age, adult corrections facilities, 2004 

Men PositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivity (%) Women 

22.0 17.6 13.2 8.8 4.4 0.0 Age 0.0 4.4 8.8 13.2 17.6 22.0 

10.7 <20 19.8

9.7 20-24 14.8

6.1 25-29 10.4

4.0 30-34 7.2

1.9 >=35 5.0

6.5 Total 9.6

Note: Percent positivity is presented from facilities reporting > 100 test results. 

82 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2004 
Figure FF. Gonorrhea — Positivity by age, juvenile corrections facilities, 2004 

Men PositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivity (%) Women 

22.0 17.6 13.2 8.8 4.4 0.0 Age 0.0 4.4 8.8 13.2 17.6 22.0 

0.2 

0.4 

0.5 

1.0 

1.4 

1.3 

1.4 

1.4 

1.1 

12 

13 

14 

15 

16 

17 

18 

19 

Total 

7.6 

4.3 

5.2 

6.1 

5.8 

5.2 

4.6 

5.1 

5.5 

Note: Percent positivity is presented from facilities reporting > 100 test results. 

Figure GG. Gonorrhea — Positivity by age, adult corrections facilities, 2004 

Men PositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivityPositivity (%) Women 

22.0 17.6 13.2 8.8 4.4 0.0 Age 0.0 4.4 8.8 13.2 17.6 22.0 

3.8 

4.0 

2.8 

3.0 

4.5 

3.7 

<20 

20-24 

25-29 

30-34 

>=35 

Total 

9.5 

6.9 

5.9 

5.1 

4.2 

5.7 

Note: Percent positivity is presented from facilities reporting > 100 test results. 

STD Surveillance 2004 Special Focus Profiles STDs in Persons Entering Corrections Facilities 83 
 

Table AA. Chlamydia — Positivity among men and women in juvenile corrections facilities, 2004 

Men Women 

No. of No. of Median % Positivity No. of No. of Median % Positivity 

State Sites Tests (Range) Sites Tests (Range) 

Alabama 0 0 0 2 399 19.4 (15.4-23.4) 

Arizona 3 4,758 6.5 (6.1-8.3) 4 1,975 15.7 (3.7-21.6) 

California* 20 29,815 3.8 (1.2-12.9) 20 12,582 12.8 (6.3-19.9) 

Connecticut 1 507 3.2 1 163 11.0 

Delaware 1 1,137 5.5 1 290 11.0 

Georgia 2 1,751 17.9 (8.3-27.5) 2 5,417 17.6 (8.8-26.5) 

Illinois 2 4,752 6.6 (4.5-8.7) 1 662 24.3 

Indiana 1 890 6.6 1 292 18.5 

Kentucky 4 819 4.6 (1.4-5.8) 2 393 6.1 (2.4-9.9) 

Maryland 5 2,375 3.8 (1.0-7.8) 1 450 18.9 

Massachusetts 2 944 5.5 (5.2-5.8) 1 310 12.6 

Michigan 3 504 6.8 (5.6-12.7) 1 133 24.1 

Nebraska 1 970 8.8 1 336 17.3 

Nevada 1 120 4.2 0 0 0 

New Jersey 2 2,011 8.6 (5.9-11.2) 1 223 25.1 

New Mexico 1 551 6.7 0 0 0 

New York 8 11,265 6.2 (1.5-10.1) 5 1,059 17.6 (5.2-24.3) 

North Dakota 1 175 6.9 0 0 0 

Ohio 1 802 13.6 1 231 24.7 

Oklahoma 3 536 10.3 (4.3-10.6) 1 148 23.6 

Oregon 3 1,883 4.3 (3.0-10.7) 2 323 11.1 (5.9-16.3) 

Pennsylvania 2 227 5.3 (4.3-6.3) 0 0 0 

South Carolina 1 353 9.6 1 178 11.8 

Texas 3 3,937 6.2 (2.4-11.1) 4 1,719 14.3 (5.0-24.2) 

Utah 2 794 4.4 (4.4-4.4) 1 187 19.3 

Virginia 1 632 10.0 0 0 0 

Washington 5 1,381 5.9 (1.3-8.1) 2 246 12.4 (7.3-17.5) 

Wisconsin 2 746 4.1 (3.1-5.1) 0 0 0 

Total 81 74,635 5.8 (1.0-27.5) 56 27,716 14.0 (2.4-26.5) 

Note: The median positivity is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco. 

Table BB. Chlamydia — Positivity among men and women in adult corrections facilities, 2004 

Men Women 

No. of No. of Median % Positivity No. of No. of Median % Positivity 

State Sites Tests (Range) Sites Tests (Range) 

Arizona 2 348 16.6 (13.1-20.1) 2 3,460 10.3 (8.7-12.0) 

California* 6 4,571 5.3 (3.4-6.3) 5 7,518 8.2 (5.7-19.2) 

Colorado 2 269 15.5 (14.4-16.7) 1 156 11.5 

Delaware 0 0 0 1 564 3.7 

Hawaii 0 0 0 2 313 11.5 (7.1-16.0) 

Illinois 3 9,008 10.2 (2.8-19.0) 4 13,200 8.7 (5.7-10.4) 

Iowa 1 364 14.3 2 635 5.0 (3.0-7.0) 

Massachusetts 3 2,724 7.7 (6.5-10.8) 2 1,245 4.8 (4.7-4.9) 

Michigan 1 105 15.2 1 109 8.3 

Missouri 1 1,422 7.9 2 314 4.9 (4.0-5.7) 

Montana 0 0 0 1 162 1.2 

Nebraska 4 2,096 9.3 (6.6-16.6) 1 253 13.8 

Nevada 1 144 23.6 1 128 22.7 

North Dakota 1 592 5.6 0 0 0 

Oregon 1 132 15.9 1 179 8.4 

Texas 1 426 11.5 2 1,936 6.8 (4.4-9.1) 

Utah 1 110 30.0 0 0 0 

Washington 0 0 0 1 1,258 5.0 

West Virginia 2 988 4.1 (0.7-7.6) 0 0 0 

Wisconsin 5 5,661 12.5 (3.2-19.1) 3 1,320 1.9 (1.8-7.2) 

Total 35 28,960 10.2 (0.7-30.0) 32 32,750 7.2 (1.2-22.7) 

Note: The median positivity is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco. 

84 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2004 
Table CC. Gonorrhea — Positivity among men and women in juvenile corrections facilities, 2004 

Men Women 

No. of No. of Median % Positivity No. of No. of Median % Positivity 

State Sites Tests (Range) Sites Tests (Range) 

Alabama 0 0 0 2 399 11.4 (10.5-12.3) 

California* 7 20,284 0.7 (0.4-0.9) 8 5,909 4.0 (0.7-6.3) 

Connecticut 1 511 0 1 164 1.2 

Delaware 1 820 1.2 1 205 3.4 

Georgia 2 1,748 10.0 (1.7-18.2) 2 5,410 5.7 (2.8-8.7) 

Illinois 2 4754 2.0 (1.5-2.4) 1 663 10.4 

Indiana 1 891 0 1 294 0 

Kentucky 4 817 0.9 (0.5-2.2) 2 394 3.9 (1.0-6.9) 

Maryland 5 2,368 0.5 (0-1.1) 1 448 5.1 

Michigan 2 379 3.7 (3.5-3.8) 1 133 5.3 

Nebraska 1 970 0.7 1 336 2.7 

New Jersey 2 2,014 1.6 (0.8-2.3) 1 222 9.9 

New Mexico 1 551 0.4 0 0 0 

New York 5 9,934 0.8 (0.5-1.4) 3 559 3.9 (3.9-4.1) 

Ohio 1 802 4.1 1 231 11.3 

Oklahoma 3 536 0.5 (0-3.6) 1 145 16.6 

Pennsylvania 1 114 0 0 0 0 

South Carolina 1 353 3.7 1 178 3.9 

Texas 2 2,457 1.3 (1.2-1.5) 3 898 6.4 (6.0-8.2) 

Utah 0 0 0 1 181 4.4 

Washington 5 1,381 0.2 (0-1.8) 2 246 3.5 (1.8-5.1) 

Wisconsin 2 743 0.8 (0-1.7) 0 0 0 

Total 49 52,427 0.8 (0-18.2) 34 17,015 4.5 (0-16.6) 

Note: The median positivity is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco. 

Table DD. Gonorrhea — Positivity among men and women in adult corrections facilities, 2004 

Men Women 

No. of No. of Median % Positivity No. of No. of Median % Positivity 

State Sites Tests (Range) Sites Tests (Range) 

California* 6 4,275 1.4 (0-5.0) 5 7,518 5.0 (1.5-7.1) 

Colorado 2 270 2.5 (1.9-3.0) 1 157 4.5 

Delaware 0 0 0 1 402 1.2 

Hawaii 0 0 0 2 313 5.0 (2.4-7.6) 

Illinois 3 9,011 3.0 (2.6-4.2) 4 13,235 5.7 (1.0-8.4) 

Iowa 1 364 0.8 2 635 2.1 (0.2-3.9) 

Missouri 1 1,421 1.8 2 313 1.9 (1.7-2.2) 

Montana 0 0 0 1 162 0 

Nebraska 4 2,096 1.1 (0-3.7) 1 253 4.7 

Nevada 1 144 13.2 1 128 7.0 

Texas 1 271 5.2 2 1,452 3.6 (1.8-5.3) 

Utah 1 110 13.6 0 0 0 

Washington 0 0 0 1 1,258 0.6 

West Virginia 2 994 31.6 (29.4-33.8) 0 0 0 

Wisconsin 5 5,660 3.5 (0-7.4) 3 1,320 0.9 (0-3.9) 

Total 27 24,616 2.6 (0-33.8) 26 27,146 3.0 (0-8.4) 

Note: The median positivity is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco. 

STD Surveillance 2004 Special Focus Profiles STDs in Persons Entering Corrections Facilities 85 
 

Table EE. Syphilis— Positivity among men and women in juvenile corrections facilities, 2004 

Men Women 

No. of No. of Median % Positivity No. of No. of Median % Positivity 

State Sites Tests (Range) Sites Tests (Range) 

California* 3 14,349 0.5 (0.3-0.5) 3 3,269 0.7 (0.6-0.8) 

Pennsylvania 1 4,723 0 1 827 0 

Texas 1 34,866 2.4 1 8,798 5.1 

Total 5 53,938 0.5 (0.0-2.4) 5 12,894 0.7 (0-5.1) 

Note: The median positivity is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco. 

Table FF. Syphilis— Positivity among men and women in adult corrections facilities, 2004 

Men Women 

No. of No. of Median % Positivity No. of No. of Median % Positivity 

State Sites Tests (Range) Sites Tests (Range) 

California* 1 1,262 4.3 1 595 3.9 

Maryland 1 14,984 2.2 1 3,583 10.0 

Massachusetts 1 3,442 1.3 1 528 1.9 

Mississippi 5 2,594 3.8 (2.6-5.9) 0 0 0 

North Carolina 7 16,997 2.9 (1.7-4.5) 7 3,611 8.3 (5.3-12.4) 

Ohio 3 30,131 0.6 (0.2-1.1) 3 5,012 1.4 (0.0-2.5) 

Pennsylvania 1 22,647 5.7 1 4,433 0.2 

Tennessee 3 24,002 2.5 (2.0-4.2) 3 5,623 6.6 (1.2-19.0) 

Texas 1 63,768 3.3 1 19,210 7.3 

Wisconsin 1 1,252 1.8 1 711 5.2 

Total 24 181,079 2.7 (0.2-5.9) 19 43,306 5.3 (0.0-19.0) 

Note: The median positivity is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco. 

86 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2004 
TABLES 

Table 1. Cases of sexually transmitted diseases reported by state health departments and rates per 100,000 

civilian population: United States, 1941–2004 

Syphilis 

All Stages Chlamydia Gonorrhea Chancroid

Primary

and 

Secondary EarlyLatent 

Late and 

Late Latent† Neurosyphilis Congenital 

Year * Cases Rate 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 NR . 17,600 13.4 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 NR . 16,918 12.8 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 NR . 16,164 12.6 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 NR . 13,578 10.7 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 NR . 12,339 9.7 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 NR . 12,106 9.0 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 NR . 12,200 8.7 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 NR . 13,931 9.7 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 NR . 13,952 9.5 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 NR . 13,377 9.0 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 NR . 11,094 7.4 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 NR . 8,553 5.6 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 NR . 7,675 5.0 NR . 238,340 153.9 3,338 2.2 

1954 130,687 82.9 7,147 4.5 23,861 15.1 89,123 56.5 NR . 6,676 4.2 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 NR . 5,354 3.3 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 NR . 5,491 3.3 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 NR . 5,288 3.1 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 NR . 4,866 2.8 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 NR . 5,130 2.9 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 NR . 4,416 2.5 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 NR . 4,163 2.3 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 NR . 4,070 2.2 NR . 263,714 143.6 1,344 0.7 

1963 124,137 66.6 22,251 11.9 18,235 9.8 78,076 41.9 NR . 4,031 2.2 NR . 278,289 149.2 1,220 0.7 

1964 114,325 60.4 22,969 12.1 17,781 9.4 68,629 36.3 NR . 3,516 1.9 NR . 300,666 159.0 1,247 0.7 

1965 112,842 58.9 23,338 12.2 17,458 9.1 67,317 35.1 NR . 3,564 1.9 NR . 324,925 169.6 982 0.5 

1966 105,159 54.4 21,414 11.1 15,950 8.2 63,541 32.9 NR . 3,170 1.6 NR . 351,738 181.9 838 0.4 

1967 102,581 52.5 21,053 10.8 15,554 8.0 61,975 31.7 NR . 2,894 1.5 NR . 404,836 207.3 784 0.4 

1968 96,271 48.8 19,019 9.6 15,150 7.7 58,564 29.7 NR . 2,381 1.2 NR . 464,543 235.7 845 0.4 

1969 92,162 46.3 19,130 9.6 15,402 7.7 54,587 27.4 NR . 2,074 1.0 NR . 534,872 268.6 1,104 0.6 

1970 91,382 45.3 21,982 10.9 16,311 8.1 50,348 24.9 NR . 1,953 1.0 NR . 600,072 297.2 1,416 0.7 

1971 95,997 46.9 23,783 11.6 19,417 9.5 49,993 24.4 NR . 2,052 1.0 NR . 670,268 327.2 1,320 0.6 

1972 91,149 43.9 24,429 11.8 20,784 10.0 43,456 20.9 NR . 1,758 0.8 NR . 767,215 369.7 1,414 0.7 

1973 87,469 41.7 24,825 11.8 23,584 11.3 37,054 17.7 NR . 1,527 0.7 NR . 842,621 402.0 1,165 0.6 

1974 83,771 39.6 25,385 12.0 25,124 11.9 31,854 15.1 NR . 1,138 0.5 NR . 906,121 428.2 945 0.4 

1975 80,356 37.6 25,561 12.0 26,569 12.4 27,096 12.7 NR . 916 0.4 NR . 999,937 467.7 700 0.3 

1976 71,761 33.2 23,731 11.0 25,363 11.7 21,905 10.1 NR . 626 0.3 NR . 1,001,994 464.1 628 0.3 

1977 64,621 29.6 20,399 9.4 21,329 9.8 22,313 10.2 NR . 463 0.2 NR . 1,002,219 459.5 455 0.2 

1978 64,875 29.4 21,656 9.8 19,628 8.9 23,038 10.4 NR . 434 0.2 NR . 1,013,436 459.7 521 0.2 

1979 67,049 30.1 24,874 11.2 20,459 9.2 21,301 9.6 NR . 332 0.1 NR . 1,004,058 450.3 840 0.4 

1980 68,832 30.5 27,204 12.1 20,297 9.0 20,979 9.3 NR . 277 0.1 NR . 1,004,029 445.1 788 0.3 

1981 72,799 32.0 31,266 13.7 21,033 9.2 20,168 8.9 NR . 287 0.1 NR . 990,864 435.2 850 0.4 

1982 75,579 32.9 33,613 14.6 21,894 9.5 19,799 8.6 NR . 259 0.1 NR . 960,633 417.9 1,392 0.6 

1983 74,637 32.1 32,698 14.1 23,738 10.2 17,896 7.7 NR . 239 0.1 NR . 900,435 387.6 847 0.4 

1984 69,872 29.6 28,607 12.1 23,131 9.8 17,829 7.6 NR . 305 0.1 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 NR . 329 0.1 25,848 17.4 911,419 383.0 2,067 0.9 

STD Surveillance 2004 National Summary Tables 87 
Table 1. Cases of sexually transmitted diseases reported by state health departments and rates per 100,000 

civilian population: United States, 1941–2004 (continued)

Primary 

and Early

Syphilis

Late and

All Stages Secondary Latent Late Latent

† Neurosyphilis Congenital Chlamydia Gonorrhea Chancroid

Year

* Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

1986 67,779 28.2 27,667 11.5 21,656 9.0 18,046 7.5 NR . 410 0.2 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 NR . 480 0.2 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 NR . 741 0.3 157,854 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 NR . 1,837 0.7 200,904 102.5 733,294 297.1 4,697 1.9

1990 135,590 54.3 50,578 20.3 55,397 22.2 25,750 10.3 NR . 3,865 1.5 323,663 160.2 690,042 276.4 4,212 1.7

1991 128,719 50.9 42,950 17.0 53,855 21.3 27,490 10.9 NR . 4,424 1.7 381,228 179.7 621,918 245.8 3,476 1.4

1992 114,730 44.7 34,009 13.3 49,929 19.5 26,725 10.4 NR . 4,067 1.6 409,694 182.3 502,858 196.0 1,906 0.7

1993 102,612 39.5 26,527 10.2 41,919 16.1 30,746 11.8 NR . 3,420 1.3 405,332 178.0 444,649 171.1 1,292 0.5

1994 82,713 31.4 20,641 7.8 32,017 12.2 27,603 10.5 NR . 2,452 0.9 451,785 192.5 419,602 163.9 782 0.3

1995 69,357 26.0 16,543 6.2 26,657 10.0 24,296 9.1 NR . 1,861 0.7 478,577 187.8 392,651 147.5 607 0.2

1996 53,238 19.8 11,405 4.2 20,187 7.5 20,366 7.6 NR . 1,280 0.5 492,631 190.6 328,169 121.8 386 0.1

1997 46,714 17.1 8,556 3.1 16,631 6.1 20,447 7.5 193 0.1 1,080 0.4 537,904 205.5 327,665 120.2 246 0.1

1998 38,288 13.9 7,007 2.5 12,696 4.6 17,743 6.4 279 0.1 842 0.3 614,250 231.8 356,492 129.2 189 0.1

1999 35,380 12.7 6,617 2.4 11,534 4.1 16,653 6.0 341 0.1 576 0.2 662,647 247.2 360,813 129.3 110 0.0

2000 31,618 11.2 5,979 2.1 9,465 3.4 15,594 5.5 334 0.1 580 0.2 709,452 251.4 363,136 128.7 78 0.0

2001 32,281 11.3 6,103 2.1 8,701 3.0 16,976 5.9 324 0.1 501 0.2 783,242 274.5 361,705 126.8 38 0.0

2002 32,916 11.4 6,862 2.4 8,429 2.9 17,168 6.0 387 0.1 457 0.2 834,555 289.4 351,852 122.0 48 0.0

2003 34,289 11.8 7,177 2.5 8,361 2.9 18,319 6.3 541 0.2 432 0.1 877,478 301.7 335,104 115.2 54 0.0

2004 33,401 11.5 7,980 2.7 7,768 2.7 17,300 5.9 833 0.3 353 0.1 929,462 319.6 330,132 113.5 30 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.

†

Late and late latent syphilis includes cases of unknown duration, late syphilis with clinical manifestations, and neurosyphilis.

§

For 1941-1994, rates include all cases of congenitally acquired syphilis per 100,000 population. As of 1995, rates of congenital syphilis < 1 year of age per 100,000 population are reported. For rates of congenital syphilis < 1 year of age per 100,000 live births see Tables 39-44. As of 1995,

cases of congenital syphilis < 1 year of age are obtained in hardcopy and electronic format based on case reporting form CDC 73.126.

Note: Adjustments to the number of cases reported from state health departments were made for hardcopy forms and for electronic data submissions 

through April 29, 2005 (see Appendix). The number of cases and the rates shown here supersede those published in previous reports. Cases and 

rates shown in this table exclude the outlying areas of Guam, Puerto Rico and Virgin Islands.

NR = No report.

88 National Summary Tables STD Surveillance 2004
* Rank State Cases Rate per 100,000 Population 

1 Mississippi 18,863 654.7 

2 Alaska 3,954 609.4 

3 Louisiana 21,837 485.7 

4 New Mexico 9,035 482.0 

5 South Carolina 18,423 444.2 

6 Hawaii 5,307 422.0 

7 Michigan 41,246 409.2 

8 Georgia 34,280 394.7 

9 Tennessee 22,515 385.4 

10 Missouri 21,319 373.7 

11 Illinois 47,185 372.9 

12 Maryland 19,952 362.2 

13 Delaware 2,954 361.3 

14 Wisconsin 19,217 351.2 

15 North Carolina 28,967 344.5 

16 California 122,197 344.4 

17 Ohio 39,379 344.3 

18 South Dakota 2,532 331.3 

19 Rhode Island 3,442 319.8 

U.S. TOTAL† 929,462 319.6 

20 Texas 70,232 317.5 

21 Colorado 14,151 311.0 

22 New York 59,097 308.0 

23 Pennsylvania 38,025 307.5 

24 Nebraska 5,238 301.2 

25 Arizona 16,786 300.8 

26 Nevada 6,690 298.5 

27 Indiana 18,440 297.6 

28 Alabama 13,314 295.8 

29 Oklahoma 10,366 295.2 

30 Virginia 21,635 292.9 

31 Arkansas 7,864 288.5 

32 Washington 17,635 287.6 

33 North Dakota 1,810 285.6 

34 Montana 2,608 284.2 

35 Kansas 7,493 275.1 

36 Connecticut 9,552 274.2 

37 Florida 42,554 250.0 

38 Oregon 8,690 244.1 

39 Iowa 6,956 236.3 

40 Minnesota 11,602 229.3 

41 Wyoming 1,082 215.9 

42 Massachusetts 13,242 205.8 

43 Idaho 2,784 203.8 

44 New Jersey 17,448 202.0 

45 Vermont 1,137 183.6 

46 Utah 3,857 164.0 

47 Maine 2,113 161.8 

48 Kentucky 6,470 157.1 

49 West Virginia 2,758 152.3 

50 New Hampshire 1,736 134.8 

Table 2. Chlamydia — Reported cases and rates by state, ranked by rates: United States, 2004 

*

States were ranked in descending order by rate, number of cases, and alphabetically by state. 

†

Total includes cases reported by Washington, D.C., but excludes outlying areas (Guam with 748 cases and rate of 457.2, Puerto Rico with 3,588 

cases and rate of 92.5, and Virgin Islands with 303 cases and rate of 278.5). 

STD Surveillance 2004 Chlamydia Tables 89 
Table 3. Chlamydia — Reported cases and rates by state/area and region listed in alphabetical order: United 

States and outlying areas, 2000–2004 

State/Area 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004 2000 2001 2002 2003 2004 

Alabama 15,323 14,524 15,611 14,209 13,314 344.2 325.0 348.0 315.7 295.8 

Alaska 2,569 2,744 3,806 3,900 3,954 409.3 433.1 591.2 601.1 609.4 

Arizona 12,591 14,346 14,973 12,819 16,786 243.7 270.3 274.4 229.7 300.8 

Arkansas 6,219 7,280 7,312 7,856 7,864 232.2 270.2 269.8 288.2 288.5 

California 95,392 101,944 110,288 117,428 122,197 280.5 294.6 314.1 330.9 344.4 

Colorado* 12,000 13,239 14,028 13,039 14,151 277.3 298.8 311.3 286.5 311.0 

Connecticut 7,604 7,718 9,808 9,393 9,552 222.9 224.7 283.4 269.7 274.2 

Delaware 2,856 2,793 2,649 3,035 2,954 363.1 350.6 328.1 371.3 361.3 

Florida 33,390 37,625 42,058 42,382 42,554 208.0 229.8 251.6 249.0 250.0 

Georgia 29,359 33,840 33,998 35,686 34,280 356.5 402.6 397.2 410.9 394.7

Hawaii 3,547 4,031 4,521 5,480 5,307 292.5 328.5 363.2 435.7 422.0 

Idaho 1,907 2,023 2,503 2,366 2,784 146.7 153.2 186.6 173.2 203.8 

Illinois 40,350 43,716 48,101 48,294 47,185 324.3 349.2 381.7 381.7 372.9 

Indiana 14,063 15,258 17,100 17,075 18,440 230.8 249.0 277.6 275.6 297.6 

Iowa 5,987 5,699 6,195 6,491 6,956 204.4 194.4 210.9 220.5 236.3 

Kansas 6,056 6,050 6,784 7,249 7,493 224.9 223.9 249.8 266.2 275.1 

Kentucky 8,063 8,881 8,756 7,981 6,470 199.1 218.3 213.9 193.8 157.1 

Louisiana 17,846 17,840 18,442 20,970 21,837 399.3 399.1 411.4 466.4 485.7 

Maine 1,474 1,338 1,805 2,030 2,113 115.4 104.2 139.4 155.5 161.8 

Maryland 14,533 15,640 16,891 16,831 19,952 273.6 290.4 309.5 305.5 362.2

Massachusetts 10,967 10,402 10,914 11,301 13,242 172.4 162.5 169.8 175.7 205.8 

Michigan 26,237 31,090 32,272 32,572 41,246 263.5 310.7 321.1 323.1 409.2

Minnesota 8,102 8,323 10,107 10,714 11,602 164.2 167.0 201.3 211.8 229.3 

Mississippi 12,697 11,793 11,800 12,193 18,863 445.7 412.4 410.9 423.2 654.7

Missouri 13,448 13,949 16,181 18,570 21,319 239.9 247.4 285.2 325.5 373.7 

Montana 1,469 1,919 2,475 2,547 2,608 162.6 212.0 272.1 277.6 284.2 

Nebraska 3,791 3,206 4,779 4,739 5,238 221.3 186.4 276.4 272.5 301.2 

Nevada 4,019 4,831 5,936 5,830 6,690 199.1 230.3 273.1 260.1 298.5 

New Hampshire 1,130 1,383 1,557 1,616 1,736 91.1 109.8 122.1 125.5 134.8 

New Jersey 10,814 16,312 14,164 16,169 17,448 128.2 191.7 164.9 187.2 202.0

New Mexico 5,204 6,254 7,417 7,480 9,035 285.7 341.6 399.8 399.0 482.0 

New York† 31,494 46,393 51,123 57,222 59,097 165.8 243.1 266.9 298.2 308.0 

North Carolina 21,985 22,101 24,726 26,187 28,967 272.0 269.3 297.2 311.5 344.5 

North Dakota 909 1,062 1,256 1,655 1,810 141.8 166.8 198.1 261.1 285.6 

Ohio 31,190 37,653 38,032 42,522 39,379 274.5 330.6 333.0 371.8 344.3 

Oklahoma 9,331 10,478 10,804 11,013 10,366 270.1 302.0 309.2 313.6 295.2 

Oregon 7,107 7,454 7,009 7,688 8,690 207.1 214.6 199.0 216.0 244.1 

Pennsylvania 26,475 28,371 31,791 37,291 38,025 215.5 230.6 257.7 301.6 307.5

Rhode Island 2,632 2,912 2,832 3,000 3,442 250.5 274.8 264.7 278.8 319.8 

South Carolina 9,950 15,329 14,314 14,623 18,423 247.3 377.4 348.5 352.6 444.2 

South Dakota 1,834 1,821 2,215 2,608 2,532 242.7 240.1 291.0 341.2 331.3 

Tennessee 15,069 15,560 16,042 20,380 22,515 264.2 270.6 276.7 348.9 385.4 

Texas 68,814 69,752 69,521 69,200 70,232 328.4 326.4 319.2 312.9 317.5 

Utah 2,190 3,004 3,540 3,893 3,857 97.6 131.8 152.8 165.6 164.0 

Vermont 526 638 954 1,060 1,137 86.2 104.1 154.7 171.2 183.6 

Virginia 15,352 18,337 18,518 19,439 21,635 216.0 254.8 253.9 263.2 292.9

Washington 13,066 13,631 14,934 16,797 17,635 221.0 227.4 246.1 273.9 287.6 

West Virginia 2,144 2,346 2,464 2,585 2,758 118.6 130.3 136.7 142.8 152.3

Wisconsin 16,365 16,284 17,000 17,942 19,217 304.5 301.2 312.4 327.9 351.2 

Wyoming 807 839 944 960 1,082 163.3 169.9 189.3 191.5 215.9 

U.S. TOTAL§ 709,452 783,242 834,555 877,478 929,462 251.4 274.5 289.4 301.7 319.6 

Northeast 93,116 115,467 124,948 139,082 145,792 173.5 214.0 230.4 255.7 268.0 

Midwest 168,332 184,111 200,022 210,431 222,417 261.0 284.0 307.1 321.7 340.1 

South 286,136 307,405 317,211 327,738 346,477 284.5 301.5 306.9 313.5 331.4 

West 161,868 176,259 192,374 200,227 214,776 255.0 272.9 293.0 301.2 323.1 

Guam 

Puerto Rico 

Virgin Islands 

525 

2,695 

131 

431 

2,748 

131 

550 

2,999 

207 

554 

2,746 

416 

748 

3,588 

303 

338.0 

70.6 

120.6 

272.2 

71.6 

119.7 

341.5 

77.7 

188.1 

338.6 

70.8 

382.3 

457.2 

92.5 

278.5 

OUTLYING AREAS 3,351 3,310 3,756 3,716 4,639 82.1 80.6 90.9 89.5 111.8 

TOTAL 712,803 786,552 838,311 881,194 934,101 249.0 271.8 286.6 298.7 316.7 

*

The number of chlamydia cases occurring in the fourth quarter of 2000 for the State of Colorado was projected based on case counts from the first 

three quarters. 

†

New York City has been reporting chlamydia cases since 1984. The State of New York, with the exception of New York City, initiated chlamydia 

reporting during the year 2000. The number of chlamydia cases reported in 2000 by the state of New York may be incomplete and the rate for New 

York State is underestimated. See Appendix (Chlamydia Morbidity Reporting). 

§

Includes cases reported by Washington, D.C., and rates exclude population of states that did not report. 

90 Chlamydia Tables STD Surveillance 2004 
Table 4. Chlamydia — Women – Reported cases and rates by state/area and region listed in alphabetical 

order: United States and outlying areas, 2000–2004 

State/Area 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004 2000 2001 2002 2003 2004 

Alabama 13,746 13,375 13,988 12,977 11,685 596.9 579.0 603.6 559.0 503.3 

Alaska 1,863 1,981 2,576 2,665 2,671 614.6 647.0 829.2 850.0 851.9 

Arizona 10,008 11,193 11,665 10,043 12,896 386.8 421.3 427.2 360.1 462.3 

Arkansas 5,015 5,949 5,817 6,284 6,252 365.8 431.6 419.8 451.5 449.2 

California 72,178 76,261 81,218 85,967 88,439 423.0 439.5 461.5 483.7 497.6 

Colorado* 8,748 9,894 10,422 9,843 10,283 407.4 449.8 466.0 436.4 455.9 

Connecticut 6,238 6,260 7,738 7,309 7,383 354.7 353.8 434.4 407.8 412.0 

Delaware 2,271 2,125 2,034 2,155 2,140 561.2 518.8 490.1 513.9 510.3 

Florida 27,562 30,647 33,902 34,581 34,437 335.4 365.9 396.9 398.2 396.5 

Georgia 24,067 27,905 27,494 28,992 27,656 575.4 654.1 633.2 659.2 628.8

Hawaii 2,757 3,053 3,445 4,113 4,019 456.8 499.2 554.9 655.9 640.9 

Idaho 1,435 1,469 1,862 1,762 2,157 221.4 223.0 278.2 258.5 316.5 

Illinois 31,771 33,124 34,154 36,284 35,996 500.4 518.7 531.7 563.1 558.6 

Indiana 10,935 11,668 13,151 13,118 14,217 352.4 374.1 419.7 416.6 451.5 

Iowa 4,480 4,295 4,680 4,915 5,208 300.3 287.7 313.1 328.5 348.1 

Kansas 4,973 4,977 5,653 5,989 6,195 365.2 364.4 412.0 436.1 451.1 

Kentucky 6,466 7,081 7,043 6,353 5,027 312.3 340.6 336.8 302.5 239.4 

Louisiana 14,099 14,416 14,758 17,046 17,549 611.2 625.3 638.8 736.6 758.4 

Maine 1,143 1,040 1,337 1,452 1,532 174.3 157.7 201.3 217.0 229.0 

Maryland 12,099 12,863 13,851 13,746 16,108 440.5 462.1 491.3 483.5 566.5

Massachusetts 8,452 7,897 8,177 8,429 9,781 256.4 238.3 245.9 253.7 294.3 

Michigan 20,905 24,550 25,129 25,903 32,624 412.0 481.7 491.2 505.1 636.2

Minnesota 5,856 6,010 7,352 7,866 8,521 235.1 238.9 290.3 308.4 334.1 

Mississippi 11,005 10,258 10,274 10,536 15,097 746.9 694.4 692.8 709.5 1,016.6

Missouri 11,525 11,854 13,253 14,750 16,306 400.2 409.5 455.3 504.8 558.0 

Montana 1,097 1,466 1,840 1,865 1,916 242.0 322.7 403.2 405.4 416.4 

Nebraska 3,018 2,521 3,609 3,435 3,812 347.4 289.2 412.1 390.3 433.2 

Nevada 3,124 3,586 4,365 4,268 4,857 315.5 348.4 409.3 388.3 441.8 

New Hampshire 889 1,042 1,168 1,196 1,265 141.0 162.9 180.4 183.1 193.7 

New Jersey 9,486 14,352 12,183 13,813 14,491 218.5 327.8 275.9 311.5 326.8

New Mexico 4,171 4,891 5,918 5,973 6,876 450.4 525.4 627.6 627.3 722.1 

New York† 26,928 38,297 41,202 43,907 44,975 273.6 387.8 415.9 442.9 453.7 

North Carolina 18,625 18,628 20,384 21,807 23,916 451.8 445.2 480.9 509.9 559.2 

North Dakota 663 716 826 1,087 1,206 206.5 224.6 260.1 342.8 380.3 

Ohio 25,105 29,521 29,558 33,549 30,377 429.5 504.2 503.7 571.6 517.5 

Oklahoma 7,715 8,600 8,764 8,990 8,237 439.2 488.0 494.1 505.0 462.7 

Oregon 5,192 5,442 5,033 5,590 6,090 300.2 311.0 283.8 312.1 340.0 

Pennsylvania 21,389 22,521 23,546 27,557 27,740 336.7 354.3 369.7 432.1 435.0

Rhode Island 1,969 2,197 2,057 2,232 2,502 360.7 399.3 370.6 400.2 448.6 

South Carolina 8,721 13,528 12,468 12,745 15,925 421.4 647.8 590.4 598.8 748.2 

South Dakota 1,308 1,311 1,608 1,864 1,824 343.6 343.3 419.7 484.9 474.5 

Tennessee 11,648 12,105 12,625 14,669 16,237 398.1 410.7 424.9 490.7 543.2 

Texas 56,817 57,611 57,438 57,549 57,470 538.6 535.8 524.4 518.0 517.3 

Utah 1,610 2,119 2,494 2,787 2,720 143.9 186.5 216.0 238.0 232.3 

Vermont 432 523 746 828 861 138.9 167.3 237.3 262.8 273.3 

Virginia 12,976 15,177 15,102 15,535 16,578 358.5 414.0 406.8 413.8 441.5 

Washington 9,583 10,159 11,003 12,341 12,835 322.8 337.6 361.2 401.4 417.5 

West Virginia 1,790 1,969 2,072 2,102 2,105 192.8 212.9 224.0 226.6 227.0

Wisconsin 12,352 12,045 12,296 12,838 13,913 454.2 440.5 446.9 464.3 503.2 

Wyoming 667 679 755 717 820 271.7 276.8 304.7 288.1 329.4 

U.S. TOTAL§ 569,658 623,958 652,858 685,017 716,675 396.3 429.6 445.0 463.6 485.0 

Northeast 76,926 94,129 98,154 106,723 110,530 277.4 337.9 350.8 380.7 394.2 

Midwest 132,891 142,592 151,269 161,598 170,199 404.1 431.7 455.9 485.6 511.4 

South 237,408 255,044 260,839 268,762 279,367 462.3 490.3 495.0 505.0 524.9 

West 122,433 132,193 142,596 147,934 156,579 385.2 408.8 434.0 445.1 471.1 

Guam 

Puerto Rico 

Virgin Islands 

430 

2,226 

108 

347 

2,313 

116 

463 

2,665 

188 

446 

2,378 

352 

608 

3,240 

232 

566.5 

112.5 

190.3 

448.1 

116.1 

199.4 

587.4 

133.1 

317.5 

556.8 

118.1 

619.0 

759.0 

160.9 

408.0 

OUTLYING AREAS 2,764 2,776 3,316 3,176 4,080 130.9 130.5 154.9 147.6 189.7 

TOTAL 572,422 626,734 656,174 688,193 720,755 392.4 425.3 440.8 459.0 480.7 

*The number of chlamydia cases occurring in the fourth quarter of 2000 for the State of Colorado was projected based on case counts from the first 

three quarters. 

†

New York City has been reporting chlamydia cases since 1984. The State of New York, with the exception of New York City, initiated chlamydia 

reporting during the year 2000. The number of chlamydia cases reported in 2000 by the state of New York may be incomplete and the rate for New 

York State is underestimated. See Appendix (Chlamydia Morbidity Reporting). 

§

Includes cases reported by Washington, D.C., and rates exclude population of states that did not report. Cases reported with unknown sex are not 

included in this table. 

STD Surveillance 2004 Chlamydia Tables 91 
Table 5. Chlamydia — Men – Reported cases and rates by state/area and region listed in alphabetical order: 

United States and outlying areas, 2000–2004 

State/Area 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004 2000 2001 2002 2003 2004 

Alabama 1,432 1,124 1,579 1,201 1,603 66.6 52.1 72.8 55.1 73.6 

Alaska 706 763 1,230 1,235 1,283 217.5 233.0 369.2 368.3 382.7 

Arizona 2,583 3,153 3,308 2,772 3,884 100.1 119.0 121.4 99.3 139.1 

Arkansas 1,204 1,325 1,486 1,567 1,612 92.1 100.7 112.2 117.5 120.9 

California 22,759 24,930 28,400 31,238 33,323 134.3 144.5 162.1 176.4 188.1 

Colorado* 3,251 3,328 3,604 3,196 3,855 149.2 149.1 158.8 139.2 168.0 

Connecticut 1,366 1,445 2,070 2,084 2,168 82.6 86.8 123.3 123.2 128.2 

Delaware 585 668 615 880 814 153.2 172.6 156.7 221.0 204.5 

Florida 5,828 6,967 8,156 7,801 8,117 74.4 87.1 99.8 93.6 97.4 

Georgia 5,102 5,926 6,363 6,509 6,411 125.9 143.2 150.9 151.8 149.6

Hawaii 777 977 1,076 1,367 1,288 127.6 158.7 172.4 216.8 204.3 

Idaho 462 528 641 604 617 70.9 79.8 95.4 88.2 90.1 

Illinois 8,578 10,588 13,942 12,009 11,187 140.8 172.6 225.7 193.4 180.2 

Indiana 3,093 3,555 3,845 3,803 4,080 103.5 118.2 127.1 124.8 133.9 

Iowa 1,505 1,401 1,505 1,561 1,743 104.7 97.3 104.4 107.8 120.4 

Kansas 1,083 1,073 1,131 1,260 1,298 81.4 80.3 84.2 93.3 96.1 

Kentucky 1,513 1,779 1,706 1,613 1,433 76.5 89.4 85.2 79.9 71.0 

Louisiana 3,747 3,424 3,525 3,808 4,016 173.2 158.1 162.3 174.5 184.0 

Maine 331 297 468 577 581 53.3 47.5 74.3 90.6 91.3 

Maryland 2,379 2,777 3,029 3,068 3,841 92.7 106.7 114.8 115.1 144.1 

Massachusetts 2,515 2,502 2,724 2,848 3,449 82.1 81.1 87.8 91.6 110.9 

Michigan 5,331 6,540 7,143 6,669 8,622 109.2 133.2 144.8 134.7 174.1

Minnesota 2,246 2,313 2,755 2,848 3,081 91.9 93.7 110.8 113.5 122.8 

Mississippi 1,647 1,535 1,526 1,657 3,766 119.7 111.0 109.9 118.7 269.7

Missouri 1,923 2,095 2,928 3,820 5,013 70.6 76.4 106.0 137.3 180.2 

Montana 371 449 625 679 685 82.4 99.5 137.9 148.4 149.7 

Nebraska 769 680 1,128 1,244 1,391 91.1 80.1 132.2 144.8 161.9 

Nevada 893 1,239 1,558 1,552 1,821 86.8 115.9 140.7 135.9 159.5 

New Hampshire 241 341 389 420 471 39.5 55.0 62.0 66.2 74.2 

New Jersey 1,279 1,948 1,962 2,332 2,945 31.3 47.1 47.0 55.5 70.1 

New Mexico 1,001 1,237 1,464 1,485 2,151 111.8 137.4 160.5 161.0 233.2 

New York† 4,436 8,042 9,885 13,106 14,031 48.4 87.3 106.8 141.3 151.3 

North Carolina 3,359 3,473 4,340 4,379 5,051 84.8 86.4 106.3 106.0 122.3 

North Dakota 246 346 429 567 601 76.9 108.9 135.5 179.0 189.7 

Ohio 5,819 7,603 7,926 8,215 8,189 105.5 137.4 142.7 147.6 147.1 

Oklahoma 1,616 1,878 2,040 2,023 2,129 95.2 110.0 118.6 116.8 123.0 

Oregon 1,915 2,012 1,976 2,098 2,600 112.5 116.7 113.1 118.6 147.0 

Pennsylvania 5,086 5,850 8,244 9,682 10,282 85.7 98.4 138.2 161.7 171.7

Rhode Island 663 715 775 768 936 131.3 140.3 150.6 148.1 180.6 

South Carolina 1,127 1,731 1,800 1,813 2,456 57.7 87.7 90.2 89.8 121.7 

South Dakota 523 510 606 742 708 139.4 135.5 160.3 195.3 186.4 

Tennessee 3,421 3,455 3,417 5,711 6,278 123.2 123.3 120.9 200.2 220.1 

Texas 11,829 12,033 11,964 11,594 12,619 113.7 113.3 110.5 105.3 114.6 

Utah 580 882 1,044 1,103 1,137 51.6 77.2 89.9 93.4 96.3 

Vermont 94 115 208 232 276 31.5 38.3 68.8 76.3 90.8 

Virginia 2,359 3,107 3,416 3,868 5,024 67.7 88.0 95.4 106.5 138.3 

Washington 3,483 3,472 3,931 4,456 4,800 118.3 116.3 130.0 145.8 157.0 

West Virginia 350 371 386 472 649 39.8 42.3 44.0 53.5 73.5

Wisconsin 4,006 4,191 4,669 5,015 5,290 150.9 156.9 173.6 185.2 195.4 

Wyoming 140 160 189 243 262 56.3 64.4 75.3 96.3 103.8 

U.S. TOTAL§ 137,957 157,304 179,585 190,244 210,396 99.6 112.3 126.8 133.0 147.1 

Northeast 16,011 21,255 26,725 32,049 35,139 61.7 81.5 101.8 121.6 133.3 

Midwest 35,122 40,895 48,007 47,753 51,203 111.1 128.7 150.2 148.6 159.4 

South 47,903 52,024 55,807 58,414 66,348 97.3 104.2 110.2 113.8 129.3 

West 38,921 43,130 49,046 52,028 57,706 122.8 133.7 149.5 156.6 173.7 

Guam 

Puerto Rico 

Virgin Islands 

95 

469 

23 

84 

435 

15 

87 

334 

19 

108 

368 

64 

140 

348 

71 

119.6 

25.5 

44.3 

103.8 

23.5 

29.3 

105.8 

18.0 

37.4 

129.4 

19.7 

123.2 

167.7 

18.7 

136.7 

OUTLYING AREAS 587 534 440 540 559 29.8 27.0 22.1 27.0 27.9 

TOTAL 138,544 157,838 180,025 190,784 210,955 98.7 111.1 125.3 131.5 145.4 

*The number of chlamydia cases occurring in the fourth quarter of 2000 for the State of Colorado was projected based on case counts from the first 

three quarters. 

†

New York City has been reporting chlamydia cases since 1984. The State of New York, with the exception of New York City, initiated chlamydia 

reporting during the year 2000. The number of chlamydia cases reported in 2000 by the state of New York may be incomplete and the rate for New 

York State is underestimated. See Appendix (Chlamydia Morbidity Reporting). 

§

Includes cases reported by Washington, D.C., and rates exclude population of states that did not report. Cases reported with unknown sex are not 

included in this table. 

92 Chlamydia Tables STD Surveillance 2004 
10

20

30

40

50

60

Table 6. Chlamydia — Reported cases and rates in selected cities ranked by rates: United States, 2004 

Rank* City† Cases Rate per 100,000 Population 

1 Detroit, MI 12,718 1,358.3 

2 St Louis, MO 4,130 1,243.1 

3 Richmond, VA 2,326 1,194.5 

4 Rochester, NY 2,862 1,156.2 

5 Philadelphia, PA 16,723 1,130.4 

6 Kansas City, MO 5,033 1,105.6 

7 Baltimore, MD 6,651 1,057.9 

8 Buffalo, NY 3,152 987.8 

9 Milwaukee, WI 9,131 978.4 

New Orleans, LA 4,347 926.8 

11 Memphis, TN 7,535 831.5 

12 Newark, NJ 2,331 772.4 

13 Albuquerque, NM 4,406 757.8 

14 Indianapolis, IN 6,124 709.4 

15 Chicago, IL 21,603 703.3 

16 Denver, CO 3,840 688.8 

17 Minneapolis, MN 2,630 682.0 

18 Boston, MA 4,018 680.8 

19 Norfolk, VA 1,629 673.9 

Atlanta, GA 5,388 658.4 

21 Washington, DC 3,493 618.9 

22 Omaha, NE 2,785 584.2 

23 Toledo, OH 2,606 573.7 

24 Oklahoma City, OK 2,430 558.1 

25 Cincinnati, OH 4,574 555.5 

26 San Antonio, TX 6,695 550.8 

27 Jacksonville, FL 4,396 537.8 

28 Birmingham, AL 3,404 517.2 

29 Fort Worth, TX 2,965 512.6 

Houston, TX 10,196 501.8 

31 Portland, OR 2,623 490.5 

32 Dallas, TX 5,852 483.4 

33 Honolulu, HI 4,347 481.6 

34 San Francisco, CA 3,618 481.3 

35 Austin, TX 3,244 479.0 

36 Sacramento, CA 6,227 467.9 

37 Nashville, TN 2,664 467.5 

38 Corpus Christi, TX 1,297 464.9 

39 Tulsa, OK 1,766 442.4 

Jersey City, NJ 1,041 433.9 

41 New York City, NY 34,378 425.2 

42 Los Angeles, CA 38,441 416.0 

43 Charlotte, NC 3,053 405.8 

44 El Paso, TX 2,234 382.5 

45 Wichita, KS 1,765 381.3 

46 Cleveland, OH 5,151 377.7 

47 San Diego, CA 10,876 371.1 

48 Columbus, OH 3,883 356.6 

49 Dayton, OH 1,950 353.1 

Des Moines, IA 1,340 344.8 

51 Oakland, CA 4,938 338.0 

52 Pittsburgh, PA 4,253 337.2 

53 San Jose, CA 5,545 330.4 

54 Phoenix, AZ 10,599 312.7 

55 Seattle, WA 5,334 302.8 

56 Tampa, FL 2,964 276.1 

57 Yonkers, NY 531 262.7 

58 St Petersburg, FL 2,425 261.8 

59 Louisville, KY 1,758 251.5 

Tucson, AZ 2,209 247.4 

61 Akron, OH 1,247 228.1 

62 Miami, FL 4,933 210.7 

63 St Paul, MN 556 197.1 

*Cities were ranked in descending order by rate, number of cases, and alphabetically by state. City-specific STD incidence rates should be considered 

estimates since population data may be estimated from county census data, approximating city jurisdictions for many areas. See Appendix 

(Reporting of City-specific Surveillance Data). 

†

Excludes cities in outlying areas (San Juan, PR, with 1,133 cases and rate of 110.3). 

STD Surveillance 2004 Chlamydia Tables 93 
Table 7. Chlamydia — Reported cases and rates in selected cities listed in alphabetical order: United States 

and outlying areas, 2000–2004 

City 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004
 2000 2001 2002 2003 2004 

Akron, OH 990 1,162 1,249 1,316 1,247
 182.1 213.2 228.6 240.7 228.1 

Albuquerque, NM 2,368 3,139 3,531 3,390 4,406 424.7 557.8 615.5 583.0 757.8

Atlanta, GA 5,558 6,426 5,560 5,999 5,388
 679.8 778.7 673.6 733.1 658.4 

Austin, TX 3,113 3,317 3,678 3,393 3,244
 491.7 507.9 547.2 501.0 479.0 

Baltimore, MD 5,433 5,405 6,267 6,413 6,651
 837.4 837.6 981.3 1,020.1 1,057.9 

Birmingham, AL 3,601 2,957 3,650 2,698 3,404 543.9 447.0 552.1 409.9 517.2

Boston, MA 3,229 2,935 3,320 3,751 4,018
 539.7 488.6 555.0 635.6 680.8 

Buffalo, NY* 722 2,379 2,217 2,318 3,152
 224.3 741.3 692.0 726.4 987.8 

Charlotte, NC 1,873 1,936 2,778 3,046 3,053
 267.4 268.6 376.4 404.9 405.8 

Chicago, IL 19,792 22,420 24,673 23,466 21,603 641.1 725.6 799.3 763.9 703.3

Cincinnati, OH 4,715 4,594 4,566 4,471 4,574
 558.6 546.8 547.7 542.9 555.5 

Cleveland, OH 3,961 4,811 4,924 5,447 5,151
 284.5 347.2 357.1 399.4 377.7 

Columbus, OH 4,298 4,850 4,581 4,155 3,883
 401.0 448.5 421.5 381.6 356.6 

Corpus Christi, TX 1,525 1,458 1,433 1,241 1,297 549.8 526.7 514.5 444.9 464.9

Dallas, TX 9,976 10,249 9,561 6,892 5,852 835.8 843.8 789.8 569.3 483.4 

Dayton, OH 1,176 2,066 1,723 1,939 1,950 210.6 371.6 310.7 351.1 353.1

Denver, CO 3,164 4,186 4,546 3,743 3,840
 568.5 743.2 811.2 671.4 688.8 

Des Moines, IA 1,075 1,122 1,322 1,456 1,340
 286.0 294.8 342.8 374.7 344.8 

Detroit, MI 9,989 11,552 11,374 10,405 12,718
 1,050.9 1,219.2 1,204.8 1,111.3 1,358.3 

El Paso, TX 2,225 2,356 2,287 2,145 2,234
 393.6 412.2 396.0 367.2 382.5 

Fort Worth, TX 4,214 4,142 4,005 3,067 2,965
 782.8 750.8 706.8 530.2 512.6 

Honolulu, HI 2,932 3,473 3,801 4,558 4,347
 334.7 392.8 424.2 504.9 481.6 

Houston, TX 12,213 11,289 11,768 9,119 10,196
 651.1 590.2 585.5 448.8 501.8 

Indianapolis, IN 5,506 6,611 6,593 6,565 6,124 639.8 765.4 763.6 760.5 709.4

Jacksonville, FL 3,501 3,551 3,926 4,566 4,396 449.0 448.0 487.0 558.5 537.8 

Jersey City, NJ 624 893 678 923 1,041 259.2 368.2 280.7 384.7 433.9

Kansas City, MO 3,128 2,747 3,348 4,351 5,033 691.4 605.0 734.3 955.8 1,105.6 

Los Angeles, CA 31,074 32,706 35,544 37,363 38,441 347.7 361.1 387.2 404.4 416.0

Louisville, KY 1,656 1,952 2,176 2,084 1,758 238.6 280.5 311.7 298.1 251.5 

Memphis, TN 4,967 5,418 5,548 6,468 7,535 552.9 601.8 612.6 713.8 831.5

Miami, FL 3,032 3,800 4,711 4,431 4,933
 134.1 165.5 202.0 189.3 210.7 

Milwaukee, WI 9,018 8,224 8,553 8,416 9,131
 959.7 876.3 912.7 901.8 978.4 

Minneapolis, MN 2,652 2,614 2,868 2,847 2,630
 689.6 675.9 742.9 738.3 682.0 

Nashville, TN 2,403 2,086 2,157 2,653 2,664
 421.5 365.2 377.9 465.6 467.5 

New Orleans, LA 3,817 3,871 4,340 4,675 4,347
 789.2 809.1 916.2 996.7 926.8 

New York City, NY 26,170 29,649 33,063 35,369 34,378 326.4 367.8 409.0 437.4 425.2

Newark, NJ 1,567 2,408 2,092 2,211 2,331
 521.6 798.6 691.4 732.6 772.4 

Norfolk, VA 1,093 1,475 1,350 1,263 1,629
 466.2 626.5 564.8 522.5 673.9 

Oakland, CA 4,975 4,682 4,623 4,880 4,938
 342.9 317.4 314.0 334.0 338.0 

Oklahoma City, OK 2,060 2,444 2,622 2,509 2,430 483.4 570.2 605.4 576.3 558.1

Omaha, NE 1,935 1,719 2,312 2,475 2,785 416.5 367.0 489.1 519.2 584.2 

Philadelphia, PA 13,584 13,628 14,458 17,747 16,723 897.2 907.5 968.9 1,199.7 1,130.4

Phoenix, AZ 7,987 8,953 9,697 7,766 10,599 257.9 279.6 293.5 229.1 312.7 

Pittsburgh, PA 2,885 3,444 4,145 4,175 4,253 225.4 270.3 326.4 331.0 337.2

Portland, OR 2,306 2,355 2,272 2,363 2,623
 441.8 445.6 425.0 441.9 490.5 

Richmond, VA 2,230 2,082 2,108 2,054 2,326
 1,129.2 1,052.8 1,067.6 1,054.8 1,194.5 

Rochester, NY* 115 1,064 1,625 3,026 2,862
 46.5 430.1 655.0 1,222.4 1,156.2 

Sacramento, CA 4,599 4,442 4,749 5,326 6,227
 373.7 350.3 363.9 400.2 467.9 

San Antonio, TX 5,871 5,749 5,777 6,193 6,695
 510.9 492.8 483.6 509.5 550.8 

San Diego, CA 8,591 9,166 10,286 10,432 10,876 304.1 319.4 353.9 355.9 371.1

San Francisco, CA 3,093 3,030 3,345 3,332 3,618
 398.1 390.5 437.8 443.3 481.3 

San Jose, CA 3,908 4,118 4,360 4,681 5,545
 231.7 242.8 259.0 278.9 330.4 

Seattle, WA 4,495 4,295 4,469 5,168 5,334
 258.5 244.9 254.0 293.4 302.8 

St Louis, MO 2,711 3,195 3,206 3,502 4,130
 781.4 932.1 947.5 1,054.1 1,243.1 

St Paul, MN 1,639 1,506 1,798 1,743 556
 575.3 527.1 632.2 618.0 197.1 

St Petersburg, FL 1,834 1,884 2,294 2,325 2,425 198.9 203.7 247.5 251.0 261.8

Tampa, FL 2,714 2,535 3,407 3,071 2,964 270.5 246.7 323.3 286.1 276.1 

Toledo, OH 1,646 2,244 2,465 1,850 2,606 361.8 493.8 543.5 407.3 573.7 

Tucson, AZ 1,786 2,700 2,580 2,426 2,209 210.4 312.7 292.8 271.7 247.4 

Tulsa, OK 1,770 1,720 1,885 1,972 1,766 448.5 433.3 471.3 494.0 442.4 

Washington, DC 3,205 3,286 3,305 3,168 3,493 560.7 572.7 578.9 561.4 618.9 

Wichita, KS 1,457 1,465 1,602 1,818 1,765 321.2 320.6 346.8 392.7 381.3 

Yonkers, NY* 379 373 456 534 531 190.4 186.0 226.3 264.1 262.7 

U.S. CITY TOTAL† 296,125 318,308 339,607 343,149 353,163 424.3 451.8 478.1 481.8 495.8 

San Juan, PR 966 1,076 1,058 803 1,133 94.6 105.2 103.2 78.2 110.3 

TOTAL 297,091 319,384 340,665 343,952 354,296 419.5 446.9 472.8 476.0 490.3 

*New York City has been reporting chlamydia cases since 1984. The State of New York, with the exception of New York City, initiated chlamydia reporting 

during the year 2000. Therefore, the number of chlamydia cases reported in 2000 by the cities of Buffalo, Rochester and Yonkers may be incomplete and 

their 2000 case rates may be underestimated. See Appendix (Chlamydia Morbidity Reporting and Reporting of City-specific Surveillance Data). 

†

Rates exclude population of cities that did not report. NR=No report 

94 Chlamydia Tables STD Surveillance 2004 
Table 8. Chlamydia — Women – Reported cases and rates in selected cities listed in alphabetical order: 

United States and outlying areas, 2000–2004 

City 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004
 2000 2001 2002 2003 2004 

Akron, OH 769 916 963 939 958
 272.9 324.4 340.3 332.0 338.7 

Albuquerque, NM 1,815 2,368 2,788 2,659 3,236 636.2 823.0 951.5 895.6 1,090.0 

Atlanta, GA 4,468 5,152 4,349 4,630 4,203
 1,076.4 1,229.7 1,037.3 1,118.0 1,014.9 

Austin, TX 2,432 2,633 2,923 2,583 2,411
 787.0 826.2 891.3 786.4 734.0 

Baltimore, MD 4,828 4,825 5,490 5,533 5,582
 1,394.8 1,400.1 1,608.1 1,646.8 1,661.4 

Birmingham, AL 2,792 2,524 2,833 2,362 2,641 797.7 722.0 811.5 681.3 761.8

Boston, MA 2,360 2,086 2,423 2,634 2,768
 762.0 670.6 781.9 863.7 907.6 

Buffalo, NY* 528 1,731 1,637 1,749 2,364
 314.4 1,034.6 980.9 1,053.2 1,423.6 

Charlotte, NC 1,498 1,484 2,179 2,487 2,439
 420.2 404.9 581.6 653.2 640.6 

Chicago, IL 15,631 16,756 16,589 17,264 16,288 981.7 1,052.0 1,043.1 1,092.4 1,030.7

Cincinnati, OH 3,938 3,740 3,711 3,576 3,615
 891.6 851.4 852.0 832.5 841.6 

Cleveland, OH 3,183 3,635 3,718 4,081 3,791
 433.3 497.6 511.6 568.1 527.8 

Columbus, OH 3,185 3,336 3,127 3,254 3,046
 577.9 600.6 560.6 583.7 546.4 

Corpus Christi, TX 1,292 1,233 1,210 1,062 1,051 912.2 871.5 849.6 744.8 737.0

Dallas, TX 7,726 8,083 7,529 5,536 4,560 1,293.4 1,331.7 1,246.5 919.6 757.5 

Dayton, OH 863 1,595 1,244 1,449 1,411 297.2 552.0 431.8 505.8 492.6

Denver, CO 2,190 2,962 3,181 2,648 2,612
 795.6 1,063.5 1,148.3 964.0 950.9 

Des Moines, IA 789 814 968 1,047 983
 407.9 415.9 488.7 525.8 493.6 

Detroit, MI 7,716 9,137 8,976 8,832 10,642
 1,535.3 1,824.1 1,798.6 1,786.0 2,152.0 

El Paso, TX 1,881 1,936 1,966 1,843 1,896
 642.7 653.8 656.3 607.1 624.6 

Fort Worth, TX 3,317 3,277 3,179 2,484 2,429
 1,220.6 1,177.8 1,113.6 854.2 835.3 

Honolulu, HI 2,239 2,574 2,829 3,350 3,239
 513.1 583.5 632.7 743.2 718.6 

Houston, TX 10,222 9,473 9,777 7,532 8,339
 1,085.9 987.5 970.7 741.1 820.5 

Indianapolis, IN 3,896 4,552 4,633 4,770 4,548 876.8 1,020.9 1,039.8 1,072.8 1,022.9

Jacksonville, FL 2,809 2,865 2,984 3,521 3,236 699.7 702.4 719.9 837.8 769.9 

Jersey City, NJ 605 818 618 858 989 493.8 663.0 503.0 705.2 812.9

Kansas City, MO 2,763 2,396 2,773 3,184 3,589 1,178.4 1,018.7 1,174.7 1,353.5 1,525.6 

Los Angeles, CA 23,056 24,358 25,587 26,645 27,315 510.1 532.1 551.9 570.9 585.2

Louisville, KY 1,301 1,511 1,696 1,581 1,273 359.2 416.2 465.9 435.2 350.4 

Memphis, TN 3,943 4,378 4,546 4,944 5,735 840.3 930.8 961.1 1,047.0 1,214.5

Miami, FL 2,449 3,079 3,804 3,574 3,955
 209.6 259.6 316.1 296.1 327.6 

Milwaukee, WI 7,077 6,308 6,323 6,132 6,672
 1,446.9 1,291.8 1,297.5 1,266.4 1,377.9 

Minneapolis, MN 1,759 1,716 1,907 1,928 1,817
 901.2 874.4 973.8 988.4 931.5 

Nashville, TN 1,758 1,537 1,604 1,862 1,828
 597.8 521.3 544.5 636.0 624.4 

New Orleans, LA 2,772 2,958 3,305 3,702 3,389
 1,078.6 1,164.1 1,313.7 1,488.5 1,362.6 

New York City, NY 22,663 25,118 27,177 27,490 26,572 537.1 592.7 640.0 648.0 626.4

Newark, NJ 1,330 2,117 1,724 1,884 1,856
 845.0 1,340.5 1,088.5 1,194.9 1,177.1 

Norfolk, VA 964 1,251 1,172 1,068 1,313
 841.3 1,089.4 1,012.1 919.2 1,130.1 

Oakland, CA 3,851 3,562 3,562 3,770 3,811
 521.7 474.4 475.2 508.1 513.6 

Oklahoma City, OK 1,686 1,941 2,007 1,985 1,897 768.5 880.6 901.5 888.5 849.2

Omaha, NE 1,516 1,346 1,738 1,764 2,061 639.0 563.2 721.4 727.7 850.3 

Philadelphia, PA 10,724 10,833 10,308 12,812 11,699 1,323.5 1,349.0 1,292.1 1,620.4 1,479.6

Phoenix, AZ 6,195 6,841 7,509 6,028 8,183 400.2 427.9 455.7 357.4 485.2 

Pittsburgh, PA 2,398 2,798 3,204 3,179 3,192 355.9 417.6 480.2 480.5 482.5

Portland, OR 1,597 1,651 1,527 1,589 1,693
 605.9 619.5 567.0 590.3 629.0 

Richmond, VA 1,900 1,752 1,723 1,551 1,604
 1,800.7 1,655.6 1,630.7 1,487.7 1,538.6 

Rochester, NY* 86 807 1,218 2,128 1,949
 67.1 630.2 949.3 1,662.6 1,522.8 

Sacramento, CA 3,391 3,279 3,583 3,897 4,539
 539.7 506.7 538.3 575.2 669.9 

San Antonio, TX 4,767 4,632 4,654 5,149 5,382
 807.9 773.9 759.8 827.5 865.0 

San Diego, CA 6,371 6,510 7,285 7,694 7,908 453.6 455.9 504.0 528.8 543.5

San Francisco, CA 1,819 1,723 1,827 1,659 1,762
 475.6 450.3 484.0 448.1 475.9 

San Jose, CA 2,948 3,017 3,150 3,366 3,922
 354.3 360.5 379.0 407.7 475.0 

Seattle, WA 3,006 2,905 2,994 3,434 3,568
 343.9 329.6 338.5 388.6 403.7 

St Louis, MO 2,362 2,787 2,665 2,955 3,186
 1,284.1 1,533.6 1,485.6 1,680.2 1,811.5 

St Paul, MN 1,154 1,098 1,318 1,267 403
 781.6 742.0 895.5 868.3 276.2 

St Petersburg, FL 1,511 1,522 1,844 1,887 1,951 313.0 314.6 380.6 390.5 403.7

Tampa, FL 2,319 2,112 2,774 2,446 2,444 452.7 403.0 516.7 448.1 447.7 

Toledo, OH 1,348 1,801 1,944 1,464 2,043 570.7 764.2 827.4 623.7 870.3 

Tucson, AZ 1,411 2,058 1,927 1,835 1,566 325.4 466.1 427.4 402.5 343.5 

Tulsa, OK 1,485 1,406 1,561 1,613 1,426 730.7 688.9 759.9 788.7 697.2 

Washington, DC 2,786 2,807 2,825 2,695 2,948 921.0 925.4 937.8 903.6 988.4 

Wichita, KS 1,134 1,166 1,315 1,507 1,417 494.4 504.5 562.8 645.3 606.8 

Yonkers, NY* 327 326 380 431 415 314.9 312.2 362.6 410.5 395.3 

U.S. CITY TOTAL† 232,899 247,912 258,284 260,782 265,560 650.5 686.4 709.7 715.7 728.8 

San Juan, PR 761 901 925 670 989 143.3 169.3 173.5 125.4 185.1 

TOTAL 233,660 248,813 259,209 261,452 266,549 643.1 678.8 702.0 707.2 721.0 

*New York City has been reporting chlamydia cases since 1984. The State of New York, with the exception of New York City, initiated chlamydia reporting 

during the year 2000. Therefore, the number of chlamydia cases reported in 2000 by the cities of Buffalo, Rochester and Yonkers may be incomplete and 

their 2000 case rates may be underestimated. See Appendix (Chlamydia Morbidity Reporting and Reporting of City-specific Surveillance Data). 

†

Rates exclude population of cities that did not report. Cases reported with unknown sex are not included in this table. NR = No report. 

STD Surveillance 2004 Chlamydia Tables 95 
Table 9. Chlamydia — Men – Reported cases and rates in selected cities listed in alphabetical order: United 

States and outlying areas, 2000–2004 

City 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004
 2000 2001 2002 2003 2004 

Akron, OH 216 243 271 294 275
 82.5 92.5 102.9 111.4 104.2 

Albuquerque, NM 521 654 723 716 1,164 191.3 237.8 257.6 251.6 409.1 

Atlanta, GA 1,079 1,273 1,185 1,337 1,145
 268.1 313.4 291.7 330.8 283.3 

Austin, TX 676 683 751 802 752
 208.6 204.2 218.2 230.0 215.6 

Baltimore, MD 550 580 777 880 1,069
 181.7 192.9 261.4 300.7 365.2 

Birmingham, AL 700 433 815 333 763 224.3 138.8 261.2 106.9 245.0

Boston, MA 869 849 896 1,111 1,248 301.1 293.1 310.8 389.5 437.6 

Buffalo, NY* 194 648 580 569 788 126.1 421.9 377.9 371.8 514.9 

Charlotte, NC 375 452 599 559 614 109.0 127.6 164.9 150.4 165.2 

Chicago, IL 4,160 5,660 8,084 6,201 5,314 278.2 378.0 540.3 415.8 356.3 

Cincinnati, OH 748 818 820 857 904
 185.9 204.0 206.0 217.6 229.5 

Cleveland, OH 748 1,145 1,179 1,336 1,322
 113.7 174.8 180.7 206.9 204.8 

Columbus, OH 1,071 1,434 1,396 861 799
 205.6 272.7 263.9 162.0 150.3 

Corpus Christi, TX 233 225 223 179 246 171.6 166.3 163.9 131.3 180.4

Dallas, TX 2,151 2,105 2,001 1,352 1,283 360.8 346.4 329.9 222.2 210.8 

Dayton, OH 302 460 475 484 527 112.6 172.3 178.3 182.1 198.3

Denver, CO 974 1,219 1,363 1,095 1,222
 346.2 428.1 480.9 387.2 432.1 

Des Moines, IA 286 307 351 404 356
 156.7 166.0 187.1 213.2 187.9 

Detroit, MI 2,273 2,415 2,398 1,573 2,076
 507.4 540.8 538.9 356.0 469.9 

El Paso, TX 343 420 320 301 338
 125.8 152.4 115.1 107.3 120.5 

Fort Worth, TX 888 858 813 577 534
 333.1 313.8 289.1 200.6 185.6 

Honolulu, HI 683 898 972 1,208 1,108
 155.4 202.7 216.6 267.3 245.2 

Houston, TX 1,971 1,804 1,981 1,581 1,825
 210.9 189.2 197.6 155.7 179.7 

Indianapolis, IN 1,604 2,045 1,909 1,741 1,569 385.4 489.3 456.8 415.9 374.8

Jacksonville, FL 692 686 942 1,045 1,160 182.9 178.3 240.5 263.1 292.1 

Jersey City, NJ 19 72 58 63 50 16.1 60.4 48.9 53.3 42.3

Kansas City, MO 365 351 575 1,167 1,444 167.5 160.4 261.5 530.6 656.5 

Los Angeles, CA 8,000 8,307 9,910 10,676 11,054 181.1 185.4 218.1 233.5 241.8

Louisville, KY 352 439 477 499 481 106.1 131.8 142.8 148.6 143.3 

Memphis, TN 1,024 1,040 1,002 1,524 1,800 238.6 241.9 231.6 351.2 414.8 

Miami, FL 583 721 907 857 978
 53.3 64.9 80.3 75.6 86.2 

Milwaukee, WI 1,935 1,881 2,210 2,222 2,459
 429.5 417.8 491.3 494.9 547.7 

Minneapolis, MN 893 898 961 919 813
 471.5 471.4 505.2 482.2 426.6 

Nashville, TN 645 549 553 791 836
 233.7 198.7 200.2 285.5 301.7 

New Orleans, LA 1,045 913 972 957 909
 461.0 407.0 437.7 434.4 412.6 

New York City, NY 3,377 4,477 5,850 7,670 7,716 88.9 117.1 152.4 199.6 200.8

Newark, NJ 234 291 366 325 473
 163.6 202.6 253.9 225.5 328.2 

Norfolk, VA 129 222 178 192 313
 107.6 184.1 144.4 152.9 249.3 

Oakland, CA 1,075 1,080 1,050 1,110 1,119
 150.8 149.1 145.3 154.4 155.6 

Oklahoma City, OK 374 503 615 524 533 180.9 241.6 292.2 247.2 251.4

Omaha, NE 416 373 569 704 715 183.0 162.6 245.5 300.5 305.2 

Philadelphia, PA 2,860 2,795 4,150 4,935 5,024 406.4 400.0 597.6 716.6 729.5 

Phoenix, AZ 1,792 2,112 2,188 1,737 2,414 115.7 131.7 132.1 102.0 141.8 

Pittsburgh, PA 487 646 941 994 1,061 80.3 106.9 156.1 165.7 176.9

Portland, OR 709 704 745 774 930
 274.4 268.8 280.8 291.4 350.1 

Richmond, VA 329 329 385 501 721
 357.8 357.8 419.4 553.7 796.9 

Rochester, NY* 29 257 407 898 913
 24.3 215.4 339.7 751.1 763.7 

Sacramento, CA 1,171 1,101 1,137 1,396 1,644
 194.4 177.3 177.8 213.7 251.7 

San Antonio, TX 1,096 1,110 1,121 1,043 1,310
 196.0 195.4 192.6 175.8 220.8 

San Diego, CA 2,072 2,232 2,641 2,715 2,844 145.8 154.8 180.7 184.0 192.7

San Francisco, CA 1,274 1,307 1,499 1,643 1,823 323.0 332.3 387.7 430.7 477.9 

San Jose, CA 937 1,065 1,155 1,299 1,592 109.6 124.0 135.5 152.3 186.7 

Seattle, WA 1,489 1,390 1,475 1,734 1,766 172.1 159.3 168.6 197.6 201.2 

St Louis, MO 349 408 541 547 944 214.1 253.4 340.3 349.9 603.8 

St Paul, MN 485 408 480 476 153 353.3 296.2 349.9 349.7 112.4 

St Petersburg, FL 323 362 450 438 474 73.5 82.1 101.8 98.9 107.0 

Tampa, FL 395 423 633 625 520 80.4 84.0 122.4 118.5 98.6 

Toledo, OH 288 430 509 379 551 131.7 196.6 232.9 172.7 251.1 

Tucson, AZ 375 642 653 590 640 90.3 152.2 151.7 135.0 146.5 

Tulsa, OK 285 314 324 359 340 148.9 162.8 166.6 184.4 174.6 

Washington, DC 405 451 459 450 529 150.5 166.7 170.2 169.1 198.8 

Wichita, KS 323 299 287 311 348 144.1 132.4 125.7 135.6 151.7 

Yonkers, NY* 52 47 76 103 116 54.6 48.9 78.6 106.0 119.4 

U.S. CITY TOTAL† 62,298 69,263 80,333 81,543 86,751 183.3 201.8 231.9 234.4 249.3 

San Juan, PR 205 175 133 133 144 41.8 35.6 27.0 27.0 29.2 

TOTAL 62,503 69,438 80,466 81,676 86,895 181.3 199.4 229.1 231.5 246.3 

*New York City has been reporting chlamydia cases since 1984. The State of New York, with the exception of New York City, initiated chlamydia reporting 

during the year 2000. Therefore, the number of chlamydia cases reported in 2000 by the cities of Buffalo, Rochester and Yonkers may be incomplete and 

their 2000 case rates may be underestimated. See Appendix (Chlamydia Morbidity Reporting and Reporting of City-specific Surveillance Data). 

†

Rates exclude population of cities that did not report. Cases reported with unknown sex are not included in this table. NR = No report. 

96 Chlamydia Tables STD Surveillance 2004 
Table 10. Chlamydia — Reported cases and rates per 100,000 population by age and sex: United States, 

2000–2004 

Year Age 

Group 

Cases Rates 

Total Male Female Total Male Female 

2000 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

14,468 

266,583 

249,360 

94,263 

39,509 

18,935 

8,442 

5,601 

1,110 

997 

931 

35,415 

50,103 

24,507 

12,216 

6,791 

3,318 

2,499 

494 

339 

13,537 

231,167 

199,257 

69,756 

27,292 

12,144 

5,123 

3,102 

617 

658 

70.2 

1,318.6 

1,302.8 

489.3 

191.9 

83.7 

37.5 

14.7 

4.5 

2.8 

8.8 

340.8 

512.2 

251.4 

117.9 

60.2 

29.7 

13.4 

4.2 

2.3 

134.8 

2,352.5 

2,129.1 

732.8 

266.8 

107.1 

45.1 

16.0 

4.9 

3.2 

TOTAL 701,339 137,233 564,106 248.5 99.1 392.4 

2001 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

15,031 

288,333 

285,589 

106,914 

45,255 

21,516 

9,940 

6,415 

1,282 

919 

1,042 

39,064 

58,597 

27,896 

14,493 

7,953 

4,124 

2,943 

638 

313 

13,989 

249,269 

226,992 

79,018 

30,763 

13,563 

5,816 

3,472 

644 

606 

71.9 

1,422.4 

1,448.8 

562.0 

217.7 

96.4 

43.6 

16.4 

5.1 

2.6 

9.7 

374.8 

581.3 

289.1 

138.4 

71.4 

36.4 

15.3 

5.2 

2.1 

137.2 

2,531.3 

2,357.0 

842.8 

298.0 

121.4 

50.6 

17.4 

4.9 

2.9 

TOTAL 783,127 157,623 625,504 274.5 112.5 430.7 

2002 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

15,294 

299,863 

305,400 

116,422 

50,339 

23,411 

11,405 

7,644 

1,451 

812 

1,076 

42,433 

66,991 

32,497 

16,847 

9,298 

5,122 

3,652 

746 

296 

14,218 

257,429 

238,408 

83,925 

33,492 

14,113 

6,283 

3,992 

705 

516 

72.4 

1,471.6 

1,510.9 

613.7 

240.2 

106.8 

49.6 

19.1 

5.5 

2.3 

9.9 

405.2 

647.3 

337.1 

159.5 

84.9 

44.9 

18.6 

5.8 

2.0 

137.9 

2,599.0 

2,417.1 

899.3 

322.2 

128.8 

54.2 

19.6 

5.1 

2.5 

TOTAL 834,503 180,039 654,464 289.4 127.1 446.1 

2003 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

14,911 

310,505 

324,411 

124,890 

53,572 

24,658 

12,287 

8,214 

1,653 

776 

1,061 

44,331 

71,476 

34,916 

17,810 

9,772 

5,675 

4,012 

883 

323 

13,849 

266,175 

252,936 

89,974 

35,762 

14,886 

6,612 

4,202 

770 

453 

70.4 

1,516.3 

1,565.1 

651.6 

258.7 

115.2 

53.5 

20.1 

5.9 

2.2 

9.8 

421.4 

670.3 

357.3 

170.4 

91.1 

49.8 

20.0 

6.6 

2.2 

134.0 

2,672.5 

2,513.3 

957.7 

348.7 

139.4 

57.2 

20.2 

5.3 

2.2 

TOTAL 877,478 190,723 686,755 301.7 133.3 464.7 

2004 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

14,817 

323,246 

344,159 

137,041 

56,759 

26,486 

13,626 

9,251 

1,885 

755 

1,172 

48,209 

79,410 

39,374 

19,353 

10,647 

6,397 

4,602 

993 

335 

13,646 

275,036 

264,749 

97,667 

37,406 

15,839 

7,229 

4,649 

892 

420 

69.9 

1,578.5 

1,660.4 

714.9 

274.1 

123.7 

59.3 

22.7 

6.8 

2.1 

10.8 

458.3 

744.7 

402.9 

185.2 

99.3 

56.1 

23.0 

7.4 

2.2 

132.0 

2,761.5 

2,630.7 

1,039.5 

364.8 

148.3 

62.6 

22.4 

6.2 

2.0 

TOTAL 929,462 210,935 718,527 319.6 147.5 486.2 

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the distribution of cases 

for which age was known. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9 

year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

STD Surveillance 2004 Chlamydia Tables 97 
Table 11A. Chlamydia — Reported cases by race/ethnicity, age group and sex: United States, 2000–2004 

Age 

Group 

White, Non-Hispanic 

Total Male Female 

Black, Non-Hispanic 

Total Male Female Total 

Hispanic 

Male Female 

Asian/Pacific Islander 

Total Male Female 

American Indian/ 

Alaska Native 

Total Male Female 

10-14 3,140 110 3,031 7,428 536 6,892 2,044 194 1,850 180 13 167 288 12 276 

15-19 74,657 6,965 67,691 117,722 18,296 99,426 39,526 5,986 33,540 3,865 484 3,381 4,634 597 4,037 

20-24 67,922 12,108 55,814 104,067 22,997 81,070 43,525 8,741 34,785 4,379 820 3,559 4,268 627 3,641 

200025-29 

30-34 

35-39 

21,679 5,274 16,406 

8,389 2,523 5,867 

4,249 1,621 2,628 

37,556 11,151 26,404 

15,044 5,620 9,424 

7,423 3,105 4,318 

20,619 

9,168 

3,782 

4,694 

2,237 

1,024 

15,925 

6,931 

2,758 

2,117 535 1,582 

1,141 270 871 

633 172 461 

1,784 313 1,470 

872 181 690 

497 105 393 

40-44 2,090 862 1,228 3,234 1,512 1,723 1,544 468 1,076 283 93 190 247 57 189 

45-54 1,385 689 696 2,068 1,140 927 968 279 689 231 86 145 183 41 141 

55-64 313 167 146 372 193 178 153 46 107 54 22 32 45 14 31 

65+ 295 114 181 378 131 247 137 39 99 31 21 10 14 2 12 

TOTAL 184,555 30,554 154,001 296,248 64,943 231,306 121,849 23,840 98,009 12,932 2,522 10,410 12,865 1,967 10,898 

10-14 3,203 122 3,081 7,271 523 6,748 2,176 225 1,951 134 7 127 245 12 233 

15-19 79,923 7,591 72,331 122,896 19,374 103,522 42,630 6,852 35,778 3,907 514 3,393 4,820 601 4,220 

20-24 79,134 14,649 64,485 115,191 26,365 88,827 49,029 10,255 38,774 4,815 905 3,910 4,255 683 3,572 

2001

25-29 

30-34 

35-39 

24,529 6,214 18,315 

9,779 3,137 6,642 

4,814 1,909 2,905 

41,444 12,463 28,981 

16,909 6,553 10,356 

8,034 3,577 4,457 

23,461 

10,347 

4,478 

5,493 

2,698 

1,193 

17,968 

7,649 

3,285 

2,364 536 1,828 

1,140 291 848 

639 213 426 

1,978 373 1,605 

878 150 728 

488 102 385 

40-44 2,369 1,057 1,311 3,795 1,904 1,892 1,833 536 1,297 286 85 202 247 59 189 

45-54 1,631 831 800 2,492 1,352 1,140 962 299 663 209 61 149 184 52 132 

55-64 371 191 179 479 291 188 169 62 107 44 17 28 24 8 17 

65+ 199 63 136 371 149 222 143 43 100 29 13 16 6 4 2 

TOTAL 206,348 35,882 170,467 319,667 72,769 246,898 135,617 27,792 107,824 13,590 2,646 10,943 13,164 2,049 11,115 

10-14 3,349 94 3,255 8,245 665 7,580 2,308 234 2,074 160 6 153 291 13 278 

15-19 87,116 8,455 78,660 138,051 22,908 115,143 48,145 7,609 40,536 3,927 479 3,448 5,158 698 4,461 

20-24 91,120 17,951 73,169 130,338 31,430 98,908 56,493 12,380 44,113 5,821 1,137 4,684 5,089 847 4,242 

200225-29 

30-34 

35-39 

29,455 7,780 21,674 

11,867 3,978 7,889 

5,723 2,500 3,223 

47,920 15,117 32,803 

20,437 8,111 12,326 

9,450 4,329 5,121 

27,621 

12,636 

5,554 

6,808 

3,259 

1,611 

20,813 

9,377 

3,943 

2,922 709 2,213 

1,621 446 1,176 

833 224 610 

2,175 434 1,741 

1,067 214 853 

574 146 428 

40-44 2,892 1,422 1,469 4,821 2,503 2,319 2,350 740 1,609 446 114 332 332 89 243 

45-54 2,129 1,165 964 3,142 1,690 1,452 1,404 435 970 384 130 253 198 57 141 

55-64 410 282 128 580 309 271 269 88 182 82 23 59 36 10 26 

65+ 226 68 158 376 166 210 141 37 104 20 7 13 10 4 7 

TOTAL 234,839 43,913 190,925 364,513 87,744 276,769 157,458 33,453 124,005 16,276 3,300 12,976 14,981 2,538 12,444 

10-14 3,336 116 3,219 8,320 721 7,600 2,210 166 2,044 145 7 139 302 19 283 

15-19 93,457 8,820 84,637 147,549 25,606 121,944 48,899 7,407 41,493 4,071 445 3,627 5,517 815 4,702 

20-24 103,138 20,467 82,671 138,950 34,080 104,871 58,996 12,572 46,424 6,046 1,156 4,890 5,428 1,001 4,427 

200325-29 

30-34 

35-39 

33,634 9,219 24,415 

13,149 4,309 8,839 

6,091 2,586 3,505 

52,640 16,408 36,232 

22,401 8,645 13,756 

10,340 4,799 5,541 

28,313 

13,001 

5,728 

6,876 

3,502 

1,644 

21,437 

9,499 

4,084 

3,120 810 2,310 

1,830 493 1,337 

876 252 624 

2,385 477 1,908 

1,066 238 828 

630 158 472 

40-44 3,331 1,689 1,642 5,339 2,859 2,480 2,355 733 1,622 434 124 310 339 75 264 

45-54 2,420 1,347 1,073 3,440 1,879 1,561 1,418 454 964 378 131 247 210 55 155 

55-64 524 326 198 635 361 273 293 113 180 89 33 56 51 15 36 

65+ 277 112 165 301 144 158 130 37 93 22 14 8 17 3 14 

TOTAL 259,808 49,115 210,693 390,660 95,741 294,918 161,629 33,576 128,053 17,042 3,469 13,573 15,964 2,859 13,105 

10-14 3,193 122 3,071 8,497 758 7,740 2,148 222 1,927 117 5 112 266 31 236 

15-19 94,906 9,448 85,457 157,175 28,113 129,062 49,315 7,746 41,569 3,292 432 2,860 5,542 776 4,766 

20-24 109,044 22,116 86,928 149,309 38,276 111,033 59,662 13,423 46,240 5,388 1,126 4,262 5,800 1,169 4,631 

200425-29 

30-34 

35-39 

37,633 10,480 27,153 

13,781 4,557 9,224 

6,497 2,712 3,784 

58,383 18,576 39,807 

24,062 9,626 14,436 

11,285 5,255 6,030 

29,318 

13,262 

5,908 

7,386 

3,558 

1,771 

21,932 

9,703 

4,137 

2,735 703 2,032 

1,633 460 1,173 

863 288 575 

2,605 548 2,057 

1,205 287 919 

645 160 485 

40-44 3,795 1,937 1,858 5,879 3,135 2,745 2,523 825 1,698 452 148 304 331 90 241 

45-54 2,503 1,337 1,165 4,174 2,315 1,859 1,407 500 907 437 166 271 264 81 183 

55-64 585 356 229 786 439 346 292 117 174 79 24 55 40 7 33 

65+ 253 117 136 280 141 140 117 37 80 23 6 17 19 7 11 

TOTAL 272,560 53,302 219,258 420,546 106,853 313,693 164,182 35,654 128,528 15,034 3,359 11,675 16,741 3,164 13,577 

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 sex-specific 

cases and rates and overall totals. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these 

variables were specified. For the following years the states listed did not report age and/or race/ethnicity for most cases and their case data and population 

denominators were excluded: 2000 (CO, DC, MI, NY); 2001 (CO, DC, MD, NJ, NY); 2002 (MI, NJ); 2003 (CO, DC, NJ); 2004; (CO, DC, HI, NJ). Differences 

between total cases from this table and others in the report are due to different reporting formats and above listed exclusions. The 0 to 9 year age group is 

not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

98 Chlamydia Tables STD Surveillance 2004 
Table 11B. Chlamydia — Rates per 100,000 population by race/ethnicity, age group and sex: United States, 

2000–2004 

Age 

Group 

White, Non-Hispanic 

Total Male Female 

Black, Non-Hispanic 

Total Male Female Total 

Hispanic 

Male Female 

Asian/Pacific Islander 

Total Male Female 

American Indian/ 

Alaska Native 

Total Male Female 

10-14 27.0 1.8 53.7 266.9 38.0 502.6 71.2 13.2 132.0 25.5 3.6 48.7 133.0 10.6 259.8 

15-19 649.8 118.5 1,206.5 4,542.0 1,394.8 7,767.0 1,394.3 396.9 2,528.2 514.7 126.5 918.3 2,258.7 570.5 4,017.6 

20-24 645.8 227.5 1,074.5 4,485.4 2,031.1 6,824.7 1,418.8 515.4 2,535.6 549.4 205.5 894.2 2,529.5 733.8 4,369.2 

25-29 

30-34 

35-39 

204.4 98.7 312.0 

70.5 42.1 99.3 

30.7 23.4 38.0 

1,716.2 1,067.7 2,308.5 

666.2 524.3 794.5 

304.8 270.6 335.2 

675.8 

325.9 

149.6 

283.6 

148.3 

77.2 

1,140.8 

531.2 

229.6 

226.5 116.2 333.4 

125.5 60.9 186.9 

72.7 40.9 102.3 

1,148.5 402.7 1,896.7 

2000

556.1 232.4 877.2 

285.3 123.1 439.7 

40-44 14.5 12.0 17.1 137.5 136.6 138.3 74.7 44.0 107.3 35.0 24.3 44.6 145.8 70.5 215.1 

45-54 5.4 5.5 5.4 58.2 69.1 48.8 34.7 20.1 49.2 17.5 14.1 20.4 68.5 32.1 102.5 

55-64 1.8 2.0 1.7 18.5 21.4 16.1 10.2 6.5 13.5 7.3 6.4 8.2 29.8 19.6 39.3 

65+ 1.1 1.1 1.2 15.7 14.2 16.7 8.9 5.9 11.1 4.0 6.5 2.2 10.6 3.8 15.7 

TOTAL 105.9 35.8 173.1 978.2 449.8 1,459.6 384.7 145.7 639.8 129.2 52.1 201.5 590.2 183.0 986.1 

10-14 27.6 2.1 54.6 264.2 37.5 497.8 74.1 14.9 136.2 19.4 1.9 37.8 110.4 10.6 213.5 

15-19 693.7 128.4 1,289.5 4,870.0 1,510.8 8,340.6 1,544.1 471.6 2,735.5 546.9 141.2 967.9 2,270.1 554.2 4,058.5 

20-24 725.0 265.4 1,195.0 4,938.4 2,304.2 7,474.9 1,603.7 604.8 2,847.8 617.6 233.2 998.6 2,379.7 753.8 4,048.7 

25-29 

30-34 

35-39 

239.2 120.0 360.7 

83.0 52.9 113.6 

36.2 28.6 43.8 

1,983.4 1,245.4 2,661.9 

782.2 638.3 912.4 

351.1 331.2 368.9 

754.2 

359.5 

175.1 

323.1 

174.5 

88.3 

1,274.0 

574.4 

272.1 

260.6 120.9 394.1 

124.0 65.1 179.8 

75.1 51.7 97.1 

1,258.6 472.3 2,052.7 

2001

550.8 188.7 909.7 

281.0 120.3 435.3 

40-44 16.5 14.8 18.3 166.8 177.7 157.0 86.6 49.0 126.7 36.6 23.0 48.8 142.2 70.3 208.7 

45-54 6.3 6.5 6.1 70.1 81.7 60.0 33.4 20.8 46.2 16.0 10.1 21.0 65.5 38.4 90.7 

55-64 2.1 2.3 2.0 24.3 32.9 17.4 11.1 8.6 13.3 6.0 4.9 7.0 15.2 9.9 20.1 

65+ 0.8 0.6 0.9 15.8 16.5 15.4 9.1 6.4 11.1 3.7 3.9 3.4 4.2 6.1 2.7 

TOTAL 118.7 42.1 192.4 1,083.9 516.8 1,602.2 423.8 167.9 698.2 138.3 55.8 215.0 587.8 185.6 978.7 

10-14 27.4 1.5 54.7 266.2 42.3 496.7 67.9 13.5 125.0 20.2 1.6 39.7 128.8 11.3 249.7 

15-19 715.7 135.2 1,329.6 4,887.6 1,595.0 8,294.0 1,566.1 475.4 2,751.1 489.7 117.4 875.6 2,356.2 624.1 4,164.2 

20-24 772.3 300.6 1,255.8 4,847.2 2,371.6 7,252.9 1,626.9 645.4 2,838.4 647.3 255.0 1,033.5 2,665.7 874.5 4,512.4 

25-29 

30-34 

35-39 

274.7 144.0 407.6 

95.4 63.5 127.7 

41.9 36.5 47.3 

2,066.4 1,365.9 2,706.0 

831.5 697.2 952.2 

367.6 358.1 376.1 

765.5 

368.7 

184.3 

343.7 

177.3 

101.5 

1,278.6 

590.3 

276.4 

281.0 141.1 411.8 

144.0 81.7 202.5 

81.9 45.4 116.3 

1,346.7 534.8 2,167.7 

2002

647.3 260.2 1,032.3 

329.7 171.2 482.5 

40-44 19.0 18.7 19.3 185.2 205.0 167.6 92.7 56.7 131.0 47.6 25.6 67.6 183.8 102.2 259.6 

45-54 7.6 8.4 6.9 75.3 87.7 64.7 40.2 24.9 55.4 24.4 17.9 30.0 66.5 39.6 91.2 

55-64 2.1 3.0 1.3 24.5 29.4 20.6 14.3 9.8 18.3 9.0 5.4 12.1 20.5 11.6 28.7 

65+ 0.8 0.6 1.0 13.9 16.1 12.6 7.5 4.6 9.6 2.2 1.8 2.4 6.6 5.6 7.4 

TOTAL 126.9 48.4 202.2 1,087.8 550.3 1,575.9 423.4 174.3 688.8 140.4 59.1 216.0 644.8 221.6 1,056.2 

10-14 26.8 1.8 53.1 257.1 43.8 477.2 63.5 9.3 120.3 18.1 1.6 35.6 132.8 16.1 252.4 

15-19 747.8 137.3 1,393.3 5,004.5 1,711.0 8,399.4 1,586.1 463.0 2,797.2 502.0 106.7 919.6 2,472.4 717.0 4,295.6 

20-24 836.7 327.1 1,362.2 4,926.4 2,426.8 7,405.0 1,662.2 640.1 2,928.8 641.0 243.0 1,046.1 2,692.8 977.9 4,462.0 

25-29 

30-34 

35-39 

305.2 165.7 447.3 

105.8 68.9 143.3 

45.0 38.1 52.0 

2,176.4 1,414.5 2,878.6 

888.2 723.6 1,036.4 

400.5 395.1 405.2 

788.7 

384.8 

191.4 

347.7 

192.9 

103.6 

1,329.4 

607.5 

290.4 

293.1 154.6 427.0 

155.2 85.5 222.0 

84.2 49.7 116.9 

1,440.8 573.2 2,318.3 

2003

642.5 288.1 995.1 

369.1 188.7 543.4 

40-44 21.6 22.0 21.3 199.9 228.9 174.4 91.2 54.8 130.3 44.7 26.5 61.6 185.1 84.6 279.1 

45-54 8.4 9.4 7.4 77.8 92.0 65.6 39.4 25.2 53.6 23.0 17.2 28.1 67.8 37.3 95.8 

55-64 2.5 3.2 1.8 25.0 31.9 19.4 14.9 12.2 17.4 9.0 7.2 10.6 27.4 16.9 37.0 

65+ 1.0 0.9 1.0 10.8 13.4 9.1 6.7 4.5 8.3 2.2 3.2 1.4 10.6 4.9 14.9 

TOTAL 136.7 52.7 217.4 1,122.3 577.4 1,617.9 428.2 172.3 701.5 141.6 59.4 219.1 672.2 244.4 1,087.2 

10-14 25.6 1.9 50.7 262.9 46.2 486.4 61.9 12.5 113.6 15.7 1.3 30.9 117.2 26.6 210.1 

15-19 760.6 147.4 1,408.8 5,336.1 1,880.5 8,897.6 1,604.1 485.6 2,810.1 434.9 111.1 776.4 2,485.9 683.1 4,358.2 

20-24 886.4 354.3 1,434.6 5,301.3 2,730.8 7,847.8 1,685.4 685.3 2,924.4 603.9 250.3 963.3 2,881.9 1,144.6 4,672.4 

25-29 

30-34 

35-39 

342.1 188.8 498.3 

111.1 73.0 149.8 

48.1 40.0 56.2 

2,417.7 1,604.6 3,166.4 

955.5 807.2 1,088.9 

437.6 433.4 441.4 

818.5 

393.3 

197.8 

374.4 

196.4 

111.9 

1,363.2 

621.8 

294.8 

268.3 140.3 392.0 

144.6 83.2 203.4 

87.5 59.9 113.7 

1,575.8 659.2 2,502.6 

2004

727.3 347.0 1,105.8 

378.2 191.4 558.7 

40-44 24.7 25.2 24.1 220.3 251.3 193.2 97.9 61.8 136.8 49.6 33.7 64.4 180.9 101.7 254.8 

45-54 8.7 9.4 8.0 94.4 113.4 78.2 39.2 27.8 50.6 28.6 23.3 33.2 85.5 55.2 113.3 

55-64 2.8 3.5 2.1 30.9 38.8 24.6 14.9 12.6 16.9 8.8 5.7 11.5 21.6 8.4 33.7 

65+ 0.9 1.0 0.8 10.0 13.1 8.1 6.1 4.5 7.2 2.6 1.5 3.5 11.6 10.5 12.4 

TOTAL 143.6 57.3 226.6 1,209.4 645.2 1,722.3 436.1 183.4 705.8 133.7 61.5 201.8 705.8 270.9 1,127.8 

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 sex-specific 

cases and rates and overall totals. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables 

were specified. For the following years the states listed did not report age and/or race/ethnicity for most cases and their case data and population denominators were 

excluded: 2000 (CO, DC, MI, NY); 2001 (CO, DC, MD, NJ, NY); 2002 (MI, NJ); 2003 (CO, DC, NJ); 2004 (CO, DC, HI, NJ). Differences between total rates from this 

table and others in the report are due to different reporting formats and above listed exclusions. The 0 to 9 year age group is not shown because some of these cases 

may not be due to sexual transmission; however, they are included in the totals. 

STD Surveillance 2004 Chlamydia Tables 99 
5

10

15

20

25

30

35

40

45

50

Table 12. Gonorrhea — Reported cases and rates by state/area, ranked by rates: United States, 2004 

Rank* State/Area Cases Rate per 100,000 Population 

1 Mississippi 7,163 248.6 

2 Louisiana 10,538 234.4 

3 South Carolina 9,171 221.1 

4 Alabama 8,206 182.3 

Georgia 15,783 181.7 

6 North Carolina 15,194 180.7 

7 Ohio 20,467 179.0 

8 Michigan 17,376 172.4 

9 Illinois 20,597 162.8 

Missouri 9,218 161.6 

11 Arkansas 4,137 151.8 

12 Maryland 8,297 150.6 

13 Tennessee 8,475 145.1 

14 Nevada 3,078 137.3 

Oklahoma 4,453 126.8 

16 Virginia 8,565 116.0 

U.S. TOTAL† 330,132 113.5 

17 Indiana 6,851 110.6 

18 Texas 24,371 110.2 

19 Delaware 894 109.4 

Florida 18,580 109.2 

21 New York 18,737 97.6 

22 Hawaii 1,193 94.9 

23 Kansas 2,542 93.3 

24 Wisconsin 5,053 92.3 

Pennsylvania 11,236 90.9 

26 Alaska 567 87.4 

27 California 30,155 85.0 

28 Connecticut 2,862 82.2 

29 New Jersey 6,696 77.5 

Rhode Island 816 75.8 

31 Arizona 4,065 72.8 

32 New Mexico 1,306 69.7 

33 Colorado 3,054 67.1 

34 Kentucky 2,758 67.0 

Nebraska 1,147 65.9 

36 Minnesota 2,957 58.4 

37 West Virginia 892 49.3 

38 Massachusetts 3,057 47.5 

39 Washington 2,810 45.8 

Iowa 1,249 42.4 

41 South Dakota 304 39.8 

42 Oregon 1,302 36.6 

43 Utah 603 25.6 

YEAR 2010 TARGET 19.0 

44 North Dakota 110 17.4 

Maine 210 16.1 

46 Vermont 86 13.9 

47 Wyoming 59 11.8 

48 New Hampshire 133 10.3 

49 Montana 88 9.6 

Idaho 103 7.5 

*States were ranked in descending order by rate, number of cases, and alphabetically by state. 

†

Total includes cases reported by Washington, D.C., but excludes outlying areas (Guam with 114 cases and rate of 69.7, Puerto Rico with 267 cases 

and rate of 6.9, and Virgin Islands with 75 cases and rate of 68.9). 

100 Gonorrhea Tables STD Surveillance 2004 
Table 13. Gonorrhea — Reported cases and rates by state/area and region listed in alphabetical order: United 

States and outlying areas, 2000–2004 

State/Area 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004 2000 2001 2002 2003 2004 

Alabama 12,063 11,182 10,118 9,303 8,206 271.0 250.2 225.5 206.7 182.3 

Alaska 361 457 641 573 567 57.5 72.1 99.6 88.3 87.4 

Arizona 4,130 3,920 3,795 3,580 4,065 79.9 73.9 69.6 64.1 72.8 

Arkansas 3,642 4,604 4,584 4,251 4,137 136.0 170.9 169.1 156.0 151.8 

California 21,619 23,296 24,606 25,963 30,155 63.6 67.3 70.1 73.2 85.0 

Colorado 3,112 3,190 3,511 2,854 3,054 71.9 72.0 77.9 62.7 67.1 

Connecticut 2,912 2,546 3,241 3,114 2,862 85.3 74.1 93.7 89.4 82.2 

Delaware 1,735 1,733 1,576 1,128 894 220.6 217.5 195.2 138.0 109.4 

Florida 22,781 21,531 21,348 18,974 18,580 141.9 131.5 127.7 111.5 109.2 

Georgia 20,265 18,920 18,383 17,686 15,783 246.1 225.1 214.7 203.6 181.7

Hawaii 483 604 740 1,263 1,193 39.8 49.2 59.4 100.4 94.9 

Idaho 98 76 94 68 103 7.5 5.8 7.0 5.0 7.5 

Illinois 24,812 24,025 24,026 21,817 20,597 199.4 191.9 190.7 172.4 162.8 

Indiana 6,525 6,972 7,395 6,681 6,851 107.1 113.8 120.1 107.8 110.6 

Iowa 1,392 1,418 1,480 1,554 1,249 47.5 48.4 50.4 52.8 42.4 

Kansas 2,795 2,669 2,744 2,647 2,542 103.8 98.8 101.0 97.2 93.3 

Kentucky 3,502 3,588 3,772 3,578 2,758 86.5 88.2 92.2 86.9 67.0 

Louisiana 13,245 12,253 11,387 11,850 10,538 296.3 274.1 254.0 263.5 234.4 

Maine 90 141 142 233 210 7.0 11.0 11.0 17.8 16.1 

Maryland 9,837 9,427 9,355 8,032 8,297 185.2 175.0 171.4 145.8 150.6 

Massachusetts 3,045 3,214 3,242 2,901 3,057 47.9 50.2 50.4 45.1 47.5 

Michigan 18,182 17,120 14,770 13,965 17,376 182.6 171.1 147.0 138.5 172.4

Minnesota 3,160 2,701 3,049 3,202 2,957 64.0 54.2 60.7 63.3 58.4 

Mississippi 9,217 7,759 6,875 6,328 7,163 323.5 271.3 239.4 219.6 248.6

Missouri 8,883 8,723 8,952 8,792 9,218 158.5 154.7 157.8 154.1 161.6 

Montana 60 104 123 122 88 6.6 11.5 13.5 13.3 9.6 

Nebraska 1,534 1,189 1,564 1,623 1,147 89.5 69.1 90.4 93.3 65.9 

Nevada 1,553 1,756 1,988 2,221 3,078 76.9 83.7 91.5 99.1 137.3 

New Hampshire 110 176 120 125 133 8.9 14.0 9.4 9.7 10.3 

New Jersey 7,232 8,921 7,894 7,944 6,696 85.8 104.8 91.9 92.0 77.5 

New Mexico 1,152 1,040 1,462 1,169 1,306 63.2 56.8 78.8 62.4 69.7 

New York 20,114 22,299 21,841 22,166 18,737 105.9 116.8 114.0 115.5 97.6 

North Carolina 17,823 16,583 15,531 15,116 15,194 220.5 202.1 186.7 179.8 180.7 

North Dakota 73 56 72 103 110 11.4 8.8 11.4 16.3 17.4 

Ohio 19,303 21,163 22,008 22,537 20,467 169.9 185.8 192.7 197.1 179.0 

Oklahoma 4,229 4,784 4,661 4,552 4,453 122.4 137.9 133.4 129.6 126.8 

Oregon 1,038 1,144 909 1,000 1,302 30.3 32.9 25.8 28.1 36.6 

Pennsylvania 13,607 14,244 13,294 11,866 11,236 110.8 115.8 107.8 96.0 90.9

Rhode Island 661 830 900 973 816 62.9 78.3 84.1 90.4 75.8 

South Carolina 8,383 10,805 9,152 8,518 9,171 208.3 266.0 222.8 205.4 221.1 

South Dakota 277 289 263 226 304 36.7 38.1 34.6 29.6 39.8 

Tennessee 11,876 10,145 9,348 8,519 8,475 208.2 176.5 161.2 145.8 145.1 

Texas 32,919 30,024 26,988 24,595 24,371 157.1 140.5 123.9 111.2 110.2 

Utah 231 219 374 412 603 10.3 9.6 16.1 17.5 25.6 

Vermont 65 76 98 97 86 10.7 12.4 15.9 15.7 13.9 

Virginia 10,175 11,095 10,462 9,066 8,565 143.2 154.2 143.4 122.7 116.0 

Washington 2,418 2,991 2,925 2,753 2,810 40.9 49.9 48.2 44.9 45.8 

West Virginia 645 732 974 847 892 35.7 40.6 54.1 46.8 49.3

Wisconsin 7,013 6,011 6,341 5,663 5,053 130.5 111.2 116.5 103.5 92.3 

Wyoming 53 77 65 46 59 10.7 15.6 13.0 9.2 11.8 

U.S. TOTAL* 363,136 361,705 351,852 335,104 330,132 128.7 126.8 122.0 115.2 113.5 

Northeast 47,836 52,447 50,772 49,419 43,833 89.1 97.2 93.6 90.8 80.6 

Midwest 93,949 92,336 92,664 88,810 87,871 145.7 142.5 142.2 135.8 134.3 

South 185,043 178,048 167,183 154,851 150,045 184.0 174.6 161.8 148.1 143.5 

West 36,308 38,874 41,233 42,024 48,383 57.2 60.2 62.8 63.2 72.8 

Guam 

Puerto Rico 

Virgin Islands 

62 

527 

24 

48 

589 

34 

49 

411 

49 

65 

276 

91 

114 

267 

75 

39.9 

13.8 

22.1 

30.3 

15.3 

31.1 

30.4 

10.6 

44.5 

39.7 

7.1 

83.6 

69.7 

6.9 

68.9 

OUTLYING AREAS 613 671 509 432 456 15.0 16.3 12.3 10.4 11.0 

TOTAL 363,749 362,376 352,361 335,536 330,588 127.0 125.2 120.5 113.8 112.1 

*Includes cases reported by Washington, D.C. 

STD Surveillance 2004 Gonorrhea Tables 101 
Table 14. Gonorrhea — Women – Reported cases and rates by state/area and region listed in alphabetical 

order: United States and outlying areas, 2000–2004 

State/Area 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004 2000 2001 2002 2003 2004 

Alabama 5,984 5,712 4,974 4,583 3,673 259.8 247.3 214.6 197.4 158.2 

Alaska 198 244 353 339 337 65.3 79.7 113.6 108.1 107.5 

Arizona 1,754 1,700 1,659 1,636 1,787 67.8 64.0 60.8 58.7 64.1 

Arkansas 1,807 2,404 2,388 2,108 2,032 131.8 174.4 172.4 151.5 146.0 

California 9,624 10,448 10,857 11,912 13,620 56.4 60.2 61.7 67.0 76.6 

Colorado 1,544 1,588 1,643 1,529 1,656 71.9 72.2 73.5 67.8 73.4 

Connecticut 1,621 1,411 1,910 1,910 1,756 92.2 79.7 107.2 106.6 98.0 

Delaware 987 1,002 858 602 508 243.9 244.6 206.7 143.5 121.1 

Florida 10,862 10,380 10,373 9,419 9,371 132.2 123.9 121.4 108.5 107.9 

Georgia 9,844 9,590 9,306 9,137 8,119 235.4 224.8 214.3 207.8 184.6

Hawaii 240 292 394 723 680 39.8 47.7 63.5 115.3 108.4 

Idaho 51 39 49 18 42 7.9 5.9 7.3 2.6 6.2 

Illinois 11,829 12,178 12,273 11,624 11,510 186.3 190.7 191.1 180.4 178.6 

Indiana 3,446 3,792 3,996 3,610 3,550 111.1 121.6 127.5 114.6 112.7 

Iowa 740 766 821 869 736 49.6 51.3 54.9 58.1 49.2 

Kansas 1,496 1,468 1,556 1,522 1,565 109.9 107.5 113.4 110.8 114.0 

Kentucky 1,725 1,812 1,936 1,845 1,415 83.3 87.2 92.6 87.8 67.4 

Louisiana 6,471 6,056 5,861 6,076 5,450 280.5 262.7 253.7 262.6 235.5 

Maine 29 55 44 84 84 4.4 8.3 6.6 12.6 12.6 

Maryland 4,577 4,591 4,592 4,166 4,327 166.7 164.9 162.9 146.5 152.2 

Massachusetts 1,568 1,591 1,579 1,342 1,531 47.6 48.0 47.5 40.4 46.1 

Michigan 9,190 9,057 7,974 7,823 9,614 181.1 177.7 155.9 152.5 187.5

Minnesota 1,681 1,461 1,688 1,784 1,712 67.5 58.1 66.7 70.0 67.1 

Mississippi 5,603 4,663 4,201 3,757 4,362 380.3 315.6 283.3 253.0 293.7

Missouri 4,489 4,540 4,810 4,794 5,139 155.9 156.8 165.2 164.1 175.9 

Montana 38 57 75 74 54 8.4 12.5 16.4 16.1 11.7 

Nebraska 849 671 909 924 656 97.7 77.0 103.8 105.0 74.5 

Nevada 618 761 965 1,062 1,417 62.4 73.9 90.5 96.6 128.9 

New Hampshire 53 96 51 57 54 8.4 15.0 7.9 8.7 8.3 

New Jersey 3,571 4,522 3,958 4,550 3,607 82.3 103.3 89.6 102.6 81.3 

New Mexico 573 472 740 598 749 61.9 50.7 78.5 62.8 78.7 

New York 10,691 11,873 11,141 11,296 9,720 108.6 120.2 112.5 113.9 98.0 

North Carolina 8,468 7,810 7,585 7,383 7,384 205.4 186.7 178.9 172.6 172.7 

North Dakota 36 30 40 59 72 11.2 9.4 12.6 18.6 22.7 

Ohio 10,311 11,257 11,944 12,390 11,144 176.4 192.2 203.5 211.1 189.9 

Oklahoma 2,433 2,670 2,566 2,562 2,471 138.5 151.5 144.7 143.9 138.8 

Oregon 486 448 357 389 567 28.1 25.6 20.1 21.7 31.7 

Pennsylvania 7,371 7,872 7,200 6,644 6,295 116.0 123.8 113.0 104.2 98.7 

Rhode Island 381 488 484 517 478 69.8 88.7 87.2 92.7 85.7 

South Carolina 4,057 5,126 4,357 4,369 5,007 196.0 245.5 206.3 205.3 235.2 

South Dakota 165 166 148 133 178 43.3 43.5 38.6 34.6 46.3 

Tennessee 5,343 4,808 4,564 4,263 4,327 182.6 163.1 153.6 142.6 144.7 

Texas 16,932 15,599 14,075 12,643 12,433 160.5 145.1 128.5 113.8 111.9 

Utah 99 95 150 153 266 8.8 8.4 13.0 13.1 22.7 

Vermont 33 42 56 48 53 10.6 13.4 17.8 15.2 16.8 

Virginia 4,856 5,485 5,445 4,809 4,650 134.1 149.6 146.7 128.1 123.8 

Washington 1,078 1,301 1,197 1,167 1,229 36.3 43.2 39.3 38.0 40.0 

West Virginia 375 418 567 464 470 40.4 45.2 61.3 50.0 50.7

Wisconsin 4,189 3,672 3,717 3,299 2,953 154.0 134.3 135.1 119.3 106.8 

Wyoming 31 43 38 28 39 12.6 17.5 15.3 11.2 15.7 

U.S. TOTAL* 181,668 183,863 179,648 174,230 172,142 126.4 126.6 122.5 117.9 116.5 

Northeast 25,318 27,950 26,423 26,448 23,578 91.3 100.3 94.4 94.3 84.1 

Midwest 48,421 49,058 49,876 48,831 48,829 147.2 148.5 150.3 146.7 146.7 

South 91,595 89,367 84,872 79,323 77,292 178.4 171.8 161.1 149.0 145.2 

West 16,334 17,488 18,477 19,628 22,443 51.4 54.1 56.2 59.1 67.5 

Guam 

Puerto Rico 

Virgin Islands 

23

238 

14 

22

279 

20 

26

230 

38 

39

121 

65 

70 

150 

48 

30.3 

12.0 

24.7 

28.4 

14.0 

34.4 

33.0 

11.5 

64.2 

48.7 

6.0 

114.3 

87.4 

7.4 

84.4 

OUTLYING AREAS 275 321 294 225 268 13.0 15.1 13.7 10.5 12.5 

TOTAL 181,943 184,184 179,942 174,455 172,410 124.7 125.0 120.9 116.4 115.0 

*Includes cases reported by Washington, D.C. 

NOTE: Cases reported with unknown sex are not included in this table. 

102 Gonorrhea Tables STD Surveillance 2004 
Table 15. Gonorrhea — Men – Reported cases and rates by state/area and region listed in alphabetical order: 

United States and outlying areas, 2000–2004 

State/Area 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004 2000 2001 2002 2003 2004 

Alabama 6,039 5,457 5,131 4,705 4,526 281.0 252.7 236.5 215.9 207.7 

Alaska 163 213 288 234 230 50.2 65.0 86.5 69.8 68.6 

Arizona 2,376 2,220 2,136 1,942 2,274 92.1 83.8 78.4 69.6 81.5 

Arkansas 1,832 2,191 2,194 2,141 2,104 140.1 166.5 165.6 160.5 157.7 

California 11,896 12,701 13,586 13,965 16,440 70.2 73.6 77.6 78.8 92.8 

Colorado 1,568 1,602 1,868 1,325 1,398 72.0 71.8 82.3 57.7 60.9 

Connecticut 1,291 1,132 1,331 1,204 1,106 78.1 68.0 79.3 71.2 65.4 

Delaware 748 731 718 526 386 195.9 188.9 183.0 132.1 97.0 

Florida 11,919 11,149 10,975 9,555 9,209 152.1 139.4 134.3 114.6 110.5 

Georgia 10,309 9,325 9,013 8,487 7,596 254.4 225.3 213.7 198.0 177.2

Hawaii 243 312 346 540 513 39.9 50.7 55.4 85.6 81.4 

Idaho 47 35 45 50 60 7.2 5.3 6.7 7.3 8.8 

Illinois 12,981 11,845 11,750 10,192 9,087 213.1 193.1 190.2 164.1 146.3 

Indiana 3,069 3,169 3,372 3,040 3,270 102.7 105.4 111.5 99.8 107.3 

Iowa 652 652 658 680 511 45.4 45.3 45.6 47.0 35.3 

Kansas 1,299 1,201 1,188 1,125 977 97.6 89.9 88.4 83.3 72.4 

Kentucky 1,751 1,769 1,834 1,727 1,338 88.5 88.9 91.6 85.6 66.3 

Louisiana 6,774 6,197 5,466 5,710 5,029 313.2 286.2 251.6 261.6 230.4 

Maine 61 86 98 149 126 9.8 13.8 15.6 23.4 19.8 

Maryland 5,196 4,836 4,756 3,858 3,969 202.5 185.8 180.2 144.7 148.9 

Massachusetts 1,477 1,622 1,663 1,552 1,524 48.2 52.5 53.6 49.9 49.0 

Michigan 8,992 8,063 6,796 6,141 7,762 184.2 164.2 137.7 124.0 156.8

Minnesota 1,479 1,240 1,361 1,418 1,245 60.5 50.2 54.7 56.5 49.6 

Mississippi 3,586 3,096 2,674 2,571 2,801 260.7 224.0 192.5 184.1 200.6

Missouri 4,394 4,183 4,142 3,998 4,079 161.2 152.5 150.0 143.7 146.6 

Montana 22 47 47 47 33 4.9 10.4 10.4 10.3 7.2 

Nebraska 681 516 653 695 488 80.6 60.8 76.5 80.9 56.8 

Nevada 935 993 1,022 1,158 1,658 90.9 92.9 92.3 101.4 145.2 

New Hampshire 57 80 69 68 79 9.3 12.9 11.0 10.7 12.5 

New Jersey 3,654 4,391 3,930 3,389 3,089 89.3 106.2 94.2 80.6 73.5 

New Mexico 572 555 716 567 557 63.9 61.7 78.5 61.5 60.4 

New York 9,378 10,397 10,688 10,813 8,985 102.4 112.9 115.5 116.6 96.9 

North Carolina 9,354 8,772 7,942 7,733 7,810 236.2 218.1 194.6 187.2 189.1 

North Dakota 37 26 32 44 38 11.6 8.2 10.1 13.9 12.0 

Ohio 8,837 9,679 9,819 9,856 9,046 160.1 174.9 176.8 177.1 162.5 

Oklahoma 1,796 2,114 2,095 1,990 1,982 105.8 123.8 121.8 114.9 114.5 

Oregon 552 696 552 611 735 32.4 40.4 31.6 34.5 41.6 

Pennsylvania 6,236 6,372 6,094 5,214 4,941 105.1 107.2 102.1 87.1 82.5 

Rhode Island 280 342 416 456 338 55.5 67.1 80.8 88.0 65.2 

South Carolina 4,256 5,640 4,766 4,118 4,136 217.8 285.7 238.9 204.0 204.9 

South Dakota 111 123 115 93 126 29.6 32.7 30.4 24.5 33.2 

Tennessee 6,533 5,337 4,784 4,256 4,148 235.2 190.5 169.3 149.2 145.4 

Texas 15,919 14,370 12,884 11,932 11,902 153.0 135.3 119.0 108.4 108.1 

Utah 132 124 223 259 337 11.7 10.9 19.2 21.9 28.5 

Vermont 32 34 42 49 33 10.7 11.3 13.9 16.1 10.9 

Virginia 5,307 5,574 5,017 4,237 3,904 152.2 157.9 140.1 116.7 107.5 

Washington 1,340 1,690 1,728 1,586 1,581 45.5 56.6 57.2 51.9 51.7 

West Virginia 269 313 406 380 421 30.6 35.7 46.3 43.0 47.7

Wisconsin 2,817 2,321 2,612 2,341 2,087 106.1 86.9 97.1 86.5 77.1 

Wyoming 22 34 27 18 20 8.9 13.7 10.8 7.1 7.9 

U.S. TOTAL* 180,701 177,194 171,504 160,106 157,303 130.5 126.5 121.1 111.9 110.0 

Northeast 22,466 24,456 24,331 22,894 20,221 86.6 93.7 92.7 86.8 76.7 

Midwest 45,349 43,018 42,498 39,623 38,716 143.5 135.3 133.0 123.3 120.5 

South 93,018 88,498 82,091 75,287 72,530 188.9 177.2 162.1 146.7 141.3 

West 19,868 21,222 22,584 22,302 25,836 62.7 65.8 68.9 67.1 77.8 

Guam 

Puerto Rico 

Virgin Islands 

39

289 

10 

26

310 

14 

23

181 

11 

26

155 

26 

44 

117 

27 

49.1 

15.7 

19.3 

32.1 

16.8 

27.3 

28.0 

9.7 

21.6 

31.1 

8.3 

50.0 

52.7 

6.3 

52.0 

OUTLYING AREAS 338 350 215 207 188 17.2 17.7 10.8 10.3 9.4 

TOTAL 181,039 177,544 171,719 160,313 157,491 128.9 125.0 119.5 110.5 108.6 

*Includes cases reported by Washington, D.C.
 

NOTE: Cases reported with unknown sex are not included in this table.
 

STD Surveillance 2004 Gonorrhea Tables 103 
Rank* † City Cases Rate per 100,000 Population 

1 St Louis, MO 2,440 734.4 

2 Detroit, MI 6,763 722.3 

3 Rochester, NY 1,578 637.5 

4 Baltimore, MD 3,938 626.4 

5 Kansas City, MO 2,782 611.1 

6 Richmond, VA 1,132 581.3 

7 New Orleans, LA 2,373 505.9 

8 Washington, DC 2,568 455.0 

9 Newark, NJ 1,300 430.7 

10 Indianapolis, IN 3,350 388.1 

11 Buffalo, NY 1,234 386.7 

12 Memphis, TN 3,277 361.6 

13 Norfolk, VA 870 359.9 

14 Chicago, IL 10,935 356.0 

15 Oklahoma City, OK 1,543 354.4 

16 Philadelphia, PA 5,206 351.9 

17 Milwaukee, WI 3,169 339.6 

18 Atlanta, GA 2,765 337.9 

19 Cincinnati, OH 2,739 332.6 

20 Birmingham, AL 2,098 318.8 

21 San Francisco, CA 2,142 285.0 

22 Fort Worth, TX 1,637 283.0 

23 Toledo, OH 1,283 282.5 

24 Minneapolis, MN 1,053 273.1 

25 Charlotte, NC 1,953 259.6 

26 Dallas, TX 3,112 257.1 

27 Jacksonville, FL 2,035 248.9 

28 Dayton, OH 1,365 247.2 

29 Cleveland, OH 3,264 239.3 

30 Denver, CO 1,302 233.6 

31 Columbus, OH 2,539 233.2 

32 Tulsa, OK 930 233.0 

33 Nashville, TN 1,221 214.3 

34 Houston, TX 4,199 206.7 

35 Louisville, KY 1,330 190.3 

36 Austin, TX 1,189 175.6 

37 Boston, MA 1,026 173.8 

38 Omaha, NE 796 167.0 

39 Corpus Christi, TX 458 164.2 

40 San Antonio, TX 1,968 161.9 

41 Akron, OH 855 156.4 

42 Wichita, KS 691 149.3 

43 St Petersburg, FL 1,382 149.2 

44 Sacramento, CA 1,955 146.9 

45 New York City, NY 11,018 136.3 

46 Jersey City, NJ 326 135.9 

47 Portland, OR 726 135.8 

48 Pittsburgh, PA 1,529 121.2 

49 Honolulu, HI 1,033 114.4 

50 Oakland, CA 1,655 113.3 

51 Tampa, FL 1,197 111.5 

52 Albuquerque, NM 620 106.6 

53 Los Angeles, CA 9,689 104.9 

54 Phoenix, AZ 2,943 86.8 

55 San Diego, CA 2,379 81.2 

56 Miami, FL 1,891 80.8 

57 Seattle, WA 1,265 71.8 

58 Des Moines, IA 262 67.4 

59 Yonkers, NY 134 66.3 

60 San Jose, CA 1,038 61.8 

61 St Paul, MN 141 50.0 

62 Tucson, AZ 442 49.5 

63 El Paso, TX 239 40.9 

YEAR 2010 TARGET 19.0 

Table 16. Gonorrhea — Reported cases and rates in selected cities ranked by rates: United States, 2004 

*Cities were ranked in descending order by rate, number of cases, and alphabetically by state. 

†

Excludes cities in outlying areas (San Juan, PR, with 125 cases and rate of 12.2). See Appendix. 

104 Gonorrhea Tables STD Surveillance 2004 
Table 17. Gonorrhea — Reported cases and rates in selected cities listed in alphabetical order: United States 

and outlying areas, 2000–2004 

City 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004
 2000 2001 2002 2003 2004 

Akron, OH 913 962 937 807 855
 168.0 176.5 171.5 147.6 156.4 

Albuquerque, NM 697 647 805 636 620 125.0 115.0 140.3 109.4 106.6 

Atlanta, GA 3,456 4,621 3,810 3,838 2,765
 422.7 560.0 461.6 469.0 337.9 

Austin, TX 1,518 1,536 1,401 1,215 1,189
 239.8 235.2 208.4 179.4 175.6 

Baltimore, MD 5,603 5,014 4,873 3,965 3,938
 863.7 777.0 763.1 630.7 626.4 

Birmingham, AL 3,018 2,600 2,489 1,970 2,098 455.8 393.0 376.5 299.3 318.8

Boston, MA 1,229 1,332 1,404 1,181 1,026
 205.4 221.7 234.7 200.1 173.8 

Buffalo, NY 1,572 2,194 1,653 1,413 1,234
 488.4 683.7 516.0 442.8 386.7 

Charlotte, NC 1,758 2,014 2,264 2,232 1,953
 250.9 279.4 306.8 296.7 259.6 

Chicago, IL 14,872 14,326 13,814 12,121 10,935 481.7 463.6 447.5 394.6 356.0

Cincinnati, OH 3,227 3,178 3,426 3,347 2,739
 382.3 378.2 410.9 406.4 332.6 

Cleveland, OH 3,497 3,854 4,115 3,967 3,264
 251.2 278.2 298.4 290.9 239.3 

Columbus, OH 3,386 3,349 2,844 2,558 2,539
 315.9 309.7 261.7 234.9 233.2 

Corpus Christi, TX 775 667 466 409 458 279.4 241.0 167.3 146.6 164.2

Dallas, TX 7,315 6,166 5,263 3,661 3,112 612.9 507.6 434.8 302.4 257.1 

Dayton, OH 1,015 1,428 1,505 1,531 1,365 181.8 256.9 271.4 277.3 247.2

Denver, CO 1,594 1,618 1,812 1,308 1,302
 286.4 287.3 323.3 234.6 233.6 

Des Moines, IA 380 270 359 373 262
 101.1 70.9 93.1 96.0 67.4 

Detroit, MI 9,610 8,220 6,845 5,535 6,763
 1,011.0 867.6 725.1 591.2 722.3 

El Paso, TX 209 291 336 263 239
 37.0 50.9 58.2 45.0 40.9 

Fort Worth, TX 2,787 2,291 1,967 1,526 1,637
 517.7 415.3 347.1 263.8 283.0 

Honolulu, HI 433 557 685 1,136 1,033
 49.4 63.0 76.4 125.8 114.4 

Houston, TX 5,918 5,489 5,235 3,902 4,199
 315.5 287.0 260.5 192.0 206.7 

Indianapolis, IN 3,206 3,383 3,510 3,191 3,350 372.6 391.6 406.5 369.6 388.1

Jacksonville, FL 3,640 2,731 2,895 2,371 2,035 466.8 344.5 359.1 290.0 248.9 

Jersey City, NJ 465 489 380 468 326 193.1 201.6 157.3 195.1 135.9

Kansas City, MO 2,688 2,161 2,625 2,549 2,782 594.1 475.9 575.7 560.0 611.1 

Los Angeles, CA 7,307 7,747 7,765 8,174 9,689 81.8 85.5 84.6 88.5 104.9

Louisville, KY 1,200 1,436 1,361 1,439 1,330 172.9 206.3 195.0 205.9 190.3 

Memphis, TN 4,941 4,420 4,074 3,286 3,277 550.0 490.9 449.8 362.6 361.6

Miami, FL 1,995 1,964 2,047 1,912 1,891
 88.2 85.5 87.8 81.7 80.8 

Milwaukee, WI 5,146 4,150 4,497 3,800 3,169
 547.6 442.2 479.9 407.2 339.6 

Minneapolis, MN 1,577 1,295 1,366 1,360 1,053
 410.1 334.9 353.8 352.7 273.1 

Nashville, TN 2,404 1,625 1,409 1,492 1,221
 421.7 284.5 246.9 261.8 214.3 

New Orleans, LA 3,015 3,160 2,685 2,899 2,373
 623.4 660.5 566.8 618.1 505.9 

New York City, NY 11,669 12,614 12,727 13,682 11,018 145.5 156.5 157.4 169.2 136.3

Newark, NJ 1,558 1,798 1,573 1,483 1,300
 518.6 596.3 519.9 491.4 430.7 

Norfolk, VA 1,490 1,450 1,463 1,061 870
 635.5 615.9 612.0 438.9 359.9 

Oakland, CA 1,793 2,039 1,949 1,617 1,655
 123.6 138.2 132.4 110.7 113.3 

Oklahoma City, OK 1,434 1,617 1,594 1,443 1,543 336.5 377.3 368.1 331.4 354.4

Omaha, NE 1,161 934 1,149 1,161 796 249.9 199.4 243.0 243.5 167.0 

Philadelphia, PA 8,198 8,096 7,006 5,731 5,206 541.5 539.1 469.5 387.4 351.9

Phoenix, AZ 3,195 2,826 2,991 2,688 2,943 103.2 88.3 90.5 79.3 86.8 

Pittsburgh, PA 1,494 1,916 2,133 1,729 1,529 116.7 150.4 168.0 137.1 121.2

Portland, OR 681 743 546 557 726
 130.5 140.6 102.1 104.2 135.8 

Richmond, VA 1,752 2,109 1,507 1,249 1,132
 887.2 1,066.4 763.2 641.4 581.3 

Rochester, NY 2,142 1,769 1,581 1,646 1,578
 866.4 715.1 637.2 664.9 637.5 

Sacramento, CA 1,295 1,171 1,442 1,744 1,955
 105.2 92.4 110.5 131.1 146.9 

San Antonio, TX 2,298 2,140 1,944 2,111 1,968
 200.0 183.4 162.7 173.7 161.9 

San Diego, CA 1,798 1,878 2,132 2,007 2,379 63.6 65.4 73.3 68.5 81.2

San Francisco, CA 2,161 2,053 2,136 1,809 2,142 278.2 264.6 279.6 240.7 285.0 

San Jose, CA 446 547 502 726 1,038 26.4 32.3 29.8 43.3 61.8 

Seattle, WA 1,221 1,556 1,462 1,351 1,265 70.2 88.7 83.1 76.7 71.8 

St Louis, MO 2,879 3,185 2,737 2,545 2,440 829.8 929.2 808.9 766.1 734.4 

St Paul, MN 703 560 584 565 141 246.7 196.0 205.4 200.3 50.0 

St Petersburg, FL 1,542 1,391 1,527 1,312 1,382 167.2 150.4 164.8 141.7 149.2 

Tampa, FL 1,653 1,517 1,912 1,643 1,197 164.8 147.7 181.4 153.1 111.5 

Toledo, OH 864 1,187 1,519 993 1,283 189.9 261.2 334.9 218.6 282.5 

Tucson, AZ 591 748 458 470 442 69.6 86.6 52.0 52.6 49.5 

Tulsa, OK 892 1,014 1,123 1,059 930 226.0 255.4 280.8 265.3 233.0 

Washington, DC 2,706 2,883 2,669 2,508 2,568 473.4 502.4 467.5 444.4 455.0 

Wichita, KS 675 837 852 870 691 148.8 183.2 184.4 187.9 149.3 

Yonkers, NY 109 143 160 237 134 54.8 71.3 79.4 117.2 66.3 

U.S. CITY TOTAL 170,766 167,906 162,300 147,832 140,272 244.7 238.3 228.5 207.5 196.9 

San Juan, PR 270 281 194 130 125 26.4 27.5 18.9 12.7 12.2 

TOTAL 171,036 168,187 162,494 147,962 140,397 241.5 235.3 225.5 204.8 194.3 

See Appendix (Reporting of City-specific Surveillance Data).
 

STD Surveillance 2004 Gonorrhea Tables 105
 
Table 18. Gonorrhea — Women – Reported cases and rates in selected cities listed in alphabetical order: 

United States and outlying areas, 2000–2004 

City 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004
 2000 2001 2002 2003 2004 

Akron, OH 463 484 493 424 432
 164.3 171.4 174.2 149.9 152.7 

Albuquerque, NM 323 254 375 294 336 113.2 88.3 128.0 99.0 113.2 

Atlanta, GA 1,543 2,110 1,679 1,660 1,254
 371.7 503.6 400.5 400.8 302.8 

Austin, TX 712 722 670 514 533
 230.4 226.6 204.3 156.5 162.3 

Baltimore, MD 2,578 2,423 2,374 2,090 1,995
 744.8 703.1 695.4 622.1 593.8 

Birmingham, AL 1,552 1,420 1,231 959 922 443.4 406.2 352.6 276.6 265.9

Boston, MA 618 623 664 483 456
 199.6 200.3 214.3 158.4 149.5 

Buffalo, NY 914 1,212 872 762 646
 544.2 724.4 522.5 458.9 389.0 

Charlotte, NC 748 830 980 1,040 877
 209.8 226.5 261.6 273.2 230.4 

Chicago, IL 6,525 6,924 6,604 6,082 5,928 409.8 434.7 415.3 384.9 375.1

Cincinnati, OH 1,868 1,743 1,882 1,879 1,604
 422.9 396.8 432.1 437.4 373.4 

Cleveland, OH 1,697 1,816 1,976 1,906 1,578
 231.0 248.6 271.9 265.3 219.7 

Columbus, OH 1,798 1,696 1,505 1,310 1,249
 326.2 305.3 269.8 235.0 224.1 

Corpus Christi, TX 355 349 229 203 192 250.7 246.7 160.8 142.4 134.6

Dallas, TX 3,494 3,103 2,610 1,843 1,478 584.9 511.2 432.1 306.2 245.5 

Dayton, OH 430 722 757 838 683 148.1 249.9 262.8 292.5 238.4

Denver, CO 714 717 756 618 581
 259.4 257.4 272.9 225.0 211.5 

Des Moines, IA 200 144 205 197 159
 103.4 73.6 103.5 98.9 79.8 

Detroit, MI 4,737 4,336 3,618 2,966 3,496
 942.6 865.6 725.0 599.8 707.0 

El Paso, TX 96 148 167 164 125
 32.8 50.0 55.7 54.0 41.2 

Fort Worth, TX 1,346 1,153 1,025 771 831
 495.3 414.4 359.1 265.1 285.8 

Honolulu, HI 217 269 365 645 569
 49.7 61.0 81.6 143.1 126.2 

Houston, TX 2,986 2,674 2,526 1,798 2,046
 317.2 278.7 250.8 176.9 201.3 

Indianapolis, IN 1,516 1,751 1,776 1,583 1,621 341.2 392.7 398.6 356.0 364.6

Jacksonville, FL 1,599 1,200 1,316 1,081 988 398.3 294.2 317.5 257.2 235.1 

Jersey City, NJ 211 234 176 292 169 172.2 189.7 143.3 240.0 138.9

Kansas City, MO 1,242 1,039 1,283 1,294 1,429 529.7 441.7 543.5 550.1 607.4 

Los Angeles, CA 3,072 3,469 3,401 3,786 4,425 68.0 75.8 73.4 81.1 94.8

Louisville, KY 510 640 632 656 619 140.8 176.3 173.6 180.6 170.4 

Memphis, TN 2,225 2,070 1,963 1,619 1,629 474.2 440.1 415.0 342.9 345.0 

Miami, FL 750 775 855 831 853
 64.2 65.3 71.0 68.8 70.7 

Milwaukee, WI 3,057 2,540 2,612 2,190 1,836
 625.0 520.2 536.0 452.3 379.2 

Minneapolis, MN 725 625 662 628 487
 371.4 318.5 338.0 322.0 249.7 

Nashville, TN 1,016 752 621 697 545
 345.5 255.1 210.8 238.1 186.2 

New Orleans, LA 1,325 1,310 1,211 1,394 1,072
 515.6 515.6 481.3 560.5 431.0 

New York City, NY 6,051 6,671 6,418 6,774 5,623 143.4 157.4 151.1 159.7 132.6

Newark, NJ 692 881 716 829 709
 439.6 557.9 452.1 525.8 449.7 

Norfolk, VA 646 662 670 512 458
 563.8 576.5 578.6 440.7 394.2 

Oakland, CA 992 1,062 999 850 826
 134.4 141.5 133.3 114.6 111.3 

Oklahoma City, OK 839 909 861 800 831 382.4 412.4 386.8 358.1 372.0

Omaha, NE 626 518 672 673 432 263.9 216.8 278.9 277.6 178.2 

Philadelphia, PA 4,288 4,421 3,609 3,038 2,680 529.2 550.5 452.4 384.2 338.9 

Phoenix, AZ 1,325 1,169 1,261 1,189 1,258 85.6 73.1 76.5 70.5 74.6 

Pittsburgh, PA 826 1,045 1,243 1,002 899 122.6 156.0 186.3 151.5 135.9

Portland, OR 303 268 184 162 258
 115.0 100.6 68.3 60.2 95.8 

Richmond, VA 783 1,016 895 697 641
 742.1 960.1 847.1 668.6 614.8 

Rochester, NY 1,102 947 802 854 757
 860.2 739.5 625.0 667.2 591.4 

Sacramento, CA 702 619 777 888 1,004
 111.7 95.7 116.7 131.1 148.2 

San Antonio, TX 1,187 1,124 1,009 1,036 993
 201.2 187.8 164.7 166.5 159.6 

San Diego, CA 702 685 718 739 936 50.0 48.0 49.7 50.8 64.3

San Francisco, CA 412 360 374 246 230 107.7 94.1 99.1 66.4 62.1 

San Jose, CA 174 198 189 321 444 20.9 23.7 22.7 38.9 53.8 

Seattle, WA 448 572 438 394 405 51.3 64.9 49.5 44.6 45.8 

St Louis, MO 1,426 1,620 1,415 1,300 1,326 775.3 891.4 788.8 739.2 754.0 

St Paul, MN 411 335 343 334 77 278.4 226.4 233.0 228.9 52.8 

St Petersburg, FL 739 651 782 655 732 153.1 134.5 161.4 135.5 151.5 

Tampa, FL 823 758 859 739 627 160.7 144.6 160.0 135.4 114.9 

Toledo, OH 487 713 899 611 795 206.2 302.5 382.6 260.3 338.7 

Tucson, AZ 257 346 204 217 173 59.3 78.4 45.2 47.6 37.9 

Tulsa, OK 494 503 588 579 465 243.1 246.5 286.2 283.1 227.4 

Washington, DC 1,271 1,241 1,224 1,137 1,293 420.2 409.1 406.3 381.2 433.5 

Wichita, KS 358 473 508 529 427 156.1 204.7 217.4 226.5 182.9 

Yonkers, NY 64 81 90 137 78 61.6 77.6 85.9 130.5 74.3 

U.S. CITY TOTAL* 81,590 82,125 78,818 72,739 69,020 227.9 227.4 216.6 199.6 189.4 

San Juan, PR 105 114 89 42 60 19.8 21.4 16.7 7.9 11.2 

TOTAL 81,695 82,239 78,907 72,781 69,080 224.8 224.4 213.7 196.9 186.8 

*Cases reported with unknown sex are not included in this table. See Appendix (Reporting of City-specific Surveillance Data). 

106 Gonorrhea Tables STD Surveillance 2004 
Table 19. Gonorrhea — Men – Reported cases and rates in selected cities listed in alphabetical order: 

United States and outlying areas, 2000–2004 

City 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004
 2000 2001 2002 2003 2004 

Akron, OH 446 474 435 340 420
 170.3 180.5 165.1 128.8 159.1 

Albuquerque, NM 367 380 427 339 284 134.8 138.2 152.1 119.1 99.8 

Atlanta, GA 1,910 2,510 2,126 2,169 1,500
 474.6 617.9 523.4 536.6 371.1 

Austin, TX 804 814 731 699 645
 248.1 243.4 212.4 200.4 185.0 

Baltimore, MD 2,961 2,591 2,499 1,875 1,943
 978.5 861.7 840.8 640.6 663.8 

Birmingham, AL 1,439 1,177 1,257 1,008 1,175 461.0 377.2 402.8 323.6 377.3

Boston, MA 611 709 740 697 570
 211.7 244.7 256.7 244.4 199.9 

Buffalo, NY 658 982 781 651 588
 427.6 639.3 508.8 425.4 384.2 

Charlotte, NC 1,010 1,184 1,283 1,192 1,076
 293.5 334.2 353.2 320.7 289.5 

Chicago, IL 8,346 7,400 7,208 6,039 5,007 558.2 494.3 481.7 404.9 335.7

Cincinnati, OH 1,343 1,417 1,514 1,444 1,106
 333.7 353.4 380.3 366.6 280.8 

Cleveland, OH 1,777 2,019 2,109 2,040 1,658
 270.2 308.3 323.3 316.0 256.8 

Columbus, OH 1,561 1,618 1,317 1,234 1,276
 299.7 307.7 248.9 232.2 240.1 

Corpus Christi, TX 420 318 237 206 266 309.4 235.0 174.2 151.1 195.1

Dallas, TX 3,775 3,028 2,642 1,817 1,629 633.2 498.3 435.6 298.6 267.7 

Dayton, OH 578 699 743 689 676 215.6 261.8 278.9 259.3 254.4

Denver, CO 880 901 1,056 690 721
 312.8 316.4 372.6 244.0 255.0 

Des Moines, IA 180 126 153 175 103
 98.7 68.1 81.6 92.4 54.4 

Detroit, MI 4,873 3,884 3,227 2,569 3,267
 1,087.8 869.7 725.2 581.5 739.5 

El Paso, TX 113 143 169 99 114
 41.4 51.9 60.8 35.3 40.6 

Fort Worth, TX 1,433 1,133 939 752 806
 537.6 414.4 333.9 261.4 280.2 

Honolulu, HI 216 288 320 491 464
 49.1 65.0 71.3 108.6 102.7 

Houston, TX 2,928 2,809 2,705 2,101 2,148
 313.3 294.7 269.8 206.9 211.5 

Indianapolis, IN 1,687 1,630 1,720 1,598 1,726 405.3 390.0 411.6 381.7 412.3

Jacksonville, FL 2,041 1,531 1,579 1,290 1,047 539.6 397.9 403.2 324.8 263.6 

Jersey City, NJ 254 255 203 175 157 214.8 214.0 171.1 148.0 132.8

Kansas City, MO 1,446 1,122 1,342 1,255 1,353 663.5 512.7 610.4 570.6 615.1 

Los Angeles, CA 4,228 4,264 4,350 4,374 5,248 95.7 95.2 95.7 95.7 114.8

Louisville, KY 688 793 728 782 708 207.4 238.1 217.9 232.9 210.9 

Memphis, TN 2,716 2,350 2,111 1,667 1,648 632.8 546.5 487.9 384.1 379.7 

Miami, FL 1,245 1,189 1,192 1,081 1,038
 113.9 107.1 105.6 95.3 91.5 

Milwaukee, WI 2,084 1,596 1,877 1,589 1,333
 462.5 354.5 417.3 353.9 296.9 

Minneapolis, MN 852 670 704 732 566
 449.9 351.7 370.1 384.1 297.0 

Nashville, TN 1,388 873 788 795 676
 502.9 316.0 285.3 286.9 244.0 

New Orleans, LA 1,690 1,850 1,463 1,500 1,284
 745.6 824.7 658.7 680.8 582.8 

New York City, NY 5,573 5,914 6,297 6,851 5,364 146.7 154.6 164.1 178.2 139.6

Newark, NJ 866 917 857 653 591 605.6 638.6 594.4 453.1 410.0 

Norfolk, VA 841 783 793 549 412 701.6 649.2 643.5 437.3 328.2 

Oakland, CA 783 960 945 766 826 109.8 132.5 130.8 106.5 114.9 

Oklahoma City, OK 595 708 733 643 712 287.8 340.1 348.3 303.3 335.9 

Omaha, NE 531 415 475 485 363 233.6 180.9 204.9 207.0 154.9 

Philadelphia, PA 3,910 3,675 3,397 2,693 2,526 555.6 526.0 489.2 391.1 366.8 

Phoenix, AZ 1,870 1,657 1,730 1,497 1,684 120.7 103.4 104.5 87.9 98.9 

Pittsburgh, PA 668 871 890 726 630 110.2 144.2 147.7 121.1 105.0

Portland, OR 378 475 362 395 468
 146.3 181.3 136.4 148.7 176.2 

Richmond, VA 968 1,083 612 549 491
 1,052.6 1,178.0 666.7 606.8 542.7 

Rochester, NY 1,040 822 779 792 821
 873.2 689.0 650.3 662.5 686.7 

Sacramento, CA 581 543 660 838 938
 96.5 87.5 103.2 128.3 143.6 

San Antonio, TX 1,110 1,015 935 1,075 974
 198.5 178.6 160.6 181.2 164.2 

San Diego, CA 1,066 1,109 1,336 1,256 1,417 75.0 76.9 91.4 85.1 96.0

San Francisco, CA 1,749 1,693 1,749 1,547 1,896 443.5 430.4 452.4 405.5 497.0 

San Jose, CA 270 349 303 401 594 31.6 40.6 35.5 47.0 69.7 

Seattle, WA 773 984 1,024 957 860 89.3 112.8 117.0 109.0 98.0 

St Louis, MO 1,453 1,565 1,322 1,245 1,114 891.4 971.8 831.7 796.3 712.5 

St Paul, MN 292 225 241 231 64 212.7 163.3 175.7 169.7 47.0 

St Petersburg, FL 803 740 745 657 650 182.7 167.8 168.5 148.4 146.8 

Tampa, FL 830 759 1,053 904 570 169.0 150.8 203.7 171.4 108.1 

Toledo, OH 370 466 613 381 477 169.2 213.0 280.5 173.6 217.3 

Tucson, AZ 334 402 254 253 267 80.5 95.3 59.0 57.9 61.1 

Tulsa, OK 398 511 535 480 465 207.9 264.9 275.0 246.5 238.8 

Washington, DC 1,430 1,627 1,436 1,361 1,269 531.3 601.5 532.5 511.5 476.9 

Wichita, KS 317 364 344 341 264 141.4 161.2 150.7 148.7 115.1 

Yonkers, NY 45 62 70 100 56 47.3 64.5 72.4 102.9 57.6 

U.S. CITY TOTAL* 88,792 85,421 83,165 74,780 70,989 261.2 248.8 240.1 214.9 204.0 

San Juan, PR 165 167 105 88 65 33.7 34.0 21.3 17.8 13.2 

TOTAL 88,957 85,588 83,270 74,868 71,054 258.0 245.8 237.0 212.2 201.4 

*Cases reported with unknown sex are not included in this table. See Appendix (Reporting of City-specific Surveillance Data). 

STD Surveillance 2004 Gonorrhea Tables 107 
Table 20. Gonorrhea — Reported cases and rates per 100,000 population by age and sex: United States, 

2000–2004 

Year Age 

Group 

Cases Rates 

Total Male Female Total Male Female 

2000 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

5,925 

102,043 

112,313 

55,929 

31,814 

22,605 

13,526 

10,344 

2,299 

897 

830 

33,312 

54,195 

32,831 

20,603 

15,765 

10,234 

8,669 

2,077 

722 

5,094 

68,731 

58,119 

23,098 

11,211 

6,840 

3,292 

1,676 

222 

175 

28.8 

504.7 

586.8 

290.3 

154.5 

99.9 

60.0 

27.2 

9.4 

2.6 

7.9 

320.6 

554.1 

336.8 

198.8 

139.8 

91.6 

46.4 

17.7 

5.0 

50.7 

699.5 

621.0 

242.7 

109.6 

60.3 

29.0 

8.6 

1.7 

0.8 

TOTAL 358,779 179,651 179,128 127.1 129.7 124.6 

2001 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

6,041 

101,065 

116,207 

56,083 

32,537 

21,799 

13,605 

10,458 

2,255 

843 

862 

31,952 

54,604 

32,181 

21,050 

15,216 

10,072 

8,655 

2,003 

651 

5,179 

69,113 

61,603 

23,902 

11,487 

6,583 

3,533 

1,803 

252 

192 

28.9 

498.6 

589.5 

294.8 

156.5 

97.7 

59.6 

26.7 

8.9 

2.4 

8.0 

306.5 

541.7 

333.6 

201.1 

136.5 

89.0 

44.9 

16.5 

4.5 

50.8 

701.8 

639.7 

254.9 

111.3 

58.9 

30.7 

9.0 

1.9 

0.9 

TOTAL 361,758 177,531 184,227 126.8 126.7 126.8 

2002 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

5,449 

96,325 

112,449 

55,480 

32,081 

21,419 

13,791 

10,927 

2,284 

791 

784 

29,921 

52,130 

31,391 

20,560 

14,878 

10,254 

8,891 

2,019 

631 

4,665 

66,404 

60,318 

24,089 

11,521 

6,541 

3,536 

2,036 

266 

159 

25.8 

472.7 

556.3 

292.4 

153.1 

97.7 

60.0 

27.3 

8.6 

2.2 

7.2 

285.7 

503.7 

325.6 

194.6 

135.8 

89.8 

45.2 

15.8 

4.3 

45.2 

670.4 

611.5 

258.1 

110.8 

59.7 

30.5 

10.0 

1.9 

0.8 

TOTAL 351,836 171,839 179,997 122.0 121.3 122.7 

2003 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

4,929 

90,340 

106,930 

53,692 

30,528 

20,212 

13,722 

11,018 

2,316 

745 

725 

27,473 

48,222 

29,368 

19,004 

13,824 

10,079 

8,905 

2,012 

617 

4,204 

62,867 

58,709 

24,325 

11,524 

6,388 

3,644 

2,113 

303 

128 

23.3 

441.1 

515.9 

280.1 

147.4 

94.4 

59.8 

27.0 

8.3 

2.1 

6.7 

261.2 

452.2 

300.5 

181.9 

128.9 

88.4 

44.4 

15.0 

4.1 

40.7 

631.2 

583.4 

258.9 

112.4 

59.8 

31.5 

10.2 

2.1 

0.6 

TOTAL 335,104 160,459 174,645 115.2 112.2 118.2 

2004 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

4,447 

87,454 

103,187 

54,857 

30,372 

19,793 

14,026 

12,078 

2,653 

745 

630 

26,607 

45,917 

29,520 

18,664 

13,350 

10,220 

9,645 

2,286 

615 

3,817 

60,847 

57,269 

25,337 

11,708 

6,443 

3,806 

2,433 

367 

130 

21.0 

427.1 

497.8 

286.2 

146.7 

92.5 

61.1 

29.6 

9.5 

2.1 

5.8 

252.9 

430.6 

302.1 

178.6 

124.5 

89.6 

48.1 

17.0 

4.1 

36.9 

610.9 

569.1 

269.7 

114.2 

60.3 

32.9 

11.7 

2.5 

0.6 

TOTAL 330,132 157,623 172,509 113.5 110.2 116.7 

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the distribution of cases 

for which age was known. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9 

year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

108 Gonorrhea Tables STD Surveillance 2004 
This page intentionally left blank.
 
Table 21A. Gonorrhea — Reported cases by race/ethnicity, age group and sex: United States, 2000–2004 

Age 

Group 

White, Non-Hispanic 

Total Male Female 

Black, Non-Hispanic 

Total Male Female Total 

Hispanic 

Male Female 

Asian/Pacific Islander 

Total Male Female 

American Indian/ 

Alaska Native 

Total Male Female 

10-14 769 50 719 4,649 689 3,960 419 82 336 38 1 37 48 7 41 

15-19 14,608 2,576 12,032 79,244 28,108 51,137 6,877 2,315 4,563 670 180 489 644 131 514 

20-24 15,597 4,831 10,766 87,435 44,977 42,459 7,757 3,762 3,995 884 431 454 655 207 448 

200025-29 

30-34 

35-39 

7,898 3,373 4,524 

5,802 3,190 2,612 

4,689 2,969 1,720 

42,931 26,572 16,359 

23,063 15,542 7,521 

16,039 11,591 4,448 

4,175 

2,347 

1,445 

2,417 

1,482 

933 

1,758 

865 

512 

565 351 214 

378 274 104 

251 181 70 

361 123 238 

219 114 105 

178 89 89 

40-44 2,724 1,840 884 9,909 7,796 2,114 668 449 219 126 96 30 96 52 44 

45-54 2,038 1,572 465 7,576 6,567 1,009 560 414 146 103 73 29 66 41 25 

55-64 495 436 59 1,636 1,513 123 115 91 24 30 19 11 22 17 5 

65+ 190 144 46 641 527 114 51 45 6 2 0 2 13 6 7 

TOTAL 54,964 21,039 33,925 273,928 144,191 129,737 24,512 12,030 12,481 3,056 1,609 1,447 2,319 793 1,526 

10-14 855 57 798 4,646 715 3,932 440 80 360 53 6 47 46 3 43 

15-19 14,961 2,611 12,351 77,554 26,692 50,862 7,095 2,312 4,783 763 205 559 692 130 562 

20-24 16,997 5,390 11,607 89,154 44,621 44,533 8,416 4,024 4,393 881 354 526 778 231 547 

2001

25-29 

30-34 

35-39 

8,535 3,610 4,924 

6,106 3,461 2,645 

4,720 3,026 1,694 

42,275 25,705 16,570 

23,242 15,644 7,597 

15,136 10,957 4,178 

4,418 

2,636 

1,630 

2,464 

1,646 

1,055 

1,954 

990 

575 

512 281 231 

327 205 122 

160 116 44 

344 124 219 

220 93 127 

149 59 90 

40-44 2,882 1,924 958 9,749 7,496 2,253 759 513 246 111 92 19 101 46 55 

45-54 2,364 1,796 568 7,386 6,356 1,030 542 398 144 84 60 25 79 45 34 

55-64 583 510 73 1,510 1,374 136 124 90 33 23 16 7 14 12 2 

65+ 207 163 44 554 443 111 57 29 28 17 11 6 7 3 4 

TOTAL 58,323 22,585 35,738 271,871 140,235 131,636 26,190 12,624 13,566 2,935 1,348 1,588 2,439 751 1,689 

10-14 786 50 736 4,181 665 3,516 412 57 355 28 4 24 41 7 34 

15-19 15,055 2,521 12,534 73,130 24,995 48,134 6,809 2,111 4,699 547 122 425 785 170 615 

20-24 18,044 5,714 12,330 84,159 41,703 42,456 8,648 4,176 4,473 772 304 468 843 244 599 

200225-29 

30-34 

35-39 

9,168 3,917 5,251 

6,450 3,628 2,822 

5,067 3,336 1,731 

40,777 24,593 16,184 

22,223 14,951 7,271 

14,263 10,190 4,073 

4,647 

2,820 

1,695 

2,470 

1,656 

1,132 

2,177 

1,164 

562 

501 263 238 

322 207 115 

214 130 84 

390 157 233 

260 117 143 

175 87 88 

40-44 3,386 2,393 993 9,226 7,098 2,128 957 637 320 109 66 44 109 58 51 

45-54 2,706 2,089 617 7,460 6,268 1,192 573 408 165 105 74 31 80 51 29 

55-64 664 574 90 1,467 1,336 132 125 95 29 23 10 13 4 3 2 

65+ 196 155 41 523 428 95 50 35 15 18 11 7 3 3 0 

TOTAL 61,671 24,429 37,243 257,986 132,498 125,488 26,829 12,822 14,007 2,646 1,196 1,450 2,704 905 1,800 

10-14 789 51 739 3,662 594 3,068 390 71 320 31 3 28 55 7 49 

15-19 15,541 2,532 13,009 66,553 22,572 43,980 7,011 2,086 4,924 533 116 417 700 163 537 

20-24 19,132 6,097 13,035 77,129 37,552 39,577 9,080 4,085 4,994 840 270 570 767 229 539 

200325-29 

30-34 

35-39 

9,891 4,159 5,732 

6,648 3,512 3,136 

5,126 3,314 1,812 

38,142 22,275 15,866 

20,459 13,498 6,961 

12,840 9,130 3,710 

4,787 

2,821 

1,823 

2,544 

1,704 

1,160 

2,243 

1,117 

663 

499 250 249 

381 206 175 

244 139 105 

375 146 229 

214 83 131 

174 80 94 

40-44 3,835 2,634 1,201 8,642 6,626 2,016 981 654 327 145 95 49 118 70 48 

45-54 2,917 2,169 748 7,268 6,172 1,096 660 467 192 105 64 41 66 32 33 

55-64 713 588 125 1,439 1,301 138 123 98 25 31 19 13 8 7 2 

65+ 239 196 43 443 379 64 44 29 15 11 7 4 8 6 2 

TOTAL 64,961 25,288 39,673 237,038 120,266 116,771 27,793 12,922 14,872 2,823 1,171 1,652 2,489 823 1,666 

10-14 678 44 634 3,336 526 2,811 366 48 318 28 5 23 38 7 31 

15-19 15,369 2,546 12,822 63,917 21,682 42,234 6,908 2,101 4,807 475 115 359 785 159 626 

20-24 19,129 5,909 13,220 73,374 35,351 38,023 8,891 4,017 4,874 868 329 538 939 319 620 

200425-29 

30-34 

35-39 

10,539 4,237 6,301 

6,751 3,459 3,293 

5,276 3,277 1,998 

38,013 21,985 16,028 

20,027 13,180 6,847 

12,243 8,667 3,576 

5,387 

2,956 

1,883 

2,882 

1,726 

1,178 

2,505 

1,230 

706 

497 262 234 

384 200 184 

214 143 72 

424 159 265 

249 99 150 

172 84 88 

40-44 4,021 2,713 1,307 8,710 6,653 2,058 1,060 736 324 116 75 40 116 40 76 

45-54 3,341 2,487 855 7,777 6,523 1,253 746 511 235 103 61 42 110 63 46 

55-64 831 695 136 1,615 1,457 158 159 116 43 35 12 23 12 7 5 

65+ 219 174 45 472 404 68 42 29 14 3 1 2 8 6 2 

TOTAL 66,250 25,585 40,665 229,843 116,537 113,306 28,455 13,360 15,096 2,726 1,205 1,521 2,858 946 1,912 

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 20 for age-specific cases and rates and Tables 13-15 for sex-specific 

cases and rates and overall totals. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables 

were specified. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9 year age group is not 

shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

110 Gonorrhea Tables STD Surveillance 2004 
Table 21B. Gonorrhea — Rates per 100,000 population by race/ethnicity, age group and sex: United States, 

2000–2004 

Age 

Group 

White, Non-Hispanic 

Total Male Female 

Black, Non-Hispanic 

Total Male Female Total 

Hispanic 

Male Female 

Asian/Pacific Islander 

Total Male Female 

American Indian/ 

Alaska Native 

Total Male Female 

10-14 5.8 0.7 11.2 145.1 42.4 250.8 13.1 5.0 21.5 4.8 0.3 9.5 20.6 5.9 36.0 

15-19 112.4 38.7 189.6 2,662.4 1,867.1 3,476.2 216.9 137.4 307.0 78.7 41.6 117.4 293.0 116.4 477.1 

20-24 130.9 80.1 182.9 3,264.8 3,448.8 3,090.2 225.3 198.4 258.2 96.0 93.5 98.4 360.1 225.1 498.4 

25-29 

30-34 

35-39 

65.6 55.6 75.7 

42.8 46.8 38.8 

29.8 37.7 21.9 

1,687.3 2,197.0 1,225.4 

874.7 1,246.2 541.3 

566.0 870.8 296.0 

121.9 

74.0 

50.5 

130.5 

87.5 

62.4 

111.7 

58.5 

37.5 

52.1 65.7 38.8 

35.9 53.2 19.3 

24.9 37.0 13.5 

215.2 146.2 284.6 

2000

128.4 134.2 122.6 

94.2 96.5 92.0 

40-44 16.7 22.5 10.8 362.8 608.6 145.8 28.5 37.5 19.1 13.5 21.7 6.1 52.5 59.5 46.1 

45-54 7.0 11.0 3.2 182.5 342.5 45.2 17.5 26.2 9.0 6.8 10.5 3.6 22.7 29.6 16.4 

55-64 2.6 4.7 0.6 68.3 141.8 9.2 6.6 11.1 2.6 3.5 4.7 2.5 13.7 22.3 5.7 

65+ 0.6 1.2 0.3 22.5 48.7 6.5 2.9 6.2 0.5 0.2 0.0 0.4 9.2 9.6 8.9 

TOTAL 27.8 21.8 33.6 778.1 862.0 702.1 68.7 65.5 72.1 26.7 28.9 24.5 98.6 68.4 128.0 

10-14 6.5 0.8 12.4 141.5 42.9 243.0 13.1 4.7 21.8 6.4 1.4 11.6 19.6 2.5 37.3 

15-19 114.8 39.0 194.8 2,586.9 1,753.8 3,446.0 223.7 138.7 317.9 89.9 47.3 134.3 309.3 113.9 513.1 

20-24 138.5 86.8 191.4 3,203.4 3,276.3 3,133.6 238.0 206.0 277.5 94.4 76.3 112.2 411.4 241.2 586.4 

25-29 

30-34 

35-39 

73.3 61.5 85.3 

45.3 51.0 39.5 

30.9 39.6 22.3 

1,683.5 2,148.2 1,260.6 

878.9 1,251.9 544.7 

537.7 828.4 280.0 

122.7 

78.3 

54.0 

125.7 

91.5 

66.6 

119.2 

63.3 

40.1 

46.3 52.2 40.7 

29.0 37.4 21.0 

15.2 22.7 8.2 

205.8 148.1 264.2 

2001

129.2 109.2 149.0 

80.2 65.2 94.8 

40-44 17.6 23.5 11.7 351.3 576.2 152.8 30.4 40.1 20.2 11.5 20.1 3.7 54.4 51.4 57.2 

45-54 8.0 12.2 3.8 170.4 317.6 44.2 15.8 23.4 8.4 5.3 8.1 2.9 26.3 31.3 21.6 

55-64 2.9 5.3 0.7 61.2 125.1 9.9 6.7 10.4 3.4 2.6 3.8 1.5 8.2 14.8 2.0 

65+ 0.7 1.3 0.3 19.2 40.3 6.2 3.1 3.8 2.6 1.8 2.9 1.0 4.6 5.0 4.3 

TOTAL 29.4 23.3 35.3 762.0 826.8 703.3 70.3 65.8 75.2 24.6 23.4 25.8 102.6 64.0 140.0 

10-14 6.0 0.7 11.5 124.9 39.1 213.2 11.6 3.1 20.6 3.4 1.0 5.9 17.4 5.9 29.2 

15-19 115.2 37.5 197.3 2,410.6 1,621.2 3,226.2 213.0 126.8 306.6 64.2 28.1 101.6 346.9 147.5 555.1 

20-24 143.4 89.7 198.3 2,927.7 2,942.8 2,913.0 239.8 209.6 277.0 81.4 64.7 97.9 427.4 244.0 616.6 

25-29 

30-34 

35-39 

80.1 67.9 92.6 

48.4 54.1 42.6 

34.4 45.3 23.6 

1,631.8 2,062.7 1,238.6 

834.8 1,187.4 518.3 

514.3 781.9 277.1 

123.8 

78.8 

53.7 

119.9 

86.3 

68.2 

128.5 

70.2 

37.6 

45.1 49.0 41.5 

26.6 35.3 18.4 

19.5 24.4 14.9 

233.3 186.1 281.2 

2002

152.3 137.3 167.3 

96.9 97.9 96.0 

40-44 20.7 29.3 12.1 329.1 540.7 142.7 36.1 46.7 24.9 10.9 13.7 8.3 58.0 64.4 52.0 

45-54 9.0 14.1 4.1 165.7 301.7 49.2 15.7 22.4 9.0 6.3 9.6 3.4 26.0 34.4 18.1 

55-64 3.2 5.6 0.8 57.2 116.9 9.2 6.3 10.2 2.8 2.3 2.1 2.5 2.4 3.2 1.7 

65+ 0.7 1.3 0.2 17.9 38.3 5.3 2.5 4.2 1.3 1.8 2.5 1.3 1.9 4.4 0.0 

TOTAL 31.0 25.1 36.7 713.7 770.7 662.1 69.2 64.1 74.6 21.4 20.0 22.6 112.5 76.3 147.6 

10-14 6.0 0.8 11.6 108.3 34.6 184.4 10.7 3.8 17.9 3.7 0.6 6.9 23.9 5.7 42.7 

15-19 118.9 37.7 204.7 2,165.6 1,447.2 2,905.9 215.9 123.8 315.1 62.2 26.3 100.1 307.6 140.7 481.1 

20-24 149.1 93.5 206.3 2,614.5 2,558.2 2,670.3 242.4 197.0 298.6 84.8 54.0 116.2 372.7 218.5 532.1 

25-29 

30-34 

35-39 

85.8 71.4 100.4 

51.0 53.5 48.4 

36.0 46.4 25.5 

1,504.2 1,831.3 1,202.6 

771.9 1,074.6 499.2 

472.6 713.9 258.0 

126.0 

78.8 

57.4 

121.6 

88.6 

69.0 

131.5 

67.4 

44.4 

44.2 45.1 43.4 

30.3 33.4 27.3 

22.0 25.8 18.4 

220.8 170.4 272.0 

2003

125.6 98.0 153.2 

99.4 92.8 105.8 

40-44 23.7 32.6 14.8 308.0 504.5 135.1 35.8 46.0 24.7 14.0 19.2 9.2 62.8 76.8 49.7 

45-54 9.6 14.4 4.9 156.6 287.9 43.9 17.3 24.5 10.1 6.0 7.8 4.4 20.7 21.4 20.0 

55-64 3.3 5.5 1.1 53.6 108.9 9.3 5.9 9.8 2.3 3.0 3.9 2.3 4.4 7.3 1.8 

65+ 0.8 1.6 0.2 15.0 33.5 3.5 2.2 3.4 1.3 1.1 1.6 0.6 4.6 8.1 2.0 

TOTAL 32.6 25.9 39.1 649.3 691.8 610.6 69.7 62.7 77.1 22.1 18.9 25.2 102.5 68.8 135.2 

10-14 5.2 0.7 10.0 98.7 30.6 168.9 10.0 2.6 17.8 3.3 1.2 5.6 16.3 5.7 27.2 

15-19 117.5 37.9 201.7 2,079.8 1,390.1 2,790.5 212.7 124.7 307.6 55.4 26.2 86.3 345.2 137.4 561.2 

20-24 149.0 90.7 209.3 2,487.2 2,408.3 2,565.4 237.3 193.7 291.4 87.6 66.0 109.7 456.1 304.6 612.8 

25-29 

30-34 

35-39 

91.4 72.8 110.3 

51.8 52.6 50.8 

37.1 45.9 28.2 

1,499.1 1,807.4 1,214.9 

755.6 1,049.2 491.0 

450.7 677.7 248.7 

141.8 

82.6 

59.3 

137.7 

89.8 

70.0 

146.8 

74.2 

47.3 

44.0 47.3 40.8 

30.5 32.5 28.6 

19.3 26.4 12.6 

249.5 185.4 314.5 

2004

146.3 116.8 175.9 

98.5 97.7 99.2 

40-44 24.8 33.6 16.1 310.5 506.5 137.9 38.7 51.9 24.5 11.2 15.2 7.5 61.8 44.6 78.0 

45-54 11.0 16.5 5.6 167.6 304.3 50.2 19.5 26.8 12.3 5.9 7.5 4.5 34.6 41.7 28.0 

55-64 3.8 6.5 1.2 60.2 121.9 10.6 7.6 11.7 4.0 3.4 2.4 4.2 6.0 7.1 5.0 

65+ 0.7 1.4 0.3 15.9 35.7 3.7 2.1 3.3 1.1 0.3 0.3 0.3 4.6 8.0 2.0 

TOTAL 33.3 26.2 40.0 629.6 670.3 592.5 71.3 64.9 78.2 21.4 19.4 23.2 117.7 79.0 155.3 

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 20 for age-specific cases and rates and Tables 13-15 for 

sex-specific cases and rates and overall totals. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for 

which these variables were specified. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9 

year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

STD Surveillance 2004 Gonorrhea Tables 111 
Table 22. All stages of syphilis* — Reported cases and rates by state/area and region listed in alphabetical 

order: United States and outlying areas, 2000–2004 

State/Area 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004 2000 2001 2002 2003 2004 

Alabama 

Alaska 

Arizona 

Arkansas 

California 

Colorado 

Connecticut 

Delaware 

Florida 

Georgia 

Hawaii 

Idaho 

Illinois 

Indiana 

Iowa 

Kansas 

Kentucky 

Louisiana 

Maine 

Maryland 

Massachusetts 

Michigan 

Minnesota 

Mississippi 

Missouri 

Montana 

Nebraska 

Nevada 

New Hampshire 

New Jersey 

New Mexico 

New York 

North Carolina 

North Dakota 

Ohio 

Oklahoma 

Oregon 

Pennsylvania 

Rhode Island 

South Carolina 

South Dakota 

Tennessee 

Texas 

Utah 

Vermont 

Virginia 

Washington 

West Virginia 

Wisconsin 

Wyoming 

753 

6 

849 

366 

3,354 

63 

151 

45 

2,770 

1,640 

22 

11 

1,638 

751 

55

67 

253 

973 

7

1,172 

448 

1,001 

77 

685 

299 

0

7 

52 

19 

802 

101 

2,948 

1,495 

1 

282 

327 

49 

685 

38 

861 

1 

1,709 

3,298 

59

0

539 

171 

13 

184 

5

724 

9 

1,149 

239 

3,053 

149 

165 

79 

2,915 

1,988 

41 

11 

1,547 

529 

44

88 

191 

793 

16 

938 

446 

1,170 

132 

654 

174 

0

16 

62 

21 

1,040 

76 

3,610 

1,422 

2 

297 

288 

48 

726 

39 

916 

1 

1,478 

3,662 

25

8

525 

174 

7 

131 

4

700 

9 

1,086 

219 

3,917 

174 

188 

62 

3,280 

1,896 

59 

23 

1,593 

320 

54

77 

212 

776 

9

843 

541 

1,184 

148 

451 

204 

5

25 

113 

24 

1,062 

115 

3,885 

1,051 

0 

351 

287 

75 

689 

67 

620 

0 

1,082 

4,109 

71

2

528 

158 

5 

135 

1

567 

8

1,106 

296 

4,207 

144 

207 

47 

3,283 

2,152 

61 

45 

1,377 

367 

46

77 

160 

1,581 

21 

975 

644 

860 

195 

435 

207 

0

27 

149 

37 

1,089 

205 

4,360 

850 

2 

481 

353 

118 

706 

90 

552 

5 

881 

3,996 

72

1

552 

239 

11 

111 

4

639 

15 

974 

249 

4,586 

179 

169 

61 

2,964 

1,588 

36 

78 

1,345 

273 

36 

87 

151 

1,645 

7 

1,002 

517 

806 

145 

404 

268 

4 

15 

253 

26 

826 

251 

4,468 

747 

0 

571 

168 

108 

574 

104 

523 

0 

799 

4,205 

78 

3 

610 

336 

18 

127 

6 

16.9 

1.0 

16.4 

13.7 

9.9 

1.5 

4.4 

5.7 

17.3 

19.9 

1.8 

0.8 

13.2 

12.3 

1.9 

2.5 

6.2 

21.8 

0.5 

22.1 

7.0 

10.1 

1.6 

24.0 

5.3 

0.0 

0.4 

2.6 

1.5 

9.5 

5.5 

15.5 

18.5 

0.2 

2.5 

9.5 

1.4 

5.6 

3.6 

21.4 

0.1 

30.0 

15.7 

2.6 

0.0 

7.6 

2.9 

0.7 

3.4 

1.0 

16.2 

1.4 

21.7 

8.9 

8.8 

3.4 

4.8 

9.9 

17.8 

23.7 

3.3 

0.8 

12.4 

8.6 

1.5 

3.3 

4.7 

17.7 

1.2 

17.4 

7.0 

11.7 

2.6 

22.9 

3.1 

0.0 

0.9 

3.0 

1.7 

12.2 

4.2 

18.9 

17.3 

0.3 

2.6 

8.3 

1.4 

5.9 

3.7 

22.5 

0.1 

25.7 

17.1 

1.1 

1.3 

7.3 

2.9 

0.4 

2.4 

0.8 

15.6 

1.4 

19.9 

8.1 

11.2 

3.9 

5.4 

7.7 

19.6 

22.1 

4.7 

1.7 

12.6 

5.2 

1.8 

2.8 

5.2 

17.3 

0.7 

15.4 

8.4 

11.8 

2.9 

15.7 

3.6 

0.5 

1.4 

5.2 

1.9 

12.4 

6.2 

20.3 

12.6 

0.0 

3.1 

8.2 

2.1 

5.6 

6.3 

15.1 

0.0 

18.7 

18.9 

3.1 

0.3 

7.2 

2.6 

0.3 

2.5 

0.2 

12.6 

1.2

19.8 

10.9 

11.9 

3.2 

5.9 

5.7 

19.3 

24.8 

4.9 

3.3 

10.9 

5.9 

1.6 

2.8 

3.9 

35.2 

1.6 

17.7 

10.0 

8.5 

3.9 

15.1 

3.6 

0.0

1.6 

6.6 

2.9 

12.6 

10.9 

22.7 

10.1 

0.3

4.2 

10.1 

3.3 

5.7 

8.4 

13.3 

0.7

15.1 

18.1 

3.1 

0.2

7.5 

3.9 

0.6 

2.0 

0.8

14.2 

2.3

17.5 

9.1 

12.9 

3.9 

4.9 

7.5 

17.4 

18.3

2.9 

5.7 

10.6 

4.4 

1.2 

3.2 

3.7 

36.6 

0.5 

18.2 

8.0 

8.0 

2.9 

14.0 

4.7 

0.4

0.9 

11.3 

2.0 

9.6 

13.4 

23.3 

8.9 

0.0

5.0 

4.8 

3.0 

4.6 

9.7 

12.6 

0.0

13.7 

19.0 

3.3 

0.5

8.3 

5.5 

1.0 

2.3 

1.2

U.S. TOTAL† 31,618 32,281 32,916 34,289 33,401 11.2 11.3 11.4 11.8 11.5 

Northeast 5,098 6,071 6,467 7,155 6,694 9.5 11.3 11.9 13.2 12.3 

Midwest 4,363 4,131 4,091 3,755 3,673 6.8 6.4 6.3 5.7 5.6 

South 17,415 17,278 16,552 17,021 16,130 17.3 16.9 16.0 16.3 15.4 

West 4,742 4,801 5,806 6,358 6,904 7.5 7.4 8.8 9.6 10.4 

Guam 

Puerto Rico 

Virgin Islands 

9

1,340 

11 

30

1,268 

9 

19

1,393 

4 

16

1,357 

14 

13 

1,152 

17 

5.8 

35.1 

10.1 

18.9 

33.0 

8.2 

11.8 

36.1 

3.6 

9.8 

35.0 

12.9 

7.9 

29.7 

15.6 

OUTLYING AREAS 1,360 1,307 1,416 1,387 1,182 33.3 31.8 34.3 33.4 28.5 

TOTAL 32,978 33,588 34,332 35,676 34,583 11.5 11.6 11.7 12.1 11.7 

*See Appendix (Syphilis Morbidity Reporting) for definition. 

†

Includes cases reported by Washington, D.C. 

112 Syphilis Tables STD Surveillance 2004 
Table 23. All stages of syphilis* — Reported cases and rates in selected cities listed in alphabetical order: 

United States and outlying areas, 2000–2004 

City 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004
 2000 2001 2002 2003 2004 

Akron, OH 2 4 5 5 10 
 0.4 0.7 0.9 0.9

Albuquerque, NM 63 43 60 75 98 11.3 7.6 10.5 12.9 16.9 

Atlanta, GA 384 799 827 966 725 47.0 96.8 100.2 118.0 88.6 

Austin, TX 59 115 101 127 169 9.3 17.6 15.0 18.8 25.0 

Baltimore, MD 728 477 400 457 484 112.2 73.9 62.6 72.7 77.0 

Birmingham, AL 212 151 127 111 103 32.0 22.8 19.2 16.9 15.7 

Boston, MA 160 157 231 298 219 26.7 26.1 38.6 50.5 37.1 

Buffalo, NY 10 12 10 9 11 3.1 3.7 3.1 2.8 3.4 

Charlotte, NC 151 130 102 109 115 21.6 18.0 13.8 14.5 15.3 

Chicago, IL 1,090 1,094 1,149 947 977 35.3 35.4 37.2 30.8 31.8 

Cincinnati, OH 14 16 21 11 39 1.7 1.9 2.5 1.3 4.7 

Cleveland, OH 42 39 26 34 48 3.0 2.8 1.9 2.5 3.5 

Columbus, OH 90 140 189 217 210 8.4 12.9 17.4 19.9 19.3 

Corpus Christi, TX 10 10 12 26 14 3.6 3.6 4.3 9.3 5.0 

Dallas, TX 587 702 1,044 850 777 49.2 57.8 86.2 70.2 64.2 

Dayton, OH 17 18 9 13 11 3.0 3.2 1.6 2.4 2.0

Denver, CO 23 64 89 77 86
 4.1 11.4 15.9 13.8 15.4 

Des Moines, IA 18 15 19 16 22
 4.8 3.9 4.9 4.1 5.7 

Detroit, MI 771 925 880 624 563
 81.1 97.6 93.2 66.6 60.1 

El Paso, TX 92 106 119 110 111
 16.3 18.5 20.6 18.8 19.0 

Fort Worth, TX 191 267 374 224 171
 35.5 48.4 66.0 38.7 29.6 

Honolulu, HI 15 30 52 53 28
 1.7 3.4 5.8 5.9 3.1 

Houston, TX 850 922 1,034 991 1,044
 45.3 48.2 51.4 48.8 51.4 

Indianapolis, IN 521 306 135 122 108 60.5 35.4 15.6 14.1 12.5

Jacksonville, FL 125 139 69 125 201 16.0 17.5 8.6 15.3 24.6 

Jersey City, NJ 27 39 59 52 61 11.2 16.1 24.4 21.7 25.4 

Kansas City, MO 46 30 37 56 54 10.2 6.6 8.1 12.3 11.9 

Los Angeles, CA 1,857 1,339 1,626 1,755 2,061 20.8 14.8 17.7 19.0 22.3 

Louisville, KY 149 100 141 101 99 21.5 14.4 20.2 14.4 14.2 

Memphis, TN 882 896 541 477 462 98.2 99.5 59.7 52.6 51.0 

Miami, FL 829 1,044 1,297 1,167 994 36.7 45.5 55.6 49.8 42.5 

Milwaukee, WI 151 98 88 62 67 16.1 10.4 9.4 6.6 7.2 

Minneapolis, MN 34 63 79 73 55 8.8 16.3 20.5 18.9 14.3 

Nashville, TN 523 379 294 198 161 91.7 66.4 51.5 34.7 28.3 

New Orleans, LA 124 101 102 204 329 25.6 21.1 21.5 43.5 70.1 

New York City, NY 2,712 3,304 3,486 3,825 3,708 33.8 41.0 43.1 47.3 45.9 

Newark, NJ 265 377 343 360 244 88.2 125.0 113.4 119.3 80.8 

Norfolk, VA 85 83 47 48 51 36.3 35.3 19.7 19.9 21.1 

Oakland, CA 91 109 176 173 144 6.3 7.4 12.0 11.8 9.9 

Oklahoma City, OK 193 160 170 193 90 45.3 37.3 39.3 44.3 20.7 

Omaha, NE 6 3 15 21 8 1.3 0.6 3.2 4.4 1.7 

Philadelphia, PA 618 646 566 586 470 40.8 43.0 37.9 39.6 31.8 

Phoenix, AZ 738 959 855 829 644 23.8 30.0 25.9 24.5 19.0 

Pittsburgh, PA 7 15 26 30 28 0.5 1.2 2.0 2.4 2.2 

Portland, OR 30 29 48 64 52 5.7 5.5 9.0 12.0 9.7 

Richmond, VA 40 58 25 42 30 20.3 29.3 12.7 21.6 15.4 

Rochester, NY 7 4 13 24 29 2.8 1.6 5.2 9.7 11.7 

Sacramento, CA 25 33 38 31 56 2.0 2.6 2.9 2.3 4.2 

San Antonio, TX 287 364 306 213 329 25.0 31.2 25.6 17.5 27.1 

San Diego, CA 232 152 162 299 356 8.2 5.3 5.6 10.2 12.1 

San Francisco, CA 163 301 604 655 706 21.0 38.8 79.1 87.1 93.9 

San Jose, CA 43 92 93 135 112 2.5 5.4 5.5 8.0 6.7 

Seattle, WA 116 110 96 134 227 6.7 6.3 5.5 7.6 12.9 

St Louis, MO 115 63 80 51 106 33.1 18.4 23.6 15.4 31.9 

St Paul, MN 9 16 16 27 8 3.2 5.6 5.6 9.6 2.8 

St Petersburg, FL 64 40 81 128 97 6.9 4.3 8.7 13.8 10.5 

Tampa, FL 132 148 222 265 197 13.2 14.4 21.1 24.7 18.4 

Toledo, OH 18 3 18 18 12 4.0 0.7 4.0 4.0 2.6 

Tucson, AZ 36 72 91 126 137 4.2 8.3 10.3 14.1 15.3 

Tulsa, OK 32 22 30 35 23 8.1 5.5 7.5 8.8 5.8 

Washington, DC 516 459 431 330 357 90.3 80.0 75.5 58.5 63.3 

Wichita, KS 10 15 13 13 29 2.2 3.3 2.8 2.8 6.3 

Yonkers, NY 10 13 27 30 38 5.0 6.5 13.4 14.8 18.8 

U.S. CITY TOTAL 17,447 18,420 19,426 19,427 18,975 25.0 26.1 27.3 27.3 26.6 

San Juan, PR 545 483 443 579 466 53.4 47.2 43.2 56.4 45.4 

TOTAL 17,992 18,903 19,869 20,006 19,441 25.4 26.4 27.6 27.7 26.9 

1.8 

*See Appendix (Syphilis Morbidity Reporting) for definition and (Reporting of City-specific Surveillance Data).
 

STD Surveillance 2004 Syphilis Tables 113
 
Table 24. Primary and secondary syphilis — Reported cases and rates by state/area, ranked by rates: 

United States, 2004 

Rank* State/Area Cases Rate per 100,000 Population 

1 Louisiana 332 7.4 

2 Maryland 380 6.9 

3 Georgia 549 6.3 

4 New Mexico 82 4.4 

5 Florida 728 4.3 

6 California 1,356 3.8 

7 New York 727 3.8 

8 Texas 827 3.7 

9 Alabama 165 3.7 

10 Illinois 386 3.1 

11 Arizona 157 2.8 

12 South Carolina 116 2.8 

U.S. TOTAL† 7,980 2.7 

13 Washington 150 2.4 

14 Rhode Island 26 2.4 

15 North Carolina 192 2.3 

16 Tennessee 130 2.2 

17 Ohio 237 2.1 

18 Mississippi 59 2.0 

19 Michigan 192 1.9 

20 Nevada 40 1.8 

21 Massachusetts 114 1.8 

22 Idaho 24 1.8 

23 New Jersey 150 1.7 

24 Arkansas 47 1.7 

25 Missouri 94 1.6 

26 Virginia 116 1.6 

27 Colorado 63 1.4 

28 Connecticut 45 1.3 

29 Alaska 8 1.2 

30 Kentucky 47 1.1 

31 Delaware 9 1.1 

32 Indiana 60 1.0 

33 Pennsylvania 118 1.0 

34 Kansas 24 0.9 

35 Oregon 29 0.8 

36 Oklahoma 25 0.7 

37 Hawaii 8 0.6 

38 Wyoming 3 0.6 

39 Utah 13 0.6 

40 Minnesota 27 0.5 

41 Wisconsin 29 0.5 

42 Montana 4 0.4 

43 Nebraska 7 0.4 

44 New Hampshire 5 0.4 

YEAR 2010 TARGET 0.2 

45 Iowa 5 0.2 

46 West Virginia 3 0.2 

47 Vermont 1 0.2 

48 Maine 2 0.2 

North Dakota 0 0.0 

South Dakota 0 0.0 

*States were ranked in descending order by rate, number of cases, and alphabetically by state. States with no cases were not ranked. †

Total includes cases reported by Washington, D.C., but excludes outlying areas (Guam with 0 cases and rate of 0.0, Puerto Rico with 182 cases and 

rate of 4.7, and Virgin Islands with 5 cases and rate of 4.6). 

114 Syphilis Tables STD Surveillance 2004 
Table 25. Primary and secondary syphilis — Counties and independent cities* ranked by number of reported 

cases: United States, 2004 

† Rank County/Independent City Cases Rate per 100,000 Population Cumulative Percent 

1 Los Angeles County, CA 506 5.1 6 

2 San Francisco County, CA 345 45.9 10 

3 Cook County, IL 340 6.4 14 

4 New York County, NY 328 21.0 19 

5 Fulton County, GA 283 34.6 22 

6 Dade County, FL 213 9.1 25 

7 Harris County, TX 211 5.9 27 

8 Baltimore (City), MD 209 33.2 30 

9 Dallas County, TX 184 8.1 32 

10 Broward County, FL 183 10.6 35 

11 Wayne County, MI 142 7.0 36 

12 San Diego County, CA 138 4.7 38 

13 Kings County, NY 134 5.4 40 

14 East Baton Rouge County, LA 124 30.1 41 

15 King County, WA 123 7.0 43 

16 De Kalb County, GA 117 17.4 44 

17 Bexar County, TX 107 7.3 46 

18 Maricopa County, AZ 106 3.1 47 

19 Franklin County, OH 105 9.6 48 

20 Queens County, NY 89 4.0 50 

*Accounting for 50% of reported primary and secondary syphilis cases. 

†

Counties were ranked in descending order by number of cases. 

STD Surveillance 2004 Syphilis Tables 115 
Table 26. Primary and secondary syphilis — Reported cases and rates by state/area and region listed in 

alphabetical order: United States and outlying areas, 2000–2004 

State/Area 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004 2000 2001 2002 2003 2004 

Alabama 123 142 149 114 165 2.8 3.2 3.3 2.5 3.7 

Alaska 0 0 0 1 8 0.0 0.0 0.0 0.2

Arizona 189 180 200 186 157 3.7 3.4 3.7 3.3 2.8 

Arkansas 104 49 34 51 47 3.9 1.8 1.3 1.9 1.7 

California 325 545 1,033 1,299 1,356 1.0 1.6 2.9 3.7 3.8 

Colorado 11 23 64 39 63 0.3 0.5 1.4 0.9 1.4 

Connecticut 16 12 28 30 45 0.5 0.3 0.8 0.9 1.3 

Delaware 9 14 11 7 9 1.1 1.8 1.4 0.9 1.1 

Florida 413 484 617 658 728 2.6 3.0 3.7 3.9 4.3 

Georgia 402 414 439 585 549 4.9 4.9 5.1 6.7 6.3 

Hawaii 2 12 11 14 8 0.2 1.0 0.9 1.1 0.6 

Idaho 1 1 8 15 24 0.1 0.1 0.6 1.1 1.8 

Illinois 412 409 479 374 386 3.3 3.3 3.8 3.0 3.1 

Indiana 351 151 62 50 60 5.8 2.5 1.0 0.8 1.0 

Iowa 11 5 8 12 5 0.4 0.2 0.3 0.4 0.2 

Kansas 6 25 20 25 24 0.2 0.9 0.7 0.9 0.9 

Kentucky 85 48 88 33 47 2.1 1.2 2.2 0.8 1.1 

Louisiana 209 173 152 183 332 4.7 3.9 3.4 4.1 7.4 

Maine 1 1 2 8 2 0.1 0.1 0.2 0.6

Maryland 300 266 228 312 380 5.6 4.9 4.2 5.7 6.9 

Massachusetts 68 46 99 133 114 1.1 0.7 1.5 2.1 1.8 

Michigan 330 428 486 249 192 3.3 4.3 4.8 2.5 1.9 

Minnesota 16 33 59 47 27 0.3 0.7 1.2 0.9 0.5 

Mississippi 137 140 49 40 59 4.8 4.9 1.7 1.4 2.0 

Missouri 29 26 34 61 94 0.5 0.5 0.6 1.1 1.6 

Montana 0 0 0 0 4 0.0 0.0 0.0 0.0

Nebraska 2 10 6 10 7 0.1 0.6 0.3 0.6 0.4 

Nevada 5 8 15 12 40 0.2 0.4 0.7 0.5 1.8 

New Hampshire 2 1 8 19 5 0.2 0.1 0.6 1.5 0.4 

New Jersey 71 137 169 170 150 0.8 1.6 2.0 2.0 1.7 

New Mexico 16 19 39 71 82 0.9 1.0 2.1 3.8 4.4 

New York 132 304 478 584 727 0.7 1.6 2.5 3.0 3.8 

North Carolina 483 445 279 152 192 6.0 5.4 3.4 1.8 2.3 

North Dakota 0 0 0 2 0 0.0 0.0 0.0 0.3

Ohio 69 81 159 197 237 0.6 0.7 1.4 1.7 2.1 

Oklahoma 116 60 72 64 25 3.4 1.7 2.1 1.8 0.7 

Oregon 12 13 28 48 29 0.3 0.4 0.8 1.3 0.8 

Pennsylvania 77 100 105 159 118 0.6 0.8 0.9 1.3 1.0 

Rhode Island 4 9 13 33 26 0.4 0.8 1.2 3.1 2.4 

South Carolina 229 235 134 94 116 5.7 5.8 3.3 2.3 2.8 

South Dakota 0 1 0 2 0 0.0 0.1 0.0 0.3

Tennessee 532 331 168 135 130 9.3 5.8 2.9 2.3 2.2 

Texas 396 478 589 654 827 1.9 2.2 2.7 3.0 3.7 

Utah 2 11 7 14 13 0.1 0.5 0.3 0.6 0.6 

Vermont 0 3 2 1 1 0.0 0.5 0.3 0.2

Virginia 126 102 71 82 116 1.8 1.4 1.0 1.1 1.6 

Washington 66 57 70 82 150 1.1 1.0 1.2 1.3 2.4 

West Virginia 3 5 2 2 3 0.2 0.3 0.1 0.1

Wisconsin 48 22 30 16 29 0.9 0.4 0.6 0.3 0.5 

Wyoming 1 1 0 0 3 0.2 0.2 0.0 0.0

U.S. TOTAL* 5,979 6,103 6,862 7,177 7,980 2.1 2.1 2.4 2.5 2.7 

Northeast 371 613 904 1,137 1,188 0.7 1.1 1.7 2.1 2.2 

Midwest 1,274 1,191 1,343 1,045 1,061 2.0 1.8 2.1 1.6 1.6 

South 3,704 3,429 3,140 3,214 3,794 3.7 3.4 3.0 3.1 3.6 

West 630 870 1,475 1,781 1,937 1.0 1.3 2.2 2.7 2.9 

Guam 

Puerto Rico 

Virgin Islands 

1

175 

3 

12

244 

0 

6

270 

1 

1

202 

3 

0 

182 

5 

0.6 

4.6 

2.8 

7.6 

6.4 

0.0 

3.7 

7.0 

0.9 

0.6 

5.2 

2.8

0.0 

4.7 

OUTLYING AREAS 179 256 277 206 187 4.4 6.2 6.7 5.0 4.5 

TOTAL 6,158 6,359 7,139 7,383 8,167 2.2 2.2 2.4 2.5 2.8 

1.2 

0.2 

0.4 

0.0 

0.0 

0.2 

0.2 

0.6 

4.6 

*Includes cases reported by Washington, D.C. 

116 Syphilis Tables STD Surveillance 2004 
Table 27. Primary and secondary syphilis — Women – Reported cases and rates by state/area and region 

listed in alphabetical order: United States and outlying areas, 2000–2004 

State/Area 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004 2000 2001 2002 2003 2004 

Alabama 63 67 63 49 52 2.7 2.9 2.7 2.1 2.2 

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0

Arizona 80 50 74 66 42 3.1 1.9 2.7 2.4 1.5 

Arkansas 58 27 18 16 18 4.2 2.0 1.3 1.1 1.3 

California 51 42 39 52 63 0.3 0.2 0.2 0.3 0.4 

Colorado 1 5 2 5 7 0.0 0.2 0.1 0.2

Connecticut 7 2 3 3 3 0.4 0.1 0.2 0.2

Delaware 1 5 4 2 1 0.2 1.2 1.0 0.5

Florida 163 135 108 73 98 2.0 1.6 1.3 0.8 1.1 

Georgia 159 129 98 68 45 3.8 3.0 2.3 1.5 1.0 

Hawaii 1 0 2 0 0 0.2 0.0 0.3 0.0

Idaho 0 0 4 5 11 0.0 0.0 0.6 0.7

Illinois 181 91 81 48 55 2.9 1.4 1.3 0.7 0.9 

Indiana 196 71 18 16 6 6.3 2.3 0.6 0.5 0.2 

Iowa 6 1 4 2 1 0.4 0.1 0.3 0.1

Kansas 1 11 6 13 7 0.1 0.8 0.4 0.9 0.5 

Kentucky 42 17 43 13 6 2.0 0.8 2.1 0.6 0.3 

Louisiana 97 83 76 79 123 4.2 3.6 3.3 3.4 5.3 

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0

Maryland 115 113 53 74 92 4.2 4.1 1.9 2.6 3.2 

Massachusetts 19 4 12 3 5 0.6 0.1 0.4 0.1 0.2 

Michigan 141 161 192 93 61 2.8 3.2 3.8 1.8 1.2 

Minnesota 5 16 4 4 3 0.2 0.6 0.2 0.2 0.1 

Mississippi 70 69 31 20 19 4.8 4.7 2.1 1.3 1.3 

Missouri 11 8 10 14 12 0.4 0.3 0.3 0.5 0.4 

Montana 0 0 0 0 1 0.0 0.0 0.0 0.0

Nebraska 1 8 2 1 4 0.1 0.9 0.2 0.1

Nevada 2 1 1 3 8 0.2 0.1 0.1 0.3

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0

New Jersey 23 44 48 49 38 0.5 1.0 1.1 1.1 0.9 

New Mexico 5 6 12 23 36 0.5 0.6 1.3 2.4 3.8 

New York 12 23 26 26 32 0.1 0.2 0.3 0.3 0.3 

North Carolina 234 191 115 47 48 5.7 4.6 2.7 1.1 1.1 

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0

Ohio 26 26 27 40 61 0.4 0.4 0.5 0.7 1.0 

Oklahoma 54 28 20 20 9 3.1 1.6 1.1 1.1 0.5 

Oregon 4 2 8 3 1 0.2 0.1 0.5 0.2

Pennsylvania 30 28 22 33 16 0.5 0.4 0.3 0.5 0.3 

Rhode Island 2 0 2 8 10 0.4 0.0 0.4 1.4

South Carolina 96 101 58 24 25 4.6 4.8 2.7 1.1 1.2 

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0

Tennessee 247 158 82 40 34 8.4 5.4 2.8 1.3 1.1 

Texas 152 169 192 162 179 1.4 1.6 1.8 1.5 1.6 

Utah 1 2 0 3 3 0.1 0.2 0.0 0.3

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0

Virginia 44 43 17 7 6 1.2 1.2 0.5 0.2 0.2 

Washington 8 7 1 4 6 0.3 0.2 0.0 0.1

West Virginia 1 1 1 2 1 0.1 0.1 0.1 0.2

Wisconsin 24 13 6 1 2 0.9 0.5 0.2 0.0 0.1 

Wyoming 1 1 0 0 1 0.4 0.4 0.0 0.0

U.S. TOTAL* 2,445 1,967 1,594 1,217 1,255 1.7 1.4 1.1 0.8 0.8 

Northeast 93 101 113 122 104 0.3 0.4 0.4 0.4 0.4 

Midwest 592 406 350 232 212 1.8 1.2 1.1 0.7 0.6 

South 1,606 1,344 988 699 760 3.1 2.6 1.9 1.3 1.4 

West 154 116 143 164 179 0.5 0.4 0.4 0.5 0.5 

Guam 

Puerto Rico 

Virgin Islands 

0

76 

2 

5

130 

0 

2

123 

0 

0

93 

2 

0 

62 

3 

0.0 

3.8 

3.5 

6.5 

6.5 

0.0 

2.5 

6.1 

0.0 

0.0

4.6 

3.5

3.1 

OUTLYING AREAS 78 135 125 95 65 3.7 6.3 5.8 4.4 3.0 

TOTAL 2,523 2,102 1,719 1,312 1,320 1.7 1.4 1.2 0.9 0.9 

0.0 

0.3 

0.2 

0.2 

0.0 

1.6 

0.1 

0.0 

0.2 

0.5 

0.7 

0.0 

0.0 

0.1 

1.8 

0.0 

0.3 

0.0 

0.2 

0.1 

0.4 

0.0 

5.3 

*Includes cases reported by Washington, D.C. 

NOTE: Cases reported with unknown sex are not included in this table. 

STD Surveillance 2004 Syphilis Tables 117 
Table 28. Primary and secondary syphilis — Men – Reported cases and rates by state/area and region listed 

in alphabetical order: United States and outlying areas, 2000–2004 

State/Area 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004 2000 2001 2002 2003 2004 

Alabama 60 75 86 65 113 2.8 3.5 4.0 3.0 5.2 

Alaska 0 0 0 1 8 0.0 0.0 0.0 0.3

Arizona 109 130 126 120 115 4.2 4.9 4.6 4.3 4.1 

Arkansas 46 22 16 35 29 3.5 1.7 1.2 2.6 2.2 

California 272 501 994 1,245 1,291 1.6 2.9 5.7 7.0 7.3 

Colorado 10 18 62 34 56 0.5 0.8 2.7 1.5 2.4 

Connecticut 9 10 25 27 42 0.5 0.6 1.5 1.6 2.5 

Delaware 8 9 7 5 8 2.1 2.3 1.8 1.3

Florida 250 349 509 585 630 3.2 4.4 6.2 7.0 7.6 

Georgia 243 285 340 517 504 6.0 6.9 8.1 12.1 11.8 

Hawaii 1 12 9 14 8 0.2 1.9 1.4 2.2 1.3 

Idaho 1 1 4 10 13 0.2 0.2 0.6 1.5 1.9 

Illinois 231 318 398 326 331 3.8 5.2 6.4 5.2 5.3 

Indiana 155 80 44 34 54 5.2 2.7 1.5 1.1 1.8 

Iowa 5 4 4 10 3 0.3 0.3 0.3 0.7 0.2 

Kansas 5 14 14 12 17 0.4 1.0 1.0 0.9 1.3 

Kentucky 43 31 45 19 41 2.2 1.6 2.2 0.9 2.0 

Louisiana 112 90 76 104 209 5.2 4.2 3.5 4.8 9.6 

Maine 1 1 2 8 2 0.2 0.2 0.3 1.3

Maryland 185 153 175 238 288 7.2 5.9 6.6 8.9 10.8 

Massachusetts 49 42 87 129 109 1.6 1.4 2.8 4.1 3.5 

Michigan 189 267 294 156 131 3.9 5.4 6.0 3.2 2.6 

Minnesota 11 17 55 43 24 0.5 0.7 2.2 1.7 1.0 

Mississippi 67 71 18 20 40 4.9 5.1 1.3 1.4 2.9 

Missouri 18 18 24 47 82 0.7 0.7 0.9 1.7 2.9 

Montana 0 0 0 0 3 0.0 0.0 0.0 0.0

Nebraska 1 2 4 9 3 0.1 0.2 0.5 1.0

Nevada 3 7 14 9 32 0.3 0.7 1.3 0.8 2.8 

New Hampshire 2 1 8 19 5 0.3 0.2 1.3 3.0 0.8 

New Jersey 48 93 121 121 112 1.2 2.3 2.9 2.9 2.7 

New Mexico 11 13 27 48 46 1.2 1.4 3.0 5.2 5.0 

New York 120 281 452 558 695 1.3 3.1 4.9 6.0 7.5 

North Carolina 249 254 164 105 144 6.3 6.3 4.0 2.5 3.5 

North Dakota 0 0 0 2 0 0.0 0.0 0.0 0.6

Ohio 43 55 132 157 176 0.8 1.0 2.4 2.8 3.2 

Oklahoma 62 32 52 44 16 3.7 1.9 3.0 2.5 0.9 

Oregon 8 11 20 45 28 0.5 0.6 1.1 2.5 1.6 

Pennsylvania 47 72 83 126 102 0.8 1.2 1.4 2.1 1.7 

Rhode Island 2 9 11 25 16 0.4 1.8 2.1 4.8 3.1 

South Carolina 133 134 76 70 91 6.8 6.8 3.8 3.5 4.5 

South Dakota 0 1 0 2 0 0.0 0.3 0.0 0.5

Tennessee 285 173 86 95 96 10.3 6.2 3.0 3.3 3.4 

Texas 244 309 397 492 648 2.3 2.9 3.7 4.5 5.9 

Utah 1 9 7 11 10 0.1 0.8 0.6 0.9 0.8 

Vermont 0 3 2 1 1 0.0 1.0 0.7 0.3

Virginia 82 59 54 75 110 2.4 1.7 1.5 2.1 3.0 

Washington 58 50 69 78 144 2.0 1.7 2.3 2.6 4.7 

West Virginia 2 4 1 0 2 0.2 0.5 0.1 0.0

Wisconsin 24 9 24 15 27 0.9 0.3 0.9 0.6 1.0 

Wyoming 0 0 0 0 2 0.0 0.0 0.0 0.0

U.S. TOTAL* 3,532 4,134 5,267 5,956 6,722 2.6 3.0 3.7 4.2 4.7 

Northeast 278 512 791 1,014 1,084 1.1 2.0 3.0 3.8 4.1 

Midwest 682 785 993 813 848 2.2 2.5 3.1 2.5 2.6 

South 2,098 2,085 2,151 2,514 3,034 4.3 4.2 4.2 4.9 5.9 

West 474 752 1,332 1,615 1,756 1.5 2.3 4.1 4.9 5.3 

Guam 

Puerto Rico 

Virgin Islands 

1

99 

1 

7

114 

0 

4

147 

1 

1

109 

1 

0 

120 

2 

1.3 

5.4 

1.9 

8.7 

6.2 

0.0 

4.9 

7.9 

2.0 

1.2

5.8 

1.9

6.4 

OUTLYING AREAS 101 121 152 111 122 5.1 6.1 7.6 5.5 6.1 

TOTAL 3,633 4,255 5,419 6,067 6,844 2.6 3.0 3.8 4.2 4.7 

2.4 

2.0 

0.3 

0.7 

0.3 

0.0 

0.0 

0.3 

0.2 

0.8 

0.0 

3.8 

*Includes cases reported by Washington, D.C. 

NOTE: Cases reported with unknown sex are not included in this table. 

118 Syphilis Tables STD Surveillance 2004 
Rank* † City Cases Rate per 100,000 Population 

1 San Francisco, CA 345 45.9 

2 Atlanta, GA 283 34.6 

3 Baltimore, MD 209 33.2 

4 New Orleans, LA 77 16.4 

5 St Louis, MO 47 14.1 

6 Detroit, MI 126 13.5 

7 Washington, DC 69 12.2 

8 Dallas, TX 141 11.6 

9 Jersey City, NJ 26 10.8 

10 Chicago, IL 297 9.7 

11 Memphis, TN 87 9.6 

12 Houston, TX 192 9.4 

13 Boston, MA 54 9.1 

14 Miami, FL 213 9.1 

15 San Antonio, TX 107 8.8 

16 Columbus, OH 94 8.6 

17 Newark, NJ 26 8.6 

18 Jacksonville, FL 70 8.6 

19 New York City, NY 621 7.7 

20 Austin, TX 52 7.7 

21 Denver, CO 41 7.4 

22 Albuquerque, NM 41 7.1 

23 Seattle, WA 123 7.0 

24 Norfolk, VA 16 6.6 

25 Fort Worth, TX 36 6.2 

26 Charlotte, NC 39 5.2 

27 Los Angeles, CA 464 5.0 

28 Philadelphia, PA 72 4.9 

29 Kansas City, MO 22 4.8 

30 Louisville, KY 33 4.7 

31 Birmingham, AL 31 4.7 

32 San Diego, CA 138 4.7 

33 Yonkers, NY 9 4.5 

34 Tampa, FL 47 4.4 

35 Tucson, AZ 38 4.3 

36 Minneapolis, MN 16 4.1 

37 St Petersburg, FL 37 4.0 

38 Oklahoma City, OK 16 3.7 

39 Richmond, VA 7 3.6 

40 Portland, OR 18 3.4 

41 Indianapolis, IN 29 3.4 

42 San Jose, CA 56 3.3 

43 Rochester, NY 8 3.2 

44 Phoenix, AZ 106 3.1 

45 Oakland, CA 41 2.8 

46 Nashville, TN 15 2.6 

47 Wichita, KS 12 2.6 

48 Cincinnati, OH 18 2.2 

49 Pittsburgh, PA 21 1.7 

50 Buffalo, NY 5 1.6 

51 El Paso, TX 9 1.5 

52 Milwaukee, WI 14 1.5 

53 Cleveland, OH 19 1.4 

54 Sacramento, CA 18 1.4 

55 Akron, OH 5 0.9 

56 Honolulu, HI 7 0.8 

57 Corpus Christi, TX 2 0.7 

58 St Paul, MN 2 0.7 

59 Toledo, OH 3 0.7 

60 Omaha, NE 3 0.6 

61 Des Moines, IA 2 0.5 

62 Tulsa, OK 2 0.5 

YEAR 2010 TARGET 0.2 

63 Dayton, OH 1 0.2 

Table 29. Primary and secondary syphilis — Reported cases and rates in selected cities, ranked by rates: 

United States, 2004 

*Cities were ranked in descending order by rate, number of cases, and alphabetically by state. 

†

Excludes cities in outlying areas (San Juan, PR, with 67 cases and rate of 6.5). See Appendix. 

STD Surveillance 2004 Syphilis Tables 119 
Table 30. Primary and secondary syphilis — Reported cases and rates in selected cities listed in alphabetical 

order: United States and outlying areas, 2000–2004 

City 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004
 2000 2001 2002 2003 2004 

Akron, OH 0 1 2 3 5
 0.0 0.2 0.4 0.5

Albuquerque, NM 11 8 21 36 41 2.0 1.4 3.7 6.2 7.1 

Atlanta, GA 116 224 257 298 283 14.2 27.1 31.1 36.4 34.6 

Austin, TX 8 17 22 28 52 1.3 2.6 3.3 4.1 7.7 

Baltimore, MD 218 161 121 153 209 33.6 24.9 18.9 24.3 33.2 

Birmingham, AL 24 12 9 22 31 3.6 1.8 1.4 3.3 4.7 

Boston, MA 25 18 48 69 54 4.2 3.0 8.0 11.7 9.1 

Buffalo, NY 1 4 3 2 5 0.3 1.2 0.9 0.6

Charlotte, NC 45 29 28 16 39 6.4 4.0 3.8 2.1 5.2 

Chicago, IL 292 317 353 267 297 9.5 10.3 11.4 8.7 9.7 

Cincinnati, OH 0 2 6 2 18 0.0 0.2 0.7 0.2

Cleveland, OH 4 3 9 16 19 0.3 0.2 0.7 1.2 1.4 

Columbus, OH 40 54 96 106 94 3.7 5.0 8.8 9.7 8.6 

Corpus Christi, TX 1 1 2 3 2 0.4 0.4 0.7 1.1

Dallas, TX 100 121 191 131 141 8.4 10.0 15.8 10.8 11.6 

Dayton, OH 5 2 4 0 1 0.9 0.4 0.7 0.0

Denver, CO 4 15 41 25 41 0.7 2.7 7.3 4.5 7.4 

Des Moines, IA 1 1 5 0 2 0.3 0.3 1.3 0.0

Detroit, MI 274 351 384 179 126 28.8 37.0 40.7 19.1 13.5 

El Paso, TX 6 12 12 2 9 1.1 2.1 2.1 0.3 1.5 

Fort Worth, TX 22 40 106 52 36 4.1 7.3 18.7 9.0 6.2 

Honolulu, HI 1 10 10 14 7 0.1 1.1 1.1 1.6 0.8 

Houston, TX 70 103 112 178 192 3.7 5.4 5.6 8.8 9.4 

Indianapolis, IN 301 128 36 25 29 35.0 14.8 4.2 2.9 3.4 

Jacksonville, FL 24 38 16 21 70 3.1 4.8 2.0 2.6 8.6 

Jersey City, NJ 1 5 16 12 26 0.4 2.1 6.6 5.0 10.8 

Kansas City, MO 1 5 8 19 22 0.2 1.1 1.8 4.2 4.8 

Los Angeles, CA 133 186 359 461 464 1.5 2.1 3.9 5.0 5.0 

Louisville, KY 57 19 77 26 33 8.2 2.7 11.0 3.7 4.7 

Memphis, TN 246 208 89 76 87 27.4 23.1 9.8 8.4 9.6 

Miami, FL 126 185 231 194 213 5.6 8.1 9.9 8.3 9.1 

Milwaukee, WI 43 18 16 10 14 4.6 1.9 1.7 1.1 1.5 

Minneapolis, MN 9 23 37 21 16 2.3 5.9 9.6 5.4 4.1 

Nashville, TN 200 76 26 21 15 35.1 13.3 4.6 3.7 2.6 

New Orleans, LA 22 24 9 25 77 4.5 5.0 1.9 5.3 16.4 

New York City, NY 117 282 435 531 621 1.5 3.5 5.4 6.6 7.7 

Newark, NJ 28 58 63 57 26 9.3 19.2 20.8 18.9 8.6 

Norfolk, VA 37 35 13 8 16 15.8 14.9 5.4 3.3 6.6 

Oakland, CA 11 23 49 33 41 0.8 1.6 3.3 2.3 2.8 

Oklahoma City, OK 82 35 52 48 16 19.2 8.2 12.0 11.0 3.7 

Omaha, NE 2 3 2 7 3 0.4 0.6 0.4 1.5

Philadelphia, PA 67 79 67 98 72 4.4 5.3 4.5 6.6 4.9 

Phoenix, AZ 172 148 155 132 106 5.6 4.6 4.7 3.9 3.1 

Pittsburgh, PA 3 7 7 17 21 0.2 0.5 0.6 1.3 1.7 

Portland, OR 11 9 20 33 18 2.1 1.7 3.7 6.2 3.4 

Richmond, VA 5 9 3 5 7 2.5 4.6 1.5 2.6

Rochester, NY 1 2 4 7 8 0.4 0.8 1.6 2.8

Sacramento, CA 1 4 11 17 18 0.1 0.3 0.8 1.3 1.4 

San Antonio, TX 67 71 45 52 107 5.8 6.1 3.8 4.3 8.8 

San Diego, CA 27 27 37 111 138 1.0 0.9 1.3 3.8 4.7 

San Francisco, CA 53 139 315 332 345 6.8 17.9 41.2 44.2 45.9 

San Jose, CA 2 10 30 56 56 0.1 0.6 1.8 3.3 3.3 

Seattle, WA 50 41 50 60 123 2.9 2.3 2.8 3.4 7.0 

St Louis, MO 11 15 13 18 47 3.2 4.4 3.8 5.4 14.1 

St Paul, MN 2 5 5 6 2 0.7 1.7 1.8 2.1

St Petersburg, FL 7 11 22 51 37 0.8 1.2 2.4 5.5 4.0 

Tampa, FL 20 15 33 43 47 2.0 1.5 3.1 4.0 4.4 

Toledo, OH 2 1 12 3 3 0.4 0.2 2.6 0.7 0.7 

Tucson, AZ 8 22 28 40 38 0.9 2.5 3.2 4.5 4.3 

Tulsa, OK 8 5 7 5 2 2.0 1.3 1.8 1.3

Washington, DC 37 43 58 48 69 6.5 7.5 10.2 8.5 12.2 

Wichita, KS 2 4 3 2 12 0.4 0.9 0.6 0.4

Yonkers, NY 1 1 2 1 9 0.5 0.5 1.0 0.5

U.S. CITY TOTAL 3,265 3,525 4,303 4,334 4,778 4.7 5.0 6.1 6.1 6.7 

San Juan, PR 68 68 78 88 67 6.7 6.6 7.6 8.6 6.5 

TOTAL 3,333 3,593 4,381 4,422 4,845 4.7 5.0 6.1 6.1 6.7 

0.7 

0.2 

0.9 

1.6 

2.2 

0.5 

0.6 

3.6 

3.2 

0.7 

0.5 

2.6 

4.5 

See Appendix (Reporting of City-specific Surveillance Data).
 

120 Syphilis Tables STD Surveillance 2004
 
Table 31. Primary and secondary syphilis — Women – Reported cases and rates in selected cities listed in 

alphabetical order: United States and outlying areas, 2000–2004 

City 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004
 2000 2001 2002 2003 2004 

Akron, OH 0 0 0 1 3
 0.0 0.0 0.0 0.4

Albuquerque, NM 3 1 6 12 18 1.1 0.3 2.0 4.0 6.1 

Atlanta, GA 37 67 57 39 23 8.9 16.0 13.6 9.4 5.6 

Austin, TX 2 3 3 2 3 0.6 0.9 0.9 0.6

Baltimore, MD 92 77 33 50 55 26.6 22.3 9.7 14.9 16.4 

Birmingham, AL 15 8 4 3 11 4.3 2.3 1.1 0.9 3.2 

Boston, MA 5 1 6 1 3 1.6 0.3 1.9 0.3

Buffalo, NY 1 0 0 1 1 0.6 0.0 0.0 0.6

Charlotte, NC 24 12 13 2 10 6.7 3.3 3.5 0.5 2.6 

Chicago, IL 129 61 43 30 47 8.1 3.8 2.7 1.9 3.0 

Cincinnati, OH 0 2 2 0 1 0.0 0.5 0.5 0.0

Cleveland, OH 2 2 3 7 1 0.3 0.3 0.4 1.0

Columbus, OH 14 17 10 16 27 2.5 3.1 1.8 2.9 4.8 

Corpus Christi, TX 1 1 1 0 0 0.7 0.7 0.7 0.0

Dallas, TX 36 49 76 48 35 6.0 8.1 12.6 8.0 5.8 

Dayton, OH 1 1 0 0 0 0.3 0.3 0.0 0.0

Denver, CO 0 2 0 1 5 0.0 0.7 0.0 0.4

Des Moines, IA 1 0 2 0 0 0.5 0.0 1.0 0.0

Detroit, MI 121 136 168 73 41 24.1 27.2 33.7 14.8 8.3 

El Paso, TX 1 2 4 0 1 0.3 0.7 1.3 0.0

Fort Worth, TX 7 16 45 25 7 2.6 5.8 15.8 8.6 2.4 

Honolulu, HI 0 0 1 0 0 0.0 0.0 0.2 0.0

Houston, TX 27 28 16 15 28 2.9 2.9 1.6 1.5 2.8 

Indianapolis, IN 170 60 10 7 1 38.3 13.5 2.2 1.6 0.2 

Jacksonville, FL 11 18 8 9 32 2.7 4.4 1.9 2.1 7.6 

Jersey City, NJ 1 2 1 1 2 0.8 1.6 0.8 0.8

Kansas City, MO 0 2 1 7 2 0.0 0.9 0.4 3.0

Los Angeles, CA 19 9 18 24 36 0.4 0.2 0.4 0.5 0.8 

Louisville, KY 26 9 39 12 6 7.2 2.5 10.7 3.3 1.7 

Memphis, TN 123 106 51 26 26 26.2 22.5 10.8 5.5 5.5 

Miami, FL 40 40 33 23 27 3.4 3.4 2.7 1.9 2.2 

Milwaukee, WI 21 12 4 1 1 4.3 2.5 0.8 0.2 0.2 

Minneapolis, MN 3 12 2 1 1 1.5 6.1 1.0 0.5 0.5 

Nashville, TN 83 29 10 4 1 28.2 9.8 3.4 1.4 0.3 

New Orleans, LA 8 11 3 9 19 3.1 4.3 1.2 3.6 7.6 

New York City, NY 10 19 18 22 22 0.2 0.4 0.4 0.5 0.5 

Newark, NJ 9 21 26 26 12 5.7 13.3 16.4 16.5 7.6 

Norfolk, VA 14 20 4 2 2 12.2 17.4 3.5 1.7 1.7 

Oakland, CA 3 1 0 0 0 0.4 0.1 0.0 0.0

Oklahoma City, OK 39 18 10 14 6 17.8 8.2 4.5 6.3 2.7 

Omaha, NE 1 1 1 1 2 0.4 0.4 0.4 0.4

Philadelphia, PA 25 24 14 15 9 3.1 3.0 1.8 1.9 1.1 

Phoenix, AZ 75 39 59 44 25 4.8 2.4 3.6 2.6 1.5 

Pittsburgh, PA 2 1 2 4 7 0.3 0.1 0.3 0.6

Portland, OR 4 1 5 1 0 1.5 0.4 1.9 0.4

Richmond, VA 2 3 1 2 0 1.9 2.8 0.9 1.9

Rochester, NY 0 1 1 1 0 0.0 0.8 0.8 0.8

Sacramento, CA 1 1 0 1 0 0.2 0.2 0.0 0.1

San Antonio, TX 23 24 12 6 18 3.9 4.0 2.0 1.0 2.9 

San Diego, CA 6 6 6 4 10 0.4 0.4 0.4 0.3

San Francisco, CA 5 2 4 3 0 1.3 0.5 1.1 0.8

San Jose, CA 0 1 1 4 4 0.0 0.1 0.1 0.5

Seattle, WA 4 1 0 1 5 0.5 0.1 0.0 0.1

St Louis, MO 3 6 4 3 8 1.6 3.3 2.2 1.7

St Paul, MN 1 1 0 1 1 0.7 0.7 0.0 0.7

St Petersburg, FL 3 2 2 1 1 0.6 0.4 0.4 0.2

Tampa, FL 10 6 8 5 2 2.0 1.1 1.5 0.9

Toledo, OH 0 0 4 0 1 0.0 0.0 1.7 0.0

Tucson, AZ 2 5 7 17 11 0.5 1.1 1.6 3.7 2.4 

Tulsa, OK 4 1 5 0 0 2.0 0.5 2.4 0.0

Washington, DC 10 8 9 3 4 3.3 2.6 3.0 1.0

Wichita, KS 1 1 1 0 4 0.4 0.4 0.4 0.0

Yonkers, NY 0 0 1 0 1 0.0 0.0 1.0 0.0

U.S. CITY TOTAL* 1,281 1,010 878 631 629 3.6 2.8 2.4 1.7 1.7 

San Juan, PR 32 38 31 44 21 6.0 7.1 5.8 8.2 3.9 

TOTAL 1,313 1,048 909 675 650 3.6 2.9 2.5 1.8 1.8 

0.0 

0.0 

1.6 

1.1 

0.7 

0.2 

1.1 

0.9 

1.0 

0.6 

0.2 

0.1 

1.8 

0.0 

0.3 

0.0 

0.9 

0.0 

0.8 

0.0 

0.0 

0.0 

0.0 

0.0 

0.5 

0.6 

4.5 

0.7 

0.4 

0.4 

0.0 

1.3 

1.7 

1.0 

*Cases reported with unknown sex are not included in this table. See Appendix (Reporting of City-specific Surveillance Data). 

STD Surveillance 2004 Syphilis Tables 121 
Table 32. Primary and secondary syphilis — Men – Reported cases and rates in selected cities listed in 

alphabetical order: United States and outlying areas, 2000–2004 

City 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004
 2000 2001 2002 2003 2004 

Akron, OH 0 1 2 2 2
 0.0 0.4 0.8 0.8

Albuquerque, NM 8 7 15 24 23 2.9 2.5 5.3 8.4 8.1 

Atlanta, GA 79 157 199 259 260 19.6 38.7 49.0 64.1 64.3 

Austin, TX 6 14 19 26 49 1.9 4.2 5.5 7.5 14.1 

Baltimore, MD 126 84 88 103 154 41.6 27.9 29.6 35.2 52.6 

Birmingham, AL 9 4 5 19 20 2.9 1.3 1.6 6.1 6.4 

Boston, MA 20 17 42 68 51 6.9 5.9 14.6 23.8 17.9 

Buffalo, NY 0 4 3 1 4 0.0 2.6 2.0 0.7

Charlotte, NC 21 17 15 14 29 6.1 4.8 4.1 3.8 7.8 

Chicago, IL 163 256 310 237 250 10.9 17.1 20.7 15.9 16.8 

Cincinnati, OH 0 0 4 2 17 0.0 0.0 1.0 0.5

Cleveland, OH 2 1 6 9 18 0.3 0.2 0.9 1.4

Columbus, OH 26 37 86 90 67 5.0 7.0 16.3 16.9 12.6 

Corpus Christi, TX 0 0 1 3 2 0.0 0.0 0.7 2.2

Dallas, TX 64 72 115 83 106 10.7 11.8 19.0 13.6 17.4 

Dayton, OH 4 1 4 0 1 1.5 0.4 1.5 0.0

Denver, CO 4 13 41 24 36 1.4 4.6 14.5 8.5 12.7 

Des Moines, IA 0 1 3 0 1 0.0 0.5 1.6 0.0

Detroit, MI 153 215 216 106 85 34.2 48.1 48.5 24.0 19.2 

El Paso, TX 5 10 8 2 8 1.8 3.6 2.9 0.7 2.9 

Fort Worth, TX 15 24 61 27 29 5.6 8.8 21.7 9.4 10.1 

Honolulu, HI 1 10 9 14 7 0.2 2.3 2.0 3.1 1.5 

Houston, TX 43 75 96 163 164 4.6 7.9 9.6 16.1 16.2 

Indianapolis, IN 131 68 26 18 28 31.5 16.3 6.2 4.3 6.7 

Jacksonville, FL 13 20 8 12 38 3.4 5.2 2.0 3.0 9.6 

Jersey City, NJ 0 3 15 11 24 0.0 2.5 12.6 9.3 20.3 

Kansas City, MO 1 3 7 12 20 0.5 1.4 3.2 5.5 9.1 

Los Angeles, CA 112 175 341 436 428 2.5 3.9 7.5 9.5 9.4 

Louisville, KY 31 10 38 13 27 9.3 3.0 11.4 3.9 8.0 

Memphis, TN 123 102 38 50 61 28.7 23.7 8.8 11.5 14.1 

Miami, FL 86 145 198 171 186 7.9 13.1 17.5 15.1 16.4 

Milwaukee, WI 22 6 12 9 13 4.9 1.3 2.7 2.0 2.9 

Minneapolis, MN 6 11 35 20 15 3.2 5.8 18.4 10.5 7.9 

Nashville, TN 117 47 16 17 14 42.4 17.0 5.8 6.1 5.1 

New Orleans, LA 14 13 6 16 58 6.2 5.8 2.7 7.3 26.3 

New York City, NY 107 263 417 509 599 2.8 6.9 10.9 13.2 15.6 

Newark, NJ 19 37 37 31 14 13.3 25.8 25.7 21.5 9.7 

Norfolk, VA 23 15 9 6 14 19.2 12.4 7.3 4.8 11.2 

Oakland, CA 8 22 49 33 41 1.1 3.0 6.8 4.6 5.7 

Oklahoma City, OK 43 17 42 34 10 20.8 8.2 20.0 16.0 4.7 

Omaha, NE 1 2 1 6 1 0.4 0.9 0.4 2.6

Philadelphia, PA 42 55 53 83 63 6.0 7.9 7.6 12.1 9.1 

Phoenix, AZ 97 109 96 88 81 6.3 6.8 5.8 5.2 4.8 

Pittsburgh, PA 1 6 5 13 14 0.2 1.0 0.8 2.2 2.3 

Portland, OR 7 8 15 32 18 2.7 3.1 5.7 12.0 6.8 

Richmond, VA 3 6 2 3 7 3.3 6.5 2.2 3.3

Rochester, NY 1 1 3 6 8 0.8 0.8 2.5 5.0

Sacramento, CA 0 3 11 16 18 0.0 0.5 1.7 2.4 2.8 

San Antonio, TX 44 47 33 46 89 7.9 8.3 5.7 7.8 15.0 

San Diego, CA 21 21 31 107 128 1.5 1.5 2.1 7.3 8.7 

San Francisco, CA 48 137 311 328 344 12.2 34.8 80.4 86.0 90.2 

San Jose, CA 2 9 29 52 52 0.2 1.0 3.4 6.1 6.1 

Seattle, WA 46 40 50 59 118 5.3 4.6 5.7 6.7 13.4 

St Louis, MO 8 9 9 15 39 4.9 5.6 5.7 9.6 24.9 

St Paul, MN 1 4 5 5 1 0.7 2.9 3.6 3.7

St Petersburg, FL 4 9 20 50 36 0.9 2.0 4.5 11.3 8.1 

Tampa, FL 10 9 25 38 45 2.0 1.8 4.8 7.2 8.5 

Toledo, OH 2 1 8 3 2 0.9 0.5 3.7 1.4

Tucson, AZ 6 17 21 23 27 1.4 4.0 4.9 5.3 6.2 

Tulsa, OK 4 4 2 5 2 2.1 2.1 1.0 2.6

Washington, DC 27 35 49 45 65 10.0 12.9 18.2 16.9 24.4 

Wichita, KS 1 3 2 2 8 0.4 1.3 0.9 0.9

Yonkers, NY 1 1 1 1 8 1.1 1.0 1.0 1.0

U.S. CITY TOTAL* 1,982 2,513 3,424 3,700 4,147 5.8 7.3 9.9 10.6 11.9 

San Juan, PR 36 30 47 44 46 7.3 6.1 9.6 8.9 9.3 

TOTAL 2,018 2,543 3,471 3,744 4,193 5.9 7.3 9.9 10.6 11.9 

1.5 

0.4 

0.8 

2.6 

4.3 

2.8 

0.5 

0.4 

7.7 

6.7 

0.7 

0.9 

1.0 

3.5 

8.2 

*Cases reported with unknown sex are not included in this table. See Appendix (Reporting of City-specific Surveillance Data). 

122 Syphilis Tables STD Surveillance 2004 
Table 33. Primary and secondary syphilis — Reported cases and rates per 100,000 population by age and sex: 

United States, 2000–2004 

Year Age 

Group 

Cases Rates 

Total Male Female Total Male Female 

10-14 23 4 19 0.1 0.0 0.2 

15-19 457 162 295 2.3 1.6 3.0 

20-24 881 419 462 4.6 4.3 4.9 

25-29 902 527 376 4.7 5.4 3.9 

30-34 957 553 404 4.7 5.3 4.0 

2000 35-39 

40-44 

1,006 

782 

606 

502 

400 

280 

4.4 

3.5 

5.4 

4.5 

3.5 

2.5 

45-54 706 528 178 1.9 2.8 0.9 

55-64 179 157 22 0.7 1.3 0.2 

65+ 76 68 8 0.2 0.5 0.0 

TOTAL 5,973 3,528 2,445 2.1 2.5 1.7 

10-14 19 2 17 0.1 0.0 0.2 

15-19 387 142 245 1.9 1.4 2.5 

20-24 836 482 354 4.2 4.8 3.7 

25-29 876 583 293 4.6 6.0 3.1 

30-34 964 660 304 4.6 6.3 2.9 

2001 35-39 

40-44 

1,146 

808 

818 

587 

328 

221 

5.1 

3.5 

7.3 

5.2 

2.9 

1.9 

45-54 805 632 173 2.1 3.3 0.9 

55-64 193 167 26 0.8 1.4 0.2 

65+ 64 57 7 0.2 0.4 0.0 

TOTAL 6,100 4,132 1,968 2.1 2.9 1.4 

10-14 15 4 11 0.1 0.0 0.1 

15-19 351 135 216 1.7 1.3 2.2 

20-24 842 533 309 4.2 5.2 3.1 

25-29 895 668 227 4.7 6.9 2.4 

2002 

30-34 

35-39 

40-44 

45-54 

1,097 

1,367 

1,023 

982 

877 

1,121 

845 

825 

220 

246 

178 

157 

5.2 

6.2 

4.4 

2.5 

8.3 

10.2 

7.4 

4.2 

2.1 

2.2 

1.5 

0.8 

55-64 217 196 21 0.8 1.5 0.2 

65+ 67 59 8 0.2 0.4 0.0 

TOTAL 6,862 5,268 1,594 2.4 3.7 1.1 

10-14 11 1 10 0.1 0.0 0.1 

15-19 322 150 172 1.6 1.4 1.7 

20-24 860 620 240 4.2 5.8 2.4 

25-29 941 760 181 4.9 7.8 1.9 

2003 

30-34 

35-39 

40-44 

45-54 

1,187 

1,460 

1,157 

991 

1,023 

1,290 

1,021 

871 

164 

170 

136 

119 

5.7 

6.8 

5.0 

2.4 

9.8 

12.0 

8.9 

4.3 

1.6 

1.6 

1.2 

0.6 

55-64 205 187 18 0.7 1.4 0.1 

65+ 42 36 6 0.1 0.2 0.0 

TOTAL 7,177 5,959 1,218 2.5 4.2 0.8 

10-14 9 2 7 0.0 0.0 0.1 

15-19 339 191 148 1.7 1.8 1.5 

2004 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

1,029 

1,125 

1,282 

1,467 

1,344 

1,035 

281 

735 

943 

1,116 

1,313 

1,198 

915 

249 

294 

182 

166 

154 

146 

120 

32 

5.0 

5.9 

6.2 

6.9 

5.9 

2.6 

1.0 

7.0 

9.7 

10.8 

12.4 

10.6 

4.6 

1.9 

3.0 

2.0 

1.6 

1.5 

1.3 

0.6 

0.2 

65+ 55 54 1 0.2 0.4 0.0 

TOTAL 7,975 6,721 1,254 2.8 4.7 0.9 

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the distribution of cases 

for which age was known. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9 

year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

STD Surveillance 2004 Syphilis Tables 123 
Table 34A. Primary and secondary syphilis — Reported cases by race/ethnicity, age group and sex: United States, 

2000–2004 

Age 

Group 

White, Non-Hispanic 

Total Male Female 

Black, Non-Hispanic 

Total Male Female Total 

Hispanic 

Male Female 

Asian/Pacific Islander 

Total Male Female 

American Indian/ 

Alaska Native 

Total Male Female 

10-14 2 0 2 20 4 16 0 0 0 0 0 0 1 0 1 

15-19 47 11 35 365 129 236 41 21 19 1 0 1 4 1 3 

20-24 110 40 70 653 310 344 101 66 35 4 1 3 13 3 10 

200025-29 

30-34 

35-39 

146 93 53 

182 119 62 

216 143 72 

631 338 293 

665 350 314 

664 374 291 

108 

94 

113 

82 

72 

81 

27 

22 

32 

8 7 1 

12 10 2 

5 4 1 

9 7 2 

5 2 3 

7 3 4 

40-44 173 118 55 550 341 209 51 38 13 2 2 0 5 3 2 

45-54 145 114 31 511 375 136 43 32 11 4 4 0 4 4 0 

55-64 42 40 2 124 106 18 11 10 1 0 0 0 2 1 1 

65+ 21 19 2 50 44 6 3 3 0 1 1 0 1 1 0 

TOTAL 1,083 698 385 4,233 2,369 1,864 567 405 162 37 29 8 52 26 26 

10-14 0 0 0 17 1 16 2 1 1 0 0 0 0 0 0 

15-19 32 13 19 290 97 193 59 29 29 2 1 1 4 2 2 

20-24 114 72 42 562 296 266 138 105 34 6 5 1 15 4 11 

2001

25-29 

30-34 

35-39 

152 121 31 

236 192 44 

332 281 51 

554 323 231 

563 330 233 

653 397 255 

140 

137 

134 

115 

117 

120 

26 

20 

13 

13 13 0 

12 12 0 

15 14 1 

18 11 6 

17 9 7 

13 5 7 

40-44 227 193 34 505 335 170 59 48 11 2 2 0 15 10 5 

45-54 220 196 24 513 377 137 61 52 9 4 3 1 6 4 2 

55-64 51 48 3 121 100 21 18 16 2 2 2 0 2 2 0 

65+ 23 22 1 36 30 6 4 4 0 0 0 0 1 1 0 

TOTAL 1,387 1,138 249 3,813 2,286 1,527 754 607 146 55 51 4 90 49 41 

10-14 2 1 1 10 2 8 2 1 1 1 0 1 0 0 0 

15-19 33 9 24 253 89 164 62 37 25 2 0 2 1 0 1 

20-24 129 89 40 546 313 233 146 117 29 13 9 4 8 5 3 

200225-29 

30-34 

35-39 

224 189 36 

404 373 31 

576 541 35 

485 323 163 

476 310 166 

568 385 183 

165 

192 

200 

138 

172 

178 

26 

20 

22 

17 16 1 

22 21 1 

15 14 1 

4 3 1 

3 1 2 

8 3 5 

40-44 452 429 23 448 305 142 102 93 8 15 14 1 7 4 3 

45-54 393 370 23 482 370 112 83 69 15 8 8 0 16 8 7 

55-64 95 91 4 110 94 16 10 10 0 0 0 0 2 1 1 

65+ 15 15 0 42 35 7 9 8 1 0 0 0 1 1 0 

TOTAL 2,325 2,108 217 3,421 2,226 1,195 971 823 147 94 83 11 51 27 24 

10-14 0 0 0 5 1 4 5 0 5 0 0 0 1 0 1 

15-19 48 24 24 205 93 112 63 28 35 6 5 1 0 0 0 

20-24 195 154 41 471 309 161 178 142 36 13 11 2 3 3 0 

200325-29 

30-34 

35-39 

301 265 36 

524 485 39 

743 703 40 

408 293 115 

416 316 100 

451 335 116 

195 

213 

222 

173 

190 

211 

23 

23 

11 

28 25 3 

20 20 0 

28 28 0 

8 4 4 

14 12 2 

16 14 2 

40-44 588 563 26 382 288 94 158 146 12 20 19 1 9 5 3 

45-54 489 472 17 373 287 86 107 97 9 10 8 1 13 6 6 

55-64 104 100 4 81 68 13 13 12 1 2 2 0 4 4 0 

65+ 17 16 1 18 16 2 5 2 3 0 0 0 1 1 0 

TOTAL 3,010 2,783 227 2,811 2,005 805 1,160 1,001 159 127 119 8 69 50 19 

10-14 0 0 0 8 2 6 1 0 1 0 0 0 0 0 0 

15-19 56 33 23 211 113 98 55 33 22 11 9 2 6 3 3 

20-24 242 185 57 573 375 198 188 156 32 19 16 3 8 4 4 

200425-29 

30-34 

35-39 

317 281 36 

512 470 42 

675 640 35 

533 420 113 

494 401 94 

489 392 98 

237 

237 

249 

213 

214 

235 

24 

23 

14 

28 25 3 

29 28 1 

36 35 1 

11 5 5 

10 3 6 

18 12 6 

40-44 684 655 29 455 353 102 178 168 9 18 18 0 10 4 5 

45-54 525 503 23 379 295 84 110 98 12 11 11 0 10 9 1 

55-64 155 145 10 101 83 18 20 20 0 2 1 1 4 1 3 

65+ 36 35 1 16 16 0 3 3 0 0 0 0 0 0 0 

TOTAL 3,203 2,947 256 3,263 2,450 813 1,278 1,140 138 153 142 11 77 42 35 

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 33 for age-specific cases and rates and Tables 26-28 for 

sex-specific cases and rates and overall totals. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for 

which these variables were specified. For 2004, IA did not report age and/or race/ethnicity for most cases and their case data and population denominators 

were excluded. Differences between total cases from this table and others in the report are due to different reporting formats and above listed exclusion. The 

0 to 9 year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

124 Syphilis Tables STD Surveillance 2004 
Table 34B. Primary and secondary syphilis — Rates per 100,000 population by race/ethnicity, age group and sex: 

United States, 2000–2004 

Age 

Group 

White, Non-Hispanic 

Total Male Female 

Black, Non-Hispanic 

Total Male Female Total 

Hispanic 

Male Female 

Asian/Pacific Islander 

Total Male Female Total 

American Indian/ 

Alaska Native 

Male Female 

10-14 0.0 0.0 0.0 0.6 0.2 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.4 0.0 0.9 

15-19 0.4 0.2 0.6 12.3 8.5 16.1 1.3 1.3 1.3 0.1 0.0 0.2 1.8 0.9 2.8 

20-24 0.9 0.7 1.2 24.4 23.7 25.0 2.9 3.5 2.3 0.4 0.2 0.7 7.2 3.3 11.2 

25-29 

30-34 

35-39 

1.2 1.5 0.9 

1.3 1.8 0.9 

1.4 1.8 0.9 

24.8 27.9 22.0 

25.2 28.1 22.6 

23.4 28.1 19.4 

3.2 

3.0 

3.9 

4.4 

4.3 

5.4 

1.7 

1.5 

2.3 

0.8 1.4 0.2 

1.1 1.8 0.4 

0.5 0.9 0.2 

5.5 

3.0 

3.8 

8.6 2.4 

2000

2.5 3.6 

3.4 4.2 

40-44 1.1 1.4 0.7 20.1 26.6 14.4 2.2 3.2 1.2 0.2 0.5 0.0 2.8 3.5 2.1 

45-54 0.5 0.8 0.2 12.3 19.5 6.1 1.3 2.0 0.7 0.3 0.6 0.0 1.4 2.9 0.0 

55-64 0.2 0.4 0.0 5.2 9.9 1.4 0.6 1.2 0.1 0.0 0.0 0.0 1.2 1.3 1.2 

65+ 0.1 0.2 0.0 1.7 4.0 0.3 0.2 0.4 0.0 0.1 0.3 0.0 0.7 1.7 0.0 

TOTAL 0.5 0.7 0.4 12.0 14.2 10.1 1.6 2.2 0.9 0.3 0.5 0.1 2.2 2.2 2.2 

10-14 0.0 0.0 0.0 0.5 0.1 1.0 0.1 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 

15-19 0.2 0.2 0.3 9.7 6.4 13.1 1.8 1.8 1.9 0.2 0.2 0.2 1.8 1.8 1.8 

20-24 0.9 1.2 0.7 20.2 21.8 18.7 3.9 5.4 2.1 0.7 1.1 0.2 8.1 4.2 12.1 

25-29 

30-34 

35-39 

1.3 2.1 0.5 

1.8 2.8 0.7 

2.2 3.7 0.7 

22.1 27.0 17.6 

21.3 26.4 16.7 

23.2 30.0 17.1 

3.9 

4.1 

4.4 

5.8 

6.5 

7.6 

1.6 

1.3 

0.9 

1.1 2.3 0.0 

1.0 2.1 0.0 

1.4 2.7 0.2 

10.6 

9.8 

6.7 

13.7 7.4 

2001

11.2 8.4 

5.9 7.6 

40-44 1.4 2.4 0.4 18.2 25.7 11.6 2.4 3.7 0.9 0.2 0.5 0.0 7.9 10.6 5.3 

45-54 0.7 1.3 0.2 11.8 18.8 5.9 1.8 3.1 0.5 0.3 0.4 0.1 2.1 2.9 1.3 

55-64 0.3 0.5 0.0 4.9 9.1 1.5 0.9 1.8 0.2 0.2 0.5 0.0 1.2 2.5 0.0 

65+ 0.1 0.2 0.0 1.2 2.7 0.3 0.2 0.5 0.0 0.0 0.0 0.0 0.7 1.5 0.0 

TOTAL 0.7 1.2 0.2 10.7 13.5 8.2 2.0 3.2 0.8 0.5 0.9 0.1 3.8 4.2 3.4 

10-14 0.0 0.0 0.0 0.3 0.1 0.5 0.1 0.1 0.1 0.1 0.0 0.2 0.0 0.0 0.0 

15-19 0.3 0.1 0.4 8.3 5.8 11.0 1.9 2.2 1.6 0.2 0.0 0.5 0.4 0.0 0.9 

20-24 1.0 1.4 0.6 19.0 22.1 16.0 4.0 5.9 1.8 1.4 2.0 0.9 4.2 5.2 3.2 

25-29 

30-34 

35-39 

2.0 3.3 0.6 

3.0 5.6 0.5 

3.9 7.3 0.5 

19.4 27.1 12.5 

17.9 24.6 11.8 

20.5 29.5 12.5 

4.4 

5.4 

6.3 

6.7 

9.0 

10.7 

1.6 

1.2 

1.5 

1.5 2.9 0.2 

1.8 3.5 0.2 

1.4 2.7 0.2 

2.5 

1.9 

4.6 

3.8 1.2 

2002

1.3 2.4 

3.7 5.5 

40-44 2.8 5.3 0.3 16.0 23.2 9.6 3.8 6.8 0.7 1.5 2.8 0.2 3.9 4.6 3.2 

45-54 1.3 2.5 0.2 10.7 17.8 4.6 2.3 3.8 0.8 0.5 1.1 0.0 5.1 5.7 4.5 

55-64 0.5 0.9 0.0 4.3 8.2 1.1 0.5 1.1 0.0 0.0 0.0 0.0 1.1 1.2 1.1 

65+ 0.0 0.1 0.0 1.4 3.1 0.4 0.5 1.0 0.1 0.0 0.0 0.0 0.7 1.5 0.0 

TOTAL 1.2 2.2 0.2 9.5 13.0 6.3 2.5 4.1 0.8 0.8 1.4 0.2 2.1 2.3 1.9 

10-14 0.0 0.0 0.0 0.1 0.1 0.2 0.1 0.0 0.3 0.0 0.0 0.0 0.4 0.0 0.9 

15-19 0.4 0.4 0.4 6.7 5.9 7.4 1.9 1.7 2.2 0.7 1.2 0.2 0.0 0.0 0.0 

20-24 1.5 2.4 0.6 16.0 21.1 10.9 4.8 6.8 2.2 1.4 2.3 0.4 1.5 3.0 0.0 

25-29 

30-34 

35-39 

2.6 4.6 0.6 

4.0 7.4 0.6 

5.2 9.8 0.6 

16.1 24.1 8.7 

15.7 25.2 7.2 

16.6 26.2 8.1 

5.1 

5.9 

7.0 

8.3 

9.9 

12.5 

1.3 

1.4 

0.8 

2.5 4.4 0.5 

1.6 3.3 0.0 

2.6 5.3 0.0 

4.9 

8.1 

9.0 

5.0 4.9 

2003

13.8 2.4 

15.9 2.3 

40-44 3.6 7.0 0.3 13.6 21.9 6.3 5.8 10.3 0.9 1.9 3.7 0.2 4.5 6.0 3.2 

45-54 1.6 3.1 0.1 8.0 13.4 3.4 2.8 5.1 0.5 0.5 1.0 0.1 4.0 4.2 3.8 

55-64 0.5 0.9 0.0 3.0 5.7 0.9 0.6 1.2 0.1 0.2 0.5 0.0 2.3 4.8 0.0 

65+ 0.1 0.1 0.0 0.6 1.4 0.1 0.3 0.3 0.3 0.0 0.0 0.0 0.7 1.5 0.0 

TOTAL 1.5 2.8 0.2 7.7 11.5 4.2 2.9 4.9 0.8 1.0 1.9 0.1 2.8 4.2 1.5 

10-14 0.0 0.0 0.0 0.2 0.1 0.4 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 

15-19 0.4 0.5 0.4 6.9 7.3 6.5 1.7 2.0 1.4 1.2 1.9 0.5 2.8 2.8 2.8 

20-24 1.9 2.9 0.9 19.5 25.6 13.4 5.0 7.5 1.9 1.9 3.2 0.6 4.1 4.0 4.1 

25-29 

30-34 

35-39 

2.8 4.9 0.6 

4.0 7.2 0.6 

4.8 9.1 0.5 

21.1 34.6 8.6 

18.7 32.0 6.7 

18.0 30.7 6.8 

6.3 

6.6 

7.9 

10.2 

11.2 

14.0 

1.4 

1.4 

1.0 

2.5 4.5 0.5 

2.3 4.6 0.2 

3.2 6.4 0.2 

6.2 

5.7 

10.4 

6.3 6.2 

2004

3.8 7.5 

13.9 7.0 

40-44 4.3 8.2 0.4 16.2 26.9 6.9 6.5 11.9 0.7 1.8 3.7 0.0 5.1 4.8 5.4 

45-54 1.8 3.4 0.1 8.2 13.8 3.4 2.9 5.1 0.6 0.6 1.3 0.0 3.1 5.8 0.6 

55-64 0.7 1.4 0.1 3.8 6.9 1.2 0.9 2.0 0.0 0.2 0.2 0.2 2.1 1.1 3.0 

65+ 0.1 0.3 0.0 0.5 1.4 0.0 0.2 0.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 

TOTAL 1.6 3.1 0.3 9.0 14.1 4.3 3.2 5.5 0.7 1.2 2.3 0.2 3.2 3.5 2.9 

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 33 for age-specific cases and rates and Tables 26-28 for sex-specific 

cases and rates and overall totals. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables 

were specified. For 2004, IA did not report age and/or race/ethnicity for most cases and their case data and population denominators were excluded. Differences between total rates from this table and others in the report are due to different reporting formats and above listed exclusion. The 0 to 9 year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

STD Surveillance 2004 Syphilis Tables 125 
Table 35. Early latent syphilis — Reported cases and rates by state/area and region listed in alphabetical 

order: United States and outlying areas, 2000–2004 

State/Area 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004 2000 2001 2002 2003 2004 

Alabama 219 192 211 140 231 4.9 4.3 4.7 3.1 5.1 

Alaska 1 0 1 0 1 0.2 0.0 0.2 0.0

Arizona 248 266 200 232 219 4.8 5.0 3.7 4.2 3.9 

Arkansas 117 60 51 71 56 4.4 2.2 1.9 2.6 2.1 

California 353 408 716 820 873 1.0 1.2 2.0 2.3 2.5 

Colorado 7 14 22 20 24 0.2 0.3 0.5 0.4 0.5 

Connecticut 9 20 13 13 16 0.3 0.6 0.4 0.4 0.5 

Delaware 10 18 9 11 25 1.3 2.3 1.1 1.3 3.1 

Florida 1,165 947 949 988 856 7.3 5.8 5.7 5.8 5.0 

Georgia 521 703 701 720 333 6.3 8.4 8.2 8.3 3.8

Hawaii 3 7 21 6 3 0.2 0.6 1.7 0.5 0.2 

Idaho 0 0 4 8 26 0.0 0.0 0.3 0.6

Illinois 382 386 528 350 322 3.1 3.1 4.2 2.8 2.5 

Indiana 184 120 53 58 45 3.0 2.0 0.9 0.9 0.7 

Iowa 8 6 8 5 12 0.3 0.2 0.3 0.2

Kansas 9 18 13 19 12 0.3 0.7 0.5 0.7 0.4 

Kentucky 62 38 49 43 24 1.5 0.9 1.2 1.0 0.6 

Louisiana 231 194 183 197 316 5.2 4.3 4.1 4.4 7.0 

Maine 0 3 1 7 0 0.0 0.2 0.1 0.5

Maryland 518 362 181 211 213 9.8 6.7 3.3 3.8 3.9 

Massachusetts 83 64 95 136 96 1.3 1.0 1.5 2.1 1.5 

Michigan 406 368 255 122 121 4.1 3.7 2.5 1.2 1.2 

Minnesota 18 16 23 45 21 0.4 0.3 0.5 0.9 0.4 

Mississippi 409 329 149 173 130 14.4 11.5 5.2 6.0 4.5 

Missouri 52 33 51 46 58 0.9 0.6 0.9 0.8 1.0 

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0

Nebraska 1 1 0 1 0 0.1 0.1 0.0 0.1

Nevada 9 7 12 35 24 0.4 0.3 0.6 1.6 1.1 

New Hampshire 0 2 1 4 0 0.0 0.2 0.1 0.3

New Jersey 109 234 220 326 344 1.3 2.7 2.6 3.8 4.0 

New Mexico 25 18 23 53 69 1.4 1.0 1.2 2.8 3.7 

New York 467 566 756 1,019 744 2.5 3.0 3.9 5.3 3.9 

North Carolina 618 483 333 261 261 7.6 5.9 4.0 3.1 3.1 

North Dakota 1 0 0 0 0 0.2 0.0 0.0 0.0

Ohio 119 100 84 92 184 1.0 0.9 0.7 0.8 1.6 

Oklahoma 128 121 124 77 62 3.7 3.5 3.5 2.2 1.8 

Oregon 19 9 18 27 29 0.6 0.3 0.5 0.8 0.8 

Pennsylvania 278 260 237 216 183 2.3 2.1 1.9 1.7 1.5 

Rhode Island 1 1 9 7 15 0.1 0.1 0.8 0.7

South Carolina 394 394 202 180 204 9.8 9.7 4.9 4.3 4.9 

South Dakota 0 0 0 3 0 0.0 0.0 0.0 0.4

Tennessee 627 553 390 228 206 11.0 9.6 6.7 3.9 3.5 

Texas 1,171 964 1,149 1,065 1,069 5.6 4.5 5.3 4.8 4.8 

Utah 10 0 8 7 5 0.4 0.0 0.3 0.3

Vermont 0 1 0 0 0 0.0 0.2 0.0 0.0

Virginia 140 133 94 74 108 2.0 1.8 1.3 1.0 1.5 

Washington 20 19 23 36 51 0.3 0.3 0.4 0.6 0.8 

West Virginia 3 1 1 2 9 0.2 0.1 0.1 0.1

Wisconsin 72 43 66 54 55 1.3 0.8 1.2 1.0 1.0 

Wyoming 0 0 0 1 0 0.0 0.0 0.0 0.2

U.S. TOTAL* 9,465 8,701 8,429 8,361 7,768 3.4 3.0 2.9 2.9 2.7 

Northeast 947 1,151 1,332 1,728 1,398 1.8 2.1 2.5 3.2 2.6 

Midwest 1,252 1,091 1,081 795 830 1.9 1.7 1.7 1.2 1.3 

South 6,571 5,711 4,968 4,593 4,216 6.5 5.6 4.8 4.4 4.0 

West 695 748 1,048 1,245 1,324 1.1 1.2 1.6 1.9 2.0 

Guam 

Puerto Rico 

Virgin Islands 

1

663 

5 

2

600 

8 

3

702 

1 

1

748 

6 

0 

353 

8 

0.6 

17.4 

4.6 

1.3 

15.6 

7.3 

1.9 

18.2 

0.9 

0.6

19.3 

5.5

9.1 

OUTLYING AREAS 669 610 706 755 361 16.4 14.9 17.1 18.2 8.7 

TOTAL 10,134 9,311 9,135 9,116 8,129 3.5 3.2 3.1 3.1 2.8 

0.2 

1.9 

0.4 

0.0 

0.0 

0.0 

0.0 

0.0 

1.4 

0.0 

0.2 

0.0 

0.5 

0.0 

0.0 

7.4 

*Includes cases reported by Washington, D.C. 

126 Syphilis Tables STD Surveillance 2004 
Table 36. Early latent syphilis — Reported cases and rates in selected cities listed in alphabetical order: 

United States and outlying areas, 2000–2004 

City 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004
 2000 2001 2002 2003 2004 

Akron, OH 1 2 1 1 4
 0.2 0.4 0.2 0.2

Albuquerque, NM 19 8 10 15 29 3.4 1.4 1.7 2.6 5.0 

Atlanta, GA 173 398 406 464 189 21.2 48.2 49.2 56.7 23.1 

Austin, TX 27 31 23 35 48 4.3 4.7 3.4 5.2 7.1 

Baltimore, MD 384 257 124 161 138 59.2 39.8 19.4 25.6 22.0 

Birmingham, AL 62 35 27 23 38 9.4 5.3 4.1 3.5 5.8 

Boston, MA 29 26 50 64 32 4.8 4.3 8.4 10.8 5.4 

Buffalo, NY 1 0 2 2 1 0.3 0.0 0.6 0.6

Charlotte, NC 63 69 40 24 41 9.0 9.6 5.4 3.2 5.4 

Chicago, IL 292 298 439 296 272 9.5 9.6 14.2 9.6 8.9 

Cincinnati, OH 2 2 0 0 7 0.2 0.2 0.0 0.0

Cleveland, OH 29 31 10 3 20 2.1 2.2 0.7 0.2 1.5 

Columbus, OH 32 33 48 35 61 3.0 3.1 4.4 3.2 5.6 

Corpus Christi, TX 3 1 1 10 1 1.1 0.4 0.4 3.6 0.4 

Dallas, TX 361 247 351 298 230 30.2 20.3 29.0 24.6 19.0 

Dayton, OH 2 4 1 3 3 0.4 0.7 0.2 0.5

Denver, CO 1 4 12 13 13 0.2 0.7 2.1 2.3 2.3 

Des Moines, IA 6 4 5 2 8 1.6 1.1 1.3 0.5

Detroit, MI 328 293 172 90 85 34.5 30.9 18.2 9.6 9.1 

El Paso, TX 11 14 32 27 23 1.9 2.4 5.5 4.6 3.9 

Fort Worth, TX 80 60 115 58 32 14.9 10.9 20.3 10.0 5.5 

Honolulu, HI 1 4 16 6 3 0.1 0.5 1.8 0.7 0.3 

Houston, TX 134 137 136 150 169 7.1 7.2 6.8 7.4 8.3 

Indianapolis, IN 125 82 30 22 21 14.5 9.5 3.5 2.5 2.4 

Jacksonville, FL 46 54 25 35 66 5.9 6.8 3.1 4.3 8.1 

Jersey City, NJ 1 6 15 13 22 0.4 2.5 6.2 5.4 9.2 

Kansas City, MO 4 1 5 15 14 0.9 0.2 1.1 3.3 3.1 

Los Angeles, CA 187 203 349 384 391 2.1 2.2 3.8 4.2 4.2 

Louisville, KY 40 20 33 26 15 5.8 2.9 4.7 3.7 2.1 

Memphis, TN 325 356 202 154 156 36.2 39.5 22.3 17.0 17.2 

Miami, FL 329 221 295 345 253 14.5 9.6 12.6 14.7 10.8 

Milwaukee, WI 55 35 51 34 29 5.9 3.7 5.4 3.6 3.1 

Minneapolis, MN 11 8 17 23 11 2.9 2.1 4.4 6.0 2.9 

Nashville, TN 173 137 109 25 22 30.3 24.0 19.1 4.4 3.9 

New Orleans, LA 32 31 39 36 63 6.6 6.5 8.2 7.7 13.4 

New York City, NY 447 548 726 958 677 5.6 6.8 9.0 11.8 8.4 

Newark, NJ 58 74 74 121 144 19.3 24.5 24.5 40.1 47.7 

Norfolk, VA 23 25 14 11 13 9.8 10.6 5.9 4.6 5.4 

Oakland, CA 4 12 12 28 16 0.3 0.8 0.8 1.9 1.1 

Oklahoma City, OK 86 73 74 53 43 20.2 17.0 17.1 12.2 9.9 

Omaha, NE 1 0 0 0 0 0.2 0.0 0.0 0.0

Philadelphia, PA 261 248 214 194 151 17.2 16.5 14.3 13.1 10.2 

Phoenix, AZ 220 243 150 161 154 7.1 7.6 4.5 4.8 4.5 

Pittsburgh, PA 1 4 6 5 6 0.1 0.3 0.5 0.4

Portland, OR 12 7 17 16 19 2.3 1.3 3.2 3.0 3.6 

Richmond, VA 18 28 11 16 9 9.1 14.2 5.6 8.2 4.6 

Rochester, NY 0 1 2 6 1 0.0 0.4 0.8 2.4

Sacramento, CA 2 5 8 3 6 0.2 0.4 0.6 0.2

San Antonio, TX 102 120 105 62 74 8.9 10.3 8.8 5.1 6.1 

San Diego, CA 10 16 34 41 84 0.4 0.6 1.2 1.4 2.9 

San Francisco, CA 18 47 173 191 202 2.3 6.1 22.6 25.4 26.9 

San Jose, CA 4 12 11 20 13 0.2 0.7 0.7 1.2 0.8 

Seattle, WA 16 14 10 24 39 0.9 0.8 0.6 1.4 2.2 

St Louis, MO 21 15 23 12 21 6.1 4.4 6.8 3.6 6.3 

St Paul, MN 1 4 2 8 2 0.4 1.4 0.7 2.8

St Petersburg, FL 23 6 19 40 38 2.5 0.6 2.1 4.3 4.1 

Tampa, FL 56 51 57 98 63 5.6 5.0 5.4 9.1 5.9 

Toledo, OH 3 1 3 7 3 0.7 0.2 0.7 1.5

Tucson, AZ 14 8 29 46 32 1.6 0.9 3.3 5.2 3.6 

Tulsa, OK 8 5 16 6 10 2.0 1.3 4.0 1.5 2.5 

Washington, DC 238 219 192 152 113 41.6 38.2 33.6 26.9 20.0 

Wichita, KS 1 7 3 4 6 0.2 1.5 0.6 0.9

Yonkers, NY 0 0 1 5 2 0.0 0.0 0.5 2.5

U.S. CITY TOTAL 5,017 4,905 5,177 5,180 4,451 7.2 7.0 7.3 7.3 6.2 

San Juan, PR 250 232 210 343 155 24.5 22.7 20.5 33.4 15.1 

TOTAL 5,267 5,137 5,387 5,523 4,606 7.4 7.2 7.5 7.6 6.4 

0.5 

0.5 

0.7 

0.3 

0.9 

2.1 

0.0 

0.4 

0.5 

0.7 

0.7 

1.3 

1.0 

See Appendix (Reporting of City-specific Surveillance Data).
 

STD Surveillance 2004 Syphilis Tables 127
 
State/Area 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004 2000 2001 2002 2003 2004 

Alabama 403 380 334 309 232 9.1 8.5 7.4 6.9 5.2 

Alaska 5 9 8 7 6 0.8 1.4 1.2 1.1

Arizona 385 672 666 659 572 7.5 12.7 12.2 11.8 10.2 

Arkansas 130 124 124 172 142 4.9 4.6 4.6 6.3 5.2 

California 2,590 2,038 2,107 2,024 2,293 7.6 5.9 6.0 5.7 6.5 

Colorado 45 111 86 82 90 1.0 2.5 1.9 1.8 2.0 

Connecticut 125 131 147 163 108 3.7 3.8 4.2 4.7 3.1 

Delaware 26 47 42 29 26 3.3 5.9 5.2 3.5 3.2 

Florida 1,150 1,446 1,686 1,610 1,364 7.2 8.8 10.1 9.5 8.0 

Georgia 695 850 743 836 701 8.4 10.1 8.7 9.6 8.1 

Hawaii 17 22 27 39 25 1.4 1.8 2.2 3.1 2.0 

Idaho 10 10 11 18 25 0.8 0.8 0.8 1.3 1.8 

Illinois 794 706 546 633 614 6.4 5.6 4.3 5.0 4.9 

Indiana 212 245 196 252 164 3.5 4.0 3.2 4.1 2.6 

Iowa 36 33 38 29 19 1.2 1.1 1.3 1.0 0.6 

Kansas 50 43 44 32 49 1.9 1.6 1.6 1.2 1.8 

Kentucky 103 104 72 83 79 2.5 2.6 1.8 2.0 1.9 

Louisiana 526 426 439 1,195 979 11.8 9.5 9.8 26.6 21.8 

Maine 6 12 6 6 5 0.5 0.9 0.5 0.5 0.4 

Maryland 338 305 415 443 399 6.4 5.7 7.6 8.0 7.2 

Massachusetts 296 334 346 375 307 4.7 5.2 5.4 5.8 4.8 

Michigan 232 347 408 451 470 2.3 3.5 4.1 4.5 4.7 

Minnesota 43 83 65 103 96 0.9 1.7 1.3 2.0 1.9 

Mississippi 125 175 247 220 212 4.4 6.1 8.6 7.6 7.4 

Missouri 215 110 118 96 114 3.8 2.0 2.1 1.7 2.0 

Montana 0 0 4 0 0 0.0 0.0 0.4 0.0

Nebraska 4 5 19 15 8 0.2 0.3 1.1 0.9 0.5 

Nevada 38 47 86 102 189 1.9 2.2 4.0 4.6 8.4 

New Hampshire 17 17 15 14 21 1.4 1.3 1.2 1.1 1.6 

New Jersey 599 637 637 572 319 7.1 7.5 7.4 6.6 3.7 

New Mexico 57 36 48 75 97 3.1 2.0 2.6 4.0 5.2 

New York 2,308 2,701 2,620 2,715 2,979 12.1 14.2 13.7 14.1 15.5 

North Carolina 375 475 424 417 285 4.6 5.8 5.1 5.0 3.4 

North Dakota 0 2 0 0 0 0.0 0.3 0.0 0.0

Ohio 89 115 105 189 148 0.8 1.0 0.9 1.7 1.3 

Oklahoma 82 102 89 211 79 2.4 2.9 2.5 6.0 2.2 

Oregon 18 26 29 43 50 0.5 0.7 0.8 1.2 1.4 

Pennsylvania 321 362 342 329 273 2.6 2.9 2.8 2.7 2.2 

Rhode Island 33 29 45 50 62 3.1 2.7 4.2 4.6 5.8 

South Carolina 206 268 269 263 194 5.1 6.6 6.5 6.3 4.7 

South Dakota 1 0 0 0 0 0.1 0.0 0.0 0.0

Tennessee 525 580 514 511 459 9.2 10.1 8.9 8.7 7.9 

Texas 1,659 2,145 2,299 2,200 2,244 7.9 10.0 10.6 9.9 10.1 

Utah 46 14 56 51 59 2.1 0.6 2.4 2.2 2.5 

Vermont 0 4 0 0 2 0.0 0.7 0.0 0.0

Virginia 266 287 362 395 380 3.7 4.0 5.0 5.3 5.1 

Washington 85 98 63 121 135 1.4 1.6 1.0 2.0 2.2 

West Virginia 7 1 2 7 6 0.4 0.1 0.1 0.4

Wisconsin 60 64 38 41 43 1.1 1.2 0.7 0.7 0.8 

Wyoming 4 3 1 3 3 0.8 0.6 0.2 0.6

U.S. TOTAL* 15,594 16,976 17,168 18,319 17,300 5.5 5.9 6.0 6.3 5.9 

Northeast 3,705 4,227 4,158 4,224 4,076 6.9 7.8 7.7 7.8 7.5 

Midwest 1,736 1,753 1,577 1,841 1,725 2.7 2.7 2.4 2.8 2.6 

South 6,853 7,910 8,241 9,030 7,955 6.8 7.8 8.0 8.6 7.6 

West 3,300 3,086 3,192 3,224 3,544 5.2 4.8 4.9 4.9 5.3 

Guam 

Puerto Rico 

Virgin Islands 

7 

485 

3 

15 

402 

0 

9 

398 

2 

13 

390 

5 

13 

608 

4 

4.5 

12.7 

2.8 

9.5 

10.5 

0.0 

5.6 

10.3 

1.8 

7.9 

10.1 

4.6

7.9 

15.7 

OUTLYING AREAS 495 417 409 408 625 12.1 10.2 9.9 9.8 15.1 

TOTAL 16,089 17,393 17,577 18,727 17,925 5.6 6.0 6.0 6.3 6.1 

0.3 

Table 37. Late and late latent syphilis — Reported cases and rates by state/area and region listed in 

alphabetical order: United States and outlying areas, 2000–2004 

0.9 

0.0 

0.0 

0.0 

0.3 

0.6 

3.7 

*Includes cases reported by Washington, D.C. 

128 Syphilis Tables STD Surveillance 2004 
Table 38. Late and late latent syphilis — Reported cases and rates in selected cities listed in alphabetical 

order: United States and outlying areas, 2000–2004 

City 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004
 2000 2001 2002 2003 2004 

Akron, OH 1 1 2 1 1
 0.2 0.2 0.4 0.2

Albuquerque, NM 33 26 29 23 28 5.9 4.6 5.1 4.0 4.8 

Atlanta, GA 88 168 159 201 253 10.8 20.4 19.3 24.6 30.9 

Austin, TX 24 64 52 63 69 3.8 9.8 7.7 9.3 10.2 

Baltimore, MD 111 57 145 138 128 17.1 8.8 22.7 22.0 20.4 

Birmingham, AL 124 101 89 65 33 18.7 15.3 13.5 9.9 5.0 

Boston, MA 106 113 133 165 133 17.7 18.8 22.2 28.0 22.5 

Buffalo, NY 8 7 5 5 5 2.5 2.2 1.6 1.6

Charlotte, NC 40 31 33 67 33 5.7 4.3 4.5 8.9 4.4 

Chicago, IL 468 444 325 369 390 15.2 14.4 10.5 12.0 12.7 

Cincinnati, OH 12 12 15 9 14 1.4 1.4 1.8 1.1 1.7 

Cleveland, OH 7 5 5 15 9 0.5 0.4 0.4 1.1 0.7 

Columbus, OH 18 52 45 76 54 1.7 4.8 4.1 7.0 5.0 

Corpus Christi, TX 6 8 9 13 11 2.2 2.9 3.2 4.7 3.9 

Dallas, TX 120 326 493 413 399 10.1 26.8 40.7 34.1 33.0 

Dayton, OH 10 12 4 10 7 1.8 2.2 0.7 1.8 1.3 

Denver, CO 18 45 36 38 31 3.2 8.0 6.4 6.8 5.6 

Des Moines, IA 11 10 9 14 12 2.9 2.6 2.3 3.6 3.1 

Detroit, MI 145 257 294 319 330 15.3 27.1 31.1 34.1 35.2 

El Paso, TX 73 78 74 77 73 12.9 13.6 12.8 13.2 12.5 

Fort Worth, TX 85 159 149 112 101 15.8 28.8 26.3 19.4 17.5 

Honolulu, HI 13 16 26 32 18 1.5 1.8 2.9 3.5 2.0 

Houston, TX 614 661 748 642 660 32.7 34.6 37.2 31.6 32.5 

Indianapolis, IN 92 87 65 74 56 10.7 10.1 7.5 8.6 6.5 

Jacksonville, FL 53 47 28 68 64 6.8 5.9 3.5 8.3 7.8 

Jersey City, NJ 22 26 26 27 13 9.1 10.7 10.8 11.3 5.4 

Kansas City, MO 39 24 24 21 18 8.6 5.3 5.3 4.6 4.0 

Los Angeles, CA 1,496 923 890 879 1,182 16.7 10.2 9.7 9.5 12.8 

Louisville, KY 51 61 31 48 51 7.3 8.8 4.4 6.9 7.3 

Memphis, TN 297 324 247 245 217 33.1 36.0 27.3 27.0 23.9 

Miami, FL 356 628 766 619 523 15.7 27.3 32.8 26.4 22.3 

Milwaukee, WI 49 43 21 18 24 5.2 4.6 2.2 1.9 2.6 

Minneapolis, MN 14 32 24 29 27 3.6 8.3 6.2 7.5 7.0 

Nashville, TN 145 162 154 149 124 25.4 28.4 27.0 26.1 21.8 

New Orleans, LA 70 46 53 142 185 14.5 9.6 11.2 30.3 39.4 

New York City, NY 2,115 2,442 2,300 2,306 2,398 26.4 30.3 28.5 28.5 29.7 

Newark, NJ 170 237 194 172 67 56.6 78.6 64.1 57.0 22.2 

Norfolk, VA 22 22 20 29 22 9.4 9.3 8.4 12.0 9.1 

Oakland, CA 75 71 114 108 86 5.2 4.8 7.7 7.4 5.9 

Oklahoma City, OK 25 50 43 92 30 5.9 11.7 9.9 21.1 6.9 

Omaha, NE 3 0 13 14 5 0.6 0.0 2.7 2.9 1.0 

Philadelphia, PA 281 315 280 292 247 18.6 21.0 18.8 19.7 16.7 

Phoenix, AZ 324 546 536 519 376 10.5 17.1 16.2 15.3 11.1 

Pittsburgh, PA 3 4 13 8 1 0.2 0.3 1.0 0.6 0.1 

Portland, OR 7 13 11 15 15 1.3 2.5 2.1 2.8 2.8 

Richmond, VA 17 20 11 21 14 8.6 10.1 5.6 10.8 7.2 

Rochester, NY 6 1 7 11 20 2.4 0.4 2.8 4.4 8.1 

Sacramento, CA 20 24 19 11 31 1.6 1.9 1.5 0.8 2.3 

San Antonio, TX 113 167 155 96 146 9.8 14.3 13.0 7.9 12.0 

San Diego, CA 195 103 87 139 124 6.9 3.6 3.0 4.7 4.2 

San Francisco, CA 91 114 116 132 159 11.7 14.7 15.2 17.6 21.2 

San Jose, CA 36 68 47 55 38 2.1 4.0 2.8 3.3 2.3 

Seattle, WA 50 55 36 50 65 2.9 3.1 2.0 2.8 3.7 

St Louis, MO 82 30 44 21 38 23.6 8.8 13.0 6.3 11.4 

St Paul, MN 6 7 9 13 4 2.1 2.4 3.2 4.6 1.4 

St Petersburg, FL 34 23 40 37 22 3.7 2.5 4.3 4.0 2.4 

Tampa, FL 55 76 130 121 86 5.5 7.4 12.3 11.3 8.0 

Toledo, OH 13 1 3 7 5 2.9 0.2 0.7 1.5

Tucson, AZ 14 42 34 39 59 1.6 4.9 3.9 4.4 6.6 

Tulsa, OK 16 12 6 24 10 4.1 3.0 1.5 6.0 2.5 

Washington, DC 237 195 180 129 174 41.5 34.0 31.5 22.9 30.8 

Wichita, KS 7 4 7 7 11 1.5 0.9 1.5 1.5

Yonkers, NY 9 12 23 24 27 4.5 6.0 11.4 11.9 13.4 

U.S. CITY TOTAL 8,845 9,710 9,686 9,678 9,556 12.7 13.8 13.6 13.6 13.4 

San Juan, PR 222 178 152 147 239 21.7 17.4 14.8 14.3 23.3 

TOTAL 9,067 9,888 9,838 9,825 9,795 12.8 13.8 13.7 13.6 13.6 

0.2 

1.6 

1.1 

2.4 

See Appendix (Reporting of City-specific Surveillance Data).
 

STD Surveillance 2004 Syphilis Tables 129
 
Table 39. Congenital syphilis — Reported cases and rates in infants < 1 year of age: United States (excluding 

outlying areas), 1963–2004 

Year Cases Rate per 100,000 Live Births 

1963* 367 9.2 

1964* 336 8.7 

1965* 335 8.9 

1966* 333 8.8 

1967 156 4.1 

1968 274 7.3 

1969 264 7.0 

1970 323 8.6 

1971 422 11.9 

1972 360 11.0 

1973 295 9.4 

1974 250 7.9 

1975 169 5.3 

1976 160 5.1 

1977 134 4.0 

1978 104 3.0 

1979 123 3.5 

1980 107 3.0 

1981 160 4.4 

1982 159 4.3 

1983 158 4.3 

1984 247 6.7 

1985 266 7.1 

1986 357 9.5 

1987 444 11.7 

1988 658 16.8 

1989 1,807 44.7 

1990 3,816 91.8 

1991 4,410 107.3 

1992 4,024 99.0 

1993 3,395 84.9 

1994 2,435 61.6 

1995 1,861 47.7 

1996 1,280 32.9 

1997 1,080 27.8 

1998 842 21.4 

1999 576 14.5 

2000 580 14.3 

2001 501 12.4 

2002 457 11.4 

2003 432 10.7 

2004 353 8.8 

*For 1963 to 1966 data were reported for the federal fiscal year ending June 30 of the year indicated. 

NOTE: The surveillance case definition for congenital syphilis changed in 1988. As of 1995, cases of congenital syphilis < 1 year of age are obtained 

using case reporting form CDC 73.126. For the period 1995 through 2004, yearly case counts in this table correspond to confirmed diagnoses of 

congenital syphilis among those known to be less than one year of age. As a result, the case counts in this table are a subset of those listed in Table 1 

for the years prior to 1995. 

130 Syphilis Tables STD Surveillance 2004 
STD Surveillance 2004 Syphilis Tables 131

Table 40. Congenital syphilis — Reported cases and rates in infants < 1 year of age by state, ranked 

by rates: United States, 2004

Rank* State† Cases Rate per 100,000 Live Births

1 Arizona 26 29.6

2 Louisiana 18 27.7

3 Alabama 11 18.7

4 Michigan 23 17.7

5 Texas 65 17.5

6 South Carolina 9 16.5

7 Idaho 3 14.3

8 Maryland 10 13.6

9 Illinois 23 12.7

10 California 64 12.1

11 New Jersey 13 11.3

12 New Mexico 3 10.8

13 Arkansas 4 10.7

14 Delaware 1 9.0

U.S. TOTAL§ 353 8.8

15 Florida 16 7.8

16 Rhode Island 1 7.8

17 North Carolina 9 7.7

18 Mississippi 3 7.2

19 New York 18 7.2

20 Virginia 6 6.0

21 Tennessee 4 5.2

22 Kansas 2 5.1

23 Indiana 4 4.7

24 Oklahoma 2 4.0

25 Georgia 5 3.8

26 Colorado 2 2.9

27 Missouri 2 2.7

28 Utah 1 2.0

29 Kentucky 1 1.8

30 Minnesota 1 1.5

31 Ohio 2 1.3

YEAR 2010 TARGET 1.0

Alaska 0 0.0

Connecticut 0 0.0

Hawaii 0 0.0

Iowa 0 0.0

Maine 0 0.0

Massachusetts 0 0.0

Montana 0 0.0

Nebraska 0 0.0

Nevada 0 0.0

New Hampshire 0 0.0

North Dakota 0 0.0

Oregon 0 0.0

Pennsylvania 0 0.0

South Dakota 0 0.0

Vermont 0 0.0

Washington 0 0.0

West Virginia 0 0.0

Wisconsin 0 0.0

Wyoming 0 0.0

*States were ranked in descending order by rate, number of cases, and alphabetically by state. States with no cases were not ranked. †

Mother’s state of residence used to assign case.

§

Total includes cases reported by Washington, D.C. but excludes outlying areas (Guam with 0 cases and rate of 0.0, Puerto Rico with 9 cases and 

rate of 17.1, and Virgin Islands with 0 cases and rate of 0.0).
132 Syphilis Tables STD Surveillance 2004

Table 41. Congenital syphilis — Reported cases and rates in infants < 1 year of age by state/area and region 

listed in alphabetical order: United States and outlying areas, 2000–2004

Cases Rates per 100,000 Live Births

State/Area* 2000 2001 2002 2003 2004 2000 2001 2002 2003 2004

Alabama 8 10 6 4 11 12.6 16.5 10.2 6.8 18.7

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 27 31 20 29 26 31.7 36.2 22.8 33.0 29.6

Arkansas 15 6 10 2 4 39.7 16.2 26.7 5.3 10.7

California 86 62 61 64 64 16.2 11.7 11.5 12.1 12.1

Colorado 0 1 2 3 2 0.0 1.5 2.9 4.4 2.9

Connecticut 1 2 0 1 0 2.3 4.7 0.0 2.4 0.0

Delaware 0 0 0 0 1 0.0 0.0 0.0 0.0 9.0

Florida 42 38 28 27 16 20.6 18.5 13.6 13.1 7.8

Georgia 22 21 13 11 5 16.6 15.7 9.8 8.3 3.8

Hawaii 0 0 0 2 0 0.0 0.0 0.0 11.4 0.0

Idaho 0 0 0 4 3 0.0 0.0 0.0 19.1 14.3

Illinois 50 46 40 20 23 27.0 25.0 22.1 11.1 12.7

Indiana 4 13 9 7 4 4.6 15.0 10.6 8.2 4.7

Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kansas 2 2 0 1 2 5.0 5.1 0.0 2.5 5.1

Kentucky 3 1 3 1 1 5.4 1.8 5.5 1.8 1.8

Louisiana 7 0 2 6 18 10.3 0.0 3.1 9.2 27.7

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 16 5 19 9 10 21.5 6.8 25.9 12.3 13.6

Massachusetts 1 2 1 0 0 1.2 2.5 1.2 0.0 0.0

Michigan 33 27 35 38 23 24.2 20.2 26.9 29.2 17.7

Minnesota 0 0 1 0 1 0.0 0.0 1.5 0.0 1.5

Mississippi 14 10 6 2 3 31.8 23.7 14.5 4.8 7.2

Missouri 3 5 1 4 2 3.9 6.6 1.3 5.3 2.7

Montana 0 0 1 0 0 0.0 0.0 9.1 0.0 0.0

Nebraska 0 0 0 1 0 0.0 0.0 0.0 3.9 0.0

Nevada 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Hampshire 0 1 0 0 0 0.0 6.8 0.0 0.0 0.0

New Jersey 23 32 36 21 13 19.9 27.6 31.4 18.3 11.3

New Mexico 3 3 5 6 3 11.0 11.1 18.0 21.6 10.8

New York 41 39 31 42 18 15.8 15.4 12.3 16.7 7.2

North Carolina 19 19 15 20 9 15.8 16.1 12.8 17.0 7.7

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 5 1 3 3 2 3.2 0.7 2.0 2.0 1.3

Oklahoma 1 5 2 1 2 2.0 10.0 4.0 2.0 4.0

Oregon 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Pennsylvania 9 4 5 2 0 6.2 2.8 3.5 1.4 0.0

Rhode Island 0 0 0 0 1 0.0 0.0 0.0 0.0 7.8

South Carolina 32 19 15 15 9 57.0 34.1 27.5 27.5 16.5

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 25 14 10 7 4 31.4 17.9 12.9 9.0 5.2

Texas 72 75 72 77 65 19.8 20.5 19.3 20.7 17.5

Utah 1 0 0 0 1 2.1 0.0 0.0 0.0 2.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 7 3 1 1 6 7.1 3.0 1.0 1.0 6.0

Washington 0 0 2 0 0 0.0 0.0 2.5 0.0 0.0

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wisconsin 4 2 1 0 0 5.8 2.9 1.5 0.0 0.0

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL† 580 501 457 432 353 14.3 12.4 11.4 10.7 8.8

Northeast 75 80 73 66 32 10.8 11.7 10.8 9.7 4.7

Midwest 101 96 90 74 57 11.2 10.8 10.3 8.4 6.5

South 287 228 203 184 165 19.3 15.4 13.7 12.4 11.1

West 117 97 91 108 99 11.9 9.9 9.2 11.0 10.0

Guam 0 1 1 1 0 0.0 28.1 31.1 31.1 0.0

Puerto Rico 17 22 23 17 9 28.7 39.4 43.6 32.2 17.1

Virgin Islands 0 1 0 0 0 0.0 59.9 0.0 0.0 0.0

OUTLYING AREAS 17 24 24 18 9 26.3 39.3 41.7 31.3 15.6

TOTAL 597 525 481 450 362 14.5 12.8 11.8 11.0 8.9

*Mother’s state of residence used to assign case.

†

Includes cases reported by Washington, D.C.
133 Syphilis Tables STD Surveillance 2004

Table 42. Congenital syphilis — Reported cases and rates in infants < 1 year of age in selected cities, ranked 

by rates: United States, 2004

Rank* City† Cases Rate per 100,000 Live Births

1 Detroit, MI 22 153.0

2 Newark, NJ 7 150.8

3 Baltimore, MD 9 93.3

4 Tucson, AZ 8 68.0

5 New Orleans, LA 4 56.6

6 San Diego, CA 10 54.2

7 Houston, TX 23 51.0

8 El Paso, TX 6 46.6

9 Miami, FL 5 38.6

10 Los Angeles, CA 24 37.9

11 Chicago, IL 18 37.5

12 Phoenix, AZ 8 31.8

13 San Jose, CA 5 30.9

14 Dallas, TX 7 28.3

15 Birmingham, AL 1 24.6

16 Toledo, OH 1 21.2

17 Charlotte, NC 2 18.8

18 Memphis, TN 2 18.2

19 Fort Worth, TX 2 17.5

20 Minneapolis, MN 1 16.0

21 Oakland, CA 1 15.4

22 Tulsa, OK 1 15.3

23 Indianapolis, IN 2 14.1

24 Washington, DC 1 13.3

25 Tampa, FL 1 12.6

26 Oklahoma City, OK 1 11.9

27 New York City, NY 12 10.1

28 Columbus, OH 1 9.1

29 Jacksonville, FL 1 8.8

30 Sacramento, CA 1 8.8

31 Denver, CO 1 8.7

32 San Antonio, TX 2 8.6

YEAR 2010 TARGET 1.0

Akron, OH 0 0.0

Albuquerque, NM 0 0.0

Atlanta, GA 0 0.0

Austin, TX 0 0.0

Boston, MA 0 0.0

Buffalo, NY 0 0.0

Cincinnati, OH 0 0.0

Cleveland, OH 0 0.0

Corpus Christi, TX 0 0.0

Dayton, OH 0 0.0

Des Moines, IA 0 0.0

Honolulu, HI 0 0.0

Jersey City, NJ 0 0.0

Kansas City, MO 0 0.0

Louisville, KY 0 0.0

Milwaukee, WI 0 0.0

Nashville, TN 0 0.0

Norfolk, VA 0 0.0

Omaha, NE 0 0.0

Philadelphia, PA 0 0.0

Pittsburgh, PA 0 0.0

Portland, OR 0 0.0

Richmond, VA 0 0.0

Rochester, NY 0 0.0

San Francisco, CA 0 0.0

Seattle, WA 0 0.0

St Louis, MO 0 0.0

St Paul, MN 0 0.0

St Petersburg, FL 0 0.0

Wichita, KS 0 0.0

Yonkers, NY 0 0.0

*Cities were ranked in descending order by rate, number of cases, and alphabetically by state. Cities with no cases were not ranked. Excludes 

outlying areas (San Juan, PR, with 5 cases and rate of 84.3).

†

Mother's city of residence used to assign case. See Appendix (Reporting of City-specific Surveillance Data).
134 Syphilis Tables STD Surveillance 2004

Table 43. Congenital syphilis — Reported cases and rates in infants < 1 year of age in selected cities listed in 

alphabetical order: United States and outlying areas, 2000–2004

Cases Rates per 100,000 Live Births

City* 2000 2001 2002 2003 2004 2000 2001 2002 2003 2004

Akron, OH 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Albuquerque, NM 0 1 0 1 0 0.0 12.5 0.0 11.9 0.0

Atlanta, GA 7 9 5 3 0 73.9 96.5 55.4 33.3 0.0

Austin, TX 0 3 4 1 0 0.0 23.3 31.4 7.8 0.0

Baltimore, MD 15 2 10 5 9 146.9 20.4 103.7 51.9 93.3

Birmingham, AL 2 3 2 1 1 43.9 69.7 49.2 24.6 24.6

Boston, MA 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Buffalo, NY 0 1 0 0 0 0.0 22.8 0.0 0.0 0.0

Charlotte, NC 3 1 1 2 2 28.1 9.6 9.4 18.8 18.8

Chicago, IL 38 35 32 15 18 74.8 70.6 66.7 31.3 37.5

Cincinnati, OH 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Cleveland, OH 2 0 2 0 0 23.2 0.0 26.1 0.0 0.0

Columbus, OH 0 1 0 0 1 0.0 9.4 0.0 0.0 9.1

Corpus Christi, TX 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Dallas, TX 6 8 9 8 7 24.5 31.7 36.4 32.3 28.3

Dayton, OH 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Denver, CO 0 0 0 1 1 0.0 0.0 0.0 8.7 8.7

Des Moines, IA 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Detroit, MI 24 24 30 36 22 151.1 156.6 208.6 250.3 153.0

El Paso, TX 2 2 1 4 6 15.4 15.4 7.8 31.1 46.6

Fort Worth, TX 4 8 4 2 2 36.8 70.6 34.9 17.5 17.5

Honolulu, HI 0 0 0 1 0 0.0 0.0 0.0 21.3 0.0

Houston, TX 32 21 38 21 23 71.4 47.5 84.3 46.6 51.0

Indianapolis, IN 3 9 4 1 2 21.1 64.4 28.2 7.0 14.1

Jacksonville, FL 2 0 0 1 1 17.5 0.0 0.0 8.8 8.8

Jersey City, NJ 3 2 2 0 0 75.6 51.6 53.1 0.0 0.0

Kansas City, MO 2 0 0 1 0 27.2 0.0 0.0 13.6 0.0

Los Angeles, CA 41 27 28 31 24 62.7 41.8 44.2 49.0 37.9

Louisville, KY 1 0 0 1 0 14.1 0.0 0.0 14.0 0.0

Memphis, TN 14 8 3 2 2 122.9 71.3 27.3 18.2 18.2

Miami, FL 18 10 5 9 5 131.7 73.7 38.6 69.6 38.6

Milwaukee, WI 4 2 0 0 0 35.9 17.9 0.0 0.0 0.0

Minneapolis, MN 0 0 1 0 1 0.0 0.0 16.0 0.0 16.0

Nashville, TN 5 4 5 3 0 56.9 46.5 58.1 34.8 0.0

New Orleans, LA 0 0 1 1 4 0.0 0.0 14.1 14.1 56.6

New York City, NY 33 32 25 30 12 27.3 26.8 21.1 25.4 10.1

Newark, NJ 9 8 12 10 7 183.0 161.8 258.5 215.4 150.8

Norfolk, VA 3 1 0 0 0 75.0 24.8 0.0 0.0 0.0

Oakland, CA 1 3 1 4 1 14.8 44.4 15.4 61.7 15.4

Oklahoma City, OK 0 2 1 0 1 0.0 25.1 11.9 0.0 11.9

Omaha, NE 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Philadelphia, PA 9 4 5 2 0 41.1 18.9 23.3 9.3 0.0

Phoenix, AZ 22 22 14 17 8 87.6 87.2 55.6 67.5 31.8

Pittsburgh, PA 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Portland, OR 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Richmond, VA 0 1 0 0 0 0.0 31.9 0.0 0.0 0.0

Rochester, NY 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Sacramento, CA 2 0 0 0 1 18.3 0.0 0.0 0.0 8.8

San Antonio, TX 5 6 1 3 2 22.6 27.2 4.3 12.9 8.6

San Diego, CA 0 6 4 8 10 0.0 32.3 21.7 43.3 54.2

San Francisco, CA 1 1 0 0 0 11.5 12.1 0.0 0.0 0.0

San Jose, CA 1 2 5 4 5 5.9 12.1 30.9 24.7 30.9

Seattle, WA 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

St Louis, MO 1 3 0 0 0 18.4 56.6 0.0 0.0 0.0

St Paul, MN 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

St Petersburg, FL 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tampa, FL 1 6 2 3 1 11.8 72.5 25.2 37.9 12.6

Toledo, OH 0 0 0 1 1 0.0 0.0 0.0 21.2 21.2

Tucson, AZ 0 0 0 1 8 0.0 0.0 0.0 8.5 68.0

Tulsa, OK 0 0 1 0 1 0.0 0.0 15.3 0.0 15.3

Washington, DC 4 2 1 1 1 52.2 26.2 13.3 13.3 13.3

Wichita, KS 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Yonkers, NY 0 0 1 0 0 0.0 0.0 35.6 0.0 0.0

U.S. CITY TOTAL 320 280 260 235 190 39.1 34.6 32.4 29.3 23.7

San Juan, PR 5 5 3 1 5 77.3 80.4 50.6 16.9 84.3

TOTAL 325 285 263 236 195 39.4 35.0 32.6 29.2 24.2

*Mother’s city of residence used to assign case. See Appendix (Reporting of City-specific Surveillance Data).
Table 44. Congenital syphilis — Reported cases and rates in infants <1 year of age by race/ethnicity of 

mother: United States, 2000–2004 

Year of Birth Race/Ethnicity Cases Rate per 100,000 Live Births 

2000 

White/Non-Hispanic 

Black/Non-Hispanic 

Hispanic 

Asian/Pacific Islander 

Native American/Alaskan Native 

Other 

37 

331 

172 

11

6 

3 

1.5 

54.5 

21.1 

5.6 

15.4 

NA 

Unknown 20 NA 

Total 580 14.3 

2001 

White/Non-Hispanic 

Black/Non-Hispanic 

Hispanic 

Asian/Pacific Islander 

Native American/Alaskan Native 

Other 

49 

262 

163 

5 

7 

2 

2.1 

44.2 

19.1 

2.5

18.0 

NA 

Unknown 13 NA 

Total 501 12.4 

2002 

White/Non-Hispanic 

Black/Non-Hispanic 

Hispanic 

Asian/Pacific Islander 

Native American/Alaskan Native 

Other 

35 

257 

144 

10 

3 

1 

1.5 

44.2 

16.4 

4.8

7.6 

NA 

Unknown 7 NA 

Total 457 11.4 

2003 

White/Non-Hispanic 

Black/Non-Hispanic 

Hispanic 

Asian/Pacific Islander 

Native American/Alaskan Native 

Other 

35 

201 

166 

14 

2 

3 

1.5 

34.6 

18.9 

6.8

5.1 

NA 

Unknown 11 NA 

Total 432 10.7 

2004 

White/Non-Hispanic 

Black/Non-Hispanic 

Hispanic 

Asian/Pacific Islander 

Native American/Alaskan Native 

Other 

40 

155 

142 

5 

2 

1 

1.7 

26.7 

16.2 

2.4

5.1 

NA 

Unknown 8 NA 

Total 353 8.8 

NA = Not applicable 

STD Surveillance 2004 Syphilis Tables 135 
Table 45. Chancroid — Reported cases and rates by state/area listed in alphabetical order: United States and 

outlying areas, 2000–2004 

State/Area 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004 2000 2001 2002 2003 2004 

Alabama 1 0 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

Arizona 0 0 0 2 2 0.0 0.0 0.0 0.0

Arkansas 0 0 0 0 0 0.0 0.0 0.0 0.0

California 3 2 2 0 1 0.0 0.0 0.0 0.0

Colorado 1 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

Delaware 0 0 0 0 0 0.0 0.0 0.0 0.0

Florida 0 2 7 2 1 0.0 0.0 0.0 0.0

Georgia 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

Idaho 0 0 0 0 2 0.0 0.0 0.0 0.0

Illinois 0 0 0 0 0 0.0 0.0 0.0 0.0

Indiana 0 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

Kansas 0 0 0 0 0 0.0 0.0 0.0 0.0

Kentucky 0 0 0 1 0 0.0 0.0 0.0 0.0

Louisiana 6 0 2 0 2 0.1 0.0 0.0 0.0

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0

Maryland 0 0 0 1 0 0.0 0.0 0.0 0.0

Massachusetts 2 2 3 3 3 0.0 0.0 0.0 0.0

Michigan 0 0 0 0 2 0.0 0.0 0.0 0.0

Minnesota 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

Missouri 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

Nebraska 0 0 0 0 0 0.0 0.0 0.0 0.0

Nevada 0 0 0 0 1 0.0 0.0 0.0 0.0

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0

New Jersey 0 4 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

New York 26 3 2 10 4 0.1 0.0 0.0 0.1 0.0 

North Carolina 5 3 0 2 1 0.1 0.0 0.0 0.0

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0

Ohio 1 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

Oregon 0 0 0 2 1 0.0 0.0 0.0 0.1

Pennsylvania 0 0 0 1 1 0.0 0.0 0.0 0.0

Rhode Island 0 0 0 0 0 0.0 0.0 0.0 0.0

South Carolina 10 15 24 24 4 0.2 0.4 0.6 0.6 0.1 

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0

Tennessee 0 0 0 0 1 0.0 0.0 0.0 0.0

Texas 19 6 5 3 3 0.1 0.0 0.0 0.0

Utah 0 1 0 2 1 0.0 0.0 0.0 0.1

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0

Virginia 2 0 1 0 0 0.0 0.0 0.0 0.0

Washington 0 0 1 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

Wisconsin 2 0 1 0 0 0.0 0.0 0.0 0.0

Wyoming 0 0 0 1 0 0.0 0.0 0.0 0.2

U.S. TOTAL* 78 38 48 54 30 0.0 0.0 0.0 0.0 0.0 

Guam 

Puerto Rico 

Virgin Islands 

0

3 

1 

0

4 

0 

0

2 

0 

0

4 

0 

0 

1 

0 

0.0 

0.1 

0.9 

0.0 

0.1 

0.0 

0.0 

0.1 

0.0 

0.0

0.1

0.0

OUTLYING AREAS 4 4 2 4 1 0.1 0.1 0.0 0.1

TOTAL 82 42 50 58 31 0.0 0.0 0.0 0.0 0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.1 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

*Includes cases reported by Washington, D.C. 

136 Chancroid Tables STD Surveillance 2004 
Table 46. Chancroid — Reported cases and rates in selected cities listed in alphabetical order: United States 

and outlying areas, 2000–2004 

City 

Cases Rates per 100,000 Population 

2000 2001 2002 2003 2004
 2000 2001 2002 2003 2004 

Akron, OH 0 0 0 0 0
 0.0 0.0 0.0 0.0

Albuquerque, NM 0 0 0 0 0 0.0 0.0 0.0 0.0

Atlanta, GA 0 0 0 0 0 0.0 0.0 0.0 0.0

Austin, TX 0 0 0 0 0 0.0 0.0 0.0 0.0

Baltimore, MD 0 0 0 1 0 0.0 0.0 0.0 0.2

Birmingham, AL 0 0 0 0 0 0.0 0.0 0.0 0.0

Boston, MA 0 0 1 0 2 0.0 0.0 0.2 0.0

Buffalo, NY 0 0 0 0 0 0.0 0.0 0.0 0.0

Charlotte, NC 0 1 0 0 0 0.0 0.1 0.0 0.0

Chicago, IL 0 0 0 0 0 0.0 0.0 0.0 0.0

Cincinnati, OH 0 0 0 0 0 0.0 0.0 0.0 0.0

Cleveland, OH 0 0 0 0 0 0.0 0.0 0.0 0.0

Columbus, OH 0 0 0 0 0 0.0 0.0 0.0 0.0

Corpus Christi, TX 0 0 1 0 0 0.0 0.0 0.4 0.0

Dallas, TX 6 1 1 1 0 0.5 0.1 0.1 0.1

Dayton, OH 0 0 0 0 0 0.0 0.0 0.0 0.0

Denver, CO 0 0 0 0 0 0.0 0.0 0.0 0.0

Des Moines, IA 0 0 0 0 0 0.0 0.0 0.0 0.0

Detroit, MI 0 0 0 0 2 0.0 0.0 0.0 0.0

El Paso, TX 1 0 0 0 1 0.2 0.0 0.0 0.0

Fort Worth, TX 2 0 0 0 0 0.4 0.0 0.0 0.0

Honolulu, HI 0 0 0 0 0 0.0 0.0 0.0 0.0

Houston, TX 3 1 3 0 0 0.2 0.1 0.1 0.0

Indianapolis, IN 0 0 0 0 0 0.0 0.0 0.0 0.0

Jacksonville, FL 0 1 0 0 0 0.0 0.1 0.0 0.0

Jersey City, NJ 0 0 0 0 0 0.0 0.0 0.0 0.0

Kansas City, MO 0 0 0 0 0 0.0 0.0 0.0 0.0

Los Angeles, CA 1 0 0 0 0 0.0 0.0 0.0 0.0

Louisville, KY 0 0 0 0 0 0.0 0.0 0.0 0.0

Memphis, TN 0 0 0 0 0 0.0 0.0 0.0 0.0

Miami, FL 0 0 0 0 0 0.0 0.0 0.0 0.0

Milwaukee, WI 0 0 1 0 0 0.0 0.0 0.1 0.0

Minneapolis, MN 0 0 0 0 0 0.0 0.0 0.0 0.0

Nashville, TN 0 0 0 0 0 0.0 0.0 0.0 0.0

New Orleans, LA 6 0 0 0 0 1.2 0.0 0.0 0.0

New York City, NY 26 3 2 9 4 0.3 0.0 0.0 0.1

Newark, NJ 0 1 0 0 0 0.0 0.3 0.0 0.0

Norfolk, VA 0 0 0 0 0 0.0 0.0 0.0 0.0

Oakland, CA 0 1 0 0 0 0.0 0.1 0.0 0.0

Oklahoma City, OK 0 0 0 0 0 0.0 0.0 0.0 0.0

Omaha, NE 0 0 0 0 0 0.0 0.0 0.0 0.0

Philadelphia, PA 0 0 0 0 0 0.0 0.0 0.0 0.0

Phoenix, AZ 0 0 0 2 2 0.0 0.0 0.0 0.1

Pittsburgh, PA 0 0 0 0 0 0.0 0.0 0.0 0.0

Portland, OR 0 0 0 0 0 0.0 0.0 0.0 0.0

Richmond, VA 0 0 0 0 0 0.0 0.0 0.0 0.0

Rochester, NY 0 0 0 0 0 0.0 0.0 0.0 0.0

Sacramento, CA 0 0 0 0 0 0.0 0.0 0.0 0.0

San Antonio, TX 1 0 0 0 0 0.1 0.0 0.0 0.0

San Diego, CA 0 0 0 0 1 0.0 0.0 0.0 0.0

San Francisco, CA 0 1 0 0 0 0.0 0.1 0.0 0.0

San Jose, CA 0 0 0 0 0 0.0 0.0 0.0 0.0

Seattle, WA 0 0 0 0 0 0.0 0.0 0.0 0.0

St Louis, MO 0 0 0 0 0 0.0 0.0 0.0 0.0

St Paul, MN 0 0 0 0 0 0.0 0.0 0.0 0.0

St Petersburg, FL 0 0 0 0 0 0.0 0.0 0.0 0.0

Tampa, FL 0 0 0 0 0 0.0 0.0 0.0 0.0

Toledo, OH 0 0 0 0 0 0.0 0.0 0.0 0.0

Tucson, AZ 0 0 0 0 0 0.0 0.0 0.0 0.0

Tulsa, OK 0 0 0 0 0 0.0 0.0 0.0 0.0

Washington, DC 0 0 0 0 0 0.0 0.0 0.0 0.0

Wichita, KS 0 0 0 0 0 0.0 0.0 0.0 0.0

Yonkers, NY 0 0 0 0 0 0.0 0.0 0.0 0.0

U.S. CITY TOTAL 46 10 9 13 12 0.1 0.0 0.0 0.0 0.0 

San Juan, PR 2 1 1 4 1 0.2 0.1 0.1 0.4

TOTAL 48 11 10 17 13 0.1 0.0 0.0 0.0 0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.3 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.2 

0.2 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.1 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.1 

See Appendix (Reporting of City-specific Surveillance Data).
 

STD Surveillance 2004 Chancroid Tables 137
 
Table 47. Selected STDs and complications — Initial visits to physicians' offices: United States, 1966–2004 

Genital Genital Vaginal Other Pelvic Inflammatory 

Year Herpes Warts Trichomoniasis* Vaginitis* 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 

*Women only. 

†

Women 15-44 only. NA = Not available.
 

NOTE: Standard errors for estimates under 100,000 are not available. The relative standard error for estimates 100,000-300,000 are between 20%
 

and 30%; 300,000-600,000 are between 16% and 20%; 600,000-1,000,000 are 13% and 15%; and 1,000,000-5,000,000 are between 9% and 13%.
 

SOURCE: National Disease and Therapeutic Index (IMS Health). See Appendix (Other Data Sources) for more information.
 

138 Selected STDs Table STD Surveillance 2004 
APPENDIX 

Interpreting STD Surveillance Data 

Much of the information in this document is based on cases of nationally notifiable sexually transmitted diseases (STDs) reported to the Division of STD Prevention (DSTDP), National Center for 

HIV, STD, and TB Prevention (NCHSTP), Centers for Disease Control and Prevention (CDC), by 

the STD control programs and health departments in the 50 states, the District of Columbia, selected cities, U.S. dependencies and possessions, and independent nations in free association with 

the United States. Included among the dependencies, possessions, and independent nations are 

Guam, Puerto Rico, and the Virgin Islands. These entities are identified as “outlying areas” of the 

United States in selected figures and tables. 

Reporting Formats 

STD morbidity data used in this report are based on a combination of hardcopy reporting forms 

and electronic data received via the National Electronic Telecommunications System for Surveillance (NETSS). 

Summary Hardcopy Forms 

The following hardcopy forms were used to report national STD morbidity data: 

1. FORM CDC 73.998: Monthly Surveillance Report of Early Syphilis. This monthly hardcopy reporting form was used to report 1984-2002 summary data for P&S syphilis and early latent syphilis 

by county and state. 

2. FORM CDC 73.688: Sexually Transmitted Disease Morbidity Report. This quarterly hardcopy 

reporting form was used to report 1963-2002 summary data for all stages of syphilis, congenital 

syphilis, gonorrhea, chancroid, chlamydia, and other STDs by sex and source of report (private vs. 

public) for the 50 states, Washington, D.C., and 64 selected cities (including San Juan, PR) and outlying areas of the United States. Note: National chlamydia data did not become available until 

1996. Congenital syphilis was dropped from this aggregate form in 1995 and replaced by the 

case-specific CDC 73.126 form listed below. 

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 hardcopy 

form was used to report 1981-2002 summary data for P&S syphilis, gonorrhea, and chlamydia by 

age, race, sex and source (public vs. private) for all states and 7 large cities (Baltimore, Chicago, New 

York City, Los Angeles, Philadelphia, San Francisco, and Washington, D.C.), and outlying areas of 

the United States. Note: National chlamydia data did not become available until 1996. 

4. FORM CDC 73.126: Congenital Syphilis (CS) Case Investigation and Report. This case-specific hardcopy form continues to be used to report 1983-2004 detailed data for congenital syphilis 

STD Surveillance 2004 Appendix Interpreting STD Surveillance Data 139 
for the states (including city, county and zip code information after 1990) and outlying areas of the 

United States. 

NETSS 

Electronic data reported through NETSS comprise the nationally notifiable disease information 

that is published in the Morbidity and Mortality Weekly Report (MMWR). 

As of December 31, 2003, all 50 states and Washington, D.C. had converted from summary 

hardcopy reporting to electronic submission of line-listed (i.e., case-specific) STD data via NETSS. 

Guam, Puerto Rico and the Virgin Islands continue to report using summary hardcopy forms. 

Jurisdictions differ in their ability to resolve differences in total cases derived from summary 

hardcopy monthly, quarterly, and annual reports (as well as electronically submitted line-listed 

data). Thus, depending on the database used, there may be discrepancies in the total number of 

cases among the figures and tables for earlier years. In most instances, these discrepancies are less 

than 5% of total reported cases and have minimal impact on national case totals and rates. However, for a specific area, the discrepancies may be larger. 

Reports and corrections sent to CDC on hardcopy forms and for NETSS electronic 

data through April 29, 2005 have been included in this report. Data received after this 

date will appear in subsequent issues. The data in the figures and tables in this document supersede those in all earlier publications. 

Population Denominators and Rate Calculations 

Crude incidence rates (new cases/population) were calculated on an annual basis per 100,000 

population. In this report, the 2004 rates for the United States, all states, cities and outlying areas 

were calculated by dividing the number of cases reported from each area in 2004 by the estimated 

area-specific 2003 population (the most current detailed population file available at time of publication). For the United States, rates were calculated using Bureau of the Census population estimates 

for 1981 through 1989 (Bureau of the Census; United States Population Estimates by Age, Sex and 

Race: 1980-1989 [Series P-25, No. 1045]; Washington: U.S. Government Printing Office, 1990; 

and United States Population Estimates by Age, Sex and Race: 1989 [Series P-25, No. 1057]; Washington: U.S. Government Printing Office, 1990). Rates for states and counties were calculated using 

published intercensal estimates based on Bureau of the Census population estimates for 1980-1989 

(Irwin R; 1980-1989 Intercensal Population Estimates by Race, Sex, and Age; Alexandria, [VA]: 

Demo-Detail, 1992; machine-readable data file). The National Center for Health Statistics released 

bridged race population counts for 2000-2003 resident population based on the Census 2000 

counts. These estimates resulted from bridging the 31 race categories used in Census 2000, as specified in the 1997 Office of Management and Budget (OMB) standards, to the four race groups specified under the 1977 OMB standards. The files were prepared under a collaborative arrangement 

with the U.S. Census Bureau. The population counts for 1990-1999 were also updated to incorporate the bridged single-race estimates of the April 1, 2000 resident population. These files were prepared by the U.S. Census Bureau with support from the National Cancer Institute. Due to use of 

the updated population data, rates for the period 1990-2003 may be different from 

prior Surveillance Reports. 

140 Interpreting STD Surveillance Data Appendix STD Surveillance 2004 
Population estimates for 1980-1988 for areas outside the United States were obtained from the 

Bureau of the Census (Bureau of the Census; population estimates for Puerto Rico and the outlying 

areas: 1980 to 1988; Current Population Reports [Series P-25, No. 1049]; Washington: U.S. Government Printing Office, 1989). From 1989 to 2002, population estimates for Guam were obtained 

from the Guam Bureau of Statistics and Plans, estimates for Puerto Rico were obtained from the Bureau of Census; and estimates for the Virgin Islands were obtained from the University of the Virgin 

Islands. After 2002, population estimates for all outlying areas were obtained from the Bureau of 

Census web site. The 2003-2004 rates were calculated using the 2003 population estimates. 

Rates of congenital syphilis for 1989-2003 were calculated using live births from the National 

Center for Health Statistics (NCHS) (Vital Statistics: Natality Tapes 1989-2002 or Vital Statistics Reports, United States 1999, Vol. 48 No.10-Natality). Race-specific rates for 2002-2004 were calculated using live births for 2002. Rates before 1989 were calculated using published live birth data 

(NCHS; Vital Statistics Report, United States, 1988 [Vol.1–Natality]). 

Reporting Practices 

Although most areas generally adhere to the case definitions for STDs found in Case Definitions 

for Infectious Conditions under Public Health Surveillance,

1 there may be differences in the policies 

and systems for collecting surveillance data. Thus, comparisons of case numbers and rates between 

jurisdictions should be interpreted with caution. However, since case definitions and surveillance 

activities within a given area remain relatively stable, trends should be minimally affected by these 

differences. In many areas, the reporting from publicly supported institutions (e.g., STD clinics) has 

been more complete than from other sources (e.g., private practitioners). Thus, trends may not be 

representative of all segments of the population. 

Reporting of City-specific Surveillance Data 

City-specific STD incidence data and rates should be considered estimates since the data may be 

derived from county data and only approximate city jurisdictions for some cities. Based on past reporting methods, including the transition from summary hardcopy reporting to NETSS reporting, 

the definition for a selected city can depend on a particular county code, city code, and/or locally-assigned site code. Dependent upon the city jurisdiction definition, city-specific incidence data 

and rates may be equivalent to those of the county, a proportion of the county, or a combination of 

the counties in which the city is located. These population data are updated annually, based on estimates from the Bureau of Census, and are verified by the STD project areas. 

Management of Unknown, Missing or Invalid Age Group, Race/Ethnicity, and 

Sex Data 

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). When the percentage of 

unknown, missing, or invalid data for the variables - age group, race/ethnicity, and sex - exceeds 50% 

for any state, the state’s incidence data and population data are excluded from the tables presenting 

data stratified by one or more of these variables (e.g. Table A1). For those states reporting > 50% valid 

data for these variables, unknown, missing or invalid data are redistributed based on the state’s distribution of known age group, race/ethnicity, and sex data, respectively. As a result of this procedure, 

STD Surveillance 2004 Appendix Interpreting STD Surveillance Data 141 
incidence and rate data stratified by one or more of the variables - age group, race/ethnicity, and sex – 

may not accurately reflect total national incidence or rates. 

Classification of STD Morbidity Reporting Sources 

Prior to 1996, states classified the source of case reports as either private source (including private 

physicians, and private hospitals and institutions) or public (clinic) 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/HMOs, hospitals (inpatient), emergency rooms, correctional facilities, 

laboratories, blood banks, National Job Training Program (formerly Job Corps), school-based clinics, mental health providers, military, and other unspecified sources. Limited data analysis of the 

data reported electronically after 1996 confirmed that the new STD clinic source of report data corresponded to the earlier reporting source category, public (clinic) source. Therefore, source of case 

report data for the period 1984-2004 are presented as STD clinic or non-STD clinic only (Table A2). 

Chlamydia Morbidity Reporting 

Trends in chlamydia morbidity reporting from many areas are more reflective of changes in diagnosis, screening, and reporting practices rather than actual trends in disease incidence. Cases and 

rates of reported chlamydia in sex-specific tables are underestimated due to some reported cases 

with unknown sex. Despite problems with under-reporting, it is important to publish available data 

to emphasize the large numbers of cases of chlamydia being detected in the United States. As areas 

develop chlamydia prevention and control programs, including improved surveillance systems to 

monitor trends, the data should improve and become more representative of true trends in disease. 

New York City has been reporting chlamydia cases since 1984. However, the State of New York, 

with the exception of New York City, initiated chlamydia reporting during the year 2000. As a result, 

the number of chlamydia cases reported by the state of New York (including the cities of Buffalo, 

Rochester and Yonkers) prior to the year 2001 may be incomplete, and the rate for New York State is 

underestimated. To be consistent with the practice used in earlier years, New York State chlamydia 

morbidity data were included in the calculation of overall national chlamydia rates. 

The number of chlamydia cases occurring in the fourth quarter of 2000 for the State of Colorado 

were not available. These cases were projected based on case counts from the first three quarters. 

Syphilis Morbidity Reporting 

"Total syphilis" or "all stages of syphilis" includes primary, secondary, early latent, late (including 

neurosyphilis, late latent, late with clinical manifestations, and unknown latent), and congenital 

syphilis. Cases of latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical 

manifestations are included in late and late latent syphilis totals. 

In 1996, "late syphilis with clinical manifestations other than neurosyphilis (late benign and cardiovascular syphilis)" was added to the syphilis case definition (see STD Case Definitions in this 

Appendix). 

142 Interpreting STD Surveillance Data Appendix STD Surveillance 2004 
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.2 In addition, many areas have greatly enhanced active 

case finding for congenital syphilis since 1988. For these reasons, the number of reported cases increased dramatically during 1989-1991. As a result of this change in surveillance activity a period of 

transition during which trends cannot be clearly interpreted has resulted; however, all reporting areas 

had implemented the new case definition for reporting congenital syphilis by January 1, 1992. Therefore, the reliability of trends is expected to have stabilized after this date. 

In addition to changing the case definition for congenital syphilis, CDC introduced a new data 

collection form (CDC 73.126) in 1990 (revised October 2003). Since 1995, the data collected on 

this form have been used for reporting congenital syphilis reported 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 analyses by race/ethnicity, if either the race or ethnicity question 

was answered, the case was included. For example, if "white" race was marked, but ethnicity was left 

blank, the individual was counted as "non-Hispanic white". Congenital syphilis cases were reported 

by state and city of residence of the mother for the period 1995 through 2004. 

Chlamydia, Gonorrhea, and Syphilis Prevalence Monitoring 

Chlamydia and gonorrhea test positivity and syphilis seroreactivity were calculated for the following: women attending family planning clinics, prenatal clinics, the National Job Training Program, 

men attending STD clinics and a large primary care clinic participating in the MSM Prevalence Monitoring Project, and men and women entering corrections facilities. Positivity was calculated by dividing the number of positive tests for chlamydia, gonorrhea, or syphilis (numerator) by the total 

number of positive and negative tests for each disease (denominator) and was expressed as a percentage. Except for the National Job Training Program screening data, the denominators for these 

data sources may include more than one test from the same individual if that person was tested 

more than once during a year. Various laboratory test methods were used for all of these data 

sources except the National Job Training Program and, for most of the figures shown, no adjustments of test positivity were made based on laboratory test type and sensitivity. However, for Figure 

8 and Figure J, the chlamydia test results for each test type were weighted to reflect the sensitivity of 

the test used.3 The weights used in this adjustment are the reciprocals of the sensitivities of the laboratory test methods used. These test-specific sensitivities were defined as estimates from published 

evaluations of chlamydia screening tests.4,5 Limitations of this adjustment include: unknown dates 

when laboratories changed tests, missing information on the test method, variation of test sensitivity 

within a technology type, and no adjustment for supplemental testing such as negative grey zone 

testing. 

For more details on chlamydia prevalence, refer to the following annual publication: Centers for 

Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2004 Supplement: 

Chlamydia Prevalence Monitoring Project Annual Report 2004. Atlanta, GA: U.S. Department of 

Health and Human Services (available first quarter 2006). 

In the MSM Prevalence Monitoring Project the syphilis seroreactivity data in most instances do 

not reflect confirmatory testing and thus biologic false positive test results were not systematically excluded. The extent to which these data reflect prevalence of active syphilis infection varies by site. 

Similarly, in the Corrections Prevalence Monitoring Project, syphilis seroreactivity test results were 

STD Surveillance 2004 Appendix Interpreting STD Surveillance Data 143 
not confirmed. Only a few juvenile corrections sites submitted data to CDC, making overall interpretation difficult due to the small sample size. Because only selected corrections facilities participated in the Corrections Prevalence Monitoring Project, state-specific positivity for syphilis, 

chlamydia, and gonorrhea may not be representative of all corrections facilities in the state. 

Prevalence data for region- and state-specific figures were published with permission from the Regional Infertility Prevention Program, selected state STD prevention programs, and the National 

Job Training Program. 

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 28 STD clinics and five regional laboratories located throughout the United States. For more details on findings from GISP gonorrhea 

surveillance activities, refer to the following annual publication: Centers for Disease Control and 

Prevention. Sexually Transmitted Disease Surveillance 2004 Supplement: Gonococcal Isolate Surveillance Project (GISP) Annual Report 2004. Atlanta, GA: U.S. Department of Health and Human 

Services (available first quarter 2006). 

Definition of DHHS Regions 

The ten U.S. Department of Health and Human Services (DHHS) regions referred to in the text and 

figures include the following jurisdictions: Region I = Connecticut, Maine, Massachusetts, New 

Hampshire, Rhode Island, and Vermont; Region II = New Jersey, New York, Puerto Rico, and U.S. 

Virgin Islands; Region III = Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and 

West Virginia; Region IV = Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South 

Carolina, and Tennessee; Region V = Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin; 

Region VI = Arkansas, Louisiana, New Mexico, Oklahoma, and Texas; Region VII = Iowa, Kansas, 

Missouri, and Nebraska; Region VIII = Colorado, Montana, North Dakota, South Dakota, Utah, and 

Wyoming; Region IX = Arizona, California, Guam, Hawaii, and Nevada; and Region X = Alaska, 

Idaho, Oregon, and Washington. 

Other Data Sources 

National Disease and Therapeutic Index (NDTI) 

The information on the number of initial visits to private physicians' offices for sexually transmitted diseases was based on analysis of data from the National Disease and Therapeutic Index (NDTI) 

(machine-readable files or summary statistics for the period 1966 through 2004). For more information on this database, contact IMS Health, 660 W. Germantown Pike, Plymouth Meeting, PA 

19462; Telephone: (800) 523-5333. 

National Hospital Discharge Survey (NHDS) 

The information on patients hospitalized for pelvic inflammatory disease or ectopic pregnancy 

was based on analysis of data from the National Hospital Discharge Survey (machine-readable files 

for years 1980-2003), an ongoing nationwide sample survey of short-stay hospitals in the United 

States, conducted by the National Center for Health Statistics. For more information, see Graves EJ; 

144 Interpreting STD Surveillance Data Appendix STD Surveillance 2004 
1988 Summary: National Hospital Discharge Survey; Advance data No. 185; Hyattsville (MD): National Center for Health Statistics, 1990. 

National Hospital Ambulatory Medical Care Survey (NHAMCS-ER) 

The National Hospital Ambulatory Medical Care Survey (NHAMCS-ER) (machine-readable files 

for 1995-2003) was used to obtain estimates of the number of emergency room visits for pelvic inflammatory disease among women ages 15 to 44. The estimates generated using these data sources 

(NHDS and NHAMCS) are based on statistical surveys and therefore have sampling variability 

associated with the estimates. 

Healthy People 2010 Objectives 

Healthy People 20106 is a set of health objectives for the U.S. to achieve over the first decade of 

the new century. It is used by people, States, communities, professional organizations, and others to 

help develop programs to improve health. Healthy People 2010 builds on initiatives pursued over 

the past two decades. The 1979 Surgeon General's Report, Healthy People, and Healthy People 

2000: National Health Promotion and Disease Prevention Objectives both established national 

health objectives and served as the basis for the development of State and community plans. Like its 

predecessors, Healthy People 2010 was developed through a broad consultation process, built on 

the best scientific knowledge and designed to measure programs over time. Healthy People 2010 is 

organized into 28 focus areas, each with objectives and measures designed to drive action that will 

support two overarching goals: 1) increasing the quality and years of healthy life and 2) eliminating 

health disparities. 

Focus area 25 of Healthy People 2010 - Sexually Transmitted Diseases, contains objectives and 

measures related to STDs. The baselines, HP2010 targets and annual progress toward the targets are 

reported in Table A3. The year 2010 targets for the diseases addressed in this report are: primary and 

secondary syphilis–0.2 case per 100,000 population; congenital syphilis–1.0 case per 100,000 live 

births; and gonorrhea–19.0 cases per 100,000 population. An additional target established in the 

HP2010 objectives is to reduce the Chlamydia trachomatis test positivity to 3% among females aged 

15-24 years who attend family planning and STD clinics and among males aged 15- 24 who attend 

STD clinics. 

GPRA Goals 

The Government Performance and Results Act of 1993 (GPRA) was enacted by Congress to increase the confidence of citizens in the capability of the federal government, to increase the effectiveness and accountability of federal programs, to improve service delivery, to provide agencies a 

uniform tool for internal management and to assist Congressional decision making. 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 STD GPRA goals: 1) reduction in pelvic inflammatory disease (PID) and 2) elimination of syphilis. Each of these goals has measures. The long-term goals and measures of progress are reported in 

Table A4. 

STD Surveillance 2004 Appendix Interpreting STD Surveillance Data 145 
1	 Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health 

surveillance, 1997. MMWR 1997;46(No. RR-10;1). 

2	 Kaufman RE, Jones OG, Blount JH, Wiesner PJ. Questionnaire survey of reported early congenital 

syphilis: problems in diagnosis, prevention, and treatment. Sexually Transmitted Diseases 1977;4:135-9. 

3	 Webster Dicker L, Mosure DJ, Levine WC, Black CM, Berman SM. The impact of switching laboratory 

tests on reported trends in Chlamydia trachomatis infections. Am J Epidemiol 2000;151:430-435. 

4	 Newhall WJ, DeLisle S, Fine D, et al. Head-to-head evaluation of five different non-culture chlamydia tests 

relative to a quality-assured culture standard. Sexually Transmitted Diseases 1994;21:S165-6. 

5	 Black CM, Marrazzo J, Johnson RE, et al. Head-to-head multicenter comparision of DNA probe and 

nucleic acid amplification tests for Chlamydia trachomatis infection in women performed with an 

improved reference standard. J Clin Micro 2002;40:3757-3763. 

6	 U.S. Department of Health and Human Services. Healthy People 2010 2ndnd ed. With Understanding and 

Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government 

Printing Office, November 2000. 

146 Interpreting STD Surveillance Data Appendix STD Surveillance 2004 
Table A1. Selected STDs — Percentage of unknown, missing, or invalid values for selected demographic 

variables by state, 2004 

State 

Primary and Secondary Syphilis Gonorrhea Chlamydia 

Percent Percent Percent 

Unknown Unknown Unknown 

Race/Ethnicity Age Sex 

Percent 

Unknown 

Race/Ethnicity 

Percent 

Unknown 

Age 

Percent 

Unknown 

Sex 

Percent 

Unknown 

Race/Ethnicity 

Percent 

Unknown 

Age 

Percent 

Unknown 

Sex 

Alabama 1.8 0.0 0.0 19.0 0.7 0.1 26.4 0.8 0.2 

Alaska* 0.0 0.0 0.0 1.9 0.0 0.0 2.4 0.0 0.0 

Arizona 15.9 0.0 0.0 12.4 0.0 0.1 15.5 0.0 0.0 

Arkansas 0.0 0.0 0.0 0.8 0.4 0.0 2.4 0.3 0.0 

California 2.4 0.0 0.1 44.6 0.9 0.3 53.8 0.8 0.4 

Colorado 7.9 0.0 0.0 44.6 0.2 0.0 68.8 0.6 0.1 

Connecticut 2.2 2.2 0.0 34.2 0.6 0.0 39.1 1.0 0.0 

Delaware* 11.1 0.0 0.0 5.0 0.0 0.0 8.0 0.0 0.0 

Florida 2.2 0.1 0.0 5.9 0.1 0.0 7.8 0.2 0.0 

Georgia 6.9 0.0 0.0 34.1 1.1 0.4 43.6 1.0 0.6 

Hawaii* 0.0 0.0 0.0 46.9 0.6 0.0 49.6 0.8 0.0 

Idaho 33.3 0.0 0.0 44.7 0.0 1.0 31.3 0.2 0.4 

Illinois 2.8 0.0 0.0 17.6 0.0 0.0 18.3 0.1 0.0 

Indiana 1.7 0.0 0.0 14.3 0.4 0.5 18.9 0.5 0.8 

Iowa* 0.0 0.0 20.0 14.3 0.2 0.2 21.2 0.6 0.1 

Kansas 0.0 0.0 0.0 18.2 0.2 0.0 24.0 0.2 0.0 

Kentucky 4.3 0.0 0.0 16.4 0.2 0.2 19.4 0.0 0.2 

Louisiana 2.4 0.0 0.0 12.5 0.4 0.6 19.6 0.7 1.2 

Maine* 0.0 0.0 0.0 5.7 0.0 0.0 16.1 0.1 0.0 

Maryland 1.8 0.0 0.0 28.6 0.7 0.0 43.6 0.6 0.0 

Massachusetts 14.9 0.0 0.0 41.1 0.4 0.1 50.1 0.4 0.1 

Michigan 0.0 0.0 0.0 28.2 1.0 0.0 31.8 0.8 0.0 

Minnesota 0.0 0.0 0.0 19.4 0.0 0.0 20.0 0.0 0.0 

Mississippi 0.0 0.0 0.0 10.9 0.3 0.0 12.0 0.2 0.0 

Missouri 0.0 0.0 0.0 17.9 0.2 0.0 23.6 0.3 0.0 

Montana* 0.0 0.0 0.0 21.6 1.1 1.1 20.9 1.0 0.3 

Nebraska* 28.6 0.0 0.0 19.4 3.1 0.3 22.2 8.5 0.7 

Nevada 10.0 0.0 0.0 34.0 0.5 0.1 42.9 0.9 0.2 

New Hampshire* 20.0 0.0 0.0 12.8 0.0 0.0 11.1 0.0 0.0 

New Jersey 16.7 0.0 0.0 50.3 1.3 0.0 55.6 1.7 0.1 

New Mexico 6.1 0.0 0.0 9.6 0.6 0.0 12.6 1.6 0.1 

New York 34.3 0.0 0.0 42.9 0.4 0.2 47.3 0.4 0.2 

North Carolina 0.0 0.0 0.0 0.7 0.0 0.0 0.9 0.0 0.0 

North Dakota* 0.0 0.0 0.0 8.2 1.8 0.0 9.5 0.3 0.2 

Ohio 0.4 0.0 0.0 32.4 1.5 1.4 38.6 1.6 2.1 

Oklahoma 0.0 0.0 0.0 0.7 0.0 0.0 1.3 0.0 0.0 

Oregon 0.0 0.0 0.0 15.8 0.0 0.0 16.0 0.0 0.0 

Pennsylvania 5.9 0.0 0.0 26.2 0.7 0.0 28.0 0.5 0.0 

Rhode Island 0.0 0.0 0.0 7.0 0.2 0.0 23.2 0.1 0.1 

South Carolina 0.0 0.0 0.0 27.4 0.7 0.3 34.5 0.7 0.2 

South Dakota* 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 

Tennessee 0.0 0.0 0.0 18.4 0.3 0.0 23.2 0.3 0.0 

Texas 1.0 0.0 0.0 10.5 0.4 0.1 10.7 0.4 0.2 

Utah 0.0 0.0 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 0.0 0.0 

Virginia 0.9 0.0 0.0 10.8 0.2 0.1 14.2 0.3 0.2 

Washington 4.0 0.0 0.0 18.8 0.5 0.0 17.8 1.0 0.0 

West Virginia* 0.0 0.0 0.0 13.7 0.2 0.1 13.6 0.5 0.1 

Wisconsin 0.0 0.0 0.0 29.2 0.0 0.3 30.5 0.0 0.1 

Wyoming* 0.0 0.0 0.0 0.0 1.7 0.0 1.9 2.6 0.0 

U.S. TOTAL† 6.1 0.0 0.0 23.3 0.5 0.2 29.3 0.6 0.3 

*Percentages for P&S syphilis are based on less than 10 cases. 

†

Includes cases reported by Washington, D.C.
 

NOTE: "Unknown" includes unknown, missing, or invalid data values.
 

STD Surveillance 2004 Appendix Percentage Unknown 147 
Table A2. Reported cases of sexually transmitted disease by sex and reporting source: United States, 2004 

Non-STD Clinic STD Clinic Total* 

Disease Male Female Total Male Female Total Male Female Total 

Chlamydia 128,209 588,112 717,732 73,948 94,197 168,318 210,396 716,675 929,462 

Gonorrhea 83,335 131,392 215,113 67,106 30,832 97,988 157,303 172,142 330,132 

Primary Syphilis 1,117 132 1,249 883 109 993 2,026 241 2,269 

Secondary Syphilis 3,257 630 3,888 1,361 368 1,729 4,696 1,014 5,711 

Early Latent Syphilis 3,484 1,426 4,912 1,852 877 2,731 5,433 2,331 7,768 

Late and Late Latent Syphilis † 7,105 4,689 11,839 3,058 2,095 5,171 10,340 6,896 17,300 

Neurosyphilis 552 143 695 84 33 117 650 182 833 

Chancroid 10 7 17 8 1 9 19 9 30 

*Totals include unknown sex and reporting source. 

†

Late and late latent syphilis includes cases of unknown duration, late syphilis with clinical manifestations, and neurosyphilis. 

See Appendix (Classification of STD Morbidity Reporting Source). 

148 STD Reporting Source Appendix STD Surveillance 2004 
Table A3. Healthy People 2010 Sexually Transmitted Diseases Objective Status 

HP 2010 Objectives 

Baseline 

Year Baseline 1998 1999 2000 2001 2002 2003 2004 

HP 2010 

Target 

25-1 Reduce the proportion of 

adolescents and young adults 

with Chlamydia trachomatis 

infections 

a. Females aged 15 to 24 years attending family planning

clinics 

b. Females aged 15 to 24 years attending STD clinics 

c. Males aged 15 to 24 years attending STD clinics 

1997 

1997 

1997 

5.0% 

12.2% 

15.7% 

6.1%* 

13.5%* 

16.9%* 

5.6%* 

13.7%* 

17.0%* 

5.9%* 

13.5%* 

16.4%* 

5.8%* 

13.3%* 

17.0%* 

6.0%* 

13.5%* 

17.5%* 

6.4%* 

14.1%* 

19.3%* 

6.9%* 

15.3%* 

20.8%* 

3.0% 

3.0% 

3.0% 

25-2 Reduce gonorrhea (cases per 

100,000 population) 

1997 123.0 129.2 129.3 128.7 126.8 122.0 115.2 113.5 19.0 

25-3 Eliminate sustained domestic 

transmission of primary and 

secondary syphilis (cases per 

100,000 population) 

1997 3.2 2.5 2.4 2.1 2.1 2.4 2.5 2.7 0.2 

25-4 Reduce the proportion of adults 

aged 20 to 29 years with genital 

herpes infection 

1988-94 17.0% NA NA NA NA 11.0% NA NA 14.0% 

25-6 Reduce the proportion of females 

aged 15 to 44 years who have 

ever required treatment for 

pelvic inflammatory disease 

(PID) 

1995 8.0% NA NA NA NA 5.0% NA NA 5.0% 

25-7 Reduce the proportion of 

childless females with fertility 

problems who have had a 

sexually transmitted disease or 

who have required treatment for 

pelvic inflammatory disease 

(PID) 

1995 27.0% NA NA NA NA 22.0% NA NA 15.0% 

25-9 Reduce congenital syphilis (cases 

per 100,000 live births) 

1997 27.0 21.4 14.5 14.3 12.4 11.4 10.7 8.8 1.0 

HP 2010 Objective Data Source 

25-1 STD Surveillance System (STDSS), CDC, NCHSTP. 

25-2 STD Surveillance System (STDSS), CDC, NCHSTP. 

25-3 STD Surveillance System (STDSS), CDC, NCHSTP. 

25-4 National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. 

25-6 National Survey of Family Growth (NSFG), CDC, NCHS. 

25-7 National Survey of Family Growth (NSFG), CDC, NCHS. 

25-9 STD Surveillance System (STDSS), CDC, NCHSTP. 

*Overall positivity not adjusted for changes in laboratory test method and associated increases in test sensitivity.
 

NOTE: Healthy People 2010 developmental objectives are not addressed in this report.
 

NA=Not available.
 

STD Surveillance 2004 Appendix Healthy People 2010 149 
Table A4. Government Performance Results Act (GPRA) Sexually Transmitted Diseases Goals and Measures 

Annual Actual Long-Term 

GPRA Goals Baseline Target Performance Goal 

2002 2004 2004 2010 

Goal 1: Reduction in PID (as measured by initial visits to physicians in 

women 15-44 years of age) 197,000 163,000 132,000 168,000 

a. Prevalence of Chlamydia in high-risk women ≤ 25 years 10.1%* 9.1%* 9.7%* 8.6%* 

b. Prevalence of Chlamydia in women ≤ 25 years in family planning clinics 5.6%* 5.2%* 6.3%* 4.9%* 

c. Incidence of Gonorrhea/100,000 population in women 15-44 years of age 279 252 278 237 

Goal 2: Elimination of Syphilis (as measured by incidence of P&S 

Syphilis/100,000 population) 2.4 2.5 2.7 2.2 

a. Incidence of P&S Syphilis/100,000 population - men 3.8 4.5 4.7 4.2 

b. Incidence of P&S Syphilis/100,000 population - women 1.1 0.5 0.8 0.38 

c. Incidence of Congenital Syphilis/100,000 live births 10.2 5.4 8.8 3.9 

d. Black:white rate ratio of P&S Syphilis 8:1 3.5:1 5.6:1 3:1 

GPRA Goals Data Source 

1 National Disease and Therapeutic Index (IMS Health). 

1-a National Job Training Program. 

1-b STD Surveillance System (STDSS), CDC, NCHSTP. 

1-c STD Surveillance System (STDSS), CDC, NCHSTP. 

2 STD Surveillance System (STDSS), CDC, NCHSTP. 

2-a STD Surveillance System (STDSS), CDC, NCHSTP. 

2-b STD Surveillance System (STDSS), CDC, NCHSTP. 

2-c STD Surveillance System (STDSS), CDC, NCHSTP. 

2-d STD Surveillance System (STDSS), CDC, NCHSTP. 

*Median state-specific chlamydia prevalence among women was not adjusted for changes in laboratory test method and associated increases in test sensitivity. 

150 GPRA Goals Appendix STD Surveillance 2004 
STD Surveillance Case Definitions 

PART 1. CASE DEFINITIONS1 FOR NATIONALLY NOTIFIABLE INFECTIOUS DISEASES 

Chancroid (Revised 9/96) 

Clinical description

A sexually transmitted disease characterized by painful genital ulceration and inflammatory inguinal adenopathy. The disease is caused by infection with Haemophilus ducreyi. 

Laboratory criteria for diagnosis

• Isolation of H. ducreyi from a clinical specimen 

Case classification

Probable: a clinically compatible case with both a) no evidence of Treponema pallidum infection by 

darkfield microscopic examination of ulcer exudate or by a serologic test for syphilis performed ?7 

days after onset of ulcers and b) either a clinical presentation of the ulcer(s) not typical of disease 

caused by herpes simplex virus (HSV) or a culture negative for HSV. 

Confirmed: a clinically compatible case that is laboratory confirmed 

Chlamydia trachomatis, Genital Infections (Revised 9/96) 

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 

Gonorrhea (Revised 9/96) 

Clinical description

A sexually transmitted infection commonly manifested by urethritis, cervicitis, or salpingitis. 

Infection may be asymptomatic. 

Laboratory criteria for diagnosis

• Isolation of typical gram-negative, oxidase-positive diplococci (presumptive
 

Neisseria gonorrhoeae) from a clinical specimen, or
 

STD Surveillance 2004 Appendix STD Surveillance Case Definitions 151 
• Demonstration of N. gonorrhoeae in a clinical specimen by detection of antigen or

nucleic acid, or

• Observation of gram-negative intracellular diplococci in a urethral smear obtained

from a male

Case classification

Probable: a) demonstration of gram-negative intracellular diplococci in an endocervical smear obtained from a female or b) a written morbidity report of gonorrhea submitted by a physician

Confirmed: a case that is laboratory confirmed

Syphilis (All Definitions Revised 9/96)

Syphilis is a complex sexually transmitted disease that has a highly variable clinical course. Classification by a clinician with expertise in syphilis may take precedence over the following case definitions developed for surveillance purposes.

Syphilis, primary

Clinical description

A stage of infection with Treponema pallidum characterized by one or more chancres (ulcers);

chancres might differ considerably in clinical appearance.

Laboratory criteria for diagnosis

• Demonstration of T. pallidum in clinical specimens by darkfield microscopy, direct

fluorescent antibody (DFA-TP), or equivalent methods

Case classification

Probable: a clinically compatible case with one or more ulcers (chancres) consistent with primary

syphilis and a reactive serologic test (nontreponemal: Venereal Disease Research Laboratory

[VDRL] or rapid plasma reagin [RPR]; treponemal: fluorescent treponemal antibody absorbed

[FTA-ABS] or microhemagglutination assay for antibody to T. pallidum [MHA-TP])

Confirmed: a clinically compatible case that is laboratory confirmed

Syphilis, secondary

Clinical description

A stage of infection caused by T. pallidum and characterized by localized or diffuse

mucocutaneous lesions, often with generalized lymphadenopathy. The primary chancre may still

be present.

Laboratory criteria for diagnosis

• Demonstration of T. pallidum in clinical specimens by darkfield microscopy, DFATP,

or equivalent methods

Case classification

Probable: a clinically compatible case with a nontreponemal (VDRL or RPR) titer ≥4

Confirmed: a clinically compatible case that is laboratory confirmed

152 STD Surveillance Case Definitions Appendix STD Surveillance 2004
Syphilis, latent

Clinical description 

A stage of infection caused by T. pallidum in which organisms persist in the body of the infected 

person without causing symptoms or signs. Latent syphilis is subdivided into early, late, and unknown categories based on the duration of infection. 

Case classification 

Probable: no clinical signs or symptoms of syphilis and the presence of one of the following: 

• No past diagnosis of syphilis, a reactive nontreponemal test (i.e., VDRL or RPR), and 

a reactive treponemal test (i.e., FTA-ABS or MHA-TP) 

• A past history of syphilis therapy and a current nontreponemal test titer demonstrating 

fourfold or greater increase from the last nontreponemal test titer 

Syphilis, early latent

Clinical description 

A subcategory of latent syphilis. When initial infection has occurred within the previous 12 

months, latent syphilis is classified as early latent. 

Case classification 

Probable: latent syphilis (see Syphilis, latent) in a person who has evidence of having acquired the 

infection within the previous 12 months based on one or more of the following criteria: 

• Documented seroconversion or fourfold or greater increase in titer of a 

nontreponemal 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 who had confirmed or probable primary or 

secondary syphilis or probable early latent syphilis (documented independently as 

duration < 1 year) 

• Reactive nontreponemal and treponemal tests from a person whose only possible 

exposure occurred within the preceding 12 months 

Syphilis, late latent

Clinical description 

A subcategory of latent syphilis. When initial infection has occurred > 1 year previously, latent 

syphilis is classified as late latent. 

Case classification 

Probable: latent syphilis (see Syphilis, latent) in a patient who has no evidence of having acquired 

the disease within the preceding 12 months (see Syphilis, early latent) and whose age and titer do 

not meet the criteria specified for latent syphilis of unknown duration. 

Syphilis, latent, of unknown duration

Clinical description 

A subcategory of latent syphilis. When the date of initial infection cannot be established as having 

occurred within the previous year and the patient’s age and titer meet criteria described below, latent syphilis is classified as latent syphilis of unknown duration. 

STD Surveillance 2004 Appendix STD Surveillance Case Definitions 153 
Case classification

Probable: latent syphilis (see Syphilis, latent) that does not meet the criteria for early latent syphilis, and the patient is aged 13–35 years and has a nontreponemal titer 2: ≥ 32

Neurosyphilis

Clinical description

Evidence of central nervous system infection with T. pallidum

Laboratory criteria for diagnosis

• A reactive serologic test for syphilis and reactive VDRL in cerebrospinal fluid (CSF) 

Case classification

Case classification

Probable: syphilis of any stage, a negative VDRL in CSF, and both the following:

• Elevated CSF protein or leukocyte count in the absence of other known causes of 

these abnormalities

• Clinical symptoms or signs consistent with neurosyphilis without other known causes 

for these clinical abnormalities

Confirmed: syphilis of any stage that meets the laboratory criteria for neurosyphilis

Syphilis, late, with clinical manifestations other than neurosyphilis (late benign syphilis 

and cardiovascular syphilis)

Clinical description

Clinical manifestations of late syphilis other than neurosyphilis may include inflammatory lesions 

of the cardiovascular system, skin, and bone. Rarely, other structures (e.g., the upper and lower respiratory tracts, mouth, eye, abdominal organs, reproductive organs, lymph nodes, and skeletal 

muscle) may be involved. Late syphilis usually becomes clinically manifest only after a period of

15–30 years of untreated infection.

Laboratory criteria for diagnosis

Demonstration of T. pallidum in late lesions by fluorescent antibody or special stains (although organisms are rarely visualized in late lesions)

Case classification

Probable: characteristic abnormalities or lesions of the cardiovascular system, skin, bone, or 

other structures with a reactive treponemal test, in the absence of other known causes of these abnormalities, and without CSF abnormalities and clinical symptoms or signs consistent with 

neurosyphilis

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Analysis of CSF for evidence of neurosyphilis is necessary in the evaluation of late syphilis with 

clinical manifestations.

154 STD Surveillance Case Definitions Appendix STD Surveillance 2004
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 2004 Appendix STD Surveillance Case Definitions 155 
PART 2. CASE DEFINITIONS1 FOR NON-NOTIFIABLE INFECTIOUS DISEASES 

Genital Herpes (Herpes Simplex Virus) (Revised 9/96) 

Clinical description

A condition characterized by visible, painful genital or anal lesions 

Laboratory criteria for diagnosis

• 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. 

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. 

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. 

156 STD Surveillance Case Definitions Appendix STD Surveillance 2004 
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 

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 

Mucopurulent Cervicitis (Revised 9/96) 

Clinical description

Cervical inflammation that is not the result of infection with Neisseria gonorrhoeae or 

Trichomonas vaginalis. Cervical inflammation is defined by the presence of one of the following 

criteria: 

• Mucopurulent secretion (from the endocervix) that is yellow or green when viewed on
 

a white, cotton-tipped swab (positive swab test)
 

•	 Induced endocervical bleeding (bleeding when the first swab is placed in the 

endocervix) 

Laboratory criteria for diagnosis

• No evidence of N. gonorrhoeae by culture, Gram stain, or antigen or nucleic acid 

detection, and no evidence of T. vaginalis on wet mount 

Case classification

Confirmed: a clinically compatible case in a female who does not have either gonorrhea or 

trichomoniasis 

Comment

Mucopurulent cervicitis (MPC) is a clinical diagnosis of exclusion. The syndrome may result from 

infection with any of several agents (see Chlamydia trachomatis, Genital Infections). If gonorrhea, 

trichomoniasis, and chlamydia are excluded, a clinically compatible illness should be classified as 

STD Surveillance 2004 Appendix STD Surveillance Case Definitions 157 
MPC. An illness in a female that meets the case definition of MPC and C. trachomatis infection

should be classified as chlamydia.

Nongonococcal Urethritis (Revised 9/96)

Clinical description

Urethral inflammation that is not the result of infection with Neisseria gonorrhoeae. Urethral inflammation may be diagnosed by the presence of one of the following criteria:

• 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, Genital Infection). If gonorrhea and chlamydia are excluded, a clinically compatible illness should be classified as NGU. An illness in a male that meets the case definition of NGU and C. trachomatis infection should be

classified as chlamydia.

Pelvic Inflammatory Disease (Revised 9/96)

Clinical case definition

A clinical syndrome resulting from the ascending spread of microorganisms from the vagina and

endocervix to the endometrium, fallopian tubes, and/or contiguous structures. In a female who has

lower abdominal pain and who has not been diagnosed as having an established cause other than

pelvic inflammatory disease (PID) (e.g., ectopic pregnancy, acute appendicitis, and functional

pain), all the following clinical criteria must be present:

• Lower abdominal tenderness, and

• Tenderness with motion of the cervix, and

• Adnexal tenderness

In addition to the preceding criteria, at least one of the following findings must also be present:

• Meets the surveillance case definition of C. trachomatis infection or gonorrhea

• Temperature > 100.4 F (> 38.0 C)

• Leukocytosis > 10,000 white blood cells/mm3

• Purulent material in the peritoneal cavity obtained by culdocentesis or laparoscopy

158 STD Surveillance Case Definitions Appendix STD Surveillance 2004
• 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. 

1 Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health 

surveillance, 1997. MMWR 1997;46(No. RR-10;1). 

STD Surveillance 2004 Appendix STD Surveillance Case Definitions 159 
STD Project Directors, STD Program Managers, and State and Territorial Epidemiologists 

We gratefully acknowledge the contributions of state STD project directors, STD program managers, and state and territorial 

epidemiologists to this report. The persons listed were in the positions shown as of September 27, 2005. 

STD Project Directors STD Program Managers State Epidemiologists 

Alabama Charles H. Woernle Maxie Fleming John Lofgren 

Alaska Wendy Crator Donna Cecere Elizabeth (Beth) Funk 

Arizona Victorio Vaz Ashraf Lasee David Engelthaler 

Arkansas Mark Barnes Gary Horton Frank Wilson 

California Gail Bolan Romni Neiman Gilberto Chavez 

Los Angeles Peter Kerndt Mary Hayes Gilberto Chavez 

San Francisco Jeffrey Klausner Wendy Wolf Gilberto Chavez 

Colorado Maureen Bush Beth Dillon Ned Calonge 

Connecticut James L. Hadler Heidi Jenkins James L. Hadler 

Delaware James C. Welch Catherine Mosley Paula Eggers 

District of Columbia Karyn Berry John Heath John Davies-Cole 

Florida Landis Crockett Karla Schmitt David Johnson (Acting) 

Georgia Stuart Brown Linda Smart-Smith Susan Lance 

Hawaii Peter Whiticar Roy Ohye Paul Effler 

Idaho Karl Kurtz Anne Williamson Christine G. Hahn 

Illinois Charlie Rabins Ed Renier Mark Dworkin 

Chicago Lora Branch Dawn Broussard Mark Dworkin 

Indiana Michael Butler Jim Beall Robert Teclaw 

Iowa Karen Thompson Jim Goodrich Patricia Quinlisk 

Kansas Sharon Patnode R. Allen Mayer Gail Hansen 

Kentucky Barry Wainscott David Raines Kraig Humbaugh 

Louisiana Lisa Ann Longfellow Lisa Ann Longfellow Raoult Ratard 

Maine Bob Woods Bethany Sanborn Kathleen F. Gensheimer 

Maryland Vacant Scott Tulloch David Blythe 

Baltimore Pierre Vigilance Glen Oltoff David Blythe 

Massachusetts Thomas Bertrand Thomas Bertrand Alfred DeMaria 

Michigan Loretta Davis-Satterla Mark A. Miller Corrine Miller (Acting) 

Minnesota Julia Ashley Julia Ashley Harry Hull 

Mississippi Craig Thompson Craig Thompson Mills McNeill 

Missouri Herbert Michael Nyla DeArmitt Bao-Ping Zhu 

Montana Vacant Laurie Kops Todd A. Damrow 

Nebraska Phil Medina Phil Medina Thomas J. Safranek 

Nevada Richard Whitley Christine Lovass-Nagy Bradford Lee (Acting) 

New Hampshire Heather Hauck Drew Thomits Jose Montero 

New Jersey Janet DeGraaf Jerry Carolina Eddy A. Bresnitz 

New Mexico Dorothy Danfelser Donald Torres C. Mack Sewell 

New York F. Bruce Coles F. Bruce Coles Perry F. Smith 

New York City Susan Blank Steve Rubin Marcelle Layton 

North Carolina Evelyn M. Foust Evelyn M. Foust Jeffrey Engel 

North Dakota Kimberly Weis Kimberly Weis Kirby Kruger 

Ohio Jeff Vasiloff Timothy Bahns Forrest W. Smith 

Oklahoma Michael Harmon Mark Turner Brett Cauthen 

Oregon Vada Latin Doug Harger Melvin Kohn 

Pennsylvania Weston Ruhrig Steve Kowalewski Veronica Urdaneta 

Philadelphia Caroline Johnson Martin Goldberg Veronica Urdaneta (Acting) 

Rhode Island Utpala Bandy Michael Gosciminski Utpala Bandy 

South Carolina Lynda Kettinger Robert Ray James J. Gibson 

South Dakota Laurie Gill David Morgan Lon Kightlinger 

Tennessee Vacant Robert Burke Allen Craig 

Texas Janna Zumbrun Jim Lee Thomas Betz (Acting) 

Utah Teresa Garrett Tim Lane Robert T. Rolfs 

Vermont Marilyn Richards Marilyn Richards Cortland Lohff 

Virginia Casey Riley Casey Riley Carl Armstrong 

Washington Larry Klopfenstein Larry Klopfenstein Jo Hofmann 

West Virginia Loretta E. Haddy Margaret Taylor Loretta E. Haddy 

Wisconsin Akan Ukoeninn Anthony Wade Jeffrey Davis 

Wyoming Sharon Renter Alexander Bowler Tracy Murphy 

American Samoa Vacant Tai Ripley Joseph Tufa 

Federated States of 

Micronesia Nena S. Nena Louisa Helgenberger Eliuel Preprick 

Government of the 

Marshall Islands Justina Langidrik Zachraias Zachraias Helen Jetnil 

Guam Josie O'Mallan Bernadette Schumann Robert L. Haddock 

Puerto Rico Vacant Luis Chiroque Francisco Alvarado-Ramy 

Republic of Palau Stevenson Kuartei Johana Ngiruchelbad Julie Erb-Alvarez 

Virgin Islands Darlene Carty Taetia Phillips-Dorsett Mavis Matthew 

160 Contributors Appendix STD Surveillance 2004