Sexually

Transmitted

Disease

Surveillance

2008

Division of STD Prevention

November 2009

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention 

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

Division of STD Prevention

Atlanta, Georgia 30333
ii STD Surveillance 2008

Acknowledgments

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

Health Departments, the Sexually Transmitted Disease Control Programs, the Regional Infertility Prevention 

Projects, and Public Health Laboratories. We also acknowledge the contributions of staff within the Division 

of STD Prevention, the Statistics and Data Management Branch and the Epidemiology and Surveillance 

Branch.
STD Surveillance 2008 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, 2008. Atlanta, GA: U.S. 

Department of Health and Human Services; November 2009.

Printed copies and the on-line version of this report can be obtained at the following web site: http://www.

cdc.gov/std/pubs/

Selected STD Surveillance and Prevention References and Websites

STD Surveillance Reports 1993–2008

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

STD Data on Wonder

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

STD Data Management & Information Technology

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

STD Fact Sheets

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

STD Treatment Guidelines

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

STD Program Evaluation Guidelines

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

STD Program Operation Guidelines

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

Recommendations for Public Health Surveillance of Syphilis in the United States

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5233a7.htm

Behavioral Surveillance

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

National Survey of Family Growth: Advance Data 362. Sexual Behavior and Selected Health Measures: Men 

and Women 15–44 Years of Age, United States, 2002. 56 pp. (PHS) 2003–1250: http://www.cdc.gov/nchs/

products/pubs/pubd/ad/361–370/ad362.htm

STD Surveillance 2008 v

Foreword

“STDs are hidden epidemics of enormous health and 

economic consequence in the United States. They 

are hidden because many Americans are reluctant 

to address sexual health issues in an open way and 

because of the biologic and social characteristics of 

these diseases. All Americans have an interest in STD 

prevention because all communities are impacted 

by STDs and all individuals directly or indirectly 

pay for the costs of these diseases. STDs are public 

health problems that lack easy solutions because 

they are rooted in human behavior and fundamental 

societal problems. 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.
vi STD Surveillance 2008

Preface

Sexually Transmitted Disease Surveillance, 2008

presents statistics and trends for sexually transmitted 

diseases (STDs) in the United States through 2008. 

This annual publication is intended as a reference 

document for policy makers, program managers, 

health planners, researchers, and others who are 

concerned with the public health implications of 

these diseases. The figures and tables in this edition 

supersede those in earlier publications of these 

data.

The surveillance information in this report is based 

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

reporting from state and local STD programs; (2) 

projects that monitor STD prevalence in various 

settings including; the Regional Infertility Prevention 

Projects (IPP); the National Job Training Program; 

the Indian Health Service; the Men Who Have Sex 

With Men (MSM) Prevalence Monitoring Project; 

the Gonococcal Isolate Surveillance Project (GISP); 

and (3) national surveys implemented by federal and 

private organizations.

The STD surveillance systems operated by state and 

local STD control programs, which provide the case 

report data for chlamydia, gonorrhea, syphilis, and 

chancroid are the data sources of many of the figures 

and most of the statistical tables in this publication. 

These systems are an integral part of program 

management at all levels of STD prevention and 

control in the United States. Because of incomplete 

diagnosis and reporting, the number of STD cases 

reported to the Centers for Disease Control and 

Prevention (CDC) is less than the actual number 

of cases occurring in the United States population. 

National summary data of case reports for other 

STDs are not available because they are not nationally 

notifiable diseases.

Sexually Transmitted Disease Surveillance, 2008

consists of four parts: (1) 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. (2) 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. (3) The Detailed Tables provide 

statistical information about STDs at the county, 

metropolitan statistical area (MSA), regional, state, 

and national levels. (4) The Appendix (Interpreting 

STD Surveillance Data) includes information 

on interpreting the STD surveillance data used to 

produce this report; Healthy People 2010 (HP2010) 

STD objectives and progress toward meeting them; 

Government Performance and Results Act (GPRA) 

goals and progress toward meeting them; and STD 

surveillance case definitions.

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/AIDS, Viral Hepatitis, 

STD, and TB Prevention

Centers for Disease Control and Prevention

1600 Clifton Road, Mailstop E-02

Atlanta, Georgia, 30333
STD Surveillance 2008 vii

Guide to Acronyms

Add Health National Longitudinal Study of Adolescent Health

CDC Centers for Disease Control and Prevention

CSF Cerebrospinal Fluid 

DHHS Department of Health and Human Services

DSTDP Division of STD Prevention

GISP Gonococcal Isolate Surveillance Project 

GPRA Government Performance and Results Act 

HEDIS Healthcare Effectiveness Data and Information Set

HIV Human Immunodeficiency Virus 

HP2010 Healthy People 2010 

HPV Human Papillomavirus

HSV Herpes Simplex Virus

IPP Infertility Prevention Project

MICs Minimum Inhibitory Concentrations

MMWR Morbidity and Mortality Weekly Report

MPC Mucopurulent Cervicitis 

MSA Metropolitan Statistical Area

MSM Men Who Have Sex With Men

NAATs Nucleic Acid Amplification Tests 

NDTI National Disease and Therapeutic Index 

NGU Nongonococcal Urethritis 

NHANES National Health and Nutrition Examination Survey 

NHDS National Hospital Discharge Survey

OMB Office of Management and Budget

P&S Primary and Secondary 

PID Pelvic Inflammatory Disease 

QRNG Quinolone-resistant Neisseria gonorrhoeae

RPR Rapid Plasma Reagin 

STD Sexually Transmitted Disease

VDRL Venereal Disease Research Laboratory

STD Surveillance 2008 ix

Contents

Acknowledgments .......................................................................................................................................... ii

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

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

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

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

Figures in the Special Focus Profiles...............................................................................................................xii

Tables in the National Profile ....................................................................................................................... xiv

Census Regions of the United States............................................................................................................ xvii

National Overview of Sexually Transmitted Diseases (STDs), 2008.................................................................1

National Profile

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

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

Gonorrhea .............................................................................................................................................17

Syphilis..................................................................................................................................................31

Other Sexually Transmitted Diseases (STDs).........................................................................................43

Special Focus Profiles

Introduction..........................................................................................................................................49

STDs in Women and Infants.................................................................................................................51

STDs in Adolescents and Young Adults.................................................................................................59

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

STDs in Men Who Have Sex with Men (MSM) ...................................................................................73

STDs in Persons Entering Corrections Facilities ....................................................................................81

Tables

National Summary ................................................................................................................................85

Chlamydia.............................................................................................................................................87

Gonorrhea .............................................................................................................................................98

Syphilis................................................................................................................................................110

Chancroid ...........................................................................................................................................131

Selected STDs .....................................................................................................................................132

Appendix

Interpreting STD Surveillance Data ....................................................................................................133

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

selected variables by state and by nationally notifiable STD, 2008.................................. 140

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

United States, 2008........................................................................................................ 141

Table A3. Healthy People 2010 Sexually Transmitted Diseases Objective Status............................. 142

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

Diseases Goals and Measures.......................................................................................... 143

STD Surveillance Case Definitions......................................................................................................145

Contributors........................................................................................................................................154
x STD Surveillance 2008

Figures in the National Profile

Chlamydia

Figure 1. Chlamydia—Rates: Total and by sex: United States, 1989–2008...................................... 10

Figure 2. Chlamydia—Rates by region: United States, 1999–2008 ................................................. 10

Figure 3. Chlamydia—Rates by state: United States and outlying areas, 2008................................. 11

Figure 4. Chlamydia—Rates by county: United States, 2008 .......................................................... 11

Figure 5. Chlamydia—Age- and sex-specific rates: United States, 2008........................................... 12

Figure 6. Chlamydia—Rates by race/ethnicity: United States, 1999–2008...................................... 12

Figure 7. Chlamydia—Cases by reporting source and sex: United States, 1999–2008 ..................... 13

Figure 8. Chlamydia—Prevalence by age group and race/ethnicity from 

a national survey, 1999–2002........................................................................................... 13

Figure 9. Chlamydia—Median state-specific positivity among 15- to 24-year-old 

women tested in family planning clinics: United States, 1997–2008 ................................ 14

Figure 10. Chlamydia—Positivity among 15- to 24-year-old women tested in 

family planning clinics by state: United States and outlying areas, 2008 ........................... 14

Figure 11. Chlamydia—Trends in positivity among 15- to 24-year-old women 

tested in family planning clinics by HHS region, 2004–2008........................................... 15

Figure 12. Chlamydia—Percent of tests that were nucleic acid amplification 

tests (NAATs) in family planning clinics among 15- to 24-year-old women 

by DHHS region, 2004–2008.......................................................................................... 15

Gonorrhea

Figure 13. Gonorrhea—Rates: United States, 1941–2008................................................................. 22

Figure 14. Gonorrhea—Rates: Total and by sex: United States, 1989–2008...................................... 22

Figure 15. Gonorrhea—Rates by region: United States, 1999–2008 ................................................. 23

Figure 16. Gonorrhea—Rates by state: United States and outlying areas, 2008 ................................. 23

Figure 17. Gonorrhea—Rates by county: United States, 2008 .......................................................... 24

Figure 18. Gonorrhea—Age- and sex-specific rates: United States, 2008........................................... 24

Figure 19. Gonorrhea—Age-specific rates among women 15 to 44 years of age:

United States, 1999–2008................................................................................................ 25

Figure 20. Gonorrhea—Age-specific rates among men 15 to 44 years of age:

United States, 1999–2008................................................................................................ 25

Figure 21. Gonorrhea—Rates by race/ethnicity: United States, 1999–2008...................................... 26

Figure 22. Gonorrhea—Cases by reporting source and sex: United States, 1999–2008 ..................... 26

Figure 23. Gonorrhea—Positivity among 15- to 24-year-old women tested in 

family planning clinics by state: United States and outlying areas, 2008 ........................... 27

Figure 24. Gonococcal Isolate Surveillance Project (GISP)—Location of participating 

sentinel sites and regional laboratories in the United States, 2008..................................... 27

Figure 25. Gonococcal Isolate Surveillance Project (GISP)—Distribution of MICs 

to ceftriaxone among GISP isolates, 2004–2008 .............................................................. 28

Figure 26. Gonococcal Isolate Surveillance Project (GISP)—Distribution of MICs 

to azithromycin among GISP isolates, 2004–2008 ........................................................... 28

Figure 27. Gonococcal Isolate Surveillance Project (GISP)—Percent of 

Neisseria gonorrhoeae isolates with resistance or intermediate

resistance to ciprofloxacin, 1990–2008............................................................................. 29
STD Surveillance 2008 xi

Figure 28. Gonococcal Isolate Surveillance Project (GISP)—Penicillin, tetracycline, 

and ciprofloxacin resistance among GISP isolates, 2008 ................................................... 29

Figure 29. Gonococcal Isolate Surveillance Project (GISP)—Drugs used to 

treat gonorrhea in GISP patients, 1988–2008 .................................................................. 30

Syphilis

Figure 30. Syphilis—Reported cases by stage of infection: United States, 1941–2008 ....................... 35

Figure 31. Primary and secondary syphilis—Rates: Total and by sex and 

male-to-female rate ratios: United States, 1989–2008....................................................... 35

Figure 32. Primary and secondary syphilis—Rates by region: United States, 1999–2008 .................. 36

Figure 33. Primary and secondary syphilis—Rates by state: United States and 

outlying areas, 2008 ......................................................................................................... 36

Figure 34. Primary and secondary syphilis—Rates by county: United States, 2008 ........................... 37

Figure 35. Primary and secondary syphilis—Age- and sex-specific rates: 

United States, 2008.......................................................................................................... 37

Figure 36. Primary and secondary syphilis—Age-specific rates among 

women 15 to 44 years of age: United States, 1999–2008.................................................. 38

Figure 37. Primary and secondary syphilis—Age-specific rates among 

men 15 to 44 years of age: United States, 1999–2008 ...................................................... 38

Figure 38. Primary and secondary syphilis—Rates by race/ethnicity: 

United States, 1999–2008................................................................................................ 39

Figure 39. Primary and secondary syphilis—Reported cases by stage and 

sexual orientation, 2008 ................................................................................................... 39

Figure 40. Primary and secondary syphilis—Reported cases by sexual orientation 

and race/ethnicity, 2008 ................................................................................................... 40

Figure 41. Primary and secondary syphilis—Reported cases by 

reporting source and sex: United States, 1999–2008 ........................................................ 40

Figure 42. Primary and secondary syphilis—Percentage of reported cases 

by sexual orientation and selected reporting sources, 2008 ............................................... 41

Figure 43. Congenital syphilis (CS)—Reported cases for infants <1 year of age 

and rates of primary and secondary syphilis among women: 

United States, 1999–2008................................................................................................ 41

Other Sexually Transmitted Diseases

Figure 44. Chancroid—Reported cases: United States, 1981–2008................................................... 45

Figure 45. Human papillomavirus (HPV)—Prevalence of high-risk and 

low-risk types among females 14 to 59 years of age 

from a national survey, 2003–2004 .................................................................................. 45

Figure 46. Genital warts—Initial visits to physicians’ offices: United States, 1966–2008 .................. 46

Figure 47. Genital herpes—Initial visits to physicians’ offices: United States, 1966–2008 ................. 46

Figure 48. Genital herpes—Herpes simplex virus, type 2, seroprevalence 

in non-Hispanic whites and non-Hispanic blacks by age group 

from national surveys, 1976–1980, 1988–1994, 1999–2004 .......................................... 47

Figure 49. Trichomoniasis and other vaginal infections in women—Initial visits to 

physicians’ offices: United States, 1966–2008................................................................... 48
xii STD Surveillance 2008

Figures in the Special Focus Profiles

STDs in Women and Infants

Figure A. Chlamydia—Rates among women by state: United States and outlying areas, 2008......... 54

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

clinics by state: United States and outlying areas, 2008..................................................... 54

Figure C. Gonorrhea—Rates among women by state: United States and outlying areas, 2008 ......... 55

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

clinics by state: United States and outlying areas, 2008..................................................... 55

Figure E. Primary and secondary syphilis—Rates among women by state: 

United States and outlying areas, 2008............................................................................. 56

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

United States and outlying areas, 2008............................................................................. 56

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

of age: United States, 1997–2006..................................................................................... 57

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

15 to 44 years of age: United States, 1999–2008 .............................................................. 57

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

United States, 1997–2006................................................................................................ 58

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 DHHS region, 2004–2008 ....................................... 61

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

the National Job Training Program by state of residence: 

United States and outlying areas, 2008............................................................................. 61

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

National Job Training Program by state of residence: 

United States and outlying areas, 2008............................................................................. 62

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

the National Job Training Program by state of residence: 

United States and outlying areas, 2008............................................................................. 62

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

the National Job Training Program by state of residence: 

United States and outlying areas, 2008............................................................................. 63

STDs in Racial and Ethnic Minorities

Figure O. Chlamydia—Rates by race/ethnicity and sex: United States, 2008 ................................... 68

Figure P. Gonorrhea—Rate ratios by race/ethnicity: United States, 1999–2008.............................. 68

Figure Q. Gonorrhea—Rates by race/ethnicity and sex: United States, 2008.................................... 69

Figure R. Gonorrhea—Rate ratios by race/ethnicity and region: United States, 2008 ...................... 69

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

United States, 2008.......................................................................................................... 70

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

by race/ethnicity: United States, 1999–2008 .................................................................... 70

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

by race/ethnicity: United States, 1999–2008 .................................................................... 71
STD Surveillance 2008 xiii

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

by mother’s race/ethnicity: United States, 1999–2008...................................................... 71

STDs in Men Who Have Sex with Men

Figure W. MSM Prevalence Monitoring Project—Number of gonorrhea tests and 

number of positive tests in men who have sex with men, 

STD clinics, 1999–2008 ................................................................................................. 76

Figure X. MSM Prevalence Monitoring Project—Syphilis serologic reactivity 

among men who have sex with men, STD clinics, 1999–2008......................................... 77

Figure Y. MSM Prevalence Monitoring Project—Clinic-specific median number 

of HIV tests and positivity among men who have sex with men,

STD clinics, 1999–2008 .................................................................................................. 78

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

chlamydia, and HIV and seroreactivity to syphilis among men who 

have sex with men, by race/ethnicity, STD clinics, 2008 .................................................. 78

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

urethral Neisseria gonorrhoeae isolates obtained from men who 

have sex with men attending STD clinics, 1989–2008 ..................................................... 79

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

urethral Neisseria gonorrhoeae isolates obtained from men who 

have sex with men attending STD clinics by GISP site, 2005–2008................................. 79

STDs in Persons Entering Corrections Facilities

Figure CC. Chlamydia—Positivity by age and sex, juvenile corrections facilities, 2008....................... 83

Figure DD. Chlamydia—Positivity by age group and sex, adult corrections facilities, 2008................. 83

Figure EE. Gonorrhea—Positivity by age and sex, juvenile corrections facilities, 2008....................... 84

Figure FF. Gonorrhea—Positivity by age group and sex, adult corrections facilities, 2008................. 84
xiv STD Surveillance 2008

Tables in the National Profile

National Summary

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

and rates per 100,000 population: United States, 1941–2008 .......................................... 85

Chlamydia

Table 2. Chlamydia—Reported cases and rates by state, ranked by rates: United States, 2008 ....... 87

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

alphabetical order: United States and outlying areas, 2004–2008 ..................................... 88

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

listed in alphabetical order: United States and outlying areas, 2004–2008 ........................ 89

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

listed in alphabetical order: United States and outlying areas, 2004–2008 ........................ 90

Table 6. Chlamydia—Reported cases and rates in selected metropolitan statistical 

areas (MSAs) listed in alphabetical order: United States, 2004–2008................................ 91

Table 7. Chlamydia—Women—Reported cases and rates in selected metropolitan 

statistical areas (MSAs) listed in alphabetical order: United States, 2004–2008................. 92

Table 8. Chlamydia—Men—Reported cases and rates in selected metropolitan 

statistical areas (MSAs) listed in alphabetical order: United States, 2004–2008................. 93

Table 9. Chlamydia—Counties and independent cities ranked by number of 

reported cases: United States, 2008 .................................................................................. 94

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

group and sex: United States, 2004–2008 ........................................................................ 95

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

United States, 2004–2008................................................................................................ 96

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

age group and sex: United States, 2004–2008 .................................................................. 97

Gonorrhea

Table 12. Gonorrhea—Reported cases and rates by state, ranked by rates: United States, 2008........ 98

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

listed in alphabetical order: United States and outlying areas, 2004–2008 ........................ 99

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

and region listed in alphabetical order: United States and outlying areas, 2004–2008..... 100

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

region listed in alphabetical order: United States and outlying areas, 2004–2008 ........... 101

Table 16. Gonorrhea—Reported cases and rates in selected metropolitan 

statistical areas (MSAs) listed in alphabetical order: United States, 2004–2008............... 102

Table 17. Gonorrhea—Women—Reported cases and rates in selected metropolitan 

statistical areas (MSAs) listed in alphabetical order: United States, 2004–2008............... 103

Table 18. Gonorrhea—Men—Reported cases and rates in selected metropolitan 

statistical areas (MSAs) listed in alphabetical order: United States, 2004–2008............... 104

Table 19. Gonorrhea—Counties and independent cities ranked by number of 

reported cases: United States, 2008 ................................................................................ 105

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

age group and sex: United States, 2004–2008 ................................................................ 106
STD Surveillance 2008 xv

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

United States, 2004–2008.............................................................................................. 108

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

age group and sex: United States, 2004–2008 ................................................................ 109

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, 2004–2008 ........... 110

Table 23. All Stages of Syphilis—Reported cases and rates in selected metropolitan 

statistical areas (MSAs) listed in alphabetical order: United States, 2004–2008............... 111

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

ranked by rates: United States, 2008............................................................................... 112

Table 25. Primary and secondary syphilis—Reported cases and rates by state/area and 

region listed in alphabetical order: United States and outlying areas, 2004–2008 ........... 113

Table 26. Primary and secondary syphilis—Women—Reported cases and 

rates by state/area and region listed in alphabetical order: 

United States and outlying areas, 2004–2008................................................................. 114

Table 27. Primary and secondary syphilis—Men—Reported cases and 

rates by state/area and region listed in alphabetical order: 

United States and outlying areas, 2004–2008................................................................. 115

Table 28. Primary and secondary syphilis—Reported cases and rates in selected metropolitan

statistical areas (MSAs) listed in alphabetical order: United States, 2004–2008............... 116

Table 29. Primary and secondary syphilis—Women—Reported cases and 

rates in selected metropolitan statistical areas (MSAs) listed in 

alphabetical order: United States, 2004–2008 ................................................................ 117

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

selected metropolitan statistical areas (MSAs) listed in alphabetical order: 

United States, 2004–2008.............................................................................................. 118

Table 31. Primary and secondary syphilis—Counties and independent cities 

ranked by number of reported cases: United States, 2008............................................... 119

Table 32. Primary and secondary syphilis—Reported cases and rates among men and 

women and male-to-female rate ratios in the counties and independent 

cities ranked in the top 30 for cases in 2008: United States, 2007–2008 ........................ 120

Table 33. Primary and secondary syphilis—Reported cases and rates 

per 100,000 population by age group and sex: United States, 2004–2008...................... 121

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

age group and sex: United States, 2004–2008 ................................................................ 122

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

by race/ethnicity, age group and sex: United States, 2004–2008..................................... 123

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

region listed in alphabetical order: United States and outlying areas, 2004–2008 ........... 124

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

statistical areas (MSAs) listed in alphabetical order: United States, 2004–2008............... 125

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, 2004–2008 ........... 126

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

statistical areas (MSAs) listed in alphabetical order: United States, 2004–2008............... 127

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

by state, ranked by rates: United States, 2008................................................................. 128
xvi STD Surveillance 2008

Table 40. 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, 2004–2008................................................................. 129

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

by race/ethnicity of mother: United States, 2004–2008.................................................. 130

Chancroid

Table 42. Chancroid—Reported cases and rates by state/area listed in alphabetical order: 

United States and outlying areas, 2004–2008................................................................. 131

Selected STDs

Table 43. Selected STDs and complications—Initial visits to physicians' offices, 

National Disease and Therapeutic Index: United States, 1966–2008 .............................. 132

Interpreting STD Surveillance Data

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

selected variables by state and by nationally notifiable STD, 2008.................................. 140

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

United States, 2008........................................................................................................ 141

Table A3. Healthy People 2010 Sexually Transmitted Diseases Objective Status............................. 142

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

Diseases Goals and Measures.......................................................................................... 143
STD Surveillance 2008 xvii

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

Census Regions of the United States

West Midwest Northeast

South

STD Surveillance 2008 Overview 1

National Overview of Sexually 

Transmitted Diseases (STDs), 2008

Organized collaboration among interested, 

committed public and private organizations and 

communities is the key to reducing STDs and their 

related health burdens. As noted in the report of 

the Institute of Medicine, The Hidden Epidemic: 

Confronting Sexually Transmitted Diseases1 surveillance 

is a key component of our efforts to prevent and 

control these diseases.

This overview summarizes national surveillance 

data on the three notifiable diseases for which there 

are federally-funded control programs: chlamydia, 

gonorrhea, and syphilis. Several observations for 2008 

are worthy of note.

Chlamydia

In 2008, 1,210,523 cases of sexually transmitted 

Chlamydia trachomatis infection were reported to 

CDC (Table 1). This is the largest number of cases 

ever reported to CDC for any condition. This 

case count corresponds to a rate of 401.3 cases per 

100,000 population, an increase of 9.2% compared 

with the rate in 2007. Rates of reported chlamydial 

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 (PID) 

and related complications. In 2008, the chlamydia 

rate in black men was 12 times higher than that in 

white men; the chlamydia rate in black women was 

eight times higher than that in white women.

The continued increase in chlamydia case reports in 

2008 most likely represents a continued increase in 

screening for this infection, more sensitive tests, and 

more complete national reporting but it may also 

reflect a true increase in morbidity.

In 2008, the overall rate of chlamydial infection 

in the United States among women (583.8 cases 

per 100,000 females) was almost three times the 

rate among men (211.1 cases per 100,000 males), 

reflecting the large number of women screened 

for this disease (Tables 4 and 5). However, with 

the increased availability of urine testing, men are 

increasingly being tested for chlamydial infection. 

From 2004 through 2008, the chlamydia rate in men 

increased by 45% (compared with a 21.5% increase 

in women over this period).

Data from multiple sources on prevalence of 

chlamydial infection in defined populations have 

been useful in monitoring disease burden and guiding 

chlamydia screening programs.

In 2008, 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 

50 states, the District of Columbia, Puerto Rico, and 

the Virgin Islands was 7.4% (range: 3.1% to 15.0%) 

(Figures 9 and 10).

At selected prenatal clinics in 22 states, Puerto Rico, 

and the Virgin Islands the median state-specific 

chlamydia positivity was 7.9% (range: 1.8% to 

19.2%) (Figure B).

The prevalence of infection is greater among 

economically-disadvantaged women 16 to 24 years of 

age who entered the National Job Training Program 

in 2008 from 39 states, the District of Columbia, and 

Puerto Rico. The median state-specific prevalence was 

12.8% (range: 5.4% to 20.8%) (Figure K). Among 

men entering the program in 2008 from 48 states, the 

District of Columbia, and Puerto Rico the median 

state-specific chlamydia prevalence was 7.0% (range: 

0.8% to 14.4%) (Figure L).

Gonorrhea

Following a 74% decline in the rate of reported 

gonorrhea from 1975 to 1997, overall gonorrhea rates 

have plateaued over the past eleven years. In 2008, 

336,742 cases of gonorrhea were reported in the 

United States, corresponding to a rate of 111.6 cases 
2 Overview STD Surveillance 2008

per 100,000 population, decreased from the rate in 

2007 of 118.9 cases (Figure 13 and Table 1). 

As in previous years, in 2008 the South had the 

highest gonorrhea rate among the four regions of the 

country (Table 13). Although the gonorrhea rate in 

the South declined for many years, it increased by 

11% between 2005 and 2006 and has continued at 

that slightly elevated plateau through 2008. The rate 

in the West decreased slightly in 2007 and again in 

2008 after a 29% increase between 2003 and 2006. 

While rates decreased in the Northeast and Midwest 

from 2007 to 2008, they have remained relatively 

stable over the past 10 years (Figure 15).

From 1996 to 2008 the rate of gonorrhea has been 

similar in men and women (Figure 14). In 2008 the 

gonorrhea rate in women was 119.4 per 100,000 

population compared to a rate of 103.0 per 100,000 

population in men (Figure 14). As with chlamydia, 

gonorrhea rates in women are highest in the 15 to 24 

year age group. In men, they are highest in the 20 to 

24 year age group (Figure 18). In 2008, the gonorrhea 

rate in black men was 28 times higher than that in 

white men; the gonorrhea rate in black women was 

16 times higher than that in white women.

As with chlamydia in 2008, 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 

parts of the United States.

In 2008, the median state-specific gonorrhea test 

positivity among 15- to 24-year-old women screened 

in selected family planning clinics in 43 states, the 

District of Columbia, Puerto Rico, and the Virgin 

Islands was 0.9% (range: 0.0% to 3.8%) (Figure 23). 

In 2008, the median state-specific gonorrhea test 

positivity among 15- to 24-year-old women screened 

in selected prenatal clinics in 20 states, Puerto Rico, 

and the Virgin Islands was 1.0% (range: 0.0% to 

5.0%) (Figure D).

For 16- to 24-year-old women entering the National 

Job Training Program in 37 states, the District of 

Columbia, and Puerto Rico in 2008, the median 

state-specific gonorrhea prevalence was 2.7% (range: 

0.0% to 5.0%) (Figure M).

Among men entering the program from 34 states, the 

District of Columbia, and Puerto Rico, the median 

state-specific gonorrhea prevalence was 0.8% (range: 

0.0% to 2.8%) (Figure N).

Among women entering juvenile corrections facilities 

the median gonorrhea positivity was 3.6% (range: 

0.0% to 19.0%); the median gonorrhea positivity for 

men entering juvenile corrections facilities was 0.9% 

(range: 0.0% to 4.4%).

Among MSM, including men who have sex with 

both women and men, attending eight STD clinics, 

the median clinic urethral gonorrhea positivity was 

8.0% (range: 4.0% to 12.0%).

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, which was announced by the Surgeon 

General in 1999 and updated in 2006.2 The rate of 

P&S syphilis in the United States declined 89.7% 

between 1990 and 2000. However, the rate of P&S 

syphilis has increased each year since 2001, mostly 

in men, but also in women for the past four years. In 

2008, 13,500 cases of P&S syphilis were reported to 

CDC. This is the highest number of cases since 1995 

and corresponds to a rate of 4.5 cases per 100,000 

population, an 18% increase from 2007. Since 2004, 

the rate of P&S syphilis has increased 67%. After 

14 years of decline, the rate of congenital syphilis 

increased in 2006 and 2007. There were 431 cases 

of congenital syphilis reported in 2008, the same 

number reported in 2007.

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 ten years. The P&S syphilis rate for 2008 in 

blacks was eight times the rate in whites, which is 

substantially lower than the disparity observed in 

1999, when the rate among blacks was 29 times 

greater than that among whites (Table 34B). 
STD Surveillance 2008 Overview 3

However, since 2003, increases in syphilis among 

blacks have been higher than increases among whites, 

reversing some of the gains made in this health 

disparity. In 2008, increases were observed among 

both black men (28.0 cases per 100,000 population, 

up from 22.9 in 2007) and black women (7.6 cases 

per 100,000 population, up from 5.5 in 2007). 

Much smaller increases were observed among white 

men (4.0 cases per 100,000 population, up from 

3.7 in 2007) and white women (0.5 per 100,000 

population, up from 0.4 per 100,000 in 2007).

While syphilis elimination efforts2 initially focused on 

minority populations in general, increases in syphilis 

among MSM of all races and ethnicities since 2001 

and more recent increases among women and blacks 

highlight the importance of continually reassessing 

and refining surveillance, prevention, and control 

strategies.

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 Division of STD Prevention. The National Plan to Eliminate 

Syphilis from the United States. National Center for HIV/AIDS, 

Viral Hepatitis, STD, and TB Prevention, Centers for Disease 

Control and Prevention, 2006.

NATIONAL PROFILE
NATIONAL PROFILE
STD Surveillance 2008 National Profile 5

National Profile

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

STDs (chlamydia, gonorrhea, syphilis and chancroid) by age, sex, race/ethnicity, and location for the United 

States.

STD Surveillance 2008 National Profile: Chlamydia 7

Chlamydia

Background

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). 

Recent studies also demonstrate the high prevalence 

of chlamydial infections in the general U.S. 

population. Among young adults (18–26 years of age) 

participating in the nationally-representative National 

Longitudinal Study of Adolescent Health (Add 

Health) from 2001 to 2002, chlamydia prevalence 

was 4.2%.1

Chlamydial infections are usually asymptomatic 

and, in women, may result in 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 

suggested that screening programs can lead to a 

reduction in the incidence of PID by as much as 

60%.2 As with other inflammatory STDs, chlamydial 

infection can facilitate the transmission of Human 

Immunodeficiency Virus (HIV) infection.3 In 

addition, pregnant women infected with chlamydia 

can pass the infection to their infants during 

delivery, potentially resulting in neonatal ophthalmia 

and pneumonia. Because of the large burden of 

disease and risks associated with infection, CDC 

recommends annual chlamydia screening of all 

sexually active women younger than 26 years of age.4

The increase in reported chlamydial infections 

during the last 20 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 

limited resources available to support screening. 

Chlamydia screening and reporting are likely to 

continue to expand further in response to the 

Healthcare Effectiveness Data and Information 

Set (HEDIS) annual measure assessing chlamydia 

screening coverage of sexually active young women 

who receive medical care through commercial or 

Medicaid managed care organizations.5 Among 

sexually active female enrollees aged 16-25 years 

(aged 16-26 years during 2000-2002) in commercial 

and Medicaid health plans in the United States, 

the annual chlamydia screening rate increased from 

25.3% in 2000 to 41.6% in 2007.6

To better monitor trends in disease burden in defined 

populations during the expansion of chlamydia 

screening activities, data on chlamydia positivity and 

prevalence among persons screened in a variety of 

settings are used. In most instances, test positivity 

serves as a reasonable approximation of prevalence.7

Chlamydia—United States 

In 2008, 1,210,523 chlamydial infections were 

reported to CDC from 50 states and the District of 

Columbia (Table 1). This case count corresponds to a 

rate of 401.3 cases per 100,000 population, an increase 

of 9.2% compared with the rate of 367.5 in 2007. 

Over the past 20 years, from 1989 through 2008, 

the rate of reported chlamydial infection increased 

from 102.5 to 401.3 cases per 100,000 population 

(Figure 1, Table 1).

Chlamydia by Region 

Between 1999 and 2008, overall rates were similar 

in the Midwest, West, and South (Figure 2, Table 3). 

Rates have consistently remained lowest in the 

Northeast. 

Chlamydia by State 

In 2008, chlamydia rates per 100,000 population by 

state ranged from 160.3 cases in New Hampshire to 

728.1 cases in Mississippi (Figure 3, Table 2). 
8 National Profile: Chlamydia STD Surveillance 2008

Chlamydia by Metropolitan Statistical 

Area (MSA) 

In 2008, the chlamydia case rate per 100,000 

population in the 50 most populous MSAs increased 

overall, among both women and men (Table 6). 

Among women, the 2008 case rate of 607.0 was 

a 7.6% increase over the 2007 case rate of 564.1 

(Table 7). The 2008 case rate among men (233.9 

per 100,000 population) increased 11.4% from the 

2007 case rate (209.9) (Table 8). In 2008, 57.0% of 

chlamydia cases were reported by these MSAs. 

Chlamydia by County 

Counties in the United States with the highest 

chlamydia case rates per 100,000 population 

were located primarily in the Southeast and West, 

including Alaska (Figure 4). In 2008, 681 (21.7%) 

of 3,141 counties had rates greater than 400.0 cases 

per 100,000 population. Fifty-four counties and 

independent cities reported 40% of all chlamydia 

cases in 2008 (Table 9). 

Chlamydia by Sex 

In 2008, the overall rate of reported chlamydial 

infection among women in all 50 states and the 

District of Columbia (583.8 cases per 100,000 

females) was almost three times higher than the rate 

among men (211.1 cases per 100,000 males), likely 

reflecting a greater number of women screened for 

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

rates among men also suggest that many of the sex 

partners of women with chlamydia are not being 

diagnosed or reported as having chlamydia. However, 

with the advent of highly sensitive nucleic acid 

amplification tests (NAATs) that can be performed 

on urine, symptomatic and asymptomatic men 

are increasingly being diagnosed with chlamydial 

infection. From 2004 through 2008, the chlamydial 

infection rate in men increased by 45.0% (from 145.6 

to 211.1 cases per 100,000 males) compared with a 

21.5% increase in women during the same period 

(from 480.6 to 583.8 cases per 100,000 females).

Chlamydia by Age

Among women, the highest age-specific rates of 

reported chlamydia in 2008 were among those 15 to 

19 years of age (3,275.8 cases per 100,000 females) 

and 20 to 24 years of age (3,179.9 cases per 100,000 

females) (Figure 5, Table 10). Age-specific rates among 

men, while substantially lower than the rates among 

women, were highest in the 20- to 24-year-old age 

group (1,056.1 cases per 100,000 males) (Figure 5, 

Table 10). 

Chlamydia by Race/Ethnicity

In 2008, chlamydia rates increased for all racial and 

ethnic groups (Figure 6, Table 11B). The rate of 

chlamydia among blacks was over eight times higher 

than that of whites (1,519.3 and 173.6 cases per 

100,000, respectively). The rates among American 

Indian/Alaska Natives (808.8) and Hispanics (510.4) 

were 4.7 and 2.9 times higher, respectively, than that 

of whites. 

Chlamydia by Reporting Source

The majority of chlamydia cases reported in 2008 

were from venues outside of STD clinics (Table 

A2). Over time, the proportion of cases reported 

from non-STD clinic sites has continued to increase 

(Figure 7). In 2008, among women, only 10.1% of 

chlamydia cases were reported through an STD clinic 

(89,943 of 893,004 total cases). In contrast, among 

men, 30.5% of chlamydia cases were reported from 

an STD clinic in 2008 (95,798 of 313,779 total 

cases).

Chlamydia Prevalence in the 

Population

NHANES is a nationally-representative survey of the 

U.S. civilian, non-institutionalized 14- to 39-year old 

population and provides an important measure of 

chlamydia disease burden. From 1999 to 2002, the 

overall prevalence of chlamydia infection was 2.2% 

and was similar between males and females (2.0% and 

2.5%, respectively).8 Prevalence was higher among 

non-Hispanic blacks than non-Hispanic whites in all 

age groups (Figure 8).
STD Surveillance 2008 National Profile: Chlamydia 9

Prevalence Monitoring Project

Chlamydia screening and prevalence monitoring 

activities were initiated in the U.S. Department of 

Health and Human Services (DHHS) Region X 

(Alaska, Idaho, Oregon, Washington) in 1988 as a 

CDC-supported demonstration project. In 1993, 

chlamydia screening services for women were expanded 

to three additional DHHS regions (III, VII, and VIII) 

and, in 1995, to the remaining DHHS regions (I, II, 

IV, V, VI, and IX). In some regions, federally-funded 

chlamydia screening supplements local- and statefunded screening programs. Screening criteria and 

practices vary by region and state.

In 2008, 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 50 states, the District of Columbia, 

Puerto Rico, and the Virgin Islands was 7.4% (range: 

3.1% to 15.0%) (Figures 9 and 10). Since 1997, 

the median chlamydia positivity rate has increased 

slightly. This increase is likely because of increasing 

use of more sensitive test technology. (See Appendix

[Chlamydia, Gonorrhea, and Syphilis Prevalence 

Monitoring section] for details.)

Chlamydia test positivity among 15 to 24-year-old 

women screened in family planning clinics fluctuated 

in all 10 DHHS regions between 2004 and 2008 

(Figure 11). Positivity has remained fairly stable 

in five regions (I, II, III, V, X). In the remaining 

five regions (IV, VI, VII, VIII, IX), positivity rates 

increased slightly over the five-year time frame from 

2004 to 2008. The positivity rates presented in Figure 

11 are not adjusted for changes in laboratory test 

methods and associated increases in test sensitivity. 

Utilization of more sensitive tests has been shown to 

impact positivity rates.9 Use of NAAT technology 

in family planning clinics to screen women aged 15 

to 24 years for chlamydia is widespread (Figure 12). 

In four regions, NAATs were used nearly exclusively 

from 2004 to 2008 (I, V, VII, VIII). In two of these 

regions (I,V), prevalence was stable while in the other 

two (VII, VIII), prevalence increased. In 2008, three 

additional regions used NAATs nearly 100% of the 

time (IV, VI, IX). The remaining three regions used 

NAATs greater than 60% of the time in 2008.

Chlamydia Among Special Populations

Additional information on chlamydia screening 

programs for women of reproductive age and chlamydia 

among adolescents, minority populations, and in 

corrections facilities is in the Special Focus Profiles.

Chlamydia Summary

Both prevalence and reported cases of genital 

Chlamydia trachomatis infections remain high across 

age groups, racial/ethnic groups, geographic locales, 

and both sexes. The burden of chlamydia appears 

higher among women, especially those of younger 

age (15 to 19 and 20 to 24 years of age), but this 

may be a reflection of screening recommendations. 

Racial differences also persist; case rates among blacks 

continue to be substantially higher than rates among 

other racial/ethnic groups.

1 Miller WC, Ford CA, Morris M, Handcock MD, Schmitz JL, 

Hobbs MM, Cohen MS, Mullan Harris K, Udry JR. Prevalence 

of chlamydial and gonococcal infections among young adults in 

the United States. JAMA 2004;291(18): 2229–36.

2 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.

3 Fleming DT, Wasserheit JN. From epidemiological synergy 

to public health policy and practice: the contribution of other 

sexually transmitted diseases to sexual transmission of HIV 

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

4 Centers for Disease Control and Prevention. Sexually Transmitted 

Diseases Treatment Guidelines, 2006. MMWR, 2006;55(No.RR11):38.

5 National Committee for Quality Assurance (NCQA). HEDIS 

2009: Technical Specifications, Washington, DC, 2008, pp. 81-

83.

6 Centers for Disease Control and Prevention. Chlamydia screening 

among sexually active young female enrollees of health plans 

—United States, 2000-2007. MMWR, 2009;58 (14):362-365.

7 Dicker LW, Mosure DJ, Levine WC. Chlamydia positivity versus 

prevalence: what’s the difference? Sex Transm Dis 1998;25:251–3.

8 Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, 

McQuillan G, Weinstock H. Gonorrhea and chlamydia in the 

United States among persons 14 to 39 years of age, 1999 to 2002. 

Ann Intern Med 2007;147(2):89–96.

9 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.
10 National Profile: Chlamydia STD Surveillance 2008

Total

Women

Men

Figure 1. Chlamydia—Rates: Total and by sex: United States, 1989–2008

Rate (per 100,000 population)

NOTE: As of January 2000, all 50 states and the District of Columbia had regulations requiring the reporting of chlamydia cases.

0

100

200

300

400

500

600

1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009

South

Northeast

Midwest

West

Figure 2. Chlamydia—Rates by region: United States, 1999–2008

Rate (per 100,000 population)

0

100

200

300

400

500

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
STD Surveillance 2008 National Profile: Chlamydia 11

Guam

396

Figure 3. Chlamydia—Rates by state: United States and outlying areas, 2008

NOTE: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico and Virgin Islands) was 398.5 per 100,000 population. 

For further information on chlamydia reporting, see Appendix (Chlamydia Morbidity Reporting).

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 192

 160

 271

 314

 357

 258

 447

 439

1177

<300.0 (n=13)

Rate per 100,000 

population

300.1–400.0 (n=17)

>400.0 (n=24)

331

287

407

377

324

711

Puerto Rico

174

Virgin

Islands

535

300 198

458

340

597

422

280

228

470

302

371

314

276

375

728

535

447

389

414

405

411

446

349

455

422

409

528

499

460

287

395 183

391

466

314

332

Figure 4. Chlamydia—Rates by county: United States, 2008

<300.0 (n=2,070)

Rate per 100,000

population

300.1–400.0 (n=390)

>400.0 (n=681)
12 National Profile: Chlamydia STD Surveillance 2008

3500 2800 2100 1400 700 0 0 700 1400 2100 2800 3500

10–14

15–19

20–24

25–29

30–34

35–39

40–44

45–54

55–64

65+

Total

13.9

701.6

1056.1

565.9

271.7

140.8

78.3

34.4

211.7

2.7

10.4

129.9

3275.8

3179.9

1240.6

498.9

205.6

85.8

30.9

585.6

2.1

8.4

Men Rate (per 100,000 population) Women

Age

Figure 5. Chlamydia—Age- and sex-specific rates: United States, 2008

White

Hispanic

Black

Asian/Pacific Islander

American Indian/AK Native

Figure 6. Chlamydia—Rates by race/ethnicity: United States, 1999–2008

Rate (per 100,000 population)

0

500

1000

1500

2000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
STD Surveillance 2008 National Profile: Chlamydia 13

STD Clinic Female

STD Clinic Male

Non-STD Clinic Female

Non-STD Clinic Male

Figure 7. Chlamydia—Cases by reporting source and sex: United States, 1999–2008

Cases (in thousands)

0

100

200

300

400

500

600

700

800

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Non-Hispanic Black

Non-Hispanic White

Figure 8. Chlamydia—Prevalence by age group and race/ethnicity from a national survey,

1999–2002

NOTE: Error bars indicate 95% condence intervals.

SOURCE: National Health and Nutrition Examination Survey. Ann Intern Med 2007;147(2):89–96.

Mexican-American

0

4

8

12

16

14–19 20–29 30–39

Prevalence, %

Age
14 National Profile: Chlamydia STD Surveillance 2008

Figure 9. Chlamydia—Median state-specific positivity among 15- to 24-year-old women 

tested in family planning clinics: United States, 1997–2008

Median state-specific positivity rate

NOTE: As of 1997, all 10 DHHS regions, representing all 50 states, the District of Columbia, and outlying areas, reported chlamydia positivity data. See 

Appendix for definitions of DHHS regions.

DATA SOURCE: Prevalence Monitoring Project (Regional Infertility Prevention Projects), Office of Population Affairs, Local and State STD Control Programs, Centers for Disease 

Control and Prevention.

0

2

4

6

8

10

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

7.2

4.7

5.9

7.6

5.9

5.4

Puerto Rico

7.4

Virgin

Islands

15.0

Guam

396

8.4 6.2

5.0

6.5

11.8

12.4

5.9

12.5

8.1

6.9

6.4

7.1

6.5

8.5

13.8

11.3

10.8

9.3

7.9

7.3

7.9

6.9

8.4

6.2

7.4

6.8

12.3

10.3

7.3

4.7

7.5 3.1

8.7

6.1

7.0

Figure 10. Chlamydia—Positivity among 15- to 24-year-old women tested in family planning 

clinics by state: United States and outlying areas, 2008

NOTE: Includes states and outlying areas that reported chlamydia positivity data on at least 500 women aged 15–24 years screened during 2008.

DATA SOURCE: Prevalence Monitoring Project (Regional Infertility Prevention Projects), Office of Population Affairs, Local and State STD Control Programs, Centers for Disease 

Control and Prevention.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

3.7

3.9

5.1

7.6

7.4

8.4

8.6

5.8

9.5

<5.0 (n=5)

Positivity (%)

5.0–9.9 (n=39)

>10.0 (n=9)

9.3
STD Surveillance 2008 National Profile: Chlamydia 15

NOTE: See Appendix for definitions of DHHS Regions.

DATA SOURCE: Prevalence Monitoring Project (Regional Infertility Prevention Projects), Office of Population Affairs, Local and State STD Control Programs, Centers for 

Disease Control and Prevention.

Figure 11. Chlamydia—Trends in positivity among 15- to 24-year-old women tested in family 

planning clinics by HHS region, 2004–2008

Region I

Region II

Region III

Region IV

Region V

Region VI Region VII

Region VIII

Region IX

Region X

4.6

04

4.7

05

4.7

06

4.8

07

5.2

08

7.1

04

5.7

05

5.6

06

5.9

07

6.2

08

6.0

04

5.8

05

5.4

06

5.5

07

6.3

08

8.4

04

8.8

05

9.0

06

9.6

07

9.6

08

7.5

04

7.7

05

7.6

06

7.6

07

7.6

08

7.4

04

7.4

05

7.9

06

8.8

07

10.2

08

5.8

04

5.8

05

6.5

06

6.5

07

6.8

08

6.3

04

6.3

05

7.2

06

7.3

07

7.8

08

6.7

04

6.4

05

6.8

06

7.3

07

7.5

08

5.9

04

5.6

05

5.7

06

5.8

07

6.0

08

IV

VII IX

I II

X

III

VI

V

VIII

Figure 12. Chlamydia—Percent of tests that were nucleic acid amplification tests (NAATs) in 

family planning clinics among 15- to 24-year-old women by DHHS region, 2004–2008

NOTE: See Appendix for definitions of DHHS Regions.

DATA SOURCE: Prevalence Monitoring Project (Regional Infertility Prevention Projects), Office of Population Affairs, Local and State STD Control Programs, Centers for Disease 

Control and Prevention.

Region I

Percent

0

20

40

60

80

100

04 05 06 07 08

Region II

Percent

0

20

40

60

80

100

04 05 06 07 08

Region III

Percent

0

20

40

60

80

100

04 05 06 07 08

Region IV

Percent

0

20

40

60

80

100

04 05 06 07 08

Region V

Percent

0

20

40

60

80

100

04 05 06 07 08

Region VI

Percent

0

20

40

60

80

100

04 05 06 07 08

Region VII

Percent

0

20

40

60

80

100

04 05 06 07 08

Region VIII

Percent

0

20

40

60

80

100

04 05 06 07 08

Region IX

Percent

0

20

40

60

80

100

04 05 06 07 08

Region X

Percent

0

20

40

60

80

100

04 05 06 07 08

STD Surveillance 2008 National Profile: Gonorrhea 17

Gonorrhea

Background

Gonorrhea is the second most commonly-reported 

notifiable disease in the United States. Infections due 

to Neisseria gonorrhoeae, like those resulting from 

Chlamydia trachomatis, are a major cause of PID in 

the United States. PID can lead to serious outcomes 

in women such as tubal infertility, ectopic pregnancy, 

and chronic pelvic pain. In addition, epidemiologic 

and biologic studies provide strong evidence that 

gonococcal infections facilitate the transmission of 

HIV infection.1

From 1975 through 1997, the national gonorrhea 

rate declined 74% following implementation of the 

national gonorrhea control program in the mid-1970s 

(Figure 13). For the past 12 years, however, gonorrhea 

rates appear to have reached a plateau (Figure 14 and 

Table 1).

Increases in gonorrhea rates in eight western states 

from 2000 to 2005 have been described among 

a wide variety of populations in the affected 

states.2 Increases in quinolone resistant Neisseria 

gonorrhoeae (QRNG) in 2007 led to changes in 

national guidelines that now limit the recommended 

treatment of gonorrhea to a single class of drugs, 

the cephalosporins.3 The combination of increases 

in gonorrhea morbidity in some populations with 

increases in resistance and decreased treatment 

options have reinforced the need for better 

understanding of the epidemiology of gonorrhea.

Although gonorrhea case reporting is useful for 

monitoring trends in gonorrhea, true increases 

or decreases in disease burden may be masked 

by changes in screening practices (affected by 

concomitant testing for chlamydia and broader use 

of urine-based testing), use of diagnostic tests with 

differing test performance, and changes in reporting 

practices.4

For most states, 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.5

For these reasons, supplemental data on gonorrhea 

prevalence in persons screened in a variety of different 

settings are useful in assessing disease burden in 

selected populations.

Gonorrhea—United States 

In 2008, 336,742 cases of gonorrhea were reported in 

the United States, a rate of 111.6 cases per 100,000 

population (Figure 13 and Table 1), reflecting a small 

decrease of 5.4% since 2007. Gonorrhea rates have 

remained relatively stable over the past 12 years.

Gonorrhea by Region 

As in previous years, in 2008 the South had the 

highest gonorrhea rate among the four regions of 

the country (152.4 cases per 100,000 population). 

Rates in the South and Midwest have remained 

substantially higher than rates in the Northeast and 

West. Rates in all regions over the last year have 

shown little change (Figure 15 and Table 13).

Gonorrhea by State 

In 2008, gonorrhea rates per 100,000 population by 

state ranged from 6.0 cases in Vermont to 256.8 cases 

in Mississippi (Figure 16, Table 12). 

Gonorrhea by Metropolitan Statistical 

Area (MSA)

The overall gonorrhea rate in the 50 most populous 

MSAs was 121.5 cases per 100,000 population in 

2008. This is decreased from the rate of 128.3 cases 

per 100,000 population in 2007. In 2008, 58.7% of 

gonorrhea cases were reported by these MSAs 

(Table 16). Similar to previous years, in 2008 the 

total gonorrhea rate among females in these MSAs 

(123.5) remained similar to that among males (118.8) 

(Tables 17 and 18).
18 National Profile: Gonorrhea STD Surveillance 2008

Gonorrhea by County 

In 2008, 1,305 (41.6%) of 3,141 counties in the 

United States had gonorrhea rates at or below the 

HP2010 national target of 19 cases per 100,000 

population. (See the Appendix [Interpreting STD 

Surveillance Data section] for an explanation of 

HP2010 target setting methods.) Rates per 100,000 

population were between 19 and 100 in 1,136 

counties (36.2%), and greater than 100 in 700 

counties (22.3%). The majority of counties with 

greater than 100 cases per 100,000 population were 

located in the South (Figure 17). 

In 2008, 50% of reported gonorrhea cases occurred 

in just 71 counties or independent cities (Table 19).

Gonorrhea by Sex

Prior to 1996, rates of gonorrhea among men were 

higher than rates among women. For the eighth 

consecutive year, however, gonorrhea rates among 

women and men were similar (Figure 14). In 2008, 

the gonorrhea rate among women was 119.4 and 

the rate among men was 103.0 cases per 100,000 

population (Tables 14 and 15).

Gonorrhea by Age

In 2008, gonorrhea rates continued to be highest 

among adolescents and young adults. Among females 

in 2008, 15- to 19- and 20- to 24-year-old women 

had the highest rates of gonorrhea (636.8 and 608.6, 

respectively). Among males, the rate was highest in 

those 20 to 24 years of age (433.6) (Figure 18 and 

Table 20). 

From 2004 to 2008, increases in gonorrhea rates were 

seen among 15- to 24- year olds (7.4% among those 

15 to 19 years of age and 5.3% among those 20 to 24 

years of age) and decreases in rate were seen among 

those 25 to 44 (3.8% among those 25 to 29 years of 

age, 4.7% among those 30 to 34 years of age, 17.6% 

among those 35 to 39 years of age, and 17.3% among 

those 40-44 years of age) (Table 20).

From 2004 to 2008, similar trends were seen by 

sex; increases occurred in gonorrhea rates in females 

and males between 15 and 19 years of age (5.6% 

and 11.2%, respectively) and in females and males 

between 20 and 24 years of age (8.1% and 2.0%, 

respectively). During the same time period, decreases 

in gonorrhea rates were seen in females and males 

between 35 and 39 years of age (10.2% and 21.1%, 

respectively) and in females and males between 40 

and 44 years of age (11.9% and 19.6%, respectively) 

(Figures 19 and 20, and Table 20).

Gonorrhea by Race/Ethnicity 

In 2008, gonorrhea rates remained highest among 

blacks (625.0 cases per 100,000 population, Figure 21 

and Table 21B). Similar to recent years, the rate among 

blacks was 20.2 times greater than the rate among 

whites (31.0 cases per 100,000 population). Gonorrhea 

rates were 3.6 times greater among American Indian/

Alaska Natives (110.2 cases per 100,000 population), 

and 2.2 times greater among Hispanics (66.8 cases 

per 100,000 population) than among whites in 2008. 

Rates among whites were 1.6 times higher than those 

among Asian/Pacific Islanders (20.0 cases per 100,000 

population) in 2008 (Figure 21).

Between 2004 and 2008, gonorrhea rates showed 

no marked changes for any racial or ethnic group. 

(Figure 21 and Table 21B). Additional information 

on gonorrhea among minority populations can be 

found in the Special Focus Profiles.

Gonorrhea by Region and Sex 

Between 2004 and 2008, gonorrhea rates among 

women increased 1.4% in the Midwest and 14.4% in 

the South. During the same time period, rates among 

women decreased 13.3% in the Northeast and 14.0% 

in the West (Table 14).

Between 2004 and 2008, gonorrhea rates among 

men decreased in the West, Northeast, and Midwest 

(15.3%, 8.9%, and 8.1%, respectively). During the 

same time period, rates among men in the South 

remained essentially the same (Table 15).

Gonorrhea by Race/Ethnicity and Sex

From 2004 to 2008, overall gonorrhea rates decreased 

among white, black, American Indian/Alaska Native, 

and Hispanic men (by 12.6%, 5.0%, 4.2%, and 

2.6%, respectively). During the same time period, 

rates increased only among Asian/Pacific Islander 

males (1.6%) (Table 21B). 
STD Surveillance 2008 National Profile: Gonorrhea 19

From 2004 to 2008 overall gonorrhea rates decreased 

among Asian/Pacific Islander, American Indian/

Alaska Native, Hispanic, and white women (by 7.1%, 

6.1%, 3.3%, and 3.0% respectively). During the 

same time period, rates increased only among black 

women (5.9%) (Table 21B). 

In 2008, 15- to 19-year-old black women again had 

the highest gonorrhea rate of any group (2,934.6 per 

100,000 population), closely followed by 20- to 24 

year-old black women (2,777.0), and 20- to 24-yearold black men (2,340.3).

Gonorrhea by Reporting Source 

In 2008, 23.0% of gonorrhea cases were reported by 

STD clinics (Table A2). This is a decrease from 2004, 

when 30.0% of gonorrhea cases were reported by STD 

clinics. In 2008, a higher proportion of male gonorrhea 

cases were reported from STD clinics than female 

cases (32.3% and 15.2% respectively) (Figure 22 and 

Table A2).

Prevalence Monitoring 

Gonorrhea test positivity data are primarily available 

from family planning clinic settings. Screening 

criteria and practices may vary by state and over time.

In 2008, the median state-specific gonorrhea test 

positivity among 15- to 24-year-old women screened 

in selected family planning clinics in 43 states, the 

District of Columbia, Puerto Rico, and the Virgin 

Islands was 0.9% (range: 0.0% to 3.8%) (Figure 23). 

Gonococcal Isolate Surveillance 

Project (GISP) 

Antimicrobial resistance remains an important 

consideration in the treatment of gonorrhea.3,6-13 In 

1986, GISP, a national sentinel surveillance system, 

was established to monitor trends in antimicrobial 

susceptibilities of strains of Neisseria gonorrhoeae in 

the United States among selected STD clinics in 

approximately 25–30 GISP sentinel sites and 4-5 

regional laboratories (Figure 24).13

Information on the GISP antimicrobial susceptibility 

criteria used is in the GISP section of the Appendix

(Interpreting STD Surveillance Data).

Susceptibility to Ceftriaxone

Susceptibility testing for ceftriaxone began in 1987. 

Figure 25 shows the distribution of Minimum 

Inhibitory Concentrations (MICs) to ceftriaxone 

among GISP isolates from 2004 to 2008. There was a 

small increase in the proportion of GISP isolates with 

MICs of 0.06 μg/ml since 2006 but no increases were 

observed at higher MIC values. 

There have been four isolates with decreased 

susceptibility to ceftriaxone in GISP; all four had 

MICs of 0.5 μg/ml. Their locations and years were: 

San Diego-1987, Cincinnati-1992 and 1993, and 

Philadelphia-1997. No isolates with decreased 

susceptibility to ceftriaxone were seen in 2008.

Susceptibility to Azithromycin

GISP began monitoring azithromycin susceptibility 

in 1992. Figure 26 shows the distribution of MICs 

to azithromycin among GISP isolates from 2004 to 

2008. The proportion of GISP isolates at MICs of 

0.5 μg/ml and 1.0 μg/ml for azithromycin has been 

increasing since 2004.

Susceptibility to Spectinomycin

All isolates were susceptible to spectinomycin in 

2008. There have been five spectinomycin-resistant 

isolates in GISP; their locations and years were: St. 

Louis-1988, Honolulu-1989, San Francisco-1989, 

Long Beach-1990, and West Palm Beach-1994.

Susceptibility to Ciprofloxacin

Resistance to ciprofloxacin (a fluoroquinolone in the 

quinolone family of antimicrobials) was first identified 

in GISP sites in 1991. However since 1999, quinolone 

resistant Neisseria gonorrhoeae (QRNG) prevalence 

has steadily increased, first in Hawaii and the Pacific 

Islands, then in the Western states, and then among 

MSM.6,8,9 In 2008, 775 (13.5%) of 5,723 GISP 

isolates collected were identified as QRNG, a decrease 

from 2007, when 891/6,009 (14.8%) isolates were 

identified as QRNG (Figure 27). 
20 National Profile: Gonorrhea STD Surveillance 2008

QRNG by Sexual Behavior

The prevalence of QRNG in isolates from MSM 

slightly decreased from 36.1% in 2007 to 33.6% in 

2008. During the same time period, the prevalence of 

QRNG in isolates from heterosexuals also decreased 

from 8.7% in 2007 to 8.2% in 2008.

QRNG by Region

The number of isolates submitted from Honolulu 

demonstrating ciprofloxacin-resistance increased from 

20 (28.6%) of 70 isolates in 2007 to 32 (40.5%) of 

79 isolates in 2008. Other Western sites reporting 

increases in QRNG prevalence from 2007 to 2008 

include: Phoenix (8.7% in 2007 to 16.5% in 2008); 

Portland (28.6% to 51.6%); and Seattle (29.3% 

to 31.3%). In contrast, a number of Western sites 

reported a decrease in QRNG prevalence from 2007 

to 2008, including Albuquerque (16.7% in 2007 to 

6.9% in 2008), Denver (17.0% to 10.7%), Las Vegas 

(18.7% to 17.7%), Los Angeles (22.4% to 16.8%), 

Orange County (41.0% to 33.3%), San Diego (36.3% 

to 29.1%) and San Francisco (31.3% to 26.1%).

In the South from 2007 to 2008, a few sites continued 

to observe increases in the prevalence of QRNG, 

including Atlanta (from 2.6% in 2007 to 10.3% 

in 2008), Baltimore (2.0% in 2007 to 5.4%) and 

Richmond (17.9% to 21.8%). Southern sites reporting 

a decrease in the prevalence of QRNG from 2007 to 

2008 include Birmingham (from 9.4% in 2007 to 8.3% 

in 2008), Dallas (7.5% to 7.1%), Greensboro (5.3% to 

3.6%), Miami (19.6% to 16.2%), New Orleans (18.1% 

to 14.9%), and Oklahoma City (6.0% to 4.4%).

A majority of the Midwestern sites reported decreases 

in QRNG prevalence including Chicago (from 8.6% 

in 2007 to 5.3% in 2008), Detroit (1.7% to 1.1%), 

Kansas City (16.4% to 7.5%), and Minneapolis 

(10.7% to 7.6%). The sites that showed an increase 

in QRNG prevalence were Cincinnati (from 1.2% 

in 2007 to 2.2% in 2008) and Cleveland (0.7% to 

4.1%).

In the Northeast, New York City reported a slight 

increase in QRNG prevalence from 14.9% in 2007 

to 15.5% in 2008. In Philadelphia, the prevalence 

of resistant isolates to ciprofloxacin decreased from 

29.1% in 2007 to 20.6% in 2008. 

Other Antimicrobial Susceptibility Testing 

Overall in 2008, 24.4% of isolates collected from 

GISP sites were resistant to penicillin, tetracycline, 

ciprofloxacin, or some combination of those 

antibiotics (Figure 28). With the renewed availability 

of cefixime, susceptibility testing for this antibiotic 

was restarted in 2009. Additionally, susceptibility 

testing for cefpodoxime was started in 2009. 

Antimicrobial Treatments Given for 

Gonorrhea

The antimicrobial agents given to GISP patients 

for gonorrhea therapy are shown in Figure 29. 

The proportion of GISP patients treated with 

cephalosporins has increased again from 81.0% in 

2007 to 95.1% in 2008. Specifically, 75.1% were 

treated with ceftriaxone in 2008 compared with 

61.5% in 2007. Conversely, the proportion of 

GISP patients being treated with fluoroquinolones 

(ciprofloxacin, ofloxacin or levofloxacin) has 

continued to decrease from 17.1% in 2007 to 2.2% 

in 2008. Treatment with azithromycin has slightly 

increased from 0.8% in 2007 to 1.2% in 2008.

Additional information on 2008 GISP data may be 

found on the GISP website: http://www.cdc.gov/std/

GISP

Gonorrhea Among Special Populations

Additional information about gonorrhea in racial and 

ethnic minority populations, women of reproductive 

age, adolescents, MSM, and other at risk populations 

can be found in the Special Focus Profiles.

Gonorrhea Summary

In summary, the national gonorrhea rate has 

remained relatively unchanged for more than ten 

years. Of particular concern are the persistent high 

rates in some geographic areas, adolescents and young 

adults, and some racial/ethnic groups.

GISP continues to monitor for the emergence 

of decreased susceptibility and resistance to 

cephalosporins and for increases in decreased 

susceptibility to azithromycin.
STD Surveillance 2008 National Profile: Gonorrhea 21

1 Fleming DT, Wasserheit JN. From epidemiological synergy 

to public health policy and practice: the contribution of other 

sexually transmitted diseases to sexual transmission of HIV 

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

2 Centers for Disease Control and Prevention. Increases 

in gonorrhea–Eight western states, 2000–2005. MMWR

2007;56:222–225.

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

Sexually Transmitted Diseases Treatment Guidelines, 2006: 

Fluoroquinolones No Longer Recommended for Treatment of 

Gonococcal Infections. MMWR, 2007;56: 332–336.

4 Centers for Disease Control and Prevention. Gonorrhea–United 

States, 1998. MMWR 2000;49:538–42.

5 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.

6 Centers for Disease Control and Prevention. Fluoroquinoloneresistance 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 2007 Supplement: Gonococcal Isolate 

Surveillance Project (GISP) Annual Report 2007. Atlanta, GA: 

U.S. Department of Health and Human Services.

8 Centers for Disease Control and Prevention. Increases in 

fluoroquinolone-resistant Neisseria gonorrhoeae–Hawaii and 

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

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.

10 Centers for Disease Control and Prevention. Sexually Transmitted 

Diseases Treatment Guidelines, 2006. MMWR, 2006;55(No.RR11).

11 Wang 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.

12 Wang SA, Harvey AB, Conner SM, et al. Antimicrobial 

Resistance for Neisseria gonorrhoeae in the United States, 1988 

to 2003: The Spread of Fluoroquinolone Resistance. Annals of 

Internal Medicine 2007;147:81–89.

13 Schwarcz S, Zenilman J, Schnell D, et al. National surveillance 

of antimicrobial resistance in Neisseria gonorrhoeae. JAMA

1990;264:1413–1417.
22 National Profile: Gonorrhea STD Surveillance 2008

Figure 13. Gonorrhea—Rates: United States, 1941–2008

Rate (per 100,000 population)

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

0

100

200

300

400

500

Total

Women

Men

Figure 14. Gonorrhea—Rates: Total and by sex: United States, 1989–2008

Rate (per 100,000 population)

0

100

200

300

400

1989 1991 1993 1995 1997 1999 2001 2003 2005 2007
STD Surveillance 2008 National Profile: Gonorrhea 23

South

Northeast

Midwest

West

Figure 15. Gonorrhea—Rates by region: United States, 1999–2008

Rate (per 100,000 population)

0

50

100

150

200

250

300

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

48.3

32.7

70.5

84.7

12.7

84.6

Puerto Rico

6.9

Virgin

Islands

109.3

Guam

62.8

22.4 7.3

88.7

89.0

214.2

134.7

12.5

18.0

71.2

23.7

47.1

82.3

58.4

108.7

256.8 210.5

170.5

127.8

176.3

134.0

146.5

169.4

138.2

142.6

136.3

143.3

220.2

159.2

160.9

107.2

77.3 41.2

54.4

56.9

81.9

Figure 16. Gonorrhea—Rates by state: United States and outlying areas, 2008

NOTE: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 110.3 per 100,000 population.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 6.0

 7.6

 33.0

 29.0

 80.0

 61.0

120.8

118.6

451.5

<19.0 (n=7)

Rate per 100,000 

population

19.1–100.0 (n=24)

>100.0 (n=23)

47.5
24 National Profile: Gonorrhea STD Surveillance 2008

Figure 17. Gonorrhea—Rates by county: United States, 2008

<19.0 (n=1,305)

Rate per 100,000

population

19.1–100.0 (n=1,136)

>100.0 (n=700)

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

10–14

15–19

20–24

25–29

30–34

35–39

40–44

45–54

55–64

65+

Total

5.8

278.3

433.6

269.9

163.3

99.6

71.7

40.1

103.3

3.5

14.0

31.0

636.8

608.6

269.4

119.0

55.2

28.9

11.2

119.7

0.5

2.5

Men Rate (per 100,000 population) Women

Age

Figure 18. Gonorrhea—Age- and sex-specific rates: United States, 2008
STD Surveillance 2008 National Profile: Gonorrhea 25

35–39

40–44

30–34

25–29

20–24

15–19

Figure 19. Gonorrhea—Age-specific rates among women 15 to 44 years of age:

United States, 1999–2008

Rate (per 100,000 population)

0

200

400

600

800

1,000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

35–39

40–44

30–34

25–29

20–24

15–19

Figure 20. Gonorrhea—Age-specific rates among men 15 to 44 years of age:

United States, 1999–2008

Rate (per 100,000 population)

0

150

300

450

600

750

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
26 National Profile: Gonorrhea STD Surveillance 2008

White

Hispanic

Black

Asian/Pacic Islander

American Indian/AK Native

Figure 21. Gonorrhea—Rates by race/ethnicity: United States, 1999–2008

Rate (per 100,000 population)

0

200

400

600

800

1,000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

STD Clinic Female

STD Clinic Male

Non-STD Clinic Female

Non-STD Clinic Male

Figure 22. Gonorrhea—Cases by reporting source and sex: United States, 1999–2008

Cases (in thousands)

0

40

80

120

160

200

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
STD Surveillance 2008 National Profile: Gonorrhea 27

0.8

1.8

1.0

0.2

Puerto Rico

0.2

Virgin

Islands

3.0

Guam

396

0.0

0.5

0.9

2.5

2.1

0.1

0.3

0.6

0.4

0.9

0.5

3.8

2.9

2.7

2.2

1.7

1.4

1.2

1.6

1.4

1.4

0.8

1.0

0.8

2.4

1.9

1.4

0.6

0.4 0.4

0.6

0.5

1.0

Figure 23. Gonorrhea—Positivity among 15- to 24-year-old women tested in family planning 

clinics by state: United States and outlying areas, 2008

* States/areas not meeting minimum inclusion criteria.

NOTE: Includes states and outlying areas that reported positivity data on at least 500 women aged 15–24 years screened during 2008.

DATA SOURCE: Prevalence Monitoring (Regional Infertility Prevention Projects), Office of Population Affairs, Local and State STD Control Programs, Centers for Disease 

Control and Prevention.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

0.0

0.3

0.7

1.3

1.4

2.0

See* (n=7)

Positivity(%)

<1.0 (n=23)

1.0–1.9 (n=14)

0.8 >2.0 (n=9)

Figure 24. Gonococcal Isolate Surveillance Project (GISP)—Location of participating sentinel 

sites and regional laboratories in the United States, 2008

 Birmingham Phoenix

 Los Angeles

 Orange Co.

 San Diego

 San Francisco Denver

 Miami

 Atlanta

 Honolulu

 Tripler AMC

 Chicago

 New Orleans

 Baltimore

 Detroit Minneapolis

 Kansas City

 Las Vegas

 Albuquerque

 New York City

 Greensboro

 Cincinnati

 Cleveland

 Oklahoma City

 Portland

 Philadelphia

 Dallas

 Richmond

 Seattle

Sentinel Sites

Sites and Regional Labs
28 National Profile: Gonorrhea STD Surveillance 2008

2005

2004

Figure 25. Gonococcal Isolate Surveillance Project (GISP)—Distribution of MICs to

ceftriaxone among GISP isolates, 2004—2008

Percent

2006

2008

2007

MIC (μg/ml)

0

20

40

60

80

100

<0.008 0.015 0.03 0.06 0.125 0.25

2005

2004

Figure 26. Gonococcal Isolate Surveillance Project (GISP)—Distribution of MICs to

azithromycin among GISP isolates, 2004—2008

Percent

2006

2008

2007

MIC (μg/ml)

0

12

24

36

48

60

<0.03 0.06 0.125 0.25 0.5 1 2 4 8 16
STD Surveillance 2008 National Profile: Gonorrhea 29

Intermediate resistance

Resistance

Figure 27. Gonococcal Isolate Surveillance Project (GISP)—Percent of Neisseria 

gonorrhoeae isolates with resistance or intermediate resistance to ciprofloxacin, 

1990–2008

Percent

NOTE: Resistant isolates have ciprooxacin MICs >1 μg/ml. Isolates with intermediate resistance have ciprooxacin MICs of 0.125–0.5 μg/ml. 

Susceptibility to ciprooxacin was rst measured in GISP in 1990.

0

4

8

12

16

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

PenR/QRNG

PenR

TetR/QRNG

PenR/TetR

QRNG

PenR/TetR/QRNG

TetR

Susceptible

Figure 28. Gonococcal Isolate Surveillance Project (GISP)—Penicillin, tetracycline, and 

ciprofloxacin resistance among GISP isolates, 2008

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

plasmid mediated tetracycline-resistant N. gonorrhoeae; QRNG=ciprofloxacin-resistant N. gonorrhoeae.

75.6%

7.4%

7.4%

4.0%

1.7%

1.6%

1.5%

0.9%
30 National Profile: Gonorrhea STD Surveillance 2008

Figure 29. Gonococcal Isolate Surveillance Project (GISP)—Drugs used to treat gonorrhea in 

GISP patients, 1988–2008

Note: For 2008, “Other” includes no therapy (1.3%), azithromycin 2g (1.2%), levofloxacin (0.02%), and other less frequently used drugs.

0

20

40

60

80

100

1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

Other Cephalosporins

Ceftriaxone 125 mg Spectinomycin

Ceftriaxone 250 mg

Cexime

Penicillins

Ciprooxacin

Tetracyclines

Ooxacin

Other

Percent
STD Surveillance 2008 National Profile: Syphilis 31

Syphilis

Background 

Syphilis, a genital ulcerative disease, causes significant 

complications if untreated and facilitates the 

transmission of HIV. 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 80% of cases.1

The rate of P&S syphilis reported in the United States 

decreased during the 1990s; in 2000, the rate was the 

lowest since reporting began in 1941 (Figure 30). The 

low rate of 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 and revised in May 

2006.2

Although the rate of P&S syphilis in the United 

States declined 89.7% between 1990 and 2000, the 

rate of P&S syphilis increased annually between 

2001 and 2008. Overall increases in rates between 

2001 and 2008 were observed primarily among men 

(increasing from 3.0 cases per 100,000 population to 

7.6 cases per 100,000 population). After persistent 

declines from 1992 to 2003, the rate of P&S 

syphilis among women increased from 0.8 cases per 

100,000 population in 2004 to 1.5 cases per 100,000 

population in 2008. 

Syphilis remains an important problem in the South 

and in urban areas in other regions of the country. 

Increases in cases among MSM (including men 

who have sex with women and men) have occurred 

and have been characterized by high rates of HIV 

co-infection and high-risk sexual behaviors.3-7 

The estimated proportion of P&S syphilis cases 

attributable to MSM increased from 4% in 2000 to 

62% in 2004.8,9 In 2005, CDC requested that all 

state health departments report sex of sex partners for 

persons with syphilis. In 2008, 63% of those P&S 

syphilis cases in 44 states and Washington, D.C. 

with available information were among MSM. Of 

reported male cases with P&S syphilis, sex of partner 

information in 2008 was available for 80%.

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

Late, Late Latent, Congenital) 

Between 2007 and 2008, the number of cases of early 

latent syphilis reported to CDC increased 15.2% 

(from 10,768 to 12,401), while the number of cases 

of late and late latent syphilis increased 9.3% (from 

18,256 to 19,945) (Table 1). The total number of 

cases of syphilis (all stages: P&S, early latent, late, 

late latent, and congenital syphilis) reported to CDC 

increased 13.1% (from 40,921 to 46,277) between 

2007 and 2008 (Table 1).

P&S Syphilis—United States

In 2008, P&S syphilis cases reported to CDC 

increased to 13,500 from 11,466 in 2007, an increase 

of 17.7%. The rate of P&S syphilis in the United 

States in 2008 (4.5 cases per 100,000 population) 

was 18.4% higher than the rate in 2007 (3.8 cases per 

100,000 population) (Figure 30, Table 1).

P&S Syphilis by Region

The South accounted for 49.7% of the P&S syphilis 

cases in 2008 and 48.8% in 2007. Between 2007 and 

2008, rates increased 19.6% in the South (from 5.1 

to 6.1 cases per 100,000 population), 8.8% in the 

Northeast (from 3.4 to 3.7), 7.5% in the West (from 

4.0 to 4.3) and 36.8% in the Midwest (from 1.9 to 

2.6) (Figure 32, Table 25).

P&S Syphilis by State 

In 2008, P&S syphilis rates in three states were less 

than or equal to the HP 2010 target of 0.2 case per 

100,000 population (Figure 33, Table 24). Four states 

reported five or fewer cases of P&S syphilis in 2008 

(Table 24) (See the Appendix [Interpreting STD 

Surveillance Data section] for an explanation of 

HP2010 target setting methods).
32 National Profile: Syphilis STD Surveillance 2008

P&S Syphilis by Metropolitan 

Statistical Area (MSA) 

The rate of P&S syphilis in 2008 for the 50 most 

populous MSAs (6.2) exceeded the HP 2010 target of 

0.2 case per 100,000 population (Table 28).

P&S Syphilis by County 

In 2008, 2,180 of 3,141 counties (69.3%) in the 

United States reported no cases of P&S syphilis 

compared with 2,275 (72.4%) in 2007. Of 966 

counties reporting at least one case of P&S syphilis in 

2008, four (0.4%) had rates at or below the HP2010 

target of 0.2 cases per 100,000 population. Rates of 

P&S syphilis were above the HP2010 target for 962 

counties in 2008 (Figure 34). These 962 counties 

(30.6% of the total number of counties in the United 

States) accounted for over 99.9% of the total P&S 

syphilis cases reported in 2008. In 2008, half of the 

total number of P&S syphilis cases were reported 

from 26 counties and two cities (Table 31).

P&S Syphilis by Sex

The rate of P&S syphilis increased 15.2% among 

men (from 6.6 cases to 7.6 cases per 100,000 men) 

between 2007 and 2008 (Figure 31, Table 27). 

During this time, the rate increased 36.4% among 

women from 1.1 to 1.5 cases per 100,000 women 

(Figure 31, Table 26).

P&S Syphilis by Age

In 2008, the rate of P&S syphilis was highest in 

persons in the 20- to 24-year-old and 25- to 29-yearold age groups (11.4 and 10.7 cases per 100,000 

population, respectively) (Table 33 and Figure 35–37).

Between 2007 and 2008, P&S syphilis rates in most 

age groups among men and women increased (Table 

33 and Figures 35–37).

P&S Syphilis by Race/Ethnicity

From 2007 to 2008, the rate of P&S syphilis 

increased in all racial and ethnic groups except 

American Indian/Alaska Natives (Figure 38). The rate 

increased 10.0% among non-Hispanic whites (from 

2.0 to 2.2 cases per 100,000 population), 25.4% 

among blacks (from 13.8 to 17.3), 11.9% among 

Hispanics (from 4.2 to 4.7), and 25.0% among 

Asian/Pacific Islanders (from 1.2 to 1.5). The rate 

decreased 32.4% (from 3.4 to 2.3 cases per 100,000 

population) among American Indian/Alaska Natives 

(Table 34B).

P&S Syphilis by Sex and Sex Behavior

The male-to-female rate ratio for P&S syphilis has risen 

steadily since 1996, when it was 1.2, consistent with 

an increase in MSM (Figure 31). In 2008, however, 

the rate of P&S syphilis in males was 5.1 times that in 

females, a small decrease from 6.0 in 2007.

In 2005, CDC began collecting information on sex 

partners of patients with P&S syphilis. In 2008, this 

information was available for 80% of male cases.

In 2008, the stage of disease was reported as follows: 

among heterosexual men (men who have sex with 

women exclusively) with P&S syphilis, 41.6% had 

primary syphilis and 58.4% had secondary syphilis. 

Among female patients, 16.6% had primary syphilis 

and 83.4% had secondary syphilis. Among MSM 

with P&S syphilis, 24.5% had primary syphilis and 

75.5% had secondary syphilis (Figure 39).

Of females with P&S syphilis, 22.4% were white, 

64.4% were black, 9.7% were Hispanic, and 3.6% 

were of other races/ethnicities. Of heterosexual men, 

16.9% were white, 65.8% were black, 13.4% were 

Hispanic, and 3.9% were of other races/ethnicities. 

Of MSM, 41.2% were white, 33.6% were black, 

18.8% were Hispanic, and 6.4% were of other races/

ethnicities (Figure 40).

P&S Syphilis by Race/Ethnicity and Sex

From 2007 to 2008, the P&S syphilis rate among 

non-Hispanic white males increased 8.1% (from 3.7 

to 4.0), and increased among non-Hispanic white 

females as well (from 0.4 to 0.5). The rate increased 

22.3% among black males (from 22.9 to 28.0) and 

38.2% among black females (from 5.5 to 7.6). The 

rate increased 12.3% among Hispanic males (from 

7.3 to 8.2), and 25.0% among Hispanic females 

(from 0.8 to 1.0). The rate increased 25.0% for Asian/

Pacific Island males (from 2.4 to 3.0), but remained 

unchanged for Asian/Pacific Island females (0.1). The 

rate decreased 23.8% among American Indian/Alaska 
STD Surveillance 2008 National Profile: Syphilis 33

Native males (from 4.2 to 3.2) and decreased 46.2% 

among American Indian/Alaska Native females (from 

2.6 to 1.4) (Table 34B).

P&S Syphilis by Race/Ethnicity, Age, 

and Sex 

In 2008, the rate of P&S syphilis among blacks was 

highest among women 20 to 24 years of age (25.3–a 

59.1% increase from 15.3 in 2007) and among men 

20 to 24 years of age (75.1–a 31% increase from 

57.2 in 2007) and 25 to 29 years of age (65.6–an 

18% increase from 55.5 in 2007). For non-Hispanic 

whites, the rate was highest among women 20 to 

24 years of age (1.4) and among men 40 to 44 years 

of age (9.8). For Hispanics, the rate was highest 

among women 20 to 24 years of age (2.8) and among 

men 35 to 39 years of age (16.3). For Asian/Pacific 

Islanders, the rate was highest among women 25 to 

29 years of age (0.7) and among men 30 to 34 years 

of age (7.5). For American Indian/Alaska Natives, the 

rate was highest among women 30 to 34 years of age 

(4.0) and among men 25 to 29 years of age (11.7) 

(Table 34B).

P&S Syphilis by Reporting Source

In 1990, 25.6% of P&S syphilis cases were reported 

from sources other than STD clinics; this figure 

increased to 39.2% in 1998. Between 1998 and 

2008, the proportion of P&S syphilis cases reported 

from sources other than STD clinics increased from 

39.2% to 66.0% (Figure 41 and Table A2). Between 

2001 and 2008, the number of cases among males 

reported from non-STD clinic sources increased 

sharply while the number from STD clinics increased 

only slightly (Figure 41).

During 2008, patients with P&S syphilis primarily 

sought care with private physicians or STD clinics. 

More cases of syphilis among MSM were reported 

from private physicians (36.9%) than STD clinics 

(30.2%) (Figure 42). More cases among women and 

heterosexual men were reported from STD clinics 

than private physicians.

Congenital Syphilis—United States

The rate of congenital syphilis remained unchanged 

between 2007 and 2008 (10.1 cases per 100,000 

live births) although there was a 16% rate increase 

between 2006 and 2007 (Table 40). In 2008, 431 

cases were reported (the same number reported in 

2007), an increase from 372 in 2006. The increase 

in the rate of congenital syphilis since 2005 when 

the rate reached a nadir at 8.2 cases per 100,000 live 

births may relate to the increase in the rate of P&S 

syphilis among women that has occurred since 2004 

(Figure 43). 

In 2008, 27 states and one outlying area had one or 

more cases of congenital syphilis (Tables 39 and 40).

Syphilis among Special Populations

Additional information about syphilis and congenital 

syphilis in racial and ethnic minority populations, 

adolescents, MSM, and other at-risk populations is 

found in the Special Focus Profiles.

Syphilis Summary

In recent years, MSM have accounted for an 

increasing number of syphilis cases in the United 

States;9 63% of reported P&S syphilis cases in the 

United States are among MSM, based on information 

from 44 states and Washington, D.C. Although the 

majority of U.S. syphilis cases have occurred among 

MSM, syphilis among heterosexuals is an emerging 

problem.10
34 National Profile: Syphilis STD Surveillance 2008

1 Ingraham NR. The value of penicillin alone in the prevention 

and treatment of congenital syphilis. Acta Derm Venereol 1951, 31 

(suppl 24):60–88.

2 Centers for Disease Control and Prevention. The National Plan 

to Eliminate Syphilis from the United States. Atlanta, GA: U.S. 

Department of Health and Human Services; May 2006

3 Centers for Disease Control and Prevention. Resurgent bacterial 

sexually transmitted disease among men who have sex with men–

King County, Washington, 1997–1999. MMWR 1999;48:773–

777

4 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.

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 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.

7 D’Souza G, Lee JH, Paffel JM. Outbreak of syphilis among 

men who have sex with men in Houston, Texas. Sex Transm Dis

2003;30:872–3.

8 Centers for Disease Control and Prevention. Primary and 

secondary syphilis–United States, 2003–2004. MMWR

2006;55:269–73.

9 Heffelfinger JD, Swint EB, Berman SM, Weinstock HS. Trends 

in primary and secondary syphilis among men who have sex with 

men in the United States. Am J Public Health 2007;97:1076–

1083.

10 Centers for Disease Control and Prevention. Primary and 

secondary syphilis—Jefferson County, Alabama, 2002–2007. 

MMWR 2009;58:463–467.
STD Surveillance 2008 National Profile: Syphilis 35

Total Syphilis

Early Latent

P&S

Figure 30. Syphilis—Reported cases by stage of infection: United States, 1941–2008

Cases (in thousands)

0

100

200

300

400

500

600

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

Male-to-Female Rate Ratio

Total Rate

Female Rate

Male Rate

Figure 31. Primary and secondary syphilis—Rates: Total and by sex and male-to-female rate

ratios: United States, 1989–2008

Rate (per 100,000 population) Rate Ratio (log scale)

1:1

2:1

4:1

8:1

16:1

0

5

10

15

20

25

1989 1991 1993 1995 1997 1999 2001 2003 2005 2007
36 National Profile: Syphilis STD Surveillance 2008

South

Northeast

Midwest

West

Figure 32. Primary and secondary syphilis—Rates by region: United States, 1999–2008

Rate (per 100,000 population)

0

2

4

6

8

10

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Guam

3.5

Figure 33. Primary and secondary syphilis—Rates by state: United States and outlying areas, 

2008

NOTE: The total rate of P&S syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 4.5 per 100,000 population.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 1.8

 1.5

 3.3

 1.7

 1.0

 2.6

 1.9

 6.7

24.8

<0.2 (n=4)

Rate per 100,000 

population

0.21–2.2 (n=23)

>2.2 (n=27)

2.8

0.7

6.0

3.0

0.7

0.1

Puerto Rico

4.2

Virgin

Islands

0.0

0.0 0.8

6.3

2.2

2.2

5.9

0.5

0.9

2.2

0.6

0.1

0.8

2.2

1.2

6.3

9.7

9.6

5.7

3.2

3.4

3.1

2.1

2.2

6.7

3.8

2.4

16.5

7.3

4.3

2.2

2.6 0.7

5.0

2.3

0.5

1.1
STD Surveillance 2008 National Profile: Syphilis 37

Figure 34. Primary and secondary syphilis—Rates by county: United States, 2008

<0.2 (n=2,184)

Rate per 100,000

population

0.21–2.2 (n=373)

>2.2 (n=584)

NOTE: In 2008, 2,180 (69.3%) of 3,141 counties in the United States reported no cases of P&S syphilis.

20 16 12 8 4 0 0 4 8 12 16 20

10–14

15–19

20–24

25–29

30–34

35–39

40–44

45–54

55–64

65+

Total

0.1

5.3

17.3

17.2

15.0

14.7

14.4

8.3

7.6

0.6

2.6

0.2

3.0

5.1

3.9

2.5

2.3

1.8

1.1

1.5

0.0

0.3

Men Rate (per 100,000 population) Women

Age

Figure 35. Primary and secondary syphilis—Age- and sex-specific rates: United States, 2008
38 National Profile: Syphilis STD Surveillance 2008

35–39

40–44

30–34

25–29

20–24

15–19

Figure 36. Primary and secondary syphilis—Age-specific rates among women 15 to 44 years 

of age: United States, 1999–2008

Rate (per 100,000 population)

0

2

4

6

8

10

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

35–39

40–44

30–34

25–29

20–24

15–19

Figure 37. Primary and secondary syphilis—Age-specific rates among men 15 to 44 years of 

age: United States, 1999–2008

Rate (per 100,000 population)

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
STD Surveillance 2008 National Profile: Syphilis 39

White

Hispanic

Black

Asian/Pacific Islander

American Indian/AK Native

Figure 38. Primary and secondary syphilis—Rates by race/ethnicity: United States, 1999–2008

Rate (per 100,000 population)

0

8

16

24

32

40

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Secondary

Primary

Figure 39. Primary and secondary syphilis—Reported cases* by stage and sexual 

orientation, 2008

Cases

* 20% of reported male cases of P&S syphilis were missing sex of sex partner information. †

 MSM denotes men who have sex with men.

0

1000

2000

3000

4000

5000

6000

W MSM† Heterosexual Men omen
40 National Profile: Syphilis STD Surveillance 2008

Black

White

Figure 40. Primary and secondary syphilis—Reported cases* by sexual orientation and 

race/ethnicity,†

 2008

Cases

* 20% of reported male cases of P&S syphilis were missing sex of sex partner information; 2% of reported male cases with sex of partner data were

missing race/ethnicity data. †

 No imputation was done for race/ethnicity. ‡

 MSM denotes men who have sex with men.

Other

Hispanic

0

500

1000

1500

2000

2500

3000

W MSM‡ Heterosexual Men omen

STD Clinic Female

STD Clinic Male

Non-STD Clinic Female

Non-STD Clinic Male

Figure 41. Primary and secondary syphilis—Reported cases by reporting source and sex: 

United States, 1999–2008

Cases (in thousands)

0

1

2

3

4

5

6

7

8

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
STD Surveillance 2008 National Profile: Syphilis 41

HIV Counseling and Testing Site

Correctional Facility

Figure 42. Primary and secondary syphilis—Percentage of reported cases* by sexual 

orientation and selected reporting sources, 2008

Percent

* 20% of reported male cases of P&S syphilis were missing sex of sex partner information; 3% of reported male cases with sex of partner data were

missing source of information data. †

 MSM denotes men who have sex with men.

STD Clinic

Private Physician/HMO

0

10

20

30

40

50

W MSM† Heterosexual Men omen

P&S Rate

CS Cases

Figure 43. Congenital syphilis (CS)—Reported cases for infants <1 year of age and rates of 

primary and secondary syphilis among women: United States, 1999–2008

CS cases (in thousands) P&S rate (per 100,000 women)

0.0

0.2

0.4

0.6

0.8

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

0

1

2

3

4

STD Surveillance 2008 National Profile: Other Sexually Transmitted Diseases 43

Other Sexually Transmitted 

Diseases (STDs)

Chancroid 

Since 1987, reported cases of chancroid declined 

steadily until 2001. Since then, the number of cases 

reported has fluctuated (Figure 44, Table 1). In 2008, 

25 cases of chancroid were reported in the United 

States. Only nine states reported one or more cases of 

chancroid in 2008 (Table 42). 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 since 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 (HPV)

Persistent infection with high-risk human 

papillomavirus (HPV) can lead to development of 

anogenital cancers (i.e., cervical cancer). In June 2006, 

a quadrivalent HPV vaccine was licensed for use in the 

United States. The vaccine provides protection against 

types 6, 11, 16, and 18. Types 6 and 11 are associated 

with genital warts while types 16 and 18 are oncogenic 

types associated with anogenital cancers.

Sentinel surveillance for cervical infection with highrisk HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 

56, 58, 59, or 68 was conducted in 26 STD, family 

planning and primary care clinics in six locations 

(Boston, Baltimore, New Orleans, Denver, Seattle 

and Los Angeles) as part of an effort to estimate 

national burden of disease and inform prevention 

efforts such as vaccine programs in the United States. 

Testing was performed using a commercially available 

test for high-risk HPV DNA (Hybrid Capture 2, 

Qiagen, Gaithersburg, MD). Results from 2003–2005 

document an overall high-risk HPV prevalence of 23%. 

Prevalence in STD clinics was 27%, 26% in family 

planning clinics, and 15% in primary care clinics. 

Prevalence by age group was 35% in those 14 to 19 

years of age; 29% in those 20 to 29 years of age; 13% 

in those 30 to 39 years of age; 11% in those 40 to 49 

years of age; and 6.3% in those 50 to 65 years of age.3

National population-based data were also obtained 

from NHANES, examining prevalence in the civilian, 

non-institutionalized female population of the 

United States, 2003–2004, of both high-risk HPV 

and low-risk HPV including types 6 and 11, which 

are responsible for approximately 90% of anogenital 

warts (Figure 45). The overall HPV prevalence of 

high- and low-risk types, was 26.8% (95% confidence 

interval (CI): 23.3–30.9) among U.S. females 14 to 

59 years of age. HPV vaccine preventable types 6 or 

11 (low-risk types) or 16 or 18 (high-risk types) were 

detected in 3.4% of female participants; HPV-6 was 

detected in 1.3% (95% CI: 0.8–2.3), HPV-11 in 

0.1% (95% CI: 0.03–0.3), HPV-16 in 1.5% (95% 

CI: 0.9–2.6), and HPV-18 in 0.8% (95% CI: 0.4–

1.5) of female participants.4

Data from the National Disease and Therapeutic 

Index (NDTI) suggest that incidence of genital warts 

(Figure 46) as measured by initial visits to physicians’ 

offices, may be increasing. The NHANES 1999–2004 

survey years demonstrated that 5.6% (95% CI: 4.9–

6.4) of sexually active 18–59 year olds self-reported a 

history of a genital wart diagnosis.5

Pelvic Inflammatory Disease (PID) 

For data on PID, see the Special Focus Profile on 

Women and Infants. 

Herpes Simplex Virus (HSV)

Case reporting data for genital HSV are not available. 

Trend data are based on estimates of the initial 

office visits in physicians’ office practices for these 

conditions from the NDTI (Figure 47 and Table 43).

National trend data on the seroprevalence of HSV-2

among those 14 to 49 years of age from the 

NHANES survey years 1999–2004 were compared 

with survey years 1988–1994. Seroprevelance 

decreased from 21% (95% CI: 19.1–23.1) in 1988–

1994 to 17.0% (95% CI: 15.8–18.3) in 1999–2004. 

These data along with data from NHANES survey 
44 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2008

years 1976–1980, indicate that blacks had higher 

seroprevalence than whites for each survey period and 

age group7 (Figure 48). In 1999–2004, the overall 

percentage of survey participants who reported having 

been diagnosed with genital herpes was 3.8%.6

While HSV-2 seroprevalence is decreasing, most persons 

with HSV-2 have not been diagnosed. Increasing visits 

for genital herpes, as suggested by NDTI data, may 

indicate increased recognition of infection.

Trichomoniasis

Case reporting data are not available for 

trichomoniasis and trend data for this infection is 

limited to estimates of initial physician office visits 

from NDTI (Figure 49 and Table 43). NHANES 

data from 2001–2004 demonstrated an overall 

prevalence of 3.1% (95% CI: 2.3–4.3), with the 

highest prevalence observed among blacks 13.3% 

(95% CI: 10.0–17.7).7

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, Ratelle S, et al. Human papillomavirus 

infection and cervical cytology in women screened for cervical 

cancer in the United States, 2003–2005. Ann Intern Med 2008 

Apr 1;148(7):493–500.

4 Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, 

Patel SS, Markowitz LE. Prevalence of HPV infection among 

females in the United States. JAMA 2007 Feb 28;297(8):813–9.

5 Dinh TH, Sternberg M, Dunne EF, Markowitz LE. Genital warts 

among 18- to 59-year-olds in the United States, national health 

and nutrition examination survey, 1999–2004. Sex Transm Dis

2008 Apr;35(4):357–60.

6 Xu F, Sternberg MR, Kottiri BJ, McQuillan G, Lee FK, Nahmias 

AJ, Berman SM, Markowitz LE. Trends in Herpes Simplex Virus 

Type 1 and Type 2 seroprevalence in the United States. JAMA

2006 Aug 23/30 (8):964–973.

7 Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman, 

S, Markowitz LE. The prevalence of Trichomonas vaginalis

infection among reproductive-age women in the United States, 

2001–2004. Clin Infect Dis 2007 Nov 15;45(10):1319–26.
STD Surveillance 2008 National Profile: Other Sexually Transmitted Diseases 45

Figure 44. Chancroid—Reported cases: United States, 1981–2008

Cases (in thousands)

0

1

2

3

4

5

1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007

0

5

10

15

20

25

30

35

40

45

14–19 20–24 25–29 30–39 40–49 50–59

Low-risk HPV

Figure 45. Human papillomavirus (HPV)—Prevalence of high-risk and low-risk types among 

females 14 to 59 years of age from a national survey, 2003–2004

Prevalence, %

NOTE: Error bars indicate 95% condence intervals. Both high-risk and low-risk HPV types were detected in some females.

SOURCE: National Health and Nutrition Examination Survey. JAMA, 2007;297:813–819. © 2007 American Medical Association. All rights reserved. 

High-risk HPV

Age
46 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2008

Figure 46. Genital warts—Initial visits to physicians’ offices: United States, 1966–2008

Visits (in thousands)

NOTE: See Appendix (Other Data Sources) and Table 43. The relative standard error for genital warts estimates range from 18% to 30%.

SOURCE: IMS Health, Integrated Promotional Services, IMS Health Report, 1966–2008 Hardcopy.

0

100

200

300

400

500

1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008

Figure 47. Genital herpes—Initial visits to physicians’ offices: United States, 1966–2008

Visits (in thousands)

NOTE: See Appendix (Other Data Sources) and Table 43. The relative standard error for genital herpes estimates range from 18% to 30%.

SOURCE: IMS Health, Integrated Promotional Services, IMS Health Report, 1966–2008 Hardcopy.

0

50

100

150

200

250

300

350

400

1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008
STD Surveillance 2008 National Profile: Other Sexually Transmitted Diseases 47

0

20

40

60

80

100

All Ages* 14–19 20–29 30–39 40–49

0

20

40

60

80

100

All Ages* 14–19 20–29 30–39 40–49

1976–1980

Figure 48. Genital herpes—Herpes simplex virus, type 2, seroprevalence in non-Hispanic 

whites and non-Hispanic blacks by age group from national surveys, 1976–1980, 

1988–1994, 1999–2004 

Percent

* Age-adjusted using the 2000 U.S. Census civilian, noninstitutionalized population aged 14 to 49 years as the standard.

NOTE: Error bars indicate 95% condence intervals.

SOURCE: National Health and Nutrition Examination Survey. JAMA 2006;296:964–973. © 2006 American Medical Association. All rights reserved. 

1988–1994 1999–2004

Percent

Non-Hispanic Blacks

Non-Hispanic Whites
48 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2008

Other Vaginitis

Trichomoniasis

Figure 49. Trichomoniasis and other vaginal infections in women—Initial visits to physicians’ 

offices: United States, 1966–2008

Visits (in thousands)

Note: See Appendix (Other Data Sources) and Table 43. The relative standard error for trichomoniasis estimates range from 16% to 27% and for other 

vaginitis estimates range from 8% to 13%.

SOURCE: IMS Health, Integrated Promotional Services, IMS Health Report, 1966–2008 Hardcopy.

0

900

1,800

2,700

3,600

4,500

1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008
SPECIAL FOCUS PROFILES
SPECIAL FOCUS PROFILES
STD Surveillance 2008 Special Focus Profiles 49

Special Focus Profiles

The Special Focus Profiles highlight trends and distribution of 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, racial and 

ethnic minorities, 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 (Figures A-FF) that highlight 

specific points made in the text.

STD Surveillance 2008 Special Focus Profiles: STDs in Women and Infant 51

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 PID, which, in turn, may lead to 

reproductive system morbidity such as ectopic 

pregnancy and tubal factor infertility. A substantial 

proportion of women with chlamydia or gonorrrhea 

may develop PID if not adequately treated, generally 

estimated to be from 10-20%, but ranging up to 

40%.1 Among women with PID, tubal scarring 

can cause involuntary infertility in 20%, ectopic 

pregnancy in 9%, and chronic pelvic pain in 18%.2

Approximately 70% of chlamydial infections 

and 50% of gonococcal infections in women are 

asymptomatic.3-5 These infections are detected 

primarily through screening. The vague symptoms 

associated with PID cause 85% of women to delay 

seeking medical care, thereby increasing the risk 

of infertility and ectopic pregnancy.6 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%.7

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 are causally related to 

cervical cancer; these types also cause Pap smear 

abnormalities. Other types cause genital warts, low 

grade Pap smear abnormalities and, rarely, recurrent 

respiratory papillomatosis in infants born to infected 

mothers.8

Direct Impact on Pregnancy

Gonorrhea and chlamydia can result in adverse 

outcomes of pregnancy, including neonatal 

ophthalmia and, in the case of chlamydia, neonatal 

pneumonia. Although topical prophylaxis of infants 

at delivery is effective for prevention of gonococcal 

ophthalmia neonatorum, prevention of neonatal 

pneumonia requires prenatal detection and treatment.

Genital infections with HSV are extremely common, 

may cause painful outbreaks, and may have serious 

consequences for pregnant women.9

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.10

Observations

Chlamydia—United States 

Between 2007 and 2008, the rate of chlamydial 

infections in women increased from 539.8 to 583.8 

per 100,000 females (Figure 1, Table 4). Chlamydia 

rates exceeded gonorrhea rates among women in all 

states (Figures A and C, Tables 4 and 14).

Prevalence Monitoring Project

Prenatal Clinics—In 2008, the median statespecific chlamydia test positivity among 15- to 

24-year-old women screened in selected prenatal 

clinics in 22 states, Puerto Rico, and the Virgin 

Islands was 7.9% (range: 1.8% to 19.2%) (Figure B). 

Family Planning Clinics—In 2008, 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 50 states, the 

District of Columbia, Puerto Rico, and the Virgin 

Islands was 7.4% (range: 3.1% to 15.0%) (Figures 9 

and 10).

Gonorrhea—United States

Like chlamydia, gonorrhea is often asymptomatic 

in women. Gonorrhea screening, therefore, is an 

important strategy for the identification of gonorrhea 

among women. Large-scale screening programs for 

gonorrhea in women began in the 1970s. After an 

initial increase in cases detected through screening, 

gonorrhea rates for both women and men declined 

steadily throughout the 1980s and early 1990s, and 
52 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2008

then reached a plateau (Figure 13). The gonorrhea 

rate for women (119.4 per 100,000 females) 

decreased slightly in 2008 for the first time in four 

years (Figure 14, Table 14).

Although the gonorrhea rate in men has historically 

been higher than the rate in women, the gonorrhea 

rate among women has been comparable to the rate 

among men for eight consecutive years (Figure 14 

and Tables 14 and 15).

Prevalence Monitoring

Prenatal Clinics—In 2008, the median statespecific gonorrhea test positivity among 15- to 

24-year-old women screened in selected prenatal 

clinics in 20 states, Puerto Rico, and the Virgin 

Islands was 1.0% (range: 0.0% to 5.0%) (Figure D). 

Family Planning Clinics—In 2008, the median 

state-specific gonorrhea test positivity among 15- to 

24-year-old women who were screened during visits 

in selected family planning clinics in 43 states, the 

District of Columbia, Puerto Rico, and the Virgin 

Islands was 0.9% (range: 0.0% to 3.8%) (Figure 23). 

Congenital Syphilis

Trends in congenital syphilis usually follow trends 

in P&S syphilis among women, with a lag of one 

to two years (Figure 43). The congenital syphilis 

rate peaked in 1991 at 107.3 cases per 100,000 

live births, and declined by 92.4% to 8.2 cases per 

100,000 live births in 2005 (Table 40). The rate of 

P&S syphilis among women declined 95.0% (from 

17.3 to 0.8 cases per 100,000 females) between 1990 

and 2004 (Figure 31). However, the rate in women 

has increased since 2004. The rate of P&S syphilis in 

2008 was 1.5 cases per 100,000 women (Table 26). 

The highest rates of P&S syphilis in women are 

observed in the South (Figure E).

After 14 years of decline, the rate of congenital 

syphilis increased 6.1% between 2005 and 2006 

(from 8.2 to 8.7 cases per 100,000 live births) 

(Table 40), and 16.1% between 2006 and 2007 (from 

8.7 to 10.1 cases per 100,000 live births) (Table 40). 

The rate for 2008 remained unchanged from 2007. 

The highest of rates of congenital syphilis are observed 

in the South and West (Figure F). 

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.11

Pelvic Inflammatory Disease (PID) 

Accurate estimates of PID and tubal factor infertility 

resulting from gonococcal and chlamydial infections 

are difficult to obtain. Definitive diagnoses of these 

conditions can be complex. Hospitalizations for PID 

have declined steadily throughout the 1980s and 

early 1990s,12,13 but have remained relatively constant 

between 2000 and 2006, the most recent year for 

which these data are available (Figure G).

The estimated number of initial visits to physicians’ 

offices for PID from the NDTI has generally declined 

from 2000 through 2008 (Figure H and Table 43).

Racial disparities in diagnosed PID have been 

observed in both ambulatory and hospitalized 

settings. Black women had rates of disease that were 

two to three times those in white women. These 

disparities are consistent with the marked racial 

disparities observed for chlamydia and gonorrhea; 

however, because of the subjective methods by which 

PID is diagnosed, racial disparity data should be 

interpreted with caution.13

Ectopic Pregnancy

Evidence suggests that health care practices associated 

with clinical management of 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. From 1997 to 2006, 

hospitalizations for ectopic pregnancy have remained 

generally stable (Figure I). As of the date of 

publication of this report, 2007 data are not available. 

Data suggest that nearly half of all ectopic pregnancies 

are treated on an outpatient basis.14
STD Surveillance 2008 Special Focus Profiles: STDs in Women and Infant 53

1 Paavonen J, Westrom L, Eschenbach D. Pelvic inflammatory 

disease. In: Holmes KK, Sparling PF, Stamm WE et al, eds. Sex 

Transm Dis, 4th edition. New York City: McGraw-Hill, Inc, 

2008:1017-1050.

2 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. Sex Transm Dis 1992;9:185–92.

3 Hook EW III, Handsfield HH. Gonococcal infections in the 

adult. In: Holmes KK, Sparling PF, Mardh PA, , et al, eds. Sex 

Transm Dis, 3rd edition. New York, New York: McGraw-Hill, 

1999.

4 Stamm WE, Holmes KK. Chlamydia trachomatis infections in 

the adult. In: Holmes KK, Mardh PA, Sparling PF, et al, eds. 

Sex Transm Dis, 2nd edition. New York City: McGraw-Hill, Inc, 

1990:181–93.

5 Zimmerman HL, Potterat JJ, Dukes RL, et al. Epidemiologic 

differences between chlamydia and gonorrhea. Am J Public Health

1990;80:1338–42.

6 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.

7 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.

8 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.

9 Kimberlin DW. Herpes simplex virus infections of the newborn. 

Seminars in Perinatology 2007 February;31(1):19-25.

10 Centers for Disease Control. Guidelines for prevention and 

control of congenital syphilis. MMWR 1988;37(No.S-1)

11 Centers for Disease Control and Prevention. Congenital syphilis–

United States, 2002. MMWR 2004;53:716–9.

12 Rolfs 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.

13 Sutton MY, Sternberg M, Zaidi A, St. Louis ME, Markowitz LE. 

Trends in pelvic inflammatory disease hospital discharges and 

ambulatory visits, United States, 1985–2001. Sex Transm Dis

2005;32(12)778–784.

14 Centers for Disease Control and Prevention. Ectopic pregnancy 

in the United States, 1990–1992. MMWR 1995;44:46–8.
54 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2008

480

394

570

567

466

990

Puerto Rico

285

Virgin

Islands

776

Guam

674

405 274

617

478

907

660

409

304

700

392

547

461

393

541

1085

786

650

562

662

590

596

660

513

650

602

608

782

736

661

399

573 269

580

455

529

Figure A. Chlamydia—Rates among women by state: United States and outlying areas, 2008

NOTE: The total chlamydial infection rate among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 580.0 per 

100,000 female population.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 284

 232

 381

 440

 515

 406

 626

 667

1431

Rate per 100,000

population

694

<400.0 (n=11)

400.1–600.0 (n=21)

>600.0 (n=22)

4.5

Puerto Rico

15.1

Virgin

Islands

19.2

Guam

3.8

9.9

11.3

5.8

10.4

14.4

7.0

7.5

9.2

9.1

4.0

8.2

6.7

15.6

11.2

11.3

3.6

1.8

5.5

6.5

Figure B. Chlamydia—Positivity in 15- to 24-year-old women tested in prenatal clinics by

state: United States and outlying areas, 2008

* States/areas not meeting minimum inclusion criteria in prenatal clinics.

NOTE: Includes states and outlying areas that reported chlamydia positivity data on at least 100 women aged 15 to 24 years during 2008.

DATA SOURCE: Prevalence Monitoring Project (Regional Infertility Prevention Projects), Office of Population Affairs, Local and State STD Control Programs, Centers for Disease 

Control and Prevention. 

VT

NH

MA

RI

CT

NJ

DE

MD

DC

3.3

See* (n=29)

Positivity (%)

<5.0 (n=6)

5.0–9.9 (n=10)

>10.0 (n=8)
STD Surveillance 2008 Special Focus Profiles: STDs in Women and Infant 55

46.9

29.3

63.6

80.4

19.2

97.7

Puerto Rico

6.2

Virgin

Islands

149.0

Guam

68.1

29.2 6.4

84.0

97.3

252.3

142.2

12.1

10.5

78.4

27.5

61.8

99.5

63.5

132.9

289.5

234.0

179.1

132.3

191.6

148.9

166.5

196.5

157.1

152.4

151.0

162.0

234.5

174.3

174.0

116.1

82.0 46.0

49.8

67.7

104.2

Figure C. Gonorrhea—Rates among women by state: United States and outlying areas, 2008

NOTE: The total gonorrhea infection rate among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 117.8 per 

100,000 female population.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 6.0

 7.4

 33.1

 24.7

 93.9

 63.4

136.0

124.3

405.9

Rate per 100,000

population

<19.0 (n=6)

19.1–100.0 (n=24)

>100.0 (n=24)

46.7

Puerto Rico

0.4

Virgin

Islands

3.3

Guam

396

0.1

1.0

1.6

0.0

2.2

2.7

1.1

1.3

2.6

0.0

0.8

0.0

1.0

5.0

2.3

1.8

0.4

0.4

0.0

0.6

Figure D. Gonorrhea—Positivity in 15- to 24-year-old women tested in prenatal clinics by

state: United States and outlying areas, 2008

* States/areas not meeting minimum inclusion criteria in prenatal clinics.

NOTE: Includes states and outlying areas that reported gonorrhea positivity data on at least 100 women aged 15 to 24 years during 2008.

DATA SOURCE: Prevalence Monitoring (Regional Infertility Prevention Projects), Office of Population Affairs, Local and State STD Control Programs, Centers for Disease 

Control and Prevention.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

See* (n=31)

Positivity (%)

<1.0 (n=10)

1.0–1.9 (n=6)

>2.0 (n=6)
56 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2008

0.2

0.1

0.6

1.1

0.2

0.0

Puerto Rico

1.4

Virgin

Islands

0.0

Guam

1.2

0.0 0.0

0.5

0.3

0.5

3.8

0.1

0.1

0.6

0.8

0.3

0.3

0.2

0.5

4.4

7.2

2.0

2.1

0.9

0.6

1.1

1.2

0.5

3.8

1.0

1.4

13.9

5.6

0.6

0.6

0.1 0.4

1.8

0.2

0.4

Figure E. Primary and secondary syphilis—Rates among women by state: United States and 

outlying areas, 2008

NOTE: The total rate of P&S syphilis among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 1.5 per 100,000 

female population.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

0.0

0.0

0.2

0.0

0.0

0.5

1.3

2.7

2.3

Rate per 100,000

population

<0.2 (n=17)

0.21–4.0 (n=33)

>4.0 (n=4)

1.1

0.0

0.0

11.0

22.5

0.0

0.0

Puerto Rico

16.5

Virgin

Islands

0.0

Guam

0.0

0.0 0.0

9.2

5.4

3.2

31.8

0.0

0.0

13.4

0.0

0.0

0.0

0.0

1.4

0.0

19.0

7.4

7.2

7.8

3.7

2.0

7.8

0.0

11.9

2.5

5.6

36.3

22.0

11.1

1.7

0.0 4.8

29.3

0.0

0.0

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

outlying areas, 2008

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 

10.2 per 100,000 live births.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 0.0

 0.0

 0.0

 0.0

 4.8

 3.5

 0.0

29.7

 0.0

Rates per 100,000

live births

<1.0 (n=26)

1.1–10.0 (n=16)

>10.0 (n=12)

0.0
STD Surveillance 2008 Special Focus Profiles: STDs in Women and Infant 57

Chronic

Acute, Unspecied

Figure G. Pelvic inflammatory disease—Hospitalizations of women 15 to 44 years of age: 

United States, 1997–2006

Hospitalizations (in thousands)

NOTE: The relative standard error for these estimates of the total number of acute unspecied PID cases ranges from 11.9% to 17.2%. The relative

standard error for these estimates of the total number of chronic PID cases ranges from 11% to 18%. Data only available through 2006.

SOURCE: National Health Statistics Report, 2006 National Hospital Discharge Survey. 2008 July. Report Number 5. Atlanta: Centers for Disease Control and Prevention.

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

0

15

30

45

60

75

Figure H. Pelvic inflammatory disease—Initial visits to physicians’ offices by women 15 to 44 

years of age: United States, 1999–2008

Visits (in thousands)

NOTE: The relative standard error for these estimates range from 21.6% to 29%. See Appendix (Other Data Sources) and Table 43.

SOURCE: IMS Health, Integrated Promotional Services, IMS Health Report, 1966–2008 Hardcopy.

0

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

60

120

180

240

300
58 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2008

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

United States, 1997–2006

Hospitalizations (in thousands)

NOTE: The relative standard error for these estimates is 14.2%. Data only available through 2006.

SOURCE: National Health Statistics Report, 2006 National Hospital Discharge Survey. 2008 July. Report Number 5. Atlanta: Centers for Disease Control and

Prevention.

0

10

20

30

40

50

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
STD Surveillance 2008 Special Focus Profiles: STDs in Adolescents and Young Adults 59

STDs in Adolescents and Young Adults

Public Health Impact

Compared to older adults, sexually-active adolescents 

15 to 19 years of age and young adults 20 to 24 

years of age are at higher risk for acquiring STDs 

for a combination of behavioral, biological, 

and cultural reasons. For some STDs, such as 

Chlamydia trachomatis, adolescent women may 

have a physiologically increased susceptibility to 

infection due to increased cervical ectopy. The higher 

prevalence of STDs among adolescents may also 

reflect multiple barriers to accessing 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. Estimates suggest that 

while representing 25% of the sexually experienced 

population, 15- to 24-year-olds acquire nearly half of 

all new STDs.1

Observations

Chlamydia

Chlamydia rates for persons 15 to 19 and 20 to 24 

years of age continue to increase, as they have for all 

age groups. Between 2007 and 2008, the increase for 

those 15 to 19 years of age was 10.7%, and for those 

20 to 24 years of age was 8.9% (Table 10).

15- to 19-Year-Old Women—As in previous 

years, in 2008, 15- to 19-year-old women had the 

highest rate of chlamydia compared to any other age/

sex group (Figure 5 and Table 10). Chlamydia rates 

for 15- to 19-year-old women increased 9.8% from 

2,982.5 per 100,000 population in 2007 to 3,275.8 

per 100,000 population in 2008.

20- to 24-Year-Old Women—In 2008, as in 

previous years, 20- to 24-year-old women had 

the second highest rate of chlamydia (3,179.9 per 

100,000 population) compared to any other age/sex 

group. Chlamydia rates in women of this age group 

increased 7.6% from 2007 to 2008.

15- to 19-Year-Old Men—Chlamydia rates for 15- 

to 19-year-old men increased 14.8% from 611.0 per 

100,000 population in 2007 to 701.6 per 100,000 

population in 2008.

20- to 24-Year-Old Men—As in previous years, 

in 2008, 20- to 24-year old men had the highest 

rate of chlamydia among men (1,056.1 per 100,000 

population). Chlamydia rates in men of this age 

group increased 12.6% from 2007 to 2008.

Gonorrhea

In 2008 gonorrhea rates for persons 15 to 19 and 20 

to 24 years of age decreased for the first time in four 

years. Between 2007 and 2008, the decrease for those 

15 to 19 years of age was 1.3%, and for those 20 to 

24 years of age, it was 2.5% (Table 20).

15- to 19-Year-Old Women—In 2008, as in previous 

years, 15- to 19-year-old women had the highest rate of 

gonorrhea (636.8 per 100,000 population) compared 

to any other age/sex group (Figure 19 and Table 20). 

Gonorrhea rates in women of this age group decreased 

1.0% from 2007 to 2008. This is the first decrease in 

this age group in the past four years.

20- to 24-Year-Old Women—In 2008, as in 

previous years, 20- to 24-year-old women had 

the second highest rate of gonorrhea (608.6 per 

100,000 population) compared to any other age/sex 

group. Gonorrhea rates in women of this age group 

decreased 1.2% from 2007 to 2008. This is the first 

decrease in this age group in the past four years.

15- to 19-Year-Old Men—In 2008 gonorrhea rates 

for 15- to 19-year-old men decreased 2.0% from 284.1 

per 100,000 population in 2007 to 278.3 per 100,000 

population. This is the first decrease in this age group 

in the past four years. (Figure 20, Table 20).

20- to 24-Year-Old Men—In 2008, as in previous 

years, 20- to 24-year old men had the highest rate 

of gonorrhea among men (433.6 per 100,000 

population). Gonorrhea rates in men of this age 

group declined 4.2% between 2007 and 2008.
60 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2008

Primary and Secondary Syphilis 

Syphilis rates among 15- to 19-year old women have 

increased annually since 2004 from 1.5 cases per 

100,000 population to 3.0 per 100,000 population 

in 2008. Rates in women have been highest each 

year in the 20 to 24 year age group with 5.1 cases per 

100,000 population in 2008 (Figures 35 and 36 and 

Table 33). 

Rates among 15- to 19-years olds are much lower than 

those in men in older age groups (Figure 35). However, 

rates in this group have increased since 2002 from 1.3 

cases per 100,000 population to 3.8 in 2007 and 5.3 

in 2008. Men in the 20 to 24 year old age group had 

the highest rate of syphilis, 17.3 cases per 100,000 

population in 2008 (Figure 35, Table 33).

Prevalence Monitoring

Chlamydia test positivity among 15- to 19-year-old 

women screened in family planning clinics fluctuated 

in all 10 DHHS regions between 2004 and 2008 

(Figure J). Positivity has remained fairly stable in four 

regions (II, III, V, X). In the remaining six regions, 

positivity rates increased slightly over this five-year 

time frame. The positivity rates presented in Figure J 

are not adjusted for changes in laboratory test 

methods and associated increases in test sensitivity.

National Job Training Program 

Since 1990, approximately 20,000 female National 

Job Training Program entrants have been screened 

each year for chlamydia. Since 2004, approximately 

35,000 male entrants have been screened annually. 

This program, administered at more than 100 sites 

throughout the country, is a job training program 

for socioeconomically-disadvantaged youth 16 to 

24 years of age. The data presented are from locales 

where more than 100 persons were screened in 2008.

Chlamydial infection is widespread geographically 

and highly prevalent among socioeconomicallydisadvantaged young women and men entering the 

National Job Training Program.2-4 Specimens from 

students in each state and outlying area were tested by 

a single national contract laboratory.* Among women 

entering the program from 39 states, the District of 

Columbia, and Puerto Rico, the median state-specific 

chlamydia prevalence was 12.8% (range: 5.4% to 

20.8%) (Figure K). Among men entering the program 

from 48 states, the District of Columbia, and Puerto 

Rico, the median state-specific chlamydia prevalence 

was 7.0% (range: 0.8% to 14.4%) (Figure L).

Data from National Job Training Program centers 

that submit gonorrhea specimens from female 

students aged 16 to 24 years to the national contract 

laboratory indicated a high prevalence of gonococcal 

infection in this population. Among women entering 

the program from 37 states, the District of Columbia, 

and Puerto Rico, the median state-specific gonorrhea 

prevalence was 2.7% (range: 0.0% to 5.0%) in 2008 

(Figure M). Among men entering the program from 

34 states, the District of Columbia, and Puerto Rico, 

the median state-specific gonorrhea prevalence was 

0.8% (range: 0.0% to 2.8%) (Figure N).

Juvenile Corrections Facilities

Among adolescent women entering juvenile 

corrections facilities, the median facility-specific 

chlamydia positivity rate was 13.8% (range: 1.0% to 

33.1%) (Table A) and a median gonorrhea positivity 

rate of 3.6% (range: 0.0% to 19.0%) (Table C). 

Among adolescent men entering juvenile corrections 

facilities, the median facility-specific chlamydia 

positivity rate was 6.1% (range: 0.6% to 13.6%) 

and the median gonorrhea positivity rate was 0.9% 

(range: 0.0% to 4.4%). See Special Focus Profiles

(STDs in Persons Entering Corrections Facilities) for 

additional details.

* Laboratory data are provided by the Center for Disease 

Detection, San Antonio, Texas.

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 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.

3 Joesoef MR, Mosure DJ. Prevalence of chlamydia in young 

men in the United States from newly implemented universal 

screening in a National Job Training Program. Sex Transm Dis

2006;33(10):636–639.

4 Joesoef MR, Mosure DJ. Prevalence of chlamydia in young 

women entering the National Job Training Program 1998–2004.

Sex Transm Dis 2006;33(9):571–575.
STD Surveillance 2008 Special Focus Profiles: STDs in Adolescents and Young Adults 61

NOTE: See Appendix for definitions of DHHS Regions.

DATA SOURCE: Prevalence Monitoring Project (Regional Infertility Prevention Projects), Office of Population Affairs, Local and State STD Control Programs, Centers for Disease 

Control and Prevention.

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

planning clinics by HHS region, 2004–2008

IV

VII IX

I II

X

III

VI

V

VIII

Region I

Region II

Region III

Region IV

Region V

Region VI Region VII

Region VIII

Region IX

Region X

4.9

04

5.4

05

5.5

06

5.6

07

5.8

08

9.1

04

7.3

05

7.3

06

7.6

07

8.3

08

7.3

04

7.1

05

6.5

06

6.8

07

7.9

08

10.0

04

10.7

05

11.0

06

11.7

07

11.9

08

8.6

04

9.0

05

8.9

06

9.0

07

9.3

08

9.0

04

9.2

05

10.2

06

10.7

07

12.6

08

6.8

04

6.7

05

7.5

06

7.6

07

7.9

08

6.5

04

6.6

05

7.7

06

8.1

07

8.7

08

7.9

04

7.4

05

8.3

06

9.0

07

9.3

08

6.9

04

6.5

05

6.6

06

6.8

07

7.2

08

8.5

7.0

8.4

12.9

8.2

9.4

Puerto Rico

11.3

Virgin

Islands

Guam

11.0 5.4

12.7

9.6

20.1

14.1

7.5

19.8

19.0

18.1

14.8

14.9

10.4

15.4

17.2

11.0

20.7

14.3

13.7

20.8

17.2

16.0

12.3

10.1

11.6

14.6

Figure K. Chlamydia—Prevalence among 16- to 24-year-old women entering the National Job 

Training Program by state of residence: United States and outlying areas, 2008

* Less than 100 women residing in these states/areas and entering the National Job Training Program were screened for chlamydia in 2008.

SOURCE: National Job Training Program, Department of Labor (in collaboration with the Center for Disease Detection, San Antonio, Texas).

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 8.5

 6.5

12.1

13.1

10.4

13.3

18.6

See* (n=12)

Prevalence (%)

<10.0 (n=10)

10.0–14.9 (n=20)

12.8 >15.0 (n=11)
62 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2008

3.6

4.2

4.2

7.7

5.3

6.6

Puerto Rico

4.0

Virgin

Islands

Guam

396

3.3 4.9

7.8

6.7

12.0

10.1

3.2

1.8

6.9

5.0

3.1

4.5

3.3

14.4

8.2

11.2

8.6

8.6

8.4

11.0

9.5

8.7

12.5

7.0

7.4

10.5

10.9

10.1

9.2

5.6 7.1

4.9

4.2

8.2

Figure L. Chlamydia—Prevalence among 16- to 24-year-old men entering the National Job 

Training Program by state of residence: United States and outlying areas, 2008

* Less than 100 men residing in these states/areas and entering the National Job Training Program were screened for chlamydia in 2008.

SOURCE: National Job Training Program, Department of Labor (in collaboration with the Center for Disease Detection, San Antonio, Texas).

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 4.2

 3.7

 0.8

 6.6

10.0

 5.2

 9.1

12.9

See* (n=3)

Prevalence (%)

<10.0 (n=38)

10.0–14.9 (n=12)

12.3 >15.0

1.3

0.0

0.8

0.4

1.0

0.0

Puerto Rico

0.4

Virgin

Islands

Guam

396

1.8 1.3

1.0

1.2

2.8

3.5

2.8

4.8

3.7

3.0

2.7

3.4

5.0

3.1

4.0

3.8

3.1

2.7

2.9

4.1

4.7

2.6

1.8

0.0

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

Job Training Program by state of residence: United States and outlying areas, 2008

* Less 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 2008.

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.

SOURCE: National Job Training Program, Department of Labor (in collaboration with the Center for Disease Detection, San Antonio, Texas).

VT

NH

MA

RI

CT

NJ

DE

MD

DC

1.1

0.7

3.0

2.0

1.6

2.5

2.9

See* (n=14)

Prevalence (%)

<2.0 (n=16)

2.0–4.9 (n=21)

5.0 >5.0 (n=2)
STD Surveillance 2008 Special Focus Profiles: STDs in Adolescents and Young Adults 63

0.4

0.0

0.3

0.2

0.0

Puerto Rico

0.0

Virgin

Islands

Guam

396

0.3

0.5

0.0

2.8

0.7

0.8

0.0

0.0

1.7 2.2

0.7

1.4

1.9

1.3

1.3

1.2

1.7

1.5

0.4

1.6

2.6

1.2

0.0 0.8

Figure N. Gonorrhea—Prevalence among 16- to 24-year-old men entering the National Job 

Training Program by state of residence: United States and outlying areas, 2008

* Less 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 2008.

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.

SOURCE: National Job Training Program, Department of Labor (in collaboration with the Center for Disease Detection, San Antonio, Texas).

VT

NH

MA

RI

CT

NJ

DE

MD

DC

0.3

0.0

0.0

1.6

1.0

1.0

See* (n=17)

Prevalence (%)

<2.0 (n=33)

2.0–4.9 (n=3)

>5.0

STD Surveillance 2008 Special Focus Profiles: STDs in Racial and Ethnic Minorities 65

STDs in Racial and Ethnic Minorities

Public Health Impact

Surveillance data show higher rates of reported 

STDs among some 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.

STD Reporting Practices

Surveillance data are based on cases of STDs reported 

to state and local health departments (see Appendix 

(Interpreting STD Surveillance Data)). In many 

state and local health jurisdictions, reporting from 

public sources, (for example, STD clinics) is thought 

to be 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. However, prevalence data from 

population-based surveys such as NHANES and 

Add Health confirm the existence of marked STD 

disparities.1,2

Completeness of Race/Ethnicity Data

To adjust for missing case report data, cases for which 

information is unknown are redistributed according to 

the distribution of cases in which race or ethnicity is 

known. This process may exacerbate any reporting bias.

Chlamydia—In 2008, 26.4% of reports on 

chlamydia cases were missing race or ethnicity data 

ranging by state from 0.0% to 59.7% (Table A1).

Gonorrhea—In 2008, 20.3% of reports on 

gonorrhea cases were missing information on race or 

ethnicity data ranging by state from 0.0% to 39.8%.

Syphilis—In 2008, only 3.2% of reports on syphilis 

cases were missing information on race or ethnicity 

data ranging from 0.0% to 18.2% among states with 

10 or more cases of P&S syphilis.

Observations

Chlamydia

All racial and ethnic groups reported increases in 

chlamydia rates from 2007 to 2008 (Table 11B). 

From 2004 to 2008, chlamydia rates increased by 

27.0% among blacks, 15.6% among American 

Indian/Alaska Natives, 21.1% among Hispanics, 

8.7% among Asian/Pacific Islanders, and 20.9% 

among whites. 

Blacks—In 2008, approximately 49% of all reported 

chlamydia cases occurred among blacks (Table 11A). 

Overall, the rate of chlamydia among blacks in the 

United States was more than eight times that among 

whites. The rate of chlamydia among black women 

was nearly eight times higher than the rate among 

white women (2,056.9 and 264.4 per 100,000 

women, respectively) (Figure O, Table 11B). The 

chlamydia rate among black men was almost 12 times 

as high as the rate among white men (928.8 and 79.4 

per 100,000 men, respectively).

American Indian/Alaska Natives—In 2008, 

the chlamydia rate among American Indian/Alaska 

Natives was 808.8 cases per 100,000 population, an 

increase of 11.5% from the 2007 rate of 725.7. In 

the most recent data available (2007), the chlamydia 

positivity rate among females aged 15–24 years 

screened in Indian Health Service (IHS) clinics 

ranged from 8.1% in DHHS region V to 11.6% in 

region VIII.

Asian/Pacific Islanders—In 2008, the chlamydia 

rate among Asian/Pacific Islanders was 151.9 cases per 

100,000 population, a slight increase from the 2007 

rate of 137.1.
66 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2008

Hispanics—In 2008, the chlamydia rate among 

Hispanics was 510.4 cases per 100,000 population, 

nearly three times higher than the rate among whites 

(173.6).

Gonorrhea

Between 2007 and 2008 decreases in gonorrhea rates 

were seen in whites, blacks, and Hispanics (decreases 

of 10.7%, 4.7%, and 0.9%, respectively). Increases 

were seen in Asian/Pacific Islanders and American 

Indian/Alaska Natives (8.1% and 4.0%, respectively) 

(Table 21B and Figure 21).

Blacks—In 2008, approximately 71% of the total 

number of reported cases of gonorrhea occurred 

among blacks (Table 21A). In 2008, the rate of 

gonorrhea among blacks was 625.0 cases per 100,000 

population. Overall, the rate of gonorrhea among 

blacks in the United States was 20 times greater than 

that among whites. This disparity has changed little 

in recent years (20 times higher in 2003, 19 times in 

2007) (Figure P, Table 21B). This disparity was higher 

for black men (27.6 times higher) than for black 

women (16.0 times higher) (Figure Q). As in 2007, 

the disparity in gonorrhea rates for blacks in 2008 

was higher in the Midwest and Northeast (28.4 and 

28.1 times higher, respectively) than in the South or 

the West (15.6 and 14.0 times higher, respectively) 

(Figure R).

In 2008, gonorrhea rates were highest for blacks 15 

to 19 and 20 to 24 years of age considering all racial, 

ethnic, and age categories. Black women 15 to 19 

years of age had a gonorrhea rate of 2,934.6 cases per 

100,000 women. This rate was 16.2 times greater 

than the rate among white women in the same age 

category (181.3). Black men in the 15- to 19-year-old 

age category had a 2008 gonorrhea rate of 1,488.6 

cases per 100,000 men, which was 40.7 times higher 

than the rate among 15- to 19-year-old white men of 

36.6 per 100,000 men. Among men and women aged 

20 to 24 years, the gonorrhea rate among blacks was 

17.1 times greater than that among whites (2,556.0 

and 149.1 cases per 100,000 population, respectively) 

(Table 21B).

American Indian/Alaska Natives—In 2008 

the gonorrhea rate among American Indian/Alaska 

Natives was 110.2 which was 3.6 times higher than 

the rate among whites. This disparity was similar 

to that in recent years (3.5 times higher in 2004) 

(Figure P, Table 21B). It was higher for American 

Indian/Alaska Native women (3.7 times higher) 

than for American Indian/Alaska Native men (3.3 

times higher) (Figure Q). In 2008, the disparity in 

gonorrhea rates for American Indian/Alaska Natives 

continued to be higher in the Midwest and the 

Northeast (4.4 and 4.1 times higher, respectively) 

than in the West or the South (3.5 and 2.8 times, 

respectively) (Figure R).

Asian/Pacific Islanders—In 2008 the gonorrhea 

rate among Asian/Pacific Islanders was 20.0 cases per 

100,000 population which was lower than the rate 

among whites (Figure P, Table 21B). This difference 

is greater for Asian/Pacific Islander women than for 

Asian/Pacific Islander men (Figure Q). In 2008 rates 

among Asian/Pacific Islanders were again consistently 

lower than among whites in all four regions of the 

U.S. (Figure R).

Hispanics—In 2008, the gonorrhea rate among 

Hispanics was 66.8 cases per 100,000 population 

which was higher than the rate among whites. This 

disparity was similar to that in recent years (Figure 

P, Table 21B) and was higher for Hispanic men 

than for Hispanic women (Figure Q). The disparity 

in gonorrhea rates for Hispanics was higher in the 

Northeast (4.2 times higher) than in the Midwest 

(2.7 times higher), the South (2.0 times higher), or 

the West (1.8 times higher) (Figure R).

Primary and Secondary Syphilis

The syphilis epidemic in the late 1980s occurred 

primarily among heterosexual and minority 

populations.3,4 During the 1990s, the rate of P&S 

syphilis declined among all racial and ethnic groups 

(Figure 36). Between 2004 and 2008, the rate of 

P&S syphilis increased among all racial and ethnic 

groups except for American Indian/Alaska Natives 

(Table 34B).
STD Surveillance 2008 Special Focus Profiles: STDs in Racial and Ethnic Minorities 67

Blacks—Between 2007 and 2008, the rate of P&S 

syphilis among blacks increased 25.4% (from 13.8 

cases per 100,000 population to 17.3 cases per 

100,000 population). In 2008, 48.9% of all cases of 

P&S syphilis reported to CDC were among blacks and 

33.1% of all cases were among non-Hispanic whites 

(Table 34A). Compared to whites, the overall 2008 rate 

for blacks was 7.9 times higher. It was 6.9 times higher 

in 2007 (Table 34B). In 2008, the P&S rate among 

black men was 7.0 times higher than that among white 

men; the rate among black women was over 15 times 

higher than that among white women (Figure S). In 

some age groups, particularly 15–19 year old black 

men and women, disparities have increased markedly 

in recent years as rates of disease have increased 

(Figures T and U). Among black men 15-24 years old, 

rates increased 3-fold from 2004 to 2008, the fastest 

rate of increase for any age or race/ethnicity group over 

this time period (Table 34B). Overall, the 2008 rate 

among men 15-19 years of age was 22 times higher for 

blacks than for whites. Among black women 15-24 

years of age, rates increased about two-fold between 

2004 and 2008. In 2008, rates were 15 times higher 

for black women 15-19 years of age than for white 

women of the same age.

Recent trends in young black men are of particular 

concern given data indicating high HIV incidence in 

this population.5

American Indian/Alaska Natives—Between 

2007 and 2008, the rate of P&S syphilis among 

American Indian/Alaska Natives decreased 32.4% 

(from 3.4 to 2.3). In 2008, 0.4% of all cases of P&S 

syphilis reported to CDC were among American 

Indian/Alaska Natives (Table 34A).

Compared to whites, the 2008 rate for American 

Indian/Alaska Natives was comparable (Table 34B).

Asian/Pacific Islanders—Between 2007 and 2008, 

the rate of P&S syphilis among Asian/Pacific Islanders 

increased 25.0% (from 1.2 to 1.5 per 100,000 

population). In 2008, 1.6% of all cases of P&S 

syphilis reported to CDC were among Asian/Pacific 

Islanders (Table 34A). The 2008 rate for Asian/Pacific 

Islanders was 0.7 times the rate for whites (Table 

34B).

Hispanics—Between 2007 and 2008, the rate of 

P&S syphilis among Hispanics increased 11.9% 

(from 4.2 to 4.7). In 2008, 15.9% of all cases of P&S 

syphilis reported to CDC were among Hispanics 

(Table 34A). Compared to whites, the 2008 rate for 

Hispanics was 2.1 times higher (Table 34B).

Congenital Syphilis

In 2008, the rate of congenital syphilis (based on the 

mother’s race/ethnicity) was 34.6 cases per 100,000 

live births among blacks and 12.8 cases per 100,000 

live births among Hispanics. These rates are 12.4 

and 4.6 times higher, respectively, than the 2008 

rate among whites (2.8 cases per 100,000 live births) 

(Figure V, Table 41).

1 Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, 

McQuillan G, et al. Gonorrhea and chlamydia in the United 

States among persons 14 to 39 years of age, 1999 to 2002. Ann 

Intern Med 2007; 147(2):89–96.

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

Hobbs MM et al. Prevalence of chlamydial and gonococcal 

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

291(18):2229–2236.

3 Nakashima AK, Rolfs RT, Flock ML, Kilmarx P, Greenspan JR. 

Epidemiology of syphilis in the United States, 1941 through 

1993. Sex Transm Dis 1996;23:16–23.

4 Peterman TA, Heffelfinger JD, Swint EB, Groseclose SL. The 

changing epidemiology of syphilis. Sex Transm Dis 2005;32:S4-

S10.

5 Centers for Disease Control and Prevention. Subpopulation 

estimates from the HIV incidence surveillance system–United 

States, 2006. MMWR 2008;57:985–989.
68 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2008

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

AI/AN

Asian/PI

Black

Hispanic

White

Total

73.6

928.8

237.3

79.4

211.1

330.0

225.9

2056.9

802.5

264.4

583.8

1272.1

Men Rate (per 100,000 population) Women

Race

Figure O. Chlamydia—Rates by race/ethnicity and sex: United States, 2008

Hispanic

Black

Asian/Pacic Islander

American Indian/AK Native

Figure P. Gonorrhea—Rate ratios* by race/ethnicity: United States, 1999–2008

Rate Ratio†

* Rate ratios are calculated as the gonorrhea rate per 100,000 population for a given racial or ethnic minority population divided by the gonorrhea rate

per 100,000 population for non-Hispanic whites. Any population with a lower rate of gonorrhea than the non-Hispanic white population will have a 

rate ratio less than 1:1.

†

 Y-axis is log scale.

1:2

1:1

2:1

4:1

8:1

16:1

32:1

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
STD Surveillance 2008 Special Focus Profiles: STDs in Racial and Ethnic Minorities 69

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

AI/AN

Asian/PI

Black

Hispanic

White

Total

19.1

629.4

61.0

22.8

103.0

75.0

20.8

621.0

73.1

38.8

119.4

144.2

Men Rate (per 100,000 population) Women

Race

Figure Q. Gonorrhea—Rates by race/ethnicity and sex: United States, 2008

Midwest

West

Figure R. Gonorrhea—Rate ratios* by race/ethnicity and region: United States, 2008

Rate Ratio†

* Rate ratios are calculated as the gonorrhea rate per 100,000 population for a given racial or ethnic minority population divided by the gonorrhea rate

per 100,000 population for non-Hispanic whites. Any population with a lower rate of gonorrhea than the non-Hispanic white population will have a 

rate ratio less than 1:1.

†

 Y-axis is log scale.

South

Northeast

1:4

1:2

1:1

2:1

4:1

8:1

16:1

32:1

Black Hispanic Asian/PI Am Ind/AK Nat
70 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2008

30 24 18 12 6 0 0 6 12 18 24 30

AI/AN

Asian/PI

Black

Hispanic

White

Total

3.0

28.0

8.2

4.0

7.6

3.2

0.1

7.6

1.0

0.5

1.5

1.4

Men Rate (per 100,000 population) Women

Race

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

United States, 2008

White

Hispanic

Black

Asian/Pacic Islander

American Indian/AK Native

Figure T. Primary and secondary syphilis—Rates among 15- to 19-year-old females by

race/ethnicity: United States, 1999–2008

Rate (per 100,000 population)

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
STD Surveillance 2008 Special Focus Profiles: STDs in Racial and Ethnic Minorities 71

White

Hispanic

Black

Asian/Pacic Islander

American Indian/AK Native

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

race/ethnicity: United States, 1999–2008

Rate (per 100,000 population)

0

5

10

15

20

25

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

White

Hispanic

Black

Asian/Pacic Islander

American Indian/AK Native

Figure V. Congenital syphilis—Rates among infants <1 year of age by mother’s

race/ethnicity: United States, 1999–2008

Rate (per 100,000 live births)

NOTE: Less than 1% of cases had missing maternal race/ethnicity information and were excluded. 

0

10

20

30

40

50

60

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

STD Surveillance 2008 Special Focus Profiles: STDs in Men Who Have Sex with Men 73

STDs in Men Who Have Sex with 

Men (MSM)

Public Health Impact

Notifiable disease surveillance data on syphilis and 

data from the Gonococcal Isolate Surveillance Project 

(GISP) suggest that some STDs in men who have 

sex with men, including men who have sex with both 

women and men (MSM) are increasing.1-4 Because 

STDs and the behaviors associated with acquiring 

them increase the likelihood of acquiring and 

transmitting HIV infection,5 the rise in STDs among 

MSM may be associated with an increase in HIV 

diagnoses among MSM.6

With the exception of reported syphilis cases, most 

nationally notifiable STD surveillance data do not 

include information on sexual behaviors; therefore, 

national trends in STDs among MSM in the United 

States are not currently available. Furthermore, testing 

strategies are often suboptimal for detecting STDs in 

MSM. Testing for gonorrhea and chlamydia in MSM 

largely focuses on detecting urethral infections, which 

are more likely to be symptomatic than pharyngeal 

or rectal infections.7 Data from enhanced surveillance 

projects are presented in this section to provide 

information on STDs in MSM.

Monitoring Trends in Prevalence of 

STDs among MSM attending STD 

Clinics, 1999–2008

From 1999 through 2008, eight U.S. cities 

participating in the MSM Prevalence Monitoring 

Project submitted syphilis, gonorrhea, chlamydia, and 

HIV test data to CDC from 162,019 MSM visits 

to STD clinics; data from 138,928 MSM visits were 

submitted from five public STD clinics (Denver, New 

York City, Philadelphia, San Francisco, and Seattle) 

and data from 23,091 MSM visits were submitted 

from three STD clinics in community-based, 

gay men’s health clinics (Chicago, the District of 

Columbia, and Houston). In 2009 and beyond, this 

type of enhanced surveillance data in MSM will 

be collected through a sentinel surveillance platform 

called the STD Surveillance Network (SSuN).8

The MSM Prevalence Monitoring Project includes 

data from culture and non-culture tests collected 

during routine care and reflects testing practices at 

participating clinics. Tests for gonorrhea included 

culture, NAATs (or nucleic acid amplification tests) 

and nucleic acid hybridization tests (DNA probes). 

Tests for chlamydia included culture, NAATs, and 

nucleic acid hybridization tests. Nontreponemal 

syphilis tests included the Rapid Plasma Reagin 

(RPR) and the Venereal Disease Research Laboratory 

(VDRL) tests.

All information is based on data collected from clinic 

visits and may reflect multiple visits by a patient rather 

than unique individuals. Clinic-specific medians and 

ranges were calculated for the proportion of tests done 

and for STD and HIV test positivity.

Gonorrhea 

Between 1999 and 2008 the trend in the number of 

positive gonorrhea tests for all anatomic sites varied 

by city (Figure W).

In 2008, 71% (range: 57–95%) of MSM visits 

included testing for urethral gonorrhea; 44%

(range: 3–53%) for rectal gonorrhea; and 64% 

(range: 4–79%) with testing for pharyngeal 

gonorrhea. 

In 2008, median clinic urethral gonorrhea positivity 

in MSM was 8% (range: 4–12%), median rectal 

gonorrhea positivity was 6% (range: 3–11%), and 

median pharyngeal gonorrhea positivity was 3% 

(range: 1–12%).
74 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2008

Chlamydia 

In 2008, a median of 69% (range: 58–94%) of MSM 

visiting participating STD clinics were tested for 

urethral chlamydia, compared to 65% (range: 57–

68%) in 1999. In 2008, the median clinic urethral 

chlamydia positivity was 7% (range: 5–9%).

Syphilis 

In 2008, 86% (range: 59–97%) of MSM visiting 

participating STD clinics had a nontreponemal 

serologic test for syphilis (RPR or VDRL) performed, 

compared with 69% (range: 53–93%) in 1999 

(Figure X).

Overall, median clinic seroreactivity among MSM 

tested for syphilis increased from 4% (range: 3–13%) 

in 1999 to 11% (range: 8–17%) in 2008.

Syphilis seroreactivity is used as a proxy for syphilis 

prevalence and has been correlated with prevalence of 

P&S syphilis in this population.13

HIV Infection 

Overall, the percent of MSM tested for HIV in STD 

clinics increased between 1999 and 2008. In 2008, 

a clinic-specific median of 72% (range: 39–84%) of 

MSM visiting STD clinics who were not previously 

known to be HIV-positive were tested for HIV, while 

44% (range: 23–55%) were tested in 1999. In 2008, 

median clinic HIV positivity in MSM was 3% 

(range: 2–8%) (Figure Y).

In 2008, median HIV prevalence among MSM, 

including persons previously known to be HIVpositive and persons testing HIV-positive at their 

current visit, was 13% (range: 8–18%).

HIV/STDs by Race/Ethnicity 

HIV positivity among persons tested for HIV during 

2008 varied by race/ethnicity, but was highest in black 

MSM. The clinic median HIV positivity was 2% 

(range: 2–3%) in whites; 6% (range: 1–11%) in blacks; 

and 3% (range: 2–6%) in Hispanics (Figure Z).

In 2008, urethral gonorrhea median positivity was 

5% (range: 4–10%) in whites; 11% (range: 7–20%) 

in blacks; and 9% (range: 4–18%) in Hispanics. 

Median clinic rectal gonorrhea positivity was 6% 

(range: 2–13%) in whites; 5% (range: 3–7%) in 

blacks; and 6% (range: 4–9%) in Hispanics. Median 

clinic pharyngeal gonorrhea positivity was 3% (range: 

1–15%) in whites; 7% (range: 3–11%) in blacks; and 

2% (range: 1–8%) in Hispanics (Figure Z).

Median clinic urethral chlamydia positivity was 5% 

(range: 4–8%) in whites; 8% (range: 6–14%) in blacks; 

and 6% (range: 4–12%) in Hispanics (Figure Z). 

Median clinic syphilis seroreactivity was 9% (range: 

7–11%) in whites; 18% (range: 8–25%) in blacks; 

and 15% (range: 9–20%) in Hispanics (Figure Z).

STDs by HIV Status, STD Clinics 

In 2008, median clinic urethral gonorrhea positivity 

was 11% (range: 8–16%) in HIV-positive MSM 

and 7% (range: 3–11%) in MSM who were HIVnegative or of unknown HIV status; median rectal 

gonorrhea positivity was 10% (range: 2–14%) in 

HIV-positive MSM and 5% (range: 3–11%) in 

MSM who were HIV-negative or of unknown HIV 

status; median pharyngeal gonorrhea positivity was 

7% (range: 2–10%) in HIV-positive MSM and 3% 

(range: 1–13%) in MSM who were HIV-negative or 

of unknown HIV status.

Median urethral chlamydia positivity was 8% (range: 

6–14%) in HIV-positive MSM and 7% (range: 

4–9%) in MSM who were HIV-negative or of 

unknown HIV status.

Median syphilis seroreactivity was 33% (range: 22–

42%) in HIV-positive MSM and 9% (range: 5–12%) 

in MSM who were HIV-negative or of unknown HIV 

status.

Nationally Notifiable Syphilis 

Surveillance Data

P&S syphilis increased in the United States between 

2004 and 2008, with a 67.4% increase in the number 

of P&S syphilis cases among men and a 78.6% 

increase in the number of cases among women 

(Tables 26 and 27). In 2008, the rate of reported 

P&S syphilis among men (7.6 cases per 100,000 

males) was 5.1 times greater than the rate among 
STD Surveillance 2008 Special Focus Profiles: STDs in Men Who Have Sex with Men 75

women (1.5 case per 100,000 females) (Tables 26 and 

27). Higher rates in men than women are observed 

for all racial and ethnic groups.

In 2008, MSM accounted for 63% of P&S syphilis 

cases in the United States. MSM account for more 

cases than heterosexual men or women for all 

racial and ethnic groups (Figure 38). Additional 

information on syphilis is in the Syphilis section of 

the National Profile.

Gonococcal Isolate Surveillance 

Project (GISP)

GISP is a national sentinel surveillance system 

designed to monitor trends in antimicrobial 

susceptibilities of strains of Neisseria gonorrhoeae in 

the United States.4, 9

GISP also reports the percentage of Neisseria 

gonorrhoeae isolates obtained from MSM. Overall, the 

proportion of isolates from MSM in selected STD 

clinics from GISP sentinel sites has increased steadily 

from 4.0% in 1989 to 22.4% in 2007; in 2008, 

this proportion decreased slightly to 21.0% (Figure 

AA). Additionally, the proportion of isolates coming 

from MSM varies geographically with the largest 

percentage from the West Coast (Figure BB).

Additional information on GISP is in the Gonorrhea 

section of the National Profile.

1 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.

2 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.

3 Helms DJ, Weinstock HS, et. al. Increases in syphilis among 

men who have sex with men attending STD clinics, 2000–2005. 

In: program and abstracts of the 17th Biennial meeting of the 

ISSTDR, Seattle, WA, July 29-August 1, 2007 [abstract P-608].

4 Centers for Disease Control and Prevention. Sexually Transmitted 

Disease Surveillance 2007 Supplement: Gonococcal Isolate 

Surveillance Project (GISP) Annual Report 2007. Atlanta, GA: 

U.S. Department of Health and Human Services.

5 Fleming DT, Wasserheit JN. From epidemiologic synergy to 

public health policy and practice: the contribution of other 

sexually transmitted diseases to sexual transmission of HIV 

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

6 Hall HI, Song R, Rhodes P, et. al. HIV Incidence Surveillance 

Group. JAMA, 2008 Aug 6;300(5):520–9.

7 Mahle KC, Helms DJ, Golden MR, Asbel LE, Cherneskie T, 

Gratzer B, Kent CK, Klausner JD, Rietmeijer C, Shahkolahi, 

Weckerly E, Weinstock HS. Missed Gonorrhea Infections by 

Anatomic Site Among Asymptomatic Men Who Have Sex with 

Men (MSM) Attending U.S. STD Clinics, 2002-2006. In: 

program and abstracts of the 2008 National STD Prevention 

Conference, Chicago, IL March 10-13, 2008 [abstract A1d].

8 Rietmeijer K, Donnelly J,Bernstein K, Bissette J, Martins S, 

Pathela P, Schillinger J,Stenger M, Weinstock H, Newman 

L. Here comes the SSuN—Early experiences with the STD 

Surveillance Network. Public Health Reports (in press)

9 Schwarcz S, Zenilman J, Schnell D, et. al. National Surveillance 

of Antimicrobial Resistance in Neisseria gonorrhoeae. JAMA 1990; 

264(11):1413–1417.
76 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2008

Figure W. MSM Prevalence Monitoring Project—Number of gonorrhea tests and number of 

positive tests in men who have sex with men, STD clinics, 1999–2008 

* Data not reported in 2006, 2007, or 2008. †

 Data not reported in 2008.

NOTE: The bars represent the number of total GC tests and the lines represent the number of positive tests considering all anatomic sites (pharyngeal,

rectal, and urethral) each year. The scales on the left and right axis differ. The bar graphs use the scale on the left. The line graphs use the scale on the right.

0

50

100

150

200

0

50

100

150

200

0

50

100

150

200

0

300

600

900

1200

0

125

250

375

500

0

125

250

375

500

0

125

250

375

500

0

125

250

375

500

Total GC tests Positives

CHICAGO

0

300

600

900

1200

1999 00 01 02 03 04 05 06 07 08

Total GC tests Positives

HOUSTON*

0

300

600

900

1200

1999 00 01 02 03 04 05 06 07 08

Total GC tests Positives

PHILADELPHIA

0

300

600

900

1200

1999 00 01 02 03 04 05 06 07 08

Total GC tests Positives

SAN FRANCISCO

0

2000

4000

6000

8000

1999 00 01 02 03 04 05 06 07 08

Total GC tests Positives

DISTRICT OF COLUMBIA†

0

600

1200

1800

2400

3000

1999 00 01 02 03 04 05 06 07 08

Total GC tests Positives

NEW YORK CITY

0

600

1200

1800

2400

3000

1999 00 01 02 03 04 05 06 07 08

Total GC tests Positives

DENVER

0

600

1200

1800

2400

3000

1999 00 01 02 03 04 05 06 07 08

Total GC tests Positives

SEATTLE

0

600

1200

1800

2400

3000

1999 00 01 02 03 04 05 06 07 08

Positive GC tests Positive GC tests in symptomatic men Total tests
STD Surveillance 2008 Special Focus Profiles: STDs in Men Who Have Sex with Men 77

Figure X. MSM Prevalence Monitoring Project—Syphilis serologic reactivity among men 

who have sex with men, STD clinics, 1999–2008

* Data not reported in 2006, 2007, or 2008. Titer data not reported in 2004 or 2005. † Data not reported in 2008.

NOTE: Seroreactivity was based on nontreponemal tests results. All sites used the Rapid Plasma Reagin (RPR) test, with the exception of San Francisco 

where the Venereal Disease Research Laboratory (VDRL) test was used and Seattle where the type of test was changed from VDRL to RPR in 2004.

CHICAGO

Percent

0

5

10

15

20

1999 00 01 02 03 04 05 06 07 08

HOUSTON*

Percent

0

5

10

15

20

1999 00 01 02 03 04 05 06 07 08

PHILADELPHIA

Percent

0

5

10

15

20

1999 00 01 02 03 04 05 06 07 08

SAN FRANCISCO

Percent

0

5

10

15

20

1999 00 01 02 03 04 05 06 07 08

DISTRICT OF COLUMBIA†

Percent

0

5

10

15

20

1999 00 01 02 03 04 05 06 07 08

NEW YORK CITY

Percent

0

5

10

15

20

1999 00 01 02 03 04 05 06 07 08

DENVER

Percent

0

5

10

15

20

1999 00 01 02 03 04 05 06 07 08

SEATTLE

Percent

0

5

10

15

20

1999 00 01 02 03 04 05 06 07 08

Seroreactivity Titer >1:16
78 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2008

0

2

4

6

8

Positivity

Number of tests

Figure Y. MSM Prevalence Monitoring Project —Clinic-specific median number of HIV tests 

and positivity among men who have sex with men, STD clinics, 1999–2008

Median number of tests Median percent positive*

* Excludes persons previously known to be HIV-positive.

NOTE: The bar graph uses the scale on the left. The line graph uses the scale on the right.

0

400

800

1200

1600

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Black

White

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

and HIV and seroreactivity to syphilis among men who have sex with men, by

race/ethnicity, STD clinics, 2008

Median positivity

* Excludes persons previously known to be HIV-positive. † Seroreactivity

Hispanic

Syphilis† Urethral HIV*

chlamydia

Pharyngeal 

gonorrhea

Rectal 

gonorrhea

Urethral 

gonorrhea

0

5

10

15

20

25
STD Surveillance 2008 Special Focus Profiles: STDs in Men Who Have Sex with Men 79

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

gonorrhoeae isolates obtained from men who have sex with men attending STD 

clinics by GISP site, 2005–2008

NOTE: Not all sites participated in GISP for the last 4 years. Sites 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; GRB=Greensboro,

NC; HON=Honolulu, HI; KCY=Kansas City, MO; LAX=Los Angeles, CA; LVG=Las Vegas, NV; MIA=Miami, FL; MIN=Minneapolis, MN; NOR=New Orleans, LA; 

NYC=New York City, NY; OKC=Oklahoma City, OK; ORA=Orange County, CA; PHI=Philadelphia, PA; PHX=Phoenix, AZ; POR=Portland, OR; RIC=Richmond,

VA; 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).

0%

50%

100%

'05 '06 '07 '08

% of Isolates 

from MSM

 BHM

 PHX

 LAX

 ORA

 SDG

 SFO DEN

 MIA

 ATL

 HON TRP

 CHI

 NOR

 BAL

 DTR

 MIN

 LVG KCY

 ALB

 NYC

 GRB

 CIN

 CLE

 OKC

 POR

 PHI

 DAL

 RIC

 SEA

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

gonorrhoeae isolates obtained from men who have sex with men attending STD 

clinics, 1989–2008

Percent

0

5

10

15

20

25

1989 1991 1993 1995 1997 1999 2001 2003 2005 2007

STD Surveillance 2008 Special Focus Profiles: STDs in Persons Entering Corrections Facilities 81

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

Prevalence rates for chlamydia and gonorrhea in these 

settings are consistently among the highest observed 

in any venue.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, 

data from one study in a locale with high syphilis 

incidence suggested that screening and treatment of 

women inmates for syphilis may result in reduction of 

syphilis in the general community.5 In some locations, 

a substantial proportion of all early syphilis cases are 

reported from corrections facilities.6

Description of Population 

In 2008, STD screening data from corrections 

facilities were reported from 38 states and Puerto 

Rico for chlamydia, 36 states and Puerto Rico for 

gonorrhea. IPP provided CDC with line-listed data 

for chlamydia and gonorrhea. Syphilis data were 

reported to CDC by local and state STD prevention 

programs.

The figures and tables shown in this section represent 

50,968 chlamydia tests in women and 129,548 in 

men and 42,124 gonorrhea tests in women and 

114,984 in men.

Chlamydia 

Overall, chlamydia positivity was higher in women 

than in men for all age groups. 

Males in Juvenile Corrections—In men 12 to 

18 years of age entering 128 juvenile corrections 

facilities, the overall chlamydia positivity was 6.4% 

(Figure CC). Chlamydia positivity increased from 

1.0% for adolescent men aged 12 years of age to 

8.7% for those 18 years of age. 

Females in Juvenile Corrections—In women 

12 to 18 years of age entering 82 juvenile corrections 

facilities, the overall chlamydia positivity was 14.5% 

(Figure CC). Positivity in women increased from 

4.6% for those 12 years of age to 16.4% for those 16 

years of age and remained high for women 17 to 18 

years of age. 

Men in Jails—In men entering 62 adult corrections 

facilities in 2008, positivity in men less than 20 years 

of age (10.6%) was higher than the overall prevalence 

observed in adolescent men entering juvenile facilities 

(6.4%) (Figure DD). Chlamydia positivity decreased 

with age from 10.6% for those younger than 20 years 

of age to 2.2% for those older than 34 years. Overall 

positivity among adult men entering corrections 

facilities in 2008 was 7.0%. 

Women in Jails—In women entering 41 adult 

corrections facilities in 2008, the chlamydia positivity 

was 8.5% (Figure DD). Chlamydia positivity 

decreased with age from 16.5% for those younger 

than 20 years of age to 3.4% for those older than 34 

years of age. Overall chlamydia positivity in women 

entering adult corrections facilities (8.5%) was 

substantially lower than that in adolescent women 

entering juvenile corrections facilities (14.5%). 

However, chlamydia positivity in women younger 

than 20 years of age attending adult corrections 

facilities was higher than that in women attending 

juvenile corrections facilities.

Gonorrhea 

Overall, gonorrhea positivity in women was 

uniformly higher than in men for all age groups.

Males in Juvenile Corrections—The overall 

positivity for adolescent men entering 110 juvenile 

corrections facilities in 2008 was 1.1% (Figure EE). 

Gonorrhea positivity increased with age from 0.2% for 

those 12 years of age to 1.7% for those 18 years of age.
82 Special Focus Profiles: STDs in Persons Entering Corrections Facilities STD Surveillance 2008

Females in Juvenile Corrections—The overall 

gonorrhea positivity was 4.6% in women entering 63 

juvenile corrections facilities in 2008 (Figure EE). In 

2008, gonorrhea positivity increased with age from 

1.2% among 12-year-olds to 5.2% among young 

women 15 years of age and remained high for women 

16 to 18 years of age. 

Men in Jails—Overall gonorrhea positivity for 

men attending 58 adult corrections facilities in 

2008 was 1.4% (Figure FF). Gonorrhea positivity 

was highest in men younger than 20 years of age 

at 2.0%, declining with age to 0.7% in men older 

than 34 years of age. Men younger than 20 years of 

age attending adult facilities had higher gonorrhea 

positivity than men attending juvenile corrections 

facilities. 

Women in Jails—Overall, in women entering 37 

adult corrections facilities in 2008, the gonorrhea 

positivity was 2.6% (Figure FF). Gonorrhea positivity 

decreased with age from 4.0% among those younger 

than 20 years of age to 1.4% among those older than 

34 years of age. Women younger than 20 years of 

age attending adult facilities had similar gonorrhea 

positivity as young women attending juvenile 

corrections facilities.

Syphilis

In 2007, reports of P&S syphilis from correctional 

facilities accounted for 7% of P&S syphilis among 

heterosexual men, 6% among women, and 1% 

among MSM. In 2008, reports of P&S syphilis 

from correctional facilities accounted for 7% of P&S 

syphilis among heterosexual men, 5% among women, 

and 1% among MSM (Figure 42).

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 Kahn RH, Mosure DJ, Blank S, Kent CK, Chow JM, Boudov 

MR, Brock J, Tulloch S, and the Jail Prevalence Monitoring 

Project. Chlamydia trachomatis and Neisseria gonorrhoeae

prevalence and coinfection in adolescents entering selected 

US juvenile detention centers, 1997–2002. Sex Transm Dis

2005;29:255–259.

3 Joesoef MR, Weinstock HS, Kent CK, Chow JM, Boudov MR, 

Parvez FM, Cox T, Lincoln T, Miller JL, Sternberg MS and the 

Corrections STD Prevalence Monitoring Group. Sex and age 

correlates of chlamydia prevalence in adolescents and adults 

entering correctional facilities, 2005: Implications for screening 

policy. Sex Transm Dis 2009;36:S67-71.

4 Satterwhite CL, Joesoef MR, Datta SD,Weinstock H. Estimates 

of Chlamydia trachomatis Infections among men:United States. 

Sex Transm Dis 2008;35:S3-S7.

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. 

Sex Transm Dis 1997;24:218–26.

6 Kahn R, Voigt R, Swint E, Weinstock H. Early syphilis in the 

United States identified in corrections facilities, 1999–2002. Sex 

Transm Dis 2004;29:271–276.
STD Surveillance 2008 Special Focus Profiles: STDs in Persons Entering Corrections Facilities 83

20 16 12 8 4 0 0 4 8 12 16 20

12

13

14

NOTE: Percent positivity is presented from facilities reporting >100 test results.

15

16

17

18

Total

2.2

3.6

5.5

7.5

8.2

8.7

6.4

1.0 4.6

10.0

13.1

15.2

16.4

14.4

13.2

14.5

Men Positivity Women

Age

Figure CC. Chlamydia—Positivity by age and sex, juvenile corrections facilities, 2008

20 16 12 8 4 0 0 4 8 12 16 20

<20

20–24

25–29

NOTE: Percent positivity is presented from facilities reporting >100 test results.

30–34

>35

Total

9.9

5.8

3.9

2.2

7.0

10.6

11.7

7.6

5.9

3.4

8.5

16.5

Men Positivity Women

Age

Figure DD. Chlamydia—Positivity by age group and sex, adult corrections facilities, 2008
84 Special Focus Profiles: STDs in Persons Entering Corrections Facilities STD Surveillance 2008

20 16 12 8 4 0 0 4 8 12 16 20

12

13

14

NOTE: Percent positivity is presented from facilities reporting >100 test results.

15

16

17

18

Total

0.4

0.6

0.9

1.3

1.2

1.7

1.1

0.2 1.2

3.1

4.4

5.2

5.1

4.3

2.4

4.6

Men Positivity Women

Age

Figure EE. Gonorrhea—Positivity by age and sex, juvenile corrections facilities, 2008

20 16 12 8 4 0 0 4 8 12 16 20

<20

20–24

25–29

NOTE: Percent positivity is presented from facilities reporting >100 test results.

30–34

>35

Total

1.7

1.2

1.4

0.7

1.4

2.0

3.4

2.4

2.2

1.4

2.6

4.0

Men Positivity Women

Age

Figure FF. Gonorrhea—Positivity by age group and sex, adult corrections facilities, 2008
TABLES
TABLES
STD Surveillance 2008 National Summary Tables 85

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

100,000 population: United States, 1941–2008

Year*

Syphilis

All Stages

Primary and

Secondary

Early

Latent

Late and

Late Latent† Congenital Chlamydia Gonorrhea Chancroid

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate‡ Cases Rate Cases Rate Cases Rate

1941 485,560 368.2 68,231 51.7 109,018 82.6 202,984 153.9 17,600 651.1 NR • 193,468 146.7 3,384 2.5

1942 479,601 363.4 75,312 57.0 116,245 88.0 202,064 153.1 16,918 566.0 NR • 212,403 160.9 5,477 4.1

1943 575,593 447.0 82,204 63.8 149,390 116.0 251,958 195.7 16,164 520.7 NR • 275,070 213.6 8,354 6.4

1944 467,755 367.9 78,443 61.6 123,038 96.7 202,848 159.6 13,578 462.0 NR • 300,676 236.5 7,878 6.1

1945 359,114 282.3 77,007 60.5 101,719 79.9 142,187 111.8 12,339 431.7 NR • 287,181 225.8 5,515 4.3

1946 363,647 271.7 94,957 70.9 107,924 80.6 125,248 93.6 12,106 354.9 NR • 368,020 275.0 7,091 5.2

1947 355,592 252.3 93,545 66.4 104,124 73.9 122,089 86.6 12,200 319.6 NR • 380,666 270.0 9,515 6.7

1948 314,313 218.2 68,174 47.3 90,598 62.9 123,312 85.6 13,931 383.0 NR • 345,501 239.8 7,661 5.3

1949 256,463 175.3 41,942 28.7 75,045 51.3 116,397 79.5 13,952 382.4 NR • 317,950 217.3 6,707 4.6

1950 217,558 146.0 23,939 16.7 59,256 39.7 113,569 70.2 13,377 368.3 NR • 286,746 192.5 4,977 3.3

1951 174,924 116.1 14,485 9.6 43,316 28.7 98,311 65.2 11,094 290.4 NR • 254,470 168.9 4,233 2.8

1952 167,762 110.2 10,449 6.9 36,454 24.0 105,238 69.1 8,553 218.8 NR • 244,957 160.8 3,738 2.5

1953 148,573 95.9 8,637 5.6 28,295 18.3 98,870 63.8 7,675 193.9 NR • 238,340 153.9 3,338 2.2

1954 130,687 82.9 7,147 4.5 23,861 15.1 89,123 56.5 6,676 164.0 NR • 242,050 153.5 3,003 1.9

1955 122,392 76.2 6,454 4.0 20,054 12.5 86,526 53.8 5,354 130.7 NR • 236,197 147.0 2,649 1.7

1956 130,201 78.7 6,392 3.9 19,783 12.0 95,097 57.5 5,491 130.4 NR • 224,346 135.7 2,135 1.3

1957 123,758 73.5 6,576 3.9 17,796 10.6 91,309 54.2 5,288 123.0 NR • 214,496 127.4 1,637 1.0

1958 113,884 66.4 7,176 4.2 16,556 9.7 83,027 48.4 4,866 114.6 NR • 232,386 135.6 1,595 0.9

1959 120,824 69.2 9,799 5.6 17,025 9.8 86,740 49.7 5,130 119.7 NR • 240,254 137.6 1,537 0.9

1960 122,538 68.8 16,145 9.1 18,017 10.1 81,798 45.9 4,416 103.7 NR • 258,933 145.4 1,680 0.9

1961 124,658 68.8 19,851 11.0 19,486 10.8 79,304 43.8 4,163 97.5 NR • 264,158 145.8 1,438 0.8

1962 126,245 68.7 21,067 11.5 19,585 10.7 79,533 43.3 4,070 97.7 NR • 263,714 143.6 1,344 0.7

1963 124,137 66.5 22,251 11.9 18,235 9.8 78,076 41.8 4,031 98.4 NR • 278,289 149.0 1,220 0.7

1964 114,325 60.4 22,969 12.1 17,781 9.4 68,629 36.3 3,516 87.3 NR • 300,666 158.9 1,247 0.7

1965 112,842 58.9 23,338 12.2 17,458 9.1 67,317 35.1 3,564 94.8 NR • 324,925 169.5 982 0.5

1966 105,159 54.2 21,414 11.0 15,950 8.2 63,541 32.7 3,170 87.9 NR • 351,738 181.2 838 0.4

1967 102,581 52.2 21,053 10.7 15,554 7.9 61,975 31.5 2,894 82.2 NR • 404,836 205.9 784 0.4

1968 96,271 48.4 19,019 9.6 15,150 7.6 58,564 29.4 2,381 68.0 NR • 464,543 233.4 845 0.4

1969 92,162 45.7 19,130 9.5 15,402 7.6 54,587 27.1 2,074 57.6 NR • 534,872 265.4 1,104 0.5

1970 91,382 44.8 21,982 10.8 16,311 8.0 50,348 24.7 1,953 52.3 NR • 600,072 294.2 1,416 0.7

1971 95,997 46.4 23,783 11.5 19,417 9.4 49,993 24.2 2,052 57.7 NR • 670,268 324.1 1,320 0.6

1972 91,149 43.6 24,429 11.7 20,784 9.9 43,456 20.8 1,758 54.0 NR • 767,215 366.6 1,414 0.7

1973 87,469 41.4 24,825 11.7 23,584 11.2 37,054 17.5 1,527 48.7 NR • 842,621 398.7 1,165 0.6

1974 83,771 39.3 25,385 11.9 25,124 11.8 31,854 14.9 1,138 36.0 NR • 906,121 424.7 945 0.4

1975 80,356 37.3 25,561 11.9 26,569 12.3 27,096 12.6 916 29.1 NR • 999,937 464.1 700 0.3

1976 71,761 33.0 23,731 10.9 25,363 11.7 21,905 10.1 626 19.8 NR • 1,001,994 460.6 628 0.3

1977 64,621 29.4 20,399 9.3 21,329 9.7 22,313 10.2 463 13.9 NR • 1,002,219 456.0 455 0.2

1978 64,875 29.2 21,656 9.8 19,628 8.8 23,038 10.4 434 13.0 NR • 1,013,436 456.3 521 0.2

1979 67,049 29.9 24,874 11.1 20,459 9.1 21,301 9.5 332 9.5 NR • 1,004,058 447.1 840 0.4

1980 68,832 30.3 27,204 12.0 20,297 8.9 20,979 9.2 277 7.7 NR • 1,004,029 442.1 788 0.3

1981 72,799 31.7 31,266 13.6 21,033 9.2 20,168 8.8 287 7.9 NR • 990,864 431.8 850 0.4

1982 75,579 32.6 33,613 14.5 21,894 9.5 19,799 8.5 259 7.0 NR • 960,633 414.7 1,392 0.6

1983 74,637 31.9 32,698 14.0 23,738 10.2 17,896 7.7 239 6.6 NR • 900,435 385.1 847 0.4

1984 69,872 29.6 28,607 12.1 23,131 9.8 17,829 7.6 305 8.3 7,594 6.5 878,556 372.5 665 0.3

1985 67,563 28.4 27,131 11.4 21,689 9.1 18,414 7.7 329 8.7 25,848 17.4 911,419 383.0 2,067 0.9
86 National Summary Tables STD Surveillance 2008

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

100,000 population: United States, 1941–2008 (continued)

Year*

Syphilis

All Stages

Primary and

Secondary

Early

Latent

Late and

Late Latent† Congenital Chlamydia Gonorrhea Chancroid

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate‡ Cases Rate Cases Rate Cases Rate

1986 67,779 28.2 27,667 11.5 21,656 9.0 18,046 7.5 410 10.9 58,001 35.2 892,229 371.5 3,045 1.3

1987 87,286 36.0 35,585 14.7 28,233 11.7 22,988 9.5 480 12.6 91,913 50.8 787,532 325.0 4,986 2.1

1988 104,546 42.8 40,474 16.6 35,968 14.7 27,363 11.2 741 19.0 157,854 87.1 738,160 301.9 4,891 2.0

1989 115,089 46.6 45,826 18.6 45,394 18.4 22,032 8.9 1,837 45.5 200,904 102.5 733,294 297.1 4,697 1.9

1990 135,590 54.3 50,578 20.3 55,397 22.2 25,750 10.3 3,865 92.9 323,663 160.2 690,042 276.4 4,212 1.7

1991 128,719 50.9 42,950 17.0 53,855 21.3 27,490 10.9 4,424 107.6 381,228 179.7 621,918 245.8 3,476 1.4

1992 114,730 44.7 34,009 13.3 49,929 19.5 26,725 10.4 4,067 100.0 409,694 182.3 502,858 196.0 1,906 0.7

1993 102,612 39.5 26,527 10.2 41,919 16.1 30,746 11.8 3,420 85.5 405,332 178.0 444,649 171.1 1,292 0.5

1994 82,713 31.4 20,641 7.8 32,017 12.2 27,603 10.5 2,452 62.0 451,785 192.5 419,602 163.9 782 0.3

1995 69,359 26.0 16,543 6.2 26,657 10.0 24,296 9.1 1,863 47.8 478,577 187.8 392,651 147.5 607 0.2

1996 53,240 19.8 11,405 4.2 20,187 7.5 20,366 7.6 1,282 32.9 492,631 190.6 328,169 121.8 386 0.1

1997 46,716 17.1 8,556 3.1 16,631 6.1 20,447 7.5 1,082 27.9 537,904 205.5 327,665 120.2 246 0.1

1998 38,289 13.9 7,007 2.5 12,696 4.6 17,743 6.4 843 21.4 614,250 231.8 356,492 129.2 189 0.1

1999 35,385 12.7 6,617 2.4 11,534 4.1 16,655 6.0 579 14.6 662,647 247.2 360,813 129.3 110 0.0

2000 31,618 11.2 5,979 2.1 9,465 3.4 15,594 5.5 580 14.3 709,452 251.4 363,136 128.7 78 0.0

2001 32,284 11.3 6,103 2.1 8,701 3.0 16,976 5.9 504 12.5 783,242 274.5 361,705 126.8 38 0.0

2002 32,919 11.4 6,862 2.4 8,429 2.9 17,168 6.0 460 11.4 834,555 289.4 351,852 122.0 48 0.0

2003 34,289 11.8 7,177 2.5 8,361 2.9 18,319 6.3 432 10.6 877,478 301.7 335,104 115.2 54 0.0

2004 33,423 11.4 7,980 2.7 7,768 2.6 17,300 5.9 375 9.1 929,462 316.5 330,132 112.4 30 0.0

2005 33,288 11.2 8,724 2.9 8,176 2.8 16,049 5.4 339 8.2 976,445 329.4 339,593 114.6 17 0.0

2006 36,958 12.3 9,756 3.3 9,186 3.1 17,644 5.9 372 8.7 1,030,911 344.3 358,366 119.7 19 0.0

2007 40,921 13.6 11,466 3.8 10,768 3.6 18,256 6.1 431 10.1 1,108,374 367.5 355,991 118.0 23 0.0

2008 46,277 15.3 13,500 4.5 12,401 4.1 19,945 6.6 431 10.1 1,210,523 401.3 336,742 111.6 25 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 late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other than 

neurosyphilis.

‡ Rates include all cases of congenitally acquired syphilis per 100,000 live births. As of 1995, cases of congenital syphilis are obtained in hardcopy and electronic 

format 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 

June 10, 2009 (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.
STD Surveillance 2008 Chlamydia Tables 87

Table 2. Chlamydia—Reported cases and rates by state, ranked by rates: United States, 2008

Rank* State Cases Rate per 100,000 Population

1 Mississippi 21,253 728.1

2 Alaska 4,861 711.2

3 South Carolina 26,323 597.2

4 Alabama 24,760 535.0

5 Louisiana 22,659 527.8

6 Arkansas 14,136 498.7

7 New Mexico 9,262 470.2

8 Hawaii 5,982 466.1

9 Illinois 59,169 460.4

10 New York 88,359 457.9

11 Tennessee 28,038 455.4

12 Delaware 3,868 447.3

13 Georgia 42,629 446.6

14 Michigan 44,923 446.0

15 Maryland 24,669 439.1

16 Missouri 24,817 422.2

17 Texas 100,870 422.0

18 North Carolina 37,516 414.0

19 Ohio 47,117 410.9

20 Oklahoma 14,803 409.2

21 California 148,798 407.1

22 Virginia 31,218 404.8

U.S. TOTAL† 1,210,523 401.3

23 Colorado 19,180 394.5

24 Arizona 24,769 390.8

25 Florida 71,017 389.1

26 Nevada 9,670 376.9

27 Wisconsin 20,996 374.8

28 South Dakota 2,956 371.3

29 Connecticut 12,519 357.4

30 Indiana 22,154 349.1

31 Pennsylvania 42,233 339.7

32 Kansas 9,208 331.7

33 Washington 21,402 330.9

34 Montana 3,101 323.7

35 Nebraska 5,573 314.0

36 Iowa 9,372 313.6

37 Rhode Island 3,317 313.6

38 Wyoming 1,577 301.6

39 North Dakota 1,921 300.3

40 Kentucky 12,163 286.8

41 Oregon 10,744 286.7

42 Idaho 4,194 279.7

43 Minnesota 14,351 276.1

44 Massachusetts 17,503 271.4

45 New Jersey 22,405 257.9

46 Utah 6,021 227.6

47 Maine 2,608 198.0

48 Vermont 1,190 191.5

49 West Virginia 3,316 183.0

50 New Hampshire 2,109 160.3

* States were ranked in descending order by rate, number of cases, and alphabetically by state.

† Total includes cases reported by the District of Columbia with 6,924 cases and a rate of 1,177.0, but excludes outlying areas (Guam with 687 cases and rate of 

395.9, Puerto Rico with 6,874 cases and rate of 174.4, and Virgin Islands with 587 cases and rate of 534.5).
88 Chlamydia Tables STD Surveillance 2008

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

order: United States and outlying areas, 2004–2008

State/Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Alabama 13,314 17,109 22,915 25,153 24,760 293.9 375.4 498.3 543.5 535.0

Alaska 3,954 4,355 4,525 4,911 4,861 603.3 656.2 675.3 718.5 711.2

Arizona 16,786 21,264 24,090 24,866 24,769 292.2 358.0 390.7 392.3 390.8

Arkansas 7,864 8,507 8,259 9,954 14,136 285.7 306.1 293.8 351.1 498.7

California 122,197 130,716 135,827 141,928 148,798 340.4 361.8 372.6 388.3 407.1

Colorado 14,151 15,432 16,313 17,186 19,180 307.5 330.8 343.2 353.5 394.5

Connecticut 9,552 11,039 10,946 11,454 12,519 272.6 314.5 312.3 327.0 357.4

Delaware 2,954 3,392 3,615 3,479 3,868 355.7 402.1 423.6 402.3 447.3

District of Columbia 3,493 3,678 3,368 6,029 6,924 631.0 668.1 579.2 1,024.8 1,177.0

Florida 42,554 43,372 48,955 57,575 71,017 244.6 243.8 270.6 315.5 389.1

Georgia 34,280 33,562 38,972 42,913 42,629 388.2 369.9 416.2 449.6 446.6

Hawaii 5,307 5,489 5,548 5,659 5,982 420.2 430.4 431.6 440.9 466.1

Idaho 2,784 2,799 3,345 3,722 4,194 199.8 195.9 228.1 248.2 279.7

Illinois 47,185 50,559 53,586 55,470 59,169 371.1 396.1 417.6 431.6 460.4

Indiana 18,440 20,063 19,859 20,712 22,154 295.6 319.9 314.5 326.4 349.1

Iowa 6,956 7,390 8,390 8,643 9,372 235.4 249.1 281.3 289.3 313.6

Kansas 7,493 7,419 7,829 8,180 9,208 273.9 270.3 283.2 294.7 331.7

Kentucky 6,470 8,351 8,940 8,798 12,163 156.1 200.1 212.5 207.4 286.8

Louisiana 21,837 17,227 17,885 19,362 22,659 483.6 380.8 417.1 451.0 527.8

Maine 2,113 2,254 2,306 2,541 2,608 160.4 170.6 174.5 192.9 198.0

Maryland 19,952 18,291 21,859 23,150 24,669 359.0 326.6 389.2 412.0 439.1

Massachusetts 13,242 14,411 15,394 16,145 17,503 206.4 225.2 239.1 250.3 271.4

Michigan 41,246 38,730 36,753 37,353 44,923 407.9 382.7 364.0 370.9 446.0

Minnesota 11,602 12,189 12,935 13,413 14,351 227.4 237.5 250.3 258.1 276.1

Mississippi 18,863 21,268 19,002 21,686 21,253 649.8 728.1 652.9 743.0 728.1

Missouri 21,319 22,371 22,982 23,308 24,817 370.5 385.7 393.3 396.5 422.2

Montana 2,608 2,400 2,650 2,748 3,101 281.4 256.5 280.5 286.9 323.7

Nebraska 5,238 5,098 5,428 5,132 5,573 299.8 289.9 307.0 289.2 314.0

Nevada 6,690 7,321 8,398 9,514 9,670 286.5 303.2 336.5 370.9 376.9

New Hampshire 1,736 1,842 1,997 2,055 2,109 133.6 140.6 151.9 156.2 160.3

New Jersey 17,448 19,152 20,194 21,536 22,405 200.6 219.7 231.5 247.9 257.9

New Mexico 9,035 8,456 9,829 9,460 9,262 474.7 438.5 502.9 480.2 470.2

New York 59,097 63,966 68,720 80,717 88,359 307.4 332.2 355.9 418.3 457.9

North Carolina 28,967 31,183 33,615 30,611 37,516 339.1 359.1 379.6 337.8 414.0

North Dakota 1,810 1,667 1,820 1,789 1,921 285.3 261.8 286.2 279.7 300.3

Ohio 39,379 43,806 40,106 47,434 47,117 343.7 382.1 349.4 413.7 410.9

Oklahoma 10,366 13,407 12,992 12,529 14,803 294.2 377.9 363.0 346.4 409.2

Oregon 8,690 9,018 9,577 9,849 10,744 241.8 247.7 258.8 262.8 286.7

Pennsylvania 38,025 37,261 39,487 42,469 42,233 306.5 299.8 317.4 341.6 339.7

Rhode Island 3,442 3,269 3,142 3,177 3,317 318.5 303.8 294.3 300.3 313.6

South Carolina 18,423 18,296 22,351 26,431 26,323 438.8 430.0 517.2 599.7 597.2

South Dakota 2,532 2,701 2,633 2,620 2,956 328.5 348.1 336.7 329.1 371.3

Tennessee 22,515 23,084 25,320 26,866 28,038 381.5 387.1 419.3 436.4 455.4

Texas 70,232 71,860 75,543 85,786 100,870 312.3 314.3 321.4 358.9 422.0

Utah 3,857 4,602 5,092 5,721 6,021 161.4 186.3 199.7 216.3 227.6

Vermont 1,137 957 1,191 1,057 1,190 183.0 153.6 190.9 170.1 191.5

Virginia 21,635 22,668 24,087 24,579 31,218 290.0 299.5 315.2 318.7 404.8

Washington 17,635 18,616 17,819 18,784 21,402 284.3 296.1 278.6 290.4 330.9

West Virginia 2,758 2,944 2,910 3,168 3,316 151.9 162.0 160.0 174.8 183.0

Wisconsin 19,217 20,461 20,190 19,555 20,996 348.8 369.6 363.4 349.1 374.8

Wyoming 1,082 1,173 1,422 1,197 1,577 213.6 230.3 276.1 228.9 301.6

U.S. TOTAL 929,462 976,445 1,030,911 1,108,374 1,210,523 316.5 329.4 344.3 367.5 401.3

Northeast 145,792 154,151 163,377 181,151 192,243 267.2 282.1 298.5 331.3 351.6

Midwest 222,417 232,454 232,511 243,609 262,557 338.4 352.4 351.1 366.9 395.5

South 346,477 358,199 390,588 428,069 486,162 327.0 333.2 358.1 387.6 440.1

West 214,776 231,641 244,435 255,545 269,561 318.6 339.2 352.4 364.6 384.6

Guam 748 807 832 822 687 450.4 478.7 486.5 473.7 395.9

Puerto Rico 3,588 3,714 5,102 7,909 6,874 92.1 94.9 129.9 200.6 174.4

Virgin Islands 303 235 203 348 587 278.6 216.2 186.9 316.9 534.5

OUTLYING AREAS 4,639 4,756 6,137 9,079 8,148 111.3 113.5 145.8 214.8 192.8

TOTAL 934,101 981,201 1,037,048 1,117,453 1,218,671 313.6 326.4 341.6 365.4 398.5
STD Surveillance 2008 Chlamydia Tables 89

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

alphabetical order: United States and outlying areas, 2004–2008

State/Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Alabama 11,685 14,532 17,915 19,186 18,744 500.6 619.4 756.0 804.2 785.7

Alaska 2,671 2,908 3,067 3,295 3,253 843.9 907.4 947.7 1,002.6 989.8

Arizona 12,896 16,201 18,485 18,794 18,358 449.3 546.2 600.1 593.7 579.9

Arkansas 6,252 6,823 6,604 7,893 10,643 445.3 481.8 460.8 546.0 736.2

California 88,439 93,646 97,170 101,175 104,201 491.9 517.8 532.9 553.6 570.2

Colorado 10,283 11,219 12,037 12,707 13,825 451.0 485.8 510.0 527.1 573.4

Connecticut 7,383 8,383 8,205 8,577 9,239 409.4 464.4 456.2 477.7 514.6

Delaware 2,140 2,493 2,625 2,554 2,789 502.7 576.8 597.6 573.3 626.1

District of Columbia 2,948 2,976 2,510 3,970 4,438 1,010.3 1,028.4 812.7 1,279.9 1,430.8

Florida 34,437 34,850 38,536 42,173 52,206 388.1 384.4 418.6 454.3 562.4

Georgia 27,656 26,317 30,546 31,827 31,515 619.5 574.0 642.7 656.1 649.7

Hawaii 4,019 4,093 4,161 4,228 4,422 635.1 640.1 648.0 663.1 693.6

Idaho 2,157 2,162 2,435 2,660 3,048 310.5 303.6 334.4 357.1 409.2

Illinois 35,996 37,672 39,705 41,733 43,112 556.3 580.3 609.5 640.2 661.3

Indiana 14,217 15,263 14,907 15,576 16,513 448.7 479.4 465.4 483.9 513.0

Iowa 5,208 5,400 6,157 6,310 6,882 347.1 358.7 407.9 416.9 454.7

Kansas 6,195 6,054 6,286 6,629 7,401 449.9 438.4 451.4 473.6 528.8

Kentucky 5,027 6,041 6,336 6,184 8,622 238.0 284.5 295.4 285.9 398.6

Louisiana 17,549 13,395 14,290 15,334 17,260 755.8 576.4 649.0 694.6 781.8

Maine 1,532 1,644 1,672 1,831 1,847 227.3 243.2 247.6 271.5 273.9

Maryland 16,108 14,653 17,339 18,230 19,337 561.8 507.5 598.1 628.7 666.8

Massachusetts 9,781 10,587 11,175 11,671 12,646 295.5 321.0 336.6 351.2 380.5

Michigan 32,624 30,079 27,915 28,341 33,719 634.2 584.6 544.6 554.4 659.6

Minnesota 8,521 8,820 9,243 9,681 10,266 331.7 341.3 355.7 371.0 393.4

Mississippi 15,097 16,684 14,853 16,718 16,323 1,010.4 1,110.4 989.4 1,110.8 1,084.5

Missouri 16,306 16,580 16,938 17,080 18,116 553.9 559.3 566.9 567.9 602.4

Montana 1,916 1,776 1,932 2,024 2,227 412.4 378.9 409.3 423.2 465.7

Nebraska 3,812 3,713 3,956 3,755 4,123 431.4 417.6 443.7 419.5 460.6

Nevada 4,857 5,362 6,185 7,044 7,131 423.8 452.3 504.2 559.7 566.6

New Hampshire 1,265 1,343 1,484 1,533 1,548 192.1 202.2 222.7 230.0 232.2

New Jersey 14,491 15,826 16,560 17,355 18,001 324.7 354.1 371.1 391.1 405.7

New Mexico 6,876 6,333 7,456 7,044 6,986 710.9 646.2 753.3 705.7 699.9

New York 44,975 45,391 48,568 56,590 61,280 453.3 457.2 488.1 569.5 616.7

North Carolina 23,916 25,702 27,301 25,110 30,693 550.8 582.6 604.6 541.9 662.4

North Dakota 1,206 1,091 1,231 1,194 1,291 379.6 342.1 389.0 374.7 405.1

Ohio 30,377 33,312 30,483 36,143 35,021 516.8 566.9 518.4 615.1 596.0

Oklahoma 8,237 10,608 9,678 9,130 11,117 461.9 591.1 533.3 499.0 607.5

Oregon 6,090 6,194 6,585 6,890 7,433 336.9 338.4 353.8 365.5 394.3

Pennsylvania 27,740 27,131 28,503 30,511 30,509 433.9 424.0 445.8 477.9 477.9

Rhode Island 2,502 2,396 2,175 2,282 2,400 447.3 430.7 394.5 418.0 439.6

South Carolina 15,925 15,694 19,055 20,793 20,492 739.7 719.6 859.3 919.8 906.5

South Dakota 1,824 1,924 1,923 1,894 2,185 470.5 492.9 491.4 474.2 547.1

Tennessee 16,237 16,453 18,352 19,604 20,479 538.6 540.8 594.3 622.2 650.0

Texas 57,470 58,668 60,327 67,966 79,002 509.1 511.4 511.5 567.4 659.5

Utah 2,720 3,081 3,457 3,926 3,982 228.6 250.6 272.7 299.8 304.1

Vermont 861 725 897 812 896 272.8 229.3 283.1 257.4 284.0

Virginia 16,578 16,805 17,682 18,136 23,172 437.6 437.2 455.0 461.8 590.1

Washington 12,835 13,471 13,021 13,793 15,581 412.8 427.8 406.1 425.0 480.1

West Virginia 2,105 2,272 2,208 2,423 2,490 226.8 244.9 238.0 262.0 269.2

Wisconsin 13,913 14,751 14,606 14,438 15,229 500.1 527.9 522.5 512.4 540.5

Wyoming 820 874 1,051 913 1,011 326.1 346.0 413.8 354.2 392.2

U.S. TOTAL 716,675 740,371 775,788 825,660 893,004 480.6 492.2 510.8 539.8 583.8

Northeast 110,530 113,426 119,239 131,162 138,366 393.4 403.5 423.8 467.1 492.8

Midwest 170,199 174,659 173,350 182,774 193,858 509.2 521.0 515.8 542.6 575.5

South 279,367 284,966 306,157 327,231 369,322 518.4 521.5 551.6 582.3 657.1

West 156,579 167,320 177,042 184,493 191,458 464.5 490.2 511.0 527.2 547.1

Guam 608 667 692 669 574 747.1 807.0 824.7 785.4 673.9

Puerto Rico 3,240 3,366 4,091 6,781 5,834 160.1 165.6 200.3 330.8 284.6

Virgin Islands 232 189 144 267 448 408.0 332.5 253.6 462.5 776.0

OUTLYING AREAS 4,080 4,222 4,927 7,717 6,856 188.8 194.4 225.7 351.9 312.7

TOTAL 720,755 744,593 780,715 833,377 899,860 476.4 488.0 506.7 537.1 580.0

NOTE: Cases reported with unknown sex are not included in this table.
90 Chlamydia Tables STD Surveillance 2008

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

alphabetical order: United States and outlying areas, 2004–2008

State/Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Alabama 1,603 2,507 4,985 5,955 6,007 73.0 113.4 223.6 265.6 267.9

Alaska 1,283 1,447 1,458 1,616 1,608 378.6 421.6 420.9 455.4 453.2

Arizona 3,884 5,058 5,588 6,055 6,401 135.2 170.1 181.1 190.8 201.7

Arkansas 1,612 1,684 1,655 2,060 3,491 119.5 123.6 120.1 148.3 251.3

California 33,323 36,449 38,003 40,213 44,060 186.0 202.0 208.5 220.0 241.1

Colorado 3,855 4,213 4,276 4,479 5,319 166.1 178.8 178.7 182.8 217.1

Connecticut 2,168 2,656 2,741 2,877 3,264 127.5 155.8 160.7 168.5 191.2

Delaware 814 899 990 925 1,079 201.1 218.6 239.0 220.6 257.3

District of Columbia 529 681 819 2,034 2,438 202.1 260.8 300.4 731.4 876.6

Florida 8,117 8,522 10,410 15,376 18,593 95.2 97.7 117.2 171.4 207.3

Georgia 6,411 6,793 8,089 10,808 10,690 146.9 151.4 175.4 230.3 227.8

Hawaii 1,288 1,396 1,384 1,431 1,560 204.4 219.6 215.1 221.6 241.6

Idaho 617 616 895 1,030 1,133 88.3 85.9 121.2 136.5 150.2

Illinois 11,187 12,886 13,881 13,736 16,052 179.2 205.5 219.7 216.9 253.4

Indiana 4,080 4,703 4,849 5,032 5,572 132.9 152.3 155.9 160.9 178.2

Iowa 1,743 1,990 2,233 2,333 2,490 119.9 136.2 151.6 158.2 168.9

Kansas 1,298 1,365 1,543 1,551 1,807 95.6 100.1 112.5 112.7 131.3

Kentucky 1,433 2,285 2,580 2,605 3,508 70.5 111.5 125.2 125.3 168.8

Louisiana 4,016 3,583 3,372 3,758 5,226 183.0 162.9 161.7 180.2 250.6

Maine 581 606 634 708 761 90.3 93.9 98.1 110.1 118.4

Maryland 3,841 3,627 4,439 4,907 5,307 142.7 133.7 163.4 180.5 195.2

Massachusetts 3,449 3,809 4,193 4,457 4,839 111.0 122.8 134.5 142.6 154.8

Michigan 8,622 8,525 8,724 8,845 11,007 173.5 171.3 175.5 178.3 221.9

Minnesota 3,081 3,369 3,692 3,732 4,085 121.7 132.2 143.7 144.2 157.8

Mississippi 3,766 4,584 4,149 4,968 4,930 267.3 323.1 294.4 351.4 348.7

Missouri 5,013 5,791 6,044 6,228 6,701 178.3 204.2 211.7 216.9 233.4

Montana 685 619 709 716 865 148.2 132.6 150.0 149.3 180.3

Nebraska 1,391 1,378 1,401 1,363 1,441 161.1 158.4 159.8 155.0 163.9

Nevada 1,821 1,955 2,211 2,460 2,539 153.2 159.0 174.2 188.3 194.3

New Hampshire 471 499 513 522 561 73.5 77.3 79.1 80.4 86.4

New Jersey 2,945 3,323 3,606 4,169 4,390 69.5 78.2 84.6 98.1 103.3

New Mexico 2,151 2,121 2,368 2,415 2,272 229.8 223.6 245.4 248.5 233.8

New York 14,031 18,547 20,148 24,045 27,056 150.8 198.9 215.4 256.9 289.0

North Carolina 5,051 5,481 6,314 5,493 6,656 120.3 128.3 145.4 124.1 150.3

North Dakota 601 574 588 594 629 189.8 180.6 184.1 185.0 195.9

Ohio 8,189 9,139 9,039 10,852 10,847 146.7 163.6 161.5 194.1 194.0

Oklahoma 2,129 2,799 3,314 3,399 3,606 122.3 159.6 187.8 190.2 201.7

Oregon 2,600 2,824 2,992 2,959 3,311 145.5 155.9 162.6 158.9 177.8

Pennsylvania 10,282 10,128 10,981 11,934 11,722 171.0 168.0 181.6 197.3 193.8

Rhode Island 936 868 962 892 915 179.6 167.0 186.4 174.3 178.8

South Carolina 2,456 2,572 3,272 5,549 5,723 120.1 124.0 155.5 258.4 266.5

South Dakota 708 774 709 725 767 184.7 200.7 181.5 182.7 193.3

Tennessee 6,278 6,619 6,968 7,262 7,559 217.5 226.6 236.1 241.6 251.5

Texas 12,619 13,138 15,178 17,687 21,812 112.7 115.4 129.6 148.3 182.9

Utah 1,137 1,521 1,635 1,795 2,039 94.8 122.6 127.5 134.4 152.6

Vermont 276 232 294 245 294 90.3 75.6 95.8 80.1 96.1

Virginia 5,024 5,823 6,384 6,433 7,985 136.8 156.4 169.9 170.0 211.0

Washington 4,800 5,145 4,798 4,991 5,767 155.1 163.9 150.4 154.9 178.9

West Virginia 649 671 698 744 825 73.1 75.5 78.4 83.9 93.0

Wisconsin 5,290 5,688 5,551 5,090 5,707 194.0 207.5 201.1 182.8 205.0

Wyoming 262 299 371 284 563 102.7 116.5 142.1 107.2 212.4

U.S. TOTAL 210,396 232,781 252,630 280,337 313,779 145.6 159.4 171.3 188.6 211.1

Northeast 35,139 40,668 44,072 49,849 53,802 132.7 153.3 165.6 187.4 202.2

Midwest 51,203 56,182 58,254 60,081 67,105 158.5 173.2 178.6 183.7 205.2

South 66,348 72,268 83,616 99,963 115,435 127.4 136.7 156.0 184.3 212.8

West 57,706 63,663 66,688 70,444 77,437 171.2 186.4 192.1 200.7 220.6

Guam 140 140 140 153 113 165.3 162.9 160.7 173.1 127.9

Puerto Rico 348 348 1,007 1,125 1,034 18.6 18.5 53.4 59.4 54.6

Virgin Islands 71 46 55 81 139 136.8 88.7 106.1 155.5 266.9

OUTLYING AREAS 559 534 1,202 1,359 1,286 27.8 26.5 59.3 66.8 63.3

TOTAL 210,955 233,315 253,832 281,696 315,065 144.0 157.6 169.7 186.9 209.1

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2008 Chlamydia Tables 91

Table 6. Chlamydia—Reported cases and rates in selected metropolitan statistical areas* (MSAs) 

listed in alphabetical order: United States, 2004–2008

Metropolitan Statistical Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Atlanta-Sandy Springs-Marietta, GA 17,068 16,748 20,979 21,609 20,722 362.5 340.6 408.3 409.3 392.5

Austin-Round Rock, TX 4,580 5,103 7,325 6,814 8,413 324.3 351.3 484.0 426.4 526.4

Baltimore-Towson, MD 10,959 11,071 11,617 13,053 13,537 415.2 416.9 437.0 489.2 507.4

Birmingham-Hoover, AL 3,905 4,720 5,338 6,913 6,690 360.8 433.0 485.3 623.8 603.7

Boston-Cambridge-Quincy, MA-NH 9,006 9,368 9,918 10,697 11,854 203.5 212.3 222.6 238.6 264.4

Buffalo-Cheektowaga-Tonawanda, NY 4,865 5,013 4,992 5,078 5,561 421.4 436.8 438.8 450.1 492.9

Charlotte-Gastonia-Concord, NC-SC 4,832 5,830 5,076 4,216 7,046 327.7 383.2 320.7 255.3 426.6

Chicago-Naperville-Joliet, IL-IN-WI 35,953 38,966 41,521 41,403 45,803 382.8 412.6 436.8 434.7 480.9

Cincinnati-Middletown, OH-KY-IN 6,438 8,516 8,616 10,080 10,016 312.8 411.3 409.5 472.4 469.4

Cleveland-Elyria-Mentor, OH 7,867 8,181 7,462 9,351 8,731 368.1 384.7 353.0 446.0 416.5

Columbus, OH 5,167 5,902 5,843 7,157 8,314 305.0 345.4 338.6 408.0 473.9

Dallas-Fort Worth-Arlington, TX 15,744 18,005 17,035 22,292 26,090 276.2 309.4 283.7 362.8 424.6

Denver-Aurora, CO 7,774 8,534 7,934 9,539 10,996 333.6 361.6 329.4 387.0 446.1

Detroit-Warren-Livonia, MI 21,378 20,497 17,201 17,934 24,987 475.8 456.7 384.9 401.4 559.3

Hartford-WestHartford-East Hartford, CT 3,040 3,815 3,799 4,300 4,781 256.6 321.1 319.6 361.6 402.1

Houston-Baytown-Sugar Land, TX 14,796 13,476 14,641 17,196 21,100 285.6 255.2 264.3 305.5 374.9

Indianapolis, IN 6,922 8,226 7,780 8,173 8,814 426.9 501.4 467.0 482.2 520.0

Jacksonville, FL 5,017 5,246 5,582 6,501 7,318 409.4 420.2 436.8 499.8 562.6

Kansas City, MO-KS 8,003 7,900 7,825 8,358 9,559 415.7 405.6 397.7 421.0 481.5

Las Vegas-Paradise, NV 5,065 5,623 6,592 7,333 7,753 306.8 328.7 370.8 399.3 422.2

Los Angeles-Long Beach-Santa Ana, CA 46,202 50,703 50,913 52,352 55,276 357.5 392.3 393.1 406.6 429.3

Louisville, KY-IN 2,396 3,143 3,319 3,493 4,953 199.5 260.1 271.6 283.1 401.5

Memphis, TN-MS-AR 8,927 9,457 10,224 11,349 11,896 714.0 750.0 802.1 886.3 929.0

Miami-Fort Lauderdale-Miami Beach, FL 11,781 10,403 12,142 13,761 18,128 219.7 191.9 222.2 254.2 334.9

Milwaukee-Waukesha-West Allis, WI 10,070 10,368 10,498 10,150 1,441 664.4 685.3 695.2 657.2 93.3

Minneapolis-St. Paul-Bloomington, MN-WI 8,139 8,513 9,271 9,514 10,093 261.2 270.9 292.0 296.6 314.6

Nashville-Davidson-Murfreesboro, TN 4,243 4,538 4,910 4,972 5,574 304.0 319.0 337.4 326.8 366.4

New Orleans-Metairie-Kenner, LA 6,858 4,761 3,401 4,573 5,109 519.7 360.9 331.9 443.8 495.8

New York-Newark-Edison, NY-NJ-PA 52,266 58,134 62,334 74,071 80,306 279.4 310.1 331.2 393.7 426.8

Oklahoma City, OK 3,939 4,798 4,627 4,646 5,650 344.2 414.8 394.7 389.4 473.6

Orlando, FL 4,888 5,862 6,579 6,825 8,287 262.6 303.2 331.5 335.8 407.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 25,285 24,913 27,417 28,116 28,749 435.9 427.8 470.5 482.4 493.3

Phoenix-Mesa-Scottsdale, AZ 11,078 11,984 15,278 15,245 14,314 298.2 310.1 378.2 364.8 342.5

Pittsburgh, PA 5,539 5,880 5,789 6,616 6,920 230.6 246.4 244.2 280.8 293.8

Portland-Vancouver-Beaverton, OR-WA 5,256 5,636 5,654 5,970 6,499 254.6 268.9 264.5 274.5 298.8

Providence-New Bedford-Fall River, RI-MA 4,269 4,316 4,197 4,297 4,551 262.1 266.0 260.2 268.4 284.3

Richmond, VA 4,923 4,710 5,044 5,294 6,783 426.5 400.6 422.4 436.4 559.2

Riverside-San Bernardino-Ontario, CA 10,913 12,179 12,472 14,316 13,557 287.7 311.5 309.8 350.8 332.2

Rochester, NY 4,040 3,850 4,168 4,833 5,294 387.9 370.5 402.5 469.0 513.7

Sacramento-Arden-Arcade-Roseville, CA 7,294 8,175 9,094 8,770 8,395 361.7 400.3 439.9 419.4 401.5

Salt Lake City, UT 2,223 2,642 2,910 3,395 3,562 218.2 255.4 272.5 308.6 323.8

San Antonio, TX 7,645 8,049 8,338 8,727 9,734 412.3 425.9 429.3 438.4 489.0

San Diego-Carlsbad-San Marcos, CA 10,876 11,520 11,980 12,693 14,373 371.0 392.7 407.3 426.7 483.1

San Francisco-Oakland-Fremont, CA 13,580 13,988 15,565 16,710 17,555 326.9 336.8 372.4 397.5 417.6

San Jose-Sunnyvale-Santa Clara, CA 5,697 5,374 5,898 5,892 5,796 327.1 306.2 330.0 326.7 321.3

Seattle-Tacoma-Bellevue, WA 9,655 10,588 9,778 10,397 11,532 304.9 330.5 299.6 314.2 348.5

St. Louis, MO-IL 11,856 13,328 13,509 13,710 14,092 428.9 479.7 483.1 489.0 502.6

Tampa-St. Petersburg-Clearwater, FL 5,996 6,315 7,475 9,501 11,230 231.7 238.5 277.1 348.8 412.3

Virginia Beach-Norfolk-Newport News, VA-NC 7,601 8,414 9,139 9,383 11,867 462.3 510.8 554.1 565.7 715.4

Washington-Arlington-Alexandria, DC-VA-MD-WV 14,046 12,827 15,456 18,069 20,943 273.3 246.0 292.2 340.5 394.7

U.S. MSA TOTAL 525,860 556,108 584,455 635,637 690,544 333.0 348.7 362.3 390.6 424.4

* MSAs selected based on largest population in 2000 U.S. Census.

NOTE: 2008 Milwaukee County STD morbidity data were misclassified resulting in incomplete case counts for MSA-Milwaukee-Waukesha-West Allis, WI.
92 Chlamydia Tables STD Surveillance 2008

Table 7. Chlamydia—Women—Reported cases and rates in selected metropolitan statistical areas* 

(MSAs) listed in alphabetical order: United States, 2004–2008

Metropolitan Statistical Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Atlanta-Sandy Springs-Marietta, GA 13,756 12,995 16,165 15,553 14,898 580.4 524.8 622.2 582.4 557.9

Austin-Round Rock, TX 3,405 3,720 5,170 4,753 5,933 492.5 522.7 699.1 609.2 760.4

Baltimore-Towson, MD 9,051 8,927 9,344 10,416 10,774 662.1 649.4 677.9 753.5 779.4

Birmingham-Hoover, AL 3,095 3,709 4,277 5,165 4,948 552.6 657.7 751.3 900.4 862.6

Boston-Cambridge-Quincy, MA-NH 6,549 6,663 7,140 7,721 8,458 287.6 293.8 311.7 335.2 367.2

Buffalo-Cheektowaga-Tonawanda, NY 3,698 3,849 3,762 3,818 4,076 616.7 646.3 637.8 653.5 697.6

Charlotte-Gastonia-Concord, NC-SC 4,059 4,878 4,189 3,430 5,469 541.9 631.9 520.7 407.4 649.6

Chicago-Naperville-Joliet, IL-IN-WI 27,271 28,860 30,600 31,134 33,220 570.2 600.4 633.8 644.2 687.3

Cincinnati-Middletown, OH-KY-IN 5,108 6,580 6,871 8,082 8,031 484.6 621.4 638.2 740.4 735.7

Cleveland-Elyria-Mentor, OH 5,909 6,066 5,458 7,023 6,487 531.6 548.7 497.2 645.2 595.9

Columbus, OH 4,058 4,445 4,549 5,428 6,027 472.8 513.4 520.7 611.1 678.5

Dallas-Fort Worth-Arlington, TX 12,536 14,641 13,466 17,251 20,125 440.7 504.7 450.4 564.5 658.5

Denver-Aurora, CO 5,558 6,122 5,827 7,020 7,824 479.3 521.7 485.8 572.1 637.6

Detroit-Warren-Livonia, MI 17,145 16,172 13,096 13,580 18,826 744.1 703.4 572.9 594.5 824.1

Hartford-WestHartford-East Hartford, CT 2,331 2,842 2,786 3,122 3,474 381.9 464.3 456.5 511.7 569.4

Houston-Baytown-Sugar Land, TX 12,258 11,539 12,178 14,170 17,287 473.1 437.0 439.8 504.4 615.4

Indianapolis, IN 5,167 5,949 5,596 5,808 6,352 625.9 712.5 660.3 673.8 736.9

Jacksonville, FL 3,759 4,021 4,273 4,627 5,392 600.4 630.6 654.9 695.7 810.8

Kansas City, MO-KS 5,993 5,930 5,791 6,231 7,115 611.3 598.8 578.2 616.2 703.7

Las Vegas-Paradise, NV 3,820 4,319 5,014 5,620 5,842 471.0 513.8 573.3 623.0 647.7

Los Angeles-Long Beach-Santa Ana, CA 32,903 36,044 35,826 36,520 38,100 504.6 552.9 549.2 563.3 587.7

Louisville, KY-IN 1,817 2,232 2,344 2,482 3,504 295.1 360.6 374.3 392.6 554.3

Memphis, TN-MS-AR 6,816 7,150 7,935 8,846 9,199 1,053.0 1,098.1 1,202.2 1,332.7 1,385.9

Miami-Fort Lauderdale-Miami Beach, FL 9,610 8,492 9,553 9,985 13,144 347.8 304.2 340.1 359.0 472.6

Milwaukee-Waukesha-West Allis, WI 7,358 7,558 7,761 7,653 1,116 945.2 973.0 1,004.8 968.8 141.3

Minneapolis-St. Paul-Bloomington, MN-WI 5,892 6,022 6,462 6,727 7,037 374.8 380.0 404.3 417.2 436.5

Nashville-Davidson-Murfreesboro, TN 3,018 3,122 3,413 3,445 3,916 426.5 433.4 462.7 446.5 507.5

New Orleans-Metairie-Kenner, LA 5,433 3,563 2,673 3,503 3,722 791.6 519.8 503.2 653.5 694.3

New York-Newark-Edison, NY-NJ-PA 41,039 42,214 45,007 52,815 56,829 423.4 435.0 462.7 543.6 584.9

Oklahoma City, OK 3,057 3,744 3,394 3,262 4,119 527.5 638.7 570.1 539.5 681.3

Orlando, FL 3,993 4,667 5,326 5,203 6,160 424.0 477.4 531.7 507.6 600.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 18,369 18,236 19,813 20,132 20,708 611.6 605.3 658.0 668.7 687.8

Phoenix-Mesa-Scottsdale, AZ 8,555 9,338 11,859 11,675 10,725 464.3 487.7 592.7 564.2 518.3

Pittsburgh, PA 4,185 4,398 4,267 4,870 5,092 334.6 354.2 346.5 398.4 416.6

Portland-Vancouver-Beaverton, OR-WA 3,555 3,816 3,769 4,109 4,468 343.2 363.1 351.7 376.7 409.6

Providence-New Bedford-Fall River, RI-MA 3,138 3,225 2,967 3,116 3,327 372.1 384.3 355.8 376.8 402.3

Richmond, VA 3,573 3,425 3,617 3,778 4,981 601.2 566.7 590.0 605.1 797.8

Riverside-San Bernardino-Ontario, CA 8,252 9,257 9,426 10,773 10,009 435.4 474.3 468.5 528.4 490.9

Rochester, NY 2,869 2,670 2,890 3,337 3,594 536.9 501.5 544.7 632.2 680.9

Sacramento-Arden-Arcade-Roseville, CA 5,326 5,890 6,614 6,310 5,997 519.5 567.4 629.1 594.0 564.5

Salt Lake City, UT 1,501 1,709 1,941 2,299 2,254 298.1 334.4 368.8 425.3 417.0

San Antonio, TX 6,182 6,105 6,232 6,567 7,206 653.1 633.1 628.0 646.8 709.7

San Diego-Carlsbad-San Marcos, CA 7,908 8,210 8,620 9,187 10,257 542.6 565.1 590.4 620.4 692.7

San Francisco-Oakland-Fremont, CA 9,151 9,217 10,418 11,118 11,514 436.4 439.6 495.3 525.7 544.5

San Jose-Sunnyvale-Santa Clara, CA 4,038 3,752 4,128 4,232 4,218 471.7 435.6 472.4 480.4 478.8

Seattle-Tacoma-Bellevue, WA 6,775 7,411 6,915 7,412 7,975 427.2 462.5 423.6 447.2 481.2

St. Louis, MO-IL 9,086 9,804 9,952 10,012 10,166 636.1 683.2 689.2 691.6 702.3

Tampa-St. Petersburg-Clearwater, FL 4,920 5,184 5,936 6,841 8,099 369.1 380.8 428.6 489.4 579.4

Virginia Beach-Norfolk-Newport News, VA-NC 5,862 6,016 6,651 6,884 8,789 704.2 720.5 789.6 811.7 1,036.3

Washington-Arlington-Alexandria, DC-VA-MD-WV 11,170 10,086 11,722 13,194 14,967 424.8 378.3 432.7 485.5 550.7

U.S. MSA TOTAL 399,877 414,784 432,983 466,239 501,750 497.5 511.3 528.1 564.1 607.0

* MSAs selected based on largest population in 2000 U.S. Census.

NOTE: 2008 Milwaukee County STD morbidity data were misclassified resulting in incomplete case counts for MSA-Milwaukee-Waukesha-West Allis, WI.
STD Surveillance 2008 Chlamydia Tables 93

Table 8. Chlamydia—Men—Reported cases and rates in selected metropolitan statistical areas* 

(MSAs) listed in alphabetical order: United States, 2004–2008

Metropolitan Statistical Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Atlanta-Sandy Springs-Marietta, GA 3,187 3,463 4,574 5,896 5,585 136.3 141.8 180.1 226.0 214.1

Austin-Round Rock, TX 1,093 1,357 2,147 2,053 2,472 151.6 183.2 277.4 251.0 302.2

Baltimore-Towson, MD 1,908 2,139 2,250 2,624 2,754 150.0 167.0 175.8 204.1 214.2

Birmingham-Hoover, AL 810 1,005 1,058 1,745 1,740 155.1 191.0 199.4 326.4 325.5

Boston-Cambridge-Quincy, MA-NH 2,449 2,697 2,762 2,966 3,383 114.0 125.8 127.6 136.1 155.2

Buffalo-Cheektowaga-Tonawanda, NY 1,167 1,164 1,229 1,260 1,485 210.4 210.8 224.4 231.7 273.0

Charlotte-Gastonia-Concord, NC-SC 770 951 887 786 1,549 106.1 126.9 113.9 97.1 191.3

Chicago-Naperville-Joliet, IL-IN-WI 8,602 10,075 10,905 10,259 12,578 186.7 217.3 233.1 218.7 268.1

Cincinnati-Middletown, OH-KY-IN 1,239 1,746 1,691 1,935 1,963 123.4 172.6 164.6 185.7 188.4

Cleveland-Elyria-Mentor, OH 1,904 1,986 1,953 2,285 2,216 185.7 194.6 192.2 226.7 219.9

Columbus, OH 1,058 1,377 1,272 1,706 2,275 126.6 163.4 149.3 197.0 262.7

Dallas-Fort Worth-Arlington, TX 3,192 3,346 3,558 4,987 5,962 111.8 114.6 118.0 161.5 193.0

Denver-Aurora, CO 2,210 2,412 2,107 2,519 3,161 188.8 203.3 174.2 203.5 255.4

Detroit-Warren-Livonia, MI 4,233 4,256 4,027 4,220 5,996 193.4 194.4 184.5 193.3 274.6

Hartford-WestHartford-East Hartford, CT 708 973 1,013 1,178 1,303 123.3 168.9 175.1 203.5 225.0

Houston-Baytown-Sugar Land, TX 2,504 1,930 2,449 2,963 3,776 96.7 73.1 88.4 105.1 133.9

Indianapolis, IN 1,744 2,242 2,167 2,340 2,451 219.1 278.3 264.7 280.9 294.2

Jacksonville, FL 1,258 1,225 1,309 1,873 1,912 209.9 200.6 209.3 294.6 300.7

Kansas City, MO-KS 2,010 1,970 2,034 2,127 2,444 212.7 205.8 210.6 218.3 250.8

Las Vegas-Paradise, NV 1,233 1,301 1,576 1,704 1,911 146.9 149.6 174.5 182.4 204.5

Los Angeles-Long Beach-Santa Ana, CA 13,208 14,585 14,921 15,639 16,886 206.2 227.7 232.2 244.7 264.2

Louisville, KY-IN 572 909 961 1,011 1,436 97.8 154.2 161.3 168.1 238.7

Memphis, TN-MS-AR 2,111 2,307 2,289 2,503 2,697 350.1 378.3 372.4 405.8 437.3

Miami-Fort Lauderdale-Miami Beach, FL 2,171 1,911 2,588 3,771 4,934 83.5 72.6 97.5 143.3 187.5

Milwaukee-Waukesha-West Allis, WI 2,711 2,804 2,720 2,473 321 367.7 380.9 368.8 327.8 42.5

Minneapolis-St. Paul-Bloomington, MN-WI 2,247 2,491 2,809 2,787 3,056 145.5 159.9 178.2 174.6 191.5

Nashville-Davidson-Murfreesboro, TN 1,225 1,415 1,497 1,527 1,658 178.0 201.5 208.6 203.7 221.1

New Orleans-Metairie-Kenner, LA 1,327 1,100 676 985 1,349 209.6 173.5 137.0 199.3 272.9

New York-Newark-Edison, NY-NJ-PA 11,125 15,890 17,301 21,165 23,441 123.4 175.7 190.3 232.6 257.6

Oklahoma City, OK 882 1,054 1,233 1,384 1,473 156.2 184.7 213.7 235.2 250.3

Orlando, FL 895 1,195 1,252 1,620 2,117 97.3 125.0 127.3 160.8 210.1

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 6,915 6,677 7,600 7,972 8,040 247.2 237.6 269.9 283.0 285.4

Phoenix-Mesa-Scottsdale, AZ 2,521 2,646 3,410 3,569 3,586 134.6 135.7 167.3 169.1 169.9

Pittsburgh, PA 1,353 1,482 1,522 1,745 1,828 117.6 129.5 133.6 154.0 161.3

Portland-Vancouver-Beaverton, OR-WA 1,701 1,820 1,885 1,861 2,029 165.4 174.2 176.9 171.6 187.1

Providence-New Bedford-Fall River, RI-MA 1,126 1,085 1,223 1,178 1,222 143.3 138.5 157.0 152.2 157.9

Richmond, VA 1,348 1,281 1,423 1,514 1,793 240.7 224.2 244.9 257.2 304.6

Riverside-San Bernardino-Ontario, CA 2,654 2,913 3,029 3,532 3,548 139.8 148.8 150.4 172.9 173.7

Rochester, NY 1,171 1,180 1,278 1,496 1,700 230.9 232.9 253.1 297.6 338.2

Sacramento-Arden-Arcade-Roseville, CA 1,901 2,220 2,431 2,387 2,346 191.7 221.1 239.3 232.0 228.0

Salt Lake City, UT 722 933 969 1,096 1,308 140.1 178.2 179.0 195.9 233.8

San Antonio, TX 1,460 1,942 2,104 2,160 2,527 160.9 209.8 221.5 221.5 259.1

San Diego-Carlsbad-San Marcos, CA 2,844 3,022 3,134 3,457 4,078 192.9 204.1 211.6 231.4 272.9

San Francisco-Oakland-Fremont, CA 4,370 4,686 5,058 5,465 5,968 212.4 227.9 243.6 261.6 285.7

San Jose-Sunnyvale-Santa Clara, CA 1,628 1,575 1,723 1,633 1,558 183.9 176.2 188.7 177.0 168.8

Seattle-Tacoma-Bellevue, WA 2,880 3,177 2,863 2,985 3,538 182.2 198.5 175.5 180.7 214.2

St. Louis, MO-IL 2,770 3,524 3,557 3,698 3,925 207.4 262.3 263.0 272.7 289.4

Tampa-St. Petersburg-Clearwater, FL 1,076 1,131 1,535 2,652 3,050 85.7 87.9 116.9 200.0 230.0

Virginia Beach-Norfolk-Newport News, VA-NC 1,724 2,375 2,481 2,494 3,064 212.4 292.4 307.4 307.7 378.0

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,848 2,706 3,637 4,849 5,897 113.5 106.2 140.9 187.3 227.8

U.S. MSA TOTAL 124,765 139,651 150,077 168,034 187,289 160.9 178.2 189.2 209.9 233.9

* MSAs selected based on largest population in 2000 U.S. Census.

NOTE: 2008 Milwaukee County STD morbidity data were misclassified resulting in incomplete case counts for MSA-Milwaukee-Waukesha-West Allis, WI.
94 Chlamydia Tables STD Surveillance 2008

Table 9. Chlamydia—Counties and independent cities* ranked by number of reported cases: 

United States, 2008

Rank† County/Independent City Cases

Rate per 100,000 

Population Cumulative Percen

1 Los Angeles County, CA 46,707 472.8 3

2 Cook County, IL 34,257 648.2 6

3 Wayne County, MI 19,218 968.1 8

4 Philadelphia County, PA 17,012 1,173.5 9

5 Kings County, NY 16,983 671.8 11

6 Harris County, TX 16,896 429.3 12

7 Bronx County, NY 15,931 1,159.7 13

8 San Diego County, CA 14,373 483.1 14

9 Dallas County, TX 13,699 578.9 16

10 Maricopa County, AZ 13,407 345.5 17

11 Queens County, NY 11,682 514.5 18

12 New York County, NY 10,887 671.7 19

13 Shelby County, TN 9,804 1,077.2 19

14 Bexar County, TX 8,964 562.2 20

15 Orange County, CA 8,569 285.9 21

16 San Bernardino County, CA 8,547 425.7 22

17 Baltimore (City), MD 8,421 1,321.0 22

18 Tarrant County, TX 7,923 461.3 23

19 Clark County, NV 7,753 422.2 24

20 Marion County, IN 7,572 863.6 24

21 Miami-Dade County, FL 7,564 316.9 25

22 Franklin County, OH 7,460 667.2 25

23 Cuyahoga County, OH 7,360 567.9 26

24 Alameda County, CA 7,132 487.1 27

25 Hamilton County, OH 7,030 834.6 27

26 Broward County, FL 6,982 396.8 28

27 Sacramento County, CA 6,958 501.8 28

28 Washington, D.C. 6,924 1,177.0 29

29 Hillsborough County, FL 6,264 533.2 29

30 Duval County, FL 6,136 722.6 30

31 King County, WA 6,057 325.8 30

32 Travis County, TX 5,837 599.1 31

33 Kern County, CA 5,822 736.3 31

34 Jefferson County, AL 5,814 882.5 32

35 Orange County, FL 5,764 540.7 32

36 Santa Clara County, CA 5,650 323.0 33

37 Fresno County, CA 5,576 620.0 33

38 Jackson County, MO 5,567 834.8 34

39 Fulton County, GA 5,363 540.6 34

40 Prince George's County, MD 5,239 632.1 35

41 Allegheny County, PA 5,203 426.8 35

42 St. Louis County, MO 5,139 516.4 35

43 Riverside County, CA 5,010 241.6 36

44 Hennepin County, MN 5,002 440.1 36

45 Essex County, NJ 4,960 639.1 37

46 Denver County, CO 4,919 836.1 37

47 Suffolk County, MA 4,883 684.8 38

48 DeKalb County, GA 4,790 649.9 38

49 Honolulu County, HI 4,769 526.6 38

50 Erie County, NY 4,722 517.0 39

51 Monroe County, NY 4,666 639.5 39

52 Oklahoma County, OK 4,366 622.1 39

53 St Louis (City), MO 4,298 1,225.3 40

54 Hartford County, CT 4,286 488.8 40

* Accounting for 40% of reported chlamydia cases.

† Counties and independent cities were ranked in descending order by number of cases reported in 2008.

NOTE: Milwaukee County was not ranked by case count or rate due to misclassification of 2008 Milwaukee County STD morbidity data. 
STD Surveillance 2008 Chlamydia Tables 95

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

United States, 2004–2008

Age

Group

Cases Rates

Total Male Female Total Male Female

10–14 14,817 1,172 13,646 70.1 10.8 132.3

2004

15–19 323,246 48,209 275,036 1,559.3 453.3 2,724.6

20–24 344,159 79,410 264,749 1,641.1 735.1 2,603.7

25–29 137,041 39,374 97,667 700.6 393.9 1,021.0

30–34 56,759 19,353 37,406 277.3 187.1 369.3

35–39 26,486 10,647 15,839 125.8 100.7 151.1

40–44 13,626 6,397 7,229 59.1 55.8 62.4

45–54 9,251 4,602 4,649 22.2 22.5 22.0

55–64 1,885 993 892 6.5 7.1 5.9

65+ 755 335 420 2.1 2.2 2.0

TOTAL 929,462 210,935 718,527 316.5 145.9 481.9

10–14 14,124 1,200 12,924 67.7 11.2 127.0

2005

15–19 336,036 53,734 282,302 1,597.2 498.0 2,754.5

20–24 360,574 86,931 273,643 1,713.9 800.7 2,687.8

25–29 148,059 44,712 103,347 737.9 435.4 1,054.8

30–34 60,065 21,102 38,964 299.2 207.8 392.6

35–39 28,509 11,700 16,809 135.7 110.8 161.0

40–44 14,397 6,940 7,458 63.0 61.0 64.9

45–54 10,105 5,203 4,902 23.8 24.9 22.7

55–64 2,191 1,169 1,021 7.2 8.0 6.5

65+ 885 402 483 2.4 2.6 2.3

TOTAL 976,445 233,553 742,892 329.4 160.0 493.9

10–14 13,601 1,238 12,364 65.9 11.7 122.8

2006

15–19 352,212 58,820 293,392 1,651.7 537.9 2,824.0

20–24 377,798 93,035 284,763 1,789.6 852.7 2,791.5

25–29 161,178 49,369 111,809 778.3 466.4 1,104.3

30–34 63,810 22,558 41,252 323.8 226.0 424.1

35–39 30,947 12,763 18,184 146.1 119.8 172.6

40–44 15,329 7,410 7,919 68.2 66.2 70.2

45–54 11,351 5,818 5,533 26.2 27.3 25.2

55–64 2,411 1,334 1,077 7.6 8.8 6.6

65+ 894 424 469 2.4 2.7 2.2

TOTAL 1,030,911 253,236 777,675 344.3 171.7 512.0

10–14 13,629 1,251 12,378 67.1 12.0 124.8

2007

15–19 379,416 67,247 312,169 1,766.9 611.0 2,982.5

20–24 402,597 101,782 300,815 1,914.2 937.8 2,955.1

25–29 174,826 54,889 119,938 830.2 509.4 1,166.5

30–34 69,417 24,633 44,785 355.4 248.7 465.2

35–39 33,654 13,838 19,816 158.9 129.9 188.3

40–44 16,617 7,992 8,625 75.6 72.9 78.3

45–54 13,141 6,881 6,261 30.0 31.9 28.1

55–64 2,842 1,531 1,311 8.7 9.7 7.7

65+ 812 417 395 2.1 2.6 1.8

TOTAL 1,108,374 280,931 827,443 367.5 189.0 540.9

10–14 14,333 1,450 12,883 70.6 13.9 129.9

2008

15–19 420,101 77,226 342,875 1,956.4 701.6 3,275.8

20–24 438,311 114,615 323,696 2,084.0 1,056.1 3,179.9

25–29 188,535 60,985 127,550 895.3 565.9 1,240.6

30–34 74,939 26,911 48,027 383.6 271.7 498.9

35–39 36,637 15,004 21,633 173.0 140.8 205.6

40–44 18,041 8,585 9,457 82.1 78.3 85.8

45–54 14,311 7,437 6,874 32.6 34.4 30.9

55–64 3,073 1,642 1,430 9.4 10.4 8.4

65+ 889 432 458 2.3 2.7 2.1

TOTAL 1,210,523 314,752 895,771 401.3 211.7 585.6

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.
96 Chlamydia Tables STD Surveillance 2008

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

United States, 2004–2008

Age

Group

White, Non-Hispanic

African-American,

Non-Hispanic Hispanic

Asian/Pacific 

Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

2004

10–14 3,199 122 3,076 8,504 759 7,745 2,152 222 1,929 135 5 130 266 31 236

15–19 95,195 9,468 85,727 157,398 28,143 129,255 49,457 7,769 41,688 3,900 485 3,415 5,551 776 4,774

20–24 109,590 22,268 87,322 149,743 38,420 111,322 59,885 13,482 46,403 6,232 1,291 4,941 5,820 1,176 4,644

25–29 37,871 10,560 27,311 58,590 18,657 39,933 29,424 7,409 22,014 3,159 802 2,357 2,614 549 2,065

30–34 13,869 4,596 9,273 24,171 9,671 14,499 13,326 3,572 9,754 1,863 502 1,361 1,209 287 922

35–39 6,553 2,748 3,806 11,323 5,277 6,047 5,927 1,777 4,150 967 324 643 646 161 486

40–44 3,815 1,947 1,868 5,900 3,148 2,753 2,532 829 1,703 499 164 335 332 90 242

45–54 2,543 1,360 1,182 4,190 2,322 1,868 1,416 501 915 471 178 294 265 82 183

55–64 593 363 231 790 444 346 292 118 174 88 26 62 40 8 33

65+ 253 116 137 281 140 140 118 37 81 27 9 17 19 7 12

TOTAL 273,854 53,669 220,186 421,608 107,202 314,407 164,762 35,786 128,976 17,358 3,791 13,568 16,787 3,174 13,613

2005

10–14 2,986 126 2,860 7,355 723 6,631 2,069 183 1,886 112 14 98 332 24 309

15–19 93,876 9,636 84,240 153,777 30,214 123,563 52,224 8,526 43,698 3,761 646 3,115 5,964 882 5,082

20–24 114,066 24,303 89,763 142,156 39,355 102,801 64,259 14,772 49,487 6,315 1,416 4,899 6,148 1,295 4,853

25–29 40,477 11,580 28,897 57,704 19,824 37,879 31,795 8,528 23,267 3,107 896 2,211 2,829 715 2,114

30–34 14,600 4,739 9,861 23,142 9,740 13,402 14,349 4,132 10,217 1,849 638 1,211 1,177 270 906

35–39 7,143 3,024 4,119 10,768 5,300 5,468 6,539 2,001 4,538 1,057 337 720 625 181 444

40–44 3,986 2,045 1,941 5,662 3,148 2,515 2,656 908 1,748 559 213 346 345 92 254

45–54 2,875 1,639 1,236 4,032 2,338 1,693 1,674 575 1,100 443 158 286 240 82 158

55–64 657 408 250 791 467 324 334 123 211 148 47 101 50 21 30

65+ 253 123 130 345 168 177 141 53 87 35 18 17 15 4 12

TOTAL 281,268 57,709 223,559 406,423 111,513 294,910 176,271 39,885 136,386 17,408 4,388 13,020 17,762 3,571 14,191

2006

10–14 2,732 84 2,648 8,187 891 7,296 2,088 233 1,856 98 3 95 309 18 290

15–19 97,442 10,379 87,063 180,893 36,692 144,201 58,312 9,483 48,829 3,387 413 2,974 6,259 1,016 5,243

20–24 120,835 26,260 94,575 164,045 45,448 118,597 71,991 16,675 55,316 5,836 1,129 4,707 6,646 1,309 5,337

25–29 46,643 13,506 33,137 67,691 23,107 44,584 36,568 9,968 26,600 3,206 826 2,381 3,103 708 2,395

30–34 16,327 5,518 10,809 26,296 11,044 15,253 16,281 4,596 11,685 1,876 523 1,354 1,421 329 1,092

35–39 8,102 3,265 4,837 12,686 6,367 6,319 7,570 2,319 5,251 998 292 706 709 171 538

40–44 4,253 2,131 2,122 6,436 3,639 2,797 3,211 1,157 2,054 633 197 437 413 106 307

45–54 3,296 1,792 1,504 5,049 2,901 2,148 1,938 695 1,242 486 190 296 271 82 189

55–64 796 474 322 943 588 355 392 157 234 133 47 86 64 16 48

65+ 285 147 139 337 177 161 176 56 119 26 14 12 28 6 22

TOTAL 301,064 63,675 237,389 473,235 131,077 342,159 198,783 45,432 153,351 16,701 3,640 13,061 19,267 3,773 15,493

2007

10–14 2,586 96 2,490 8,301 894 7,407 2,139 214 1,925 125 7 119 249 17 232

15–19 102,471 11,768 90,703 199,686 42,634 157,052 60,919 10,273 50,647 3,919 555 3,364 5,801 909 4,893

20–24 127,025 27,910 99,114 181,659 52,169 129,490 73,166 17,063 56,103 6,127 1,232 4,895 6,212 1,281 4,930

25–29 50,642 14,958 35,684 75,660 26,692 48,967 37,779 10,367 27,412 3,661 941 2,720 2,992 651 2,342

30–34 17,687 5,926 11,761 29,957 12,456 17,501 16,772 4,754 12,018 1,948 579 1,368 1,299 319 979

35–39 9,118 3,531 5,587 14,181 7,024 7,158 7,721 2,438 5,283 1,144 369 775 638 152 486

40–44 4,626 2,243 2,383 7,190 3,983 3,207 3,366 1,214 2,152 649 254 395 371 108 263

45–54 3,916 2,225 1,691 5,955 3,440 2,515 2,183 800 1,383 510 192 317 249 71 178

55–64 924 574 350 1,196 688 508 430 138 292 181 76 105 30 8 22

65+ 279 171 108 318 157 162 145 56 89 31 14 17 12 5 7

TOTAL 319,675 69,524 250,151 524,817 150,384 374,433 204,855 47,389 157,467 18,310 4,223 14,087 17,872 3,525 14,348

2008

10–14 2,686 143 2,543 8,714 1,020 7,694 2,380 235 2,144 94 8 86 215 14 201

15–19 110,221 13,270 96,951 223,088 49,101 173,987 68,593 12,020 56,573 4,187 544 3,643 6,397 1,003 5,394

20–24 135,198 30,684 104,514 199,298 58,689 140,609 80,714 19,741 60,973 6,888 1,469 5,419 6,912 1,443 5,468

25–29 54,253 16,559 37,694 81,611 29,326 52,286 40,786 11,731 29,056 4,073 1,076 2,997 3,434 790 2,643

30–34 19,540 6,668 12,872 31,778 13,256 18,522 18,211 5,355 12,855 2,191 666 1,525 1,436 344 1,093

35–39 9,742 3,833 5,910 15,044 7,438 7,607 8,912 2,765 6,147 1,306 433 873 708 169 539

40–44 5,016 2,464 2,552 7,619 4,128 3,491 3,923 1,418 2,505 633 240 394 392 124 268

45–54 4,245 2,362 1,883 6,374 3,655 2,718 2,427 915 1,513 614 249 365 328 83 245

55–64 1,007 606 401 1,277 743 534 457 175 282 210 68 142 51 11 40

65+ 303 181 122 331 155 175 161 54 108 53 22 31 20 9 11

TOTAL 342,555 76,880 265,675 575,822 167,755 408,067 226,793 54,487 172,306 20,274 4,780 15,493 19,917 3,997 15,920

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 3–5 for total and sex-specific 

cases and rates. 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: 2004 

(CO, DC, NJ); 2005 (CO, DC, GA, HI, NJ); 2006 (CO, HI); 2007 (CO, HI); 2008 (CO, HI). 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.
STD Surveillance 2008 Chlamydia Tables 97

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

United States, 2004–2008

Age

Group

White, NonHispanicAfrican-American,

Non-Hispanic Hispanic

Asian/Pacific 

Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

10–14 26.0 1.9 51.5 263.3 46.3 487.3 59.8 12.1 109.8 16.6 1.2 32.9 119.7 27.2 214.2

2004

15–19 757.4 146.7 1,402.3 5,217.4 1,840.6 8,687.4 1,562.2 474.9 2,725.0 475.0 114.9 856.3 2,467.3 677.8 4,323.7

20–24 878.2 350.5 1,425.4 5,215.0 2,673.0 7,762.9 1,677.8 686.3 2,891.6 658.5 269.6 1,056.5 2,790.5 1,113.2 4,512.3

25–29 337.6 186.4 491.8 2,351.1 1,553.3 3,093.3 794.8 361.4 1,332.5 294.5 152.1 432.4 1,541.8 641.3 2,459.7

30–34 114.9 75.6 154.7 963.4 813.6 1,098.2 381.1 189.7 604.4 153.2 84.3 219.2 734.2 350.3 1,115.4

35–39 49.9 41.7 58.2 447.4 442.3 452.0 191.9 108.1 287.2 89.7 61.7 116.4 389.7 196.4 578.0

40–44 24.9 25.5 24.4 219.1 249.9 192.0 93.0 58.5 130.3 49.4 33.7 64.1 180.0 100.9 254.4

45–54 8.7 9.4 8.0 92.2 110.6 76.4 37.3 26.3 48.4 27.7 22.3 32.4 83.8 54.0 111.0

55–64 2.7 3.4 2.1 29.6 37.3 23.4 14.0 11.8 15.9 8.3 5.2 11.0 20.5 8.0 31.9

65+ 0.9 1.0 0.8 9.9 12.9 8.0 5.8 4.3 6.8 2.5 2.1 2.9 11.1 9.9 11.9

TOTAL 143.6 57.4 226.7 1,196.6 638.4 1,704.8 421.4 177.1 682.4 139.8 62.9 212.3 699.9 268.8 1,117.9

10–14 25.6 2.1 50.5 251.4 48.7 460.9 57.2 9.9 106.8 14.8 3.6 26.7 157.4 22.1 295.9

2005

15–19 766.1 153.2 1,412.8 5,348.8 2,073.2 8,716.3 1,613.2 511.2 2,784.1 492.4 164.2 840.9 2,665.3 775.9 4,617.5

20–24 938.3 391.5 1,508.7 5,324.4 2,927.8 7,754.4 1,854.2 782.9 3,134.6 727.6 321.8 1,144.8 2,920.5 1,215.3 4,669.1

25–29 364.1 206.5 524.5 2,432.2 1,722.3 3,101.1 855.5 414.0 1,404.5 307.6 180.5 430.5 1,635.7 817.9 2,472.6

30–34 130.1 83.9 176.8 1,028.3 911.8 1,133.5 409.4 219.0 631.4 159.6 112.7 204.4 738.5 340.3 1,135.0

35–39 57.1 48.1 66.2 467.7 487.3 450.1 208.5 119.9 309.5 100.7 65.9 133.7 390.9 229.4 548.5

40–44 27.4 28.2 26.7 229.3 272.4 191.5 95.5 62.6 131.2 58.6 46.1 70.2 193.8 106.0 276.6

45–54 10.0 11.5 8.5 93.1 116.9 72.8 42.2 28.7 55.9 27.5 20.9 33.4 75.5 54.2 94.9

55–64 3.0 3.8 2.2 30.1 39.8 22.3 15.1 11.7 18.2 14.4 10.0 18.2 24.8 21.2 28.1

65+ 0.9 1.0 0.8 12.6 16.0 10.5 6.6 5.9 7.1 3.6 4.4 3.0 8.8 4.8 11.8

TOTAL 151.7 63.4 236.7 1,234.3 709.9 1,712.6 444.5 194.9 710.5 148.4 77.0 215.9 747.0 305.3 1,174.6

10–14 22.5 1.4 44.9 255.3 54.7 462.2 54.2 11.8 98.6 11.7 0.7 23.2 149.4 17.6 284.7

2006

15–19 748.9 155.4 1,374.9 5,483.0 2,195.4 8,858.2 1,646.6 519.5 2,845.8 402.3 95.2 729.3 2,748.8 879.6 4,672.9

20–24 940.2 398.9 1,508.7 5,435.0 2,980.0 7,942.6 1,964.5 838.3 3,301.5 627.9 238.5 1,032.1 3,066.6 1,187.9 5,008.6

25–29 385.5 221.9 550.9 2,425.6 1,705.6 3,105.1 900.9 440.4 1,481.2 288.6 151.1 421.5 1,696.7 767.3 2,642.2

30–34 142.2 95.6 189.4 1,046.0 926.6 1,153.6 424.6 220.7 666.9 146.1 83.3 206.2 889.7 411.4 1,368.0

35–39 61.0 49.0 73.1 482.4 514.6 453.7 219.1 125.8 325.9 82.5 49.5 113.9 434.9 211.8 653.6

40–44 28.5 28.6 28.4 231.8 280.4 189.1 105.0 72.1 141.3 58.7 37.5 78.8 232.5 121.8 338.0

45–54 10.7 11.7 9.7 101.4 126.3 80.1 43.9 31.1 57.0 26.8 22.3 30.8 81.9 52.3 108.8

55–64 3.3 4.1 2.6 30.3 42.5 20.6 15.8 13.2 18.1 11.2 8.6 13.5 29.7 15.5 42.6

65+ 1.0 1.2 0.8 10.9 14.8 8.4 7.5 5.6 8.8 2.4 3.0 2.0 14.9 7.4 20.7

TOTAL 152.8 65.9 236.6 1,261.3 733.3 1,741.8 459.2 203.0 733.6 127.2 57.0 193.6 790.1 314.5 1,250.8

10–14 21.8 1.6 43.1 266.0 56.4 482.4 55.2 10.8 101.7 14.8 1.5 28.5 125.3 17.1 236.6

2007

15–19 789.6 176.7 1,435.6 5,953.3 2,509.0 9,490.0 1,664.0 544.9 2,852.4 461.4 126.7 817.8 2,547.7 789.2 4,346.9

20–24 988.8 423.8 1,583.1 5,987.0 3,400.4 8,632.6 2,030.1 882.8 3,356.8 681.1 268.5 1,111.3 2,843.3 1,153.4 4,592.0

25–29 409.8 240.4 581.4 2,640.6 1,905.9 3,343.1 928.1 457.4 1,519.3 334.4 174.1 490.9 1,579.4 680.4 2,495.6

30–34 156.7 104.4 209.6 1,198.3 1,049.4 1,332.9 430.7 223.9 678.4 155.0 94.5 212.8 809.4 397.4 1,222.6

35–39 69.6 53.7 85.7 537.5 565.5 512.7 216.9 128.2 318.6 90.7 60.0 120.0 390.0 187.6 589.3

40–44 32.1 31.2 33.0 263.7 312.6 220.8 107.5 73.8 145.0 59.2 47.7 70.2 214.6 127.7 297.5

45–54 12.6 14.5 10.8 117.2 146.7 91.9 47.0 33.9 60.6 27.4 21.9 32.4 73.7 43.8 100.7

55–64 3.7 4.8 2.8 36.8 47.6 28.2 16.3 10.9 21.4 14.5 13.2 15.6 13.1 7.4 18.2

65+ 0.9 1.3 0.6 10.1 12.9 8.3 5.9 5.4 6.3 2.7 2.8 2.7 6.0 6.1 5.8

TOTAL 162.0 71.8 248.9 1,384.7 832.6 1,887.3 461.0 206.4 733.3 137.1 65.0 205.4 725.7 291.0 1,146.4

10–14 22.6 2.3 44.0 279.2 64.3 501.0 61.4 11.9 113.3 11.1 2.0 20.6 108.3 14.1 205.2

2008

15–19 849.3 199.3 1,534.5 6,651.0 2,889.5 10513.4 1,873.6 637.5 3,186.2 493.0 124.2 885.7 2,809.3 870.6 4,792.6

20–24 1,052.4 465.9 1,669.3 6,568.4 3,825.4 9,373.9 2,239.5 1,021.4 3,648.2 765.7 319.9 1,230.4 3,163.6 1,299.2 5,092.9

25–29 439.0 266.2 614.1 2,848.3 2,093.9 3,569.7 1,002.0 517.6 1,610.3 372.0 199.0 541.0 1,812.3 826.5 2,817.1

30–34 173.1 117.5 229.4 1,271.2 1,116.9 1,410.6 467.6 252.3 725.6 174.4 108.6 237.2 895.0 427.6 1,364.0

35–39 74.4 58.3 90.6 570.2 598.8 544.8 250.3 145.4 370.8 103.6 70.3 135.3 432.9 208.3 654.2

40–44 34.8 34.2 35.4 279.4 323.9 240.3 125.3 86.2 168.8 57.8 45.0 70.0 227.0 146.9 303.3

45–54 13.7 15.3 12.0 125.4 155.9 99.3 52.3 38.8 66.2 33.1 28.4 37.3 97.0 51.7 138.1

55–64 4.1 5.0 3.2 39.3 51.4 29.7 17.4 13.8 20.7 16.8 11.8 21.1 22.3 9.7 33.8

65+ 1.0 1.4 0.7 10.4 12.8 9.0 6.6 5.1 7.6 4.6 4.5 4.7 9.9 9.9 9.8

TOTAL 173.6 79.4 264.4 1,519.3 928.8 2,056.9 510.4 237.3 802.5 151.9 73.6 225.9 808.8 330.0 1,272.1

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 3–5 for total and sex-specific 

cases and rates. 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: 2004 

(CO, DC, NJ); 2005 (CO, DC, GA, HI, NJ); 2006 (CO, HI); 2007 (CO, HI); 2008 (CO, HI). 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.
98 Gonorrhea Tables STD Surveillance 2008

Table 12. Gonorrhea—Reported cases and rates by state, ranked by rates: United States, 2008

Rank* State Cases Rate per 100,000 Population

1 Mississippi 7,494 256.8

2 Louisiana 9,455 220.2

3 South Carolina 9,442 214.2

4 Alabama 9,740 210.5

5 North Carolina 15,972 176.3

6 Georgia 16,272 170.5

7 Michigan 17,064 169.4

8 Illinois 20,674 160.9

9 Arkansas 4,514 159.2

10 Ohio 16,803 146.5

11 Oklahoma 5,185 143.3

12 Tennessee 8,780 142.6

13 Indiana 8,769 138.2

14 Missouri 8,014 136.3

15 Texas 32,199 134.7

16 Virginia 10,337 134.0

17 Florida 23,326 127.8

18 Delaware 1,045 120.8

19 Maryland 6,666 118.6

U.S. TOTAL† 336,742 111.6

20 Wisconsin 6,087 108.7

21 Kentucky 4,548 107.2

22 Pennsylvania 11,071 89.0

23 New York 17,108 88.7

24 Nevada 2,172 84.7

25 Alaska 578 84.6

26 Nebraska 1,460 82.3

27 Kansas 2,274 81.9

28 Connecticut 2,801 80.0

29 Colorado 3,757 77.3

30 New Mexico 1,403 71.2

31 California 25,787 70.5

32 New Jersey 5,298 61.0

33 Minnesota 3,037 58.4

34 Iowa 1,700 56.9

35 Arizona 3,449 54.4

36 Washington 3,127 48.3

37 Hawaii 610 47.5

38 South Dakota 375 47.1

39 West Virginia 746 41.2

40 Massachusetts 2,129 33.0

41 Oregon 1,225 32.7

42 Rhode Island 307 29.0

43 Wyoming 124 23.7

44 North Dakota 143 22.4

YEAR 2010 TARGET 19.0

45 Utah 477 18.0

46 Montana 122 12.7

47 Idaho 187 12.5

48 New Hampshire 100 7.6

49 Maine 96 7.3

50 Vermont 37 6.0

* States were ranked in descending order by rate, number of cases, and alphabetically by state.

† Total includes cases reported by the District of Columbia with 2,656 cases and a rate of 451.5, but excludes outlying areas (Guam with 109 cases and rate of 62.8, 

Puerto Rico with 273 cases and rate of 6.9, and Virgin Islands with 120 cases and rate of 109.3).
STD Surveillance 2008 Gonorrhea Tables 99

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

order: United States and outlying areas, 2004–2008

State/Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Alabama 8,206 9,406 10,665 10,885 9,740 181.1 206.4 231.9 235.2 210.5

Alaska 567 600 630 579 578 86.5 90.4 94.0 84.7 84.6

Arizona 4,065 4,951 5,949 5,062 3,449 70.8 83.4 96.5 79.9 54.4

Arkansas 4,137 4,476 4,306 4,168 4,514 150.3 161.1 153.2 147.0 159.2

California 30,155 34,338 33,740 31,294 25,787 84.0 95.0 92.5 85.6 70.5

Colorado 3,054 3,224 3,695 3,376 3,757 66.4 69.1 77.7 69.4 77.3

Connecticut 2,862 2,750 2,610 2,327 2,801 81.7 78.3 74.5 66.4 80.0

Delaware 894 913 1,485 1,293 1,045 107.7 108.2 174.0 149.5 120.8

District of Columbia 2,568 2,146 1,887 2,373 2,656 463.9 389.8 324.5 403.4 451.5

Florida 18,580 20,225 23,976 23,327 23,326 106.8 113.7 132.5 127.8 127.8

Georgia 15,783 15,860 19,669 17,835 16,272 178.8 174.8 210.1 186.9 170.5

Hawaii 1,193 1,024 885 659 610 94.5 80.3 68.8 51.3 47.5

Idaho 103 119 206 269 187 7.4 8.3 14.0 17.9 12.5

Illinois 20,597 20,019 20,186 20,813 20,674 162.0 156.8 157.3 161.9 160.9

Indiana 6,851 8,094 8,732 8,790 8,769 109.8 129.1 138.3 138.5 138.2

Iowa 1,249 1,606 1,966 1,928 1,700 42.3 54.1 65.9 64.5 56.9

Kansas 2,542 2,605 2,210 2,282 2,274 92.9 94.9 80.0 82.2 81.9

Kentucky 2,758 2,935 3,277 3,449 4,548 66.5 70.3 77.9 81.3 107.2

Louisiana 10,538 9,572 10,883 11,137 9,455 233.4 211.6 253.8 259.4 220.2

Maine 210 142 137 118 96 15.9 10.7 10.4 9.0 7.3

Maryland 8,297 7,035 7,328 6,768 6,666 149.3 125.6 130.5 120.5 118.6

Massachusetts 3,057 2,537 2,429 2,695 2,129 47.6 39.6 37.7 41.8 33.0

Michigan 17,376 17,684 15,677 15,482 17,064 171.8 174.7 155.3 153.7 169.4

Minnesota 2,957 3,482 3,303 3,459 3,037 58.0 67.8 63.9 66.5 58.4

Mississippi 7,163 7,171 7,511 8,314 7,494 246.7 245.5 258.1 284.8 256.8

Missouri 9,218 9,455 10,204 9,876 8,014 160.2 163.0 174.6 168.0 136.3

Montana 88 158 194 122 122 9.5 16.9 20.5 12.7 12.7

Nebraska 1,147 1,158 1,433 1,434 1,460 65.6 65.8 81.0 80.8 82.3

Nevada 3,078 2,880 2,791 2,357 2,172 131.8 119.3 111.8 91.9 84.7

New Hampshire 133 177 180 138 100 10.2 13.5 13.7 10.5 7.6

New Jersey 6,696 5,722 5,492 6,076 5,298 77.0 65.6 62.9 70.0 61.0

New Mexico 1,306 1,552 1,733 1,796 1,403 68.6 80.5 88.7 91.2 71.2

New York 18,737 17,717 17,459 17,697 17,108 97.5 92.0 90.4 91.7 88.7

North Carolina 15,194 15,072 17,312 16,666 15,972 177.9 173.6 195.5 183.9 176.3

North Dakota 110 128 153 116 143 17.3 20.1 24.1 18.1 22.4

Ohio 20,467 20,985 19,190 21,066 16,803 178.6 183.1 167.2 183.7 146.5

Oklahoma 4,453 5,228 4,951 4,827 5,185 126.4 147.4 138.3 133.4 143.3

Oregon 1,302 1,562 1,461 1,236 1,225 36.2 42.9 39.5 33.0 32.7

Pennsylvania 11,236 11,222 11,466 12,706 11,071 90.6 90.3 92.2 102.2 89.0

Rhode Island 816 438 508 402 307 75.5 40.7 47.6 38.0 29.0

South Carolina 9,171 8,561 10,320 10,326 9,442 218.5 201.2 238.8 234.3 214.2

South Dakota 304 351 367 261 375 39.4 45.2 46.9 32.8 47.1

Tennessee 8,475 8,605 9,694 9,564 8,780 143.6 144.3 160.5 155.3 142.6

Texas 24,371 26,110 30,449 32,073 32,199 108.4 114.2 129.5 134.2 134.7

Utah 603 727 888 821 477 25.2 29.4 34.8 31.0 18.0

Vermont 86 60 72 64 37 13.8 9.6 11.5 10.3 6.0

Virginia 8,565 8,346 6,476 6,269 10,337 114.8 110.3 84.7 81.3 134.0

Washington 2,810 3,739 4,231 3,653 3,127 45.3 59.5 66.2 56.5 48.3

West Virginia 892 770 953 930 746 49.1 42.4 52.4 51.3 41.2

Wisconsin 5,053 5,869 6,927 6,752 6,087 91.7 106.0 124.7 120.5 108.7

Wyoming 59 87 120 81 124 11.6 17.1 23.3 15.5 23.7

U.S. TOTAL 330,132 339,593 358,366 355,991 336,742 112.4 114.6 119.7 118.0 111.6

Northeast 43,833 40,765 40,353 42,223 38,947 80.3 74.6 73.7 77.2 71.2

Midwest 87,871 91,436 90,348 92,259 86,400 133.7 138.6 136.4 139.0 130.1

South 150,045 152,431 171,142 170,204 168,377 141.6 141.8 156.9 154.1 152.4

West 48,383 54,961 56,523 51,305 43,018 71.8 80.5 81.5 73.2 61.4

Guam 114 106 98 141 109 68.6 62.9 57.3 81.2 62.8

Puerto Rico 267 328 302 323 273 6.9 8.4 7.7 8.2 6.9

Virgin Islands 75 30 34 69 120 68.9 27.6 31.3 62.8 109.3

OUTLYING AREAS 456 464 434 533 502 10.9 11.1 10.3 12.6 11.9

TOTAL 330,588 340,057 358,800 356,524 337,244 111.0 113.1 118.2 116.6 110.3
100 Gonorrhea Tables STD Surveillance 2008

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

alphabetical order: United States and outlying areas, 2004–2008

State/Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Alabama 3,673 4,494 5,983 6,095 5,582 157.4 191.5 252.5 255.5 234.0

Alaska 337 349 356 326 321 106.5 108.9 110.0 99.2 97.7

Arizona 1,787 2,338 2,847 2,342 1,577 62.3 78.8 92.4 74.0 49.8

Arkansas 2,032 2,252 2,182 2,275 2,520 144.7 159.0 152.3 157.4 174.3

California 13,620 15,827 15,688 14,533 11,625 75.8 87.5 86.0 79.5 63.6

Colorado 1,656 1,619 1,879 1,807 1,978 72.6 70.1 79.6 75.0 82.0

Connecticut 1,756 1,590 1,478 1,372 1,686 97.4 88.1 82.2 76.4 93.9

Delaware 508 515 829 699 606 119.3 119.2 188.7 156.9 136.0

District of Columbia 1,293 1,029 808 1,077 1,259 443.1 355.6 261.6 347.2 405.9

Florida 9,371 10,204 12,427 11,793 12,279 105.6 112.6 135.0 127.0 132.3

Georgia 8,119 7,819 10,002 9,334 8,687 181.9 170.5 210.4 192.4 179.1

Hawaii 680 619 476 295 298 107.5 96.8 74.1 46.3 46.7

Idaho 42 57 113 152 90 6.0 8.0 15.5 20.4 12.1

Illinois 11,510 10,998 10,926 11,312 11,342 177.9 169.4 167.7 173.5 174.0

Indiana 3,550 4,453 4,806 4,884 5,056 112.0 139.9 150.0 151.7 157.1

Iowa 736 885 1,179 1,121 1,024 49.1 58.8 78.1 74.1 67.7

Kansas 1,565 1,645 1,327 1,401 1,459 113.6 119.1 95.3 100.1 104.2

Kentucky 1,415 1,530 1,709 1,887 2,511 67.0 72.1 79.7 87.2 116.1

Louisiana 5,450 4,761 5,605 5,822 5,177 234.7 204.9 254.5 263.7 234.5

Maine 84 61 54 45 43 12.5 9.0 8.0 6.7 6.4

Maryland 4,327 3,620 3,850 3,529 3,604 150.9 125.4 132.8 121.7 124.3

Massachusetts 1,531 1,320 1,214 1,282 1,100 46.3 40.0 36.6 38.6 33.1

Michigan 9,614 10,161 8,900 8,984 10,047 186.9 197.5 173.6 175.7 196.5

Minnesota 1,712 1,909 1,814 1,930 1,657 66.6 73.9 69.8 74.0 63.5

Mississippi 4,362 4,234 4,400 4,901 4,357 291.9 281.8 293.1 325.6 289.5

Missouri 5,139 5,334 5,752 5,481 4,542 174.6 179.9 192.5 182.3 151.0

Montana 54 102 123 75 92 11.6 21.8 26.1 15.7 19.2

Nebraska 656 688 865 847 891 74.2 77.4 97.0 94.6 99.5

Nevada 1,417 1,343 1,257 1,066 1,012 123.7 113.3 102.5 84.7 80.4

New Hampshire 54 97 97 63 49 8.2 14.6 14.6 9.5 7.4

New Jersey 3,607 3,077 2,829 3,059 2,813 80.8 68.9 63.4 68.9 63.4

New Mexico 749 884 1,003 974 783 77.4 90.2 101.3 97.6 78.4

New York 9,720 9,031 8,479 8,324 8,349 98.0 91.0 85.2 83.8 84.0

North Carolina 7,384 7,545 8,718 8,941 8,876 170.0 171.0 193.1 193.0 191.6

North Dakota 72 76 86 66 93 22.7 23.8 27.2 20.7 29.2

Ohio 11,144 11,592 10,508 11,771 9,784 189.6 197.3 178.7 200.3 166.5

Oklahoma 2,471 3,018 2,780 2,606 2,964 138.6 168.2 153.2 142.4 162.0

Oregon 567 661 609 564 553 31.4 36.1 32.7 29.9 29.3

Pennsylvania 6,295 6,271 6,219 6,945 6,210 98.5 98.0 97.3 108.8 97.3

Rhode Island 478 227 273 169 135 85.4 40.8 49.5 31.0 24.7

South Carolina 5,007 4,601 5,406 5,640 5,704 232.6 211.0 243.8 249.5 252.3

South Dakota 178 196 215 153 247 45.9 50.2 54.9 38.3 61.8

Tennessee 4,327 4,395 5,104 5,247 4,801 143.5 144.5 165.3 166.5 152.4

Texas 12,433 13,827 15,619 16,192 17,029 110.1 120.5 132.4 135.2 142.2

Utah 266 319 369 345 137 22.4 25.9 29.1 26.3 10.5

Vermont 53 26 39 30 19 16.8 8.2 12.3 9.5 6.0

Virginia 4,650 4,402 3,287 3,369 5,847 122.7 114.5 84.6 85.8 148.9

Washington 1,229 1,622 1,938 1,858 1,522 39.5 51.5 60.4 57.2 46.9

West Virginia 470 427 488 504 425 50.6 46.0 52.6 54.5 46.0

Wisconsin 2,953 3,433 4,047 4,066 3,744 106.1 122.9 144.8 144.3 132.9

Wyoming 39 54 71 41 71 15.5 21.4 28.0 15.9 27.5

U.S. TOTAL 172,142 177,537 187,033 187,594 182,577 115.4 118.0 123.1 122.6 119.4

Northeast 23,578 21,700 20,682 21,289 20,404 83.9 77.2 73.5 75.8 72.7

Midwest 48,829 51,370 50,425 52,016 49,886 146.1 153.2 150.0 154.4 148.1

South 77,292 78,673 89,197 89,911 92,228 143.4 144.0 160.7 160.0 164.1

West 22,443 25,794 26,729 24,378 20,059 66.6 75.6 77.2 69.7 57.3

Guam 70 71 49 66 58 86.0 85.9 58.4 77.5 68.1

Puerto Rico 150 194 152 165 128 7.4 9.5 7.4 8.0 6.2

Virgin Islands 48 18 23 51 86 84.4 31.7 40.5 88.3 149.0

OUTLYING AREAS 268 283 224 282 272 12.4 13.0 10.3 12.9 12.4

TOTAL 172,410 177,820 187,257 187,876 182,849 114.0 116.5 121.5 121.1 117.8

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2008 Gonorrhea Tables 101

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

alphabetical order: United States and outlying areas, 2004–2008

State/Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Alabama 4,526 4,892 4,678 4,786 4,151 206.1 221.2 209.8 213.5 185.1

Alaska 230 251 274 253 257 67.9 73.1 79.1 71.3 72.4

Arizona 2,274 2,610 3,097 2,718 1,869 79.1 87.8 100.4 85.7 58.9

Arkansas 2,104 2,223 2,122 1,890 1,993 156.0 163.1 154.0 136.0 143.5

California 16,440 18,348 17,856 16,632 14,025 91.8 101.7 98.0 91.0 76.7

Colorado 1,398 1,605 1,816 1,569 1,777 60.2 68.1 75.9 64.0 72.5

Connecticut 1,106 1,160 1,132 955 1,113 65.1 68.0 66.3 55.9 65.2

Delaware 386 398 656 594 439 95.4 96.8 158.4 141.7 104.7

District of Columbia 1,269 1,113 1,072 1,284 1,383 484.9 426.2 393.2 461.7 497.3

Florida 9,209 10,021 11,546 11,527 10,995 108.0 114.9 130.0 128.5 122.6

Georgia 7,596 7,885 9,510 8,401 7,465 174.0 175.7 206.2 179.0 159.0

Hawaii 513 405 409 364 312 81.4 63.7 63.6 56.4 48.3

Idaho 60 60 92 112 97 8.6 8.4 12.5 14.8 12.9

Illinois 9,087 9,020 9,260 9,501 9,331 145.5 143.8 146.6 150.0 147.3

Indiana 3,270 3,616 3,895 3,880 3,693 106.6 117.1 125.2 124.1 118.1

Iowa 511 721 787 807 676 35.1 49.4 53.4 54.7 45.8

Kansas 977 960 883 881 815 71.9 70.4 64.4 64.0 59.2

Kentucky 1,338 1,399 1,561 1,559 2,030 65.8 68.2 75.7 75.0 97.7

Louisiana 5,029 4,744 5,186 5,201 4,233 229.2 215.7 248.6 249.4 203.0

Maine 126 81 83 73 53 19.6 12.5 12.8 11.4 8.2

Maryland 3,969 3,410 3,461 3,238 3,054 147.5 125.7 127.4 119.1 112.3

Massachusetts 1,524 1,216 1,212 1,412 1,026 49.1 39.2 38.9 45.2 32.8

Michigan 7,762 7,468 6,738 6,447 6,876 156.2 150.1 135.6 130.0 138.6

Minnesota 1,245 1,573 1,489 1,529 1,380 49.2 61.7 58.0 59.1 53.3

Mississippi 2,801 2,937 3,111 3,413 3,135 198.8 207.0 220.7 241.4 221.8

Missouri 4,079 4,121 4,452 4,395 3,472 145.1 145.3 156.0 153.1 120.9

Montana 33 56 71 47 29 7.1 12.0 15.0 9.8 6.0

Nebraska 488 467 552 583 568 56.5 53.7 63.0 66.3 64.6

Nevada 1,658 1,535 1,533 1,291 1,160 139.5 124.9 120.8 98.8 88.8

New Hampshire 79 80 83 75 51 12.3 12.4 12.8 11.6 7.9

New Jersey 3,089 2,645 2,657 3,014 2,483 72.9 62.3 62.3 70.9 58.4

New Mexico 557 668 730 822 619 59.5 70.4 75.7 84.6 63.7

New York 8,985 8,680 8,976 9,363 8,751 96.6 93.1 95.9 100.0 93.5

North Carolina 7,810 7,527 8,594 7,725 7,023 186.0 176.2 198.0 174.5 158.6

North Dakota 38 52 67 50 50 12.0 16.4 21.0 15.6 15.6

Ohio 9,046 9,035 8,493 9,164 6,693 162.1 161.7 151.7 163.9 119.7

Oklahoma 1,982 2,210 2,171 2,221 2,212 113.9 126.0 123.0 124.3 123.7

Oregon 735 901 852 672 672 41.1 49.8 46.3 36.1 36.1

Pennsylvania 4,941 4,950 5,247 5,758 4,860 82.2 82.1 86.8 95.2 80.3

Rhode Island 338 211 235 232 172 64.8 40.6 45.5 45.3 33.6

South Carolina 4,136 3,925 4,899 4,665 3,712 202.2 189.2 232.9 217.3 172.9

South Dakota 126 155 152 107 128 32.9 40.2 38.9 27.0 32.3

Tennessee 4,148 4,209 4,590 4,317 3,979 143.7 144.1 155.5 143.6 132.4

Texas 11,902 12,269 14,812 15,819 15,150 106.3 107.7 126.4 132.6 127.0

Utah 337 408 519 476 340 28.1 32.9 40.5 35.6 25.5

Vermont 33 34 33 34 18 10.8 11.1 10.7 11.1 5.9

Virginia 3,904 3,939 3,187 2,895 4,477 106.3 105.8 84.8 76.5 118.3

Washington 1,581 2,117 2,293 1,795 1,600 51.1 67.4 71.9 55.7 49.6

West Virginia 421 343 465 426 321 47.4 38.6 52.2 48.0 36.2

Wisconsin 2,087 2,431 2,870 2,673 2,332 76.5 88.7 104.0 96.0 83.8

Wyoming 20 33 49 40 53 7.8 12.9 18.8 15.1 20.0

U.S. TOTAL 157,303 161,117 170,508 167,685 153,103 108.8 110.4 115.6 112.8 103.0

Northeast 20,221 19,057 19,658 20,916 18,527 76.4 71.8 73.9 78.6 69.6

Midwest 38,716 39,619 39,638 40,017 36,014 119.8 122.1 121.5 122.4 110.1

South 72,530 73,444 81,621 79,961 75,752 139.3 138.9 152.3 147.4 139.6

West 25,836 28,997 29,591 26,791 22,810 76.7 84.9 85.3 76.3 65.0

Guam 44 35 49 75 51 51.9 40.7 56.2 84.9 57.7

Puerto Rico 117 134 150 158 145 6.3 7.1 8.0 8.3 7.7

Virgin Islands 27 12 11 18 34 52.0 23.1 21.2 34.6 65.3

OUTLYING AREAS 188 181 210 251 230 9.4 9.0 10.4 12.3 11.3

TOTAL 157,491 161,298 170,718 167,936 153,333 107.5 109.0 114.2 111.4 101.8

NOTE: Cases reported with unknown sex are not included in this table.
102 Gonorrhea Tables STD Surveillance 2008

Table 16. Gonorrhea—Reported cases and rates in selected metropolitan statistical areas* (MSAs) 

listed in alphabetical order: United States, 2004–2008

Metropolitan Statistical Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Atlanta-Sandy Springs-Marietta, GA 7,355 7,838 10,223 9,060 8,084 156.2 159.4 199.0 171.6 153.1

Austin-Round Rock, TX 1,472 1,706 2,446 2,075 2,388 104.2 117.5 161.6 129.8 149.4

Baltimore-Towson, MD 5,256 4,779 4,653 4,156 4,146 199.2 180.0 175.0 155.8 155.4

Birmingham-Hoover, AL 2,377 2,381 2,444 3,129 2,891 219.6 218.4 222.2 282.3 260.9

Boston-Cambridge-Quincy, MA-NH 1,998 1,684 1,542 1,770 1,464 45.2 38.2 34.6 39.5 32.7

Buffalo-Cheektowaga-Tonawanda, NY 1,670 1,926 2,068 2,289 1,898 144.7 167.8 181.8 202.9 168.2

Charlotte-Gastonia-Concord, NC-SC 2,998 3,330 3,388 2,388 3,249 203.3 218.9 214.0 144.6 196.7

Chicago-Naperville-Joliet, IL-IN-WI 15,684 14,857 15,127 14,979 16,181 167.0 157.3 159.1 157.3 169.9

Cincinnati-Middletown, OH-KY-IN 3,455 3,927 3,862 4,583 3,926 167.9 189.7 183.5 214.8 184.0

Cleveland-Elyria-Mentor, OH 4,472 4,641 4,663 4,286 2,770 209.3 218.3 220.6 204.4 132.1

Columbus, OH 3,004 3,445 3,303 4,136 3,853 177.3 201.6 191.4 235.8 219.6

Dallas-Fort Worth-Arlington, TX 7,119 8,416 8,365 10,064 9,197 124.9 144.6 139.3 163.8 149.7

Denver-Aurora, CO 2,232 2,147 2,253 2,238 2,625 95.8 91.0 93.5 90.8 106.5

Detroit-Warren-Livonia, MI 9,299 10,766 8,535 8,554 10,850 207.0 239.9 191.0 191.5 242.9

Hartford-WestHartford-East Hartford, CT 933 993 988 920 1,029 78.8 83.6 83.1 77.4 86.5

Houston-Baytown-Sugar Land, TX 5,525 5,213 7,318 7,757 7,290 106.7 98.7 132.1 137.8 129.5

Indianapolis, IN 3,510 4,142 4,410 4,543 4,194 216.5 252.5 264.7 268.0 247.4

Jacksonville, FL 2,197 2,578 2,954 3,113 2,979 179.3 206.5 231.1 239.3 229.0

Kansas City, MO-KS 3,832 3,769 3,822 3,683 3,268 199.0 193.5 194.3 185.5 164.6

Las Vegas-Paradise, NV 2,645 2,487 2,478 2,112 1,918 160.2 145.4 139.4 115.0 104.4

Los Angeles-Long Beach-Santa Ana, CA 11,103 12,697 12,210 11,059 9,832 85.9 98.2 94.3 85.9 76.4

Louisville, KY-IN 1,484 1,551 1,749 1,908 2,300 123.6 128.3 143.1 154.7 186.4

Memphis, TN-MS-AR 3,832 3,782 4,665 4,756 4,475 306.5 299.9 366.0 371.4 349.5

Miami-Fort Lauderdale-Miami Beach, FL 4,622 4,497 5,356 5,152 5,471 86.2 82.9 98.0 95.2 101.1

Milwaukee-Waukesha-West Allis, WI 3,311 4,031 5,006 4,960 446 218.4 266.4 331.5 321.2 28.9

Minneapolis-St. Paul-Bloomington, MN-WI 2,439 2,920 2,780 2,834 2,345 78.3 92.9 87.6 88.3 73.1

Nashville-Davidson-Murfreesboro, TN 1,602 1,474 1,734 1,692 1,541 114.8 103.6 119.2 111.2 101.3

New Orleans-Metairie-Kenner, LA 3,316 2,609 1,962 2,713 2,045 251.3 197.7 191.5 263.3 198.5

New York-Newark-Edison, NY-NJ-PA 16,915 15,533 14,949 15,396 15,116 90.4 82.9 79.4 81.8 80.3

Oklahoma City, OK 2,153 2,548 2,315 2,373 2,403 188.1 220.3 197.5 198.9 201.4

Orlando, FL 2,285 2,848 3,393 2,743 2,704 122.7 147.3 170.9 135.0 133.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 7,818 7,719 8,163 8,669 7,724 134.8 132.6 140.1 148.7 132.5

Phoenix-Mesa-Scottsdale, AZ 3,161 3,133 4,260 3,333 2,211 85.1 81.1 105.5 79.7 52.9

Pittsburgh, PA 1,799 2,157 2,057 2,599 2,569 74.9 90.4 86.8 110.3 109.1

Portland-Vancouver-Beaverton, OR-WA 1,173 1,393 1,128 1,053 1,033 56.8 66.5 52.8 48.4 47.5

Providence-New Bedford-Fall River, RI-MA 1,048 650 693 621 455 64.3 40.1 43.0 38.8 28.4

Richmond, VA 2,160 2,361 1,778 2,199 2,698 187.1 200.8 148.9 181.3 222.4

Riverside-San Bernardino-Ontario, CA 2,631 3,012 2,994 3,166 2,199 69.4 77.0 74.4 77.6 53.9

Rochester, NY 1,900 1,899 1,457 1,207 1,345 182.4 182.8 140.7 117.1 130.5

Sacramento-Arden-Arcade-Roseville, CA 2,066 2,450 2,235 2,315 1,771 102.4 120.0 108.1 110.7 84.7

Salt Lake City, UT 371 460 623 573 346 36.4 44.5 58.3 52.1 31.5

San Antonio, TX 2,183 2,300 2,701 2,601 3,113 117.7 121.7 139.1 130.7 156.4

San Diego-Carlsbad-San Marcos, CA 2,379 2,695 2,767 2,385 2,066 81.1 91.9 94.1 80.2 69.4

San Francisco-Oakland-Fremont, CA 4,967 5,713 6,029 5,695 5,065 119.6 137.6 144.2 135.5 120.5

San Jose-Sunnyvale-Santa Clara, CA 1,084 1,055 1,065 893 712 62.2 60.1 59.6 49.5 39.5

Seattle-Tacoma-Bellevue, WA 1,883 2,704 3,079 2,572 2,182 59.5 84.4 94.3 77.7 65.9

St. Louis, MO-IL 5,719 6,391 6,547 6,483 5,003 206.9 230.0 234.1 231.2 178.4

Tampa-St. Petersburg-Clearwater, FL 2,801 2,910 3,667 3,819 3,852 108.2 109.9 135.9 140.2 141.4

Virginia Beach-Norfolk-Newport News, VA-NC 3,812 3,355 2,544 2,504 4,935 231.8 203.7 154.2 151.0 297.5

Washington-Arlington-Alexandria, DC-VA-MD-WV 5,803 4,497 4,358 4,665 5,557 112.9 86.2 82.4 87.9 104.7

U.S. MSA TOTAL 194,853 202,369 209,106 208,773 197,714 123.4 126.9 129.6 128.3 121.5

* MSAs selected based on largest population in 2000 U.S. Census.

NOTE: 2008 Milwaukee County STD morbidity data were misclassified resulting in incomplete case counts for MSA-Milwaukee-Waukesha-West Allis, WI.
STD Surveillance 2008 Gonorrhea Tables 103

Table 17. Gonorrhea—Women—Reported cases and rates in selected metropolitan statistical 

areas* (MSAs) listed in alphabetical order: United States, 2004–2008

Metropolitan Statistical Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Atlanta-Sandy Springs-Marietta, GA 3,563 3,567 5,026 4,515 3,967 150.3 144.1 193.5 169.1 148.5

Austin-Round Rock, TX 692 830 1,134 992 1,177 100.1 116.6 153.3 127.1 150.8

Baltimore-Towson, MD 2,710 2,426 2,470 2,179 2,302 198.2 176.5 179.2 157.6 166.5

Birmingham-Hoover, AL 1,060 1,133 1,511 1,761 1,655 189.2 200.9 265.4 307.0 288.5

Boston-Cambridge-Quincy, MA-NH 937 793 728 773 720 41.2 35.0 31.8 33.6 31.3

Buffalo-Cheektowaga-Tonawanda, NY 920 1,079 1,153 1,258 1,059 153.4 181.2 195.5 215.3 181.3

Charlotte-Gastonia-Concord, NC-SC 1,413 1,604 1,584 1,188 1,697 188.6 207.8 196.9 141.1 201.6

Chicago-Naperville-Joliet, IL-IN-WI 8,546 7,948 7,853 7,813 8,594 178.7 165.3 162.7 161.7 177.8

Cincinnati-Middletown, OH-KY-IN 2,038 2,274 2,465 2,884 2,696 193.3 214.8 229.0 264.2 247.0

Cleveland-Elyria-Mentor, OH 2,192 2,264 2,277 2,180 1,469 197.2 204.8 207.4 200.3 135.0

Columbus, OH 1,475 1,896 1,758 2,142 2,062 171.8 219.0 201.2 241.1 232.1

Dallas-Fort Worth-Arlington, TX 3,547 4,135 4,129 4,905 4,953 124.7 142.6 138.1 160.5 162.1

Denver-Aurora, CO 1,144 996 1,044 1,128 1,345 98.7 84.9 87.0 91.9 109.6

Detroit-Warren-Livonia, MI 4,850 6,079 4,613 4,721 6,226 210.5 264.4 201.8 206.7 272.5

Hartford-WestHartford-East Hartford, CT 533 520 521 522 609 87.3 85.0 85.4 85.6 99.8

Houston-Baytown-Sugar Land, TX 2,813 3,016 3,806 3,805 3,749 108.6 114.2 137.5 135.5 133.5

Indianapolis, IN 1,698 2,163 2,297 2,385 2,290 205.7 259.1 271.1 276.7 265.7

Jacksonville, FL 1,083 1,240 1,506 1,532 1,587 173.0 194.5 230.8 230.4 238.6

Kansas City, MO-KS 2,027 2,035 2,099 2,040 1,888 206.8 205.5 209.6 201.8 186.7

Las Vegas-Paradise, NV 1,206 1,163 1,123 954 880 148.7 138.4 128.4 105.8 97.6

Los Angeles-Long Beach-Santa Ana, CA 4,997 5,687 5,657 5,001 4,214 76.6 87.2 86.7 77.1 65.0

Louisville, KY-IN 720 740 887 1,026 1,228 116.9 119.6 141.6 162.3 194.2

Memphis, TN-MS-AR 1,926 1,990 2,548 2,789 2,472 297.6 305.6 386.0 420.2 372.4

Miami-Fort Lauderdale-Miami Beach, FL 2,307 2,317 2,708 2,444 2,661 83.5 83.0 96.4 87.9 95.7

Milwaukee-Waukesha-West Allis, WI 1,906 2,298 2,923 2,972 300 244.9 295.8 378.4 376.2 38.0

Minneapolis-St. Paul-Bloomington, MN-WI 1,373 1,548 1,486 1,500 1,210 87.3 97.7 93.0 93.0 75.0

Nashville-Davidson-Murfreesboro, TN 742 661 794 800 783 104.9 91.8 107.6 103.7 101.5

New Orleans-Metairie-Kenner, LA 1,606 1,287 965 1,322 984 234.0 187.8 181.7 246.6 183.6

New York-Newark-Edison, NY-NJ-PA 8,821 7,784 7,015 6,979 7,089 91.0 80.2 72.1 71.8 73.0

Oklahoma City, OK 1,181 1,486 1,275 1,202 1,294 203.8 253.5 214.2 198.8 214.0

Orlando, FL 1,063 1,286 1,688 1,377 1,424 112.9 131.6 168.5 134.3 138.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 4,189 4,219 4,257 4,416 4,098 139.5 140.0 141.4 146.7 136.1

Phoenix-Mesa-Scottsdale, AZ 1,373 1,456 2,014 1,497 988 74.5 76.0 100.7 72.3 47.7

Pittsburgh, PA 1,063 1,216 1,174 1,530 1,524 85.0 97.9 95.3 125.2 124.7

Portland-Vancouver-Beaverton, OR-WA 491 551 436 446 420 47.4 52.4 40.7 40.9 38.5

Providence-New Bedford-Fall River, RI-MA 607 365 374 282 209 72.0 43.5 44.9 34.1 25.3

Richmond, VA 1,187 1,256 824 1,122 1,436 199.7 207.8 134.4 179.7 230.0

Riverside-San Bernardino-Ontario, CA 1,323 1,572 1,602 1,705 1,237 69.8 80.5 79.6 83.6 60.7

Rochester, NY 919 1,006 748 608 744 172.0 188.9 141.0 115.2 141.0

Sacramento-Arden-Arcade-Roseville, CA 1,049 1,307 1,164 1,190 917 102.3 125.9 110.7 112.0 86.3

Salt Lake City, UT 143 183 246 229 88 28.4 35.8 46.7 42.4 16.3

San Antonio, TX 1,109 1,155 1,412 1,279 1,557 117.2 119.8 142.3 126.0 153.3

San Diego-Carlsbad-San Marcos, CA 936 1,108 1,158 961 803 64.2 76.3 79.3 64.9 54.2

San Francisco-Oakland-Fremont, CA 1,580 2,052 2,122 2,174 1,863 75.4 97.9 100.9 102.8 88.1

San Jose-Sunnyvale-Santa Clara, CA 467 457 488 385 312 54.6 53.1 55.8 43.7 35.4

Seattle-Tacoma-Bellevue, WA 717 1,060 1,300 1,205 965 45.2 66.1 79.6 72.7 58.2

St. Louis, MO-IL 3,213 3,638 3,718 3,539 2,756 225.0 253.5 257.5 244.5 190.4

Tampa-St. Petersburg-Clearwater, FL 1,474 1,542 2,064 1,973 2,006 110.6 113.3 149.0 141.1 143.5

Virginia Beach-Norfolk-Newport News, VA-NC 1,990 1,717 1,305 1,355 2,875 239.1 205.6 154.9 159.8 339.0

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,973 2,269 2,048 2,268 2,711 113.1 85.1 75.6 83.5 99.8

U.S. MSA TOTAL 97,892 102,374 105,497 105,253 102,093 121.8 126.2 128.7 127.3 123.5

* MSAs selected based on largest population in 2000 U.S. Census.

NOTE: 2008 Milwaukee County STD morbidity data were misclassified resulting in incomplete case counts for MSA-Milwaukee-Waukesha-West Allis, WI.
104 Gonorrhea Tables STD Surveillance 2008

Table 18. Gonorrhea—Men—Reported cases and rates in selected metropolitan statistical areas* 

(MSAs) listed in alphabetical order: United States, 2004–2008

Metropolitan Statistical Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Atlanta-Sandy Springs-Marietta, GA 3,750 4,183 5,083 4,484 4,054 160.4 171.3 200.1 171.9 155.4

Austin-Round Rock, TX 768 870 1,310 1,081 1,208 106.5 117.4 169.2 132.2 147.7

Baltimore-Towson, MD 2,546 2,352 2,180 1,976 1,841 200.1 183.6 170.3 153.7 143.2

Birmingham-Hoover, AL 1,316 1,243 932 1,367 1,235 252.1 236.2 175.6 255.7 231.0

Boston-Cambridge-Quincy, MA-NH 1,060 890 812 996 742 49.4 41.5 37.5 45.7 34.0

Buffalo-Cheektowaga-Tonawanda, NY 750 847 913 1,031 839 135.2 153.4 166.7 189.6 154.3

Charlotte-Gastonia-Concord, NC-SC 1,583 1,726 1,804 1,199 1,542 218.1 230.4 231.7 148.1 190.4

Chicago-Naperville-Joliet, IL-IN-WI 7,122 6,900 7,267 7,161 7,586 154.5 148.8 155.4 152.6 161.7

Cincinnati-Middletown, OH-KY-IN 1,375 1,616 1,373 1,674 1,224 136.9 159.7 133.6 160.6 117.5

Cleveland-Elyria-Mentor, OH 2,236 2,329 2,366 2,091 1,295 218.0 228.2 232.8 207.4 128.5

Columbus, OH 1,509 1,531 1,537 1,985 1,788 180.6 181.6 180.4 229.2 206.5

Dallas-Fort Worth-Arlington, TX 3,560 4,276 4,230 5,123 4,243 124.7 146.5 140.3 165.9 137.4

Denver-Aurora, CO 1,088 1,151 1,209 1,110 1,278 92.9 97.0 100.0 89.7 103.2

Detroit-Warren-Livonia, MI 4,449 4,657 3,890 3,786 4,502 203.2 212.7 178.2 173.4 206.2

Hartford-WestHartford-East Hartford, CT 400 473 467 398 418 69.7 82.1 80.7 68.7 72.2

Houston-Baytown-Sugar Land, TX 2,707 2,194 3,504 3,930 3,525 104.5 83.1 126.4 139.4 125.0

Indianapolis, IN 1,808 1,972 2,106 2,150 1,902 227.1 244.8 257.3 258.1 228.3

Jacksonville, FL 1,114 1,338 1,448 1,581 1,392 185.9 219.1 231.5 248.7 218.9

Kansas City, MO-KS 1,805 1,734 1,723 1,643 1,380 191.0 181.1 178.4 168.6 141.6

Las Vegas-Paradise, NV 1,436 1,322 1,354 1,158 1,038 171.0 152.0 149.9 123.9 111.1

Los Angeles-Long Beach-Santa Ana, CA 6,084 6,985 6,505 6,023 5,543 95.0 109.1 101.2 94.2 86.7

Louisville, KY-IN 761 811 858 881 1,070 130.0 137.6 144.0 146.5 177.9

Memphis, TN-MS-AR 1,906 1,792 2,117 1,967 2,003 316.1 293.9 344.4 318.9 324.8

Miami-Fort Lauderdale-Miami Beach, FL 2,315 2,180 2,648 2,706 2,801 89.1 82.9 99.7 102.8 106.4

Milwaukee-Waukesha-West Allis, WI 1,405 1,731 2,080 1,975 145 190.6 235.2 282.0 261.8 19.2

Minneapolis-St. Paul-Bloomington, MN-WI 1,066 1,372 1,294 1,334 1,135 69.0 88.1 82.1 83.6 71.1

Nashville-Davidson-Murfreesboro, TN 860 813 940 892 758 125.0 115.8 131.0 119.0 101.1

New Orleans-Metairie-Kenner, LA 1,684 1,299 981 1,352 1,050 265.9 204.9 198.8 273.5 212.4

New York-Newark-Edison, NY-NJ-PA 8,063 7,744 7,929 8,406 8,017 89.4 85.6 87.2 92.4 88.1

Oklahoma City, OK 972 1,062 1,040 1,171 1,103 172.1 186.1 180.2 199.0 187.5

Orlando, FL 1,222 1,562 1,704 1,366 1,277 132.8 163.4 173.3 135.6 126.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 3,629 3,500 3,904 4,250 3,626 129.7 124.5 138.6 150.9 128.7

Phoenix-Mesa-Scottsdale, AZ 1,787 1,676 2,242 1,834 1,222 95.4 85.9 110.0 86.9 57.9

Pittsburgh, PA 736 941 883 1,069 1,045 63.9 82.2 77.5 94.3 92.2

Portland-Vancouver-Beaverton, OR-WA 682 842 692 607 611 66.3 80.6 64.9 56.0 56.4

Providence-New Bedford-Fall River, RI-MA 441 285 318 338 246 56.1 36.4 40.8 43.7 31.8

Richmond, VA 971 1,105 954 1,074 1,261 173.4 193.4 164.2 182.4 214.2

Riverside-San Bernardino-Ontario, CA 1,308 1,440 1,390 1,450 961 68.9 73.5 69.0 71.0 47.0

Rochester, NY 981 893 709 599 601 193.4 176.3 140.4 119.2 119.6

Sacramento-Arden-Arcade-Roseville, CA 1,002 1,123 1,046 1,098 835 101.1 111.8 103.0 106.7 81.2

Salt Lake City, UT 228 277 377 344 258 44.2 52.9 69.6 61.5 46.1

San Antonio, TX 1,073 1,145 1,289 1,322 1,556 118.2 123.7 135.7 135.5 159.5

San Diego-Carlsbad-San Marcos, CA 1,417 1,500 1,531 1,415 1,254 96.1 101.3 103.4 94.7 83.9

San Francisco-Oakland-Fremont, CA 3,367 3,644 3,882 3,493 3,179 163.7 177.2 186.9 167.2 152.2

San Jose-Sunnyvale-Santa Clara, CA 617 597 570 506 398 69.7 66.8 62.4 54.8 43.1

Seattle-Tacoma-Bellevue, WA 1,166 1,644 1,779 1,367 1,216 73.8 102.7 109.1 82.7 73.6

St. Louis, MO-IL 2,506 2,753 2,829 2,944 2,247 187.6 204.9 209.2 217.1 165.7

Tampa-St. Petersburg-Clearwater, FL 1,327 1,368 1,602 1,842 1,822 105.7 106.3 122.0 138.9 137.4

Virginia Beach-Norfolk-Newport News, VA-NC 1,816 1,636 1,237 1,148 2,058 223.7 201.4 153.3 141.6 253.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,822 2,220 2,291 2,385 2,823 112.4 87.1 88.8 92.1 109.0

U.S. MSA TOTAL 96,596 99,544 103,129 103,082 95,153 124.6 127.0 130.0 128.8 118.8

* MSAs selected based on largest population in 2000 U.S. Census.

NOTE: 2008 Milwaukee County STD morbidity data were misclassified resulting in incomplete case counts for MSA-Milwaukee-Waukesha-West Allis, WI.
STD Surveillance 2008 Gonorrhea Tables 105

Table 19. Gonorrhea—Counties and independent cities* ranked by number of reported cases: 

United States, 2008

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percent

1 Cook County, IL 13,227 250.3 3

2 Wayne County, MI 9,081 457.5 6

3 Los Angeles County, CA 8,959 90.7 9

4 Harris County, TX 6,164 156.6 11

5 Dallas County, TX 5,137 217.1 12

6 Philadelphia County, PA 4,950 341.5 14

7 Marion County, IN 3,971 452.9 15

8 Shelby County, TN 3,849 422.9 16

9 Franklin County, OH 3,666 327.9 17

10 Kings County, NY 3,313 131.0 18

11 Hamilton County, OH 3,185 378.1 19

12 Baltimore (City), MD 3,181 499.0 20

13 Fulton County, GA 2,944 296.7 21

14 Tarrant County, TX 2,940 171.2 22

15 Bexar County, TX 2,932 183.9 23

16 Duval County, FL 2,661 313.4 23

17 Washington, D.C. 2,656 451.5 24

18 Bronx County, NY 2,629 191.4 25

19 Jefferson County, AL 2,604 395.3 26

20 Cuyahoga County, OH 2,478 191.2 26

21 New York County, NY 2,472 152.5 27

22 Jackson County, MO 2,345 351.6 28

23 Broward County, FL 2,323 132.0 29

24 Allegheny County, PA 2,158 177.0 29

25 Maricopa County, AZ 2,128 54.8 30

26 Mecklenburg County, NC 2,121 244.6 30

27 Miami-Dade County, FL 2,120 88.8 31

28 DeKalb County, GA 2,116 287.1 32

29 Oklahoma County, OK 2,099 299.1 32

30 Hillsborough County, FL 2,092 178.1 33

31 Orange County, FL 2,075 194.6 34

32 San Diego County, CA 2,066 69.4 34

33 Jefferson County, KY 2,043 288.0 35

34 San Francisco County, CA 2,023 264.5 35

35 Alameda County, CA 1,952 133.3 36

36 Clark County, NV 1,918 104.4 36

37 St Louis (City), MO 1,890 538.8 37

38 Travis County, TX 1,884 193.4 38

39 Queens County, NY 1,873 82.5 38

40 St. Louis County, MO 1,731 173.9 39

41 Essex County, NJ 1,662 214.2 39

42 Sacramento County, CA 1,642 118.4 40

43 Erie County, NY 1,569 171.8 40

44 Pinellas County, FL 1,505 164.0 41

45 Prince George's County, MD 1,500 181.0 41

46 Denver County, CO 1,480 251.6 41

47 Tulsa County, OK 1,471 251.4 42

48 Hennepin County, MN 1,448 127.4 42

49 San Bernardino County, CA 1,370 68.2 43

50 King County, WA 1,315 70.7 43

51 Hinds County, MS 1,309 525.4 44

52 Caddo County, LA 1,299 514.2 44

53 Monroe County, NY 1,298 177.9 44

54 Richmond (City), VA 1,279 639.1 45

55 Genesee County, MI 1,264 290.8 45

56 Orleans County, LA 1,232 515.2 45

57 Charleston County, SC 1,222 356.3 46

58 Wake County, NC 1,222 146.7 46

59 Bell County, TX 1,210 436.9 46

60 Oakland County, MI 1,164 96.5 47

61 Norfolk (City), VA 1,155 489.9 47

62 Montgomery County, OH 1,154 214.5 48

63 Lake County, IN 1,146 232.9 48

64 Pulaski County, AR 1,130 302.2 48

65 Davidson County, TN 1,091 176.1 49

66 Cumberland County, NC 1,068 348.4 49

67 Mobile County, AL 1,057 261.4 49

68 Kent County, MI 1,056 174.7 49

69 Leon County, FL 1,054 403.9 50

70 New Haven County, CT 1,046 123.7 50

71 Palm Beach County, FL 1,028 81.2 50

* Accounting for 50% of reported gonorrhea cases.

† Counties and independent cities were ranked in descending order by number of cases reported in 2008.

NOTE: Milwaukee County was not ranked by case count or rate due to misclassification of 2008 Milwaukee County STD morbidity data. 
106 Gonorrhea Tables STD Surveillance 2008

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

United States, 2004–2008

Age

Group

Cases Rates

Total Male Female Total Male Female

2004

10–14 4,447 630 3,817 21.0 5.8 37.0

15–19 87,454 26,607 60,847 421.9 250.2 602.8

20–24 103,187 45,917 57,269 492.0 425.0 563.2

25–29 54,857 29,520 25,337 280.4 295.4 264.9

30–34 30,372 18,664 11,708 148.4 180.5 115.6

35–39 19,793 13,350 6,443 94.0 126.3 61.5

40–44 14,026 10,220 3,806 60.8 89.2 32.8

45–54 12,078 9,645 2,433 29.0 47.2 11.5

55–64 2,653 2,286 367 9.1 16.3 2.4

65+ 745 615 130 2.1 4.1 0.6

TOTAL 330,132 157,623 172,509 112.4 109.1 115.7

2005

10–14 4,278 646 3,631 20.5 6.0 35.7

15–19 90,840 27,781 63,060 431.8 257.5 615.3

20–24 106,280 47,187 59,093 505.2 434.6 580.4

25–29 57,195 30,631 26,565 285.0 298.3 271.1

30–34 30,044 18,244 11,800 149.6 179.7 118.9

35–39 19,948 13,413 6,535 95.0 127.0 62.6

40–44 14,346 10,406 3,940 62.8 91.5 34.3

45–54 12,636 10,063 2,573 29.7 48.2 11.9

55–64 2,777 2,399 378 9.1 16.4 2.4

65+ 763 631 132 2.1 4.1 0.6

TOTAL 339,593 161,557 178,036 114.6 110.7 118.4

2006

10–14 4,250 675 3,574 20.6 6.4 35.5

15–19 96,524 30,119 66,405 452.6 275.4 639.2

20–24 110,969 49,304 61,665 525.6 451.9 604.5

25–29 61,843 32,946 28,897 298.6 311.3 285.4

30–34 31,313 18,858 12,455 158.9 188.9 128.1

35–39 20,674 13,813 6,861 97.6 129.7 65.1

40–44 14,534 10,636 3,898 64.6 95.0 34.6

45–54 13,847 11,064 2,782 32.0 52.0 12.7

55–64 3,137 2,686 451 9.9 17.6 2.8

65+ 800 648 152 2.1 4.1 0.7

TOTAL 358,366 170,902 187,464 119.7 115.9 123.4

2007

10–14 3,958 623 3,335 19.5 6.0 33.6

15–19 98,579 31,270 67,309 459.1 284.1 643.1

20–24 111,788 49,101 62,687 531.5 452.4 615.8

25–29 61,364 32,296 29,068 291.4 299.7 282.7

30–34 30,294 18,114 12,180 155.1 182.9 126.5

35–39 19,094 12,724 6,370 90.2 119.4 60.5

40–44 13,184 9,704 3,480 60.0 88.5 31.6

45–54 13,346 10,690 2,656 30.4 49.5 11.9

55–64 3,179 2,692 487 9.7 17.1 2.9

65+ 710 620 89 1.9 3.9 0.4

TOTAL 355,991 168,012 187,979 118.0 113.0 122.9

2008

10–14 3,668 598 3,070 18.1 5.8 31.0

15–19 97,293 30,637 66,656 453.1 278.3 636.8

20–24 109,005 47,053 61,951 518.3 433.6 608.6

25–29 56,791 29,089 27,701 269.7 269.9 269.4

30–34 27,629 16,177 11,452 141.4 163.3 119.0

35–39 16,419 10,615 5,804 77.5 99.6 55.2

40–44 11,048 7,859 3,189 50.3 71.7 28.9

45–54 11,152 8,659 2,493 25.4 40.1 11.2

55–64 2,629 2,203 426 8.0 14.0 2.5

65+ 657 552 104 1.7 3.5 0.5

TOTAL 336,742 153,599 183,143 111.6 103.3 119.7

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.
STD Surveillance 2008 107

This page was intentionally left blank.
108 Gonorrhea Tables STD Surveillance 2008

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

United States, 2004–2008

Age

Group

White, Non-Hispanic

African-American,

Non-Hispanic Hispanic

Asian/Pacific 

Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

2004

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

25–29 10,539 4,237 6,301 38,013 21,985 16,028 5,387 2,882 2,505 497 262 234 424 159 265

30–34 6,751 3,459 3,293 20,027 13,180 6,847 2,956 1,726 1,230 384 200 184 249 99 150

35–39 5,276 3,277 1,998 12,243 8,667 3,576 1,883 1,178 706 214 143 72 172 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

2005

10–14 691 35 655 3,154 549 2,604 355 52 304 25 1 23 45 8 37

15–19 15,758 2,679 13,079 66,165 22,563 43,602 7,299 2,134 5,165 606 176 430 845 196 650

20–24 20,892 6,509 14,383 73,365 35,373 37,991 9,742 4,438 5,303 960 418 542 1,012 344 668

25–29 11,681 4,667 7,013 38,213 22,200 16,013 5,915 3,126 2,790 633 341 293 569 216 353

30–34 6,790 3,405 3,385 19,172 12,540 6,632 3,248 1,830 1,418 405 281 124 314 137 177

35–39 5,384 3,256 2,127 12,004 8,570 3,433 2,009 1,270 739 268 180 88 193 97 97

40–44 4,255 2,863 1,392 8,606 6,593 2,012 1,153 776 377 146 93 53 119 44 75

45–54 3,535 2,668 867 7,993 6,667 1,325 831 561 270 118 79 39 93 46 46

55–64 853 721 132 1,653 1,490 163 191 134 57 44 28 16 24 17 6

65+ 242 203 39 452 386 66 55 36 19 8 4 4 3 1 2

TOTAL 70,209 27,050 43,159 231,076 117,025 114,050 30,845 14,374 16,471 3,214 1,602 1,612 3,225 1,112 2,113

2006

10–14 596 53 543 3,227 549 2,678 367 70 297 23 1 21 36 1 34

15–19 16,038 2,612 13,426 70,992 24,675 46,317 8,055 2,451 5,603 556 125 431 877 251 626

20–24 21,590 6,684 14,906 77,200 37,200 40,000 10,340 4,739 5,601 809 335 474 1,045 356 689

25–29 12,907 5,147 7,760 41,339 23,863 17,477 6,408 3,424 2,985 558 278 280 634 238 396

30–34 6,948 3,313 3,636 20,334 13,363 6,971 3,340 1,861 1,478 365 207 157 325 114 211

35–39 5,570 3,281 2,289 12,565 9,018 3,547 2,097 1,270 827 246 154 93 193 89 103

40–44 4,231 2,800 1,432 8,798 6,831 1,967 1,241 843 398 144 102 42 117 59 59

45–54 3,952 2,875 1,077 8,744 7,427 1,317 896 619 277 125 69 56 128 74 55

55–64 1,019 836 183 1,886 1,699 187 172 116 55 32 14 18 27 19 8

65+ 269 226 44 450 370 80 65 44 21 8 3 5 8 6 2

TOTAL 73,200 27,848 45,353 245,855 125,102 120,753 33,044 15,460 17,584 2,869 1,290 1,579 3,398 1,208 2,189

2007

10–14 477 20 457 3,066 537 2,529 364 64 300 22 0 22 30 3 27

15–19 15,620 2,700 12,920 74,252 25,860 48,392 7,536 2,439 5,097 498 122 376 668 147 521

20–24 20,828 6,344 14,485 79,557 37,666 41,891 9,761 4,544 5,217 767 297 470 884 256 628

25–29 12,481 4,997 7,484 42,001 23,643 18,358 5,880 3,188 2,692 519 285 234 485 186 299

30–34 6,516 3,006 3,510 20,077 12,995 7,082 3,120 1,822 1,298 354 207 146 227 85 143

35–39 4,984 2,778 2,206 11,915 8,578 3,337 1,843 1,170 673 187 120 67 164 78 86

40–44 3,680 2,451 1,228 8,238 6,433 1,805 1,048 710 339 119 82 37 98 28 70

45–54 3,786 2,808 979 8,540 7,176 1,364 824 594 230 114 64 50 81 48 33

55–64 1,010 833 177 1,908 1,680 228 196 133 63 49 33 16 15 13 2

65+ 275 244 31 367 318 49 50 44 6 13 10 3 4 4 0

TOTAL 69,753 26,209 43,544 250,260 125,010 125,250 30,676 14,729 15,947 2,643 1,221 1,422 2,659 850 1,809

2008

10–14 448 37 411 2,847 507 2,340 312 44 268 27 4 23 33 6 27

15–19 14,141 2,484 11,657 74,285 25,450 48,835 7,651 2,410 5,240 529 130 399 681 159 522

20–24 19,542 5,774 13,768 78,084 36,182 41,902 9,637 4,454 5,183 842 349 493 906 300 606

25–29 11,213 4,326 6,887 38,706 21,221 17,486 5,814 3,086 2,727 552 279 273 509 180 329

30–34 5,692 2,575 3,117 18,355 11,619 6,736 3,016 1,725 1,291 322 169 153 243 90 154

35–39 3,967 2,165 1,802 10,258 7,093 3,165 1,834 1,149 685 211 144 67 148 65 83

40–44 2,987 1,946 1,041 6,725 5,017 1,708 1,096 751 345 134 100 34 105 45 60

45–54 3,158 2,288 870 6,933 5,642 1,290 796 562 233 162 111 51 103 55 48

55–64 804 671 133 1,588 1,372 215 168 112 56 47 29 18 22 19 3

65+ 270 224 46 317 281 35 45 32 13 14 6 7 11 9 2

TOTAL 62,306 22,518 39,788 238,410 114,496 123,915 30,412 14,339 16,073 2,849 1,327 1,522 2,764 926 1,838

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 total and sexspecific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were 

specified. In 2005, Hawaii did not report age and/or race/ethnicity for most cases and its 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. 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 2008 Gonorrhea Tables 109

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

States, 2004–2008

Age

Group

White, Non-Hispanic

African-American,

Non-Hispanic Hispanic

Asian/Pacific 

Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

10–14 5.3 0.7 10.1 98.8 30.7 169.2 9.7 2.5 17.2 3.3 1.2 5.5 16.6 5.8 27.7

2004

15–19 116.8 37.7 200.4 2,032.9 1,360.8 2,723.6 207.3 122.0 298.4 54.7 25.8 85.3 342.3 136.3 556.1

20–24 147.1 89.3 207.1 2,449.7 2,357.1 2,542.6 236.2 193.8 288.0 87.2 65.4 109.4 440.7 295.1 590.4

25–29 89.9 71.6 108.6 1,457.9 1,748.9 1,187.0 137.6 132.9 143.4 43.7 47.0 40.5 243.5 180.3 308.0

30–34 53.3 54.2 52.3 761.0 1,056.8 494.6 79.9 86.6 72.0 29.5 31.4 27.7 147.4 117.7 177.0

35–39 38.2 47.3 29.1 460.3 690.9 254.4 57.6 67.7 46.1 18.6 25.4 12.1 101.3 100.0 102.5

40–44 25.0 33.8 16.2 308.0 502.7 136.7 36.7 49.1 23.3 10.7 14.5 7.2 61.5 44.2 77.7

45–54 10.9 16.3 5.5 163.2 296.5 48.9 18.5 25.3 11.7 5.7 7.2 4.3 33.8 40.8 27.3

55–64 3.7 6.3 1.2 57.4 116.2 10.1 7.2 11.0 3.7 3.1 2.3 3.9 5.7 6.8 4.7

65+ 0.7 1.4 0.3 15.7 35.1 3.7 2.0 3.1 1.1 0.3 0.3 0.3 4.4 7.6 2.0

TOTAL 33.2 26.1 40.0 622.5 662.5 586.2 68.9 62.6 75.6 20.7 18.8 22.4 116.5 78.3 153.6

10–14 5.5 0.5 10.7 95.5 32.8 160.2 9.2 2.6 16.1 3.0 0.3 5.8 20.9 7.4 34.7

2005

15–19 119.3 39.5 203.6 2,044.5 1,376.4 2,730.3 211.5 119.9 308.9 73.1 41.2 107.1 367.8 167.5 575.2

20–24 160.0 97.6 225.1 2,437.0 2,333.5 2,542.0 261.7 218.3 314.0 102.5 88.0 117.4 466.7 312.9 625.0

25–29 97.5 77.2 118.1 1,412.1 1,692.4 1,148.5 147.1 139.7 156.5 57.7 63.1 52.4 317.6 238.4 398.8

30–34 55.7 55.5 55.9 742.3 1,024.0 488.3 85.7 89.3 81.4 31.8 45.1 19.0 189.8 165.9 213.7

35–39 39.7 47.7 31.5 455.3 688.7 246.6 59.4 70.3 46.9 23.2 31.9 14.9 116.5 117.7 115.3

40–44 27.1 36.5 17.7 305.6 500.6 134.3 38.5 49.6 26.3 13.9 18.3 9.9 64.6 49.5 79.0

45–54 11.4 17.3 5.5 163.3 294.9 50.3 19.5 26.1 12.8 6.7 9.6 4.2 28.2 29.5 26.9

55–64 3.6 6.3 1.1 55.7 112.7 9.9 8.1 11.9 4.6 3.9 5.4 2.6 11.3 17.2 5.8

65+ 0.8 1.6 0.2 14.7 32.8 3.5 2.4 3.7 1.5 0.8 1.0 0.7 1.9 1.8 1.9

TOTAL 35.1 27.6 42.4 619.4 658.0 584.2 72.4 65.3 80.1 25.2 25.8 24.6 131.5 92.1 169.7

10–14 4.8 0.8 9.0 100.0 33.5 168.6 9.3 3.5 15.4 2.6 0.3 4.9 17.1 1.4 33.2

2006

15–19 121.0 38.4 208.3 2,139.5 1,467.6 2,829.6 222.3 131.3 319.2 61.8 27.0 98.7 379.0 214.1 548.9

20–24 164.6 99.4 233.2 2,540.8 2,421.0 2,663.3 275.6 232.6 326.7 82.1 66.8 97.9 473.3 317.3 634.8

25–29 104.3 82.7 126.2 1,471.2 1,748.0 1,209.6 153.9 147.5 162.1 47.5 48.1 46.9 339.5 252.5 428.2

30–34 59.2 56.1 62.4 803.0 1,111.7 524.0 85.0 87.2 82.4 27.0 31.5 22.8 199.1 139.7 258.6

35–39 41.1 48.2 33.9 474.4 722.8 253.2 59.4 67.3 50.2 19.3 24.7 14.2 115.7 108.4 123.0

40–44 27.8 36.8 18.8 314.8 522.4 132.3 39.7 51.4 26.8 12.5 18.3 7.1 64.7 66.2 63.3

45–54 12.6 18.4 6.8 174.6 321.3 48.8 19.8 27.1 12.4 6.4 7.5 5.5 38.0 45.9 30.9

55–64 4.2 7.0 1.5 60.4 122.1 10.8 6.8 9.6 4.2 2.5 2.3 2.6 12.4 18.2 7.0

65+ 0.9 1.8 0.2 14.4 30.8 4.2 2.7 4.3 1.5 0.6 0.6 0.7 4.3 7.2 2.1

TOTAL 36.5 28.3 44.4 651.2 695.1 611.3 74.6 67.4 82.2 20.4 18.9 21.9 136.9 98.9 173.7

10–14 3.9 0.3 7.8 97.6 33.6 163.6 9.2 3.1 15.5 2.4 0.0 4.9 14.7 2.7 27.1

2007

15–19 118.2 39.8 200.9 2,200.9 1,512.6 2,907.9 201.2 126.4 280.5 54.8 26.1 85.4 288.5 125.4 455.4

20–24 158.9 94.3 226.9 2,604.2 2,436.3 2,776.2 264.5 229.4 305.1 80.4 61.1 100.5 396.9 226.0 574.3

25–29 98.7 78.5 119.2 1,455.2 1,674.3 1,245.4 140.8 137.1 145.6 44.9 50.0 40.0 250.4 190.3 311.8

30–34 56.5 51.8 61.2 797.3 1,085.4 536.1 78.1 83.7 71.5 26.8 32.2 21.7 138.6 103.3 174.1

35–39 37.3 41.3 33.1 448.3 684.5 237.6 50.6 60.1 39.7 14.0 18.4 9.8 98.0 93.8 102.2

40–44 25.0 33.4 16.7 300.2 500.9 123.6 32.8 42.2 22.3 10.2 14.4 6.2 55.4 32.1 77.6

45–54 12.0 17.9 6.1 167.0 303.9 49.6 17.3 24.6 9.8 5.7 6.8 4.7 23.6 29.4 18.3

55–64 4.0 6.8 1.4 58.5 115.6 12.6 7.3 10.3 4.5 3.6 5.2 2.2 6.5 11.9 1.5

65+ 0.9 1.9 0.2 11.5 26.0 2.5 2.0 4.1 0.4 1.0 1.8 0.4 2.2 5.0 0.0

TOTAL 34.7 26.5 42.5 656.0 687.1 627.7 67.4 62.6 72.6 18.5 17.6 19.4 106.0 68.8 142.0

10–14 3.7 0.6 7.0 90.6 31.8 151.4 7.9 2.2 13.8 3.0 0.9 5.2 16.2 5.6 27.2

2008

15–19 107.0 36.6 181.3 2,201.9 1,488.6 2,934.6 204.2 124.9 288.4 58.2 27.7 90.7 294.1 135.5 456.5

20–24 149.1 85.8 215.7 2,556.0 2,340.3 2,777.0 261.2 224.9 303.2 88.3 71.7 105.6 406.7 264.8 554.0

25–29 88.7 67.9 109.7 1,341.1 1,502.8 1,186.2 139.2 132.7 147.5 47.8 48.9 46.7 262.8 183.6 343.7

30–34 49.3 44.4 54.4 728.9 970.5 509.9 75.5 79.2 71.1 24.4 26.3 22.6 148.2 108.9 187.8

35–39 29.6 32.2 27.1 386.0 566.0 225.3 50.4 59.0 40.4 15.9 22.2 9.8 88.8 78.1 99.3

40–44 20.3 26.5 14.1 245.0 390.7 116.9 34.2 44.6 22.7 11.6 17.7 5.7 59.7 52.0 67.0

45–54 10.0 14.6 5.4 135.6 239.0 46.9 16.7 23.3 10.0 8.1 11.8 4.9 29.9 33.5 26.7

55–64 3.2 5.5 1.0 48.6 94.4 11.9 6.2 8.6 4.0 3.5 4.7 2.4 9.4 16.9 2.6

65+ 0.9 1.7 0.3 10.0 23.0 1.8 1.8 3.0 0.9 1.0 1.1 1.0 5.5 10.4 1.6

TOTAL 31.0 22.8 38.8 625.0 629.4 621.0 66.8 61.0 73.1 20.0 19.1 20.8 110.2 75.0 144.2

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 total and sexspecific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were 

specified. In 2005, Hawaii did not report age and/or race/ethnicity for most cases and its 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. 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 Syphilis Tables STD Surveillance 2008

Table 22. All Stages of Syphilis*—Reported cases and rates by state/area and region listed in 

alphabetical order: United States and outlying areas, 2004–2008

State/Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Alabama 639 551 931 1,006 1,187 14.1 12.1 20.2 21.7 25.6

Alaska 15 22 25 16 9 2.3 3.3 3.7 2.3 1.3

Arizona 974 792 926 1,245 1,394 17.0 13.3 15.0 19.6 22.0

Arkansas 249 231 246 371 508 9.0 8.3 8.8 13.1 17.9

California 4,590 5,340 6,046 6,323 6,909 12.8 14.8 16.6 17.3 18.9

Colorado 179 144 182 157 352 3.9 3.1 3.8 3.2 7.2

Connecticut 169 166 197 148 173 4.8 4.7 5.6 4.2 4.9

Delaware 61 35 74 63 59 7.3 4.1 8.7 7.3 6.8

District of Columbia 357 365 314 416 370 64.5 66.3 54.0 70.7 62.9

Florida 2,964 2,888 2,945 3,918 4,585 17.0 16.2 16.3 21.5 25.1

Georgia 1,589 1,924 1,933 2,254 2,833 18.0 21.2 20.6 23.6 29.7

Hawaii 36 57 66 58 68 2.9 4.5 5.1 4.5 5.3

Idaho 78 54 12 14 26 5.6 3.8 0.8 0.9 1.7

Illinois 1,348 1,608 1,473 1,220 1,565 10.6 12.6 11.5 9.5 12.2

Indiana 273 288 250 216 351 4.4 4.6 4.0 3.4 5.5

Iowa 36 28 68 65 75 1.2 0.9 2.3 2.2 2.5

Kansas 87 88 87 97 125 3.2 3.2 3.1 3.5 4.5

Kentucky 151 129 188 153 218 3.6 3.1 4.5 3.6 5.1

Louisiana 1,646 1,239 1,390 1,808 2,024 36.5 27.4 32.4 42.1 47.1

Maine 7 6 22 21 27 0.5 0.5 1.7 1.6 2.0

Maryland 1,002 1,005 1,038 1,170 1,088 18.0 17.9 18.5 20.8 19.4

Massachusetts 517 398 378 399 479 8.1 6.2 5.9 6.2 7.4

Michigan 806 488 384 473 546 8.0 4.8 3.8 4.7 5.4

Minnesota 145 208 189 186 265 2.8 4.1 3.7 3.6 5.1

Mississippi 404 371 520 707 736 13.9 12.7 17.9 24.2 25.2

Missouri 269 372 430 484 542 4.7 6.4 7.4 8.2 9.2

Montana 4 7 2 8 10 0.4 0.7 0.2 0.8 1.0

Nebraska 15 18 34 30 36 0.9 1.0 1.9 1.7 2.0

Nevada 254 343 389 396 325 10.9 14.2 15.6 15.4 12.7

New Hampshire 26 33 35 52 41 2.0 2.5 2.7 4.0 3.1

New Jersey 826 813 799 926 1,009 9.5 9.3 9.2 10.7 11.6

New Mexico 251 183 237 180 189 13.2 9.5 12.1 9.1 9.6

New York 4,472 3,853 4,586 4,999 5,515 23.3 20.0 23.8 25.9 28.6

North Carolina 747 713 962 1,093 998 8.7 8.2 10.9 12.1 11.0

North Dakota 0 1 3 2 4 0.0 0.2 0.5 0.3 0.6

Ohio 571 502 491 549 763 5.0 4.4 4.3 4.8 6.7

Oklahoma 168 159 251 216 257 4.8 4.5 7.0 6.0 7.1

Oregon 108 109 99 59 97 3.0 3.0 2.7 1.6 2.6

Pennsylvania 574 712 888 844 902 4.6 5.7 7.1 6.8 7.3

Rhode Island 104 64 71 76 55 9.6 5.9 6.7 7.2 5.2

South Carolina 524 549 397 411 412 12.5 12.9 9.2 9.3 9.3

South Dakota 0 4 29 12 6 0.0 0.5 3.7 1.5 0.8

Tennessee 804 917 1,015 1,212 1,283 13.6 15.4 16.8 19.7 20.8

Texas 4,205 4,289 4,956 5,506 6,336 18.7 18.8 21.1 23.0 26.5

Utah 78 50 68 45 40 3.3 2.0 2.7 1.7 1.5

Vermont 3 1 7 11 18 0.5 0.2 1.1 1.8 2.9

Virginia 610 655 701 736 789 8.2 8.7 9.2 9.5 10.2

Washington 336 359 423 367 438 5.4 5.7 6.6 5.7 6.8

West Virginia 18 18 30 27 44 1.0 1.0 1.6 1.5 2.4

Wisconsin 128 138 170 170 187 2.3 2.5 3.1 3.0 3.3

Wyoming 6 1 1 6 9 1.2 0.2 0.2 1.1 1.7

U.S. TOTAL 33,423 33,288 36,958 40,921 46,277 11.4 11.2 12.3 13.6 15.3

Northeast 6,698 6,046 6,983 7,476 8,219 12.3 11.1 12.8 13.7 15.0

Midwest 3,678 3,743 3,608 3,504 4,465 5.6 5.7 5.4 5.3 6.7

South 16,138 16,038 17,891 21,067 23,727 15.2 14.9 16.4 19.1 21.5

West 6,909 7,461 8,476 8,874 9,866 10.2 10.9 12.2 12.7 14.1

Guam 13 19 13 37 45 7.8 11.3 7.6 21.3 25.9

Puerto Rico 1,154 1,223 1,068 1,269 797 29.6 31.3 27.2 32.2 20.2

Virgin Islands 17 13 5 5 1 15.6 12.0 4.6 4.6 0.9

OUTLYING AREAS 1,184 1,255 1,086 1,311 843 28.4 30.0 25.8 31.0 19.9

TOTAL 34,607 34,543 38,044 42,232 47,120 11.6 11.5 12.5 13.8 15.4

* See Appendix (Syphilis Morbidity Reporting) for definition.
STD Surveillance 2008 Syphilis Tables 111

Table 23. All Stages of Syphilis*—Reported cases and rates in selected metropolitan statistical 

areas† (MSAs) listed in alphabetical order: United States, 2004–2008

Metropolitan Statistical Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Atlanta-Sandy Springs-Marietta, GA 1,315 1,626 1,641 1,904 2,243 27.9 33.1 31.9 36.1 42.5

Austin-Round Rock, TX 200 193 212 234 344 14.2 13.3 14.0 14.6 21.5

Baltimore-Towson, MD 647 679 642 650 685 24.5 25.6 24.1 24.4 25.7

Birmingham-Hoover, AL 117 243 561 483 504 10.8 22.3 51.0 43.6 45.5

Boston-Cambridge-Quincy, MA-NH 410 339 329 324 383 9.3 7.7 7.4 7.2 8.5

Buffalo-Cheektowaga-Tonawanda, NY 24 14 42 26 20 2.1 1.2 3.7 2.3 1.8

Charlotte-Gastonia-Concord, NC-SC 154 235 303 301 223 10.4 15.4 19.1 18.2 13.5

Chicago-Naperville-Joliet, IL-IN-WI 1,296 1,541 1,386 1,116 1,452 13.8 16.3 14.6 11.7 15.2

Cincinnati-Middletown, OH-KY-IN 54 55 58 77 105 2.6 2.7 2.8 3.6 4.9

Cleveland-Elyria-Mentor, OH 84 52 53 83 127 3.9 2.4 2.5 4.0 6.1

Columbus, OH 254 227 229 222 311 15.0 13.3 13.3 12.7 17.7

Dallas-Fort Worth-Arlington, TX 1,374 1,495 1,678 1,643 1,780 24.1 25.7 27.9 26.7 29.0

Denver-Aurora, CO 135 111 141 120 269 5.8 4.7 5.9 4.9 10.9

Detroit-Warren-Livonia, MI 679 390 284 339 304 15.1 8.7 6.4 7.6 6.8

Hartford-WestHartford-East Hartford, CT 46 57 65 51 71 3.9 4.8 5.5 4.3 6.0

Houston-Baytown-Sugar Land, TX 1,289 1,188 1,570 2,048 2,088 24.9 22.5 28.3 36.4 37.1

Indianapolis, IN 128 134 121 95 189 7.9 8.2 7.3 5.6 11.2

Jacksonville, FL 218 151 165 198 308 17.8 12.1 12.9 15.2 23.7

Kansas City, MO-KS 101 193 228 268 237 5.2 9.9 11.6 13.5 11.9

Las Vegas-Paradise, NV 225 300 355 364 299 13.6 17.5 20.0 19.8 16.3

Los Angeles-Long Beach-Santa Ana, CA 2,483 3,159 3,594 3,581 3,572 19.2 24.4 27.8 27.8 27.7

Louisville, KY-IN 115 102 101 77 91 9.6 8.4 8.3 6.2 7.4

Memphis, TN-MS-AR 519 585 612 761 746 41.5 46.4 48.0 59.4 58.3

Miami-Fort Lauderdale-Miami Beach, FL 1,687 1,444 1,455 1,863 2,408 31.5 26.6 26.6 34.4 44.5

Milwaukee-Waukesha-West Allis, WI 85 77 100 127 138 5.6 5.1 6.6 8.2 8.9

Minneapolis-St. Paul-Bloomington, MN-WI 125 187 161 170 223 4.0 6.0 5.1 5.3 7.0

Nashville-Davidson-Murfreesboro, TN 194 189 194 240 277 13.9 13.3 13.3 15.8 18.2

New Orleans-Metairie-Kenner, LA 449 350 352 560 491 34.0 26.5 34.4 54.3 47.7

New York-Newark-Edison, NY-NJ-PA 4,918 4,318 4,924 5,503 6,097 26.3 23.0 26.2 29.2 32.4

Oklahoma City, OK 110 87 116 114 161 9.6 7.5 9.9 9.6 13.5

Orlando, FL 267 413 403 583 460 14.3 21.4 20.3 28.7 22.6

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 678 583 773 778 812 11.7 10.0 13.3 13.3 13.9

Phoenix-Mesa-Scottsdale, AZ 754 595 757 866 857 20.3 15.4 18.7 20.7 20.5

Pittsburgh, PA 32 112 152 122 98 1.3 4.7 6.4 5.2 4.2

Portland-Vancouver-Beaverton, OR-WA 84 94 74 51 64 4.1 4.5 3.5 2.3 2.9

Providence-New Bedford-Fall River, RI-MA 137 75 92 100 71 8.4 4.6 5.7 6.2 4.4

Richmond, VA 85 87 106 129 226 7.4 7.4 8.9 10.6 18.6

Riverside-San Bernardino-Ontario, CA 319 399 376 340 452 8.4 10.2 9.3 8.3 11.1

Rochester, NY 41 36 90 76 51 3.9 3.5 8.7 7.4 4.9

Sacramento-Arden-Arcade-Roseville, CA 64 39 136 117 243 3.2 1.9 6.6 5.6 11.6

Salt Lake City, UT 53 35 41 35 35 5.2 3.4 3.8 3.2 3.2

San Antonio, TX 361 458 473 420 598 19.5 24.2 24.4 21.1 30.0

San Diego-Carlsbad-San Marcos, CA 356 448 572 788 828 12.1 15.3 19.4 26.5 27.8

San Francisco-Oakland-Fremont, CA 917 719 741 783 1,044 22.1 17.3 17.7 18.6 24.8

San Jose-Sunnyvale-Santa Clara, CA 113 121 94 159 156 6.5 6.9 5.3 8.8 8.6

Seattle-Tacoma-Bellevue, WA 273 285 356 309 359 8.6 8.9 10.9 9.3 10.8

St. Louis, MO-IL 189 173 186 252 322 6.8 6.2 6.7 9.0 11.5

Tampa-St. Petersburg-Clearwater, FL 303 326 428 612 680 11.7 12.3 15.9 22.5 25.0

Virginia Beach-Norfolk-Newport News, VA-NC 198 246 245 232 248 12.0 14.9 14.9 14.0 15.0

Washington-Arlington-Alexandria, DC-VA-MD-WV 896 894 928 1,162 956 17.4 17.1 17.5 21.9 18.0

U.S. MSA TOTAL 25,555 25,859 28,695 31,456 34,706 16.2 16.2 17.8 19.3 21.3

* See Appendix (Syphilis Morbidity Reporting) for definition.

† MSAs selected based on largest population in 2000 U.S. Census.
112 Syphilis Tables STD Surveillance 2008

Table 24. Primary and secondary syphilis—Reported cases and rates by state, ranked by rates: 

United States, 2008

Rank* State Cases Rate per 100,000 Population

1 Louisiana 707 16.5

2 Alabama 449 9.7

3 Georgia 914 9.6

4 Arkansas 206 7.3

5 Maryland 378 6.7

6 Tennessee 413 6.7

7 New York 1,217 6.3

8 Mississippi 184 6.3

9 California 2,204 6.0

10 Texas 1,405 5.9

11 Florida 1,044 5.7

12 Arizona 317 5.0

U.S. TOTAL† 13,500 4.5

13 Illinois 554 4.3

14 Missouri 224 3.8

15 Virginia 266 3.4

16 Massachusetts 216 3.3

17 North Carolina 287 3.2

18 Ohio 351 3.1

19 Nevada 77 3.0

20 Washington 181 2.8

21 Colorado 128 2.6

22 New Jersey 226 2.6

23 Oklahoma 86 2.4

24 Hawaii 29 2.3

25 New Mexico 44 2.2

26 Minnesota 116 2.2

27 South Carolina 98 2.2

28 Indiana 140 2.2

29 Kentucky 93 2.2

30 Pennsylvania 272 2.2

31 Michigan 210 2.1

32 Delaware 16 1.9

33 Vermont 11 1.8

34 Rhode Island 18 1.7

35 New Hampshire 20 1.5

36 Wisconsin 65 1.2

37 Kansas 30 1.1

38 Connecticut 34 1.0

39 Utah 25 0.9

40 Nebraska 15 0.8

41 Maine 10 0.8

42 Montana 7 0.7

43 West Virginia 13 0.7

44 Oregon 26 0.7

45 Wyoming 3 0.6

46 Iowa 16 0.5

47 Idaho 7 0.5

YEAR 2010 TARGET 0.2

48 Alaska 1 0.1

49 South Dakota 1 0.1

North 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 the District of Columbia with 146 cases and a rate of 24.8, but excludes outlying areas (Guam with 6 cases and rate of 3.5, Puerto 

Rico with 167 cases and rate of 4.2, and Virgin Islands with 0 cases and rate of 0.0).
STD Surveillance 2008 Syphilis Tables 113

Table 25. Primary and secondary syphilis—Reported cases and rates by state/area and region 

listed in alphabetical order: United States and outlying areas, 2004–2008

State/Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Alabama 165 169 319 380 449 3.6 3.7 6.9 8.2 9.7

Alaska 8 9 11 7 1 1.2 1.4 1.6 1.0 0.1

Arizona 157 175 203 296 317 2.7 2.9 3.3 4.7 5.0

Arkansas 47 52 77 122 206 1.7 1.9 2.7 4.3 7.3

California 1,356 1,585 1,835 2,038 2,204 3.8 4.4 5.0 5.6 6.0

Colorado 63 46 69 57 128 1.4 1.0 1.5 1.2 2.6

Connecticut 45 58 64 39 34 1.3 1.7 1.8 1.1 1.0

Delaware 9 11 20 18 16 1.1 1.3 2.3 2.1 1.9

District of Columbia 69 114 116 178 146 12.5 20.7 19.9 30.3 24.8

Florida 728 724 719 913 1,044 4.2 4.1 4.0 5.0 5.7

Georgia 549 645 581 680 914 6.2 7.1 6.2 7.1 9.6

Hawaii 8 11 18 9 29 0.6 0.9 1.4 0.7 2.3

Idaho 24 20 3 1 7 1.7 1.4 0.2 0.1 0.5

Illinois 386 525 431 464 554 3.0 4.1 3.4 3.6 4.3

Indiana 60 62 93 54 140 1.0 1.0 1.5 0.9 2.2

Iowa 5 9 19 21 16 0.2 0.3 0.6 0.7 0.5

Kansas 24 19 27 28 30 0.9 0.7 1.0 1.0 1.1

Kentucky 47 52 73 56 93 1.1 1.2 1.7 1.3 2.2

Louisiana 332 278 342 533 707 7.4 6.1 8.0 12.4 16.5

Maine 2 1 9 9 10 0.2 0.1 0.7 0.7 0.8

Maryland 380 313 300 345 378 6.8 5.6 5.3 6.1 6.7

Massachusetts 114 125 124 155 216 1.8 2.0 1.9 2.4 3.3

Michigan 192 105 118 123 210 1.9 1.0 1.2 1.2 2.1

Minnesota 27 70 47 59 116 0.5 1.4 0.9 1.1 2.2

Mississippi 59 49 86 133 184 2.0 1.7 3.0 4.6 6.3

Missouri 94 147 168 239 224 1.6 2.5 2.9 4.1 3.8

Montana 4 7 1 8 7 0.4 0.7 0.1 0.8 0.7

Nebraska 7 4 7 4 15 0.4 0.2 0.4 0.2 0.8

Nevada 40 109 137 111 77 1.7 4.5 5.5 4.3 3.0

New Hampshire 5 16 13 30 20 0.4 1.2 1.0 2.3 1.5

New Jersey 150 133 173 227 226 1.7 1.5 2.0 2.6 2.6

New Mexico 82 56 79 46 44 4.3 2.9 4.0 2.3 2.2

New York 727 705 736 1,068 1,217 3.8 3.7 3.8 5.5 6.3

North Carolina 192 274 309 323 287 2.2 3.2 3.5 3.6 3.2

North Dakota 0 1 1 1 0 0.0 0.2 0.2 0.2 0.0

Ohio 237 211 184 194 351 2.1 1.8 1.6 1.7 3.1

Oklahoma 25 44 70 65 86 0.7 1.2 2.0 1.8 2.4

Oregon 29 41 29 18 26 0.8 1.1 0.8 0.5 0.7

Pennsylvania 118 199 264 263 272 1.0 1.6 2.1 2.1 2.2

Rhode Island 26 24 14 36 18 2.4 2.2 1.3 3.4 1.7

South Carolina 116 84 66 91 98 2.8 2.0 1.5 2.1 2.2

South Dakota 0 2 13 7 1 0.0 0.3 1.7 0.9 0.1

Tennessee 130 217 249 367 413 2.2 3.6 4.1 6.0 6.7

Texas 827 873 1,064 1,160 1,405 3.7 3.8 4.5 4.9 5.9

Utah 13 10 21 20 25 0.5 0.4 0.8 0.8 0.9

Vermont 1 1 3 10 11 0.2 0.2 0.5 1.6 1.8

Virginia 116 143 190 230 266 1.6 1.9 2.5 3.0 3.4

Washington 150 152 182 154 181 2.4 2.4 2.8 2.4 2.8

West Virginia 3 3 11 6 13 0.2 0.2 0.6 0.3 0.7

Wisconsin 29 41 68 66 65 0.5 0.7 1.2 1.2 1.2

Wyoming 3 0 0 4 3 0.6 0.0 0.0 0.8 0.6

U.S. TOTAL 7,980 8,724 9,756 11,466 13,500 2.7 2.9 3.3 3.8 4.5

Northeast 1,188 1,262 1,400 1,837 2,024 2.2 2.3 2.6 3.4 3.7

Midwest 1,061 1,196 1,176 1,260 1,722 1.6 1.8 1.8 1.9 2.6

South 3,794 4,045 4,592 5,600 6,705 3.6 3.8 4.2 5.1 6.1

West 1,937 2,221 2,588 2,769 3,049 2.9 3.3 3.7 4.0 4.3

Guam 0 2 3 8 6 0.0 1.2 1.8 4.6 3.5

Puerto Rico 182 224 150 169 167 4.7 5.7 3.8 4.3 4.2

Virgin Islands 5 1 1 0 0 4.6 0.9 0.9 0.0 0.0

OUTLYING AREAS 187 227 154 177 173 4.5 5.4 3.7 4.2 4.1

TOTAL 8,167 8,951 9,910 11,643 13,673 2.7 3.0 3.3 3.8 4.5
114 Syphilis Tables STD Surveillance 2008

Table 26. Primary and secondary syphilis—Women—Reported cases and rates by state/area and 

region listed in alphabetical order: United States and outlying areas, 2004–2008

State/Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Alabama 52 69 116 143 171 2.2 2.9 4.9 6.0 7.2

Alaska 0 1 2 1 0 0.0 0.3 0.6 0.3 0.0

Arizona 42 49 33 64 56 1.5 1.7 1.1 2.0 1.8

Arkansas 18 21 35 50 81 1.3 1.5 2.4 3.5 5.6

California 63 121 128 115 110 0.4 0.7 0.7 0.6 0.6

Colorado 7 2 5 2 3 0.3 0.1 0.2 0.1 0.1

Connecticut 3 2 2 2 0 0.2 0.1 0.1 0.1 0.0

Delaware 1 2 4 1 6 0.2 0.5 0.9 0.2 1.3

District of Columbia 4 11 6 5 7 1.4 3.8 1.9 1.6 2.3

Florida 98 100 98 153 193 1.1 1.1 1.1 1.6 2.1

Georgia 45 47 41 53 96 1.0 1.0 0.9 1.1 2.0

Hawaii 0 0 1 1 7 0.0 0.0 0.2 0.2 1.1

Idaho 11 6 2 1 1 1.6 0.8 0.3 0.1 0.1

Illinois 55 47 37 39 38 0.9 0.7 0.6 0.6 0.6

Indiana 6 10 10 8 16 0.2 0.3 0.3 0.2 0.5

Iowa 1 1 6 3 3 0.1 0.1 0.4 0.2 0.2

Kansas 7 2 2 6 5 0.5 0.1 0.1 0.4 0.4

Kentucky 6 3 7 9 14 0.3 0.1 0.3 0.4 0.6

Louisiana 123 112 123 209 307 5.3 4.8 5.6 9.5 13.9

Maine 0 0 2 0 0 0.0 0.0 0.3 0.0 0.0

Maryland 92 88 61 47 77 3.2 3.0 2.1 1.6 2.7

Massachusetts 5 4 7 10 6 0.2 0.1 0.2 0.3 0.2

Michigan 61 20 26 27 60 1.2 0.4 0.5 0.5 1.2

Minnesota 3 2 4 1 5 0.1 0.1 0.2 0.0 0.2

Mississippi 19 12 36 35 66 1.3 0.8 2.4 2.3 4.4

Missouri 12 12 19 27 29 0.4 0.4 0.6 0.9 1.0

Montana 1 1 0 2 1 0.2 0.2 0.0 0.4 0.2

Nebraska 4 0 1 0 3 0.5 0.0 0.1 0.0 0.3

Nevada 8 24 34 12 14 0.7 2.0 2.8 1.0 1.1

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 38 17 12 16 21 0.9 0.4 0.3 0.4 0.5

New Mexico 36 16 22 15 6 3.7 1.6 2.2 1.5 0.6

New York 32 28 29 32 52 0.3 0.3 0.3 0.3 0.5

North Carolina 48 58 67 60 44 1.1 1.3 1.5 1.3 0.9

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 61 40 43 28 63 1.0 0.7 0.7 0.5 1.1

Oklahoma 9 17 19 24 25 0.5 0.9 1.0 1.3 1.4

Oregon 1 2 0 2 2 0.1 0.1 0.0 0.1 0.1

Pennsylvania 16 34 34 34 21 0.3 0.5 0.5 0.5 0.3

Rhode Island 10 6 0 2 0 1.8 1.1 0.0 0.4 0.0

South Carolina 25 17 11 10 12 1.2 0.8 0.5 0.4 0.5

South Dakota 0 0 5 2 1 0.0 0.0 1.3 0.5 0.3

Tennessee 34 64 73 113 119 1.1 2.1 2.4 3.6 3.8

Texas 179 243 261 297 450 1.6 2.1 2.2 2.5 3.8

Utah 3 1 3 0 1 0.3 0.1 0.2 0.0 0.1

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 6 19 23 16 25 0.2 0.5 0.6 0.4 0.6

Washington 6 5 4 6 5 0.2 0.2 0.1 0.2 0.2

West Virginia 1 0 1 2 4 0.1 0.0 0.1 0.2 0.4

Wisconsin 2 3 3 6 14 0.1 0.1 0.1 0.2 0.5

Wyoming 1 0 0 1 2 0.4 0.0 0.0 0.4 0.8

U.S. TOTAL 1,255 1,339 1,458 1,692 2,242 0.8 0.9 1.0 1.1 1.5

Northeast 104 91 86 96 100 0.4 0.3 0.3 0.3 0.4

Midwest 212 137 156 147 237 0.6 0.4 0.5 0.4 0.7

South 760 883 982 1,227 1,697 1.4 1.6 1.8 2.2 3.0

West 179 228 234 222 208 0.5 0.7 0.7 0.6 0.6

Guam 0 1 1 4 1 0.0 1.2 1.2 4.7 1.2

Puerto Rico 62 81 46 56 29 3.1 4.0 2.3 2.7 1.4

Virgin Islands 3 0 0 0 0 5.3 0.0 0.0 0.0 0.0

OUTLYING AREAS 65 82 47 60 30 3.0 3.8 2.2 2.7 1.4

TOTAL 1,320 1,421 1,505 1,752 2,272 0.9 0.9 1.0 1.1 1.5

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2008 Syphilis Tables 115

Table 27. Primary and secondary syphilis—Men—Reported cases and rates by state/area and 

region listed in alphabetical order: United States and outlying areas, 2004–2008

State/Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Alabama 113 100 203 237 278 5.1 4.5 9.1 10.6 12.4

Alaska 8 8 9 6 1 2.4 2.3 2.6 1.7 0.3

Arizona 115 125 166 230 261 4.0 4.2 5.4 7.2 8.2

Arkansas 29 31 42 72 125 2.2 2.3 3.0 5.2 9.0

California 1,291 1,463 1,706 1,921 2,092 7.2 8.1 9.4 10.5 11.4

Colorado 56 44 64 55 125 2.4 1.9 2.7 2.2 5.1

Connecticut 42 56 62 37 34 2.5 3.3 3.6 2.2 2.0

Delaware 8 9 16 17 10 2.0 2.2 3.9 4.1 2.4

District of Columbia 65 103 110 173 139 24.8 39.4 40.3 62.2 50.0

Florida 630 624 621 760 850 7.4 7.2 7.0 8.5 9.5

Georgia 504 598 540 626 818 11.5 13.3 11.7 13.3 17.4

Hawaii 8 11 17 8 22 1.3 1.7 2.6 1.2 3.4

Idaho 13 14 1 0 6 1.9 2.0 0.1 0.0 0.8

Illinois 331 478 394 425 516 5.3 7.6 6.2 6.7 8.1

Indiana 54 52 83 46 124 1.8 1.7 2.7 1.5 4.0

Iowa 3 8 13 18 13 0.2 0.5 0.9 1.2 0.9

Kansas 17 17 25 22 25 1.3 1.2 1.8 1.6 1.8

Kentucky 41 49 66 47 79 2.0 2.4 3.2 2.3 3.8

Louisiana 209 166 219 324 400 9.5 7.5 10.5 15.5 19.2

Maine 2 1 7 9 10 0.3 0.2 1.1 1.4 1.6

Maryland 288 225 239 298 301 10.7 8.3 8.8 11.0 11.1

Massachusetts 109 121 117 145 210 3.5 3.9 3.8 4.6 6.7

Michigan 131 85 92 96 150 2.6 1.7 1.9 1.9 3.0

Minnesota 24 68 43 58 111 0.9 2.7 1.7 2.2 4.3

Mississippi 40 37 50 98 118 2.8 2.6 3.5 6.9 8.3

Missouri 82 135 149 212 195 2.9 4.8 5.2 7.4 6.8

Montana 3 6 1 6 6 0.6 1.3 0.2 1.3 1.3

Nebraska 3 4 6 4 12 0.3 0.5 0.7 0.5 1.4

Nevada 32 85 103 99 63 2.7 6.9 8.1 7.6 4.8

New Hampshire 5 16 13 30 20 0.8 2.5 2.0 4.6 3.1

New Jersey 112 116 161 211 205 2.6 2.7 3.8 5.0 4.8

New Mexico 46 40 57 31 38 4.9 4.2 5.9 3.2 3.9

New York 695 677 707 1,036 1,165 7.5 7.3 7.6 11.1 12.4

North Carolina 144 216 242 263 243 3.4 5.1 5.6 5.9 5.5

North Dakota 0 1 1 1 0 0.0 0.3 0.3 0.3 0.0

Ohio 176 171 141 166 288 3.2 3.1 2.5 3.0 5.2

Oklahoma 16 27 51 41 61 0.9 1.5 2.9 2.3 3.4

Oregon 28 39 29 16 24 1.6 2.2 1.6 0.9 1.3

Pennsylvania 102 165 230 229 251 1.7 2.7 3.8 3.8 4.1

Rhode Island 16 18 14 34 18 3.1 3.5 2.7 6.6 3.5

South Carolina 91 67 55 81 86 4.4 3.2 2.6 3.8 4.0

South Dakota 0 2 8 5 0 0.0 0.5 2.0 1.3 0.0

Tennessee 96 153 176 254 294 3.3 5.2 6.0 8.4 9.8

Texas 648 630 803 863 955 5.8 5.5 6.9 7.2 8.0

Utah 10 9 18 20 24 0.8 0.7 1.4 1.5 1.8

Vermont 1 1 3 10 11 0.3 0.3 1.0 3.3 3.6

Virginia 110 124 167 214 241 3.0 3.3 4.4 5.7 6.4

Washington 144 147 178 148 176 4.7 4.7 5.6 4.6 5.5

West Virginia 2 3 10 4 9 0.2 0.3 1.1 0.5 1.0

Wisconsin 27 38 65 60 51 1.0 1.4 2.4 2.2 1.8

Wyoming 2 0 0 3 1 0.8 0.0 0.0 1.1 0.4

U.S. TOTAL 6,722 7,383 8,293 9,769 11,255 4.7 5.1 5.6 6.6 7.6

Northeast 1,084 1,171 1,314 1,741 1,924 4.1 4.4 4.9 6.5 7.2

Midwest 848 1,059 1,020 1,113 1,485 2.6 3.3 3.1 3.4 4.5

South 3,034 3,162 3,610 4,372 5,007 5.8 6.0 6.7 8.1 9.2

West 1,756 1,991 2,349 2,543 2,839 5.2 5.8 6.8 7.2 8.1

Guam 0 1 2 4 5 0.0 1.2 2.3 4.5 5.7

Puerto Rico 120 143 104 113 138 6.4 7.6 5.5 6.0 7.3

Virgin Islands 2 1 1 0 0 3.9 1.9 1.9 0.0 0.0

OUTLYING AREAS 122 145 107 117 143 6.1 7.2 5.3 5.8 7.0

TOTAL 6,844 7,528 8,400 9,886 11,398 4.7 5.1 5.6 6.6 7.6

NOTE: Cases reported with unknown sex are not included in this table.
116 Syphilis Tables STD Surveillance 2008

Table 28. Primary and secondary syphilis—Reported cases and rates in selected metropolitan 

statistical areas* (MSAs) listed in alphabetical order: United States, 2004–2008

Metropolitan Statistical Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Atlanta-Sandy Springs-Marietta, GA 508 598 529 608 765 10.8 12.2 10.3 11.5 14.5

Austin-Round Rock, TX 56 44 84 74 107 4.0 3.0 5.5 4.6 6.7

Baltimore-Towson, MD 276 244 213 211 270 10.5 9.2 8.0 7.9 10.1

Birmingham-Hoover, AL 33 101 244 189 188 3.0 9.3 22.2 17.1 17.0

Boston-Cambridge-Quincy, MA-NH 84 106 117 131 173 1.9 2.4 2.6 2.9 3.9

Buffalo-Cheektowaga-Tonawanda, NY 9 7 18 11 3 0.8 0.6 1.6 1.0 0.3

Charlotte-Gastonia-Concord, NC-SC 46 103 121 103 58 3.1 6.8 7.6 6.2 3.5

Chicago-Naperville-Joliet, IL-IN-WI 373 510 416 427 535 4.0 5.4 4.4 4.5 5.6

Cincinnati-Middletown, OH-KY-IN 22 24 13 34 62 1.1 1.2 0.6 1.6 2.9

Cleveland-Elyria-Mentor, OH 40 22 18 29 64 1.9 1.0 0.9 1.4 3.1

Columbus, OH 109 109 107 76 135 6.4 6.4 6.2 4.3 7.7

Dallas-Fort Worth-Arlington, TX 279 305 320 265 328 4.9 5.2 5.3 4.3 5.3

Denver-Aurora, CO 55 38 56 46 103 2.4 1.6 2.3 1.9 4.2

Detroit-Warren-Livonia, MI 153 77 82 91 100 3.4 1.7 1.8 2.0 2.2

Hartford-WestHartford-East Hartford, CT 13 14 23 15 8 1.1 1.2 1.9 1.3 0.7

Houston-Baytown-Sugar Land, TX 235 279 396 501 456 4.5 5.3 7.1 8.9 8.1

Indianapolis, IN 34 35 47 26 80 2.1 2.1 2.8 1.5 4.7

Jacksonville, FL 72 50 41 44 67 5.9 4.0 3.2 3.4 5.2

Kansas City, MO-KS 35 89 112 149 102 1.8 4.6 5.7 7.5 5.1

Las Vegas-Paradise, NV 38 103 132 102 72 2.3 6.0 7.4 5.6 3.9

Los Angeles-Long Beach-Santa Ana, CA 551 806 945 1,061 920 4.3 6.2 7.3 8.2 7.1

Louisville, KY-IN 38 46 41 32 36 3.2 3.8 3.4 2.6 2.9

Memphis, TN-MS-AR 99 138 145 208 234 7.9 10.9 11.4 16.2 18.3

Miami-Fort Lauderdale-Miami Beach, FL 434 395 369 414 509 8.1 7.3 6.8 7.6 9.4

Milwaukee-Waukesha-West Allis, WI 19 22 38 53 45 1.3 1.5 2.5 3.4 2.9

Minneapolis-St. Paul-Bloomington, MN-WI 26 68 43 57 105 0.8 2.2 1.4 1.8 3.3

Nashville-Davidson-Murfreesboro, TN 17 34 40 84 85 1.2 2.4 2.7 5.5 5.6

New Orleans-Metairie-Kenner, LA 101 88 90 168 170 7.7 6.7 8.8 16.3 16.5

New York-Newark-Edison, NY-NJ-PA 816 773 811 1,208 1,353 4.4 4.1 4.3 6.4 7.2

Oklahoma City, OK 20 23 24 36 61 1.7 2.0 2.0 3.0 5.1

Orlando, FL 69 106 94 145 126 3.7 5.5 4.7 7.1 6.2

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 95 127 173 205 214 1.6 2.2 3.0 3.5 3.7

Phoenix-Mesa-Scottsdale, AZ 106 113 157 193 211 2.9 2.9 3.9 4.6 5.0

Pittsburgh, PA 22 69 91 60 38 0.9 2.9 3.8 2.5 1.6

Portland-Vancouver-Beaverton, OR-WA 26 39 25 11 21 1.3 1.9 1.2 0.5 1.0

Providence-New Bedford-Fall River, RI-MA 30 28 18 44 25 1.8 1.7 1.1 2.7 1.6

Richmond, VA 11 13 28 38 92 1.0 1.1 2.3 3.1 7.6

Riverside-San Bernardino-Ontario, CA 103 121 108 95 157 2.7 3.1 2.7 2.3 3.8

Rochester, NY 12 6 14 16 9 1.2 0.6 1.4 1.6 0.9

Sacramento-Arden-Arcade-Roseville, CA 19 16 32 59 102 0.9 0.8 1.5 2.8 4.9

Salt Lake City, UT 5 9 15 19 23 0.5 0.9 1.4 1.7 2.1

San Antonio, TX 116 129 136 157 195 6.3 6.8 7.0 7.9 9.8

San Diego-Carlsbad-San Marcos, CA 138 194 235 347 345 4.7 6.6 8.0 11.7 11.6

San Francisco-Oakland-Fremont, CA 422 331 363 308 478 10.2 8.0 8.7 7.3 11.4

San Jose-Sunnyvale-Santa Clara, CA 56 44 52 56 42 3.2 2.5 2.9 3.1 2.3

Seattle-Tacoma-Bellevue, WA 138 125 160 138 153 4.4 3.9 4.9 4.2 4.6

St. Louis, MO-IL 71 50 65 112 121 2.6 1.8 2.3 4.0 4.3

Tampa-St. Petersburg-Clearwater, FL 89 85 110 195 191 3.4 3.2 4.1 7.2 7.0

Virginia Beach-Norfolk-Newport News, VA-NC 50 60 84 88 98 3.0 3.6 5.1 5.3 5.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 199 233 250 377 297 3.9 4.5 4.7 7.1 5.6

U.S. MSA TOTAL 6,368 7,149 7,845 9,116 10,132 4.0 4.5 4.9 5.6 6.2

* MSAs selected based on largest population in 2000 U.S. Census.
STD Surveillance 2008 Syphilis Tables 117

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

metropolitan statistical areas* (MSAs) listed in alphabetical order: 

United States, 2004–2008

Metropolitan Statistical Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Atlanta-Sandy Springs-Marietta, GA 36 36 33 40 51 1.5 1.5 1.3 1.5 1.9

Austin-Round Rock, TX 3 3 11 12 16 0.4 0.4 1.5 1.5 2.1

Baltimore-Towson, MD 70 84 53 40 70 5.1 6.1 3.8 2.9 5.1

Birmingham-Hoover, AL 11 35 94 80 77 2.0 6.2 16.5 13.9 13.4

Boston-Cambridge-Quincy, MA-NH 5 1 7 10 4 0.2 0.0 0.3 0.4 0.2

Buffalo-Cheektowaga-Tonawanda, NY 1 0 2 0 0 0.2 0.0 0.3 0.0 0.0

Charlotte-Gastonia-Concord, NC-SC 12 20 28 20 9 1.6 2.6 3.5 2.4 1.1

Chicago-Naperville-Joliet, IL-IN-WI 55 50 43 31 40 1.1 1.0 0.9 0.6 0.8

Cincinnati-Middletown, OH-KY-IN 2 0 5 6 14 0.2 0.0 0.5 0.5 1.3

Cleveland-Elyria-Mentor, OH 3 1 2 5 13 0.3 0.1 0.2 0.5 1.2

Columbus, OH 31 22 30 11 19 3.6 2.5 3.4 1.2 2.1

Dallas-Fort Worth-Arlington, TX 73 100 112 93 116 2.6 3.4 3.7 3.0 3.8

Denver-Aurora, CO 6 1 3 1 1 0.5 0.1 0.3 0.1 0.1

Detroit-Warren-Livonia, MI 49 17 20 22 27 2.1 0.7 0.9 1.0 1.2

Hartford-WestHartford-East Hartford, CT 0 0 1 1 0 0.0 0.0 0.2 0.2 0.0

Houston-Baytown-Sugar Land, TX 39 61 65 108 114 1.5 2.3 2.3 3.8 4.1

Indianapolis, IN 2 4 1 3 8 0.2 0.5 0.1 0.3 0.9

Jacksonville, FL 32 20 11 11 16 5.1 3.1 1.7 1.7 2.4

Kansas City, MO-KS 5 5 17 25 20 0.5 0.5 1.7 2.5 2.0

Las Vegas-Paradise, NV 8 21 32 11 11 1.0 2.5 3.7 1.2 1.2

Los Angeles-Long Beach-Santa Ana, CA 40 63 72 58 31 0.6 1.0 1.1 0.9 0.5

Louisville, KY-IN 6 3 3 2 3 1.0 0.5 0.5 0.3 0.5

Memphis, TN-MS-AR 33 50 52 87 71 5.1 7.7 7.9 13.1 10.7

Miami-Fort Lauderdale-Miami Beach, FL 41 43 40 60 74 1.5 1.5 1.4 2.2 2.7

Milwaukee-Waukesha-West Allis, WI 1 1 2 5 11 0.1 0.1 0.3 0.6 1.4

Minneapolis-St. Paul-Bloomington, MN-WI 3 3 3 1 5 0.2 0.2 0.2 0.1 0.3

Nashville-Davidson-Murfreesboro, TN 2 2 2 13 14 0.3 0.3 0.3 1.7 1.8

New Orleans-Metairie-Kenner, LA 27 23 25 51 53 3.9 3.4 4.7 9.5 9.9

New York-Newark-Edison, NY-NJ-PA 58 37 31 42 60 0.6 0.4 0.3 0.4 0.6

Oklahoma City, OK 7 9 6 13 16 1.2 1.5 1.0 2.2 2.6

Orlando, FL 10 14 14 13 21 1.1 1.4 1.4 1.3 2.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 16 13 6 14 17 0.5 0.4 0.2 0.5 0.6

Phoenix-Mesa-Scottsdale, AZ 25 23 18 29 24 1.4 1.2 0.9 1.4 1.2

Pittsburgh, PA 7 25 28 25 6 0.6 2.0 2.3 2.0 0.5

Portland-Vancouver-Beaverton, OR-WA 0 0 0 1 0 0.0 0.0 0.0 0.1 0.0

Providence-New Bedford-Fall River, RI-MA 10 7 0 2 0 1.2 0.8 0.0 0.2 0.0

Richmond, VA 1 1 1 3 6 0.2 0.2 0.2 0.5 1.0

Riverside-San Bernardino-Ontario, CA 1 12 10 4 5 0.1 0.6 0.5 0.2 0.2

Rochester, NY 0 1 0 1 0 0.0 0.2 0.0 0.2 0.0

Sacramento-Arden-Arcade-Roseville, CA 0 0 3 2 18 0.0 0.0 0.3 0.2 1.7

Salt Lake City, UT 1 1 1 0 1 0.2 0.2 0.2 0.0 0.2

San Antonio, TX 20 34 32 35 58 2.1 3.5 3.2 3.4 5.7

San Diego-Carlsbad-San Marcos, CA 10 25 12 12 12 0.7 1.7 0.8 0.8 0.8

San Francisco-Oakland-Fremont, CA 2 8 7 12 12 0.1 0.4 0.3 0.6 0.6

San Jose-Sunnyvale-Santa Clara, CA 4 2 7 4 3 0.5 0.2 0.8 0.5 0.3

Seattle-Tacoma-Bellevue, WA 6 4 2 4 2 0.4 0.2 0.1 0.2 0.1

St. Louis, MO-IL 9 5 3 9 16 0.6 0.3 0.2 0.6 1.1

Tampa-St. Petersburg-Clearwater, FL 3 8 15 52 54 0.2 0.6 1.1 3.7 3.9

Virginia Beach-Norfolk-Newport News, VA-NC 4 15 18 10 12 0.5 1.8 2.1 1.2 1.4

Washington-Arlington-Alexandria, DC-VA-MD-WV 16 13 11 12 15 0.6 0.5 0.4 0.4 0.6

U.S. MSA TOTAL 806 926 994 1,106 1,246 1.0 1.1 1.2 1.3 1.5

* MSAs selected based on largest population in 2000 U.S. Census.
118 Syphilis Tables STD Surveillance 2008

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

statistical areas* (MSAs) listed in alphabetical order: United States, 2004–2008

Metropolitan Statistical Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Atlanta-Sandy Springs-Marietta, GA 472 562 496 567 714 20.2 23.0 19.5 21.7 27.4

Austin-Round Rock, TX 53 41 73 62 91 7.4 5.5 9.4 7.6 11.1

Baltimore-Towson, MD 206 160 160 171 200 16.2 12.5 12.5 13.3 15.6

Birmingham-Hoover, AL 22 66 150 109 111 4.2 12.5 28.3 20.4 20.8

Boston-Cambridge-Quincy, MA-NH 79 105 110 121 169 3.7 4.9 5.1 5.6 7.8

Buffalo-Cheektowaga-Tonawanda, NY 8 7 16 11 3 1.4 1.3 2.9 2.0 0.6

Charlotte-Gastonia-Concord, NC-SC 34 83 93 83 49 4.7 11.1 11.9 10.3 6.1

Chicago-Naperville-Joliet, IL-IN-WI 318 460 373 396 495 6.9 9.9 8.0 8.4 10.6

Cincinnati-Middletown, OH-KY-IN 20 24 8 28 48 2.0 2.4 0.8 2.7 4.6

Cleveland-Elyria-Mentor, OH 37 21 16 24 51 3.6 2.1 1.6 2.4 5.1

Columbus, OH 78 87 77 65 116 9.3 10.3 9.0 7.5 13.4

Dallas-Fort Worth-Arlington, TX 206 205 208 172 212 7.2 7.0 6.9 5.6 6.9

Denver-Aurora, CO 49 37 53 45 102 4.2 3.1 4.4 3.6 8.2

Detroit-Warren-Livonia, MI 104 60 62 69 73 4.8 2.7 2.8 3.2 3.3

Hartford-WestHartford-East Hartford, CT 13 14 22 14 8 2.3 2.4 3.8 2.4 1.4

Houston-Baytown-Sugar Land, TX 196 218 331 393 342 7.6 8.3 11.9 13.9 12.1

Indianapolis, IN 32 31 46 23 72 4.0 3.8 5.6 2.8 8.6

Jacksonville, FL 40 30 30 33 51 6.7 4.9 4.8 5.2 8.0

Kansas City, MO-KS 30 84 95 124 82 3.2 8.8 9.8 12.7 8.4

Las Vegas-Paradise, NV 30 82 100 91 61 3.6 9.4 11.1 9.7 6.5

Los Angeles-Long Beach-Santa Ana, CA 511 743 873 1,002 889 8.0 11.6 13.6 15.7 13.9

Louisville, KY-IN 32 43 38 30 33 5.5 7.3 6.4 5.0 5.5

Memphis, TN-MS-AR 66 88 93 121 163 10.9 14.4 15.1 19.6 26.4

Miami-Fort Lauderdale-Miami Beach, FL 393 352 329 354 435 15.1 13.4 12.4 13.5 16.5

Milwaukee-Waukesha-West Allis, WI 18 21 36 48 34 2.4 2.9 4.9 6.4 4.5

Minneapolis-St. Paul-Bloomington, MN-WI 23 65 40 56 100 1.5 4.2 2.5 3.5 6.3

Nashville-Davidson-Murfreesboro, TN 15 32 38 71 71 2.2 4.6 5.3 9.5 9.5

New Orleans-Metairie-Kenner, LA 74 65 65 117 117 11.7 10.3 13.2 23.7 23.7

New York-Newark-Edison, NY-NJ-PA 758 736 780 1,166 1,293 8.4 8.1 8.6 12.8 14.2

Oklahoma City, OK 13 14 18 23 45 2.3 2.5 3.1 3.9 7.6

Orlando, FL 59 92 80 132 105 6.4 9.6 8.1 13.1 10.4

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 79 114 167 191 197 2.8 4.1 5.9 6.8 7.0

Phoenix-Mesa-Scottsdale, AZ 81 89 136 162 187 4.3 4.6 6.7 7.7 8.9

Pittsburgh, PA 15 44 63 35 32 1.3 3.8 5.5 3.1 2.8

Portland-Vancouver-Beaverton, OR-WA 26 39 25 10 21 2.5 3.7 2.3 0.9 1.9

Providence-New Bedford-Fall River, RI-MA 20 21 18 42 25 2.5 2.7 2.3 5.4 3.2

Richmond, VA 10 12 27 35 86 1.8 2.1 4.6 5.9 14.6

Riverside-San Bernardino-Ontario, CA 102 108 98 90 150 5.4 5.5 4.9 4.4 7.3

Rochester, NY 12 5 14 15 9 2.4 1.0 2.8 3.0 1.8

Sacramento-Arden-Arcade-Roseville, CA 19 16 29 57 84 1.9 1.6 2.9 5.5 8.2

Salt Lake City, UT 4 8 14 19 22 0.8 1.5 2.6 3.4 3.9

San Antonio, TX 96 95 104 122 137 10.6 10.3 10.9 12.5 14.0

San Diego-Carlsbad-San Marcos, CA 128 169 223 335 333 8.7 11.4 15.1 22.4 22.3

San Francisco-Oakland-Fremont, CA 419 323 355 296 466 20.4 15.7 17.1 14.2 22.3

San Jose-Sunnyvale-Santa Clara, CA 52 42 45 52 39 5.9 4.7 4.9 5.6 4.2

Seattle-Tacoma-Bellevue, WA 132 121 158 134 151 8.3 7.6 9.7 8.1 9.1

St. Louis, MO-IL 62 45 62 103 105 4.6 3.3 4.6 7.6 7.7

Tampa-St. Petersburg-Clearwater, FL 86 77 95 143 137 6.9 6.0 7.2 10.8 10.3

Virginia Beach-Norfolk-Newport News, VA-NC 46 45 66 78 86 5.7 5.5 8.2 9.6 10.6

Washington-Arlington-Alexandria, DC-VA-MD-WV 183 220 239 365 282 7.3 8.6 9.3 14.1 10.9

U.S. MSA TOTAL 5,561 6,221 6,847 8,005 8,884 7.2 7.9 8.6 10.0 11.1

* MSAs selected based on largest population in 2000 U.S. Census.
STD Surveillance 2008 Syphilis Tables 119

Table 31. Primary and secondary syphilis—Counties and independent cities* ranked by number of 

reported cases: United States, 2008

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percent

1 Los Angeles County, CA 822 8.3 6

2 New York County, NY 491 30.3 9

3 Cook County, IL 488 9.2 13

4 Fulton County, GA 386 38.9 16

5 Harris County, TX 380 9.7 19

6 San Diego County, CA 345 11.6 21

7 San Francisco County, CA 344 45.0 24

8 Kings County, NY 275 10.9 26

9 Miami-Dade County, FL 254 10.6 28

10 Broward County, FL 215 12.2 29

11 Dallas County, TX 213 9.0 31

12 Maricopa County, AZ 207 5.3 32

13 Baltimore (City), MD 198 31.1 34

14 Shelby County, TN 198 21.8 35

15 Bexar County, TX 184 11.5 37

16 Jefferson County, AL 183 27.8 38

17 DeKalb County, GA 182 24.7 39

18 Bronx County, NY 174 12.7 41

19 Philadelphia County, PA 150 10.3 42

20 Washington, D.C. 146 24.8 43

21 Jefferson County, TX 141 58.3 44

22 Caddo County, LA 130 51.5 45

23 Franklin County, OH 129 11.5 46

24 King County, WA 128 6.9 47

25 Queens County, NY 122 5.4 48

26 Riverside County, CA 118 5.7 48

27 Hillsborough County, FL 117 10.0 49

28 Tarrant County, TX 103 6.0 50

29 Suffolk County, MA 101 14.2 51

30 Orange County, CA 98 3.3 52

31 Madison County, AL 96 30.7 52

32 Orange County, FL 94 8.8 53

33 Sacramento County, CA 94 6.8 54

34 Orleans County, LA 93 38.9 54

35 Travis County, TX 91 9.3 55

36 Genesee County, MI 86 19.8 56

37 Wayne County, MI 86 4.3 56

38 Alameda County, CA 81 5.5 57

39 Hennepin County, MN 79 7.0 57

40 Davidson County, TN 76 12.3 58

41 Cobb County, GA 76 11.0 59

42 Prince George's County, MD 75 9.0 59

43 Pima County, AZ 74 7.7 60

44 Marion County, IN 73 8.3 60

45 Clark County, NV 72 3.9 61

46 Pinellas County, FL 66 7.2 61

47 Knox County, TN 63 14.9 62

48 Jackson County, MO 62 9.3 62

49 St Louis (City), MO 60 17.1 63

50 Denver County, CO 60 10.2 63

51 Hudson County, NJ 60 10.0 63

52 Duval County, FL 60 7.1 64

53 Lafayette County, LA 59 28.8 64

54 Pulaski County, AR 58 15.5 65

55 East Baton Rouge County, LA 57 13.2 65

56 Oklahoma County, OK 57 8.1 66

57 Cuyahoga County, OH 57 4.4 66

58 Essex County, NJ 56 7.2 66

59 Jefferson County, LA 49 11.6 67

60 Hamilton County, OH 49 5.8 67

61 Gwinnett County, GA 48 6.2 68

62 Mecklenburg County, NC 48 5.5 68

63 Milwaukee County, WI 45 4.7 68

64 Richmond (City), VA 44 22.0 69

65 Summit County, OH 42 7.7 69

66 Palm Beach County, FL 40 3.2 69

67 Santa Clara County, CA 40 2.3 69

68 San Bernardino County, CA 39 1.9 70

69 Middlesex County, MA 37 2.5 70

70 Allegheny County, PA 36 3.0 70

* Accounting for 70% of reported primary and secondary syphilis cases.

† Counties and independent cities were ranked in descending order by number of cases reported in 2008.
120 Syphilis Tables STD Surveillance 2008

Table 32. Primary and secondary syphilis—Reported cases and rates* among men and women 

and male-to-female rate ratios in the counties and independent cities ranked in the 

top 30 for cases in 2008: United States, 2007–2008

Male Female Male-to-Female 

2007 2008 2007 2008 Rate Ratio

City† Case Rate Case Rate Case Rate Case Rate 2007 2008

Jefferson County, AL 95 30.4 107 34.3 71 20.5 76 21.9 1.5 1.6

Maricopa County, AZ 162 8.3 185 9.5 26 1.3 22 1.1 6.4 8.6

Los Angeles County, CA 866 17.7 793 16.2 52 1.0 29 0.6 17.7 27.0

Orange County, CA 136 9.1 96 6.4 6 0.4 2 0.1 22.8 64.0

Riverside County, CA 76 7.3 112 10.8 3 0.3 4 0.4 24.3 27.0

San Diego County, CA 335 22.4 333 22.3 12 0.8 12 0.8 28.0 27.9

San Francisco County, CA 199 51.1 338 86.8 3 0.8 6 1.6 63.9 54.3

Washington, D.C. 173 62.2 139 50.0 5 1.6 7 2.3 38.9 21.7

Broward County, FL 161 18.8 194 22.7 17 1.9 21 2.3 9.9 9.9

Hillsborough County, FL 72 12.4 80 13.8 43 7.2 37 6.2 1.7 2.2

Miami-Dade County, FL 173 14.9 207 17.9 37 3.0 47 3.8 5.0 4.7

DeKalb County, GA 135 37.6 166 46.3 6 1.6 16 4.2 23.5 11.0

Fulton County, GA 276 56.4 368 75.2 17 3.4 18 3.6 16.6 20.9

Cook County, IL 364 14.1 456 17.7 27 1.0 32 1.2 14.1 14.8

Caddo County, LA 24 20.0 71 59.2 9 6.8 59 44.5 2.9 1.3

Baltimore (City), MD 112 37.7 140 47.1 28 8.2 58 17.1 4.6 2.8

Suffolk County, MA 65 18.8 100 28.9 8 2.2 1 0.3 8.5 96.3

Bronx County, NY 109 17.0 163 25.3 7 1.0 11 1.5 17.0 16.9

Kings County, NY 244 20.4 259 21.7 11 0.8 16 1.2 25.5 18.1

New York County, NY 387 49.9 482 62.2 7 0.8 9 1.1 62.4 56.5

Queens County, NY 136 12.3 118 10.7 2 0.2 4 0.3 61.5 35.7

Franklin County, OH 58 10.6 111 20.2 10 1.8 18 3.2 5.9 6.3

Philadelphia County, PA 129 19.0 142 20.9 7 0.9 8 1.0 21.1 20.9

Shelby County, TN 112 25.8 138 31.7 79 16.6 60 12.6 1.6 2.5

Bexar County, TX 120 15.4 130 16.7 35 4.3 54 6.6 3.6 2.5

Dallas County, TX 95 7.9 136 11.3 57 4.9 77 6.6 1.6 1.7

Harris County, TX 359 18.2 291 14.7 95 4.8 89 4.5 3.8 3.3

Jefferson County, TX 32 26.1 74 60.4 7 5.9 67 56.1 4.4 1.1

Tarrant County, TX 59 6.9 66 7.7 28 3.3 37 4.3 2.1 1.8

King County, WA 111 11.9 127 13.7 1 0.1 1 0.1 119.0 137.0

* Cases per 100,000 population

† Counties and independent cities are listed alphabetically by state.
STD Surveillance 2008 Syphilis Tables 121

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

group and sex: United States, 2004–2008

Age

Group

Cases Rates

Total Male Female Total Male Female

10–14 9 2 7 0.0 0.0 0.1

2004

15–19 339 191 148 1.6 1.8 1.5

20–24 1,029 735 294 4.9 6.8 2.9

25–29 1,126 944 182 5.8 9.4 1.9

30–34 1,285 1,118 167 6.3 10.8 1.6

35–39 1,467 1,313 154 7.0 12.4 1.5

40–44 1,345 1,199 146 5.8 10.5 1.3

45–54 1,035 915 120 2.5 4.5 0.6

55–64 281 249 32 1.0 1.8 0.2

65+ 55 54 1 0.2 0.4 0.0

TOTAL 7,980 6,725 1,255 2.7 4.7 0.8

10–14 10 2 8 0.0 0.0 0.1

2005

15–19 443 251 192 2.1 2.3 1.9

20–24 1,181 875 306 5.6 8.1 3.0

25–29 1,214 1,008 206 6.0 9.8 2.1

30–34 1,329 1,178 150 6.6 11.6 1.5

35–39 1,574 1,394 179 7.5 13.2 1.7

40–44 1,418 1,253 164 6.2 11.0 1.4

45–54 1,192 1,080 111 2.8 5.2 0.5

55–64 304 284 20 1.0 1.9 0.1

65+ 59 57 2 0.2 0.4 0.0

TOTAL 8,724 7,385 1,339 2.9 5.1 0.9

10–14 13 2 11 0.1 0.0 0.1

2006

15–19 565 332 233 2.7 3.0 2.2

20–24 1,382 1,083 299 6.5 9.9 2.9

25–29 1,574 1,333 241 7.6 12.6 2.4

30–34 1,221 1,058 163 6.2 10.6 1.7

35–39 1,581 1,427 154 7.5 13.4 1.5

40–44 1,516 1,363 153 6.7 12.2 1.4

45–54 1,443 1,278 165 3.3 6.0 0.8

55–64 375 340 35 1.2 2.2 0.2

65+ 81 79 2 0.2 0.5 0.0

TOTAL 9,756 8,297 1,459 3.3 5.6 1.0

10–14 13 5 8 0.1 0.0 0.1

2007

15–19 664 416 248 3.1 3.8 2.4

20–24 1,818 1,462 356 8.6 13.5 3.5

25–29 1,841 1,576 265 8.7 14.6 2.6

30–34 1,500 1,306 193 7.7 13.2 2.0

35–39 1,721 1,530 191 8.1 14.4 1.8

40–44 1,745 1,553 192 7.9 14.2 1.7

45–54 1,664 1,464 200 3.8 6.8 0.9

55–64 409 379 30 1.3 2.4 0.2

65+ 91 82 9 0.2 0.5 0.0

TOTAL 11,466 9,773 1,693 3.8 6.6 1.1

10–14 27 8 19 0.1 0.1 0.2

2008

15–19 903 585 318 4.2 5.3 3.0

20–24 2,398 1,878 520 11.4 17.3 5.1

25–29 2,257 1,853 404 10.7 17.2 3.9

30–34 1,734 1,490 244 8.9 15.0 2.5

35–39 1,810 1,569 241 8.5 14.7 2.3

40–44 1,777 1,575 202 8.1 14.4 1.8

45–54 2,028 1,792 236 4.6 8.3 1.1

55–64 458 412 46 1.4 2.6 0.3

65+ 105 97 8 0.3 0.6 0.0

TOTAL 13,500 11,258 2,242 4.5 7.6 1.5

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.
122 Syphilis Tables STD Surveillance 2008

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

United States, 2004–2008

Age

Group

White, 

Non-Hispanic

African-American,

Non-Hispanic Hispanic

Asian/Pacific 

Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

2004

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

25–29 317 281 36 534 421 113 237 213 24 28 25 3 11 5 5

30–34 512 470 41 496 402 95 238 215 23 29 28 1 10 3 6

35–39 675 640 35 489 392 98 249 235 14 36 35 1 18 12 6

40–44 684 655 29 455 353 102 179 169 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 3,266 2,452 814 1,280 1,142 138 153 142 11 77 42 35

2005

10–14 0 0 0 9 1 8 1 1 0 0 0 0 0 0 0

15–19 67 36 30 304 173 131 62 36 26 5 4 1 5 1 4

20–24 281 230 51 660 459 201 216 167 49 15 11 4 8 7 1

25–29 331 299 32 612 480 132 236 198 38 27 25 2 8 6 2

30–34 491 456 35 554 455 99 230 216 14 43 42 1 12 10 2

35–39 761 712 49 518 415 103 268 244 24 19 19 0 8 4 4

40–44 741 700 40 446 350 97 193 172 21 26 24 2 12 7 4

45–54 660 631 29 385 320 65 126 111 14 15 14 1 6 4 2

55–64 167 162 5 102 90 13 30 28 2 4 4 0 0 0 0

65+ 26 26 0 23 21 2 8 8 0 2 2 0 0 0 0

TOTAL 3,524 3,254 270 3,615 2,764 850 1,370 1,182 188 156 145 11 60 40 20

2006

10–14 1 0 1 11 2 9 0 0 0 0 0 0 1 0 1

15–19 71 39 33 419 246 173 74 46 28 1 1 0 0 0 0

20–24 291 247 44 853 630 223 218 187 31 12 11 1 8 7 1

25–29 431 381 50 795 641 154 304 271 34 37 35 2 7 6 1

30–34 433 395 38 497 398 99 243 223 20 34 31 3 14 11 3

35–39 720 676 44 532 447 85 282 263 18 33 32 1 14 9 5

40–44 802 756 46 443 356 87 227 213 14 30 29 1 15 10 5

45–54 766 729 38 500 394 107 143 129 14 24 22 2 9 5 4

55–64 194 186 8 139 115 24 35 33 2 2 2 0 5 4 1

65+ 34 34 0 25 23 2 17 17 0 0 0 0 5 5 0

TOTAL 3,744 3,443 301 4,215 3,253 962 1,543 1,381 162 173 163 10 80 57 24

2007

10–14 0 0 0 13 5 8 0 0 0 0 0 0 0 0 0

15–19 95 49 46 470 299 171 91 66 26 0 0 0 7 2 5

20–24 338 271 67 1,124 883 240 328 289 40 15 12 2 13 6 7

25–29 486 431 54 954 784 170 352 319 33 35 34 1 15 7 7

30–34 506 455 51 612 504 108 325 298 27 38 35 3 19 15 4

35–39 699 650 49 683 559 125 293 280 12 31 31 0 15 10 5

40–44 841 783 58 605 486 119 265 254 11 27 26 1 6 4 2

45–54 824 773 51 620 489 132 187 171 16 24 24 0 10 7 2

55–64 213 210 3 154 130 24 41 38 3 2 2 0 0 0 0

65+ 47 45 2 38 31 7 5 5 0 1 1 0 0 0 0

TOTAL 4,049 3,668 381 5,274 4,170 1,104 1,887 1,720 167 171 164 7 85 52 33

2008

10–14 2 1 1 23 7 16 2 0 2 0 0 0 0 0 0

15–19 123 72 50 645 411 235 126 98 29 7 5 2 2 0 2

20–24 453 366 87 1,543 1,161 381 357 308 49 34 34 0 11 8 3

25–29 583 500 83 1,203 926 277 412 375 37 45 41 4 15 11 3

30–34 552 499 53 772 617 155 349 317 33 49 49 0 12 8 3

35–39 688 615 73 742 607 134 345 317 28 30 27 2 5 2 3

40–44 781 718 63 684 562 122 282 267 15 24 23 1 5 4 1

45–54 996 935 61 779 624 155 225 206 19 22 22 0 5 4 1

55–64 229 219 9 185 151 33 36 34 2 7 7 0 2 1 1

65+ 62 59 3 30 25 5 11 11 0 2 2 0 0 0 0

TOTAL 4,469 3,983 486 6,607 5,093 1,514 2,146 1,931 214 220 211 9 58 40 18

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 33 for age-specific cases and rates and Tables 25–27 for total and sexspecific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were 

specified. In 2007, Idaho did not report age and/or race/ethnicity for most cases and its 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 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 2008 Syphilis Tables 123

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

group and sex: United States, 2004–2008

Age

Group

White, 

Non-Hispanic

African-American,

Non-Hispanic Hispanic

Asian/Pacific 

Islander

American Indian/

Alaska Native

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

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

2004

15–19 0.4 0.5 0.4 6.7 7.1 6.3 1.6 1.9 1.3 1.2 1.9 0.5 2.7 2.7 2.8

20–24 1.9 2.8 0.9 19.1 25.0 13.2 5.0 7.5 1.9 1.9 3.1 0.6 3.9 3.9 3.9

25–29 2.7 4.7 0.6 20.5 33.5 8.4 6.1 9.8 1.4 2.4 4.4 0.5 6.1 6.1 6.0

30–34 4.0 7.4 0.7 18.9 32.2 6.8 6.4 10.8 1.4 2.3 4.4 0.2 5.7 3.9 7.5

35–39 4.9 9.2 0.5 18.4 31.2 6.9 7.6 13.5 0.9 3.1 6.2 0.2 10.6 14.1 7.1

40–44 4.3 8.2 0.4 16.1 26.7 6.8 6.2 11.3 0.7 1.7 3.6 0.0 5.1 4.7 5.4

45–54 1.7 3.3 0.1 8.0 13.4 3.3 2.7 4.8 0.6 0.6 1.3 0.0 3.0 5.6 0.6

55–64 0.7 1.3 0.1 3.6 6.6 1.2 0.9 1.9 0.0 0.2 0.2 0.2 2.0 1.1 2.9

65+ 0.1 0.3 0.0 0.5 1.4 0.0 0.1 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0

TOTAL 1.6 3.0 0.3 8.8 13.9 4.2 3.1 5.4 0.7 1.2 2.2 0.2 3.1 3.5 2.8

10–14 0.0 0.0 0.0 0.3 0.1 0.5 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0

2005

15–19 0.5 0.5 0.5 9.4 10.6 8.2 1.8 2.0 1.6 0.6 0.9 0.2 2.3 0.9 3.7

20–24 2.1 3.4 0.8 21.9 30.2 13.5 5.8 8.2 2.9 1.6 2.3 0.8 3.8 6.6 0.9

25–29 2.8 4.9 0.5 22.6 36.5 9.5 5.8 8.8 2.1 2.4 4.5 0.4 4.6 6.6 2.6

30–34 4.0 7.4 0.6 21.4 37.1 7.3 6.0 10.5 0.8 3.2 6.5 0.2 7.1 11.6 2.5

35–39 5.6 10.4 0.7 19.6 33.3 7.4 7.9 13.5 1.5 1.5 3.2 0.0 5.1 5.3 4.9

40–44 4.7 8.9 0.5 15.8 26.5 6.4 6.4 11.0 1.5 2.3 4.4 0.4 6.2 8.3 4.3

45–54 2.1 4.1 0.2 7.9 14.1 2.5 2.9 5.2 0.7 0.8 1.6 0.1 1.9 2.7 1.2

55–64 0.7 1.4 0.0 3.5 6.8 0.8 1.3 2.5 0.2 0.3 0.7 0.0 0.0 0.0 0.0

65+ 0.1 0.2 0.0 0.7 1.8 0.1 0.4 0.9 0.0 0.2 0.4 0.0 0.0 0.0 0.0

TOTAL 1.8 3.3 0.3 9.7 15.5 4.4 3.2 5.4 0.9 1.1 2.2 0.2 2.4 3.3 1.6

10–14 0.0 0.0 0.0 0.3 0.1 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.5 0.0 1.0

2006

15–19 0.5 0.6 0.5 12.6 14.7 10.6 2.0 2.5 1.6 0.1 0.2 0.0 0.0 0.0 0.0

20–24 2.2 3.7 0.7 28.1 41.0 14.8 5.8 9.2 1.8 1.3 2.3 0.2 3.7 6.3 1.1

25–29 3.5 6.1 0.8 28.3 46.9 10.7 7.3 11.7 1.8 3.1 6.0 0.3 3.9 6.7 1.1

30–34 3.7 6.7 0.6 19.6 33.1 7.4 6.2 10.4 1.1 2.5 4.7 0.4 8.4 13.0 3.7

35–39 5.3 9.9 0.7 20.1 35.8 6.1 8.0 14.0 1.1 2.6 5.2 0.2 8.3 10.5 6.1

40–44 5.3 9.9 0.6 15.9 27.3 5.8 7.3 13.0 1.0 2.6 5.1 0.2 8.1 10.8 5.5

45–54 2.4 4.7 0.2 10.0 17.0 4.0 3.2 5.6 0.6 1.2 2.4 0.2 2.8 3.3 2.3

55–64 0.8 1.6 0.1 4.5 8.3 1.4 1.4 2.7 0.2 0.2 0.4 0.0 2.4 4.0 0.9

65+ 0.1 0.3 0.0 0.8 1.9 0.1 0.7 1.6 0.0 0.0 0.0 0.0 2.7 6.3 0.0

TOTAL 1.9 3.5 0.3 11.2 18.1 4.9 3.5 6.0 0.8 1.2 2.4 0.1 3.2 4.7 1.9

10–14 0.0 0.0 0.0 0.4 0.3 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

2007

15–19 0.7 0.7 0.7 13.9 17.5 10.3 2.4 3.4 1.4 0.0 0.0 0.0 3.1 1.8 4.5

20–24 2.6 4.1 1.1 36.8 57.2 15.9 8.9 14.6 2.3 1.5 2.6 0.4 6.0 5.5 6.5

25–29 3.9 6.8 0.9 33.1 55.5 11.5 8.5 13.8 1.8 3.0 5.9 0.2 7.6 7.6 7.6

30–34 4.4 7.9 0.9 24.3 42.1 8.2 8.2 13.7 1.5 2.9 5.4 0.5 11.6 18.1 5.1

35–39 5.3 9.7 0.7 25.7 44.6 8.9 8.1 14.4 0.7 2.3 4.8 0.0 8.9 11.7 6.2

40–44 5.8 10.7 0.8 22.0 37.8 8.2 8.3 15.1 0.7 2.3 4.5 0.2 3.6 5.0 2.3

45–54 2.6 4.9 0.3 12.1 20.7 4.8 3.9 7.1 0.7 1.2 2.5 0.0 2.8 4.6 1.2

55–64 0.9 1.7 0.0 4.7 8.9 1.3 1.5 2.9 0.2 0.2 0.3 0.0 0.0 0.0 0.0

65+ 0.2 0.3 0.0 1.2 2.5 0.4 0.2 0.5 0.0 0.1 0.2 0.0 0.0 0.0 0.0

TOTAL 2.0 3.7 0.4 13.8 22.9 5.5 4.2 7.3 0.8 1.2 2.4 0.1 3.4 4.2 2.6

10–14 0.0 0.0 0.0 0.7 0.4 1.0 0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0

2008

15–19 0.9 1.1 0.8 19.1 24.0 14.1 3.4 5.1 1.6 0.8 1.1 0.5 0.9 0.0 1.9

20–24 3.5 5.4 1.4 50.5 75.1 25.3 9.7 15.6 2.8 3.6 7.0 0.0 5.2 7.3 2.9

25–29 4.6 7.8 1.3 41.7 65.6 18.8 9.9 16.1 2.0 3.9 7.1 0.7 7.6 11.7 3.4

30–34 4.8 8.6 0.9 30.7 51.6 11.7 8.7 14.5 1.8 3.7 7.5 0.0 7.1 10.3 4.0

35–39 5.1 9.1 1.1 27.9 48.5 9.6 9.5 16.3 1.6 2.2 4.2 0.3 3.2 2.5 3.9

40–44 5.3 9.8 0.9 24.9 43.8 8.3 8.8 15.9 1.0 2.1 4.1 0.2 3.0 4.9 1.2

45–54 3.1 5.9 0.4 15.2 26.4 5.6 4.7 8.6 0.8 1.1 2.3 0.0 1.5 2.6 0.6

55–64 0.9 1.8 0.1 5.7 10.4 1.8 1.3 2.6 0.1 0.5 1.2 0.0 0.9 0.9 0.9

65+ 0.2 0.5 0.0 0.9 2.0 0.3 0.4 1.0 0.0 0.2 0.4 0.0 0.0 0.0 0.0

TOTAL 2.2 4.0 0.5 17.3 28.0 7.6 4.7 8.2 1.0 1.5 3.0 0.1 2.3 3.2 1.4

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 33 for age-specific cases and rates and Tables 25–27 for total and sexspecific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were 

specified. In 2007, Idaho did not report age and/or race/ethnicity for most cases and its 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 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.
124 Syphilis Tables STD Surveillance 2008

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

alphabetical order: United States and outlying areas, 2004–2008

State/Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Alabama 231 184 341 363 440 5.1 4.0 7.4 7.8 9.5

Alaska 1 8 6 3 2 0.2 1.2 0.9 0.4 0.3

Arizona 219 134 186 269 258 3.8 2.3 3.0 4.2 4.1

Arkansas 56 48 67 115 144 2.0 1.7 2.4 4.1 5.1

California 873 1,153 1,369 1,421 1,648 2.4 3.2 3.8 3.9 4.5

Colorado 24 27 38 35 91 0.5 0.6 0.8 0.7 1.9

Connecticut 16 19 27 20 28 0.5 0.5 0.8 0.6 0.8

Delaware 25 9 16 14 23 3.0 1.1 1.9 1.6 2.7

District of Columbia 113 103 77 84 77 20.4 18.7 13.2 14.3 13.1

Florida 856 726 760 1,155 1,252 4.9 4.1 4.2 6.3 6.9

Georgia 333 380 366 423 563 3.8 4.2 3.9 4.4 5.9

Hawaii 3 4 2 11 9 0.2 0.3 0.2 0.9 0.7

Idaho 26 13 3 3 6 1.9 0.9 0.2 0.2 0.4

Illinois 322 397 267 224 271 2.5 3.1 2.1 1.7 2.1

Indiana 45 42 46 39 83 0.7 0.7 0.7 0.6 1.3

Iowa 12 6 6 6 11 0.4 0.2 0.2 0.2 0.4

Kansas 12 18 18 25 54 0.4 0.7 0.7 0.9 1.9

Kentucky 24 23 36 34 47 0.6 0.6 0.9 0.8 1.1

Louisiana 316 252 481 722 809 7.0 5.6 11.2 16.8 18.8

Maine 0 2 7 5 10 0.0 0.2 0.5 0.4 0.8

Maryland 213 289 193 320 313 3.8 5.2 3.4 5.7 5.6

Massachusetts 96 105 82 116 149 1.5 1.6 1.3 1.8 2.3

Michigan 121 69 43 73 99 1.2 0.7 0.4 0.7 1.0

Minnesota 21 46 58 55 47 0.4 0.9 1.1 1.1 0.9

Mississippi 130 162 197 269 232 4.5 5.5 6.8 9.2 7.9

Missouri 58 108 93 120 145 1.0 1.9 1.6 2.0 2.5

Montana 0 0 0 0 1 0.0 0.0 0.0 0.0 0.1

Nebraska 0 2 1 3 0 0.0 0.1 0.1 0.2 0.0

Nevada 24 64 119 174 168 1.0 2.7 4.8 6.8 6.5

New Hampshire 0 0 2 13 4 0.0 0.0 0.2 1.0 0.3

New Jersey 344 289 314 343 415 4.0 3.3 3.6 3.9 4.8

New Mexico 69 53 85 66 45 3.6 2.7 4.3 3.4 2.3

New York 744 1,084 993 1,149 1,372 3.9 5.6 5.1 6.0 7.1

North Carolina 261 215 294 247 221 3.1 2.5 3.3 2.7 2.4

North Dakota 0 0 0 0 2 0.0 0.0 0.0 0.0 0.3

Ohio 184 136 115 135 224 1.6 1.2 1.0 1.2 2.0

Oklahoma 62 64 121 115 117 1.8 1.8 3.4 3.2 3.2

Oregon 29 16 19 6 18 0.8 0.4 0.5 0.2 0.5

Pennsylvania 183 204 286 309 309 1.5 1.6 2.3 2.5 2.5

Rhode Island 15 5 6 10 7 1.4 0.5 0.6 0.9 0.7

South Carolina 204 222 174 143 192 4.9 5.2 4.0 3.2 4.4

South Dakota 0 0 6 4 3 0.0 0.0 0.8 0.5 0.4

Tennessee 206 203 233 304 312 3.5 3.4 3.9 4.9 5.1

Texas 1,069 1,013 1,312 1,467 1,733 4.8 4.4 5.6 6.1 7.2

Utah 5 7 7 2 10 0.2 0.3 0.3 0.1 0.4

Vermont 0 0 2 1 6 0.0 0.0 0.3 0.2 1.0

Virginia 108 148 165 177 238 1.4 2.0 2.2 2.3 3.1

Washington 51 63 81 76 98 0.8 1.0 1.3 1.2 1.5

West Virginia 9 3 6 9 16 0.5 0.2 0.3 0.5 0.9

Wisconsin 55 58 60 91 78 1.0 1.0 1.1 1.6 1.4

Wyoming 0 0 0 0 1 0.0 0.0 0.0 0.0 0.2

U.S. TOTAL 7,768 8,176 9,186 10,768 12,401 2.6 2.8 3.1 3.6 4.1

Northeast 1,398 1,708 1,719 1,966 2,300 2.6 3.1 3.1 3.6 4.2

Midwest 830 882 713 775 1,017 1.3 1.3 1.1 1.2 1.5

South 4,216 4,044 4,839 5,961 6,729 4.0 3.8 4.4 5.4 6.1

West 1,324 1,542 1,915 2,066 2,355 2.0 2.3 2.8 2.9 3.4

Guam 0 0 3 3 2 0.0 0.0 1.8 1.7 1.2

Puerto Rico 353 432 368 408 241 9.1 11.0 9.4 10.3 6.1

Virgin Islands 8 7 0 1 0 7.4 6.4 0.0 0.9 0.0

OUTLYING AREAS 361 439 371 412 243 8.7 10.5 8.8 9.7 5.8

TOTAL 8,129 8,615 9,557 11,180 12,644 2.7 2.9 3.1 3.7 4.1
STD Surveillance 2008 Syphilis Tables 125

Table 36. Early latent syphilis—Reported cases and rates in selected metropolitan statistical 

areas* (MSAs) listed in alphabetical order: United States, 2004–2008

Metropolitan Statistical Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Atlanta-Sandy Springs-Marietta, GA 281 314 293 363 402 6.0 6.4 5.7 6.9 7.6

Austin-Round Rock, TX 59 59 51 66 109 4.2 4.1 3.4 4.1 6.8

Baltimore-Towson, MD 167 211 136 185 214 6.3 7.9 5.1 6.9 8.0

Birmingham-Hoover, AL 42 82 220 196 199 3.9 7.5 20.0 17.7 18.0

Boston-Cambridge-Quincy, MA-NH 70 84 65 95 124 1.6 1.9 1.5 2.1 2.8

Buffalo-Cheektowaga-Tonawanda, NY 4 3 14 6 10 0.3 0.3 1.2 0.5 0.9

Charlotte-Gastonia-Concord, NC-SC 58 71 98 63 62 3.9 4.7 6.2 3.8 3.8

Chicago-Naperville-Joliet, IL-IN-WI 322 395 269 209 251 3.4 4.2 2.8 2.2 2.6

Cincinnati-Middletown, OH-KY-IN 8 13 7 12 23 0.4 0.6 0.3 0.6 1.1

Cleveland-Elyria-Mentor, OH 33 21 11 21 48 1.5 1.0 0.5 1.0 2.3

Columbus, OH 72 41 55 47 89 4.3 2.4 3.2 2.7 5.1

Dallas-Fort Worth-Arlington, TX 380 381 532 468 496 6.7 6.5 8.9 7.6 8.1

Denver-Aurora, CO 22 22 32 30 68 0.9 0.9 1.3 1.2 2.8

Detroit-Warren-Livonia, MI 103 59 34 47 45 2.3 1.3 0.8 1.1 1.0

Hartford-WestHartford-East Hartford, CT 5 7 10 8 10 0.4 0.6 0.8 0.7 0.8

Houston-Baytown-Sugar Land, TX 246 207 291 468 555 4.7 3.9 5.3 8.3 9.9

Indianapolis, IN 24 19 18 20 56 1.5 1.2 1.1 1.2 3.3

Jacksonville, FL 75 56 56 51 86 6.1 4.5 4.4 3.9 6.6

Kansas City, MO-KS 23 51 41 70 79 1.2 2.6 2.1 3.5 4.0

Las Vegas-Paradise, NV 19 57 112 170 166 1.2 3.3 6.3 9.3 9.0

Los Angeles-Long Beach-Santa Ana, CA 445 666 851 893 910 3.4 5.2 6.6 6.9 7.1

Louisville, KY-IN 16 16 18 12 20 1.3 1.3 1.5 1.0 1.6

Memphis, TN-MS-AR 170 171 174 222 199 13.6 13.6 13.7 17.3 15.5

Miami-Fort Lauderdale-Miami Beach, FL 477 302 304 440 563 8.9 5.6 5.6 8.1 10.4

Milwaukee-Waukesha-West Allis, WI 37 36 46 65 60 2.4 2.4 3.0 4.2 3.9

Minneapolis-St. Paul-Bloomington, MN-WI 19 43 52 54 43 0.6 1.4 1.6 1.7 1.3

Nashville-Davidson-Murfreesboro, TN 30 29 42 56 54 2.1 2.0 2.9 3.7 3.5

New Orleans-Metairie-Kenner, LA 85 68 127 222 239 6.4 5.2 12.4 21.5 23.2

New York-Newark-Edison, NY-NJ-PA 1,012 1,281 1,178 1,360 1,628 5.4 6.8 6.3 7.2 8.7

Oklahoma City, OK 47 36 74 65 72 4.1 3.1 6.3 5.4 6.0

Orlando, FL 90 124 91 160 148 4.8 6.4 4.6 7.9 7.3

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 220 171 280 310 305 3.8 2.9 4.8 5.3 5.2

Phoenix-Mesa-Scottsdale, AZ 165 97 166 165 160 4.4 2.5 4.1 3.9 3.8

Pittsburgh, PA 8 28 43 45 43 0.3 1.2 1.8 1.9 1.8

Portland-Vancouver-Beaverton, OR-WA 23 12 9 5 11 1.1 0.6 0.4 0.2 0.5

Providence-New Bedford-Fall River, RI-MA 25 10 9 12 13 1.5 0.6 0.6 0.7 0.8

Richmond, VA 18 24 29 45 81 1.6 2.0 2.4 3.7 6.7

Riverside-San Bernardino-Ontario, CA 40 64 64 49 89 1.1 1.6 1.6 1.2 2.2

Rochester, NY 4 13 8 5 5 0.4 1.3 0.8 0.5 0.5

Sacramento-Arden-Arcade-Roseville, CA 11 11 23 16 39 0.5 0.5 1.1 0.8 1.9

Salt Lake City, UT 5 3 5 2 10 0.5 0.3 0.5 0.2 0.9

San Antonio, TX 79 144 172 115 203 4.3 7.6 8.9 5.8 10.2

San Diego-Carlsbad-San Marcos, CA 84 117 123 156 179 2.9 4.0 4.2 5.2 6.0

San Francisco-Oakland-Fremont, CA 235 220 220 200 281 5.7 5.3 5.3 4.8 6.7

San Jose-Sunnyvale-Santa Clara, CA 13 18 18 25 25 0.7 1.0 1.0 1.4 1.4

Seattle-Tacoma-Bellevue, WA 42 60 74 70 91 1.3 1.9 2.3 2.1 2.7

St. Louis, MO-IL 31 34 30 57 70 1.1 1.2 1.1 2.0 2.5

Tampa-St. Petersburg-Clearwater, FL 103 101 177 294 275 4.0 3.8 6.6 10.8 10.1

Virginia Beach-Norfolk-Newport News, VA-NC 45 78 74 54 69 2.7 4.7 4.5 3.3 4.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 182 208 171 265 224 3.5 4.0 3.2 5.0 4.2

U.S. MSA TOTAL 5,774 6,338 6,997 8,034 9,201 3.7 4.0 4.3 4.9 5.7

* MSAs selected based on largest population in 2000 U.S. Census.
126 Syphilis Tables STD Surveillance 2008

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, 2004–2008

State/Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Alabama 232 193 262 254 286 5.1 4.2 5.7 5.5 6.2

Alaska 6 5 8 6 6 0.9 0.8 1.2 0.9 0.9

Arizona 572 455 521 650 789 10.0 7.7 8.4 10.3 12.4

Arkansas 142 124 92 122 149 5.2 4.5 3.3 4.3 5.3

California 2,293 2,527 2,773 2,777 2,995 6.4 7.0 7.6 7.6 8.2

Colorado 90 70 73 63 133 2.0 1.5 1.5 1.3 2.7

Connecticut 108 88 106 87 109 3.1 2.5 3.0 2.5 3.1

Delaware 26 15 38 31 20 3.1 1.8 4.5 3.6 2.3

District of Columbia 174 148 120 153 147 31.4 26.9 20.6 26.0 25.0

Florida 1,364 1,422 1,445 1,830 2,272 7.8 8.0 8.0 10.0 12.4

Georgia 701 898 977 1,142 1,345 7.9 9.9 10.4 12.0 14.1

Hawaii 25 42 46 38 30 2.0 3.3 3.6 3.0 2.3

Idaho 25 21 6 10 13 1.8 1.5 0.4 0.7 0.9

Illinois 614 663 760 522 720 4.8 5.2 5.9 4.1 5.6

Indiana 164 182 111 121 128 2.6 2.9 1.8 1.9 2.0

Iowa 19 13 43 37 48 0.6 0.4 1.4 1.2 1.6

Kansas 49 51 41 44 41 1.8 1.9 1.5 1.6 1.5

Kentucky 79 54 78 63 77 1.9 1.3 1.9 1.5 1.8

Louisiana 979 696 551 516 485 21.7 15.4 12.9 12.0 11.3

Maine 5 3 6 7 7 0.4 0.2 0.5 0.5 0.5

Maryland 399 387 526 482 374 7.2 6.9 9.4 8.6 6.7

Massachusetts 307 168 172 128 114 4.8 2.6 2.7 2.0 1.8

Michigan 470 297 210 262 227 4.6 2.9 2.1 2.6 2.3

Minnesota 96 89 83 72 102 1.9 1.7 1.6 1.4 2.0

Mississippi 212 160 237 305 320 7.3 5.5 8.1 10.4 11.0

Missouri 114 114 166 124 171 2.0 2.0 2.8 2.1 2.9

Montana 0 0 1 0 2 0.0 0.0 0.1 0.0 0.2

Nebraska 8 12 26 23 21 0.5 0.7 1.5 1.3 1.2

Nevada 189 169 117 104 71 8.1 7.0 4.7 4.1 2.8

New Hampshire 21 17 20 9 17 1.6 1.3 1.5 0.7 1.3

New Jersey 319 375 297 345 364 3.7 4.3 3.4 4.0 4.2

New Mexico 97 68 66 62 96 5.1 3.5 3.4 3.1 4.9

New York 2,979 2,054 2,833 2,766 2,903 15.5 10.7 14.7 14.3 15.0

North Carolina 285 213 352 516 480 3.3 2.5 4.0 5.7 5.3

North Dakota 0 0 2 1 2 0.0 0.0 0.3 0.2 0.3

Ohio 148 153 192 219 185 1.3 1.3 1.7 1.9 1.6

Oklahoma 79 50 58 33 51 2.2 1.4 1.6 0.9 1.4

Oregon 50 52 51 33 53 1.4 1.4 1.4 0.9 1.4

Pennsylvania 273 308 335 264 313 2.2 2.5 2.7 2.1 2.5

Rhode Island 62 35 51 30 30 5.7 3.3 4.8 2.8 2.8

South Carolina 194 239 155 176 120 4.6 5.6 3.6 4.0 2.7

South Dakota 0 2 10 1 2 0.0 0.3 1.3 0.1 0.3

Tennessee 459 493 527 537 548 7.8 8.3 8.7 8.7 8.9

Texas 2,244 2,336 2,501 2,780 3,071 10.0 10.2 10.6 11.6 12.8

Utah 59 33 38 23 5 2.5 1.3 1.5 0.9 0.2

Vermont 2 0 2 0 1 0.3 0.0 0.3 0.0 0.2

Virginia 380 361 343 328 281 5.1 4.8 4.5 4.3 3.6

Washington 135 144 160 135 159 2.2 2.3 2.5 2.1 2.5

West Virginia 6 12 13 11 14 0.3 0.7 0.7 0.6 0.8

Wisconsin 43 37 42 12 43 0.8 0.7 0.8 0.2 0.8

Wyoming 3 1 1 2 5 0.6 0.2 0.2 0.4 1.0

U.S. TOTAL 17,300 16,049 17,644 18,256 19,945 5.9 5.4 5.9 6.1 6.6

Northeast 4,076 3,048 3,822 3,636 3,858 7.5 5.6 7.0 6.6 7.1

Midwest 1,725 1,613 1,686 1,438 1,690 2.6 2.4 2.5 2.2 2.5

South 7,955 7,801 8,275 9,279 10,040 7.5 7.3 7.6 8.4 9.1

West 3,544 3,587 3,861 3,903 4,357 5.3 5.3 5.6 5.6 6.2

Guam 13 16 7 24 37 7.8 9.5 4.1 13.8 21.3

Puerto Rico 608 554 535 682 381 15.6 14.2 13.6 17.3 9.7

Virgin Islands 4 5 4 4 1 3.7 4.6 3.7 3.6 0.9

OUTLYING AREAS 625 575 546 710 419 15.0 13.7 13.0 16.8 9.9

TOTAL 17,925 16,624 18,190 18,966 20,364 6.0 5.5 6.0 6.2 6.7

* Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other 

than neurosyphilis.
STD Surveillance 2008 Syphilis Tables 127

Table 38. Late and late latent syphilis*—Reported cases and rates in selected metropolitan 

statistical areas† (MSAs) listed in alphabetical order: United States, 2004–2008

Metropolitan Statistical Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Atlanta-Sandy Springs-Marietta, GA 522 714 814 929 1,068 11.1 14.5 15.8 17.6 20.2

Austin-Round Rock, TX 85 89 74 94 127 6.0 6.1 4.9 5.9 7.9

Baltimore-Towson, MD 195 209 283 236 186 7.4 7.9 10.6 8.8 7.0

Birmingham-Hoover, AL 40 57 94 93 110 3.7 5.2 8.5 8.4 9.9

Boston-Cambridge-Quincy, MA-NH 256 149 147 98 86 5.8 3.4 3.3 2.2 1.9

Buffalo-Cheektowaga-Tonawanda, NY 11 4 7 9 7 1.0 0.3 0.6 0.8 0.6

Charlotte-Gastonia-Concord, NC-SC 45 61 83 133 100 3.1 4.0 5.2 8.1 6.1

Chicago-Naperville-Joliet, IL-IN-WI 576 611 687 469 650 6.1 6.5 7.2 4.9 6.8

Cincinnati-Middletown, OH-KY-IN 24 18 37 31 20 1.2 0.9 1.8 1.5 0.9

Cleveland-Elyria-Mentor, OH 11 9 24 33 15 0.5 0.4 1.1 1.6 0.7

Columbus, OH 72 76 67 99 84 4.3 4.4 3.9 5.6 4.8

Dallas-Fort Worth-Arlington, TX 701 792 809 881 934 12.3 13.6 13.5 14.3 15.2

Denver-Aurora, CO 56 51 51 43 98 2.4 2.2 2.1 1.7 4.0

Detroit-Warren-Livonia, MI 400 238 155 187 154 8.9 5.3 3.5 4.2 3.4

Hartford-WestHartford-East Hartford, CT 28 35 32 27 51 2.4 2.9 2.7 2.3 4.3

Houston-Baytown-Sugar Land, TX 783 685 856 1,032 1,024 15.1 13.0 15.5 18.3 18.2

Indianapolis, IN 68 80 56 49 53 4.2 4.9 3.4 2.9 3.1

Jacksonville, FL 70 41 63 102 153 5.7 3.3 4.9 7.8 11.8

Kansas City, MO-KS 40 53 75 49 55 2.1 2.7 3.8 2.5 2.8

Las Vegas-Paradise, NV 167 139 95 85 52 10.1 8.1 5.3 4.6 2.8

Los Angeles-Long Beach-Santa Ana, CA 1,451 1,649 1,759 1,588 1,722 11.2 12.8 13.6 12.3 13.4

Louisville, KY-IN 60 40 42 33 34 5.0 3.3 3.4 2.7 2.8

Memphis, TN-MS-AR 242 272 287 326 306 19.4 21.6 22.5 25.5 23.9

Miami-Fort Lauderdale-Miami Beach, FL 769 742 773 997 1,326 14.3 13.7 14.1 18.4 24.5

Milwaukee-Waukesha-West Allis, WI 28 18 16 9 32 1.8 1.2 1.1 0.6 2.1

Minneapolis-St. Paul-Bloomington, MN-WI 79 74 65 59 75 2.5 2.4 2.0 1.8 2.3

Nashville-Davidson-Murfreesboro, TN 145 126 112 100 138 10.4 8.9 7.7 6.6 9.1

New Orleans-Metairie-Kenner, LA 259 190 133 157 75 19.6 14.4 13.0 15.2 7.3

New York-Newark-Edison, NY-NJ-PA 3,058 2,241 2,905 2,913 3,089 16.3 12.0 15.4 15.5 16.4

Oklahoma City, OK 42 28 18 12 26 3.7 2.4 1.5 1.0 2.2

Orlando, FL 106 183 217 277 184 5.7 9.5 10.9 13.6 9.1

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 361 284 315 253 287 6.2 4.9 5.4 4.3 4.9

Phoenix-Mesa-Scottsdale, AZ 468 363 424 486 468 12.6 9.4 10.5 11.6 11.2

Pittsburgh, PA 2 15 18 17 17 0.1 0.6 0.8 0.7 0.7

Portland-Vancouver-Beaverton, OR-WA 35 43 40 34 32 1.7 2.1 1.9 1.6 1.5

Providence-New Bedford-Fall River, RI-MA 81 37 65 44 33 5.0 2.3 4.0 2.7 2.1

Richmond, VA 56 50 49 46 53 4.9 4.3 4.1 3.8 4.4

Riverside-San Bernardino-Ontario, CA 174 208 203 194 202 4.6 5.3 5.0 4.8 4.9

Rochester, NY 25 17 68 55 37 2.4 1.6 6.6 5.3 3.6

Sacramento-Arden-Arcade-Roseville, CA 33 8 78 40 100 1.6 0.4 3.8 1.9 4.8

Salt Lake City, UT 42 23 21 14 2 4.1 2.2 2.0 1.3 0.2

San Antonio, TX 164 178 156 142 190 8.8 9.4 8.0 7.1 9.5

San Diego-Carlsbad-San Marcos, CA 124 133 202 273 292 4.2 4.5 6.9 9.2 9.8

San Francisco-Oakland-Fremont, CA 258 165 156 263 277 6.2 4.0 3.7 6.3 6.6

San Jose-Sunnyvale-Santa Clara, CA 39 56 22 76 84 2.2 3.2 1.2 4.2 4.7

Seattle-Tacoma-Bellevue, WA 93 100 122 99 115 2.9 3.1 3.7 3.0 3.5

St. Louis, MO-IL 85 86 89 82 129 3.1 3.1 3.2 2.9 4.6

Tampa-St. Petersburg-Clearwater, FL 110 139 140 119 212 4.3 5.2 5.2 4.4 7.8

Virginia Beach-Norfolk-Newport News, VA-NC 100 105 85 89 80 6.1 6.4 5.2 5.4 4.8

Washington-Arlington-Alexandria, DC-VA-MD-WV 511 453 496 514 425 9.9 8.7 9.4 9.7 8.0

U.S. MSA TOTAL 13,150 12,137 13,585 13,990 15,069 8.3 7.6 8.4 8.6 9.3

* Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other 

than neurosyphilis.

† MSAs selected based on largest population in 2000 U.S. Census.
128 Syphilis Tables STD Surveillance 2008

Table 39. Congenital syphilis—Reported cases and rates in infants <1 year of age by state, ranked 

by rates: United States, 2008

Rank* State† Cases Rate per 100,000 Live Births

1 Louisiana 23 36.3

2 Texas 127 31.8

3 Maryland 23 29.7

4 Arizona 30 29.3

5 Nevada 9 22.5

6 Arkansas 9 22.0

7 Alabama 12 19.0

8 New Mexico 4 13.4

9 Tennessee 10 11.9

10 Illinois 20 11.1

11 California 62 11.0

U.S. TOTAL‡ 431 10.1

12 New York 23 9.2

13 Michigan 10 7.8

14 North Carolina 10 7.8

15 Georgia 11 7.4

16 Florida 17 7.2

17 Oklahoma 3 5.6

18 Pennsylvania 8 5.4

19 Connecticut 2 4.8

20 West Virginia 1 4.8

21 Virginia 4 3.7

22 New Jersey 4 3.5

23 South Carolina 2 3.2

24 Missouri 2 2.5

25 Ohio 3 2.0

26 Kentucky 1 1.7

27 Wisconsin 1 1.4

YEAR 2010 TARGET 1.0

Alaska 0 0.0

Colorado 0 0.0

Delaware 0 0.0

Hawaii 0 0.0

Idaho 0 0.0

Indiana 0 0.0

Iowa 0 0.0

Kansas 0 0.0

Maine 0 0.0

Massachusetts 0 0.0

Minnesota 0 0.0

Mississippi 0 0.0

Montana 0 0.0

Nebraska 0 0.0

New Hampshire 0 0.0

North Dakota 0 0.0

Oregon 0 0.0

Rhode Island 0 0.0

South Dakota 0 0.0

Utah 0 0.0

Vermont 0 0.0

Washington 0 0.0

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 the District of Columbia with 0 cases and a rate of 0.0, but excludes outlying areas (Guam with 0 cases and rate of 0.0, Puerto Rico 

with 8 cases and rate of 16.5, and Virgin Islands with 0 cases and rate of 0.0).
STD Surveillance 2008 Syphilis Tables 129

Table 40. 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, 2004–2008

State/Area*

Cases Rates per 100,000 Live Births

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Alabama 11 5 9 9 12 18.5 8.3 14.2 14.2 19.0

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 26 28 16 30 30 27.8 29.1 15.6 29.3 29.3

Arkansas 4 7 10 12 9 10.4 17.9 24.4 29.3 22.0

California 68 75 69 87 62 12.5 13.7 12.3 15.5 11.0

Colorado 2 1 2 2 0 2.9 1.5 2.8 2.8 0.0

Connecticut 0 1 0 2 2 0.0 2.4 0.0 4.8 4.8

Delaware 1 0 0 0 0 8.8 0.0 0.0 0.0 0.0

District of Columbia 1 0 1 1 0 12.6 0.0 11.7 11.7 0.0

Florida 16 16 21 20 17 7.3 7.1 8.9 8.4 7.2

Georgia 6 1 9 9 11 4.3 0.7 6.1 6.1 7.4

Hawaii 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Idaho 3 0 0 0 0 13.3 0.0 0.0 0.0 0.0

Illinois 26 23 15 10 20 14.4 12.8 8.3 5.5 11.1

Indiana 4 2 0 2 0 4.6 2.3 0.0 2.3 0.0

Iowa 0 0 0 1 0 0.0 0.0 0.0 2.5 0.0

Kansas 2 0 1 0 0 5.0 0.0 2.4 0.0 0.0

Kentucky 1 0 1 0 1 1.8 0.0 1.7 0.0 1.7

Louisiana 19 13 16 37 23 29.1 21.3 25.2 58.4 36.3

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 10 16 19 23 23 13.4 21.3 24.5 29.7 29.7

Massachusetts 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Michigan 23 17 13 15 10 17.7 13.3 10.2 11.8 7.8

Minnesota 1 3 1 0 0 1.4 4.2 1.4 0.0 0.0

Mississippi 3 0 0 0 0 7.0 0.0 0.0 0.0 0.0

Missouri 3 3 3 1 2 3.9 3.8 3.7 1.2 2.5

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nevada 1 1 16 7 9 2.8 2.7 40.0 17.5 22.5

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 13 16 15 11 4 11.3 14.1 13.0 9.6 3.5

New Mexico 3 6 7 6 4 10.6 20.8 23.4 20.0 13.4

New York 22 10 24 16 23 8.8 4.1 9.6 6.4 9.2

North Carolina 9 11 7 7 10 7.5 8.9 5.5 5.5 7.8

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 2 2 0 1 3 1.3 1.3 0.0 0.7 2.0

Oklahoma 2 1 2 3 3 3.9 1.9 3.7 5.6 5.6

Oregon 0 0 0 2 0 0.0 0.0 0.0 4.1 0.0

Pennsylvania 0 1 3 8 8 0.0 0.7 2.0 5.4 5.4

Rhode Island 1 0 0 0 0 7.8 0.0 0.0 0.0 0.0

South Carolina 10 4 2 1 2 17.7 6.9 3.2 1.6 3.2

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 9 4 6 4 10 11.3 4.9 7.1 4.7 11.9

Texas 65 67 79 99 127 17.0 17.4 19.8 24.8 31.8

Utah 1 0 2 0 0 2.0 0.0 3.7 0.0 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 6 3 3 1 4 5.8 2.9 2.8 0.9 3.7

Washington 0 0 0 2 0 0.0 0.0 0.0 2.3 0.0

West Virginia 0 0 0 1 1 0.0 0.0 0.0 4.8 4.8

Wisconsin 1 2 0 1 1 1.4 2.8 0.0 1.4 1.4

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 375 339 372 431 431 9.1 8.2 8.7 10.1 10.1

Northeast 36 28 42 37 37 5.3 4.2 6.2 5.4 5.4

Midwest 62 52 33 31 36 7.0 5.9 3.7 3.4 4.0

South 173 148 185 227 253 11.3 9.6 11.5 14.1 15.7

West 104 111 112 136 105 10.2 10.8 10.5 12.7 9.8

Guam 0 1 0 2 0 0.0 31.4 0.0 59.0 0.0

Puerto Rico 11 13 15 10 8 21.5 25.7 30.9 20.6 16.5

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 11 14 15 12 8 19.6 25.3 27.9 22.4 14.9

TOTAL 386 353 387 443 439 9.3 8.4 9.0 10.3 10.2

* Mother's state of residence used to assign case.
130 Syphilis Tables STD Surveillance 2008

Table 41. Congenital Syphilis—Reported cases and rates in infants <1 year of age by race/ethnicity 

of mother: United States, 2004–2008

Year 

of 

Birth Race/Ethnicity Cases Rate per 100,000 Live Births 2004

White, Non-Hispanic 41 1.8

Black, Non-Hispanic 168 28.8

Hispanic 145 15.3

Asian/Pacific Islander 6 2.7

American Indian/Alaska Native 2 5.0

Other 1 NA

Unknown 12 NA

Total 375

2005

White, Non-Hispanic 31 1.3

Black, Non-Hispanic 156 26.6

Hispanic 124 12.6

Asian/Pacific Islander 15 6.8

American Indian/Alaska Native 5 12.2

Other 2 NA

Unknown 6 NA

Total 339

2006

White, Non-Hispanic 39 1.7

Black, Non-Hispanic 151 24.3

Hispanic 151 14.5

Asian/Pacific Islander 10 4.3

American Indian/Alaska Native 5 11.7

Other 5 NA

Unknown 11 NA

Total 372

2007

White, Non-Hispanic 53 2.3

Black, Non-Hispanic 191 30.7

Hispanic 144 13.9

Asian/Pacific Islander 20 8.6

American Indian/Alaska Native 8 18.7

Other 4 NA

Unknown 11 NA

Total 431 

2008

White, Non-Hispanic 65 2.8

Black, Non-Hispanic 215 34.6

Hispanic 133 12.8

Asian/Pacific Islander 7 3.0

American Indian/Alaska Native 6 14.0

Other 1 NA

Unknown 4 NA

Total 431 

NA = Not applicable.
STD Surveillance 2008 Chancroid Tables 131

Table 42. Chancroid—Reported cases and rates by state/area listed in alphabetical order: United 

States and outlying areas, 2004–2008

State/Area

Cases Rates per 100,000 Population

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Alabama 0 0 0 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 0.0

Arizona 2 1 0 0 0 0.0 0.0 0.0 0.0 0.0

Arkansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

California 1 1 0 1 2 0.0 0.0 0.0 0.0 0.0

Colorado 0 0 0 0 2 0.0 0.0 0.0 0.0 0.0

Connecticut 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Delaware 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

District of Columbia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Florida 1 1 1 3 0 0.0 0.0 0.0 0.0 0.0

Georgia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Hawaii 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Idaho 2 0 0 0 0 0.1 0.0 0.0 0.0 0.0

Illinois 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Indiana 0 0 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 0.0

Kansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kentucky 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Louisiana 2 4 1 4 0 0.0 0.1 0.0 0.1 0.0

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Massachusetts 3 1 0 1 4 0.0 0.0 0.0 0.0 0.1

Michigan 2 0 1 0 0 0.0 0.0 0.0 0.0 0.0

Minnesota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Mississippi 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Missouri 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nevada 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Mexico 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New York 4 1 5 5 2 0.0 0.0 0.0 0.0 0.0

North Carolina 1 5 5 2 4 0.0 0.1 0.1 0.0 0.0

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 0 1 0 0 1 0.0 0.0 0.0 0.0 0.0

Oklahoma 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Oregon 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Pennsylvania 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Rhode Island 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

South Carolina 4 0 0 0 1 0.1 0.0 0.0 0.0 0.0

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Texas 3 1 5 5 8 0.0 0.0 0.0 0.0 0.0

Utah 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 0 0 1 0 0 0.0 0.0 0.0 0.0 0.0

Washington 0 0 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 0.0

Wisconsin 0 0 0 2 0 0.0 0.0 0.0 0.0 0.0

Wyoming 0 1 0 0 0 0.0 0.2 0.0 0.0 0.0

U.S. TOTAL 30 17 19 23 25 0.0 0.0 0.0 0.0 0.0

Guam 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Puerto Rico 1 3 0 0 0 0.0 0.1 0.0 0.0 0.0

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 1 3 0 0 0 0.0 0.1 0.0 0.0 0.0

TOTAL 31 20 19 23 25 0.0 0.0 0.0 0.0 0.0
132 Selected STDs Tables STD Surveillance 2008

Table 43. Selected STDs and complications—Initial visits to physicians' offices, National Disease 

and Therapeutic Index: United States, 1966–2008

Year

Genital

Herpes

Genital

Warts

Vaginal

Trichomoniasis*

Other

Vaginitis*

Pelvic Inflammatory

Disease†

1966 19,000 56,000 579,000 1,155,000 NA

1967 15,000 72,000 515,000 1,277,000 NA

1968 16,000 87,000 463,000 1,460,000 NA

1969 15,000 61,000 421,000 1,390,000 NA

1970 17,000 119,000 529,000 1,500,000 NA

1971 49,000 128,000 484,000 1,281,000 NA

1972 26,000 165,000 574,000 1,810,000 NA

1973 51,000 198,000 466,000 1,858,000 NA

1974 75,000 202,000 427,000 1,907,000 NA

1975 36,000 181,000 500,000 1,919,000 NA

1976 57,000 217,000 473,000 1,690,000 NA

1977 116,000 221,000 324,000 1,713,000 NA

1978 76,000 269,000 329,000 2,149,000 NA

1979 83,000 200,000 363,000 1,662,000 NA

1980 57,000 218,000 358,000 1,670,000 423,000

1981 133,000 191,000 369,000 1,742,000 283,000

1982 134,000 256,000 268,000 1,859,000 374,000

1983 106,000 203,000 424,000 1,932,000 424,000

1984 157,000 224,000 381,000 2,450,000 381,000

1985 124,000 263,000 291,000 2,728,000 425,000

1986 136,000 275,000 338,000 3,118,000 457,000

1987 102,000 351,000 293,000 3,087,000 403,000

1988 163,000 290,000 191,000 3,583,000 431,000

1989 148,000 220,000 165,000 3,374,000 413,000

1990 172,000 275,000 213,000 4,474,000 358,000

1991 235,000 282,000 198,000 3,822,000 377,000

1992 139,000 218,000 182,000 3,428,000 335,000

1993 172,000 167,000 207,000 3,755,000 407,000

1994 142,000 239,000 199,000 4,123,000 332,000

1995 160,000 253,000 141,000 3,927,000 262,000

1996 208,000 191,000 245,000 3,472,000 286,000

1997 176,000 145,000 176,000 3,100,000 260,000

1998 188,000 211,000 164,000 3,200,000 233,000

1999 224,000 240,000 171,000 3,077,000 250,000

2000 179,000 220,000 222,000 3,470,000 254,000

2001 157,000 233,000 210,000 3,365,000 244,000

2002 216,000 266,000 150,000 3,315,000 197,000

2003 203,000 264,000 179,000 3,516,000 123,000

2004 269,000 316,000 221,000 3,602,000 132,000

2005 266,000 357,000 165,000 4,071,000 176,000

2006 371,000 422,000 200,000 3,891,000 106,000

2007 317,000 312,000 205,000 3,723,000 146,000

2008 292,000 385,000 204,000 3,571,000 104,000

* 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 between 13% and 16%; and 1,000,000–5,000,000 are between 9% and 13%.

SOURCE: IMS Health, Integrated Promotional Services, IMS Health Report, 1966–2008 Hardcopy. See Appendix (Other Data Sources) for more information.
APPENDIX
APPENDIX
STD Surveillance 2008 Appendix: Interpreting STD Surveillance Data 133

Interpreting STD Surveillance Data 

Sexually Transmitted Disease Surveillance, 2008

presents surveillance information derived from 

the official statistics for the reported occurrence of 

nationally notifiable STDs in the United States, 

test positivity and prevalence data from numerous 

prevalence monitoring initiatives, sentinel surveillance 

of gonococcal antimicrobial resistance, and national 

health care services surveys.

Nationally Notifiable STD Surveillance

Nationally notifiable STD surveillance data are 

collected and compiled from reports sent by the STD 

control programs and health departments in the 50 

states, the District of Columbia, selected cities, U.S. 

dependencies and possessions, and independent 

nations in free association with the United States 

to the Division of STD Prevention, National 

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

TB Prevention, Centers for Disease Control and 

Prevention. Included among the dependencies, 

possessions, and independent nations are Guam, 

Puerto Rico, and the Virgin Islands. These entities are 

identified as “outlying areas” of the United States in 

selected figures and tables.

Reporting Formats

STD morbidity data presented in this report are 

compiled from a combination of data reported 

on standardized hardcopy report forms and 

electronic data received via the National Electronic 

Telecommunications System for Surveillance (NETSS).

Summary Report Forms (hardcopy 

format)

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 from 1984 to 2002 to report 

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 from 1963 to 2002 to 

report summary data for all stages of syphilis, 

congenital syphilis, gonorrhea, chancroid, 

chlamydia, and other STDs by sex and source 

of report (private vs. public) for the 50 states, 

Washington, D.C., and 64 selected cities 

(including San Juan, Puerto Rico) and outlying 

areas of the United States. Note: Chlamydial 

infection became a nationally notifiable condition 

in 1996, and the form was modified to support 

reporting of chlamydia that year. Congenital 

syphilis was dropped from this aggregate form 

in 1995 and replaced by the case-specific CDC 

73.126 form described 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 from 1981 to 2002 to report summary data 

for P&S syphilis, gonorrhea, and chlamydia by 

age, race, sex and source (public vs. private) for all 

states and seven large cities (Baltimore, Chicago, 

New York City, Los Angeles, Philadelphia, San 

Francisco, and Washington, D.C.), and outlying 

areas of the United States. Note: Chlamydial 

infection became a nationally notifiable condition 

in 1996 and the form was modified to support 

reporting of chlamydia that year.

4. FORM CDC 73.126: Congenital Syphilis (CS) 

Case Investigation and Report. This case-specific 

hardcopy form was first used in 1983 and 

continues to be used to report detailed casespecific data for congenital syphilis in some 

reporting areas.
134 Appendix: Interpreting STD Surveillance Data STD Surveillance 2008

National Electronic 

Telecommunications System for 

Surveillance (NETSS, electronic 

format)

Notifiable STD data reported electronically 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 (42 reporting areas are submitting 

congenital syphilis surveillance data via NETSS). 

Puerto Rico converted to electronic reporting in 2006. 

Guam 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 jurisdiction, the 

discrepancies may be larger.

Surveillance data and updates sent to CDC via 

NETSS and on hardcopy forms through June 10, 

2009 have been included in this report. Data received 

after this date will appear in subsequent annual 

Surveillance Reports. The data presented in the 

figures and tables in this document supersede those in 

all earlier publications.

Population Denominators and Rate 

Calculations

2000—2008 Rates and Population

The National Center for Health Statistics released 

bridged race population counts for 2000–2007 

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 five race/ethnicity groups specified 

under the 1977 OMB standards.

Population estimates for Guam, Puerto Rico and 

the Virgin Islands were obtained from the Bureau of 

Census web site: http://www.census.gov/ipc/www/

idb/tables.html. The 2007–2008 rates for outlying 

areas were calculated using the 2007 population 

estimates.

Because of use of the updated population data, rates 

for the period 2000–2007 may be different from 

prior Surveillance Reports.

1990—1999 Rates and Population

The population counts for 1990 through 1999 

incorporated the bridged single-race estimates of the 

April 1, 2000 resident population. These files were 

prepared by the U.S. Census Bureau with support 

from the National Cancer Institute.

1981—1989 Rates and Population

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).

1941—1980 Rates and Population

Rates for 1941 through 1980 are based on population 

estimates from the Bureau of Census and currently 

maintained by the Division of STD Prevention 

(DSTDP).

1941—2008 Congenital Syphilis Rates and 

Live Births

Congenital syphilis (CS) data in Table 1 of Sexually 

Transmitted Disease Surveillance 2008 represent the 

number of congenital syphilis cases per 100,000 live 

births for all years during the period 1941 through 

2008. Previous publications presented congenital 

syphilis rates per 100,000 population for 1941 through 
STD Surveillance 2008 Appendix: Interpreting STD Surveillance Data 135

1994 and rates for cases diagnosed at younger than 1 

year of age per 100,000 live births for 1995 through 

2007. To allow for trends in congenital syphilis rates 

to be compared over the period 1941 through 2008, 

live births are used as the denominator for congenital 

syphilis and case counts are no longer limited to those 

diagnosed within the first year of life. Congenital 

syphilis morbidity (i.e., case reports) is assigned by year 

of birth. Rates of congenital syphilis for 1963 through 

1988 were calculated using published live birth data 

(NCHS; Vital Statistics Report, United States, 1988 

[Vol.1-Natality]). Congenital syphilis rates for 1989 

through 2006 were calculated using live birth data 

based on information coded by the States and provided 

to the National Center for Health Statistics (NCHS) 

through the Vital Statistics Cooperative Program. Rates 

for 2007 through 2008 were calculated using live birth 

data for 2006.

Reporting Practices

Although most state and local STD programs 

generally adhere to the national notifiable STD case 

definitions collaboratively developed by the Council 

of State and Territorial Epidemiologists and CDC, 

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 over time, trends should 

be minimally affected by these differences. In many 

state and local STD jurisdictions, 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 Metropolitan Statistical 

Area-specific Surveillance Data

Sexually Transmitted Disease Surveillance, 2008

continues the presentation of STD incidence data and 

rates for the fifty MSAs with the largest populations 

based on 2000 U.S. Census data. Sexually Transmitted 

Disease Surveillance reports prior to 2005 presented 

data by selected cities which estimated city-specific 

morbidity and were derived from county data. 

Since county data were used to estimate city-specific 

morbidity and current STD project areas’ reporting 

practices do not support direct identification of cityspecific morbidity reports, MSAs (described below) 

were chosen as a geographic unit smaller than a state 

or territory for presentation of STD morbidity data.

MSAs are defined by the OMB to provide nationally 

consistent definitions for collecting, tabulating, and 

publishing federal statistics for a set of geographic 

areas.1 An MSA is associated with at least one 

urbanized area that has a population of at least 

50,000. The MSA comprises the central county or 

counties containing the core, plus adjacent outlying 

counties having a high degree of social and economic 

integration with the central county as measured 

through commuting. The title of an MSA includes 

the name of its principal city with the largest Census 

2000 population. If there are multiple principal 

cities, the names of the second largest and third 

largest principal cities appear in the title in order of 

descending population size.

The MSA concept has been used as a statistical 

representation of the social and economic linkages 

between urban cores and outlying, integrated areas. 

However, MSAs do not equate to an urban-rural 

classification; all counties included in MSAs and many 

other counties contain both urban and rural territory 

and populations. STD programs that treat all parts of 

an MSA as if they were as urban as the densely settled 

core ignore the rural conditions that may exist in some 

parts of the area. In short, MSAs are not designed as a 

general purpose geographic framework for nonstatistical 

activities or for use in program funding formulas.

For more information on MSA definitions used 

in this report, please visit this web site: http://

www.census.gov/population/estimates/metrocity/03mfips.txt

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).
136 Appendix: Interpreting STD Surveillance Data STD Surveillance 2008

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. For those states reporting greater than 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, 

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, school-based 

clinics, mental health providers, military, Indian 

Health Service, and other unspecified sources. 

Analysis of the data reported electronically after 1996 

confirmed that the new STD clinic source of report 

data corresponded to the earlier reporting source 

category, public (clinic) source. Therefore, source of 

case report data for 1984 through 2008 are presented 

as STD clinic or non-STD clinic only (Table A2).

Definition of DHHS Regions

The ten U.S. 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.

Chlamydia Morbidity

Trends in chlamydia morbidity reporting from 

many state and local jurisdictions are more reflective 

of changes in diagnostic, screening, and reporting 

practices than of actual trends in disease incidence. 

In particular, morbidity trends are likely highly 

influenced by changes in test technology, as use 

of more sensitive NAATs tests increases. As more 

jurisdictions 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.

Syphilis Morbidity Reporting 

“Total syphilis” or “all stages of syphilis” includes 

primary, secondary, latent (including early latent, 

late latent, and latent syphilis of unknown duration), 

neurosyphilis, late (including late syphilis with 

clinical manifestations other than neurosyphilis), and 

congenital syphilis.

In 1996, the syphilis stage, “late syphilis with clinical 

manifestations other than neurosyphilis (late benign 

and cardiovascular syphilis)”, was added to the 

syphilis case definition (see STD Case Definitions in 

this Appendix).

While neurosyphilis can occur at almost any stage of 

syphilis, between 1996 and 2005, it was classified and 

reported as one of several mutually exclusive stages 

of syphilis. Beginning in 2005, neurosyphilis was 

no longer classified or reported as a distinct stage of 

syphilis. 
STD Surveillance 2008 Appendix: Interpreting STD Surveillance Data 137

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 state and local STD programs greatly 

enhanced active case finding for congenital syphilis 

since 1988. For these reasons, as well as increasing 

morbidity, the number of reported cases increased 

dramatically between 1989 and 1991. All reporting 

areas had implemented the new case definition for 

reporting congenital syphilis by January 1, 1992.

In addition to changing the case definition for 

congenital syphilis, CDC introduced a new data 

collection form (CDC 73.126) in 1990 (revised 

October 2003). Since 1995, the data collected on 

this form have been used for reporting congenital 

syphilis cases and associated rates. This form is used 

to collect individual case information which allows 

more thorough analysis of case characteristics. For the 

purpose of analyzing race/ethnicity, cases are classified 

by race/ethnicity of the mother. Congenital syphilis 

cases were reported by state and city of residence of 

the mother for 1995 through 2008.

Congenital syphilis reporting may be delayed 

as a result of case investigation and validation. 

Congenital syphilis cases for prior years are added to 

CDC’s surveillance databases throughout the year. 

Congenital syphilis data reported after publication of 

the current annual Surveillance Report will appear in 

subsequent surveillance reports and are assigned by 

case patient’s year of birth.

Chlamydia, Gonorrhea, and Syphilis 

Prevalence Monitoring

Chlamydia and gonorrhea test positivity were 

calculated for the following: women attending family 

planning clinics and prenatal clinics, men and women 

entering the National Job Training Program, and 

men and women entering corrections facilities. In 

addition, chlamydia test positivity was calculated 

for women attending Indian Health Service clinics. 

Syphilis seroreactivity was calculated for men who 

have sex with men attending STD clinics in the 

MSM Prevalence Monitoring Project. 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, these data sources may 

include more than one test from the same individual 

if that person was tested more than once during a 

year.

To increase the stability of the annual National Job 

Training Program prevalence estimates, chlamydia 

or gonorrhea prevalence data are presented when 

valid test results for 100 or more students per year 

are available for the population subgroup and state. 

The majority of the National Job Training Program’s 

chlamydia screening tests are tested by a single 

national contract laboratory, which provides these 

data to CDC. Gonorrhea screening tests for male and 

female students in many training centers are tested 

by local laboratories; these data are not available 

to CDC. To insure that state-specific gonorrhea 

screening data presented here are representative of 

all students entering training centers, gonorrhea test 

results for students at centers submitting specimens 

to the national contract laboratory are included 

only if the number of gonorrhea tests submitted is 

greater than 90% of the number of chlamydia tests 

submitted from the same center for the same time 

period.

Various laboratory test methods were used for all of 

these data sources. No adjustments for laboratory 

test type and sensitivity were made to any figures 

presenting test positivity or prevalence data. 

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.

Because only selected corrections facilities participated 

in the Prevalence Monitoring Project, state-specific 

positivity for chlamydia and gonorrhea may not be 

representative of all corrections facilities in the state.
138 Appendix: Interpreting STD Surveillance Data STD Surveillance 2008

Prevalence data for region- and state-specific figures 

were published with permission from the Regional 

IPP, selected state STD prevention programs, the 

National Job Training Program, and the Indian 

Health Service.

Gonococcal Isolate Surveillance 

Project (GISP)

Data on antimicrobial susceptibility in Neisseria 

gonorrhoeae were collected through GISP, a sentinel 

system of selected STD clinics in approximately 25-

30 GISP sentinel sites and 4-5 regional laboratories in 

the United States. For more details on findings from 

GISP, refer to the GISP website at http://www.cdc.

gov/std/GISP.

For 2008, the antimicrobial agents tested in GISP 

were: ceftriaxone, azithromycin, spectinomycin, 

ciprofloxacin, penicillin, and tetracycline. 

Below are the antimicrobial susceptibility criteria used 

in GISP for 2008. The majority of the antimicrobial 

susceptibility criteria are also recommended by the 

Clinical and Laboratory Standards Institute (CLSI):3-6

* Ceftriaxone, MIC ≥ 0.5 μg/ml (decreased 

susceptibility)

* Azithromycin, MIC ≥ 2.0 μg/ml (decreased 

susceptibility)

 Spectinomycin, MIC ≥ 128.0 μg/ml (resistance)

 Ciprofloxacin, MIC 0.125 - 0.5 μg/ml (intermediate 

resistance)

 Ciprofloxacin, MIC ≥ 1.0 μg/ml (resistance)

 Penicillin, MIC ≥ 2.0 μg/ml (resistance)

 Tetracycline, MIC ≥ 2.0 μg/ml (resistance)

NOTE: The CLSI criteria for decreased susceptibility 

and resistance to ceftriaxone and azithromycin and 

for susceptibility to azithromycin have not been 

established for N. gonorrhoeae. 

Other Surveillance Data Sources

National Health and Nutrition Examination 

Survey (NHANES)

NHANES is a series of cross-sectional surveys 

designed to provide national statistics on the health 

and nutritional status of the general household 

population. Data are collected through household 

interviews, standardized physical examinations, 

and the collection of biological samples in special 

mobile examination centers. In 1999, NHANES 

became a continuous survey with data released 

every 2 years. The sampling plan of the survey is a 

stratified, multistage, probability cluster design that 

selects a sample representative of the U.S. civilian 

noninstitutionalized population.

National Disease and Therapeutic Index 

(NDTI)

The information on the number of initial visits to 

private physicians’ offices for STDs was based on 

analysis of data from NDTI (machine-readable 

files or summary statistics for 1966 through 2008). 

The NDTI is a probability sample survey of private 

physicians’ clinical management practices. 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 PID or 

ectopic pregnancy was based on analysis of data from 

the National Hospital Discharge Survey (machinereadable files for 1980 through 2006), an ongoing 

nationwide sample survey of medical records of 

patients discharged from acute care hospitals in the 

United States, conducted by the National Center for 

Health Statistics. For more information, see Graves EJ. 

1988 Summary: National Hospital Discharge Survey; 

Advance data No. 185; Hyattsville (MD): National 

Center for Health Statistics, 1990.

The estimates generated using NHDS data are based 

on statistical surveys and therefore have sampling 

variability associated with the estimates.

Healthy People 2010 Objectives

Healthy People 20107 is a set of health objectives 

for the United States 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. HP2010 builds on initiatives pursued over 

the past two decades. The 1979 Surgeon General’s 
STD Surveillance 2008 Appendix: Interpreting STD Surveillance Data 139

Report, Healthy People, and Healthy People 2000: 

National Health Promotion and Disease Prevention 

Objectives established national health objectives and 

served as the basis for the development of State and 

community plans. Like its predecessors, HP2010 

was developed through a broad consultation process, 

built on the best scientific knowledge and designed 

to measure programs over time. HP2010 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 HP2010—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 to 24 years who attend family 

planning and STD clinics and among males aged 15 

to 24 who attend STD clinics.

HP 2010 targets were based on a national baseline. 

For most HP2010 objectives, one target was set for 

all population groups to reach by the year 2010, and 

was set as a “better than the best” measure for any 

racial or ethnic group at the baseline. For example, 

at the 1997 baseline for objective 25-2, gonorrhea 

rate per 100,000 population, the Asian/Pacific 

Islander group had the “best” rate of 20 cases per 

100,000 population. Using the “better than the best” 

methodology resulted in the target for that objective 

being set at 19 per 100,000 population, even though 

the overall rate for the U.S. in 1997 was 123 cases per 

100,000 population.

Government Performance and Results 

Act of 1993 (GPRA) Goals

GPRA of 1993 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 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.

1 Office of Management and Budget. Standards for Defining 

Metropolitan and Micropolitan Statistical Areas: Notice Federal 

Register December 27, 2000; 65(249):82228-38.

2 Kaufman RE, Jones OG, Blount JH, Wiesner PJ. Questionnaire 

survey of reported early congenital syphilis: problems in diagnosis, 

prevention, and treatment. Sex Transm Dis 1977;4:135-9.

3 National Committee for Clinical Laboratory Standards. 1993. 

Approved standard M7 - A3. Methods for dilution antimicrobial 

susceptibility tests for bacteria that grow aerobically. National 

Committee for Clinical Laboratory Standards, Villanova, PA.

4 National Committee for Clinical Laboratory Standards. 1998. 

Approved standard M100-38. Performance standards for 

antimicrobial susceptibility testing. National Committee for 

Clinical Laboratory Standards, Wayne, PA.

5 National Committee for Clinical Laboratory Standards. 2002. 

Approved standard M100-S12, 22. Performance standards for 

antimicrobial susceptibility testing. National Committee for 

Clinical Laboratory Standards, Wayne, PA.

6 Clinical and Laboratory Standards Institute. January 2007. 

Approved standard M100-S17, 27 (1). Performance standards for 

antimicrobial susceptibility testing; Seventeenth Informational 

Supplement.

7 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.
140 Appendix: Percentage Unknown STD Surveillance 2008

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

by state and by nationally notifiable STD, 2008

Primary and Secondary Syphilis Gonorrhea Chlamydia

State

Percent

Unknown

Race/

Ethnicity

Percent

Unknown

Age

Percent

Unknown

Sex

Percent

Unknown

Sex

Partner

Percent

Unknown

Race/

Ethnicity

Percent

Unknown

Age

Percent

Unknown

Sex

Percent

Unknown

Race/

Ethnicity

Percent

Unknown

Age

Percent

Unknown

Sex

Alabama 2.2 0.0 0.0 2.2 23.5 0.0 0.1 27.2 0.0 0.0

Alaska* 0.0 0.0 0.0 100.0 0.3 0.0 0.0 0.5 0.0 0.0

Arizona 2.8 0.0 0.0 58.0 21.8 0.0 0.1 28.6 0.0 0.0

Arkansas 0.0 0.0 0.0 30.6 7.4 0.0 0.0 6.1 0.0 0.0

California 3.4 0.0 0.1 10.1 32.2 0.0 0.5 34.2 0.0 0.4

Colorado 3.1 0.0 0.0 12.5 30.5 0.0 0.1 59.7 0.0 0.2

Connecticut 2.9 0.0 0.0 2.9 25.1 0.0 0.1 36.8 0.0 0.1

Delaware 0.0 0.0 0.0 100.0 2.4 0.0 0.0 3.2 0.0 0.0

District of Columbia 2.7 0.0 0.0 26.0 28.7 0.0 0.5 36.6 0.0 0.7

Florida 5.9 0.0 0.1 3.1 13.0 0.0 0.2 17.4 0.0 0.3

Georgia 0.8 0.0 0.0 20.7 39.3 0.0 0.7 47.6 0.0 1.0

Hawaii 0.0 0.0 0.0 0.0 33.8 0.0 0.0 50.3 0.0 0.0

Idaho* 28.6 0.0 0.0 28.6 27.8 0.0 0.0 30.0 0.0 0.3

Illinois 4.0 0.0 0.0 27.1 8.8 0.0 0.0 12.1 0.0 0.0

Indiana 0.0 0.0 0.0 7.9 12.6 0.0 0.2 16.6 0.0 0.3

Iowa 0.0 0.0 0.0 18.8 7.1 0.0 0.0 11.0 0.0 0.0

Kansas 0.0 0.0 0.0 6.7 21.6 0.0 0.0 32.7 0.0 0.0

Kentucky 5.4 0.0 0.0 21.5 29.6 0.0 0.2 36.2 0.0 0.3

Louisiana 1.1 0.0 0.0 100.0 14.0 0.0 0.5 18.8 0.0 0.8

Maine 0.0 0.0 0.0 0.0 5.2 0.0 0.0 15.7 0.0 0.0

Maryland 0.8 0.0 0.0 10.6 29.0 0.0 0.1 36.2 0.0 0.1

Massachusetts 5.1 0.0 0.0 6.9 27.5 0.0 0.1 36.8 0.0 0.1

Michigan 2.4 0.0 0.0 17.1 39.8 0.0 0.8 42.1 0.0 0.4

Minnesota 3.4 0.0 0.0 9.5 13.3 0.0 0.0 15.3 0.0 0.0

Mississippi 2.7 0.0 0.0 1.6 21.1 0.0 0.0 25.0 0.0 0.0

Missouri 0.0 0.0 0.0 1.3 15.2 0.0 0.0 23.2 0.0 0.0

Montana* 14.3 0.0 0.0 100.0 32.8 0.0 0.8 24.9 0.0 0.3

Nebraska 20.0 0.0 0.0 33.3 24.0 0.0 0.1 34.2 0.0 0.2

Nevada 18.2 0.0 0.0 2.6 27.8 0.0 0.0 37.8 0.0 0.0

New Hampshire 0.0 0.0 0.0 5.0 8.0 0.0 0.0 11.4 0.0 0.0

New Jersey 0.4 0.0 0.0 9.3 30.7 0.0 0.0 44.4 0.0 0.1

New Mexico 6.8 0.0 0.0 6.8 20.0 0.0 0.1 17.4 0.0 0.0

New York 9.7 0.0 0.0 19.5 35.1 0.0 0.0 44.7 0.0 0.0

North Carolina 0.0 0.0 0.0 100.0 7.4 0.0 0.5 9.5 0.0 0.4

North Dakota* 0.0 0.0 0.0 0.0 30.8 0.0 0.0 26.8 0.0 0.1

Ohio 7.4 0.0 0.0 8.0 26.0 0.0 1.9 33.6 0.0 2.7

Oklahoma 0.0 0.0 0.0 7.0 6.4 0.0 0.2 9.3 0.0 0.5

Oregon 3.8 0.0 0.0 100.0 8.2 0.0 0.0 17.1 0.0 0.0

Pennsylvania 4.0 0.0 0.0 1.1 20.5 0.0 0.0 22.7 0.0 0.0

Rhode Island 0.0 0.0 0.0 0.0 10.4 0.0 0.0 20.9 0.0 0.1

South Carolina 1.0 0.0 0.0 6.1 26.5 0.0 0.3 32.1 0.0 0.4

South Dakota* 0.0 0.0 0.0 0.0 1.9 0.0 0.0 2.7 0.0 0.1

Tennessee 0.0 0.0 0.0 1.2 7.1 0.0 0.0 10.0 0.0 0.0

Texas 0.6 0.0 0.0 2.3 4.4 0.0 0.1 5.1 0.0 0.1

Utah 0.0 0.0 0.0 16.0 0.0 0.0 0.0 0.0 0.0 0.0

Vermont 0.0 0.0 0.0 45.5 0.0 0.0 0.0 0.2 0.0 0.0

Virginia 0.4 0.0 0.0 2.6 14.7 0.0 0.1 23.6 0.0 0.2

Washington 4.4 0.0 0.0 1.7 24.0 0.0 0.2 23.4 0.0 0.3

West Virginia 0.0 0.0 0.0 23.1 9.0 0.0 0.0 13.9 0.0 0.0

Wisconsin 1.5 0.0 0.0 7.7 25.5 0.0 0.2 29.6 0.0 0.3

Wyoming* 33.3 0.0 0.0 100.0 26.6 0.0 0.0 35.3 0.0 0.2

U.S. TOTAL 3.2 0.0 0.0 18.3 20.3 0.0 0.3 26.4 0.0 0.3

* Percentages for P&S Syphilis are based on less than 10 cases.

NOTE: Unknown includes unknown, missing, or invalid data values.
STD Surveillance 2008 Appendix: STD Reporting Source 141

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

United States, 2008

 Non-STD Clinic STD Clinic Total

Disease Male Female Total* Male Female Total* Male† Female† Total‡

Chlamydia 189,994 719,718 911,842 95,798 89,943 185,879 313,779 893,004 1,210,523

Gonorrhea 89,741 136,913 227,213 49,495 27,825 77,368 153,103 182,577 336,742

Primary Syphilis 1,889 216 2,105 1,224 149 1,373 3,230 372 3,602

Secondary Syphilis 5,589 1,211 6,803 2,203 622 2,825 8,025 1,870 9,898

Early Latent Syphilis 6,054 2,330 8,387 2,696 997 3,695 8,997 3,399 12,401

Late and Late Latent Syphilis§ 9,401 5,298 14,718 2,411 1,285 3,698 12,821 7,102 19,945

Chancroid 10 12 22 0 0 0 11 14 25

* Total includes unknown sex.

† Total includes unknown reporting source.

‡ Total includes unknown sex and reporting source.

§ Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other 

than neurosyphilis.
142 Appendix: Healthy People 2010 STD Surveillance 2008

Table A3. Healthy People 2010 Sexually Transmitted Diseases Objective Status

HP2010 Objectives

Baseline 

Year Baseline 2004 2005 2006 2007 2008

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* 1997 5.0% 6.9% 6.9% 7.1% 7.5% 7.8% 3.0%

b. Females aged 15 to 24 years attending STD clinics* 1997 12.2% 15.3% 15.4% 14.8% 15.3% 16.3% 3.0%

c. Males aged 15 to 24 years attending STD clinics* 1997 15.7% 20.8% 20.5% 20.8% 22.4% 23.7% 3.0%

d. Females aged 24 years or less enrolled in National Job 

Training Program 2002 10.1% 9.7% 9.2% 13.1% 13.2% 12.8% 6.8%

25–2 Reduce the incidence of gonorrhea (new cases per 

100,000 population)

a. Reduce gonorrhea incidence per 100, 000 population 1997 123.0 112.4 114.6 119.7 118.0 111.6 19.0

b. Females aged 15 to 44 years 2002 279.0 267.0 275.0 289.0 291.0 285.0 42.0

25–3 Eliminate sustained domestic transmission of 

primary and secondary syphilis (cases per 100,000 

population)

1997 3.2 2.7 2.9 3.3 3.8 4.5 0.2

25–4 Reduce the proportion of adults aged 20 to 29 years 

with genital herpes infection 1988–94 17.0% 10.0%† NA NA 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 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 NA 15.0%

25–9 Reduce congenital syphilis (cases per 100,000 live 

births) 1997 27.0 9.1 8.2 8.7 10.1 10.1 1.0

25–11 Adolescent sexual behavior (grades 9 through 12)

a. Increase the proportion of adolescents (grades 9 

through 12) who abstain from sexual intercourse or 

use condoms if currently sexually active

1999 50.0 NA 53.0 NA 52.0 NA 56.0

b. Increase the proportion of adolescents (grades 9 

through 12) who had sexual intercourse but not in the 

past 3 months

1999 27.0 NA 27.0 NA 27.0 NA 30.0

c. Increase the proportion of adolescents (grades 9 

through 12) who used condoms at last intercourse 1999 58.0 NA 63.0 NA 62.0 NA 65.0

25–13 Increase the proportion of Tribal state and local 

sexually transmitted disease programs that routinely 

offer hepatitis B vaccines to all STD clients

1998 5.0 NA NA NA NA NA 90.0

25–16 Increase the proportion of sexually active females 

aged 25 years and under who are screened annually 

for genital chlamydia infections

a. Females aged 25 years and under enrolled in 

commercial MCOs 2003 25 32 35 37 38 42 62

b. Females aged 25 years and under enrolled in Medicaid 

MCOs 2003 41 47 51 52 52 56 62

HP 2010 Objective Data Source

25–1 a, b, c Regional Infertility Prevention Projects (IPP), STD Surveillance System (STDSS), NCHHSTP, CDC.

25–1 d National Job Training Program, STD Surveillance System (STDSS), NCHHSTP, CDC.

25–2 a, b STD Surveillance System (STDSS), NCHHSTP, CDC.

25–3 STD Surveillance System (STDSS), NCHHSTP, CDC.

25–4 National Health and Nutrition Examination Survey (NHANES) , NCHS, CDC.

25–6 National Survey of Family Growth (NSFG) , NCHS, CDC.

25–7 National Survey of Family Growth (NSFG) , NCHS, CDC.

25–9 STD Surveillance System, NCHHSTP, CDC, National Vital Statistics System- Natality (NVSS-N), NCHS, CDC.

25–11 a, b, c Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC.

25–13 Survey of STD Programs, National Coalition of STD Directors (NCSD); IHS.

25–16 a, b Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA).

* Overall chlamydia positivity.

† Data for years 1999–2004.

NA=Not available.

NOTE: Healthy People 2010 developmental objectives are not addressed in this report.
STD Surveillance 2008 Appendix: GPRA Goals 143

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

and Measures

GPRA Goals Baseline Actual Performance

Long-Term 

Goal

2002 2007 2008 2010

Goal 1: Reduction in PID (as measured by initial visits to physicians in women 

15 to 44 years of age) 197,000 146,000 104,000 168,000

 a. Prevalence of Chlamydia in high-risk women <25 years* 10.1% 13.2% 12.8% 15.1%

 b. Prevalence of Chlamydia in women <25 years in family planning clinics* 5.6% 6.9% 7.4% 7.4%

 c. Incidence of Gonorrhea/100, 000 population in women 15–44 years of age 278.0 291.0 285.0 296

Goal 2: Elimination of Syphilis (as measured by incidence of P&S 

Syphilis/100,000 population) 2.4 3.8 4.5 2.2

 a. Incidence of P&S Syphilis/100, 000 population—men 3.8 6.6 7.6 7.2

 b. Incidence of P&S Syphilis/100, 000 population—women 1.1 1.1 1.5 1.2

 c. Incidence of Congenital Syphilis/100, 000 live births 10.2 10.1 10.1 9.4 

 d. Black:white rate ratio of P&S Syphilis 8:1 7:1 8:1 6.7:1

GPRA Goals Data Source

1 National Disease and Therapeutic Index (IMS Health).

1–a National Job Training Program.

1–b Regional Infertility Prevention Projects (IPP), STD Surveillance System (STDSS), NCHHSTP, CDC.

1–c STD Surveillance System (STDSS), NCHHSTP, CDC.

2 STD Surveillance System (STDSS), NCHHSTP, CDC.

2–a STD Surveillance System (STDSS), NCHHSTP, CDC.

2–b STD Surveillance System (STDSS), NCHHSTP, CDC.

2–c STD Surveillance System (STDSS), NCHHSTP, CDC.

2–d STD Surveillance System (STDSS), NCHHSTP, CDC.

*Median state-specific chlamydia prevalence/positivity.

STD Surveillance 2008 Appendix: STD Surveillance Case Definitions 145

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, Infection (Revised 6/09)

Clinical description

Infection with Chlamydia trachomatis may result in urethritis, epididymitis, cervicitis, acute salpingitis, or 

other syndromes when sexually transmitted; however, the infection is often asymptomatic in women. Perinatal 

infections may result in inclusion conjunctivitis and pneumonia in newborns. Other syndromes caused by C. 

trachomatis include lymphogranuloma venereum (see Lymphogranuloma Venereum) and trachoma.

Laboratory criteria for diagnosis

•	 Isolation of C. trachomatis by culture or

•	 Demonstration of C. trachomatis in a clinical specimen by detection of antigen or nucleic acid

Case classification

Confirmed: a case that is laboratory confirmed

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

•	 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
146 Appendix: STD Surveillance Case Definitions STD Surveillance 2008

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

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.
STD Surveillance 2008 Appendix: STD Surveillance Case Definitions 147

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.

Case classification

Probable: latent syphilis (see Syphilis, latent) that does not meet the criteria for early latent syphilis, and the 

patient is aged 13–35 years and has a nontreponemal titer ≥32

Neurosyphilis

Note

Since neurosyphilis can occur at almost any stage of syphilis, between 1996 and 2005, it was classified and 

reported as one of several mutually exclusive stages of syphilis. In 2005, the Division of STD Prevention 

requested that STD control programs discontinue classifying and reporting neurosyphilis as a distinct stage of 

syphilis. Since 2005, if the patient has confirmed or probable neurosyphilis, the case should be reported as the 

appropriate state of syphilis and neurological manifestations should be noted.
148 Appendix: STD Surveillance Case Definitions STD Surveillance 2008

Clinical description

Evidence of central nervous system infection with T. pallidum

Laboratory criteria for diagnosis

•	 A reactive serologic test for syphilis and reactive VDRL in cerebrospinal fluid (CSF) 

Case classification

Probable: syphilis of any stage, a negative VDRL in CSF, and both 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.

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.

*Inadequate treatment consists of any nonpenicillin therapy or penicillin administered <30 days before delivery.
STD Surveillance 2008 Appendix: STD Surveillance Case Definitions 149

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.
150 Appendix: STD Surveillance Case Definitions STD Surveillance 2008

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.
STD Surveillance 2008 Appendix: STD Surveillance Case Definitions 151

Granuloma Inguinale

Clinical description

A slowly progressive ulcerative disease of the skin and lymphatics of the genital and perianal area caused by 

infection with Calymmatobacterium granulomatis. A clinically compatible case would have one or more painless 

or minimally painful granulomatous lesions in the anogenital area.

Laboratory criteria for diagnosis

•	 Demonstration of intracytoplasmic Donovan bodies in Wright or Giemsa-stained smears or biopsies of 

granulation tissue

Case classification

Confirmed: a clinically compatible case that is laboratory confirmed

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, cottontipped 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
152 Appendix: STD Surveillance Case Definitions STD Surveillance 2008

Case classification

Confirmed: a clinically compatible case in a female who does not have either gonorrhea or trichomoniasis

Comment

Mucopurulent cervicitis (MPC) is a clinical diagnosis of exclusion. The syndrome may result from infection 

with any of several agents (see Chlamydia trachomatis, Genital Infections). If gonorrhea, trichomoniasis, and 

chlamydia are excluded, a clinically compatible illness should be classified as MPC. An illness in a female that 

meets the case definition of MPC and C. trachomatis infection should be classified as chlamydia.

Nongonococcal Urethritis (Revised 9/96)

Clinical description

Urethral inflammation that is not the result of infection with Neisseria gonorrhoeae. Urethral inflammation may 

be diagnosed by the presence of one of the following criteria:

•	 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
STD Surveillance 2008 Appendix: STD Surveillance Case Definitions 153

•	 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).
154 Appendix: Contributors STD Surveillance 2008

STD Project Directors, STD Program Managers, State and Territorial 

Epidemiologists, and Laboratory Directors

We gratefully acknowledge the contributions of state STD project directors, STD program managers, state 

and territorial epidemiologists, and laboratory directors. The persons listed were in the positions shown as of 

September 23, 2009.

State/City/Outlying Area STD Project Directors STD Program Managers State Epidemiologists Laboratory Directors

Alabama Charles Woernle Anthony Merriweather Charles Woernle Sharon Massingale

Alaska Mollie Rosier Donna Cecere Joe McLaughlin Bernard Jilly

Arizona Judy Norton Roxanne Ereth Kenneth Komatsu Victor Waddell

Arkansas Kevin Detner Mark Barnes Jim Phillips Glen Baker

California Gail Bolan Romni Neiman Gilberto Chavez Paul Kimsey

Los Angeles Peter Kerndt Mary Hayes Gilberto Chavez Sue Sabat

San Francisco Susan Philip Wendy Wolf Gilberto Chavez Sally Liska

Colorado Ralph Wilmoth Ralph Wilmoth Ken Gershman David Butcher

Connecticut Matthew Cartter Heidi Jenkins Matthew Cartter John Fontana

Delaware James Welch Catherine Mosley Paula Eggers (Acting) Jane Getchell

District of Columbia Shannon Hader John Heath John Davies-Cole Maurice Knuckles

Florida Karla Schmitt Karla Schmitt Richard Hopkins Max Salfinger

Georgia Vacant Vacant Susan Lance Elizabeth Franko

Hawaii Peter Whiticar Roy Ohye Sarah Park A. Christian Whelen

Idaho Kathy Cohen Annabeth Elliott Christine Hahn Christopher Ball

Illinois Charlie Rabins Ed Renier Craig Conover Tom Johnson

Chicago Will Wong John Paffel Craig Conover Susan Gerber

Indiana Larry Harris Clay Koher James Howell Judith Lovchik

Iowa Mary Jones Karen Thompson Patricia Quinlisk Christopher Atchison

Kansas Brenda Walker Derek Coppedge Charles Hunt Dennis Dobson

Kentucky Robert Brawley Chang Lee Kraig Humbaugh Stephanie Gibson

Louisiana Lisa Ann Longfellow Lisa Ann Longfellow Raoult Ratard Stephen Martin

Maine James Markiewicz Jennah Godo Dora Mills Kenneth Pote

Maryland Barbara Conrad Glen Oltoff David Blythe Jack DeBoy

Baltimore Vacant Victoria Stovall David Blythe Jack DeBoy

Massachusetts Thomas Bertrand Thomas Bertrand Alfred DeMaria Mary Gilchrist

Michigan Kristine Judd Kristine Judd Corrine Miller Frances Downes

Minnesota Christine Jones Peter Carr Ruth Lynfield Joanne Bartkus

Mississippi Craig Thompson Craig Thompson Mary Currier Daphne Ware

Missouri Michael Herbert Michael Herbert Sarah Patrick Bill Whitmar

Montana Laurie Kops Lisa Underwood Steve Helgerson Anne Weber

Nebraska Phil Medina Phil Medina Thomas Safranek Steve Hinrichs

Nevada Richard Whitley Julia Spaulding Ishan Azzam L. Dee Brown

New Hampshire Denise Rondeau Drew Thomits Jose Montero Christine Bean

New Jersey Gary Ludwig Patricia Mason Christina Tan Dennis Flynn

New Mexico Daniel Burke Carmelita Garcia C. Mack Sewell David Mills

New York F. Bruce Coles Dennis Murphy Perry Smith Lawrence Sturman

New York City Susan Blank Steve Rubin Perry Smith Sara Beatrice

North Carolina Evelyn Foust Evelyn Foust Megan Davies Leslie Wolf

North Dakota Vacant Julie Wagendorf Kirby Kruger Myra Kosse

Ohio Jan Keagy Amy LaGesse Forrest Smith Rosemarie Gearhart

Oklahoma Jan Fox Kristen Eberly Kristy Bradley Garry McKee

Oregon Vada Latin Doug Harger Katrina Hedberg Michael Skeels

Pennsylvania Weston Ruhrig Steve Kowalewski Veronica Urdaneta S.I. Shahied

Philadelphia Caroline Johnson Melinda Salmon Veronica Urdaneta Kerry Buchs

Rhode Island Utpala Bandy Michael Gosciminski Utpala Bandy Ewa King

South Carolina Andre Rawls (Acting) Vickie Boazman-Holmes (Acting) James Gibson Arthur Wozniak

South Dakota Laurie Gill David Morgan Lon Kightlinger Michael Smith

Tennessee Jeanece Seals Jane Russell Tim Jones David Smalley

Texas Ann Robbins Jim Lee Vincent Fonseca Susan Neill

Utah Emily Holmes Lynn Meinor Robert Rolfs Patrick Luedtke

Vermont Daniel Daltry Daniel Daltry Patsy Kelso Mary Celotti

Virginia Kathryn Hafford Kathryn Hafford (Acting) Keri Hall James Pearson

Washington Mark Aubin Mark Aubin Anthony Marfin Romesh Gautom

West Virginia Caroline Williams Caroline Williams Loretta Haddy Andrea Labik

Wisconsin Sandra Breitborde Anthony Wade Jeffrey Davis Charles Brokopp

Wyoming Brownen Anderson Canyon Hardesty Tracy Murphy Richard Harris

American Samoa Laumoli Salamo Fara Utu Sharmain Edwards Utoofili Mago

Federated States of Micronesia Vita Skilling Maylean Ekiek Nena Nena

Government of the Marshall Islands Justina Langidrik Zachraias Zachraias Paul Lalita

Northern Marianas (CNMI) Joseph Villagomez John Moreno James Hosfschneider Kevin Villagomez

Guam Josie O'Mallan Bernadette Schumann Lourdes Duguies Josie O'Mallan

Puerto Rico Greduvel Duran-Guzman Trinidad Garcia John Rullan Myriam Garcia-Negron

Republic of Palau Victor Yano Johana Ngiruchelbad Julie Erb-Alvarez Francis Permeteet

Virgin Islands Darlene Carty Gritell Martinez Eugene Tull Joseph Mark