Sex ually

Trans mitted

Dis ease

Sur veil lance

2007

Di vi sion of STD Pre ven tion

December 2008

 DE PART MENT OF HEALTH AND HU MAN SERVICES

Cen ters for Dis ease Con trol and Preven tion 

Na tional Cen ter for HIV/AIDS, Vi ral Hep a ti tis, STD, and TB Preven tion

Di vi sion of STD Pre ven tion

At lanta, Geor gia 30333

Cen ters for Dis ease Con trol and 

 Preven tion........................................Julie Lou ise Gerberding, M.D., M.P.H.

Di rec tor

Co or di nat ing Cen ter for 

 In fec tious Dis eases ...............................................Mitch ell L. Co hen, M.D.

Di rec tor

 Na tional Cen ter for HIV/AIDS, Vi ral Hepatitis, STD,

 and TB Preven tion..........................................Kevin Fenton, M.D., Ph.D.

Di rec tor

 Di vi sion of STD Preven tion ............................John M. Douglas, Jr., M.D.

Di rec tor

 Ep i de mi ol ogy and Surveil lance 

 Branch ...............................................Stu art M. Berman, M.D., Sc.M.

Chief

Surveil lance and Spe cial Stud ies 

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

Lead

Sta tis tics and Data Man age ment 

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

Chief

Delicia Carey, Ph.D.

Team Lead

iii
Copy right In for ma tion

All ma te rial con tained in this re port is in the pub lic do main and may be used and re printed

 without spe cial per mis sion; ci ta tion to source, how ever, is ap pre ci ated.

Sug gested Ci ta tion

Cen ters for Dis ease Con trol and Pre ven tion. Sex ually Trans mitted Dis ease Sur veil lance,

2007. At lanta, GA: U.S. De part ment of Health and Hu man Services; December 2008.

Printed cop ies and the on-line ver sion of this re port can be ob tained at the fol low ing web site: 

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

Selected STD Surveillance and Prevention References and Websites

Sup ple men tal STD Sur veil lance Re ports – 2007

• 2007 Chlamydia Prev a lence Mon i tor ing Pro ject: http://www.cdc.gov/std/chlamydia2007/

• 2007 Gono coc cal Iso late Sur veil lance Pro ject: http://www.cdc.gov/std/GISP2007/

• 2007 Syph i lis Sur veil lance Pro ject: http://www.cdc.gov/std/Syphilis2007/

STD Sur veil lance Re ports 1993–2007

• http://www.cdc.gov/std/stats/

STD Data on Won der

• 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 Treat ment Guide lines

• http://www.cdc.gov/STD/treatment/

STD Pro gram Evaluation Guide lines

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

STD Pro gram Op er a tion Guide lines

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

Rec om men da tions for Public Health Sur veil lance of Syph i lis in the United States

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

Be hav ioral Sur veil lance

• 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

iv
v

Fore word

“STDs are hid den epi dem ics of enormous

health and eco nomic con se quence in the

United States. They are hid den be cause

many Amer i cans are re luc tant to ad dress

sex ual health is sues in an open way and

be cause of the bi o logic and so cial

char ac ter is tics of these dis eases. All

Ameri cans have an in terest in STD

pre ven tion be cause all com mu ni ties are

im pacted by STDs and all in di vid u als

di rectly or in di rectly pay for the costs of

these dis eases. STDs are pub lic health

prob lems that lack easy so lu tions be cause

they are rooted in hu man be hav ior and

fun da men tal so ci etal prob lems. In deed,

there are many obsta cles to ef fec tive

pre ven tion ef forts. The first hur dle will be to 

con front the re luc tance of Amer i can so ci ety 

to openly con front is sues surround ing

sex u al ity and STDs. De spite the bar ri ers,

there are ex ist ing in di vid ual- and

com mu nity-based in ter ven tions that are

ef fec tive and can be im ple mented

im me di ately. That is why a multifaceted

approach is necessary to both the

individual and community levels.

To suc cess fully pre vent STDs, many

stakeholders need to re de fine their

mis sion, re fo cus their ef forts, mod ify

how they de liver services, and ac cept

new re spon si bil i ties. In this pro cess,

strong lead er ship, in no va tive think ing,

part ner ships, and ad e quate re sources

will be re quired. The ad di tional

in vest ment re quired to ef fec tively

pre vent STDs may be con sid er able, but

it is neg li gi ble when compared with the

likely re turn on the in vest ment. The

pro cess of pre vent ing STDs must be a

col lab o ra tive one. No one agency,

or ga ni za tion, or sec tor can ef fec tively do 

it alone; all mem bers of the com mu nity

must do their part. A suc cess ful na tional

ini tia tive to con front and pre vent STDs

re quires wide spread pub lic aware ness

and par tic i pa tion and bold na tional

lead er ship from the high est lev els.”1

1Con clud ing state ment from the In sti tute of

Med i cine’s Sum mary Re port, The Hid den

Ep i demic: Con front ing Sex u ally Trans mit ted

Dis eases, Na tional Acad emy Press, Wash ing ton,

DC, 1997, p.43.
Pref ace

Sex u ally Trans mit ted Dis ease Sur veil lance,

2007 pres ents sta tis tics and trends for

sex u ally trans mit ted dis eases (STDs) in the

United States through 2007. This an nual

pub li ca tion is in tended as a ref er ence

doc u ment for pol icy mak ers, pro gram

man ag ers, health plan ners, re search ers,

and oth ers who are con cerned with the

pub lic health im pli ca tions of these dis eases. 

The figures and ta bles in this edition

su per sede those in earlier

pub li ca tions of these data.

The sur veil lance in for ma tion in this re port

is based on the fol low ing sources of data:

(1) case re ports from state and lo cal STD

pro grams; (2) the Re gional In fer til ity

Pre ven tion Pro jects, the Na tional Job

Train ing Pro gram, the Cor rec tions STD

Prev a lence Mon i tor ing Pro ject, the Indian

Health Service, and the Men Who Have

Sex With Men (MSM) Prev a lence

Mon i tor ing Pro ject; (3) the Gono coc cal

Iso late Surveil lance Pro ject (GISP); and (4)

na tional sur veys im ple mented by fed eral

and pri vate or ga ni za tions.

The STD sur veil lance sys tems op er ated by

state and lo cal STD control pro grams,

which pro vide the case re port data for

chlamydia, gon or rhea, syph i lis, and

chancroid are the data sources of many of

the fig ures and most of the sta tis ti cal ta bles

in this pub li ca tion. These sys tems are an

in te gral part of pro gram man age ment at all

lev els of STD pre ven tion and con trol in the

United States. Be cause of in com plete

di ag no sis and re port ing, the num ber of

STD cases re ported to CDC is less than the

ac tual num ber of cases oc curring in the

United States pop u la tion. Case re port data

for other STDs are not avail able be cause

they are not na tion ally no ti fi able dis eases.

Sex u ally Trans mit ted Dis ease Sur veil lance, 

2007 con sists of four parts. The Na tional

Pro file con tains fig ures that pro vide an

overview of STD mor bid ity in the United

States. The ac com pa ny ing text iden ti fies

ma jor find ings and trends for se lected

STDs. The Spe cial Fo cus Pro files

con tain fig ures and text de scrib ing STDs in 

se lected sub groups and pop u la tions that

are a fo cus of na tional and state

pre ven tion ef forts. The De tailed Ta bles

pro vide sta tis ti cal in for ma tion about STDs

at the county, met ro pol i tan sta tis ti cal area

(MSA), re gional, state, and na tional lev els. 

The Ap pen dix in cludes in for ma tion on

in ter pret ing the STD sur veil lance data

used to produce this re port, Healthy

Peo ple 2010 STD ob jec tives, Gov ern ment

Performance and Re sults Act (GPRA)

goals, and STD surveil lance case

def i ni tions.

Se lected fig ures and ta bles in this doc u ment 

iden tify goals that re flect progress to wards

some of the Healthy Peo ple 2010

(HP2010) na tional health sta tus ob jec tives

for STDs.1 Ap pen dix Ta ble A3 dis plays

prog ress made to wards the HP2010 tar gets

for STDs. These tar gets are used as

ref erence points through out this edi tion of

Sex u ally Trans mit ted Dis ease Sur veil lance

2007.

vi 
Any comments and sug ges tions that

would im prove the use ful ness of fu ture

pub li ca tions are ap pre ci ated and should

be sent to Di rec tor, Di vi sion of STD

Pre ven tion, Na tional Cen ter for

HIV/AIDS, Viral Hepatitis, STD, and TB

Pre ven tion, Cen ters for Dis ease Con trol

and Pre ven tion, 1600 Clifton Road,

Mailstop E-02, At lanta, Georgia, 30333.

 vii

1 U.S. De part ment of Health and Hu man Ser vices.

Healthy Peo ple 2010. 2nd ed. With Un der standing

and Im prov ing Health and Ob jec tives for Improv ing 

Health. 2 vols. Wash ing ton, DC: U.S. Gov ern ment

Print ing Of fice, November 2000.
Ac knowl edg ments

Publication of this re port would not have been pos si ble with out the con tri bu tions of the

State and Ter ri to rial Health De part ments and the Sex u ally Trans mit ted Dis ease Con trol

Pro grams and the Re gional In fer til ity Pre ven tion Pro jects, which pro vided sur veil lance

data to the Cen ters for Dis ease Con trol and Pre ven tion.

This re port was pre pared by the fol low ing staff and con trac tors of the Di vi sion of STD

Pre ven tion, Na tional Cen ter for HIV/AIDS, Viral Hepatitis, STD, and TB Pre ven tion, Cen ters for 

Dis ease Con trol and Pre ven tion:

Office of the Director

Keith Da vis

John Douglas

Melinda Flock

Su zanne Haecker

Amy Pulver

Jill Wasserman

Ra chel Wynn

Epidemiology and Surveillance Branch

Stu art Berman

Deblina Datta

Kristen Mahle

Lori Newman

Catherine Lindsey Satterwhite

John Su

Hillard Weinstock

Eileen Yee

Statistics and Data Management Branch

 Su san Bradley

Jim Braxton

Delicia Carey

Sharon Clanton

Darlene Da vis

LaZetta Grier

Sam uel Groseclose

Alesia Harvey

Rose Hors ley

Kathleen Hutchins

Rob Nel son

Maya Stern berg

Akbar Zaidi

viii
ix

Con tents

Fore word ............................................................. v

Pref ace ............................................................. vi

Ac knowl edg ments ....................................................... viii

Fig ures in the Na tional Profile ............................................... x

Fig ures in the Spe cial Fo cus Profiles.......................................... xii

Ta bles in the Na tional Profile............................................... xiv

Geo graphic Di vi sions of the United States .................................... xvii

Na tional Over view of Sex u ally Trans mit ted Dis eases, 2007 ......................... 1

Na tional Pro file

In tro duc tion ............................................................. 5

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

Gon or rhea ............................................................ 17

Syph i lis ............................................................ 33

Other Sex u ally Trans mit ted Dis eases ......................................... 45

Spe cial Fo cus Profiles

In tro duc tion ............................................................ 51

STDs in Women and In fants ............................................... 53

STDs in Ado les cents and Young Adults ....................................... 63

STDs in Ra cial and Eth nic Mi nori ties ........................................ 69

STDs in Men Who Have Sex with Men ...................................... 79

STDs in Per sons En ter ing Cor rec tions Fa cil i ties ................................. 87

Ta bles

Na tional Sum mary ...................................................... 99

Chlamydia ........................................................... 101

Gon or rhea ........................................................... 112

Syph i lis ........................................................... 124

Chancroid ........................................................... 145

Se lected STDs ......................................................... 146

Ap pen dix

In ter pret ing STD Sur veil lance Data ......................................... 147

Ta ble A1. Se lected STDs — Per cent age of un known, miss ing, or in valid values

for se lected de mo graphic vari ables by state, 2007 ..................... 155

Ta ble A2. Re ported cases of sex u ally trans mit ted dis ease by sex and re port ing source:

United States, 2007 ............................................ 156

Ta ble A3. Healthy Peo ple 2010 Sex u ally Trans mit ted Dis eases Ob jec tive Sta tus ...... 157

Ta ble A4. Gov ern ment Per for mance Re sults Act (GPRA) Sex u ally Trans mit ted

Dis eases Goals and Mea sures..................................... 158

STD Sur veil lance Case Def i ni tions.......................................... 159

Con tri bu tors........................................................... 168
Fig ures in the Na tional Pro file

Chlamydia

Fig ure 1. Chlamydia — Rates: To tal and by sex: United States, 1988–2007 .......... 11

Fig ure 2. Chlamydia — Rates by re gion: United States, 1998–2007 ................ 11

Fig ure 3. Chlamydia — Rates by state: United States and out ly ing ar eas, 2007 ....... 12

Fig ure 4. Chlamydia — Rates by county: United States, 2007 .................... 12

Fig ure 5. Chlamydia — Age- and sex-spe cific rates: United States, 2007 ............ 13

Fig ure 6. Chlamydia — Rates by race/eth nic ity: United States, 1998–2007 .......... 13

Fig ure 7. Chlamydia — Cases by re port ing source and sex: United States,

1998–2007 ................................................... 14

Fig ure 8. Chlamydia — Prev a lence by age group and race/eth nic ity re ported

from a national sur vey, 1999–2002 ................................. 14

Fig ure 9. Chlamydia — Me dian state-spe cific positivity among 15- to 24-year-old

women tested in family plan ning clin ics: United States, 1997–2007 ......... 15

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

plan ning clin ics by state: United States and out ly ing ar eas, 2007 ........... 15

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

tested in fam ily plan ning clin ics by HHS re gion, 2003–2007 .............. 16

Fig ure 12. Chlamydia — Per cent of nu cleic acid ampli fi ca tion tests (NAATs)

used in fam ily plan ning clin ics among 15- to 24-year-old women by

HHS re gion, 2003–2007 ......................................... 16

Gon or rhea 

Fig ure 13. Gon or rhea — Rates: United States, 1941–2007 and the Healthy

Peo ple 2010 tar get.............................................. 24

Fig ure 14. Gon or rhea — Rates: To tal and by sex: United States, 1988–2007 and

the Healthy Peo ple 2010 tar get .................................... 24

Fig ure 15. Gon or rhea — Rates by re gion: United States, 1998–2007 and the

Healthy Peo ple 2010 tar get ....................................... 25

Fig ure 16. Gon or rhea — Rates by state: United States and out ly ing ar eas, 2007 ....... 25

Fig ure 17. Gon or rhea — Rates by county: United States, 2007 .................... 26

Fig ure 18. Gon or rhea — Age- and sex-spe cific rates: United States, 2007 ............ 26

Fig ure 19. Gon or rhea — Age-spe cific rates among women 15 to 44 years of age: 

United States, 1998–2007 ........................................ 27

Fig ure 20. Gon or rhea — Age-spe cific rates among men 15 to 44 years of age: 

United States, 1998–2007 ........................................ 27

Fig ure 21. Gon or rhea — Rates by race/eth nic ity: United States, 1998–2007 .......... 28

Fig ure 22. Gon or rhea — Cases by re port ing source and sex: United States,

1998–2007 ................................................... 28

Fig ure 23. Gon or rhea — Positivity among 15- to 24-year-old women tested

in fam ily plan ning clin ics by state: United States and out ly ing

ar eas, 2007 ................................................... 29

Fig ure 24. Gono coc cal Iso late Sur veil lance Pro ject (GISP) — Prev a lence of

ciprofloxacin re sis tant Neisseria gonorrhoeae by GISP site, 2004–2007 ...... 29

Fig ure 25. Gono coc cal Iso late Sur veil lance Pro ject (GISP) — Pen i cil lin, tet ra cy cline,

and ciprofloxacin re sis tance among GISP iso lates, 2007 ................. 30

x
Fig ure 26. Gono coc cal Iso late Sur veil lance Pro ject (GISP) — Per cent of Neisseria

gonorrhoeae iso lates with re sis tance or in ter me di ate re sis tance to

ciprofloxacin, 1990–2007......................................... 30

Fig ure 27. Gono coc cal Iso late Sur veil lance Pro ject (GISP) — Per cent of Neisseria

gonorrhoeae iso lates with re sis tance to ciprofloxacin by sex ual be hav ior,

2001–2007 ................................................... 31

Syph i lis 

Fig ure 28. Syph i lis — Re ported cases by stage of in fec tion: United States, 1941–2007... 37

Fig ure 29. Pri mary and sec ond ary syph i lis — Rates: To tal and by sex: United States,

1988–2007 and the Healthy Peo ple 2010 tar get ....................... 37

Fig ure 30. Pri mary and sec ond ary syph i lis — Rates by re gion: United States,

1998–2007 and the Healthy Peo ple 2010 tar get ....................... 38

Fig ure 31. Pri mary and sec ond ary syph i lis — Rates by state: United States and

out ly ing ar eas, 2007 ............................................ 38

Fig ure 32. Pri mary and sec ond ary syph i lis — Rates by county: United States, 2007..... 39

Fig ure 33. Pri mary and sec ond ary syph i lis — Age- and sex-spe cific rates:

United States, 2007 ............................................. 39

Fig ure 34. Pri mary and sec ond ary syph i lis — Age-spe cific rates among women

15 to 44 years of age: United States, 1998–2007 ....................... 40

Fig ure 35. Pri mary and sec ond ary syph i lis — Age-spe cific rates among men

15 to 44 years of age: United States, 1998–2007 ....................... 40

Fig ure 36. Primary and sec ond ary syph i lis — Rates by race/eth nic ity: United States,

1998–2007 .................................................... 41

Fig ure 37. Pri mary and sec ond ary syph i lis — Re ported cases by stage and sex ual

ori en ta tion, 2007 ............................................... 41

Fig ure 38. Pri mary and sec ond ary syph i lis — Re ported cases by sex ual ori en ta tion

and race/eth nic ity, 2007.......................................... 42

Fig ure 39. Pri mary and sec ond ary syph i lis — Re ported cases by re port ing source

and sex: United States, 1998–2007 ................................. 42

Fig ure 40. Pri mary and sec ond ary syph i lis — Per cent age of re ported cases by

sex ual ori en ta tion and se lected re port ing sources, 2007.................. 43

Fig ure 41. Con gen i tal syph i lis (CS) — Re ported cases for in fants < 1 year of age

and rates of pri mary and sec ond ary syph i lis among women:

United States, 1998–2007 ........................................ 43

Other Sex u ally Trans mit ted Dis eases

Fig ure 42. Chancroid — Re ported cases: United States, 1981–2007................. 48

Fig ure 43. Hu man papillomavirus (HPV) — Prev a lence of high-risk and low-risk

types among fe males 14 to 59 years of age reported from a na tional

sur vey, 2003–2004 ............................................. 48

Fig ure 44. Gen i tal warts — Ini tial vis its to phy si cians’ of fices: United States,

1966–2007 ................................................... 49

Fig ure 45. Gen i tal her pes — Ini tial vis its to phy si cians’ of fices: United States,

1966–2007 ................................................... 49

Fig ure 46. Gen i tal her pes — Her pes sim plex vi rus, type 2, seroprevalence in

non-His panic whites and non-His panic blacks by age group re ported

from a national sur vey, 1976–1980, 1988–1994, 1999–2004 ............. 50

Fig ure 47. Trichomoniasis and other vagi nal in fec tions in women — Ini tial vis its

to physi cians’ of fices: United States, 1966–2007 ....................... 51

xi
Fig ures in the Spe cial Fo cus Pro files

STDs in Women and In fants

Fig ure A. Chlamydia — Rates among women by state: United States and

out ly ing ar eas, 2007............................................. 59

Fig ure B. Chlamydia — Positivity in 15- to 24-year-old women tested in pre na tal

clin ics by state: United States and out ly ing ar eas, 2007 .................. 59

Fig ure C. Gon or rhea — Rates among women by state: United States and

out ly ing ar eas, 2007............................................. 60

Fig ure D. Gon or rhea — Positivity in 15- to 24-year-old women tested in pre na tal

clin ics by state: United States and out ly ing ar eas, 2007 .................. 60

Fig ure E. Pri mary and sec ond ary syph i lis — Rates among women by state:

United States and out ly ing ar eas, 2007 .............................. 61

Fig ure F. Con gen i tal syph i lis — Rates for in fants < 1 year of age by state:

United States and out ly ing ar eas, 2007 .............................. 61

Fig ure G. Ectopic preg nancy — Hos pi tal iza tions of women 15 to 44 years of age:

United States, 1997–2006 ........................................ 62

Fig ure H. Pel vic in flam ma tory dis ease — Hos pi tal iza tions of women 15 to 44 years

of age: United States, 1997–2006 .................................. 62

Fig ure I. Pel vic in flam ma tory dis ease — Ini tial vis its to phy si cians’ of fices by women

15 to 44 years of age: United States, 1998–2007 ....................... 63

STDs in Ad o les cents and Young Adults 

Fig ure J. Chlamydia — Trends in positivity among 15- to 19-year-old women

tested in fam ily plan ning clin ics by HHS re gion, 2003–2007 .............. 68

Fig ure K. Chlamydia — Prev a lence among 16- to 24-year-old women en ter ing

the Na tional Job Train ing Pro gram by state of resi dence: United States

and out ly ing ar eas, 2007 ......................................... 68

Fig ure L. Chlamydia — Prev a lence among 16- to 24-year-old men en ter ing

the Na tional Job Train ing Pro gram by state of resi dence: United States

and out ly ing ar eas, 2007 ......................................... 69

Fig ure M. Gon or rhea — Prev a lence among 16- to 24-year-old women en ter ing

the Na tional Job Train ing Pro gram by state of resi dence: United States

and out ly ing ar eas, 2007.......................................... 69

Fig ure N. Gon or rhea — Prev a lence among 16- to 24-year-old men en ter ing

the Na tional Job Train ing Pro gram by state of resi dence: United States

and out ly ing ar eas, 2007 ......................................... 70

STDs in Ra cial and Eth nic Mi nor i ties 

Fig ure O. Chlamydia — Rates by race/eth nic ity and sex: United States, 2007 ......... 75

Fig ure P. Chlamydia — Positivity among 15- to 24-year-old women screened

in In dian Health Service (IHS) clin ics by HHS re gion, 2007............... 75

Fig ure Q. Gon or rhea — Rate ra tios by race/eth nic ity: United States, 1998–2007 ...... 76

Fig ure R. Gon or rhea — Rates by race/eth nic ity and sex: United States, 2007 ......... 76

Fig ure S. Gon or rhea — Rate ra tios by race/eth nic ity and re gion: United States, 2007 . . 77

Fig ure T. Pri mary and sec ond ary syph i lis — Rates by race/eth nic ity and sex:

United States, 2007 ............................................. 77

xii
Fig ure U. Pri mary and sec ond ary syph i lis — Rates among 15- to 19-year-old

fe males by race/eth nic ity: United States, 1998–2007 .................... 78

Fig ure V. Pri mary and sec ond ary syph i lis — Rates among 15- to 19-year-old

 males by race/eth nic ity: United States, 1998–2007 ..................... 78

Fig ure W. Con gen i tal syph i lis — Rates among in fants < 1 year of age by mother’s

race/eth nic ity: United States, 1998–2007 ............................. 79

STDs in Men Who Have Sex with Men 

Fig ure X. MSM Prev a lence Mon i tor ing Pro ject — Num ber of gon or rhea tests

and num ber of posi tive tests in men who have sex with men, STD clin ics,

1999–2007 ................................................... 85

Fig ure Y. MSM Prev a lence Mon i tor ing Pro ject — Syph i lis se ro logic re ac tiv ity

among men who have sex with men, STD clin ics, 1999–2007............. 85

Fig ure Z. MSM Prev a lence Mon i tor ing Pro ject — City-spe cific me dian num ber

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

STD clin ics, 1999–2007 .......................................... 87

Fig ure AA. MSM Prev a lence Mon i tor ing Pro ject — Test positivity for gon or rhea,

chlamydia, and HIV and seroreactivity to syph i lis among men who

have sex with men, by race/eth nic ity, STD clin ics, 2007.................. 87

Fig ure BB. Gono coc cal Iso late Sur veil lance Pro ject (GISP) — Per cent of ure thral

Neisseria gonorrhoeae iso lates ob tained from men who have sex with

men at tend ing STD clin ics, 1988–2007 .............................. 88

Fig ure CC. Gono coc cal Iso late Sur veil lance Pro ject (GISP) — Per cent of ure thral

Neisseria gonorrhoeae iso lates ob tained from men who have sex with

men at tend ing STD clin ics by GISP site, 2004–2007 .................... 88

STDs in Per sons En ter ing Cor rec tions Fa cil i ties 

Fig ure DD. Chlamydia — Positivity by age and sex, ju ve nile cor rec tions

fa cil i ties, 2007 ................................................. 92

Fig ure EE. Chlamydia — Positivity by age group and sex, adult cor rec tions

fa cil i ties, 2007 ................................................. 92

Fig ure FF. Gon or rhea — Positivity by age and sex, ju ve nile cor rec tions

fa cil i ties, 2007 ................................................. 93

Fig ure GG.Gon or rhea — Positivity by age group and sex, adult cor rec tions

fa cil i ties, 2007 ................................................. 93

xiii
Ta bles in the Na tional Pro file

Na tional Sum mary

Ta ble 1. Cases of sex u ally trans mit ted dis eases re ported by state health

de part ments and rates per 100,000 pop u la tion: United States,

1941–2007 .................................................. 99 

Chlamydia

Ta ble 2. Chlamydia — Re ported cases and rates by state, ranked by rates:

United States, 2007 ............................................ 101

Ta ble 3. Chlamydia — Re ported cases and rates by state/area and re gion

 listed in al pha bet i cal order: United States and out ly ing ar eas, 2003–2007... 102

Ta ble 4. Chlamydia — Women – Re ported cases and rates by state/area

and re gion listed in al pha bet i cal order: United States and out ly ing ar eas,

2003–2007 .................................................. 103

Ta ble 5. Chlamydia — Men – Re ported cases and rates by state/area

 and re gion listed in al pha bet i cal order: United States and out ly ing ar eas,

2003–2007 .................................................. 104

Ta ble 6. Chlamydia — Re ported cases and rates in se lected met ro pol i tan

sta tis ti cal ar eas (MSAs) listed in al pha bet i cal or der: United States,

2003–2007 .................................................. 105

Ta ble 7. Chlamydia — Women – Re ported cases and rates in se lected

met ro pol i tan sta tis ti cal ar eas (MSAs) listed in al pha bet i cal or der:

United States, 2003–2007 ....................................... 106

Ta ble 8. Chlamydia — Men – Re ported cases and rates in se lected

met ro pol i tan sta tis ti cal ar eas (MSAs) listed in al pha bet i cal or der:

United States, 2003–2007 ....................................... 107

Ta ble 9. Chlamydia — Coun ties and in de pend ent cit ies ranked by num ber

of re ported cases: United States, 2007 .............................. 108

Ta ble 10. Chlamydia — Re ported cases and rates per 100,000 pop u la tion

by age group and sex: United States, 2003–2007 ..................... 109

Ta ble 11A. Chlamydia — Re ported cases by race/eth nic ity, age group and sex:

United States, 2003–2007 ....................................... 110

Ta ble 11B. Chlamydia — Rates per 100,000 pop u la tion by race/eth nic ity,

age group and sex: United States, 2003–2007 ........................ 111

Gon or rhea

Ta ble 12. Gon or rhea — Re ported cases and rates by state, ranked by rates:

 United States, 2007............................................ 112

Ta ble 13. Gon or rhea — Re ported cases and rates by state/area and re gion

listed in al pha bet i cal order: United States and out ly ing ar eas, 2003–2007 ... 113

Ta ble 14. Gon or rhea — Women – Re ported cases and rates by state/area

and re gion listed in al pha bet i cal order: United States and out ly ing ar eas,

2003–2007 .................................................. 114

Ta ble 15. Gon or rhea — Men – Re ported cases and rates by state/area

and re gion listed in al pha bet i cal order: United States and out ly ing ar eas,

2003–2007 .................................................. 115

xiv
Ta ble 16. Gon or rhea — Re ported cases and rates in se lected met ro pol i tan

sta tis ti cal ar eas (MSAs) listed in al pha bet i cal or der:

United States, 2003–2007 ....................................... 116

Ta ble 17. Gon or rhea — Women – Re ported cases and rates in se lected

met ro pol i tan sta tis ti cal ar eas (MSAs) listed in al pha bet i cal or der:

United States, 2003–2007 ....................................... 117

Ta ble 18. Gon or rhea — Men – Re ported cases and rates in se lected met ro pol i tan

sta tis ti cal ar eas (MSAs) listed in al pha bet i cal or der: United States,

2003–2007 .................................................. 118

Ta ble 19. Gon or rhea — Coun ties and in de pend ent cit ies ranked by num ber

of re ported cases: United States, 2007 .............................. 119

Ta ble 20. Gon or rhea — Re ported cases and rates per 100,000 pop u la tion

by age group and sex: United States, 2003–2007 ..................... 120

Ta ble 21A. Gon or rhea — Re ported cases by race/eth nic ity, age group and sex:

United States, 2003–2007 ....................................... 122

Ta ble 21B. Gon or rhea — Rates per 100,000 pop u la tion by race/eth nic ity,

age group and sex: United States, 2003–2007 ........................ 123

Syph i lis

Ta ble 22. All stages of syph i lis — Re ported cases and rates by state/area

and re gion listed in al pha bet i cal order: United States and out ly ing ar eas,

2003–2007 .................................................. 124

Ta ble 23. All stages of syph i lis — Re ported cases and rates in se lected

met ro pol i tan sta tis ti cal ar eas† (MSAs) listed in al pha bet i cal order:

United States, 2003–2007 ....................................... 125

Ta ble 24. Pri mary and sec ond ary syph i lis — Re ported cases and rates by state,

ranked by rates: United States, 2007 ............................... 126

Ta ble 25. Pri mary and sec ond ary syph i lis — Re ported cases and rates by

state/area and re gion listed in al pha bet i cal order: United States and

out ly ing ar eas, 2003–2007....................................... 127

Ta ble 26. Pri mary and sec ond ary syph i lis — Women – Re ported cases and

rates by state/area and re gion listed in al pha bet i cal order: United States

and out ly ing ar eas, 2003–2007 ................................... 128

Ta ble 27. Pri mary and sec ond ary syph i lis — Men – Re ported cases and rates

by state/area and re gion listed in al pha bet i cal order: United States

and out ly ing ar eas, 2003–2007 ................................... 129

Ta ble 28. Pri mary and sec ond ary syph i lis — Re ported cases and rates in

se lected met ro pol i tan sta tis ti cal ar eas (MSAs) listed in al pha bet i cal

or der: United States, 2003–2007 .................................. 130

Ta ble 29. Pri mary and sec ond ary syph i lis — Women – Re ported cases and

rates in se lected met ro pol i tan sta tis ti cal ar eas (MSAs) listed in al pha bet i cal

or der: United States, 2003–2007 .................................. 131

Ta ble 30. Pri mary and sec ond ary syph i lis — Men – Re ported cases and rates

in se lected met ro pol i tan sta tis ti cal ar eas (MSAs) listed in al pha bet i cal

or der: United States, 2003–2007 .................................. 132

Ta ble 31. Pri mary and sec ond ary syph i lis — Coun ties and in de pend ent cit ies

ranked by num ber of re ported cases: United States, 2007 ............... 133

Ta ble 32. Pri mary and sec ond ary syph i lis — Re ported cases and rates per 100,000

pop u la tion by age group and sex: United States, 2003–2007............. 134

Ta ble 33A. Pri mary and sec ond ary syph i lis — Re ported cases by race/eth nic ity,

age group and sex: United States, 2003–2007 ........................ 136

xv
Ta ble 33B. Pri mary and sec ond ary syph i lis — Rates per 100,000 pop u la tion by

race/eth nic ity, age group and sex: United States, 2003–2007............. 137

Ta ble 34. Early la tent syph i lis — Re ported cases and rates by state/area and

re gion listed in al pha bet i cal order: United States and out ly ing ar eas,

2003–2007 .................................................. 138

Ta ble 35. Early la tent syph i lis — Re ported cases and rates in se lected met ro pol i tan

sta tis ti cal ar eas (MSAs) listed in al pha bet i cal or der: United States,

2003–2007 .................................................. 139

Ta ble 36. Late and late la tent syph i lis — Re ported cases and rates by state/area

and re gion listed in al pha bet i cal order: United States and out ly ing ar eas,

2003–2007 .................................................. 140

Ta ble 37. Late and late la tent syph i lis — Re ported cases and rates in se lected

met ro pol i tan sta tis ti cal ar eas (MSAs) listed in al pha bet i cal or der:

United States, 2003–2007 ....................................... 137

Ta ble 38. Con gen i tal syph i lis — Re ported cases and rates in in fants < 1 year of age

by state, ranked by rates: United States, 2007 ........................ 142

Ta ble 39. Con gen i tal syph i lis — Re ported cases and rates in in fants < 1 year of age

by state/area and re gion listed in al pha bet i cal order: United States

and out ly ing ar eas, 2003–2007 ................................... 143

Ta ble 40. Con gen i tal syph i lis — Re ported cases and rates in in fants < 1 year of age

by race/eth nic ity of mother: United States, 2003–2007 ................. 144

Chancroid

Ta ble 41. Chancroid — Re ported cases and rates by state/area listed in al pha bet i cal

or der: United States and out ly ing areas, 2003–2007 ................... 145

Se lected STDs

Ta ble 42. Se lected STDs and compli ca tions — Ini tial vis its to phy si cians' of fices,

Na tional Dis ease and Ther a peu tic In dex: United States, 1966–2007 ....... 146

In ter pret ing STD Sur veil lance Data 

Ta ble A1. Se lected STDs — Per cent age of un known, miss ing, or in valid values

for se lected vari ables by state and by na tion ally no ti fi able STD, 2007 ...... 155

Ta ble A2. Re ported cases of sex u ally trans mit ted dis ease by re port ing source

and sex: United States, 2007 ..................................... 156

Ta ble A3. Healthy Peo ple 2010 Sex u ally Trans mit ted Dis eases Ob jec tive Sta tus ...... 157

Ta ble A4. Gov ern ment Per for mance Re sults Act (GPRA) Sex u ally Trans mit ted

Dis eases Goals and Mea sures..................................... 158

xvi
xvii

West Midwest Northeast

South

Geographic Divisions of the United States

West Midwest South Northeast

Alaska Il li nois Al a bama Con nect i cut

Ar i zona In di ana Ar kan sas Maine

Cal i for nia Iowa Del a ware Mas sa chu setts

Col o rado Kan sas Dis trict of Co lum bia New Hamp shire

Ha waii Mich i gan Florida New Jer sey

Idaho Min ne sota Geor gia New York

Montana Mis souri Ken tucky Penn syl va nia

Ne vada Ne braska Lou i si ana Rhode Is land

New Mex ico North Da kota Mary land Ver mont

Or e gon Ohio Mis sis sippi

Utah South Da kota North Carolina

Wash ing ton Wis con sin Oklahoma

Wy o ming South Carolina

Ten nes see

Texas

Vir ginia

West Virginia

National Overview of Sexually

Transmitted Diseases, 2007

The logo on the cover of Sexually

Transmitted Disease Surveillance, 2007 is a 

reminder of the multifaceted, national

dimensions of the morbidity, mortality, and

costs that result from sexually transmitted

diseases (STDs) in the United States. It

highlights the central role of STD

prevention in improving health among

women and infants and in promoting HIV

prevention. Organized collaboration among 

interested, committed public and private

organizations 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 Diseases,

1

 surveillance is a key

component of our efforts to prevent and

control these diseases.

This overview summarizes national

surveillance data on the three notifiable

diseases for which there are federallyfunded control programs: chlamydia,

gonorrhea, and syphilis. Several

observations for 2007 are worthy of note.

Chlamydia

In 2007, 1,108,374 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 370.2

cases per 100,000 population, an increase

of 7.5% compared with the rate in 2006.

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 and related

complications. The continued increase in

chlamydia case reports in 2007 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 2007, the overall rate of chlamydial

infection in the United States among

women (543.6 cases per 100,000 females)

was almost three times the rate among men 

(190.0 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 2003 through

2007, the chlamydia rate in men increased

by 43% (compared with a 17% 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 2007, the median state-specific

chlamydia test positivity among women 15

to 24 years of age who were screened at

selected family planning clinics in all states,

the District of Columbia, Puerto Rico, and

the Virgin Islands was 6.9% (range: 2.9% to 

16.8%) (Figures 9 and 10).

STD Surveillance 2007 Overview 1
At selected prenatal clinics in 22 states,

Puerto Rico, and the Virgin Islands the

median state-specific chlamydia

prevalence was 7.4% (range: 2.0% to

20.7%) (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 2007

from 40 states, the District of Columbia,

and Puerto Rico. The median state-specific

prevalence was 13.2% (range: 3.8% to

23.5%) (Figure K). Among men entering the

program in 2007 from 47 states, the District

of Columbia, and Puerto Rico the median

state-specific chlamydia prevalence was

7.2% (range: 2.0% to 14.5%) (Figure L).

The prevalence is also high among

adolescent women entering juvenile

detention centers. In 73 centers the median

chlamydia positivity by facility was 14.3%

(range: 2.5% to 32.1%) (Table A).

Among adolescent men entering 109

juvenile detention centers, the median

chlamydia positivity by facility was 5.7% 

(range: 0.0% to 14.2%) (Table A).

Although these data on prevalence are not

entirely comparable because of differences

in the populations screened, in the

performance characteristics of the screening 

tests, and variations in screening criteria,

they provide important information on the

continuing high burden of disease in the

United States.

Gonorrhea

Following a 74% decline in the rate of

reported gonorrhea from 1975 to 1997,

overall gonorrhea rates appeared to

plateau. In 2007, 355,991 cases of

gonorrhea were reported in the United

States, corresponding to a rate of 118.9

cases per 100,000 population, little change

from the rate in 2006 of 119.7 cases 

(Figure 13 and Table 1). This rate

considerably exceeds the Healthy People

2010 (HP2010) target of 19 cases per

100,000 population.

As in previous years, in 2007 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 5.3%

between 2003 and 2006. In 2007, the rate

remained essentially unchanged from 2006. 

The rate in the West decreased slightly in

2007 after a 29% increase between 2003

and 2006. While rates increased slightly in

the Northeast and Midwest from 2006 to

2007, they have remained relatively stable

over the past five years.

For the sixth consecutive year, the

gonorrhea rate in women in 2007 was

higher (123.5 per 100,000 population) than 

the rate among men (113.7 per 100,000

population) (Figure 14). As with chlamydia, 

gonorrhea rates in women 15 to 24 years

of age are particularly high. In men, they

are highest among men 20 to 29 years of

age (Figure 18). In 2007, the gonorrhea

rate among black men was 26 times higher

than that in white men; the gonorrhea rate

for black women was 15 times higher than

that in white women.

In 2007, 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.

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

National Job Training Program in 36 states, 

and Puerto Rico in 2007, the median

state-specific gonorrhea prevalence was

3.0% (range: 0.0% to 7.2%) (Figure M).

Among men entering the program from 32

states and Puerto Rico, the median

state-specific gonorrhea prevalence was

1.1% (range: 0.0% to 4.4%) (Figure N).

Among women entering juvenile

corrections facilities the median gonorrhea

2 Overview STD Surveillance 2007
positivity was 5.3% (range: 0.0% to

13.9%); the median gonorrhea positivity

for men entering juvenile corrections

facilities was 1.0% (range: 0.0% to 4.5%).

Among men who have sex with men

(MSM) attending eight STD clinics, the

median clinic urethral gonorrhea positivity

was 8.0% (range: 5% to 15%).

In the Gonococcal Isolate Surveillance

Project (GISP), a sentinel surveillance

project in 30 STD clinics throughout the

United States, 36% of the isolates from

MSM were resistant to ciprofloxacin in

2007. The overall proportion of resistant

isolates among heterosexuals was 8.7%. As

a result of the high prevalence of quinolone 

resistant N. gonorrhoeae among MSM and

heterosexuals, CDC revised the STD

Treatment Guidelines in 2007.

Fluoroquinolones are no longer

recommended for the treatment of

gonorrhea and associated conditions such

as pelvic inflammatory disease.2

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 2006.3 The rate of

P&S syphilis in the United States declined

by 89.7% from 1990 through 2000.

However, the rate of P&S syphilis has

increased each year since 2001, mostly in

men, but also in women for the past three

years. In 2007, 11,466 cases of P&S

syphilis were reported to CDC,

corresponding to a rate of 3.8 cases per

100,000 population, a 15% increase from

2006. Since 2001, the rate of P&S syphilis

has increased 81%. After 14 years of

decline, the rate of congenital syphilis

increased in 2006 and again in 2007, a

28% increase since 2005. There were 430

cases of congenital syphilis reported in

2007 compared to 373 reported cases in

2006 and 339 in 2005.

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 eight

years. The P&S syphilis rate for 2007 in

blacks was 7 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 33B). However, with

increases in syphilis among blacks occurring 

since 2003 at a greater rate than those

among whites, we are no longer seeing

declines in this health disparity. In 2007,

increases were observed among both black

men (23.2 cases per 100,000 population,

up from 18.1 in 2006) and black women

(5.6 cases per 100,000 population, up from 

4.9 in 2006). Smaller increases were

observed among white men (3.7 cases per

100,000 population, up from 3.5 in 2006)

and white women (0.4 per 100,000

population, up from 0.3 per 100,000 in

2006).

While syphilis elimination efforts have

successfully focused on heterosexual

minority populations at risk for syphilis,

increases in syphilis among MSM since

2001 and more recent increases among

women and blacks highlight the importance 

of continually reassessing and refining

surveillance, prevention, and control

strategies.

STD Surveillance 2007 Overview 3
4 Overview STD Surveillance 2007

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 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.

3 Division of STD Prevention. The National Plan

to Eliminate Syphilis from the United States.

National Center for HIV, STD, and TB

Prevention, Centers for Disease Control and

Prevention, 2006
ELI FORP LANOI TAN
ELI FORP LANOI TAN
Na tional Pro file

The Na tional Pro file sec tion con tains fig ures show ing trends and the dis tri bu tion of

na tion ally re port able sex u ally trans mit ted dis eases (chlamydia, gon or rhea, syph i lis and

chancroid) by age, sex, race/eth nic ity, and lo ca tion for the United States. Where rel e vant, the

fig ures il lus trate progress to wards spe cific Healthy Peo ple 2010 tar gets* for the na tion.1

STD Sur veil lance 2007 National Profile Na tional Pro file 5

* See the Ap pen dix for a list ing of the Healthy

Peo ple 2010 ob jec tives for the dis eases

ad dressed in this re port.

1 U.S. De part ment of Health and Hu man

Ser vices. Healthy Peo ple 2010. 2nd ed. With

Un der stand ing and Im prov ing Health and

Ob jec tives for Im prov ing Health. 2 vols.

Wash ing ton, DC: U.S. Gov ern ment Print ing

Of fice, No vem ber 2000.

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

from 2001 to 2002, chlamydia prevalence

was 4.2%.1

In women, chlamydial infections, which are 

usually asymptomatic, may result in pelvic

inflammatory disease (PID), which is a

major cause of infertility, ectopic pregnancy, 

and chronic pelvic pain. Data from a

randomized controlled trial of chlamydia

screening in a managed care setting

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 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. Due to the

large burden of disease and risks associated 

with infection, CDC recommends screening 

all sexually active women younger than 26

years of age for chlamydia annually.

4

The increase in reported chlamydial

infections during the last 10 years reflects

the expansion of chlamydia screening

activities, use of increasingly sensitive

diagnostic tests, an increased emphasis on

case reporting from providers and

laboratories, improvements in the

information systems for reporting, and,

possibly, true increases in disease.

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 women 16 through 25 years 

of age who receive medical care through

commercial or Medicaid managed care

organizations.5 In 2007, 36.4% of women

aged 16–20 years were screened in

commercial care settings; in Medicaid

populations, 48.8% of women aged 16–20

years were screened.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 2000, for the first time, all 50 states and

the District of Columbia had regulations

requiring the reporting of chlamydia cases. 

In 2007, 1,108,374 chlamydial infections

were reported to CDC from 50 states and

the District of Columbia (Table 1). This case 

STD Sur veil lance 2007 National Profile Chlamydia 7
count corresponds to a rate of 370.2 cases

per 100,000 population, an increase of

7.5% compared with the rate of 344.3 in

2006. The reported number of chlamydial

infections was over three times the number

of reported cases of gonorrhea (355,991

gonorrhea cases were reported in 2007)

(Table 1). 

From 1988 through 2007, the rate of

reported chlamydial infection increased

from 87.1 to 370.2 cases per 100,000

population (Figure 1, Table 1).

Chlamydia by Region 

For the years 1998 to 2007, overall rates

were similar in the Midwest, West, and

South (Figure 2). Rates have consistently

remained lowest in the Northeast. In

2007, reported cases continued to

increase in all regions (Table 3).

Chlamydia by State 

In 2007, chlamydia rates per 100,000

population by state ranged from 156.3

cases in New Hampshire to 745.1 cases in

Mississippi (Figure 3, Table 2). Fifteen

states, the District of Columbia, and Guam

had chlamydia case rates higher than 400

cases per 100,000 population.

Chlamydia by Metropolitan Statistical

Area (MSA) 

In 2007, 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 2007 case rate of 568.7 was a

7.7% increase over the 2006 case rate of

528.1 (Table 7). The 2007 case rate among

men (211.8 per 100,000 population)

increased 11.9% from the 2006 case rate

(189.2) (Table 8). In 2007, 57.3% 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 2007, 597 (19.0%) of 3,140

counties had rates greater than 400.0 cases

per 100,000 population. Rates per 100,000 

population were 300.0 or less in 2,228

counties (71.0%) and between 300.1 and 

400.0 in 315 counties (10.0%). Fifty-three 

counties and independent cities reported

40% of all chlamydia cases in 2007

(Table 9). Case rates ranged from 247.9

(Miami-Dade County, Florida) to 1,265.0

(St. Louis (City), Missouri) per 100,000

population.

Chlamydia by Sex 

In 2007, the overall rate of reported

chlamydial infection among women in all

50 states and the District of Columbia

(543.6 cases per 100,000 females) was

almost three times higher than the rate

among men (190.0 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 2003 through

2007, the chlamydial infection rate in men

increased by 42.9% (from 133.0 to 190.0

cases per 100,000 males) compared with a

17.3% increase in women during the same

period (from 463.6 to 543.6 cases per

100,000 females).

Chlamydia by Age

Among women, the highest age-specific

rates of reported chlamydia in 2007 were

8 Chlamydia National Profile STD Sur veil lance 2007
among those 15 to 19 years of age

(3,004.7 cases per 100,000 females) and

20 to 24 years of age (2,948.8 cases per

100,000 females) (Figure 5, Table 10).

When compared to 2003, case rates per

100,000 women have increased in these

two age groups by 12.4% and 17.3%,

respectively. These increased rates in

women may, in part, reflect increased

screening in this group. Age-specific rates

among men, while substantially lower

than the rates among women, were

highest in the 20- to 24-year-old age

group (932.9 cases per 100,000 males)

(Figure 5, Table 10). Chlamydia case

rates among men have increased in most

age groups since 2003.

Chlamydia by Race/Ethnicity

In 2007, chlamydia rates increased for all

racial and ethnic groups except American

Indian/Alaska Natives. (Figure 6, Table 11B). 

The rate of chlamydia among blacks was

over eight times higher than that of whites

(1,398.7 and 162.3 cases per 100,000,

respectively). The rates among American

Indian/Alaska Natives (732.9) and Hispanics 

(473.2) were also higher than that of whites 

(4.5 and 2.9 times higher, respectively). In

2007, the chlamydia case rate per 100,000

population among Asian/Pacific Islanders

was 139.5.

Chlamydia by Reporting Source

The majority of chlamydia cases reported in

2007 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

2007, among women, only 11.9% of

chlamydia cases were reported through an

STD clinic (98,382 of 825,660 total cases).

In contrast, among men, 33.1% of

chlamydia cases were reported through an

STD clinic in 2007 (92,906 of 280,337 total

cases).

Chlamydia Preva lence in the

Pop u la tion

The National Health and Nutrition

Examination Survey (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).

Chlamydia Prevalence Monitoring

Project

Chlamydia screening and prevalence

monitoring activities were initiated in

Health and Human Services (HHS) Region

X (Alaska, Idaho, Oregon, Washington) in

1988 as a CDC-supported demonstration

project. In 1993, chlamydia screening

services for women were expanded to three 

additional HHS regions (III, VII, and VIII)

and, in 1995, to the remaining HHS

regions (I, II, IV, V, VI, and IX). In some

regions, federally-funded chlamydia

screening supplements local-and

state-funded screening programs. Screening 

criteria and practices vary by region and

state.

Fam ily Plan ning Clin ics

In 2007, 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, Puerto Rico, and the

Virgin Islands was 6.9% (range: 2.9% to

16.8%) (Figures 9 and 10). Since 1997, the 

median chlamydia positivity rate has

slightly increased over time. This increase is 

likely due primarily to increasing usage of

more sensitive test technology. See

STD Sur veil lance 2007 National Profile Chlamydia 9
Appendix (Chlamydia, Gonorrhea, and

Syphilis Prevalence Monitoring) for details.

Chlamydia test positivity among

15–24-year-old women screened in family

planning clinics fluctuated in all 10 HHS

regions between 2003 and 2007 (Figure 11). 

Positivity has remained fairly stable in four

regions (I, III, V, X). From 2003 to 2006,

slight decreases in positivity occurred in one

region (II), followed by a small increase in

2007. In the remaining five regions (IV, VI,

VII, VIII, IX), positivity rates increased slightly 

over the five-year time frame from 2003 to

2007. 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 Usage of NAAT

technology in family planning clinics to

screen women aged 15–24 years for

chlamydia is widespread (Figure 12). In

four regions, NAATs were used nearly

exclusively from 2003 to 2007 (I, V, VII,

VIII). By 2007, five additional regions used

NAATs over 50% of the time (II, III, IV, IX,

X). Only one region (VI) reported a low

NAAT-usage rate in 2007; however, usage

increased from 2003 to 2007.

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 can be found 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 persons

recommended for screening. Racial

differences also persist; case rates among

blacks continue to be substantially higher

than rates among other racial/ethnic

groups.

10 Chlamydia National Profile STD Sur veil lance 2007

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.RR-11):38.

5 National Committee for Quality Assurance

(NCQA). HEDIS 2000: Technical Specifications, 

Washington, DC, 1999, pp. 68–70, 285–286.

6 National Committee for Quality Assurance

(NCQA). The state of healthcare quality 2008,

Washington, DC, 2008, pp.39.

7 Dicker LW, Mosure DJ, Levine WC. Chlamydia

positivity versus prevalence: what’s the

difference? Sexually Transmitted Diseases

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.
STD Surveillance 2007 National Profile Chlamydia 11

0

120

240

360

480

600

1988 90 92 94 96 98 2000 02 04 06

Rate (per 100,000 population)

Men

Women

Total

Fig ure 1. Chlamydia — Rates: Total and by sex: United States, 1988–2007

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

reporting of chlamydia cases.

0

80

160

240

320

400

1998 99 2000 01 02 03 04 05 06 07

Rate (per 100,000 population)

West

Midwest

Northeast

South

Fig ure 2. Chlamydia — Rates by re gion: United States, 1998–2007
12 Chlamydia National Profile STD Surveillance 2007

Rate per 100,000

population

Guam 481

Puerto Rico 201

Virgin Is. 320

<=300

300.1-400

>400

(n= 20)

(n= 17)

(n= 17)

VT 169

NH 156

MA 251

RI 298

CT 327

NJ 247

DE 408

MD 412

DC 1037

547

733

403

354

389 362

318

458

440

254

432 328

290

296

209

452

192

370

260

745

399

291

290 381

484

418

346

281

413

350

266

341

612

335

445

365

224

322

294

174

352

232

Fig ure 3. Chlamydia — Rates by state: United States and outlying areas, 2007

Note: The to tal rate of chlamydia for the United States and out ly ing ar eas (Guam, Puerto Rico and

Virgin Islands) was 368.1 per 100,000 population. For further information on chlamydia

reporting, see Appendix (Chlamydia Morbidity Reporting).

Rate per 100,000

population

<=300.0 (n= 2,228)

300.1-400.0 (n= 315)

>400.0 (n= 597)

Fig ure 4. Chlamydia — Rates by county: United States, 2007
STD Surveillance 2007 National Profile Chlamydia 13

Men Rate (per 100,000 population) Women

3250 2600 1950 1300 650 0 Age 0 650 1300 1950 2600 3250

11.8 10-14 123.0

615.0 15-19 3004.7

932.9 20-24 2948.8

518.6 25-29 1184.6

246.8 30-34 460.4

129.9 35-39 188.1

71.4 40-44 76.5

32.3 45-54 28.5

10.1 55-64 8.0

2.7 65+ 1.8

190.4 Total 544.8

Fig ure 5. Chlamydia — Age- and sex-specific rates: United States, 2007

0

340

680

1020

1360

1700

1998 99 2000 01 02 03 04 05 06 07

Rate (per 100,000 population)

American Indian/AK Native

Asian/Pacific Islander

Black

Hispanic White

Fig ure 6. Chlamydia — Rates by race/ethnicity: United States, 1998–2007
14 Chlamydia National Profile STD Surveillance 2007

0

150

300

450

600

750

1998 99 2000 01 02 03 04 05 06 07

Cases (in thousands)

non-STD Clinic Male

non-STD Clinic Female

STD Clinic Male

STD Clinic Female

Fig ure 7. Chlamydia — Cases by reporting source and sex: United States, 1998–2007

Prevalence

Non-Hispanic White

Non-Hispanic Black

Mexican-American

0

4

8

12

16

14-19 20-29 30-39

Fig ure 8. Chlamydia — Prevalence by age group and race/ethnicity reported from a

national survey, 1999–2002 

Note: Error bars indicate 95% confidence intervals.

SOURCE: National Health and Nutrition Examination Survey

Ann Intern Med. 2007 Jul 17;147(2):89–96.
STD Surveillance 2007 National Profile Chlamydia 15

Median state-specific positivity rate

0

2

4

6

8

10

1997 98 99 2000 01 02 03 04 05 06 07

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

tested in family planning clinics: United States, 1997–2007

Note: As of 1997, all 10 Health and Human Services (HHS) regions, representing all 50 states,

the District of Columbia, and outlying areas, reported chlamydia positivity data. See

Appendix for definitions of HHS regions.

SOURCE: Chlamydia Prevalence Monitoring Project (Re gional In fer til ity Prevention Pro jects); Of fice of Pop u la tion Af fairs;

Lo cal and State STD Con trol Pro grams; Cen ters for Dis ease Con trol and Pre ven tion

Positivity (%)

Puerto Rico 7.7

Virgin Is. 16.8

See*

<5.0

5.0-9.9

>=10.0

(n= 1)

(n= 6)

(n= 39)

(n= 7)

VT 3.5

NH 3.8

MA 4.5

RI 5.7

CT 6.8

NJ 7.7

DE 6.4

MD 5.7

DC

12.7

5.2

8.3

8.2

6.2 6.9

8.3

12.3

8.4

5.4

7.2 8.0

5.8

6.4

5.0

8.1

6.1

7.2

6.1

13.8

7.2

5.7

6.9 6.9

8.3

4.8

7.8

8.0

8.0

6.9

4.7

5.3

11.3

6.5

6.5

13.8

12.8

7.5

7.1

2.9

8.2

6.1

Fig ure 10. Chlamydia — Positivity among 15- to 24-year-old women tested in fam ily plan ning

clin ics by state: United States and outlying areas, 2007

*Data not available in 2007.

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

women aged 15–24 years screened during 2007.

SOURCE: Chlamydia Prevalence Monitoring Project (Re gional In fer til ity Prevention Pro jects); Of fice of Pop u la tion Af fairs;

Lo cal and State STD Con trol Pro grams; Cen ters for Dis ease Con trol and Pre ven tion
16 Chlamydia National Profile STD Surveillance 2007

Region I

Region II

Region III

Region IV

Region V

Region VII Region VI

Region VIII

Region IX

Region X

4.7

03

4.6

04

4.7

05

4.7

06

4.8

07

7.4

03

7.1

04

5.7

05

5.6

06

5.9

07

5.6

03

6.0

04

5.8

05

5.4

06

5.5

07

6.2

03

8.4

04

8.8

05

9.0

06

9.6

07

7.3

03

7.5

04

7.7

05

7.6

06

7.6

07

7.3

03

7.4

04

7.4

05

7.9

06

8.8

07

5.5

03

5.8

04

5.8

05

6.5

06

6.5

07

5.9

03

6.3

04

6.3

05

7.2

06

7.3

07

6.5

03

6.7

04

6.4

05

6.8

06

7.3

07

5.8

03

5.9

04

5.6

05

5.7

06

5.8

07

IV

VII IX

I

II

X

III

VI

V

VIII

Fig ure 11. Chlamydia — Trends in positivity among 15- to 24-year-old women tested in fam ily

plan ning clin ics by HHS re gion, 2003–2007

Note: See Appendix for definitions of HHS Regions.

SOURCE: Chlamydia Prevalence Monitoring Project (Re gional In fer til ity Prevention Pro jects); Of fice of Pop u la tion Af fairs;

Lo cal and State STD Con trol Pro grams; Cen ters for Dis ease Con trol and Pre ven tion

Region I

Percent

0

20

40

60

80

100

03 04 05 06 07

Region II

Percent

0

20

40

60

80

100

03 04 05 06 07

Region III

Percent

0

20

40

60

80

100

03 04 05 06 07

Region IV

Percent

0

20

40

60

80

100

03 04 05 06 07

Region V

Percent

0

20

40

60

80

100

03 04 05 06 07

Region VI

Percent

0

20

40

60

80

100

03 04 05 06 07

Region VII

Percent

0

20

40

60

80

100

03 04 05 06 07

Region VIII

Percent

0

20

40

60

80

100

03 04 05 06 07

Region IX

Percent

0

20

40

60

80

100

03 04 05 06 07

Region X

Percent

0

20

40

60

80

100

03 04 05 06 07

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 HHS

region, 2003–2007

Note: See Appendix for definitions of HHS Regions.

SOURCE: Chlamydia Prevalence Monitoring Project (Re gional In fer til ity Prevention Pro jects); Of fice of Pop u la tion Af fairs;

Lo cal and State STD Con trol Pro grams; Cen ters for Dis ease Con trol and Pre ven tion
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 ten years,

however, gonorrhea rates appear to

have reached a plateau, unfortunately

still far from the Healthy People 2010

target of 19 cases per 100,000

population (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 2006 led to

changes in national guidelines that now

limit the recommended treatment of

gonorrhea to a single class of drug, 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 areas, the number of gonorrhea

cases reported to CDC is affected by many

factors, in addition to the occurrence of the

infection within the population. As with

reporting of other STDs, reporting of

gonorrhea cases to CDC is incomplete.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 2007, 355,991 cases of gonorrhea were

reported in the United States. The rate of

reported gonorrhea in the United States

was 118.9 cases per 100,000 population in

2007 (Figure 13 and Table 1), a decrease of 

0.7% since 2006. Gonorrhea rates have

remained relatively stable for over 10 years.

Gonorrhea by Region 

As in previous years, in 2007 the South had 

the highest gonorrhea rate among the four

regions of the country (156.0 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

STD Sur veil lance 2007 National Profile Gonorrhea 17
have shown little change (Figure 15 and

Table 13).

An evaluation of increases in gonorrhea in

eight western states from 2000 to 2005

suggested that increases were likely due to

a variety of factors such as changes in

testing practices (increased volume and use

of more sensitive tests) as well as real

increases in disease.2

Gonorrhea by State

In 2007, only seven states and Puerto Rico

had gonorrhea rates below the HP2010

national target of 19 cases per 100,000

population (Figure 16 and Tables 12 and

13).6 This is an increase from 2006 of three

states (Montana, North Dakota, and

Wyoming) that now meet the HP2010

target.

Gonorrhea by Metropolitan Statistical

Area (MSA)

The overall gonorrhea rate in the 50 most

populous MSAs was 129.4 cases per

100,000 population in 2007. This is

essentially unchanged from 2006. All of

these MSAs had rates higher than the

HP2010 target of 19 cases per 100,000

population. In 2007, 58.6% of

gonorrhea cases were reported by these

MSAs (Table 16). Similar to previous

years, in 2007 the total gonorrhea rate

among females in these MSAs (128.4)

remained similar to that among males

(129.9) (Tables 17 and 18).

Gonorrhea by County 

In 2007, 1,305 (41.6%) of 3,140 counties

in the United States had gonorrhea rates at

or below the HP2010 national target of 19

cases per 100,000 population. Rates per

100,000 population were between 19 and

100 in 1,099 counties (35.0%), and greater

than 100 in 736 counties (23.4%). The

majority of counties with greater than 100

cases per 100,000 population were located

in the South (Figure 17). 

In 2007, 50% of reported gonorrhea cases

occurred in just 69 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 seventh consecutive year, however,

gonorrhea rates among women and men

were similar with rates among women

being slightly higher (Figure 14). In 2007,

the gonorrhea rate among women was

123.5 and the rate among men was 113.7

cases per 100,000 population (Tables 14

and 15).

Gonorrhea by Age

In 2007, gonorrhea rates continued to be

highest among adolescents and young

adults. Among females in 2007, 15- to 19

and 20- to 24-year-old women had the

highest rates of gonorrhea (647.9 and

614.5, respectively). Among males, the rate 

was highest in those 20 to 24 years of age 

(450.1) (Figure 18 and Table 20). 

From 2003 to 2007, slight increases were

seen among the age groups under 35 years

(4.8% among those 15 to 19 years of age,

2.6% among those 20 to 24 years of age,

5.8% among those 25 to 29 years of age,

and 4.3% among those 30 to 34 years of

age) (Table 20). Slight decreases were seen

among those 35 to 39 years of age (4.6%),

and those 40 to 44 years of age (2.0%).

Among females between 15 and 44 years

of age (from 2003 to 2007) increases were

greatest in those 25 to 29 years of age

(10.9%) and those 30 to 34 years of age

(11.4%). Among males between 15 and 44

years of age, increases over that time

period were seen among those 15 to 19

years of age (9.5%) and those 25 to 29

years of age (1.5%) (Figures 19 and 20,

and Table 20).

18 Gonorrhea National Profile STD Sur veil lance 2007
Gonorrhea by Race/Ethnicity 

In 2007, gonorrhea rates remained highest

among blacks (662.9 cases per 100,000

population, Table 21B and Figure 21).

Similar to recent years, the rate among

blacks was 19.1 times greater than the rate

among whites (34.7 cases per 100,000

population). Gonorrhea rates were 3.1

times greater among American

Indian/Alaska Natives (107.1 cases per

100,000 population), and 2.0 times greater

among Hispanics (69.2 cases per 100,000

population) than among whites in 2007.

Rates among whites were 1.8 times higher

than those among Asian Pacific Islanders

(18.8 cases per 100,000 population in

2007 (Figure 21).

Between 2003 and 2007, gonorrhea rates

showed no marked changes for any racial

or ethnic group, except for a 14.9% decline 

among Asian Pacific Islanders. There was a 

21.8% decline among American Indian/

Alaska Natives from 2006 to 2007 (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 2003 and 2007, gonorrhea rates

among women increased 19.1% in the

West, 8.7% in the South, and 5.5% in the

Midwest. Gonorrhea rates among women

decreased 19.7% in the Northeast during

the same time period.

Between 2003 and 2007, gonorrhea rates

among men increased 15.1% in the West

and 1.7% in the South, and decreased

9.4% in the Northeast and 0.5% in the

Midwest (Tables 14 and 15).

Gonorrhea by Race/Ethnicity and Sex

From 2003 to 2007, overall rates among

white, Hispanic, American Indian/Alaska

Native, and black men increased (2.7%,

2.6%, 1.0%, and 0.4% respectively).

Gonorrhea rates decreased only among

Asian/Pacific Islander males (5.3%)

(Table 21B).

Between 2003 and 2007 the overall rate

among white, American Indian/Alaska

Native, and black women increased (9.0%,

6.1%, and 3.8% respectively). However,

decreases were seen among Asian/Pacific

Islander and Hispanic women (21.8% and

3.4% respectively) (Table 21 B). 

Currently, 15- to 19-year-old black women

still have the highest gonorrhea rate of any

group (2,955.7 per 100,000 population),

closely followed by 20- to 24 year-old black 

women (2,789.2), and 20- to 24-year-old

black men (2,451.3).

Gonorrhea by Reporting Source 

In 2007, 26.7% of gonorrhea cases were

reported by STD clinics (Table A2). This

is a slight change from 2003, when

29.9% of gonorrhea cases were reported

by STD clinics. In 2007, a higher

proportion of male gonorrhea cases were

reported from STD clinics than female

cases (37.2% and 17.3% respectively)

(Figure 22 and Table A2).

Gonorrhea Prevalence Monitoring

Project

Gonorrhea test positivity data are available

from a variety of settings. Screening criteria

and practices may vary by state and over

time.

Fam ily Plan ning Clin ics

In 2007, the median state-specific

gonorrhea test positivity among 15- to

24-year-old women screened in selected

family planning clinics in 43 states, Puerto

Rico, and the Virgin Islands was 0.9%

(range: 0.1% to 4.9%) (Figure 23). Median

gonorrhea positivity in family planning

clinics has shown minimal change in recent

years (range: 0.8% to 1.1% between 2003

and 2007).

STD Sur veil lance 2007 National Profile Gonorrhea 19
Pre na tal Clin ics

For women attending selected prenatal

clinics in 19 states, Puerto Rico, and the

Virgin Islands, the median positivity was

0.8% (range: 0.0% to 3.9%) (Figure D).

Median gonorrhea positivity in prenatal

clinics has shown minimal change in recent

years (range: 0.8% to1.0% between 2003

and 2007).

Na tional Job Train ing Pro gram

Among 16- to 24-year-old women entering

the National Job Training Program in 36

states and Puerto Rico in 2007, the median 

state-specific gonorrhea prevalence was

3.0% (range: 0.0% to 7.2%) (Figure M).

Among men entering the program from 32

states and Puerto Rico in 2007, the median 

state-specific gonorrhea positivity was 1.1% 

(range: 0.0% to 4.4%) (Figure N).

Ju ve nile Cor rec tions

In 2007, the median positivity for

gonorrhea by facility in women entering 52

juvenile corrections facilities was 5.3%

(range: 0.0% to 13.9%). In men entering

90 juvenile corrections facilities in 2007, the 

median was 1.0% (range: 0.0% to 4.5%)

(Table C).

Gonococcal Isolate Surveillance

Project (GISP) 

Antimicrobial resistance remains an

important consideration in the treatment of

gonorrhea.3, 109118127,3,14,,, In 1986, the Gonococcal

Isolate Surveillance Project (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 sites14

(Figure 24). 

Overall in 2007, 27% of isolates collected

from 29 of 30 GISP sites were resistant to

penicillin, tetracycline, ciprofloxacin, or

some combination of those antibiotics

(Figure 25).

Quinolone-re sis tant N. Gonorrhoeae (QRNG)

Resistance to ciprofloxacin (a fluoroquinolone 

in the quinolone family of antimicrobials) was 

first identified in GISP sites in 1991. From

1991 through 1998, fewer than nine

quinolone-resistant N. gonorrhoeae (QRNG)

isolates were identified each year, and such

isolates were identified in only a few GISP

clinics. However since 1999 QRNG

prevalence has steadily increased, first in

Hawaii and the Pacific Islands, then in the

Western states, and then among MSM.

7,9,10

In 2007, 891 (14.8%) of 6,009 GISP

isolates collected were identified as QRNG,

an increase from 2006, when 843/6,089

(13.8%) isolates were identified as QRNG

(Figure 26). QRNG isolates were identified

from all 29 GISP sites that submitted

isolates in 2007. GISP did not receive any

isolates from Tripler in 2007.

QRNG by Re gion

In 2007, QRNG increased most markedly

in those regions where prevalence had

been relatively low.

In 2007, 20 (28.6%) of 70 isolates

submitted from Honolulu demonstrated

ciprofloxacin-resistance, a decrease from 

34 (35.8%) of 95 isolates in 2006.

From 2006 to 2007, several western sites

demonstrated an increase in the number of

isolates resistant to ciprofloxacin. In

Albuquerque, the prevalence of QRNG

more than doubled to 16.7% of isolates

collected in 2007 from 7.3% in 2006; in

Denver, 17% were resistant to

fluoroquinolones in 2007 compared with

15.7% in 2006; in Las Vegas, the

prevalence also doubled to 18.7% in 2007

from 8.7% in 2006; in Long Beach, 30.4%

were resistant in 2007 compared to 28.4%

in 2006; in Orange County, 41% were

resistant in 2007 compared with 34.6% in

2006; in Portland, 28.6% were resistant in

20 Gonorrhea National Profile STD Sur veil lance 2007

3,7-14
2007 compared with 27.2% in 2006; and

in San Diego, 36.3% were resistant in 2007

compared with 35.1% in 2006. The

prevalence in Los Angeles was relatively the 

same at 22.4% in 2007. In other western

sites such as Phoenix, San Francisco, and

Seattle, the prevalence of QRNG decreased 

slightly during the same time period. In

Phoenix, 8.7% of isolates were QRNG

when compared with 11.9% in 2006; in

San Francisco, the prevalence of QRNG

decreased to 31.3% in 2007 from 44.5% in 

2006; and in Seattle to 29.3% in 2007 from 

31.8% in 2006.

In the South from 2006 to 2007, most of

the sites continued to observe increases in

the prevalence of QRNG. In Baltimore,

QRNG resistance increased to 2% in 2007

from 1.4% in 2006; in Birmingham, the

prevalence increased about eight fold to

9.4% in 2007 from 1.1% in 2006; in Dallas, 

the prevalence increased to 7.5% from

6.1%; in Greensboro, it tripled to 5.3%

from 1.7%; in New Orleans it increased to

18.1% from 10.2%; and in Oklahoma City,

it increased to 6% from 4.3%. However, in

Atlanta, where isolates were submitted from 

January—April 2007 only, the prevalence

of QRNG decreased to 2.6% in 2007 from

5.7% in 2006. In Miami, the prevalence of

QRNG remained about the same in 2007

at 19.6%.

In the Midwest and Northeast there were 

dramatic increases in prevalence of QRNG

from 2006 to 2007 among several sites. In

Chicago, the prevalence of isolates that

were resistant to ciprofloxacin doubled to

8.6% in 2007 from 4.1% in 2006; in

Cincinnati, the prevalence almost doubled

to 1.2% in 2007 from 0.7% in 2006; in

Detroit, it increased by five fold to 1.7% in

2007 from 0.3% in 2006; in Minneapolis, it 

doubled to 10.7% in 2007 from 5.7% in

2006; and in New York City, it also almost

doubled to 14.9% in 2007 from 7.6% in

2006. There was a decrease in QRNG

prevalence in Cleveland to 0.7% in 2007

from 3.1% in 2006 and in Philadelphia to

29.1% from 30.3%, respectively.

New sites in GISP that identified

ciprofloxacin-resistant isolates included

Kansas City and Richmond. Kansas City

rejoined GISP in September 2007 and

observed a QRNG prevalence of 16.4% in

2007. Richmond started collection in

November 2007 and QRNG was identified

in 17.9% of isolates.

QRNG by Sex ual Be hav ior

The prevalence of QRNG in isolates from

MSM slightly decreased from 39% in 2006

to 36% in 2007. During the same time

period, the prevalence of QRNG in isolates

from heterosexuals increased from 7% to

9% (Figure 27).

As a result of high and continued

widespread prevalence of QRNG among

MSM and then more recently, among

heterosexuals, CDC revised the 2006 CDC

STD Treatment Guidelines in April 2007.3

Therefore, CDC states that

fluoroquinolones are no longer

recommended for use in the United States

for the treatment of gonococcal infections

and associated conditions such as pelvic

inflammatory disease.3

Other Antimicrobial Sus cep ti bil ity Test ing 

The proportion of GISP isolates

demonstrating decreased susceptibility to

ceftriaxone or cefixime has remained very

low over time. Overall in GISP, from 1987

to 2007, there have been a total of four

isolates with decreased susceptibility to

ceftriaxone (all four had minimum

inhibitory concentrations (MICs) of 0.5

μg/ml) and 48 isolates with decreased

susceptibility to cefixime (MIC range from

0.5–2.0 μg/ml) in GISP. In 2007, there were 

no isolates identified with decreased

susceptibility to ceftriaxone. (Note:

Cefixime was discontinued in 2007 from

the GISP antibiotic susceptibility panel.)

STD Sur veil lance 2007 National Profile Gonorrhea 21
The proportion of GISP isolates

demonstrating elevated MICs to

azithromycin has been increasing since

GISP began monitoring azithromycin

susceptibility in 1992. In 2005, there was a

change in the media used for antimicrobial

susceptibility testing which resulted in an

observational shift of the MIC curve for

azithromycin. Thus, the azithromycin MIC

for decreased susceptibility was changed

from 1.0 μg/ml to 2.0 μg/ml in 2005

and thereafter. In 2007, 0.5% (27/6,009)

isolates had azithromycin MIC ≥ 2.0 μg/ml

compared to 0.2% (14/6,089) in 2006.

Additional information on antimicrobial

susceptibility data and on GISP may be

found in the 2007 GISP report

8

 or the GISP 

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

Gonorrhea Among Special Populations

Additional information about gonorrhea in

racial and ethnic minority populations,

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

approximately ten years. Unfortunately the

2007 rate of 118.9 cases per 100,000

population is still greater than the Healthy

People 2010 goal of 19 cases per 100,000

population. Of particular concern are the

persistent high rates in some geographic

areas, adolescents and young adults, and

some racial/ethnic groups.

Although fluoroquinolones are no longer

recommended for treatment of gonococcal

infections in the U.S., GISP data continues

to show widespread increases in QRNG

prevalence throughout the country. With

only one class of antibiotics recommended

for treating gonorrhea, continued

monitoring for the emergence of decreased

susceptibility and resistance to

cephalosporins is critical.

22 Gonorrhea National Profile STD Sur veil lance 2007

1

Flem ing DT, Wasserheit JN. From

ep i de mi o log i cal syn ergy to pub lic health pol icy

and practice: the con tri bu tion of other sex u ally

trans mit ted dis eases to sex ual trans mis sion of

HIV in fec tion. 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 Con trol and Pre ven tion.

Up date to CDC’s Sex u ally Trans mit ted

Dis eases Treat ment Guide lines, 2006:

Fluoroquinolones No Lon ger Recom mended for 

Treat ment of Gono coc cal In fec tions. MMWR,

2007;56: 332–336.

4 Cen ters for Dis ease Con trol and Pre ven tion.

Gon or rhea – United States, 1998. MMWR

2000;49:538–42.

5

Sex u ally Trans mit ted Dis eases in Amer ica: How

Many Cases and At What Cost? Pre pared for

the Kai ser Fam ily Foun da tion by: Amer i can

So cial Health As so ci a tion, De cem ber 1998,

ASHA: Re search Tri an gle Park, NC, Kaiser

Fam ily Foun da tion: Menlo Park, CA 94025.

6 U.S. Department of Health and Human

Services. Healthy People 2010. 2nd ed. With

Understanding and Improving Health and

Objectives for Improving Health. 2 vols.

Washington, DC: U.S. Government Printing

Office, November 2000.

7 Centers for Disease Control and Prevention.

Fluoroquinolone-resistance in Neisseria

gonorrhoeae, Hawaii, 1999, and decreased

susceptibility to azithromycin in N. gonorrhoeae, 

Missouri, 1999. MMWR 2000;49:833–837.
STD Sur veil lance 2007 National Profile Gonorrhea 23

8 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 (available first quarter 2009).

9 Centers for Disease Control and Prevention.

Increases in fluoroquinolone-resistant Neisseria

gonorrhoeae – Hawaii and California, 2001

MMWR 2002;51:1041–1044.

10Centers 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.

11Centers for Disease Control and Prevention.

Sexually Transmitted Diseases Treatment

Guidelines, 2006. MMWR, 2006;55(No.RR-11).

12Wang 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.

13Wang 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.

14Schwarcz S, Zenilman J, Schnell D, et al.

National surveillance of antimicrobial resistance

in Neisseria gonorrhoeae. JAMA

1990;264:1413–1417.
24 Gonorrhea National Profile STD Surveillance 2007

0

100

200

300

400

500

1941 46 51 56 61 66 71 76 81 86 91 96 2001 06

Rate (per 100,000 population)

Gonorrhea

2010 Target

Figure 13. Gon or rhea — Rates: United States, 1941–2007 and the Healthy Peo ple 2010

target

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

0

80

160

240

320

400

1988 90 92 94 96 98 2000 02 04 06

Rate (per 100,000 population)

Male

Female

Total

2010 Target

Figure 14. Gon or rhea — Rates: Total and by sex: United States, 1988–2007 and the

Healthy People 2010 target

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.
STD Surveillance 2007 National Profile Gonorrhea 25

0

60

120

180

240

300

1998 99 2000 01 02 03 04 05 06 07

Rate (per 100,000 population)

West

Midwest

Northeast

South

2010 Target

Figure 15. Gon or rhea — Rates by region: United States, 1998–2007 and the Healthy People 

2010 target

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

Rate per 100,000

population

Guam 82.4

Puerto Rico 8.2

Virgin Is. 63.5

<=19.0

19.1-100.0

>100

(n= 8)

(n= 25)

(n= 21)

VT 10.3

NH 10.5

MA 41.9

RI 37.7

CT 66.4

NJ 69.6

DE 151.5

MD 120.5

DC 408.1

236.7

86.4

82.1

148.3

85.8 71.0

129.0

190.5

51.3

18.3

162.2 139.2

64.7

82.6

82.0

259.7

8.9

153.4

66.9

285.7

169.0

12.9

81.1 94.4

91.9

91.7

188.2

18.2

183.5

134.9

33.4

102.1

239.0

33.4

158.4

136.4

32.2

82.0

57.1

51.1

121.5

15.7

Figure 16. Gon or rhea — Rates by state: United States and outlying areas, 2007 

Note: The to tal rate of gon or rhea for the United States and out ly ing ar eas (Guam, Puerto Rico and

Vir gin Is lands) was 117.4 per 100,000 pop u la tion. The Healthy People 2010 target is 19.0

cases per 100,000 population. 
26 Gonorrhea National Profile STD Surveillance 2007

Rate per 100,000

population

<=19.0 (n= 1,305)

19.1-100.0 (n= 1,099)

>100.0 (n= 736)

Figure 17. Gon or rhea — Rates by county: United States, 2007

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

Men Rate (per 100,000 population) Women

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

5.9 10-14 33.1

286.0 15-19 647.9

450.1 20-24 614.5

305.1 25-29 287.1

181.5 30-34 125.2

119.5 35-39 60.5

86.6 40-44 30.8

50.2 45-54 12.1

17.7 55-64 3.0

4.0 65+ 0.4

113.9 Total 123.8

Figure 18. Gon or rhea — Age- and sex-specific rates: United States, 2007
STD Surveillance 2007 National Profile Gonorrhea 27

0

200

400

600

800

1,000

1998 99 2000 01 02 03 04 05 06 07

Rate (per 100,000 population)

15-19 20-24

25-29 30-34

35-39 40-44

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

United States, 1998–2007

0

150

300

450

600

750

1998 99 2000 01 02 03 04 05 06 07

Rate (per 100,000 population)

15-19 20-24

25-29 30-34

35-39 40-44

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

United States, 1998–2007
28 Gonorrhea National Profile STD Surveillance 2007

0

180

360

540

720

900

1998 99 2000 01 02 03 04 05 06 07

Rate (per 100,000 population)

American Indian/AK Native

Asian/Pacific Islander

Black

Hispanic White

Figure 21. Gon or rhea — Rates by race/ethnicity: United States, 1998–2007

0

40

80

120

160

200

1998 99 2000 01 02 03 04 05 06 07

Cases (in thousands)

non-STD Clinic Male

non-STD Clinic Female

STD Clinic Male

STD Clinic Female

Figure 22. Gon or rhea — Cases by reporting source and sex: United States, 1998–2007
STD Surveillance 2007 National Profile Gonorrhea 29

Positivity (%)

Puerto Rico 0.1

Virgin Is. 3.6

See*

<1.0

1.0-1.9

>=2.0

(n= 8)

(n= 24)

(n= 12)

(n= 9)

VT 0.1

NH 0.1

MA

RI

CT 0.6

NJ 1.4

DE 1.1

MD

DC

3.8

0.4

0.8

2.0

1.1 0.6

1.5

2.7

0.8

0.2

1.6 1.6

0.6

0.9

0.7

2.2

0.1

1.7

0.5

3.3

1.3

0.8

0.9 0.8

0.9

0.5

1.5

1.8

0.8

0.9

2.4

0.9

2.8

1.1

1.2

0.5

4.9

0.2

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

clinics by state: United States and outlying areas, 2007

*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 2007.

SOURCE: Gonorrhea Prevalence Monitoring Project (Re gional In fer til ity Prevention Pro jects); Of fice of Pop u la tion Af fairs;

Lo cal and State STD Con trol Pro grams; Cen ters for Dis ease Con trol and Pre ven tion

0%

25%

50%

'04 '05 '06 '07

QRNG Prevalence

BHM

PHX

LBC

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 24. Gono coc cal Iso late Sur veil lance Pro ject (GISP) — Prevalence of ciprofloxacin

resistant Neisseria gonorrhoeae by GISP site, 2004–2007

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; LBC=Long Beach, 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
30 Gonorrhea National Profile STD Surveillance 2007

Susceptible

PenR

TetR

QRNG

PenR/TetR

PenR/QRNG

TetR/QRNG

PenR/TetR/QRNG

73.0%

1.7%

8.0%

4.0%

2.4%

0.7%

2.0%

8.0%

Figure 25. Gono coc cal Iso late Sur veil lance Pro ject (GISP) — Penicillin, tetracycline, and

ciprofloxacin resistance among GISP isolates, 2007

Note: PenR=penicillinase producing N. gonorrhoeae and chro mo som ally me di ated

pen i cil lin-resistant N. gonorrhoeae; TetR=chromosomally and plasmid mediated

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

Percent

Resistance

Intermediate resistance

0

4

8

12

16

1990 91 92 93 94 95 96 97 98 99 2000 01 02 03 04 05 06 07

Figure 26. Gono coc cal Iso late Sur veil lance Pro ject (GISP) — Percent of Neisseria

gonorrhoeae isolates with re sis tance or intermediate resistance to

ciprofloxacin, 1990–2007

Note: Re sis tant iso lates have ciprofloxacin MICs 1 g/ml. Iso lates with intermediate resistance

have ciprofloxacin MICs of 0.125 – 0.5 μg/ml. Susceptibility to ciprofloxacin was first

measured in GISP in 1990.
STD Surveillance 2007 National Profile Gonorrhea 31

Percent

Heterosexual men

Men who have sex with men (MSM)

0

8

16

24

32

40

2001 2002 2003 2004 2005 2006 2007

Figure 27. Gono coc cal Iso late Sur veil lance Pro ject (GISP) — Percent of Neisseria

gonorrhoeae isolates with resistance to ciprofloxacin by sexual behavior,

2001–2007

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 primary and secondary (P&S)

syphilis reported in the United States

decreased during the 1990s; in 2000, the

rate was the lowest since reporting began in 

1941 (Figure 28). 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

2007. Overall increases in rates between

2001 and 2007 were observed primarily

among men (from 3.0 cases per 100,000

population to 6.6 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 0.9

cases per 100,000 population in 2005 to

1.0 case per 100,000 population in 2006,

to 1.1 case per 100,000 population in

2007. 

Syphilis remains an important problem in

the South and in urban areas in other

regions of the country. Increases in cases 

among MSM have occurred and have

been characterized by high rates of HIV

co-infection and high-risk sexual

behavior.

34,5,6,7,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 2007, 

65% 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 2007 was

available for 79%.

Syphilis — All Stages (P&S, Early

Latent, Late, Late Latent,

Congenital) 

Between 2006 and 2007, the number of

cases of early latent syphilis reported to

CDC increased 17.2% (from 9,186 to

10,768), while the number of cases of late

and late latent syphilis increased 3.5%

(from 17,644 to 18,256) (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 10.7% (from 36,959 to 40,920)

between 2006 and 2007 (Table 1). 

P&S Syphilis — United States

In 2007, P&S syphilis cases reported to

CDC increased to 11,466 from 9,756 in

2006, an increase of 17.5%. The rate of

P&S syphilis in the United States in 2007

(3.8 cases per 100,000 population) was

STD Sur veil lance 2007 National Profile Syphilis 33

3-7
15.2% higher than the rate in 2006 (3.3

cases per 100,000 population), and it is

greater than the HP 2010 target of 0.2

case per 100,000 population (Figure 29,

Table 1).10

P&S Syphilis by Region 

The South accounted for 48.8% of the P&S 

syphilis cases in 2007 and 47.1% in 2006.

Between 2006 and 2007, rates increased

21.4% in the South (from 4.2 to 5.1 cases

per 100,000 population), 30.8% in the

Northeast (from 2.6 to 3.4), 8.1% in the

West (from 3.7 to 4.0) and 5.6% in the

Midwest (from 1.8 to 1.9). The 2007 rates

in all regions were greater than the HP

2010 target of 0.2 cases per 100,000

population (Figure 30, Table 25).

P&S Syphilis by State 

In 2007, 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 31, Table 24). Four states and one

outlying area reported five or fewer cases of 

P&S syphilis in 2007 (Table 24).

P&S Syphilis by Metropolitan

Statistical Area (MSA) 

The rate of P&S syphilis in 2007 for the 50

most populous MSAs (5.7) exceeded the

HP 2010 target of 0.2 cases per 100,000

population (Table 28).

P&S Syphilis by County 

In 2007, 2,275 of 3,140 counties (72.4%)

in the United States reported no cases of

P&S syphilis compared with 2,360 (75.2%)

in 2006. Of 865 counties reporting at least

one case of P&S syphilis in 2007, five

(0.6%) 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 860 counties in 2007

(Figure 32). These 860 counties (27.4% of

the total number of counties in the United

States) accounted for 99.9% of the total

P&S syphilis cases reported in 2007. In

2007, half of the total number of P&S

syphilis cases were reported from 23

counties and two cities (Table 31).

P&S Syphilis by Sex

The rate of P&S syphilis increased 17.9%

among men (from 5.6 cases to 6.6 cases

per 100,000 men) between 2006 and 2007 

(Figure 29, Table 27). During this time, the

rate increased 10.0% among women from

1.0 to 1.1 cases per 100,000 women

(Figure 29, Table 26).

P&S Syphilis by Age

In 2007, the rate of P&S syphilis was

highest in persons in the 25- to 29-year-old

age group (8.9 cases per 100,000

population) (Figure 33 and Table 32).

Between 2006 and 2007, P&S syphilis

rates in most age groups among men and

women increased (Table 32 and Figures 34

and 35).

P&S Syphilis by Race/Ethnicity

From 2006 to 2007, the rate of P&S

syphilis increased in all racial and ethnic

groups except Asian/Pacific Islanders

(Figure 36). The rate increased 5.3%

among non-Hispanic whites (from 1.9 to

2.0), 25% among blacks (from 11.2 to

14.0), 22.9% among Hispanics (from 3.5 to

4.3), and 6.3% among American

Indian/Alaska Natives (from 3.2 to 3.4). 

The rate remained the same at 1.2 cases

per 100,000 population among

Asian/Pacific Islanders (Table 33B).

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, suggesting an increase among

MSM. In 2007, the rate of P&S syphilis in

34 Syphilis National Profile STD Sur veil lance 2007
males was 6.0 times that in females, an

increase from 5.7 in 2006.

In 2005, CDC began collecting information

on the sexual orientation of patients with

P&S syphilis. In 2007, this information was

available for 79% of male cases.

In 2007, the stage of disease was reported

as follows: among heterosexual men with

P&S syphilis, 43.0% had primary syphilis

and 57% had secondary syphilis. Among

female patients, 17.9% had primary syphilis 

and 82.1% had secondary syphilis. Among

men who had sex with men with P&S

syphilis, 24.3% had primary syphilis and

75.7% had secondary syphilis (Figure 37).

Of females with P&S syphilis, 21.9% were

white, 63.5% were black, 9.6% were

Hispanic, and 5.0% were of other

races/ethnicities. Of heterosexual men,

19.3% were white, 59.8% were black,

16.1% were Hispanic, and 4.8% were of

other race/ethnicities. Of men who had sex

with men, 40.8% were white, 33.2% were

black, 19.3% were Hispanic, and 6.7%

were of other races/ethnicities (Figure 38).

P&S Syphilis by Race/Ethnicity and

Sex

From 2006 to 2007, the P&S syphilis rate

among non-Hispanic white males increased 

5.7% (from 3.5 to 3.7), and increased

among non-Hispanic white females as well

(from 0.3 to 0.4). The rate increased 28.2% 

among black males (from 18.1 to 23.2) and 

14.3% among black females (from 4.9 to

5.6). The rate increased 25.0% among

Hispanic males (from 6.0 to 7.5), but

remained unchanged among Hispanic

females (0.8). The rate remained

unchanged for both Asian/Pacific Island

males (2.4), and Asian/Pacific Island

females (0.1). The rate increased 36.8%

among American Indian/Alaska Native

females (from 1.9 to 2.6), but decreased

8.5% among American Indian/Alaska

Native males (from 4.7 to 4.3) (Table 33B).

P&S Syphilis by Race/Ethnicity, Age,

and Sex 

In 2007, the rate of P&S syphilis among

blacks was highest among women aged 20

to 24 years (16.0) and among men aged 20 

to 24 years (57.5) and 25 to 29 years

(57.4). For non-Hispanic whites, the rate

was highest among women aged 20 to 24

years (1.1) and among men aged 40 to 44

years (10.4). For Hispanics, the rate was

highest among women aged 20 to 24 years 

(2.3) and among men aged 40 to 44 years

(15.5). For Asian/Pacific Islanders, the rate

was highest among women aged 20 to 24

years and 30 to 34 years (both 0.4) and

among men aged 25 to 29 years (5.8). For

American Indian/Alaska Natives, the rate

was highest among women aged 25 to 29

years (7.8) and among men aged 30 to 34

years (18.2) (Table 33B).

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 2007, the

proportion of P&S syphilis cases reported

from sources other than STD clinics

increased from 39.2% to 68.7% (Figure 39

and Table A2). Between 2001 and 2007,

the number of cases among males reported 

from non-STD clinic sources increased

sharply while the number from STD clinics

increased slightly (Figure 39).

During 2007, patients with P&S syphilis

primarily sought care with private

physicians or STD clinics. Men who have

sex with men were more frequently

reported from private physicians (36.7%)

than STD clinics (27.1%) (Figure 40). More

cases among women and heterosexual men 

were reported from STD clinics than private 

physicians.

STD Sur veil lance 2007 National Profile Syphilis 35
Congenital Syphilis — United States

After 14 years of decline in the United

States, the rate of congenital syphilis

increased 15.4% between 2006 and 2007

(from 9.1 to 10.5 cases per 100,000 live

births) (Table 39). In 2007, 430 cases were

reported, an increase from 373 in 2006.

This increase in the rate of congenital

syphilis may relate to the increase in the

rate of P&S syphilis among women that has

occurred in recent years (Figure 41).

Congenital Syphilis by State

In 2007, 29 states, the District of Columbia, 

and two outlying area had rates of

congenital syphilis that exceeded the HP

2010 target of one case per 100,000 live

births (Tables 38 and 39).

Syphilis Among Special Populations

Additional information about syphilis and

congenital syphilis in racial and ethnic

minority populations, adolescents, MSM,

and other at-risk populations can be found

in the Special Focus Profiles.

Syphilis Summary

In recent years, MSM have accounted for

an increasing number of estimated syphilis

cases in the United States9 and now

account for 65% of syphilis cases in the

United States based on information from

44 states and Washington, D.C. Despite the 

majority of U.S. syphilis cases occurring

among MSM, syphilis cases among

heterosexuals is an emerging problem given 

the recent increases among women and

infants. 

36 Syphilis National Profile STD Sur veil lance 2007

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 CDC. 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. Out break of

syph i lis among men who have sex with men in

Hous ton, Texas. Sex u ally Trans mit ted Dis eases

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.

10U.S. De part ment of Health and Hu man

Ser vices. Healthy Peo ple 2010. 2nd ed. With

Un der stand ing and Im prov ing Health and

Ob jec tives for Im prov ing Health. 2 vols.

Wash ing ton, DC: U.S. Gov ern ment Print ing

Of fice, November 2000.
STD Surveillance 2007 National Profile Syphilis 37

0

120

240

360

480

600

1941 46 51 56 61 66 71 76 81 86 91 96 2001 06

Cases (in thousands)

P&S

Early Latent

Total Syphilis

Figure 28. Syph i lis — Re ported cases by stage of infection: United States, 1941–2007

0

5

10

15

20

25

1988 90 92 94 96 98 2000 02 04 06

Rate (per 100,000 population)

Male

Female

Total

2010 Target

Figure 29. Primary and secondary syph i lis — Rates: Total and by sex: United States,

1988–2007 and the Healthy Peo ple 2010 target

Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population.
38 Syphilis National Profile STD Surveillance 2007

Rate (per 100,000 population)

Midwest

Northeast

South

West

2010 Target

0

2

4

6

8

10

1998 99 2000 01 02 03 04 05 06 07

Figure 30. Pri mary and sec ond ary syph i lis — Rates by re gion: United States, 1998–2007 

and the Healthy Peo ple 2010 target

Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population.

Rate per 100,000

population

Guam 4.7

Puerto Rico 4.3

Virgin Is. 0.0

<=0.2

0.21-2.2

>2.2

(n= 4)

(n= 24)

(n= 26)

VT 1.6

NH 2.3

MA 2.4

RI 3.4

CT 1.1

NJ 2.6

DE 2.1

MD 6.1

DC 30.6

8.3

1.0

4.8

4.3

5.6 1.2

5.0

7.3

0.7

0.1

3.6 0.9

0.7

1.0

1.3

12.4

0.7

1.2

1.1

4.6

4.1

0.8

0.2 4.4

2.4

5.5

3.6

0.2

1.7

1.8

0.5

2.1

2.1

0.9

6.1

4.9

0.8

3.0

2.4

0.3

1.2

0.8

Figure 31. Pri mary and sec ond ary syph i lis — Rates by state: United States and out ly ing 

areas, 2007

Note: The total rate of P&S syphilis for the United States and outlying areas (Guam, Puerto Rico and

Virgin Islands) was 3.8 per 100,000 population. The Healthy People 2010 target is 0.2 case per 

100,000 population.
STD Surveillance 2007 National Profile Syphilis 39

Rate per 100,000

population

<=0.2 (n= 2,280)

0.21-2.2 (n= 369)

>2.2 (n= 491)

Figure 32. Pri mary and sec ond ary syph i lis — Rates by county: United States, 2007

Note: The Healthy People 2010 target for P&S syphilis is 0.2 case per 100,000 population. In 2007,

2,274 (72.4%) of 3,140 counties in the U.S. reported no cases of P&S syphilis.

Men Rate (per 100,000 population) Women

15 12 9 6 3 0 Age 0 3 6 9 12 15

0.0 10-14 0.1

3.8 15-19 2.4

13.4 20-24 3.5

14.9 25-29 2.6

13.1 30-34 2.0

14.4 35-39 1.8

13.9 40-44 1.7

6.9 45-54 0.9

2.5 55-64 0.2

0.5 65+ 0.0

6.6 Total 1.1

Figure 33. Primary and secondary syph i lis — Age- and sex-specific rates: United States,

2007
40 Syphilis National Profile STD Surveillance 2007

0

2

4

6

8

10

1998 99 2000 01 02 03 04 05 06 07

Rate (per 100,000 population)

15-19

20-24

25-29

30-34

35-39

40-44

Figure 34. Pri mary and sec ond ary syph i lis — Age-specific rates among women 15 to 44

years of age: United States, 1998–2007

0

3

6

9

12

15

1998 99 2000 01 02 03 04 05 06 07

Rate (per 100,000 population)

15-19

20-24

25-29

30-34

35-39

40-44

Figure 35. Pri mary and sec ond ary syph i lis — Age-specific rates among men 15 to 44 years 

of age: United States, 1998–2007
STD Surveillance 2007 National Profile Syphilis 41

0

8

16

24

32

40

1998 99 2000 01 02 03 04 05 06 07

Rate (per 100,000 population)

American Indian/AK Native

Asian/Pacific Islander

Black

Hispanic White

Figure 36. Pri mary and sec ond ary syph i lis — Rates by race/eth nic ity: United States,

1998–2007

Cases

†

Primary

Secondary

0

1250

2500

3750

5000

Heterosexual Men Women MSM

Figure 37. Pri mary and sec ond ary syph i lis — Re ported cases* by stage and sexual

orientation, 2007

*21% of reported male cases with P&S syphilis were missing sex of sex partner information.

†MSM denotes men who have sex with men.
42 Syphilis National Profile STD Surveillance 2007

Cases

‡

White

Black

Hispanic

Other

0

750

1500

2250

3000

Heterosexual Men Women MSM

Fig ure 38. Pri mary and sec ond ary syph i lis — Re ported cases* by sexual orientation and

race/ethnicity†, 2007

*21% of reported male cases with P&S syphilis were missing sex of sex partner information; 3%

of reported males 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.

0

1

2

3

4

5

6

7

8

1998 99 2000 01 02 03 04 05 06 07

Cases (in thousands)

non-STD Clinic Male

non-STD Clinic Female

STD Clinic Male

STD Clinic Female

Figure 39. Primary and secondary syph i lis — Reported cases by reporting source and sex:

United States, 1998–2007
STD Surveillance 2007 National Profile Syphilis 43

Percent

†

Correctional Facility HIV Counseling & Testing Site

Private Physician/HMO STD Clinic

0

10

20

30

40

50

Heterosexual Men Women MSM

Figure 40. Primary and secondary syph i lis — Percentage of reported cases* by sexual

orientation and selected reporting sources, 2007

*21% of reported male cases with P&S syphilis were missing sex of sex partner information; 3.3% 

of reported male cases with sex of partner data were missing source of information data.

†MSM denotes men who have sex with men.

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

P&S Rate

CS Cases

0.0

0.3

0.6

0.9

1.2

1998 99 2000 01 02 03 04 05 06 07

0

1

2

3

4

Figure 41. Con gen i tal syph i lis (CS) — Re ported cases for in fants < 1 year of age and rates

of pri mary and sec ond ary syph i lis among women: United States, 1998–2007

Other Sexually Transmitted

Diseases

Chancroid 

Since 1987, reported cases of chancroid

declined steadily until 2001. Since then, the

number of cases reported has fluctuated

(Figure 42, Table 1). In 2007, 23 cases of

chancroid were reported in the United

States. Only eight states reported one or

more cases of chancroid in 2007 (Table 41).

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 

Persistent infection with high risk human

papillomavirus (HR-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 high-risk human papillomavirus 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 programs

such as vaccine programs in the U.S.

Testing was performed using a

commercially available test for HR-HPV

DNA (Hybrid Capture 2, Qiagen,

Gaithersburg, MD). Results from

2003–2005 document an overall HR-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: 14 to 19

years 35%; 20 to 29 years 29%; 30 to 39

years 13%; 40 to 49 years 11%; and 50 to

65 years 6%.3

Preliminary results from the sentinel

surveillance project from 2003–2004 also

report PCR-based HPV type-specific

prevalence estimates for types 16 and 18.

Overall prevalence of infection with HPV

types 16 or 18 was 8%. Prevalence of HPV

16 or 18 by age group was: 16% in 14 to

19 year olds; 10% in 20 to 29 year olds;

3% in 30 to 39 year olds; 2% in 40 to 49

year olds and 1% in 50 to 65 year olds.4

National population-based data were also

obtained from the National Health and

Nutrition Examination Survey (NHANES)

identifying prevalence of both HR-HPV and 

low-risk HPV (LR-HPV, which is associated

with development of anogenital warts) in

the civilian, non-institutionalized female

population of the U.S., 2003–2004 (Figure

43). The overall HPV prevalence including

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

confidence interval (CI): 23.3–30.9) among 

U.S. females aged 14 to 59 years. HPV

vaccine preventable types 6 or 11 (low-risk

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

STD Sur veil lance 2007 National Profile Other Sexually Transmitted Diseases 45
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.5

Data from the National Disease and

Therapeutic Index (NDTI) suggest that

genital warts (Figure 44) 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.6

Pelvic Inflammatory Disease 

For data on Pelvic Inflammatory Disease

(PID), see the Special Focus Profile on

Women and Infants. 

Herpes Simplex Virus (HSV)

Case reporting data for genital herpes

simplex virus are not available. Trend data

are based on estimates of the initial office

visits in physicians’ office practices for these 

conditions from the National Disease and

Therapeutic Index (NDTI) (Figure 45 and

Table 42).

National trend data on the seroprevalence

of HSV-2 among those aged 14 to 49 years 

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. When including

data on blacks and whites from NHANES

survey years 1976–1980, blacks had higher

seroprevalence than whites for each survey

period and age group7 (Figure 46). In

1999–2004, the overall percentage of

survey participants who reported having

been diagnosed with genital herpes was

3.8%.7

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 47 

and Table 42). NHANES data from

2001–2004 demonstrated an overall

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

highest prevalence observed among blacks

13.3% (95% CI: 10.0–17.7).8

46 Other Sexually Transmitted Diseases National Profile STD Sur veil lance 2007

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 Datta SD, Koutsky L, Ratelle S, et al.

Type-Specific High-Risk HPV Prevalence from

the HPV Sentinel Surveillance Project, US,

2003–2005 [Abstract no. P-099]. In Program

and abstracts of the International Human

Papillomavirus Meeting, Prague, Czech

Republic, September 2006.

5 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.
STD Sur veil lance 2007 National Profile Other Sexually Transmitted Diseases 47

6 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.

7 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.

8

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.
48 Other Sexually Transmitted Diseases National Profile STD Surveillance 2007

0

1

2

3

4

5

1981 83 85 87 89 91 93 95 97 99 2001 03 05 07

Cases (in thousands)

Figure 42. Chancroid — Re ported cases: United States, 1981–2007

Prevalence

Low Risk HPV

High Risk HPV

0

5

10

15

20

25

30

35

40

45

14-19 20-24 25-29 30-39 40-49 50-59

Figure 43. Human papillomavirus (HPV) — Prevalence of high-risk and low-risk types

among females 14 to 59 years of age reported from a national survey,

2003–2004

Note: Error bars indicate 95% confidence 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 Copyright © 2007, American Medical Association. All Rights reserved.
STD Surveillance 2007 National Profile Other Sexually Transmitted Diseases 49

0

90

180

270

360

450

1966 69 72 75 78 81 84 87 90 93 96 99 2002 05

Visits (in thousands)

Figure 44. Gen i tal warts — Initial vis its to phy si cians’ of fices: United States, 1966–2007 

Note: See Appendix (Other Data Sources) and Table 42. The relative standard error for genital

warts estimates range from 17% to 29.3%.

SOURCE: National Disease and Therapeutic Index (IMS Health)

0

80

160

240

320

400

1966 69 72 75 78 81 84 87 90 93 96 99 2002 05

Visits (in thousands)

Fig ure 45. Gen i tal her pes — Initial vis its to phy si cians’ of fices: United States, 1966–2007

Note: See Appendix (Other Data Sources) and Table 42. The relative standard error for genital

herpes estimates range from 17% to 29.3%.

SOURCE: National Disease and Therapeutic Index (IMS Health)
50 Other Sexually Transmitted Diseases National Profile STD Surveillance 2007

Non-Hispanic White

Percent

0

20

40

60

80

100

All Ages* 14-19 20-29 30-39 40-49

Non-Hispanic Black

Percent

0

20

40

60

80

100

All Ages* 14-19 20-29 30-39 40-49

1976-1980

1988-1994

1999-2004

Fig ure 46. Gen i tal her pes — Herpes simplex virus, type 2, seroprevalence in non-Hispanic

whites and non-Hispanic blacks by age group reported from national surveys,

1976–1980, 1988–1994, 1999–2004

Note: Error bars indicate 95% confidence intervals.

SOURCE: National Health and Nutrition Examination Survey

JAMA, 2006, 296:964–973. Copyright © 2006, American Medical Association. All Rights reserved. 
STD Surveillance 2007 National Profile Other Sexually Transmitted Diseases 51

0

900

1,800

2,700

3,600

4,500

1966 69 72 75 78 81 84 87 90 93 96 99 2002 05

Visits (in thousands)

Trichomoniasis

Other Vaginitis

Fig ure 47. Trichomoniasis and other vag i nal in fec tions in women — Ini tial vis its to

phy si cians’ of fices: United States, 1966–2007

Note: See Appendix (Other Data Sources) and Table 42. The relative standard error for

trichomoniasis estimates range from 16% to 29.3% and for other vaginitis estimates range

from 8% to 13%.

SOURCE: National Disease and Therapeutic Index (IMS Health)

SELI FORP SUCOF LAI CEPS
SELI FORP SUCOF LAI CEPS
Spe cial Fo cus Pro files

The Spe cial Fo cus Pro files high light trends and dis tri bu tion of STDs in pop u la tions of

partic u lar in terest for STD and HIV pre ven tion pro grams in state and lo cal health

de part ments. These pop u la tions are most vulner a ble to STDs and their con se quences:

women and in fants, ad o les cents and young adults, racial and ethnic mi nor i ties, MSM, and

per sons en ter ing cor rec tions fa cil i ties. The Spe cial Fo cus Pro files re fer to fig ures lo cated

in dis ease-spe cific sec tions in the Na tional Pro file and ad di tional fig ures and ta bles

(Fig ures A-EE and Ta bles A-F) that high light spe cific points made in the text.

STD Sur veil lance 2007 Spe cial Fo cus Pro files 53

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. If not adequately treated, up to

40% of women infected with chlamydia or

gonorrhea may develop PID.1,2 Among

women with PID, tubal scarring can cause

involuntary infertility in 20%, ectopic

pregnancy in 9%, and chronic pelvic pain

in 18%.3 Approximately 70% of chlamydial 

infections and 50% of gonococcal

infections in women are asymptomatic.45,6,

These infections are detected primarily

through screening programs. The vague

symptoms associated with chlamydial and

gonococcal PID cause 85% of women to

delay seeking medical care, thereby

increasing the risk of infertility and ectopic

pregnancy.

7

 Data from a randomized

controlled trial of chlamydia screening in a

managed care setting suggest that such

screening programs can reduce the

incidence of PID by as much as 60%.8

Human papillomavirus (HPV) infections are

highly prevalent, especially among young

sexually-active women. While the great

majority of HPV infections in women

resolve within one year, they are a major

concern because persistent infection with

specific types 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.9

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 herpes simplex virus 

are extremely common, may cause painful

outbreaks, and may have serious

consequences for pregnant women.10

When a woman has a syphilis infection

during pregnancy, she may transmit the

infection to the fetus in utero. This may

result in fetal death or an infant born with

physical and mental developmental

disabilities. Most cases of congenital

syphilis are easily preventable if women

are screened for syphilis and treated early

during prenatal care.11

Observations

Chlamydia — United States 

Between 2006 and 2007, the rate of

chlamydial infections in women

increased from 510.8 to 543.6 per

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

Chlamydia rates exceed gonorrhea rates

among women in all states (Figures A

and C, Tables 4 and 14).

STD Sur veil lance 2007 Special Focus Profiles STDs in Women and Infants 55

4-6
Chlamydia Prevalence Monitoring

Project

Prenatal Clinics — In 2007, the median

state-specific 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

7.4% (range: 2.0% to 20.7%) (Figure B). 

Family Planning Clinics — In 2007, 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,

Puerto Rico, and the Virgin Islands was

6.9% (range: 2.9% to 16.8%) (Figures 9

and 10).

Gonorrhea — United States

Gonorrhea rates among women were higher 

than the overall HP 2010 target of 19.0

cases per 100,000 population12 in 45 states,

Washington D.C., Guam, and the Virgin

Islands in 2007 (Figure C, Table 14).

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

then reached a plateau (Figure 13). The

gonorrhea rate for women (123.5 per

100,000 females) increased slightly in 2007

for the third consecutive year (Figure 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 seven consecutive years (Figure 14

and Tables 14 and 15).

Gonorrhea Prevalence Monitoring

Project

Prenatal Clinics — In 2007, the

median state-specific gonorrhea test

positivity among 15- to 24-year-old

women screened in selected prenatal

clinics in 19 states, Puerto Rico, and the

Virgin Islands was 0.8% (range: 0.0% to

3.9%) (Figure D). Median gonorrhea

positivity in prenatal clinics has shown

minimal change in recent years.

Family Planning Clinics — In 2007, the

median state-specific gonorrhea test

positivity among 15- to 24-year-old

women screened in selected family

planning clinics in 43 states, Puerto Rico,

and the Virgin Islands was 0.9% (range:

0.1% to 4.9%) (Figure 23). Median

gonorrhea positivity in family planning

clinics has shown minimal change in recent 

years.

Primary and Secondary Syphilis by

State

The HP 2010 target for primary and

secondary (P&S) syphilis is 0.2 case per

100,000 population. In 2007, 32 states

and the District of Columbia had rates of

P&S syphilis for women that were greater

than 0.2 case per 100,000 population

(Table 26).

Congenital Syphilis

The HP 2010 target for congenital syphilis

is 1.0 case per 100,000 live births. In

2007, 29 states, the District of Columbia,

Guam, and Puerto Rico had rates higher

than this target (Table 38). 

Trends in congenital syphilis usually follow

trends in P&S syphilis among women, with 

a lag of one to two years (Figure 41). 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 39).

The rate of P&S syphilis among women

56 STDs in Women and Infants Special Focus Profiles STD Sur veil lance 2007
declined 94.8% (from 17.3 to 0.9 cases per

100,000 females) during 1990–2005

(Figure 29).

After 14 years of decline in the United

States, the rate of congenital syphilis

increased 11.0% between 2005 and 2006

(from 8.2 to 9.1 cases per 100,000 live

births) (Table 39). Rates increased again

between 2006 and 2007 by 15.4% (from

9.1 to 10.5 cases per 100,000 live births)

(Table 39).

The 2007 rate of congenital syphilis for the

United States is currently 10.5 times higher

than the HP 2010 target of 1.0 case per

100,000 live births (Table 38).

While most cases of congenital syphilis

occur among infants whose mothers have

had some prenatal care, late or limited

prenatal care has been associated with

congenital syphilis. Failure of health care

providers to adhere to maternal syphilis

screening recommendations also contributes 

to the occurrence of congenital syphilis.13

Pelvic Inflammatory Disease 

Accurate estimates of pelvic inflammatory

disease (PID) and tubal factor infertility

resulting from gonococcal and 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,14,15 but have remained

relatively constant between 2000 and 2006

(Figure H).

The estimated number of initial visits to

physicians’ offices for PID from the National

Disease and Therapeutic Index (NDTI) has 

generally declined from 2000 through

2007 (Figure I and Table 42).

Since 2000, the number of cases of PID

diagnosed in emergency departments

among women 15 to 44 years of age has

generally declined though cases increased

from 2005–2006.

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.15

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 G). 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.16

STD Sur veil lance 2007 Special Focus Profiles STDs in Women and Infants 57
58 STDs in Women and Infants Special Focus Profiles STD Sur veil lance 2007

1

Stamm WE, Guinan ME, John son C. Ef fect of

treat ment reg i mens for Neisseria gonorrhoeae

on si mul ta neous in fec tions with Chlamydia

trachomatis. N Engl J Med 1984;310:545–9.

2

Platt R, Rice PA, McCormack WM. Risk of

ac quir ing gon or rhea and prev a lence of

ab nor mal adnexal find ings among women

re cently ex posed to gon or rhea. JAMA

1983;250:3205–9.

3 Westrom L, Joesoef R, Reynolds G, et al. Pelvic

in flam ma tory dis ease and fer til ity: a co hort

study of 1,844 women with laparoscopically

ver i fied dis ease and 657 con trol women with

nor mal lap a ros copy. Sexually Transmitted

Diseases 1992;9:185–92.

4 Hook EW III, Handsfield HH. Gono coc cal

in fec tions in the adult. In: Holmes KK, Sparling

PF, Mardh PA, , et al, eds. Sex u ally Trans mit ted 

Dis eases, 3rd edi tion. New York, New York:

McGraw-Hill, 1999.

5

Stamm WE, Holmes KK. Chlamydia trachomatis

in fec tions in the adult. In: Holmes KK, Mardh

PA, Spar ling PF, et al, eds. Sex u ally

Trans mit ted Dis eases, 2nd edi tion. New York

City: McGraw-Hill, Inc, 1990:181–93.

6

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

Epidemiologic dif fer ences be tween chlamydia

and gon or rhea. Am J Public Health

1990;80:1338–42.

7 Hillis SD, Joesoef R, Marchbanks PA, et al.

De layed care of pel vic in flam ma tory dis ease as

a risk fac tor for im paired fer til ity. Am J Obstet

Gynecol 1993;168:1503–9.

8

Scholes D, Stergachis A, Heidrich FE, Andrilla

H, Holmes KK, Stamm WE. Pre ven tion of pel vic 

in flam ma tory dis ease by screen ing for cer vi cal

chlamydial in fec tion. N Engl J Med

1996;34(21):1362–6.

9 Division of STD Pre ven tion. Pre ven tion of

Gen i tal HPV In fec tion and Sequelae: Re port of

an Ex ter nal Con sul tants’ Meet ing. Na tional

Center for HIV, STD, and TB Pre ven tion,

Cen ters for Dis ease Con trol and Pre ven tion,

At lanta, December 1999.

10Handsfield HH, Stone KM, Wasserheit JN.

Pre ven tion agenda for gen i tal her pes. Sexually

Transmitted Diseases 1999;26:228–231.

11Centers for Disease Con trol. Guide lines for

pre ven tion and con trol of con gen i tal syph i lis.

MMWR 1988;37(No.S-1)

12U.S. De part ment of Health and Hu man

Ser vices. Healthy Peo ple 2010. 2nd ed. With

Un der stand ing and Im prov ing Health and

Ob jec tives for Im prov ing Health. 2 vols.

Wash ing ton, DC: U.S. Gov ern ment Print ing

Of fice, November 2000.

13Centers for Disease Con trol and Pre ven tion.

Con gen i tal syph i lis – United States, 2002.

MMWR 2004;53:716–9.

14Rolfs RT, Galaid EI, Zaidi AA. Pel vic

in flam ma tory dis ease: trends in hos pi tal iza tion

and of fice vis its, 1979 through 1988. Am J

Obstet Gynecol 1992;166:983–90.

15Sutton MY, Sternberg M, Zaidi A, St. Louis ME,

Markowitz LE. Trends in pelvic inflammatory

disease hospital discharges and ambulatory

visits, United States, 1985–2001. Sexually

Transmitted Diseases 2005;32(12)778–784.

16Centers for Disease Con trol and Pre ven tion.

Ectopic pregnancy in the United States,

1990–1992. MMWR 1995;44:46–8.
STD Surveillance 2007 Special Focus Profiles STDs in Women and Infants 59

Rate per 100,000

population

Guam 797

Puerto Rico 332

Virgin Is. 470

<=400

400.1-600

>600

(n= 14)

(n= 25)

(n= 15)

VT 256

NH 230

MA 352

RI 414

CT 477

NJ 389

DE 582

MD 629

DC 1285

810

1018

610

551

555 538

458

670

658

365

641 486

418

476

288

696

271

553

373

1114

572

429

421 574

712

569

556

377

615

503

370

477

938

484

635

576

310

467

430

261

517

359

Fig ure A. Chlamydia — Rates among women by state: United States and out ly ing ar eas, 2007

Note: The total chlamydial infection rate among women in the United States and outlying areas

(Guam, Puerto Rico and Virgin Islands) was 540.9 per 100,000 female population.

Positivity (%)

Puerto Rico 15.6

Virgin Is. 20.7

See*

<5.0

5.0-9.9

>=10.0

(n= 29)

(n= 8)

(n= 12)

(n= 4)

VT

NH

MA

RI

CT

NJ

DE

MD 2.0

DC

8.6

6.2

8.4

7.5

12.5 9.3

4.9

5.5

4.0

8.6

15.4

9.5

8.6

4.0

4.2

7.3

7.2

2.9

7.9

3.3

2.5

Fig ure B. Chlamydia — Positivity in 15- to 24-year-old women tested in pre na tal

clin ics by state: United States and outlying areas, 2007

*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 2007.

SOURCE: Chlamydia Prevalence Monitoring Project (Re gional In fer til ity Prevention Pro jects); Of fice of Pop u la tion Af fairs;

Lo cal and State STD Con trol Pro grams; Cen ters for Dis ease Con trol and Pre ven tion
60 STDs in Women and Infants Special Focus Profiles STD Surveillance 2007

Rate per 100,000

population

Guam 78.7

Puerto Rico 8.1

Virgin Is. 89.8

<=19.0

19.1-100.0

>100.0

(n= 6)

(n= 25)

(n= 23)

VT 9.5

NH 9.5

MA 38.6

RI 30.6

CT 76.3

NJ 68.6

DE 159.1

MD 121.7

DC 348.7

257.2

100.7

76.0

158.7

79.7 76.6

128.1

196.4

45.9

20.9

173.6 152.5

74.3

100.6

88.0

264.4

6.7

175.3

74.3

326.5

183.4

15.9

95.0 86.9

98.4

83.6

198.0

20.9

200.2

143.6

30.3

108.6

254.3

39.1

169.9

137.3

27.2

86.7

58.0

54.3

145.4

16.1

Fig ure C. Gon or rhea — Rates among women by state: United States and out ly ing ar eas, 2007

Note: The total gonorrhea infection rate among women in the United States and outlying areas

(Guam, Puerto Rico and Virgin Islands) was 121.9 per 100,000 female population.

Positivity (%)

Puerto Rico 0.7

Virgin Is. 2.9

See*

<1.0

1.0-1.9

>=2.0

(n= 32)

(n= 14)

(n= 3)

(n= 4)

VT

NH

MA

RI

CT

NJ

DE

MD

DC

1.7

0.8

0.0

0.9

3.4 0.7

0.5

0.3

0.4

2.7

3.9

0.6

1.5

0.9

0.1

1.5

0.5

0.8

0.6

Fig ure D. Gon or rhea — Positivity in 15- to 24-year-old women tested in prenatal

clin ics by state: United States and outlying areas, 2007

*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 2007.

SOURCE: Gonorrhea Prevalence Monitoring Project (Re gional In fer til ity Prevention Pro jects); Of fice of Pop u la tion Af fairs;

Lo cal and State STD Con trol Pro grams; Cen ters for Dis ease Con trol and Pre ven tion
STD Surveillance 2007 Special Focus Profiles STDs in Women and Infants 61

Rate per 100,000

population

Guam 4.8

Puerto Rico 2.7

Virgin Is. 0.0

<=0.2

0.21-4.0

>4.0

(n= 19)

(n= 32)

(n= 3)

VT 0.0

NH 0.0

MA 0.3

RI 0.4

CT 0.1

NJ 0.4

DE 0.2

MD 1.6

DC 1.6

6.0

0.3

2.1

3.5

0.6 0.1

1.7

1.1

0.2

0.1

0.6 0.2

0.2

0.4

0.4

9.5

0.0

0.5

0.0

2.3

0.9

0.4

0.0 1.0

1.5

0.3

1.3

0.0

0.5

1.3

0.1

0.5

0.5

0.5

3.7

2.5

0.0

0.4

0.2

0.2

0.2

0.4

Fig ure E. Pri mary and sec ond ary syph i lis — Rates among women by state: United States and

out ly ing ar eas, 2007

Note: The total rate of P&S syphilis among women in the United States and outlying areas (Guam,

Puerto Rico, and Virgin Islands) was 1.1 per 100,000 female population.

Rate per 100,000

live births

Guam 58.6

Puerto Rico 15.6

Virgin Is. 0.0

<=1.0

1.1-10.0

>10.0

(n= 22)

(n= 19)

(n= 13)

VT 0.0

NH 0.0

MA 0.0

RI 0.0

CT 4.8

NJ 9.5

DE 0.0

MD 30.8

DC 12.6

15.1

0.0

32.0

31.1

16.0 2.9

9.2

6.5

0.0

0.0

5.5 3.4

2.6

0.0

0.0

55.1

0.0

10.8

0.0

0.0

1.3

0.0

0.0 19.9

21.1

6.4

5.8

0.0

0.7

5.8

4.4

5.5

1.8

0.0

5.0

26.0

0.0

1.0

2.4

4.8

1.4

0.0

Fig ure F. Con gen i tal syph i lis — Rates for in fants < 1 year of age by state: United States and

out ly ing ar eas, 2007

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 10.5 per 100,000 live births. The Healthy

People 2010 target is 1.0 case per 100,000 live births.
62 STDs in Women and Infants Special Focus Profiles STD Surveillance 2007

0

10

20

30

40

50

1997 98 99 2000 2000 02 03 04 05 06

Hospitalizations (in thousands)

Fig ure G. Ectopic pregnancy — Hos pi tal iza tions of women 15 to 44 years of age: United

States, 1997–2006

Note: The relative standard error for these estimates is 14.2%. Data only available through 2006.

SOURCE: National Hospital Discharge Survey (National Center for Health Statistics, CDC)

0

15

30

45

60

75

1997 98 99 2000 01 02 03 04 05 06

Hospitalizations (in thousands)

Acute, Unspecified

Chronic

Fig ure H. Pel vic in flam ma tory dis ease — Hos pi tal iza tions of women 15 to 44 years

of age: United States, 1997–2006

Note: The relative standard error for these estimates of the total number of acute unspecified 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 Hospital Discharge Survey (National Center for Health Statistics, CDC)
STD Surveillance 2007 Special Focus Profiles STDs in Women and Infants 63

0

60

120

180

240

300

1998 99 2000 01 02 03 04 05 06 07

Visits (in thousands)

Fig ure I. Pel vic in flam ma tory dis ease — Ini tial vis its to phy si cians’ of fices by women

15 to 44 years of age: United States, 1998–2007

Note: The relative standard error for these estimates range from 21.6% to 29.3%. See Ap pen dix

(Other Data Sources) and Table 42.

SOURCE: National Disease and Therapeutic Index (IMS Health)

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, for

example, Chlamydia trachomatis,

adolescent women may have a

physiologically increased susceptibility to

infection due to increased cervical ectopy.

The higher prevalence of STDs among

adolescents also reflects multiple barriers to

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. Recent

estimates suggest that while representing

25% of the ever sexually active 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 2006

and 2007, the increase for those 15 to 19

years of age was 7.7%, and for those 20 to

24 years of age was 6.6% (Table 10).

15- to 19-Year-Old Women — As in

previous years, in 2007 15- to 19-year-old

women had the highest rate of chlamydia

(3,004.7 per 100,000 population) compared 

to any other age/sex group (Figure 5 and

Table 10). Chlamydia rates for 15- to

19-year-old women increased 6.4%

from 2,824 per 100,000 population in

2006 to 3,004.7 per 100,000 population

in 2007.

20- to 24-Year-Old Women — In 2007,

as in previous years, 20- to 24-year-old

women had the second highest rate of

chlamydia (2,948.8 per 100,000

population) compared to any other age/sex 

group. Chlamydia rates in women of this

age group increased 5.6% from 2006 to

2007.

15- to 19-Year-Old Men — Chlamydia

rates for 15- to 19-year-old men increased

14.3% from 537.9 per 100,000 population 

in 2006 to 615.0 per 100,000 population

in 2007.

20- to 24-Year-Old Men — As in

previous years, in 2007, 20- to 24-year old 

men had the highest rate of chlamydia

among men (932.9 per 100,000

population). Chlamydia rates in men of

this age group increased 9.4% from 2006

to 2007.

Gonorrhea

For the third consecutive year, gonorrhea

rates for persons 15 to 19 and 20 to 24

years of age increased. Between 2006 and

2007, the increase for those 15 to 19 years

of age was 2.1%, and for those 20 to 24

years of age was 0.7% (Table 20).

15- to 19-Year-Old Women — As in

previous years, in 2007 15- to 19-year-old

women had the highest rate of gonorrhea

STD Sur veil lance 2007 Special Focus Profiles STDs in Adolescents and Young Adults 65
(647.9 per 100,000 population) compared

to any other age/sex group (Figure 19 and

Table 20). Gonorrhea rates in women of this 

age group have increased for the past three

years.

20- to 24-Year-Old Women — In 2007,

as in previous years, 20- to 24-year-old

women had the second highest rate of

gonorrhea (614.5 per 100,000 population)

compared to any other age/sex group.

Gonorrhea rates in women of this age group 

have also increased for the past three years.

15- to 19-Year-Old Men — Gonorrhea

rates for 15- to 19-year-old men increased

3.8% from 275.4 per 100,000 population in

2006 to 286.0 per 100,000 population in

2007. Gonorrhea rates in men of this age

group have increased for the past three

years. (Figure 20, Table 20).

20- to 24-Year-Old Men — As in previous 

years, in 2007, 20- to 24-year old men had

the highest rate of gonorrhea among men

(450.1 per 100,000 population). Gonorrhea

rates in men of this age group declined

0.4% from 2006 to 2007.

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

2.4 per 100,000 population in 2007. Rates

in women have been the highest each year

in the 20 to 24 year age group. In this age

group there were 3.5 cases per 100,000

population in 2007 (Figure 33, Table 32).

Syphilis rates for women in these younger

age groups are comparable to rates in older

age groups.

In contrast, in men, rates among 15- to

19-years olds are much lower than those in

men in older age groups. However, these

rates have increased since 2002 from 1.3

cases per 100,000 population in 2002 to 3.0 

in 2006 and 3.8 in 2007. During 2003 to

2006, rates in men had been the highest

each year in the 35 to 39 year old age

group. In 2007, rates in men were highest

in the 25 to 29 year old age group, with

14.9 cases per 100,000 population, and

14.4 cases per 100,000 population in the

35 to 39 year old age group (Figure 33,

Table 32).

Chlamydia Prevalence Monitoring

Project

Chlamydia test positivity among 15- to

19-year-old women screened in family

planning clinics fluctuated in all 10 HHS

regions between 2003 and 2007 (Figure

J). Positivity has remained fairly stable in

four regions (I, III, V, X). From 2003 to

2006, slight decreases in positivity

occurred in one region (II), followed by a

small increase in 2007. In the remaining

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

rates increased slightly over the five-year

time frame from 2003 to 2007. 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 by

the National Job Training Program at

more than 100 sites throughout the

country, is a job training program for

socioeconomically-disadvantaged youth

aged 16 to 24 years of age.

Chlamydial infection is widespread

geographically and highly prevalent

among socioeconomically-disadvantaged

young women and men entering the

National Job Training Program.23, 4,

Specimens from at least 100 students from

each state and outlying area were tested by 

a single national contract laboratory.*

Among women entering the program from

66 STDs in Adolescents and Young Adults Special Focus Profiles STD Sur veil lance 2007

2–4
40 states, the District of Columbia, and

Puerto Rico in 2007, based on their place of 

residence before program entry, the median

state-specific chlamydia prevalence was

13.2% (range: 3.8% to 23.5%) (Figure K).

Among men entering the program from 47

states, the District of Columbia, and Puerto

Rico in 2007, the median state-specific

chlamydia prevalence was 7.2% (range:

2.0% to 14.5%) (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. Specimens from at least 100 

students from each state and outlying area

were tested by the contract laboratory.

Among women entering the program from

36 states and Puerto Rico, the median

state-specific gonorrhea prevalence was 3.0% 

(range: 0.0% to 7.2%) in 2007 (Figure M).

Among men entering the program from 32

states and Puerto Rico in 2007, the median

state-specific gonorrhea prevalence was 1.1% 

(range: 0.0% to 4.4%) (Figure N).

Juvenile Corrections Facilities

Among adolescent women entering

juvenile corrections facilities, the

Corrections STD Prevalence Monitoring

Project identified a median facility-specific

chlamydia positivity rate of 14.3% (range:

2.5% to 32.1%) (Table A) and a median

gonorrhea positivity rate of 5.3% (range:

0.0% to 13.9%) (Table C). Among

adolescent men entering juvenile

corrections facilities, the median

facility-specific chlamydia positivity rate

was 5.7% (range: 0.0% to 14.2%) and the

median gonorrhea positivity rate was 1.0% 

(range: 0.0% to 4.5%). 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. 

STD Sur veil lance 2007 Special Focus Profiles STDs in Adolescents and Young Adults 67

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, Ran som RL, St. Louis ME, Groseclose 

SL, Hadgu A, Le vine WC, Hay man C. De cline

in the prev a lence of gen i tal chlamydia in fec tion

in young women en ter ing a Na tional Job

Train ing Pro gram, 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. Sexually

Transmitted Diseases 2006;33(10):636–639.

4

Joesoef MR, Mosure DJ. Prevalence of

chlamydia in young women entering the 

National Job Training Program 1998–2004.

Sexually Transmitted Diseases

2006;33(9):571–575.
68 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2007

Region I

Region II

Region III

Region IV

Region V

Region VII Region VI

Region VIII

Region IX

Region X

5.1

03

4.9

04

5.4

05

5.5

06

5.6

07

9.3

03

9.1

04

7.3

05

7.3

06

7.6

07

6.8

03

7.3

04

7.1

05

6.5

06

6.8

07

7.7

03

10.0

04

10.7

05

11.0

06

11.7

07

8.3

03

8.6

04

9.0

05

8.9

06

9.0

07

8.7

03

9.0

04

9.2

05

10.2

06

10.7

07

6.2

03

6.8

04

6.7

05

7.5

06

7.6

07

6.4

03

6.5

04

6.6

05

7.7

06

8.1

07

7.3

03

7.9

04

7.4

05

8.3

06

9.0

07

6.8

03

6.9

04

6.5

05

6.6

06

6.8

07

IV

VII IX

I

II

X

III

VI

V

VIII

Fig ure J. Chlamydia — Trends in positivity among 15- to 19-year-old women tested in fam ily

plan ning clin ics by HHS region, 2003–2007

Note: See Appendix for definitions of HHS Regions.

SOURCE: Re gional In fer til ity Pre ven tion Pro jects; Of fice of Pop u la tion Af fairs; Lo cal and State STD Con trol Pro grams; Cen ters 

for Dis ease Con trol and Pre ven tion

Prevalence (%)

Puerto Rico 11.2

Virgin Is.

See*

<10.0

10.0-14.9

>=15.0

(n= 11)

(n= 8)

(n= 18)

(n= 16)

VT 3.8

NH

MA 8.1

RI 10.5

CT 14.3

NJ 19.0

DE 8.0

MD 15.5

DC 15.7

17.6

12.3

20.8

10.4

16.7

17.5

18.4

13.3

16.0 12.0

13.7

13.0

23.5

5.6

16.0

18.6

13.2

11.2

15.5

12.7

18.6

10.7

12.1

12.2

4.9

9.1

13.4

19.8

18.5

9.1

14.3

8.9

13.2

Fig ure K. Chlamydia — Prev a lence among 16- to 24-year-old women enter ing the National Job

Training Program by state of res i dence: United States and outlying areas, 2007

*Fewer than 100 women residing in these states/areas and entering the National Job Training

Program were screened for chlamydia in 2007.

SOURCE: National Job Training Program; Department of Labor (in collaboration with the Center for Disease Detection, San

Antonio, Texas)
STD Surveillance 2007 Special Focus Profiles STDs in Adolescents and Young Adults 69

Prevalence (%)

Puerto Rico 5.5

Virgin Is.

See*

<10.0

10.0-14.9

>=15.0

(n= 4)

(n= 38)

(n= 11)

VT 3.3

NH

MA 4.7

RI 2.8

CT 6.0

NJ 8.1

DE 6.7

MD 12.3

DC 14.1

13.6

3.7

7.2

9.5

3.8

7.5

12.6

9.6

3.9

9.7 10.0

2.0

5.3

9.0

10.6

3.4

9.4

5.7

11.0

9.3

4.4

5.2 10.6

5.4

8.8

7.9

6.2

12.1

6.8

2.1

7.2

11.8

6.1

14.5

9.6

2.9

8.4

3.2

7.9

4.4

Fig ure L. Chlamydia — Prev a lence among 16- to 24-year-old men en ter ing the National Job

Training Program by state of res i dence: United States and outlying areas, 2007

*Fewer than 100 men residing in these states/areas and entering the National Job Training

Program were screened for chlamydia in 2007.

SOURCE: National Job Training Program; Department of Labor (in collaboration with the Center for Disease Detection, San

Antonio, Texas)

Prevalence (%)

Puerto Rico 0.0

Virgin Is.

See*

<2.0

2.0-4.9

>=5.0

(n= 16)

(n= 16)

(n= 18)

(n= 3)

VT 1.0

NH

MA 1.1

RI 0.0

CT 3.6

NJ 3.4

DE 1.4

MD 0.7

DC

4.0

2.7

7.2

1.9

2.9

3.6

5.3 3.2

3.3

6.0

0.0

3.3

3.4

4.2

0.0

1.7

1.2

3.3

0.8

3.1

3.7

0.8

1.4

0.7

3.5

3.1

3.1

1.0

3.0

Fig ure M. Gon or rhea — Prev a lence among 16- to 24-year-old women enter ing the National Job

Training Program by state of res i dence: United States and outlying areas, 2007

*Fewer than 100 women residing in these states/areas and entering the National Job Training

Program were screened for gonorrhea by the national contract laboratory in 2007.

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)
70 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2007

Prevalence (%)

Puerto Rico 0.0

Virgin Is.

See*

<2.0

2.0-4.9

>=5.0

(n= 20)

(n= 27)

(n= 6)

VT 0.9

NH

MA 0.5

RI 0.0

CT 1.7

NJ 2.0

DE

MD 2.4

DC

2.0

0.3

0.6

1.9

1.3

1.6

2.5

0.2

1.5

0.5

1.2

1.6

0.4 1.3

0.3

1.0

2.4

1.3

0.6

0.5

0.0

4.4

0.6

1.4

0.5

0.7

Fig ure N. Gon or rhea — Prev a lence among 16- to 24-year-old men en ter ing the National Job

Training Program by state of res i dence: United States and outlying areas, 2007

*Fewer than 100 men residing in these states/areas and entering the National Job Training Program

were screened for gonorrhea by the national contract laboratory in 2007.

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)
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). In many

areas, 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 the

National Health and Nutrition Examination

Survey (NHANES) and the National

Longitudinal Study of Adolescent Health

(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 2007, 25.7% of reports

on chlamydia cases were missing race or

ethnicity (ranging by state from 0.0% to

55.5%) (Table A1).

Gonorrhea — In 2007, 20.3% of reports

on gonorrhea cases were missing

information on race or ethnicity (ranging

by state from 0.0% to 40.2%).

Syphilis — In 2007, only 4.1% of reports 

on syphilis cases were missing information

on race or ethnicity (ranging from 0.0% to

22.6% among states with 10 or more cases 

of P&S syphilis).

Observations

Chlamydia

All racial and ethnic groups except

American Indian/Alaska Natives reported

increases in chlamydia rates from 2006 to

2007 (Table 11B). From 2003 to 2007,

chlamydia rates increased by 24.6%

among blacks; 9.0% among American

Indian/Alaska Natives; 10.5% among

Hispanics; and 18.7% among whites. Over 

the same time period, rates decreased by

1.5% among Asian/Pacific Islanders.

STD Sur veil lance 2007 Special Focus Profiles STDs in Racial and Ethnic Minorities 71
Blacks — In 2007, approximately 48% of

all 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

more than seven times higher than the rate

among white women (1,906.0 and 249.3

per 100,000 women, respectively) (Figure O,

Table 11B). The chlamydia rate among black

men was more than 11 times higher than that 

among white men (841.3 and 71.9 per

100,000 men, respectively).

American Indian/Alaska Natives — In

2007, the chlamydia rate among American

Indian/Alaska Natives was 732.9 cases per

100,000 population, a decrease of 7.2%

from the 2006 rate of 790.1. The chlamydia 

positivity rate among females aged 15–24

years screened in Indian Health Service

(IHS) clinics ranged from 8.1% in HHS

region V to 11.6% in region VIII (Figure P).

Asian/Pacific Islanders — In 2007, the

chlamydia rate among Asian/Pacific

Islanders was 139.5 cases per 100,000

population, a slight increase from the 2006

rate of 127.2.

Hispanics — In 2007, the chlamydia rate

among Hispanics was 473.2 cases per

100,000 population, nearly three times

higher than the rate among whites (162.3).

Gonorrhea

All racial and ethnic groups except blacks

saw declines in gonorrhea rates from 2006

to 2007. In contrast, the gonorrhea rate

among blacks increased by 1.8% from 2006

to 2007 (Table 21B and Figure 21).

Blacks — In 2007, approximately 70% of

the total number of reported cases of

gonorrhea occurred among blacks (Table

21A). In 2007, the rate of gonorrhea among 

blacks was 662.9 cases per 100,000

population. Overall, the rate of gonorrhea

among blacks in the United States was 19

times greater than that among whites This

disparity is unchanged from recent years

(20 times higher in 2003) (Figure Q, Table

21B). This disparity was higher for black

men (26.1 times higher) than for black

women (14.9 times higher) (Figure R). The 

disparity in gonorrhea rates for blacks was

higher in the Midwest and Northeast (27.2

and 24.8 times higher, respectively) than in 

the South or the West (15.6 and 12.4

times higher, respectively) (Figure S).

In 2007, gonorrhea rates were highest for

blacks aged 15 to 19 and 20 to 24 years

among all racial, ethnic, and age

categories. Black women aged 15 to 19

years had a gonorrhea rate of 2,955.7

cases per 100,000 women. This rate was

14.7 times greater than the 2007 rate

among white women of similar age

(200.6). Black men in the 15- to

19-year-old age category had a 2007

gonorrhea rate of 1,537.8 cases per

100,000 men, which was 38.7 times

higher than the rate among 15- to

19-year-old white men of 39.7 per

100,000 men. Among those aged 20 to

24 years, the gonorrhea rate among

blacks was 16.5 times greater than that

among whites (2,618.3 and 158.8 cases

per 100,000 population, respectively)

(Table 21B).

American Indian/Alaska Natives — In

2007 the gonorrhea rate among American

Indian/Alaska Natives was 107.1 which

was 3.1 times higher than the rate among

whites. This disparity is similar to recent

years (3.1 times higher in 2003) (Figure Q, 

Table 21B). This disparity was higher for

American Indian/Alaska Native women

(3.4 times higher) than for American

Indian/Alaska Native men (2.6 times

higher) (Figure R). The disparity in

gonorrhea rates for American

Indian/Alaska Natives was higher in the

Northeast and the Midwest (3.9 and 3.3

times higher, respectively) than in the West 

or the South (2.9 and 2.6 times,

respectively) (Figure S).

72 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Sur veil lance 2007
Asian/Pacific Islanders — In 2007 the

gonorrhea rate among Asian/Pacific

Islanders was 18.8 cases per 100,000

population which was lower than the rate

among whites (Figure Q, Table 21B). This

difference is greater for Asian/Pacific

Islander women than for Asian/Pacific

Islander men (Figure R). Rates among

Asian/Pacific Islanders are consistently

lower than among whites in all four regions 

of the U.S. (Figure S).

Hispanics — In 2007, the gonorrhea rate

among Hispanics was 69.2 which was

higher than the rate among whites. This

disparity is similar to that in recent years

(Figure Q, Table 21B). This disparity was

higher for Hispanic men than for Hispanic

women (Figure R). The disparity in

gonorrhea rates for Hispanics was higher in

the Northeast than in the West, the Midwest, 

or the South (Figure S).

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 2003 and 2007, the rate of P&S

syphilis increased among all racial and

ethnic groups.

Blacks — Between 2006 and 2007, the rate

of P&S syphilis among blacks increased

25.0% (from 11.2 to 14.0). In 2007, 46.0% of

all cases of P&S syphilis reported to CDC

were among blacks and 35.3% of all cases

were among non-Hispanic whites (Table 33A). 

Compared to whites, the overall 2007 rate for

blacks was 7.0 times higher. It was 5.9 times

higher in 2006 (Table 33B). In 2007, the P&S

rate among black men was more than 6.0

times higher than that among white men;

the rate among black women was 14 times

higher than that among white women. In

some age groups, particularly 15–19 year

old black men, disparities have increased

markedly in recent years as rates of disease 

have increased (Figure V).

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 2006 and 2007, the rate of P&S

syphilis among American Indian/Alaska

Natives increased 6.3% (from 3.2 to 3.4).

In 2007, 0.7% of all cases of P&S syphilis

reported to CDC were among American

Indian/Alaska Natives (Table 33A).

Compared to whites, the 2007 rate for

American Indian/Alaska Natives was 1.7

times higher (Table 33B).

Asian/Pacific Islanders — Between

2006 and 2007, the rate of P&S syphilis

among Asian/Pacific Islanders remained

unchanged (1.2 per 100,000 population).

In 2007, 1.2% of all cases of P&S syphilis

reported to CDC were among Asian/Pacific 

Islanders (Table 33A). The 2007 rate for

Asian/Pacific Islanders was 0.6 times the

rate for whites (Table 33B).

Hispanics — Between 2006 and 2007,

the rate of P&S syphilis among Hispanics

increased 22.9% (from 3.5 to 4.3). In

2007, 16.5% of all cases of P&S syphilis

reported to CDC were among Hispanics

(Table 33A). Compared to whites, the

2007 rate for Hispanics was 2.2 times

higher (Table 33B).

Congenital Syphilis

In 2007, the rate of congenital syphilis

(based on the mother’s race/ethnicity) was

32.3 cases per 100,000 live births among

blacks and 15.3 cases per 100,000 live

births among Hispanics. These rates are 14 

and 6.6 times higher, respectively, than the 

2007 rate among whites (2.3 cases per

100,000 live births) (Figure W, Table 40). 

STD Sur veil lance 2007 Special Focus Profiles STDs in Racial and Ethnic Minorities 73
74 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Sur veil lance 2007

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. Ep i de mi ol ogy of syph i lis in the

United States, 1941 through 1993. Sexually

Transmitted Diseases 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.
STD Surveillance 2007 Special Focus Profiles STDs in Racial and Ethnic Minorities 75

Men Rate (per 100,000 population) Women

2000 1600 1200 800 400 0 Race 0 400 800 1200 1600 2000

293.8 AI/AN 1158.2

66.3 Asian/PI 208.8

841.3 Black 1906.0

211.7 Hispanic 753.3

71.9 White 249.3

190.4 Total 544.8

Fig ure O. Chlamydia — Rates by race/eth nic ity and sex: United States, 2007

I*

II*

III*

IV*

V

8.1

VI

11.3

VII*

VIII

11.6

IX

9.6

X

8.8

Fig ure P. Chlamydia — Positivity among 15- to 24-year-old women screened in Indian

Health Service (IHS) clinics by HHS region, 2007

*Chlamydia positivity data not available. See Appendix for definitions of HHS Regions.
76 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Surveillance 2007

1:2

1:1

2:1

4:1

8:1

16:1

32:1

1998 99 2000 01 02 03 04 05 06 07

† Rate Ratio

Black

Hispanic

Asian/Pacific Islander

American Indian/AK Native

Fig ure Q. Gonorrhea — Rate ratios* by race/ethnicity: United States, 1998–2007

*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.

Men Rate (per 100,000 population) Women

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

69.5 AI/AN 143.4

17.9 Asian/PI 19.7

694.6 Black 634.0

64.3 Hispanic 74.5

26.6 White 42.6

113.9 Total 123.8

Fig ure R. Gonorrhea — Rates by race/ethnicity and sex: United States, 2007
STD Surveillance 2007 Special Focus Profiles STDs in Racial and Ethnic Minorities 77

Rate Ratio

†

West

Midwest

Northeast

South

1:4

1:2

1:1

2:1

4:1

8:1

16:1

32:1

Black Hispanic Asian/PI Am Ind/AK Nat

Fig ure S. Gonorrhea — Rate ratios* by race/ethnicity and region: United States, 2007

*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.

Men Rate (per 100,000 population) Women

25 20 15 10 5 0 Race 0 5 10 15 20 25

4.3 AI/AN 2.6

2.4 Asian/PI 0.1

23.2 Black 5.6

7.5 Hispanic 0.8

3.7 White 0.4

6.6 Total 1.1

Fig ure T. Pri mary and sec ond ary syph i lis — Rates by race/ethnicity and sex: United

States, 2007
78 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Surveillance 2007

0

5

10

15

20

25

1998 99 2000 01 02 03 04 05 06 07

Rate (per 100,000 population)

American Indian/AK Native

Asian/Pacific Islander

Black

Hispanic White

Fig ure U. Pri mary and sec ond ary syph i lis — Rates among 15- to 19-year-old females by

race/eth nic ity: United States, 1998–2007

0

4

8

12

16

20

1998 99 2000 01 02 03 04 05 06 07

Rate (per 100,000 population)

American Indian/AK Native

Asian/Pacific Islander

Black

Hispanic White

Fig ure V. Pri mary and sec ond ary syph i lis — Rates among 15- to 19-year-old males by

race/eth nic ity: United States, 1998–2007
STD Surveillance 2007 Special Focus Profiles STDs in Racial and Ethnic Minorities 79

0

20

40

60

80

100

1998 99 2000 01 02 03 04 05 06 07

Rate (per 100,000 live births)

American Indian/AK Native

Asian/Pacific Islander

Black

Hispanic White

Fig ure W. Con gen i tal syph i lis — Rates among in fants < 1 year of age by mother’s

race/eth nic ity: United States, 1998–2007

Note: The Healthy People 2010 target for congenital syphilis is 1.0 case per 100,000 live births.

Less than 5% of cases had missing maternal race/ethnicity information and were excluded.

STDs in Men Who Have Sex with

Men

Public Health Impact

Notifiable disease surveillance data on

syphilis and data from the Gonococcal

Isolate Surveillance Project (GISP) suggest

that an increasing number of MSM are

acquiring STDs.1234567,,,,,, Data also suggest that an

increasing number of MSM engage in sexual 

behaviors that place them at risk for STDs

and HIV infection.8 Several factors may be

contributing to this change, including the

availability of highly active antiretroviral

therapy (HAART) for HIV infection.9

Because STDs and the behaviors associated 

with acquiring them increase the likelihood

of acquiring and transmitting HIV

infection,10 the rise in STDs among MSM

may be associated with an increase in HIV

diagnoses among MSM.11

With the exception of reported syphilis

cases, most nationally notifiable STD

surveillance data do not include information 

regarding sexual behaviors; national trends

in STDs among MSM in the United States

are not currently available. Data from

enhanced surveillance projects are

presented in this section to provide

information regarding STDs in MSM.

Monitoring Trends in Prevalence of

STDs, HIV and Risk Behaviors

among Men Who Have Sex with Men 

(MSM Prevalence Monitoring

Project), STD Clinics, 1999–2007

From 1999 through 2007, eight U.S. cities

participating in the MSM Prevalence

Monitoring Project submitted syphilis,

gonorrhea, chlamydia, and HIV test data to

CDC from 143,478 MSM visits to STD

clinics; data from 121,353 MSM visits were 

submitted from five public STD clinics

(Denver, New York City, Philadelphia, San

Francisco, and Seattle) and data from

22,125 MSM visits were submitted from

three STD clinics in community-based, gay 

men’s health clinics (Chicago, the District

of Columbia, and Houston).

Changes in testing technology for

gonorrhea and chlamydia have occurred

in recent years with the advent of nucleic

acid amplification tests (NAATs) which

achieve greater sensitivity than traditional

culture methods.12,13 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 hybridization tests (DNA

probes). Tests for chlamydia included

culture, NAATs, DNA probes, or direct

fluorescent antibody tests (DFAs).

Nontreponemal syphilis tests included the

Rapid Plasma Reagin (RPR) test and the

Venereal Disease Research Laboratory

(VDRL) test.

All statistics were based on data collected

from clinic visits and may reflect multiple

visits by a patient rather than unique

individuals. City-specific medians and

ranges were calculated for the proportion

of tests done and for STD and HIV test

positivity.

STD Sur veil lance 2007 Special Focus Profiles STDs in Men Who Have Sex with Men 81

1-7
Gon or rhea 

Between 1999 and 2007 the number of

gonorrhea tests for all anatomic sites

combined increased in all eight cities. The

trend in the number of positive gonorrhea

tests for all anatomic sites varied by city.

For all cities, the number of positive

gonorrhea tests in symptomatic men

accounted for the majority of the overall

positive tests (Figure X).

In 2007, 79% (range: 58–90%) of MSM

were tested for urethral gonorrhea, 37%

(range: 5–51%) were tested for rectal

gonorrhea, and 58% (range: 5–83%) were

tested for pharyngeal gonorrhea. 

In 2007, median clinic urethral gonorrhea 

positivity in MSM was 8% (range:

5–15%), median rectal gonorrhea

positivity was 7% (range: 3–11%), and

median pharyngeal gonorrhea positivity

was 6% (range: 1–13%).

Chlamydia 

In 2007, a median of 79% (range: 59–90%)

of MSM visiting participating STD clinics

were tested for urethral chlamydia,

compared to 65% (range: 57–68%) in 1999. 

In 2007, the median urethral chlamydia

positivity was 7% (range: 5–9%).

Syph i lis

In 2007, 79% (range: 60–96%) 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 Y).

Overall, median seroreactivity among MSM

tested for syphilis increased from 4% (range: 

3–13%) in 1999 to 8% (range: 4–18%) in

2007.

Syphilis seroreactivity is used as a proxy for 

syphilis prevalence and has been correlated

with prevalence of P&S syphilis in this

population.14

HIV In fec tion

Overall, the percent of MSM tested for HIV 

in STD clinics increased between 1999 and 

2007. In 2007, a median of 70% (range:

38–87%) 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 2007, median HIV positivity in MSM

was 4% (range: 2–5%) (Figure Z). 

In 2007, median HIV prevalence among

MSM, including persons previously known

to be HIV-positive and persons testing

HIV-positive at their current visit, was 13% 

(range: 7–15%).

HIV/STDs by Race/Eth nic ity 

HIV positivity among persons tested for

HIV during 2007 varied by race/ethnicity,

but was highest in black MSM. HIV

positivity was 2% (range: 2–3%) in whites,

8% (range: 2–10%) in blacks, and 5%

(range: 2–7%) in Hispanics (Figure AA).

HIV positivity was 9% (range: 6–15%) in

whites, 17% (range: 15–24%) in blacks,

and 14% (range: 6–16%) in Hispanics.

In 2007, urethral gonorrhea positivity was

6% (range: 5–14%) in whites, 15% (range: 

7–27) in blacks, and 6% (range: 4–14%) in 

Hispanics. Rectal gonorrhea positivity was

6% (range: 2–10%) in whites, 7%

(range: 2–11%) in blacks, and 5%

(range: 1–7%) in Hispanics. Pharyngeal

gonorrhea positivity was 6% (range:

1–15%) in whites, 6% (range: 1–13%) in 

blacks, and 5% (range: 1–10%) in

Hispanics (Figure AA).

Urethral chlamydia positivity was 6%

(range: 3–8%) in whites; 8% (range:

5–10%) in blacks, and 5% (range: 3–13%) 

in Hispanics (Figure AA). 

Median syphilis seroreactivity was 7%

(range: 4–12%) in whites; 14% (range:

82 STDs in Men Who Have Sex with Men Special Focus Profiles STD Sur veil lance 2007
8–30%) in blacks, and 11% (range: 3–22%)

in Hispanics (Figure AA).

STDs by HIV Sta tus, STD Clin ics 

In 2007, urethral gonorrhea positivity was

11% (range: 8–16%) in HIV-positive MSM

and 7% (range: 5–15%) in MSM who were

HIV-negative or of unknown HIV status;

rectal gonorrhea positivity was 10% (range:

4–14%) in HIV-positive MSM and 4%

(range: 3–10%) in MSM who were

HIV-negative or of unknown HIV status;

pharyngeal gonorrhea positivity was 4%

(range: 2–12%) in HIV-positive MSM and

5% (range: 1–13%) in MSM who were

HIV-negative or of unknown HIV status.

Median urethral chlamydia positivity was

6% (range: 3–12%) in HIV-positive MSM

and 7% (range: 4–9%) in MSM who were

HIV-negative or of unknown HIV status.

Median syphilis seroreactivity was 32%

(range: 19–42%) in HIV-positive MSM and

6% (range: 3–13%) 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 2003 and 2007, with a 64.0%

increase in the number of P&S syphilis cases 

among men and a 39.0% increase in the

number of cases among women (Tables 26

and 27). In 2007, the rate of reported P&S

syphilis among men (6.6 cases per 100,000

males) was 6.0 times greater than the rate

among women (1.1 case per 100,000

females) (Tables 26 and 27). Higher rates

in men are observed for all racial and

ethnic groups.

In 2007, MSM accounted for 65% 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 can be found in the Syphilis

section (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.15,16

GISP also reports the percentage of N.

gonorrhoeae isolates obtained from MSM.

Overall, the proportion of isolates from

MSM in selected STD clinics from GISP

sentinel sites have increased steadily from

4% in 1988 to 22.4% in 2007 (Figure BB). 

Additionally, the proportion of isolates

coming from MSM varies geographically

with the largest percentage from the West

Coast (Figure CC).

Additional information on GISP may be

found in the Gonorrhea section (National 

Profile).

STD Sur veil lance 2007 Special Focus Profiles STDs in Men Who Have Sex with Men 83
84 STDs in Men Who Have Sex with Men Special Focus Profiles STD Sur veil lance 2007

1 Centers for Disease Con trol and Pre ven tion.

Gon or rhea among men who have sex with men 

– se lected sex u ally trans mit ted dis ease clin ics,

1993–1996. MMWR 1997;46:889–92.

2 Centers for Disease Con trol and Pre ven tion.

Re sur gent bac te rial sex u ally trans mit ted dis ease

among men who have sex with men – King

County, Wash ing ton, 1997–1999. MMWR

1999;48:773–7.

3 Centers for Disease Con trol and Pre ven tion.

Out break of syph i lis among men who have sex

with men – South ern Cal i for nia, 2000. MMWR

2001;50:117–20.

4

Fox KK, del Rio C, Holmes K, et. al. Gonor rhea

in the HIV era: A re ver sal in trends among men

who have sex with men. Am J Public Health

2001;91:959–964.

5 Centers for Disease Con trol and Pre ven tion.

Pri mary and sec ond ary syph i lis among men

who have sex with men – New York City, 2001. 

MMWR 2002;51:853–6.

6 Centers for Disease Con trol and Pre ven tion.

Pri mary and sec ond ary syphi lis – United States,

2003–2004. MMWR 2006;55:269–73.

7 Beltrami JF, Shouse RL, Blake PA. Trends in

infectious diseases and the male to female ratio:

possible clues to changes in behavior among

men who have sex with men. AIDS Educ Prev

2005;17:S49-S59.

8

Stall R, Hays R, Waldo C, Ekstrand M,

McFarland W. The gay ‘90s: a re view of

re search in the 1990s on sex ual be hav ior and

HIV risk among men who have sex with men.

AIDS 2000;14:S1-S14.

9

Scheer S, Chu PL, Klausner JD, Katz MH,

Schwarcz SK. Ef fect of highly ac tive

antiretroviral ther apy on di ag no ses of sex u ally

trans mit ted dis eases in peo ple with AIDS.

Lan cet 2001;357:432–5.

10Fleming DT, Wasserheit JN. From

epidemiologic syn ergy to pub lic health pol icy

and practice: the con tri bu tion of other sex u ally

trans mit ted dis eases to sex ual trans mis sion of

HIV in fec tion. Sex Transm Infect 1999;75:3–17.

11Hall HI, Song R, Rhodes P, et. al. HIV Incidence 

Surveillance Group. JAMA, 2008 Aug

6;300(5):520–9.

12Kent CK, Chow JK, Wong W, et. al. Prevalence

of rectal, urethral, and pharyngeal chlamydia

and gonorrhea detected in 2 clinical settings

among men who have sex with men: San

Francisco, California, 2003. Clin Infect Dis

2005;41:67–74.

13 Jespersen DJ, Flatten KS, Jones MF, Smith TF.

Prospective comparison of cell cultures and

nucleic acid amplification tests for laboratory

diagnosis of Chlamydia trachomatis infections. J 

Clin Microbiol 2005; 43(10):5324–6.

14Helms 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].

15Schwarcz S, Zenilman J, Schnell D, et. al.

National Surveillance of Antimicrobial

Resistance in Neisseria gonorrhoeae. JAMA

1990; 264(11): 1413–1417.

16Centers 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 (available first quarter 2009).
STD Surveillance 2007 Special Focus Profiles STDs in Men Who Have Sex with Men 85

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 2000 2001 2002 2003 2004 2005 2006 2007

Total GC tests Positives

HOUSTON*

0

300

600

900

1200

1999 2000 2001 2002 2003 2004 2005 2006 2007

Total GC tests Positives

PHILADELPHIA

0

300

600

900

1200

1999 2000 2001 2002 2003 2004 2005 2006 2007

Total GC tests Positives

SAN FRANCISCO

0

2000

4000

6000

8000

1999 2000 2001 2002 2003 2004 2005 2006 2007

Total GC tests Positives

DISTRICT OF COLUMBIA

0

600

1200

1800

2400

3000

1999 2000 2001 2002 2003 2004 2005 2006 2007

Total GC tests Positives

NEW YORK CITY

0

600

1200

1800

2400

3000

1999 2000 2001 2002 2003 2004 2005 2006 2007

Total GC tests Positives

DENVER

0

600

1200

1800

2400

3000

1999 2000 2001 2002 2003 2004 2005 2006 2007

Total GC tests Positives

SEATTLE

0

600

1200

1800

2400

3000

1999 2000 2001 2002 2003 2004 2005 2006 2007

Positive GC tests

Positive GC tests in symptomatic men

Total tests

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

of positive tests in men who have sex with men, STD clinics, 1999–2007 

*Data not reported in 2006 or 2007.

Note: The bars represent the number of total GC 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.
86 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2007

CHICAGO

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006 2007

HOUSTON*

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006 2007

PHILADELPHIA

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006 2007

SAN FRANCISCO

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006 2007

DISTRICT OF COLUMBIA

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006 2007

NEW YORK CITY

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006 2007

DENVER

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006 2007

SEATTLE

Percent

0

5

10

15

20

1999 2000 2001 2002 2003 2004 2005 2006 2007

Seroreactivity

Titer >= 1:16

Figure Y. MSM Prevalence Monitoring Project — Syphilis serologic reactivity among men

who have sex with men, STD clinics, 1999–2007

*Data not reported in 2006 or 2007. Titer data not reported in 2004 or 2005.

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.
STD Surveillance 2007 Special Focus Profiles STDs in Men Who Have Sex with Men 87

0

300

600

900

1200

99 2000 01 02 03 04 05 06 07

0

1

2

3

4

5

6

Median number of tests Median percent positive*

Number of tests Positivity

Fig ure Z. MSM Prevalence Monitoring Project — City-specific median number of HIV tests 

and positivity among men who have sex with men, STD clinics, 1999–2007

*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.

Median positivity

†

White

Black

Hispanic

0

5

10

15

20

25

Urethral

gonorrhea

Rectal

gonorrhea

Pharyngeal

gonorrhea

Urethral

chlamydia

HIV* Syphilis

Fig ure AA. 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, 2007

*Excludes persons previously known to be HIV-positive.

†Seroreactivity
88 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2007

0

5

10

15

20

25

1988 90 92 94 96 98 2000 02 04 06

Percent

Fig ure BB. Gono coc cal Iso late Sur veil lance Pro ject (GISP) — Per cent of urethral

Neisseria gonorrhoeae isolates obtained from men who have sex with men

attending STD clin ics, 1988–2007

0%

50%

100%

'04 '05 '06 '07

% of Isolates

from MSM

BHM

PHX

LBC

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

Fig ure CC. Gono coc cal Iso late Sur veil lance Pro ject (GISP) — Per cent of urethral

Neisseria gonorrhoeae isolates obtained from men who have sex with men

attending STD clin ics by GISP site, 2004–2007

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; LBC=Long Beach,

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).
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.123,4,, 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 2007, STD screening data from

corrections facilities were reported from 37

states and Puerto Rico for chlamydia, 33

states and Puerto Rico for gonorrhea, and

19 states for syphilis. The Infertility

Prevention Project (IPP) provided CDC with 

line-listed data for chlamydia and

gonorrhea. Aggregate syphilis data were

reported to CDC by local and state STD

prevention programs.

The figures and tables shown in this section

represent 47,042 chlamydia tests in women

and 115,014 in men; 37,243 gonorrhea

tests in women and 97,666 in men; and

50,666 syphilis serologic tests in women and 

200,064 in men entering corrections

facilities during 2007. 

Chlamydia 

Overall, chlamydia positivity was higher in

women than in men for all age groups. 

Adolescent Men — In adolescent men

entering 109 juvenile corrections facilities

in 2007, the median chlamydia positivity

by facility was 5.7% (range: 0.0% to

14.2%) (Table A). In men 12 to 18 years of 

age entering these facilities, the overall

chlamydia positivity was 6.4% (Figure

DD). Chlamydia positivity increased from

1.4% for adolescent men aged 12 years to

9.1% for those aged 18 years. 

Adolescent Women — In adolescent

women entering 73 juvenile corrections

facilities in 2007, median chlamydia

positivity by facility was 14.3% (range:

2.5% to 32.1%); positivity was greater

than 10% in almost all facilities reporting

data (Table A). In women 12 to18 years of

age entering these facilities, the overall

chlamydia positivity was 14.8% (Figure

DD). Positivity in women increased from

6.8% for those aged 12 years to 15.7% for 

those aged 14 years and, then remained

high for women aged 15 to 18 years. 

Men — In men entering 51 adult

corrections facilities in 2007, the median

chlamydia positivity by facility was 7.7%

(range: 0.5% to 25.3%) (Table D).

Positivity in young adult men aged less

than 25 years in these facilities (8.7%) was

higher than the overall prevalence

STD Sur veil lance 2007 Special Focus Profiles STDs in Persons Entering Corrections Facilities 89

1-4
observed in adolescent men entering

juvenile facilities (6.4%) (Figure EE).

Chlamydia positivity decreased with age

from 8.7% for those younger than 25 years

of age to 1.8% for those older than 34

years. Overall positivity among adult men

entering corrections facilities in 2007 was

6.2% 

Women — In women entering 37 adult

corrections facilities in 2007, median

positivity for chlamydia by facility was 6.4%

(range: 0.0% to 21.0%) (Table B). Overall,

in women entering these facilities, the

chlamydia positivity was 9.7% (Figure EE).

Chlamydia positivity decreased with age

from 18.6% for those younger than 20 years 

to 3.5% for those older than 34 years.

Overall chlamydia positivity in women

entering adult corrections facilities (9.7%)

was significantly lower than that in

adolescent women entering juvenile

corrections facilities (14.8%). 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.

Adolescent Men — The median positivity

for gonorrhea by facility in adolescent men

entering 90 juvenile corrections facilities in

2007 was 1.0% (range: 0.0% to 4.5%)

(Table C). The overall positivity was 1.2% in 

men 12 to 18 years of age attending these

facilities. (Figure FF). Gonorrhea positivity

increased with age from 0.1% for those

aged 12 years to 2.1% for those aged 18

years.

Adolescent Women — The median

positivity for gonorrhea by facility in women 

entering 52 juvenile corrections facilities in

2007 was 5.3% (range: 0.0% to 13.9%)

(Table C). In women 12 to18 years of age

entering these, the overall gonorrhea

positivity was 5.6% (Figure FF). In 2007,

gonorrhea positivity increased with age

from 1.8% among 12-year-olds to 7.1%

among young women aged 18 years of

age. 

Men — In men entering 42 adult

corrections facilities in 2007, the median

gonorrhea positivity was 1.7% (range:

0.0% to 10.7%) (Table D). Overall

gonorrhea positivity for men attending

these facilities was 1.6% (Figure GG).

Gonorrhea positivity was highest in men

aged 20 to 24 years at 2.2%, declining

with age to 0.9% in men older than 34

years. Men aged younger than 20 years

attending adult facilities had higher

gonorrhea positivity than men attending

juvenile detention facilities. 

Women — In women entering 31 adult

corrections facilities in 2007, the median

gonorrhea positivity by facility was 2.9%

(range: 0.0% to 7.3%) (Table D). Overall,

in women entering these facilities, the

gonorrhea positivity was 3.7% (Figure

GG). Gonorrhea positivity decreased with

age from 6.5% for those younger than 20

years to 1.5% for those older than 34

years. Women younger than 20 years

attending adult facilities had higher

gonorrhea positivity than young women

attending juvenile detention facilities.

Syphilis

Adolescent Men — In 2007, the median

syphilis serologic positivity by facility was

0.1% (range: 0.0% to 0.9%) in adolescent

men entering eight juvenile corrections

facilities (Table E).

Adolescent Women — In 2007, the

median syphilis serologic positivity by

facility was 0.2% (range: 0.0% to 2.1%) in

adolescent women entering five juvenile

corrections facilities (Table E). 

Men — In men entering 60 adult

corrections facilities in 2007, the median

90 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Sur veil lance 2007
syphilis serologic positivity by facility was

1.0% (range: 0.0% to 47.0%) (Table F). 

Women — In women entering 36 adult

corrections facilities in 2007, the median

serologic positivity by facility was 2.1%

(range: 0.0% to 28.0%) (Table F).

STD Sur veil lance 2007 Special Focus Profiles STDs in Persons Entering Corrections Facilities 91

1 Heimberger TS. Chang HG. Birkhead GS.

DiFerdinando GD. Greenberg AJ. Gunn R.

Morse DL. High prev a lence of syph i lis de tected

through a jail screen ing program. A po ten tial

pub lic health mea sure to ad dress the syph i lis

ep i demic. Arch In tern 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 (in press).

4

Satterwhite CL, Joesoef MR, Datta SD, 

Weinstock H. Estimates of Chlamydia

trachomatis Infections among men:United

States. Sex Trans Dis (in press).

5 Blank S, McDonnell DD, Ru bin SR et al. New

ap proaches to syph i lis con trol. Find ing

op por tu ni ties for syph i lis treat ment and

con gen i tal syph i lis pre ven tion in a women’s

cor rec tional set ting. Sexually Transmitted

Diseases 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 Trans Dis

2004; 29:271–276.
92 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2007

Men Positivity Women

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

1.4 12 6.8

1.4 13 9.6

3.1 14 15.7

5.5 15 14.8

7.3 16 15.2

8.0 17 15.2

9.1 18 16.8

6.4 Total 14.8

Fig ure DD. Chlamydia — Positivity by age and sex, juvenile cor rec tions fa cil i ties, 2007

Note: Percent positivity is presented from facilities reporting > 100 test results.

Men Positivity Women

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

8.7 <20 18.6

8.7 20-24 13.6

5.5 25-29 9.7

5.6 30-34 7.1

1.8 >=35 3.5

6.2 Total 9.7

Fig ure EE. Chlamydia — Positivity by age group and sex, adult cor rec tions fa cil i ties, 2007

Note: Percent positivity is presented from facilities reporting > 100 test results.
STD Surveillance 2007 Special Focus Profiles STDs in Persons Entering Corrections Facilities 93

Men Positivity Women

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

0.1 12 1.8

0.4 13 3.6

0.5 14 5.2

0.9 15 5.7

1.4 16 5.7

1.7 17 6.2

2.1 18 7.1

1.2 Total 5.6

Fig ure FF. Gon or rhea — Positivity by age and sex, ju ve nile cor rec tions fa cil i ties, 2007

Note: Percent positivity is presented from facilities reporting > 100 test results.

Men Positivity Women

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

2.1 <20 6.5

2.2 20-24 4.4

1.5 25-29 3.8

1.1 30-34 3.7

0.9 >=35 1.5

1.6 Total 3.7

Fig ure GG. Gon or rhea — Positivity by age group and sex, adult cor rec tions fa cil i ties, 2007

Note: Percent positivity is presented from facilities reporting > 100 test results.
94 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2007

Men Women

State 

No. of 

Facilities

No. of

Tests

Median % Positivity

(Range) 

No. of 

Facilities

No. of

Tests

Median % Positivity

(Range) 

Alabama – – – 1 119 16.0

Arizona 6 5,375 5.4 (2.4-8.4) 5 1,503 16.1 (3.2-20.8)

California* 18 24,033 4.9 (0.0-10.6) 22 11,007 11.1 (2.5-27.0)

Colorado 1 236 7.6 – – –

Connecticut 2 726 3.2 (2.6-3.8) 2 257 11.3 (10.9-11.6)

Georgia 15 5,787 6.2 (1.7-11.0) 11 2,101 20.0 (13.5-27.7)

Hawaii 1 147 8.8 – – –

Idaho – – – 1 208 11.5

Illinois 5 4,705 7.8 (6.5-10.9) 1 396 17.9

Indiana 1 979 10.1 1 237 21.1

Kentucky 7 2,152 4.9 (2.3-9.8) 1 176 12.5

Maryland 4 1,731 5.9 (2.7-7.5) 2 408 15.1 (14.3-15.9)

Massachusetts 1 412 2.2 – – –

Michigan 8 5,096 10.1 (6.2-13.9) 4 1,378 17.0 (10.3-19.7)

Minnesota 1 306 11.8 – – –

Mississippi 1 465 9.0 1 106 15.1

Missouri 1 449 6.9 – – –

Nebraska 1 368 6.3 1 193 12.4

Nevada 2 1,388 8.9 (3.7-14.2) 2 278 23.0 (13.9-32.1)

New Jersey 3 2,786 7.9 (6.6-11.4) 1 169 18.3

New Mexico 2 638 5.7 (4.1-7.2) – – –

New York 7 4,616 4.2 (2.6-6.1) 5 1,086 14.6 (12.1-15.7)

North Dakota 1 132 6.8 – – –

Ohio 5 6,216 8.2 (5.0-11.2) 3 1,314 18.8 (7.6-20.4)

Oregon 3 1,442 4.5 (3.3-8.6) 3 423 7.6 (6.5-19.5)

Pennsylvania 1 127 3.1 – – –

Puerto Rico 2 354 4.1 (3.5-4.7) 1 107 20.6

Tennessee 1 1,911 4.3 1 825 12.4

Texas 1 832 9.4 1 199 16.6

Virginia 1 729 8.1 – – –

Washington 5 1,030 5.0 (2.7-13.4) 3 907 12.4 (3.5-21.0)

Wisconsin 2 576 5.6 (4.5-6.8) – – –

Total 109 75,744 5.7 (0.0-14.2) 73 23,397 14.3 (2.5-32.1)

Table A. Chlamydia — Po sitivity among men and women in juvenile corrections facilities, 2007

Note: The percent positivity by facility is presented from facilities reporting > 100 test results.

*Includes Los Angeles and San Francisco project areas.
STD Surveillance 2007 Special Focus Profiles STDs in Persons Entering Corrections Facilities 95

Men Women

State 

No. of 

Facilities

No. of

Tests

Median % Positivity

(Range) 

No. of 

Facilities

No. of

Tests

Median % Positivity

(Range) 

Arizona 3 874 13.9 (11.5-15.7) 2 1,474 9.9 (4.7-15.2)

California* 5 4,338 4.2 (2.9-5.8) 4 9,316 11.2 (5.3-15.6)

Delaware 1 679 4.1 2 1,008 7.8 (5.1-10.4)

Hawaii – – – 2 288 12.3 (6.4-18.3)

Illinois 6 2,621 10.5 (5.9-14.8) 3 2,903 5.1 (3.3-5.7)

Indiana 1 1,209 6.7 2 1,433 10.1 (10.1-10.2)

Iowa 2 768 13.8 (8.1-19.4) 1 435 5.1

Maryland 1 633 6.0 – – –

Massachusetts 2 3,601 4.7 (4.7-4.8) 2 911 4.0 (3.6-4.3)

Michigan 1 154 25.3 1 240 10.4

Missouri 1 3,018 5.8 1 570 4.6

Montana – – – 1 106 0.0

Nebraska 4 1,585 8.2 (6.2-19.9) 1 225 11.6

Nevada 1 294 9.5 1 182 8.8

New Mexico 1 130 10.8 1 478 10.5

New York 2 7,054 7.0 (3.7-10.3) 1 249 5.2

North Dakota 1 469 5.5 1 101 5.9

Oregon 2 233 20.4 (18.4-22.3) 1 169 7.7

Pennsylvania 3 2,210 7.7 (4.3-10.3) 3 610 5.4 (4.9-6.9)

South Carolina 2 1,101 8.6 (7.9-9.3) 1 145 8.3

Texas 3 2,264 7.1 (0.5-16.6) 2 942 19.1 (17.3-21.0)

Utah 1 110 9.1 1 171 11.7

Washington – – – 1 801 6.1

West Virginia 4 1,510 2.9 (0.5-5.1) 1 151 0.7

Wisconsin 4 4,415 9.0 (5.6-13.5) 1 737 2.0

Total 51 39,270 7.7 (0.5-25.3) 37 23,645 6.4 (0.0-21.0)

Table B. Chlamydia — Po sitivity among men and women in adult corrections facilities, 2007

Note: The percent positivity by facility is presented from facilities reporting > 100 test results.

*Includes Los Angeles and San Francisco project areas.
96 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2007

Men Women

State 

No. of 

Facilities

No. of

Tests

Median % Positivity

(Range) 

No. of 

Facilities

No. of

Tests

Median % Positivity

(Range) 

Alabama – – – 1 120 10.8

Arizona 6 5,373 0.9 (0.0-1.4) 5 1,503 3.8 (0.9-5.6)

California* 6 16,309 0.5 (0.0-1.2) 6 4,426 4.2 (0.8-5.9)

Colorado 1 236 1.7 – – –

Connecticut 2 724 0.5 (0.0-1.1) 2 258 4.1 (1.7-6.5)

Georgia 15 5,781 1.8 (0.0-4.5) 11 2,098 8.3 (1.8-13.9)

Hawaii 1 147 0.0 – – –

Idaho – – – 1 208 0.0

Illinois 5 4,708 1.0 (0.0-2.3) 1 398 8.8

Indiana 1 979 3.8 1 237 7.2

Kentucky 7 2,151 1.2 (0.5-2.5) 1 176 3.4

Maryland 4 1,731 0.8 (0.0-1.1) 2 408 4.7 (4.7-4.7)

Michigan 8 4,979 1.9 (0.4-2.9) 4 1,353 6.7 (1.7-7.3)

Minnesota 1 307 4.2 – – –

Mississippi 1 464 1.1 1 106 5.7

Missouri 1 449 2.9 – – –

Nebraska 1 368 2.4 1 193 5.2

Nevada 2 1,389 0.8 (0.5-1.0) 2 278 2.7 (0.8-4.5)

New Jersey 3 2,787 2.0 (0.4-2.2) 1 169 5.3

New Mexico 2 638 0.3 (0.0-0.7) – – –

New York 6 4,085 0.5 (0.0-1.0) 4 962 3.4 (1.7-6.7)

Ohio 5 6,215 1.7 (0.0-1.8) 3 1,314 6.5 (3.5-6.6)

Pennsylvania 1 127 0.0 – – –

Puerto Rico 2 354 0.0 1 107 1.9

Tennessee 1 1,913 0.7 1 828 4.0

Texas 1 832 1.6 1 199 8.0

Virginia 1 729 0.5 – – –

Washington 4 649 0.0 (0.0-2.2) 2 723 5.8 (4.5-7.1)

Wisconsin 2 572 0.6 (0.0-1.3) – – –

Total 90 64,996 1.0 (0.0-4.5) 52 16,064 5.3 (0.0-13.9)

Table C. Gonor rhea — Po sitivity among men and women in juvenile corrections facilities, 2007

Note: The percent positivity by facility is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco project areas.

Men Women

State 

No. of 

Facilities

No. of

Tests

Median % Positivity

(Range) 

No. of 

Facilities

No. of

Tests

Median % Positivity

(Range) 

Arizona 3 873 10.7 (9.6-10.7) 2 1,475 5.8 (5.3-6.2)

California* 5 4,340 1.2 (0.4-2.2) 4 9,310 4.2 (2.5-5.4)

Delaware 1 679 1.2 2 1,008 3.6 (2.9-4.3)

Hawaii – – – 2 290 3.3 (0.6-6.1)

Illinois 7 2,634 2.9 (0.6-5.5) 3 2,397 1.6 (1.6-2.9)

Indiana 1 1,209 2.7 2 1,433 7.1 (6.8-7.3)

Iowa 2 768 4.4 (0.8-7.9) 1 435 0.7 

Maryland 1 633 0.9 – – –

Michigan 1 154 7.1 1 240 2.9 

Missouri 1 3,020 1.2 1 570 1.9 

Montana – – – 1 106 0.0 

Nebraska 4 1,585 0.9 (0.0-8.2) 1 225 5.3 

Nevada 1 294 2.7 1 182 2.7 

New Mexico 1 131 2.3 1 477 2.1 

New York 1 6,373 0.5 – – –

Pennsylvania 3 2,210 1.7 (0.5-2.8) 3 610 2.4 (1.3-4.0)

South Carolina 2 991 1.7 (0.8-2.7) 1 133 4.5 

Texas 3 2,263 1.6 (0.0-5.1) 2 943 5.9 (5.3-6.6)

Utah 1 110 1.8 1 170 0.6 

Washington – – – 1 467 1.7 

Wisconsin 4 4,403 2.3 (0.7-6.1) 1 708 0.1 

Total 42 32,670 1.7 (0.0-10.7) 31 21,179 2.9 (0.0-7.3)

Table D. Gonor rhea — Po sitivity among men and women in adult corrections facilities, 2007

Note: The percent positivity by facility is presented from facilities reporting > 100 test results. *Includes Los Angeles and San Francisco project areas.
STD Surveillance 2007 Special Focus Profiles STDs in Persons Entering Corrections Facilities 97

Men Women

State 

No. of 

Facilities

No. of

Tests

Median % Positivity

(Range) 

No. of 

Facilities

No. of

Tests

Median % Positivity

(Range) 

Arizona 2 2,345 0.3 (0.1-0.5) 1 478 0.2

Illinois 1 796 0.9 1 142 2.1

Mississippi 1 141 0.0 – – –

North Carolina 1 354 0.0 – – –

Texas 3 2,653 0.1 (0.0-0.8) 3 1,036 0.2 (0.0-1.6)

Total 8 6,289 0.1 (0.0-0.9) 5 1,656 0.2 (0.0-2.1)

Table E. Syphilis— Po sitivity among men and women in juvenile corrections facilities, 2007

Note: The percent positivity by facility is presented from facilities reporting > 100 test results. 

Men Women

State 

No. of 

Facilities

No. of

Tests

Median % Positivity

(Range) 

No. of 

Facilities

No. of

Tests

Median % Positivity

(Range) 

Arizona 1 27,629 2.0 1 6,310 4.3

Connecticut – – – 1 3,108 2.0

Illinois 3 575 0.7 (0.0-1.4) 1 111 3.6

Indiana 1 1,120 0.4 1 1,284 1.4

Kentucky 1 324 0.3 1 332 0.3

Louisiana – – – 1 1,003 28.0

Maryland 12 37,183 0.8 (0.3-3.7) 6 8,821 3.4 (0.8-8.5)

Massachusetts 16 17,546 1.1 (0.0-3.0) 4 3,883 0.9 (0.5-1.2)

Michigan 1 8,638 1.5 1 736 4.9

Mississippi 3 1,678 7.2 (4.0-12.6) – – –

Missouri 3 6,103 1.8 (1.1-47.0) 2 956 2.5 (1.1-4.0)

New Jersey 3 31,007 1.8 (0.7-3.8) 3 3,762 0.0 (0.0-8.9)

New York* 2 8,782 1.7 (1.1-2.4) 2 1,802 4.0 (2.3-5.7)

North Carolina 6 4,908 0.7 (0.0-0.8) 5 1,418 1.8 (0.0-3.5)

Oklahoma 1 1,402 0.0 1 2,019 0.0

Tennessee 1 8,027 3.3 1 5,322 9.4

Texas 4 31,096 3.0 (0.5-6.0) 4 6,643 7.7 (4.7-12.6)

Washington 1 7,270 4.0 1 1,500 0.0

Wisconsin 1 487 0.6 – – –

Total 60 193,775 1.0 (0.0-47.0) 36 49,010 2.1 (0.0-28.0)

Table F. Syphilis— Po sitivity among men and women in adult corrections facilities, 2007

Note: The percent positivity by facility is presented from facilities reporting > 100 test results.

*New York data is for confirmatory results.

SELBAT
SELBAT
STD Surveillance 2007 National Summary Tables 99

Syphilis

All Stages

Primary

and

Secondary

Early

Latent

Late and

Late Latent† Congenital‡ Chlamydia Gonorrhea

 

Chancroid

Year* Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

1941 485,560 368.2 68,231 51.7 109,018 82.6 202,984 153.9 17,600 651.1 NR . 193,468 146.7 3,384 2.5

1942 479,601 363.4 75,312 57.0 116,245 88.0 202,064 153.1 16,918 566.0 NR . 212,403 160.9 5,477 4.1

1943 575,593 447.0 82,204 63.8 149,390 116.0 251,958 195.7 16,164 520.7 NR . 275,070 213.6 8,354 6.4

1944 467,755 367.9 78,443 61.6 123,038 96.7 202,848 159.6 13,578 462.0 NR . 300,676 236.5 7,878 6.1

1945 359,114 282.3 77,007 60.5 101,719 79.9 142,187 111.8 12,339 431.7 NR . 287,181 225.8 5,515 4.3

1946 363,647 271.7 94,957 70.9 107,924 80.6 125,248 93.6 12,106 354.9 NR . 368,020 275.0 7,091 5.2

1947 355,592 252.3 93,545 66.4 104,124 73.9 122,089 86.6 12,200 319.6 NR . 380,666 270.0 9,515 6.7

1948 314,313 218.2 68,174 47.3 90,598 62.9 123,312 85.6 13,931 383.0 NR . 345,501 239.8 7,661 5.3

1949 256,463 175.3 41,942 28.7 75,045 51.3 116,397 79.5 13,952 382.4 NR . 317,950 217.3 6,707 4.6

1950 217,558 146.0 23,939 16.7 59,256 39.7 113,569 70.2 13,377 368.3 NR . 286,746 192.5 4,977 3.3

1951 174,924 116.1 14,485 9.6 43,316 28.7 98,311 65.2 11,094 290.4 NR . 254,470 168.9 4,233 2.8

1952 167,762 110.2 10,449 6.9 36,454 24.0 105,238 69.1 8,553 218.8 NR . 244,957 160.8 3,738 2.5

1953 148,573 95.9 8,637 5.6 28,295 18.3 98,870 63.8 7,675 193.9 NR . 238,340 153.9 3,338 2.2

1954 130,687 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

Table 1. Cases of sexually transmitted diseases reported by state health departments and rates per 100,000

population: United States, 1941–2007 
100 National Summary Tables STD Surveillance 2007

Syphilis

All Stages

Primary

and

Secondary

Early

Latent

Late and

Late Latent† Congenital‡ Chlamydia Gonorrhea

 

Chancroid

Year* Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

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 46,715 17.1 8,556 3.1 16,631 6.1 20,447 7.5 1,081 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 36,959 12.3 9,756 3.3 9,186 3.1 17,644 5.9 373 9.1 1,030,911 344.3 358,366 119.7 19 0.0

2007 40,920 13.7 11,466 3.8 10,768 3.6 18,256 6.1 430 10.5 1,108,374 370.2 355,991 118.9 23 0.0

Table 1. Cases of sexually transmitted diseases reported by state health departments and rates per 100,000

population: United States, 1941–2007 (continued)

*For 1941–1946, data were re ported for the fed eral fis cal year end ing June 30 of the year in di cated. From 1947 to the present, data were re ported for

the cal en dar year end ing De cem ber 31. For 1941–1958, data for Alaska and Ha waii were not in cluded.

†

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 con gen i tal syph i lis are ob tained in hardcopy or

elec tronic for mat based on case re port ing form CDC 73.126.

 Note: Ad just ments to the num ber of cases re ported from state health de part ments were made for hardcopy forms and for elec tronic data sub mis sions

through June 25, 2008 (see Ap pen dix). The num ber of cases and the rates shown here su per sede those pub lished in pre vi ous re ports. Cases and

rates shown in this ta ble exclude the outlying areas of Guam, Puerto Rico and Virgin Islands.

NR = No re port.
STD Surveillance 2007 Chlamydia Tables 101

Rank* State Cases Rate per 100,000 Population

1 Mississippi 21,686 745.1

2 Alaska 4,911 732.9

3 South Carolina 26,431 611.7

4 Alabama 25,153 546.9

5 New Mexico 9,460 484.0

6 Georgia 42,913 458.3

7 Louisiana 19,362 451.6

8 Tennessee 26,866 444.9

9 Hawaii 5,659 440.2

10 Illinois 55,470 432.3

11 New York 80,717 418.1

12 Ohio 47,434 413.3

13 Maryland 23,150 412.2

14 Delaware 3,479 407.6

15 Arizona 24,866 403.3

16 Missouri 23,308 398.9

17 California 141,928 389.3

18 Nevada 9,514 381.2

U.S. TOTAL†1,108,374 370.2

19 Michigan 37,353 370.0

20 Texas 85,786 364.9

21 Colorado 17,186 361.6

22 Arkansas 9,954 354.1

23 Wisconsin 19,555 351.9

24 Oklahoma 12,529 350.0

25 North Carolina 30,611 345.6

26 Pennsylvania 42,469 341.4

27 South Dakota 2,620 335.1

28 Indiana 20,712 328.1

29 Connecticut 11,454 326.8

30 Virginia 24,579 321.6

31 Florida 57,575 318.3

32 Rhode Island 3,177 297.6

33 Kansas 8,180 295.9

34 Washington 18,784 293.7

35 Montana 2,748 290.9

36 Nebraska 5,132 290.2

37 Iowa 8,643 289.8

38 North Dakota 1,789 281.3

39 Oregon 9,849 266.1

40 Minnesota 13,413 259.6

41 Idaho 3,722 253.8

42 Massachusetts 16,145 250.8

43 New Jersey 21,536 246.8

44 Wyoming 1,197 232.4

45 Utah 5,721 224.3

46 Kentucky 8,798 209.2

47 Maine 2,541 192.3

48 West Virginia 3,168 174.2

49 Vermont 1,057 169.4

50 New Hampshire 2,055 156.3

Table 2. Chlamydia — Reported cases and rates by state, ranked by rates: United States, 2007

*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 6,029 cases and a rate of 1036.7, but excludes outlying areas (Guam with 822 cases

and rate of 480.6, Puerto Rico with 7,909 cases and rate of 201.3, and Virgin Islands with 348 cases and rate of 320.4).
102 Chlamydia Tables STD Surveillance 2007

Cases Rates per 100,000 Population

State/Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Alabama 14,209 13,314 17,109 22,915 25,153 315.7 293.9 375.4 498.3 546.9

Alaska 3,900 3,954 4,355 4,525 4,911 601.1 603.3 656.2 675.3 732.9

Arizona 12,819 16,786 21,264 24,090 24,866 229.7 292.2 358.0 390.7 403.3

Arkansas 7,856 7,864 8,507 8,259 9,954 288.2 285.7 306.1 293.8 354.1

California 117,428 122,197 130,716 135,827 141,928 330.9 340.4 361.8 372.6 389.3

Colorado 13,039 14,151 15,432 16,313 17,186 286.5 307.5 330.8 343.2 361.6

Connecticut 9,393 9,552 11,039 10,946 11,454 269.7 272.6 314.5 312.3 326.8

Delaware 3,035 2,954 3,392 3,615 3,479 371.3 355.7 402.1 423.6 407.6

District of Columbia 3,168 3,493 3,678 3,368 6,029 561.4 631.0 668.1 579.2 1,036.7

Florida 42,382 42,554 43,372 48,955 57,575 249.0 244.6 243.8 270.6 318.3

Georgia 35,686 34,280 33,562 38,972 42,913 410.9 388.2 369.9 416.2 458.3

Hawaii 5,480 5,307 5,489 5,548 5,659 435.7 420.2 430.4 431.6 440.2

Idaho 2,366 2,784 2,799 3,345 3,722 173.2 199.8 195.9 228.1 253.8

Illinois 48,294 47,185 50,559 53,586 55,470 381.7 371.1 396.1 417.6 432.3

Indiana 17,075 18,440 20,063 19,859 20,712 275.6 295.6 319.9 314.5 328.1

Iowa 6,491 6,956 7,390 8,390 8,643 220.5 235.4 249.1 281.3 289.8

Kansas 7,249 7,493 7,419 7,829 8,180 266.2 273.9 270.3 283.2 295.9

Kentucky 7,981 6,470 8,351 8,940 8,798 193.8 156.1 200.1 212.5 209.2

Louisiana 20,970 21,837 17,227 17,885 19,362 466.4 483.6 380.8 417.1 451.6

Maine 2,030 2,113 2,254 2,306 2,541 155.5 160.4 170.6 174.5 192.3

Maryland 16,831 19,952 18,291 21,859 23,150 305.5 359.0 326.6 389.2 412.2

Massachusetts 11,301 13,242 14,411 15,394 16,145 175.7 206.4 225.2 239.1 250.8

Michigan 32,572 41,246 38,730 36,753 37,353 323.1 407.9 382.7 364.0 370.0

Minnesota 10,714 11,602 12,189 12,935 13,413 211.8 227.4 237.5 250.3 259.6

Mississippi 12,193 18,863 21,268 19,002 21,686 423.2 649.8 728.1 652.9 745.1

Missouri 18,570 21,319 22,371 22,982 23,308 325.5 370.5 385.7 393.3 398.9

Montana 2,547 2,608 2,400 2,650 2,748 277.6 281.4 256.5 280.5 290.9

Nebraska 4,739 5,238 5,098 5,428 5,132 272.5 299.8 289.9 307.0 290.2

Nevada 5,830 6,690 7,321 8,398 9,514 260.1 286.5 303.2 336.5 381.2

New Hampshire 1,616 1,736 1,842 1,997 2,055 125.5 133.6 140.6 151.9 156.3

New Jersey 16,169 17,448 19,152 20,194 21,536 187.2 200.6 219.7 231.5 246.8

New Mexico 7,480 9,035 8,456 9,829 9,460 399.0 474.7 438.5 502.9 484.0

New York 57,222 59,097 63,966 68,720 80,717 298.2 307.4 332.2 355.9 418.1

North Carolina 26,187 28,967 31,183 33,615 30,611 311.5 339.1 359.1 379.6 345.6

North Dakota 1,655 1,810 1,667 1,820 1,789 261.1 285.3 261.8 286.2 281.3

Ohio 42,522 39,379 43,806 40,106 47,434 371.8 343.7 382.1 349.4 413.3

Oklahoma 11,013 10,366 13,407 12,992 12,529 313.6 294.2 377.9 363.0 350.0

Oregon 7,688 8,690 9,018 9,577 9,849 216.0 241.8 247.7 258.8 266.1

Pennsylvania 37,291 38,025 37,261 39,487 42,469 301.6 306.5 299.8 317.4 341.4

Rhode Island 3,000 3,442 3,269 3,142 3,177 278.8 318.5 303.8 294.3 297.6

South Carolina 14,623 18,423 18,296 22,351 26,431 352.6 438.8 430.0 517.2 611.7

South Dakota 2,608 2,532 2,701 2,633 2,620 341.2 328.5 348.1 336.7 335.1

Tennessee 20,380 22,515 23,084 25,320 26,866 348.9 381.5 387.1 419.3 444.9

Texas 69,200 70,232 71,860 75,543 85,786 312.9 312.3 314.3 321.4 364.9

Utah 3,893 3,857 4,602 5,092 5,721 165.6 161.4 186.3 199.7 224.3

Vermont 1,060 1,137 957 1,191 1,057 171.2 183.0 153.6 190.9 169.4

Virginia 19,439 21,635 22,668 24,087 24,579 263.2 290.0 299.5 315.2 321.6

Washington 16,797 17,635 18,616 17,819 18,784 273.9 284.3 296.1 278.6 293.7

West Virginia 2,585 2,758 2,944 2,910 3,168 142.8 151.9 162.0 160.0 174.2

Wisconsin 17,942 19,217 20,461 20,190 19,555 327.9 348.8 369.6 363.4 351.9

Wyoming 960 1,082 1,173 1,422 1,197 191.5 213.6 230.3 276.1 232.4

U.S. TOTAL 877,478 929,462 976,445 1,030,911 1,108,374 301.7 316.5 329.4 344.3 370.2

Northeast 139,082 145,792 154,151 163,377 181,151 255.7 267.2 282.1 298.5 330.9

Midwest 210,431 222,417 232,454 232,511 243,609 321.7 338.4 352.4 351.1 367.9

South 327,738 346,477 358,199 390,588 428,069 313.5 327.0 333.2 358.1 392.4

West 200,227 214,776 231,641 244,435 255,545 301.2 318.6 339.2 352.4 368.5

Guam 554 748 807 832 822 338.6 450.4 478.7 486.5 480.6

Puerto Rico 2,746 3,588 3,714 5,102 7,909 70.8 92.1 94.9 129.9 201.3

Virgin Islands 416 303 235 203 348 382.3 278.6 216.2 186.9 320.4

OUTLYING AREAS 3,716 4,639 4,756 6,137 9,079 89.5 111.3 113.5 145.8 215.8

TOTAL 881,194 934,101 981,201 1,037,048 1,117,453 298.7 313.6 326.4 341.6 368.1

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

States and outlying areas, 2003–2007
STD Surveillance 2007 Chlamydia Tables 103

Cases Rates per 100,000 Population

State/Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Alabama 12,977 11,685 14,532 17,915 19,186 559.0 500.6 619.4 756.0 809.7

Alaska 2,665 2,671 2,908 3,067 3,295 850.0 843.9 907.4 947.7 1,018.1

Arizona 10,043 12,896 16,201 18,485 18,794 360.1 449.3 546.2 600.1 610.1

Arkansas 6,284 6,252 6,823 6,604 7,893 451.5 445.3 481.8 460.8 550.7

California 85,967 88,439 93,646 97,170 101,175 483.7 491.9 517.8 532.9 554.9

Colorado 9,843 10,283 11,219 12,037 12,707 436.4 451.0 485.8 510.0 538.3

Connecticut 7,309 7,383 8,383 8,205 8,577 407.8 409.4 464.4 456.2 476.9

Delaware 2,155 2,140 2,493 2,625 2,554 513.9 502.7 576.8 597.6 581.5

District of Columbia 2,695 2,948 2,976 2,510 3,970 903.6 1,010.3 1,028.4 812.7 1,285.3

Florida 34,581 34,437 34,850 38,536 42,173 398.2 388.1 384.4 418.6 458.1

Georgia 28,992 27,656 26,317 30,546 31,827 659.2 619.5 574.0 642.7 669.6

Hawaii 4,113 4,019 4,093 4,161 4,228 655.9 635.1 640.1 648.0 658.4

Idaho 1,762 2,157 2,162 2,435 2,660 258.5 310.5 303.6 334.4 365.3

Illinois 36,284 35,996 37,672 39,705 41,733 563.1 556.3 580.3 609.5 640.6

Indiana 13,118 14,217 15,263 14,907 15,576 416.6 448.7 479.4 465.4 486.3

Iowa 4,915 5,208 5,400 6,157 6,310 328.5 347.1 358.7 407.9 418.1

Kansas 5,989 6,195 6,054 6,286 6,629 436.1 449.9 438.4 451.4 476.0

Kentucky 6,353 5,027 6,041 6,336 6,184 302.5 238.0 284.5 295.4 288.3

Louisiana 17,046 17,549 13,395 14,290 15,334 736.6 755.8 576.4 649.0 696.4

Maine 1,452 1,532 1,644 1,672 1,831 217.0 227.3 243.2 247.6 271.2

Maryland 13,746 16,108 14,653 17,339 18,230 483.5 561.8 507.5 598.1 628.9

Massachusetts 8,429 9,781 10,587 11,175 11,671 253.7 295.5 321.0 336.6 351.5

Michigan 25,903 32,624 30,079 27,915 28,341 505.1 634.2 584.6 544.6 552.9

Minnesota 7,866 8,521 8,820 9,243 9,681 308.4 331.7 341.3 355.7 372.6

Mississippi 10,536 15,097 16,684 14,853 16,718 709.5 1,010.4 1,110.4 989.4 1,113.6

Missouri 14,750 16,306 16,580 16,938 17,080 504.8 553.9 559.3 566.9 571.6

Montana 1,865 1,916 1,776 1,932 2,024 405.4 412.4 378.9 409.3 428.8

Nebraska 3,435 3,812 3,713 3,956 3,755 390.3 431.4 417.6 443.7 421.2

Nevada 4,268 4,857 5,362 6,185 7,044 388.3 423.8 452.3 504.2 574.3

New Hampshire 1,196 1,265 1,343 1,484 1,533 183.1 192.1 202.2 222.7 230.1

New Jersey 13,813 14,491 15,826 16,560 17,355 311.5 324.7 354.1 371.1 388.9

New Mexico 5,973 6,876 6,333 7,456 7,044 627.3 710.9 646.2 753.3 711.7

New York 43,907 44,975 45,391 48,568 56,590 442.9 453.3 457.2 488.1 568.7

North Carolina 21,807 23,916 25,702 27,301 25,110 509.9 550.8 582.6 604.6 556.1

North Dakota 1,087 1,206 1,091 1,231 1,194 342.8 379.6 342.1 389.0 377.3

Ohio 33,549 30,377 33,312 30,483 36,143 571.6 516.8 566.9 518.4 614.6

Oklahoma 8,990 8,237 10,608 9,678 9,130 505.0 461.9 591.1 533.3 503.1

Oregon 5,590 6,090 6,194 6,585 6,890 312.1 336.9 338.4 353.8 370.2

Pennsylvania 27,557 27,740 27,131 28,503 30,511 432.1 433.9 424.0 445.8 477.3

Rhode Island 2,232 2,502 2,396 2,175 2,282 400.2 447.3 430.7 394.5 413.9

South Carolina 12,745 15,925 15,694 19,055 20,793 598.8 739.7 719.6 859.3 937.7

South Dakota 1,864 1,824 1,924 1,923 1,894 484.9 470.5 492.9 491.4 484.0

Tennessee 14,669 16,237 16,453 18,352 19,604 490.7 538.6 540.8 594.3 634.9

Texas 57,549 57,470 58,668 60,327 67,966 518.0 509.1 511.4 511.5 576.3

Utah 2,787 2,720 3,081 3,457 3,926 238.0 228.6 250.6 272.7 309.7

Vermont 828 861 725 897 812 262.8 272.8 229.3 283.1 256.2

Virginia 15,535 16,578 16,805 17,682 18,136 413.8 437.6 437.2 455.0 466.7

Washington 12,341 12,835 13,471 13,021 13,793 401.4 412.8 427.8 406.1 430.2

West Virginia 2,102 2,105 2,272 2,208 2,423 226.6 226.8 244.9 238.0 261.1

Wisconsin 12,838 13,913 14,751 14,606 14,438 464.3 500.1 527.9 522.5 516.5

Wyoming 717 820 874 1,051 913 288.1 326.1 346.0 413.8 359.4

U.S. TOTAL 685,017 716,675 740,371 775,788 825,660 463.6 480.6 492.2 510.8 543.6

Northeast 106,723 110,530 113,426 119,239 131,162 380.7 393.4 403.5 423.8 466.2

Midwest 161,598 170,199 174,659 173,350 182,774 485.6 509.2 521.0 515.8 543.9

South 268,762 279,367 284,966 306,157 327,231 505.0 518.4 521.5 551.6 589.6

West 147,934 156,579 167,320 177,042 184,493 445.1 464.5 490.2 511.0 532.5

Guam 446 608 667 692 669 556.8 747.1 807.0 824.7 797.3

Puerto Rico 2,378 3,240 3,366 4,091 6,781 118.1 160.1 165.6 200.3 332.1

Virgin Islands 352 232 189 144 267 619.0 408.0 332.5 253.6 470.2

OUTLYING AREAS 3,176 4,080 4,222 4,927 7,717 147.6 188.8 194.4 225.7 353.6

TOTAL 688,193 720,755 744,593 780,715 833,377 459.0 476.4 488.0 506.7 540.9

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

order: United States and outlying areas, 2003–2007

Note: Cases reported with unknown sex are not included in this table.
104 Chlamydia Tables STD Surveillance 2007

Cases Rates per 100,000 Population

State/Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Alabama 1,201 1,603 2,507 4,985 5,955 55.1 73.0 113.4 223.6 267.1

Alaska 1,235 1,283 1,447 1,458 1,616 368.3 378.6 421.6 420.9 466.5

Arizona 2,772 3,884 5,058 5,588 6,055 99.3 135.2 170.1 181.1 196.2

Arkansas 1,567 1,612 1,684 1,655 2,060 117.5 119.5 123.6 120.1 149.5

California 31,238 33,323 36,449 38,003 40,213 176.4 186.0 202.0 208.5 220.7

Colorado 3,196 3,855 4,213 4,276 4,479 139.2 166.1 178.8 178.7 187.2

Connecticut 2,084 2,168 2,656 2,741 2,877 123.2 127.5 155.8 160.7 168.6

Delaware 880 814 899 990 925 221.0 201.1 218.6 239.0 223.3

District of Columbia 450 529 681 819 2,034 169.1 202.1 260.8 300.4 746.0

Florida 7,801 8,117 8,522 10,410 15,376 93.6 95.2 97.7 117.2 173.1

Georgia 6,509 6,411 6,793 8,089 10,808 151.8 146.9 151.4 175.4 234.4

Hawaii 1,367 1,288 1,396 1,384 1,431 216.8 204.4 219.6 215.1 222.4

Idaho 604 617 616 895 1,030 88.2 88.3 85.9 121.2 139.5

Illinois 12,009 11,187 12,886 13,881 13,736 193.4 179.2 205.5 219.7 217.4

Indiana 3,803 4,080 4,703 4,849 5,032 124.8 132.9 152.3 155.9 161.8

Iowa 1,561 1,743 1,990 2,233 2,333 107.8 119.9 136.2 151.6 158.4

Kansas 1,260 1,298 1,365 1,543 1,551 93.3 95.6 100.1 112.5 113.1

Kentucky 1,613 1,433 2,285 2,580 2,605 79.9 70.5 111.5 125.2 126.4

Louisiana 3,808 4,016 3,583 3,372 3,758 174.5 183.0 162.9 161.7 180.2

Maine 577 581 606 634 708 90.6 90.3 93.9 98.1 109.5

Maryland 3,068 3,841 3,627 4,439 4,907 115.1 142.7 133.7 163.4 180.6

Massachusetts 2,848 3,449 3,809 4,193 4,457 91.6 111.0 122.8 134.5 143.0

Michigan 6,669 8,622 8,525 8,724 8,845 134.7 173.5 171.3 175.5 178.0

Minnesota 2,848 3,081 3,369 3,692 3,732 113.5 121.7 132.2 143.7 145.3

Mississippi 1,657 3,766 4,584 4,149 4,968 118.7 267.3 323.1 294.4 352.5

Missouri 3,820 5,013 5,791 6,044 6,228 137.3 178.3 204.2 211.7 218.2

Montana 679 685 619 709 716 148.4 148.2 132.6 150.0 151.5

Nebraska 1,244 1,391 1,378 1,401 1,363 144.8 161.1 158.4 159.8 155.5

Nevada 1,552 1,821 1,955 2,211 2,460 135.9 153.2 159.0 174.2 193.9

New Hampshire 420 471 499 513 522 66.2 73.5 77.3 79.1 80.5

New Jersey 2,332 2,945 3,323 3,606 4,169 55.5 69.5 78.2 84.6 97.8

New Mexico 1,485 2,151 2,121 2,368 2,415 161.0 229.8 223.6 245.4 250.3

New York 13,106 14,031 18,547 20,148 24,045 141.3 150.8 198.9 215.4 257.0

North Carolina 4,379 5,051 5,481 6,314 5,493 106.0 120.3 128.3 145.4 126.5

North Dakota 567 601 574 588 594 179.0 189.8 180.6 184.1 186.0

Ohio 8,215 8,189 9,139 9,039 10,852 147.6 146.7 163.6 161.5 193.9

Oklahoma 2,023 2,129 2,799 3,314 3,399 116.8 122.3 159.6 187.8 192.6

Oregon 2,098 2,600 2,824 2,992 2,959 118.6 145.5 155.9 162.6 160.8

Pennsylvania 9,682 10,282 10,128 10,981 11,934 161.7 171.0 168.0 181.6 197.3

Rhode Island 768 936 868 962 892 148.1 179.6 167.0 186.4 172.8

South Carolina 1,813 2,456 2,572 3,272 5,549 89.8 120.1 124.0 155.5 263.8

South Dakota 742 708 774 709 725 195.3 184.7 200.7 181.5 185.6

Tennessee 5,711 6,278 6,619 6,968 7,262 200.2 217.5 226.6 236.1 246.1

Texas 11,594 12,619 13,138 15,178 17,687 105.3 112.7 115.4 129.6 151.0

Utah 1,103 1,137 1,521 1,635 1,795 93.4 94.8 122.6 127.5 140.0

Vermont 232 276 232 294 245 76.3 90.3 75.6 95.8 79.8

Virginia 3,868 5,024 5,823 6,384 6,433 106.5 136.8 156.4 169.9 171.2

Washington 4,456 4,800 5,145 4,798 4,991 145.8 155.1 163.9 150.4 156.5

West Virginia 472 649 671 698 744 53.5 73.1 75.5 78.4 83.5

Wisconsin 5,015 5,290 5,688 5,551 5,090 185.2 194.0 207.5 201.1 184.4

Wyoming 243 262 299 371 284 96.3 102.7 116.5 142.1 108.8

U.S. TOTAL 190,244 210,396 232,781 252,630 280,337 133.0 145.6 159.4 171.3 190.0

Northeast 32,049 35,139 40,668 44,072 49,849 121.6 132.7 153.3 165.6 187.4

Midwest 47,753 51,203 56,182 58,254 60,081 148.6 158.5 173.2 178.6 184.2

South 58,414 66,348 72,268 83,616 99,963 113.8 127.4 136.7 156.0 186.6

West 52,028 57,706 63,663 66,688 70,444 156.6 171.2 186.4 192.1 202.9

Guam 108 140 140 140 153 129.4 165.3 162.9 160.7 175.6

Puerto Rico 368 348 348 1,007 1,125 19.7 18.6 18.5 53.4 59.6

Virgin Islands 64 71 46 55 81 123.2 136.8 88.7 106.1 156.3

OUTLYING AREAS 540 559 534 1,202 1,359 27.0 27.8 26.5 59.3 67.1

TOTAL 190,784 210,955 233,315 253,832 281,696 131.5 144.0 157.6 169.7 188.4

Table 5. Chlamydia — Men – Reported cases and rates by state/area and region listed in alphabetical order:

United States and outlying areas, 2003–2007

Note: Cases reported with unknown sex are not included in this table.
STD Surveillance 2007 Chlamydia Tables 105

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Atlanta-Sandy Springs-Marietta, GA 18,135 17,068 16,748 20,979 21,609 393.4 362.5 340.6 408.3 420.6

Austin-Round Rock, TX 4,456 4,580 5,103 7,325 6,814 323.5 324.3 351.3 484.0 450.2

Baltimore-Towson, MD 10,044 10,959 11,071 11,617 13,053 383.9 415.2 416.9 437.0 491.0

Birmingham-Hoover, AL 3,189 3,905 4,720 5,338 6,913 297.3 360.8 433.0 485.3 628.4

Boston-Cambridge-Quincy, MA-NH 7,831 9,006 9,368 9,918 10,697 176.4 203.5 212.3 222.6 240.1

Buffalo-Cheektowaga-Tonawanda, NY 3,513 4,865 5,013 4,992 5,078 303.0 421.4 436.8 438.8 446.4

Charlotte-Gastonia-Concord, NC-SC 4,619 4,832 5,830 5,076 4,216 321.3 327.7 383.2 320.7 266.3

Chicago-Naperville-Joliet, IL-IN-WI 37,017 35,953 38,966 41,521 41,403 396.6 382.8 412.6 436.8 435.6

Cincinnati-Middletown, OH-KY-IN 6,789 6,438 8,516 8,616 10,080 331.6 312.8 411.3 409.5 479.0

Cleveland-Elyria-Mentor, OH 8,489 7,867 8,181 7,462 9,351 396.8 368.1 384.7 353.0 442.3

Columbus, OH 5,758 5,167 5,902 5,843 7,157 343.8 305.0 345.4 338.6 414.8

Dallas-Fort Worth-Arlington, TX 16,828 15,744 18,005 17,035 22,292 301.1 276.2 309.4 283.7 371.3

Denver-Aurora, CO 7,039 7,774 8,534 7,934 9,539 305.9 333.6 361.6 329.4 396.0

Detroit-Warren-Livonia, MI 16,071 21,378 20,497 17,201 17,934 358.4 475.8 456.7 384.9 401.3

Hartford-West Hartford-East Hartford, CT 3,224 3,040 3,815 3,799 4,300 273.7 256.6 321.1 319.6 361.7

Houston-Baytown-Sugar Land, TX 13,530 14,796 13,476 14,641 17,196 266.6 285.6 255.2 264.3 310.4

Indianapolis, IN 7,304 6,922 8,226 7,780 8,173 457.8 426.9 501.4 467.0 490.6

Jacksonville, FL 5,200 5,017 5,246 5,582 6,501 432.3 409.4 420.2 436.8 508.7

Kansas City, MO-KS 7,105 8,003 7,900 7,825 8,358 373.0 415.7 405.6 397.7 424.8

Las Vegas-Paradise, NV 4,379 5,065 5,623 6,592 7,333 277.8 306.8 328.7 370.8 412.5

Los Angeles-Long Beach-Santa Ana, CA 46,342 46,202 50,703 50,913 52,352 361.2 357.5 392.3 393.1 404.3

Louisville, KY-IN 2,775 2,396 3,143 3,319 3,493 233.2 199.5 260.1 271.6 285.8

Memphis, TN-MS-AR 7,362 8,927 9,457 10,224 11,349 594.0 714.0 750.0 802.1 890.3

Miami-Fort Lauderdale-Miami Beach, FL 11,024 11,781 10,403 12,142 13,761 208.4 219.7 191.9 222.2 251.9

Milwaukee-Waukesha-West Allis, WI 9,320 10,070 10,368 10,498 10,150 615.5 664.4 685.3 695.2 672.2

Minneapolis-St. Paul-Bloomington, MN-WI 8,081 8,139 8,513 9,271 9,514 262.1 261.2 270.9 292.0 299.6

Nashville-Davidson-Murfreesboro, TN 3,981 4,243 4,538 4,910 4,972 290.3 304.0 319.0 337.4 341.7

New Orleans-Metairie-Kenner, LA 7,116 6,858 4,761 3,401 4,573 540.1 519.7 360.9 331.9 446.3

New York-Newark-Edison, NY-NJ-PA 51,614 52,266 58,134 62,334 74,071 276.9 279.4 310.1 331.2 393.6

Oklahoma City, OK 4,124 3,939 4,798 4,627 4,646 364.1 344.2 414.8 394.7 396.3

Orlando, FL 4,673 4,888 5,862 6,579 6,825 259.2 262.6 303.2 331.5 343.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 25,347 25,285 24,913 27,417 28,116 439.1 435.9 427.8 470.5 482.5

Phoenix-Mesa-Scottsdale, AZ 8,084 11,078 11,984 15,278 15,245 225.0 298.2 310.1 378.2 377.4

Pittsburgh, PA 5,499 5,539 5,880 5,789 6,616 228.1 230.6 246.4 244.2 279.1

Portland-Vancouver-Beaverton, OR-WA 4,703 5,256 5,636 5,654 5,970 230.5 254.6 268.9 264.5 279.3

Providence-New Bedford-Fall River, RI-MA 3,714 4,269 4,316 4,197 4,297 228.8 262.1 266.0 260.2 266.4

Richmond, VA 4,472 4,923 4,710 5,044 5,294 392.9 426.5 400.6 422.4 443.4

Riverside-San Bernardino-Ontario, CA 10,688 10,913 12,179 12,472 14,316 293.4 287.7 311.5 309.8 355.6

Rochester, NY 4,142 4,040 3,850 4,168 4,833 397.8 387.9 370.5 402.5 466.8

Sacramento-Arden-Arcade-Roseville, CA 6,240 7,294 8,175 9,094 8,770 316.0 361.7 400.3 439.9 424.3

Salt Lake City, UT 2,264 2,223 2,642 2,910 3,395 225.2 218.2 255.4 272.5 318.0

San Antonio, TX 7,212 7,645 8,049 8,338 8,727 396.1 412.3 425.9 429.3 449.3

San Diego-Carlsbad-San Marcos, CA 10,432 10,876 11,520 11,980 12,693 355.9 371.0 392.7 407.3 431.5

San Francisco-Oakland-Fremont, CA 12,774 13,580 13,988 15,565 16,710 307.3 326.9 336.8 372.4 399.8

San Jose-Sunnyvale-Santa Clara, CA 4,796 5,697 5,374 5,898 5,892 276.5 327.1 306.2 330.0 329.7

Seattle-Tacoma-Bellevue, WA 9,457 9,655 10,588 9,778 10,397 301.0 304.9 330.5 299.6 318.6

St. Louis, MO-IL 10,081 11,856 13,328 13,509 13,710 368.5 428.9 479.7 483.1 490.3

Tampa-St. Petersburg-Clearwater, FL 6,002 5,996 6,315 7,475 9,501 237.1 231.7 238.5 277.1 352.2

Virginia Beach-Norfolk-Newport News, VA-NC 6,668 7,601 8,414 9,139 9,383 407.3 462.3 510.8 554.1 568.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 11,230 14,046 12,827 15,456 18,069 220.6 273.3 246.0 292.2 341.5

U.S. MSA TOTAL 500,737 525,860 556,108 584,455 635,637 320.5 333.0 348.7 362.3 394.0

Table 6. Chlamydia — Reported cases and rates in selected metropolitan statistical areas* (MSAs) listed in

alphabetical order: United States, 2003–2007

*MSAs selected based on largest population in 2000 U.S. census.
106 Chlamydia Tables STD Surveillance 2007

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Atlanta-Sandy Springs-Marietta, GA 14,519 13,756 12,995 16,165 15,553 624.4 580.4 524.8 622.2 598.6

Austin-Round Rock, TX 3,418 3,405 3,720 5,170 4,753 506.4 492.5 522.7 699.1 642.7

Baltimore-Towson, MD 8,412 9,051 8,927 9,344 10,416 620.5 662.1 649.4 677.9 755.7

Birmingham-Hoover, AL 2,825 3,095 3,709 4,277 5,165 508.3 552.6 657.7 751.3 907.2

Boston-Cambridge-Quincy, MA-NH 5,715 6,549 6,663 7,140 7,721 249.8 287.6 293.8 311.7 337.1

Buffalo-Cheektowaga-Tonawanda, NY 2,677 3,698 3,849 3,762 3,818 444.3 616.7 646.3 637.8 647.3

Charlotte-Gastonia-Concord, NC-SC 3,915 4,059 4,878 4,189 3,430 536.5 541.9 631.9 520.7 426.3

Chicago-Naperville-Joliet, IL-IN-WI 27,419 27,271 28,860 30,600 31,134 576.5 570.2 600.4 633.8 644.9

Cincinnati-Middletown, OH-KY-IN 5,458 5,108 6,580 6,871 8,082 520.2 484.6 621.4 638.2 750.7

Cleveland-Elyria-Mentor, OH 6,548 5,909 6,066 5,458 7,023 588.0 531.6 548.7 497.2 639.8

Columbus, OH 4,525 4,058 4,445 4,549 5,428 532.1 472.8 513.4 520.7 621.3

Dallas-Fort Worth-Arlington, TX 13,633 12,536 14,641 13,466 17,251 488.3 440.7 504.7 450.4 577.0

Denver-Aurora, CO 5,225 5,558 6,122 5,827 7,020 455.8 479.3 521.7 485.8 585.2

Detroit-Warren-Livonia, MI 13,008 17,145 16,172 13,096 13,580 565.6 744.1 703.4 572.9 594.1

Hartford-West Hartford-East Hartford, CT 2,510 2,331 2,842 2,786 3,122 413.6 381.9 464.3 456.5 511.6

Houston-Baytown-Sugar Land, TX 11,325 12,258 11,539 12,178 14,170 446.0 473.1 437.0 439.8 511.8

Indianapolis, IN 5,337 5,167 5,949 5,596 5,808 656.5 625.9 712.5 660.3 685.4

Jacksonville, FL 4,051 3,759 4,021 4,273 4,627 658.1 600.4 630.6 654.9 709.2

Kansas City, MO-KS 5,434 5,993 5,930 5,791 6,231 559.4 611.3 598.8 578.2 622.1

Las Vegas-Paradise, NV 3,318 3,820 4,319 5,014 5,620 428.5 471.0 513.8 573.3 642.6

Los Angeles-Long Beach-Santa Ana, CA 33,124 32,903 36,044 35,826 36,520 511.9 504.6 552.9 549.2 559.8

Louisville, KY-IN 2,144 1,817 2,232 2,344 2,482 351.2 295.1 360.6 374.3 396.3

Memphis, TN-MS-AR 5,650 6,816 7,150 7,935 8,846 880.2 1,053.0 1,098.1 1,202.2 1,340.3

Miami-Fort Lauderdale-Miami Beach, FL 9,027 9,610 8,492 9,553 9,985 331.4 347.8 304.2 340.1 355.5

Milwaukee-Waukesha-West Allis, WI 6,756 7,358 7,558 7,761 7,653 868.3 945.2 973.0 1,004.8 990.8

Minneapolis-St. Paul-Bloomington, MN-WI 5,792 5,892 6,022 6,462 6,727 371.9 374.8 380.0 404.3 420.8

Nashville-Davidson-Murfreesboro, TN 2,834 3,018 3,122 3,413 3,445 406.9 426.5 433.4 462.7 467.1

New Orleans-Metairie-Kenner, LA 5,736 5,433 3,563 2,673 3,503 836.7 791.6 519.8 503.2 659.4

New York-Newark-Edison, NY-NJ-PA 40,956 41,039 42,214 45,007 52,815 423.7 423.4 435.0 462.7 543.0

Oklahoma City, OK 3,301 3,057 3,744 3,394 3,262 573.5 527.5 638.7 570.1 547.9

Orlando, FL 3,852 3,993 4,667 5,326 5,203 421.9 424.0 477.4 531.7 519.4

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 18,707 18,369 18,236 19,813 20,132 625.3 611.6 605.3 658.0 668.6

Phoenix-Mesa-Scottsdale, AZ 6,303 8,555 9,338 11,859 11,675 353.6 464.3 487.7 592.7 583.5

Pittsburgh, PA 4,191 4,185 4,398 4,267 4,870 333.7 334.6 354.2 346.5 395.5

Portland-Vancouver-Beaverton, OR-WA 3,332 3,555 3,816 3,769 4,109 325.2 343.2 363.1 351.7 383.4

Providence-New Bedford-Fall River, RI-MA 2,784 3,138 3,225 2,967 3,116 331.0 372.1 384.3 355.8 373.7

Richmond, VA 3,421 3,573 3,425 3,617 3,778 582.6 601.2 566.7 590.0 616.3

Riverside-San Bernardino-Ontario, CA 8,122 8,252 9,257 9,426 10,773 445.9 435.4 474.3 468.5 535.4

Rochester, NY 2,990 2,869 2,670 2,890 3,337 558.8 536.9 501.5 544.7 629.0

Sacramento-Arden-Arcade-Roseville, CA 4,603 5,326 5,890 6,614 6,310 458.6 519.5 567.4 629.1 600.2

Salt Lake City, UT 1,574 1,501 1,709 1,941 2,299 316.8 298.1 334.4 368.8 436.9

San Antonio, TX 5,985 6,182 6,105 6,232 6,567 644.1 653.1 633.1 628.0 661.8

San Diego-Carlsbad-San Marcos, CA 7,694 7,908 8,210 8,620 9,187 528.8 542.6 565.1 590.4 629.2

San Francisco-Oakland-Fremont, CA 8,824 9,151 9,217 10,418 11,118 420.4 436.4 439.6 495.3 528.5

San Jose-Sunnyvale-Santa Clara, CA 3,465 4,038 3,752 4,128 4,232 406.0 471.7 435.6 472.4 484.3

Seattle-Tacoma-Bellevue, WA 6,606 6,775 7,411 6,915 7,412 419.5 427.2 462.5 423.6 454.0

St. Louis, MO-IL 8,179 9,086 9,804 9,952 10,012 577.7 636.1 683.2 689.2 693.3

Tampa-St. Petersburg-Clearwater, FL 4,846 4,920 5,184 5,936 6,841 371.1 369.1 380.8 428.6 493.9

Virginia Beach-Norfolk-Newport News, VA-NC 5,378 5,862 6,016 6,651 6,884 648.6 704.2 720.5 789.6 817.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 9,065 11,170 10,086 11,722 13,194 347.6 424.8 378.3 432.7 487.0

U.S. MSA TOTAL 384,513 399,877 414,784 432,983 466,239 483.1 497.5 511.3 528.1 568.7

Table 7. Chlamydia — Women – Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2003–2007

*MSAs selected based on largest population in 2000 U.S. census.
STD Surveillance 2007 Chlamydia Tables 107

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Atlanta-Sandy Springs-Marietta, GA 3,526 3,187 3,463 4,574 5,896 154.3 136.3 141.8 180.1 232.1

Austin-Round Rock, TX 1,026 1,093 1,357 2,147 2,053 146.0 151.6 183.2 277.4 265.2

Baltimore-Towson, MD 1,627 1,908 2,139 2,250 2,624 129.1 150.0 167.0 175.8 205.0

Birmingham-Hoover, AL 361 810 1,005 1,058 1,745 69.8 155.1 191.0 199.4 328.8

Boston-Cambridge-Quincy, MA-NH 2,097 2,449 2,697 2,762 2,966 97.4 114.0 125.8 127.6 137.0

Buffalo-Cheektowaga-Tonawanda, NY 836 1,167 1,164 1,229 1,260 150.1 210.4 210.8 224.4 230.1

Charlotte-Gastonia-Concord, NC-SC 700 770 951 887 786 98.9 106.1 126.9 113.9 101.0

Chicago-Naperville-Joliet, IL-IN-WI 9,542 8,602 10,075 10,905 10,259 208.5 186.7 217.3 233.1 219.3

Cincinnati-Middletown, OH-KY-IN 1,268 1,239 1,746 1,691 1,935 127.0 123.4 172.6 164.6 188.3

Cleveland-Elyria-Mentor, OH 1,875 1,904 1,986 1,953 2,285 182.8 185.7 194.6 192.2 224.8

Columbus, OH 1,174 1,058 1,377 1,272 1,706 142.5 126.6 163.4 149.3 200.3

Dallas-Fort Worth-Arlington, TX 3,179 3,192 3,346 3,558 4,987 113.6 111.8 114.6 118.0 165.5

Denver-Aurora, CO 1,814 2,210 2,412 2,107 2,519 157.1 188.8 203.3 174.2 208.3

Detroit-Warren-Livonia, MI 3,063 4,233 4,256 4,027 4,220 140.3 193.4 194.4 184.5 193.3

Hartford-West Hartford-East Hartford, CT 714 708 973 1,013 1,178 125.0 123.3 168.9 175.1 203.6

Houston-Baytown-Sugar Land, TX 2,185 2,504 1,930 2,449 2,963 86.1 96.7 73.1 88.4 106.9

Indianapolis, IN 1,906 1,744 2,242 2,167 2,340 243.6 219.1 278.3 264.7 285.9

Jacksonville, FL 1,149 1,258 1,225 1,309 1,873 195.6 209.9 200.6 209.3 299.4

Kansas City, MO-KS 1,671 2,010 1,970 2,034 2,127 179.0 212.7 205.8 210.6 220.2

Las Vegas-Paradise, NV 1,051 1,233 1,301 1,576 1,704 131.0 146.9 149.6 174.5 188.7

Los Angeles-Long Beach-Santa Ana, CA 13,161 13,208 14,585 14,921 15,639 207.0 206.2 227.7 232.2 243.3

Louisville, KY-IN 626 572 909 961 1,011 108.0 97.8 154.2 161.3 169.7

Memphis, TN-MS-AR 1,712 2,111 2,307 2,289 2,503 286.6 350.1 378.3 372.4 407.2

Miami-Fort Lauderdale-Miami Beach, FL 1,997 2,171 1,911 2,588 3,771 77.9 83.5 72.6 97.5 142.0

Milwaukee-Waukesha-West Allis, WI 2,486 2,711 2,804 2,720 2,473 337.7 367.7 380.9 368.8 335.3

Minneapolis-St. Paul-Bloomington, MN-WI 2,289 2,247 2,491 2,809 2,787 150.0 145.5 159.9 178.2 176.8

Nashville-Davidson-Murfreesboro, TN 1,147 1,225 1,415 1,497 1,527 170.0 178.0 201.5 208.6 212.8

New Orleans-Metairie-Kenner, LA 1,355 1,327 1,100 676 985 214.4 209.6 173.5 137.0 199.6

New York-Newark-Edison, NY-NJ-PA 10,437 11,125 15,890 17,301 21,165 116.3 123.4 175.7 190.3 232.8

Oklahoma City, OK 823 882 1,054 1,233 1,384 147.7 156.2 184.7 213.7 239.9

Orlando, FL 821 895 1,195 1,252 1,620 92.3 97.3 125.0 127.3 164.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 6,628 6,915 6,677 7,600 7,972 238.3 247.2 237.6 269.9 283.1

Phoenix-Mesa-Scottsdale, AZ 1,779 2,521 2,646 3,410 3,569 98.2 134.6 135.7 167.3 175.1

Pittsburgh, PA 1,296 1,353 1,482 1,522 1,745 112.3 117.6 129.5 133.6 153.2

Portland-Vancouver-Beaverton, OR-WA 1,371 1,701 1,820 1,885 1,861 135.0 165.4 174.2 176.9 174.6

Providence-New Bedford-Fall River, RI-MA 930 1,126 1,085 1,223 1,178 118.9 143.3 138.5 157.0 151.2

Richmond, VA 1,045 1,348 1,281 1,423 1,514 189.6 240.7 224.2 244.9 260.6

Riverside-San Bernardino-Ontario, CA 2,563 2,654 2,913 3,029 3,532 140.7 139.8 148.8 150.4 175.4

Rochester, NY 1,152 1,171 1,180 1,278 1,496 227.6 230.9 232.9 253.1 296.3

Sacramento-Arden-Arcade-Roseville, CA 1,588 1,901 2,220 2,431 2,387 163.5 191.7 221.1 239.3 235.0

Salt Lake City, UT 689 722 933 969 1,096 135.5 140.1 178.2 179.0 202.4

San Antonio, TX 1,225 1,460 1,942 2,104 2,160 137.4 160.9 209.8 221.5 227.4

San Diego-Carlsbad-San Marcos, CA 2,715 2,844 3,022 3,134 3,457 184.0 192.9 204.1 211.6 233.4

San Francisco-Oakland-Fremont, CA 3,908 4,370 4,686 5,058 5,465 189.9 212.4 227.9 243.6 263.2

San Jose-Sunnyvale-Santa Clara, CA 1,315 1,628 1,575 1,723 1,633 149.2 183.9 176.2 188.7 178.8

Seattle-Tacoma-Bellevue, WA 2,851 2,880 3,177 2,863 2,985 182.0 182.2 198.5 175.5 183.0

St. Louis, MO-IL 1,902 2,770 3,524 3,557 3,698 144.1 207.4 262.3 263.0 273.5

Tampa-St. Petersburg-Clearwater, FL 1,156 1,076 1,131 1,535 2,652 94.3 85.7 87.9 116.9 202.0

Virginia Beach-Norfolk-Newport News, VA-NC 1,276 1,724 2,375 2,481 2,494 157.9 212.4 292.4 307.4 309.0

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,120 2,848 2,706 3,637 4,849 85.4 113.5 106.2 140.9 187.9

U.S. MSA TOTAL 115,127 124,765 139,651 150,077 168,034 150.2 160.9 178.2 189.2 211.8

Table 8. Chlamydia — Men – Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2003–2007

*MSAs selected based on largest population in 2000 U.S. census.
108 Chlamydia Tables STD Surveillance 2007

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percent

1 Los Angeles County, CA 44,030 442.6 3

2 Cook County, IL 30,881 583.9 6

3 Philadelphia County, PA 17,029 1175.7 8

4 Kings County, NY 15,655 624.0 9

5 Bronx County, NY 14,572 1070.3 11

6 Maricopa County, AZ 14,542 385.9 12

7 Harris County, TX 13,387 344.5 13

8 San Diego County, CA 12,693 431.5 14

9 Wayne County, MI 12,403 629.0 15

10 Dallas County, TX 12,279 523.4 16

11 Queens County, NY 10,050 445.6 17

12 Milwaukee County, WI 9,637 1053.1 18

13 New York County, NY 9,605 596.0 19

14 Shelby County, TN 9,428 1034.4 20

15 Orange County, CA 8,322 277.2 21

16 Cuyahoga County, OH 8,219 625.4 21

17 San Bernardino County, CA 8,122 406.2 22

18 Bexar County, TX 8,055 517.8 23

19 Hamilton County, OH 7,404 900.1 24

20 Sacramento County, CA 7,372 536.3 24

21 Baltimore (City), MD 7,362 1166.0 25

22 Clark County, NV 7,333 412.5 26

23 Marion County, IN 7,157 826.9 26

24 Alameda County, CA 6,929 475.4 27

25 Franklin County, OH 6,336 578.3 27

26 Riverside County, CA 6,194 305.6 28

27 Tarrant County, TX 6,184 370.0 28

28 Jefferson County, AL 6,139 934.8 29

29 Washington, D.C. 6,029 1036.7 30

30 Miami-Dade County, FL 5,956 247.9 30

31 Santa Clara County, CA 5,740 331.5 31

32 Duval County, FL 5,509 657.4 31

33 Fulton County, GA 5,454 568.1 32

34 Broward County, FL 5,413 302.8 32

35 Fresno County, CA 5,362 601.3 33

36 King County, WA 5,308 290.6 33

37 DeKalb County, GA 5,202 718.9 34

38 Hillsborough County, FL 5,155 445.3 34

39 Jackson County, MO 5,032 757.7 34

40 St. Louis County, MO 4,894 489.2 35

41 Allegheny County, PA 4,893 399.9 35

42 Orange County, FL 4,862 465.9 36

43 Prince George’s County, MD 4,857 577.3 36

44 Essex County, NJ 4,851 617.1 37

45 Travis County, TX 4,844 525.9 37

46 Hennepin County, MN 4,742 422.6 38

47 Honolulu County, HI 4,497 494.3 38

48 Suffolk County, MA 4,459 648.5 38

49 Kern County, CA 4,433 568.2 39

50 St Louis (City), MO 4,392 1265.0 39

51 Erie County, NY 4,350 472.1 40

52 Monroe County, NY 4,224 578.0 40

53 Richland County, SC 4,211 1209.3 40

Table 9. Chlamydia — Counties and independent cities* ranked by number of reported cases: United States,

2007

*Accounting for 40% of reported chlamydia cases.

†Counties and independent cities were ranked in descending order by number of cases reported in 2007. 
STD Surveillance 2007 Chlamydia Tables 109

 Age

Group

Cases Rates

Year Total Male Female Total Male Female

2003

10–14 14,911 1,061 13,849 70.4 9.8 134.0

15–19 310,505 44,331 266,175 1,516.3 421.4 2,672.5

20–24 324,411 71,476 252,936 1,565.1 670.3 2,513.3

25–29 124,890 34,916 89,974 651.6 357.3 957.7

30–34 53,572 17,810 35,762 258.7 170.4 348.7

35–39 24,658 9,772 14,886 115.2 91.1 139.4

40–44 12,287 5,675 6,612 53.5 49.8 57.2

45–54 8,214 4,012 4,202 20.1 20.0 20.2

55–64 1,653 883 770 5.9 6.6 5.3

65+ 776 323 453 2.2 2.2 2.2

TO TAL 877,478 190,723 686,755 301.7 133.3 464.7

2004

10–14 14,817 1,172 13,646 70.1 10.8 132.3

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

TO TAL 929,462 210,935 718,527 316.5 145.9 481.9

2005

10–14 14,124 1,200 12,924 67.7 11.2 127.0

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

TO TAL 976,445 233,553 742,892 329.4 160.0 493.9

2006

10–14 13,601 1,238 12,364 65.9 11.7 122.8

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

TO TAL 1,030,911 253,236 777,675 344.3 171.7 512.0

2007

10–14 13,629 1,251 12,378 66.1 11.8 123.0

15–19 379,418 67,248 312,170 1,779.3 615.0 3,004.7

20–24 402,595 101,780 300,815 1,907.0 932.9 2,948.8

25–29 174,828 54,890 119,939 844.2 518.6 1,184.6

30–34 69,416 24,633 44,784 352.3 246.8 460.4

35–39 33,654 13,838 19,816 158.9 129.9 188.1

40–44 16,617 7,992 8,625 73.9 71.4 76.5

45–54 13,141 6,881 6,261 30.4 32.3 28.5

55–64 2,842 1,531 1,311 9.0 10.1 8.0

65+ 812 417 395 2.2 2.7 1.8

TO TAL 1,108,374 280,931 827,443 370.2 190.4 544.8

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

States, 2003–2007

 NOTE: This ta ble should be used only for age com par i sons. If age was not speci fied, cases were pro rated ac cord ing to the dis tri bu tion of cases

for which age was known. Dif fer ences be tween to tal cases from this ta ble and oth ers in the re port are due to dif fer ent re port ing formats. The 0 to 9

year age group is not shown because some of these cases may not be due to sex ual trans mis sion; how ever, they are in cluded in the to tals.
110 Chlamydia Tables STD Surveillance 2007

Age 

Group 

 White, Non-His panic Black, Non-His panic His panic Asian/Pa cific Is lander 

Amer i can In dian/

 Alaska Na tive 

To tal Male Fe male To tal Male Fe male To tal Male Fe male To tal Male Fe male To tal Male Fe male

3

0

0

2

10–14 3,336 116 3,219 8,320 721 7,600 2,210 166 2,044 145 7 139 302 19 283

15–19 93,457 8,820 84,637 147,549 25,606 121,944 48,899 7,407 41,493 4,071 445 3,627 5,517 815 4,702

20–24 103,138 20,467 82,671 138,950 34,080 104,871 58,996 12,572 46,424 6,046 1,156 4,890 5,428 1,001 4,427

25–29 33,634 9,219 24,415 52,640 16,408 36,232 28,313 6,876 21,437 3,120 810 2,310 2,385 477 1,908

30–34 13,149 4,309 8,839 22,401 8,645 13,756 13,001 3,502 9,499 1,830 493 1,337 1,066 238 828

35–39 6,091 2,586 3,505 10,340 4,799 5,541 5,728 1,644 4,084 876 252 624 630 158 472

40–44 3,331 1,689 1,642 5,339 2,859 2,480 2,355 733 1,622 434 124 310 339 75 264

45–54 2,420 1,347 1,073 3,440 1,879 1,561 1,418 454 964 378 131 247 210 55 155

55–64 524 326 198 635 361 273 293 113 180 89 33 56 51 15 36

65+ 277 112 165 301 144 158 130 37 93 22 14 8 17 3 14

TO TAL 259,808 49,115 210,693 390,660 95,741 294,918 161,629 33,576 128,053 17,042 3,469 13,573 15,964 2,859 13,105

4

0

0

2

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

TO TAL 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

5

0

0

2

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

TO TAL 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

6

0

0

2

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

TO TAL 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

7

0

0

2

10–14 2,584 96 2,488 8,304 894 7,410 2,139 214 1,924 125 7 119 249 17 232

15–19 102,492 11,770 90,721 199,668 42,631 157,037 60,923 10,274 50,649 3,916 556 3,360 5,801 909 4,892

20–24 127,034 27,906 99,128 181,647 52,167 129,480 73,166 17,065 56,101 6,128 1,235 4,893 6,211 1,281 4,930

25–29 50,643 14,958 35,685 75,661 26,691 48,970 37,775 10,366 27,409 3,665 944 2,721 2,992 651 2,341

30–34 17,688 5,927 11,760 29,955 12,454 17,502 16,772 4,754 12,017 1,948 579 1,368 1,299 319 979

35–39 9,117 3,531 5,586 14,183 7,025 7,158 7,721 2,438 5,283 1,144 369 775 638 152 486

40–44 4,627 2,244 2,383 7,190 3,983 3,207 3,364 1,213 2,152 649 254 395 371 108 263

45–54 3,915 2,223 1,691 5,956 3,441 2,515 2,184 801 1,383 510 193 317 249 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

TO TAL 319,703 69,523 250,180 524,791 150,377 374,415 204,853 47,391 157,462 18,311 4,230 14,081 17,871 3,525 14,346

Table 11A. Chlamydia — Re ported cases by race/eth nic ity, age group and sex: United States, 2003–2007

NOTE: These ta bles should be used only for race/eth nic ity com par i sons. See Ta ble 10 for age-spe cific cases and rates and Ta bles 3-5 for total and

sex-spe cific cases and rates. If age or race/eth nic ity was not speci fied, cases were pro rated ac cord ing to the dis tri bu tion of cases for which these vari -

ables were speci fied. For the fol low ing years the states listed did not re port age and/or race/eth nic ity for most cases and their case data and pop u la tion de -

nom i na tors were excluded: 2003 (CO, DC, NJ); 2004 (CO, DC, NJ); 2005 (CO, DC, GA, HI, NJ); 2006 (CO, HI); 2007 (CO, HI). Dif fer ences be tween to tal

cases from this ta ble and oth ers in the re port are due to dif fer ent re port ing for mats and above listed ex clu sions. The 0 to 9 year age group is not shown

because some of these cases may not be due to sex ual trans mis sion; how ever, they are in cluded in the to tals.
STD Surveillance 2007 Chlamydia Tables 111

Age 

Group

 White, Non-His panic Black, Non-His panic His panic Asian/Pa cific Is lander 

Amer i can In dian/

 Alaska Na tive 

To tal Male Fe male To tal Male Fe male To tal Male Fe male To tal Male Fe male To tal Male Fe male

10–14 26.8 1.8 53.1 257.1 43.8 477.2 63.5 9.3 120.3 18.1 1.6 35.6 132.8 16.1 252.4

2

0

0

3

15–19 747.8 137.3 1,393.3 5,004.5 1,711.0 8,399.4 1,586.1 463.0 2,797.2 502.0 106.7 919.6 2,472.4 717.0 4,295.6

20–24 836.7 327.1 1,362.2 4,926.4 2,426.8 7,405.0 1,662.2 640.1 2,928.8 641.0 243.0 1,046.1 2,692.8 977.9 4,462.0

25–29 305.2 165.7 447.3 2,176.4 1,414.5 2,878.6 788.7 347.7 1,329.4 293.1 154.6 427.0 1,440.8 573.2 2,318.3

30–34 105.8 68.9 143.3 888.2 723.6 1,036.4 384.8 192.9 607.5 155.2 85.5 222.0 642.5 288.1 995.1

35–39 45.0 38.1 52.0 400.5 395.1 405.2 191.4 103.6 290.4 84.2 49.7 116.9 369.1 188.7 543.4

40–44 21.6 22.0 21.3 199.9 228.9 174.4 91.2 54.8 130.3 44.7 26.5 61.6 185.1 84.6 279.1

45–54 8.4 9.4 7.4 77.8 92.0 65.6 39.4 25.2 53.6 23.0 17.2 28.1 67.8 37.3 95.8

55–64 2.5 3.2 1.8 25.0 31.9 19.4 14.9 12.2 17.4 9.0 7.2 10.6 27.4 16.9 37.0

65+ 1.0 0.9 1.0 10.8 13.4 9.1 6.7 4.5 8.3 2.2 3.2 1.4 10.6 4.9 14.9

TO TAL 136.7 52.7 217.4 1,122.3 577.4 1,617.9 428.2 172.3 701.5 141.6 59.4 219.1 672.2 244.4 1,087.2

10–14 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

2

0

0

4

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

TO TAL 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

2

0

0

5

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

TO TAL 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

2

0

0

6

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

TO TAL 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 21.3 1.5 42.2 258.9 54.9 469.4 55.5 10.9 102.3 14.9 1.5 28.9 120.4 16.4 227.1

2

0

0

7

15–19 787.7 176.2 1,432.7 6,052.0 2,550.8 9,646.7 1,720.4 562.8 2,951.9 465.0 128.0 823.8 2,547.7 786.8 4,360.4

20–24 988.5 423.9 1,581.4 6,018.2 3,420.5 8,671.5 1,996.5 857.9 3,348.4 659.3 260.9 1,072.8 2,866.1 1,163.3 4,626.3

25–29 418.5 245.8 593.3 2,711.3 1,970.1 3,410.6 930.7 458.1 1,526.3 329.8 172.8 481.7 1,636.1 705.7 2,582.6

30–34 154.1 102.7 206.0 1,191.5 1,044.8 1,323.7 437.4 228.3 685.9 151.7 92.4 208.4 813.3 400.0 1,226.5

35–39 68.6 52.9 84.5 539.3 567.7 514.0 223.5 132.3 327.9 94.5 62.5 124.9 391.1 188.6 589.5

40–44 31.0 30.1 31.9 258.9 306.9 216.9 110.0 75.6 148.0 60.2 48.4 71.3 208.8 124.3 289.4

45–54 12.7 14.5 10.9 119.6 149.8 93.7 49.5 35.8 63.4 28.2 22.6 33.1 75.2 44.8 102.7

55–64 3.9 4.9 2.9 38.5 49.7 29.5 17.3 11.6 22.6 15.3 13.8 16.5 13.7 7.8 19.1

65+ 0.9 1.4 0.6 10.2 13.1 8.4 6.2 5.6 6.6 2.9 3.0 2.8 6.3 6.5 6.1

TO TAL 162.3 71.9 249.3 1,398.7 841.3 1,906.0 473.2 211.7 753.3 139.5 66.3 208.8 732.9 293.8 1,158.2

Ta ble 11B. Chlamydia — Rates per 100,000 pop u la tion by race/eth nic ity, age group and sex: United States,

2003–2007

NOTE: These ta bles should be used only for race/eth nic ity com par i sons. See Ta ble 10 for age-spe cific cases and rates and Ta bles 3-5 for total and

sex-spe cific cases and rates. If age or race/eth nic ity was not specified, cases were pro rated ac cord ing to the dis tri bu tion of cases for which these vari ables were

spec i fied. For the fol low ing years the states listed did not re port age and/or race/eth nic ity for most cases and their case data and pop u la tion de nom i na tors were excluded: 2003 (CO, DC, NJ); 2004 (CO, DC, NJ); 2005 (CO, DC, GA, HI, NJ); 2006 (CO, HI); 2007 (CO, HI). Dif fer ences be tween to tal rates from this ta ble and oth ers

in the re port are due to dif fer ent re port ing for mats and above listed ex clu sions. The 0 to 9 year age group is not shown because some of these cases may not be due

to sex ual trans mis sion; how ever, they are in cluded in the to tals.
112 Gonorrhea Tables STD Surveillance 2007

Rank* State Cases Rate per 100,000 Population

1 Mississippi 8,314 285.7

2 Louisiana 11,137 259.7

3 South Carolina 10,326 239.0

4 Alabama 10,885 236.7

5 Georgia 17,835 190.5

6 North Carolina 16,666 188.2

7 Ohio 21,066 183.5

8 Missouri 9,876 169.0

9 Illinois 20,813 162.2

10 Tennessee 9,564 158.4

11 Michigan 15,482 153.4

12 Delaware 1,293 151.5

13 Arkansas 4,168 148.3

14 Indiana 8,790 139.2

15 Texas 32,073 136.4

16 Oklahoma 4,827 134.9

17 Florida 23,327 129.0

18 Wisconsin 6,752 121.5

19 Maryland 6,768 120.5

U.S. TOTAL†355,991 118.9

20 Pennsylvania 12,706 102.1

21 Nevada 2,357 94.4

22 New Mexico 1,796 91.9

23 New York 17,697 91.7

24 Alaska 579 86.4

25 California 31,294 85.8

26 Kansas 2,282 82.6

27 Arizona 5,062 82.1

28 Virginia 6,269 82.0

29 Kentucky 3,449 82.0

30 Nebraska 1,434 81.1

31 Colorado 3,376 71.0

32 New Jersey 6,076 69.6

33 Minnesota 3,459 66.9

34 Connecticut 2,327 66.4

35 Iowa 1,928 64.7

36 Washington 3,653 57.1

37 Hawaii 659 51.3

38 West Virginia 930 51.1

39 Massachusetts 2,695 41.9

40 Rhode Island 402 37.7

41 Oregon 1,236 33.4

42 South Dakota 261 33.4

43 Utah 821 32.2

YEAR 2010 TARGET 19.0

44 Idaho 269 18.3

45 North Dakota 116 18.2

46 Wyoming 81 15.7

47 Montana 122 12.9

48 New Hampshire 138 10.5

49 Vermont 64 10.3

50 Maine 118 8.9

Table 12. Gonorrhea — Reported cases and rates by state, ranked by rates: United States, 2007

*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 2,373 cases and a rate of 408.1, but excludes outlying areas (Guam with 141 cases

and rate of 82.4, Puerto Rico with 323 cases and rate of 8.2, and Virgin Islands with 69 cases and rate of 63.5).
STD Surveillance 2007 Gonorrhea Tables 113

Cases Rates per 100,000 Population

State/Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Alabama 9,303 8,206 9,406 10,665 10,885 206.7 181.1 206.4 231.9 236.7

Alaska 573 567 600 630 579 88.3 86.5 90.4 94.0 86.4

Arizona 3,580 4,065 4,951 5,949 5,062 64.1 70.8 83.4 96.5 82.1

Arkansas 4,251 4,137 4,476 4,306 4,168 156.0 150.3 161.1 153.2 148.3

California 25,963 30,155 34,338 33,740 31,294 73.2 84.0 95.0 92.5 85.8

Colorado 2,854 3,054 3,224 3,695 3,376 62.7 66.4 69.1 77.7 71.0

Connecticut 3,114 2,862 2,750 2,610 2,327 89.4 81.7 78.3 74.5 66.4

Delaware 1,128 894 913 1,485 1,293 138.0 107.7 108.2 174.0 151.5

District of Columbia 2,508 2,568 2,146 1,887 2,373 444.4 463.9 389.8 324.5 408.1

Florida 18,974 18,580 20,225 23,976 23,327 111.5 106.8 113.7 132.5 129.0

Georgia 17,686 15,783 15,860 19,669 17,835 203.6 178.8 174.8 210.1 190.5

Hawaii 1,263 1,193 1,024 885 659 100.4 94.5 80.3 68.8 51.3

Idaho 68 103 119 206 269 5.0 7.4 8.3 14.0 18.3

Illinois 21,817 20,597 20,019 20,186 20,813 172.4 162.0 156.8 157.3 162.2

Indiana 6,681 6,851 8,094 8,732 8,790 107.8 109.8 129.1 138.3 139.2

Iowa 1,554 1,249 1,606 1,966 1,928 52.8 42.3 54.1 65.9 64.7

Kansas 2,647 2,542 2,605 2,210 2,282 97.2 92.9 94.9 80.0 82.6

Kentucky 3,578 2,758 2,935 3,277 3,449 86.9 66.5 70.3 77.9 82.0

Louisiana 11,850 10,538 9,572 10,883 11,137 263.5 233.4 211.6 253.8 259.7

Maine 233 210 142 137 118 17.8 15.9 10.7 10.4 8.9

Maryland 8,032 8,297 7,035 7,328 6,768 145.8 149.3 125.6 130.5 120.5

Massachusetts 2,901 3,057 2,537 2,429 2,695 45.1 47.6 39.6 37.7 41.9

Michigan 13,965 17,376 17,684 15,677 15,482 138.5 171.8 174.7 155.3 153.4

Minnesota 3,202 2,957 3,482 3,303 3,459 63.3 58.0 67.8 63.9 66.9

Mississippi 6,328 7,163 7,171 7,511 8,314 219.6 246.7 245.5 258.1 285.7

Missouri 8,792 9,218 9,455 10,204 9,876 154.1 160.2 163.0 174.6 169.0

Montana 122 88 158 194 122 13.3 9.5 16.9 20.5 12.9

Nebraska 1,623 1,147 1,158 1,433 1,434 93.3 65.6 65.8 81.0 81.1

Nevada 2,221 3,078 2,880 2,791 2,357 99.1 131.8 119.3 111.8 94.4

New Hampshire 125 133 177 180 138 9.7 10.2 13.5 13.7 10.5

New Jersey 7,944 6,696 5,722 5,492 6,076 92.0 77.0 65.6 62.9 69.6

New Mexico 1,169 1,306 1,552 1,733 1,796 62.4 68.6 80.5 88.7 91.9

New York 22,166 18,737 17,717 17,459 17,697 115.5 97.5 92.0 90.4 91.7

North Carolina 15,116 15,194 15,072 17,312 16,666 179.8 177.9 173.6 195.5 188.2

North Dakota 103 110 128 153 116 16.3 17.3 20.1 24.1 18.2

Ohio 22,537 20,467 20,985 19,190 21,066 197.1 178.6 183.1 167.2 183.5

Oklahoma 4,552 4,453 5,228 4,951 4,827 129.6 126.4 147.4 138.3 134.9

Oregon 1,000 1,302 1,562 1,461 1,236 28.1 36.2 42.9 39.5 33.4

Pennsylvania 11,866 11,236 11,222 11,466 12,706 96.0 90.6 90.3 92.2 102.1

Rhode Island 973 816 438 508 402 90.4 75.5 40.7 47.6 37.7

South Carolina 8,518 9,171 8,561 10,320 10,326 205.4 218.5 201.2 238.8 239.0

South Dakota 226 304 351 367 261 29.6 39.4 45.2 46.9 33.4

Tennessee 8,519 8,475 8,605 9,694 9,564 145.8 143.6 144.3 160.5 158.4

Texas 24,595 24,371 26,110 30,449 32,073 111.2 108.4 114.2 129.5 136.4

Utah 412 603 727 888 821 17.5 25.2 29.4 34.8 32.2

Vermont 97 86 60 72 64 15.7 13.8 9.6 11.5 10.3

Virginia 9,066 8,565 8,346 6,476 6,269 122.7 114.8 110.3 84.7 82.0

Washington 2,753 2,810 3,739 4,231 3,653 44.9 45.3 59.5 66.2 57.1

West Virginia 847 892 770 953 930 46.8 49.1 42.4 52.4 51.1

Wisconsin 5,663 5,053 5,869 6,927 6,752 103.5 91.7 106.0 124.7 121.5

Wyoming 46 59 87 120 81 9.2 11.6 17.1 23.3 15.7

U.S. TOTAL 335,104 330,132 339,593 358,366 355,991 115.2 112.4 114.6 119.7 118.9

Northeast 49,419 43,833 40,765 40,353 42,223 90.8 80.3 74.6 73.7 77.1

Midwest 88,810 87,871 91,436 90,348 92,259 135.8 133.7 138.6 136.4 139.3

South 154,851 150,045 152,431 171,142 170,204 148.1 141.6 141.8 156.9 156.0

West 42,024 48,383 54,961 56,523 51,305 63.2 71.8 80.5 81.5 74.0

Guam 65 114 106 98 141 39.7 68.6 62.9 57.3 82.4

Puerto Rico 276 267 328 302 323 7.1 6.9 8.4 7.7 8.2

Virgin Islands 91 75 30 34 69 83.6 68.9 27.6 31.3 63.5

OUTLYING AREAS 432 456 464 434 533 10.4 10.9 11.1 10.3 12.7

TOTAL 335,536 330,588 340,057 358,800 356,524 113.8 111.0 113.1 118.2 117.4

Table 13. Gonorrhea — Reported cases and rates by state/area and region listed in alphabetical order: United 

States and outlying areas, 2003–2007
114 Gonorrhea Tables STD Surveillance 2007

Cases Rates per 100,000 Population

State/Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Alabama 4,583 3,673 4,494 5,983 6,095 197.4 157.4 191.5 252.5 257.2

Alaska 339 337 349 356 326 108.1 106.5 108.9 110.0 100.7

Arizona 1,636 1,787 2,338 2,847 2,342 58.7 62.3 78.8 92.4 76.0

Arkansas 2,108 2,032 2,252 2,182 2,275 151.5 144.7 159.0 152.3 158.7

California 11,912 13,620 15,827 15,688 14,533 67.0 75.8 87.5 86.0 79.7

Colorado 1,529 1,656 1,619 1,879 1,807 67.8 72.6 70.1 79.6 76.6

Connecticut 1,910 1,756 1,590 1,478 1,372 106.6 97.4 88.1 82.2 76.3

Delaware 602 508 515 829 699 143.5 119.3 119.2 188.7 159.1

District of Columbia 1,137 1,293 1,029 808 1,077 381.2 443.1 355.6 261.6 348.7

Florida 9,419 9,371 10,204 12,427 11,793 108.5 105.6 112.6 135.0 128.1

Georgia 9,137 8,119 7,819 10,002 9,334 207.8 181.9 170.5 210.4 196.4

Hawaii 723 680 619 476 295 115.3 107.5 96.8 74.1 45.9

Idaho 18 42 57 113 152 2.6 6.0 8.0 15.5 20.9

Illinois 11,624 11,510 10,998 10,926 11,312 180.4 177.9 169.4 167.7 173.6

Indiana 3,610 3,550 4,453 4,806 4,884 114.6 112.0 139.9 150.0 152.5

Iowa 869 736 885 1,179 1,121 58.1 49.1 58.8 78.1 74.3

Kansas 1,522 1,565 1,645 1,327 1,401 110.8 113.6 119.1 95.3 100.6

Kentucky 1,845 1,415 1,530 1,709 1,887 87.8 67.0 72.1 79.7 88.0

Louisiana 6,076 5,450 4,761 5,605 5,822 262.6 234.7 204.9 254.5 264.4

Maine 84 84 61 54 45 12.6 12.5 9.0 8.0 6.7

Maryland 4,166 4,327 3,620 3,850 3,529 146.5 150.9 125.4 132.8 121.7

Massachusetts 1,342 1,531 1,320 1,214 1,282 40.4 46.3 40.0 36.6 38.6

Michigan 7,823 9,614 10,161 8,900 8,984 152.5 186.9 197.5 173.6 175.3

Minnesota 1,784 1,712 1,909 1,814 1,930 70.0 66.6 73.9 69.8 74.3

Mississippi 3,757 4,362 4,234 4,400 4,901 253.0 291.9 281.8 293.1 326.5

Missouri 4,794 5,139 5,334 5,752 5,481 164.1 174.6 179.9 192.5 183.4

Montana 74 54 102 123 75 16.1 11.6 21.8 26.1 15.9

Nebraska 924 656 688 865 847 105.0 74.2 77.4 97.0 95.0

Nevada 1,062 1,417 1,343 1,257 1,066 96.6 123.7 113.3 102.5 86.9

New Hampshire 57 54 97 97 63 8.7 8.2 14.6 14.6 9.5

New Jersey 4,550 3,607 3,077 2,829 3,059 102.6 80.8 68.9 63.4 68.6

New Mexico 598 749 884 1,003 974 62.8 77.4 90.2 101.3 98.4

New York 11,296 9,720 9,031 8,479 8,324 113.9 98.0 91.0 85.2 83.6

North Carolina 7,383 7,384 7,545 8,718 8,941 172.6 170.0 171.0 193.1 198.0

North Dakota 59 72 76 86 66 18.6 22.7 23.8 27.2 20.9

Ohio 12,390 11,144 11,592 10,508 11,771 211.1 189.6 197.3 178.7 200.2

Oklahoma 2,562 2,471 3,018 2,780 2,606 143.9 138.6 168.2 153.2 143.6

Oregon 389 567 661 609 564 21.7 31.4 36.1 32.7 30.3

Pennsylvania 6,644 6,295 6,271 6,219 6,946 104.2 98.5 98.0 97.3 108.6

Rhode Island 517 478 227 273 169 92.7 85.4 40.8 49.5 30.6

South Carolina 4,369 5,007 4,601 5,406 5,640 205.3 232.6 211.0 243.8 254.3

South Dakota 133 178 196 215 153 34.6 45.9 50.2 54.9 39.1

Tennessee 4,263 4,327 4,395 5,104 5,247 142.6 143.5 144.5 165.3 169.9

Texas 12,643 12,433 13,827 15,619 16,192 113.8 110.1 120.5 132.4 137.3

Utah 153 266 319 369 345 13.1 22.4 25.9 29.1 27.2

Vermont 48 53 26 39 30 15.2 16.8 8.2 12.3 9.5

Virginia 4,809 4,650 4,402 3,287 3,369 128.1 122.7 114.5 84.6 86.7

Washington 1,167 1,229 1,622 1,938 1,858 38.0 39.5 51.5 60.4 58.0

West Virginia 464 470 427 488 504 50.0 50.6 46.0 52.6 54.3

Wisconsin 3,299 2,953 3,433 4,047 4,066 119.3 106.1 122.9 144.8 145.4

Wyoming 28 39 54 71 41 11.2 15.5 21.4 28.0 16.1

U.S. TOTAL 174,230 172,142 177,537 187,033 187,595 117.9 115.4 118.0 123.1 123.5

Northeast 26,448 23,578 21,700 20,682 21,290 94.3 83.9 77.2 73.5 75.7

Midwest 48,831 48,829 51,370 50,425 52,016 146.7 146.1 153.2 150.0 154.8

South 79,323 77,292 78,673 89,197 89,911 149.0 143.4 144.0 160.7 162.0

West 19,628 22,443 25,794 26,729 24,378 59.1 66.6 75.6 77.2 70.4

Guam 39 70 71 49 66 48.7 86.0 85.9 58.4 78.7

Puerto Rico 121 150 194 152 165 6.0 7.4 9.5 7.4 8.1

Virgin Islands 65 48 18 23 51 114.3 84.4 31.7 40.5 89.8

OUTLYING AREAS 225 268 283 224 282 10.5 12.4 13.0 10.3 12.9

TOTAL 174,455 172,410 177,820 187,257 187,877 116.4 114.0 116.5 121.5 121.9

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

order: United States and outlying areas, 2003–2007

 NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2007 Gonorrhea Tables 115

Cases Rates per 100,000 Population

State/Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Alabama 4,705 4,526 4,892 4,678 4,786 215.9 206.1 221.2 209.8 214.7

Alaska 234 230 251 274 253 69.8 67.9 73.1 79.1 73.0

Arizona 1,942 2,274 2,610 3,097 2,718 69.6 79.1 87.8 100.4 88.1

Arkansas 2,141 2,104 2,223 2,122 1,890 160.5 156.0 163.1 154.0 137.2

California 13,965 16,440 18,348 17,856 16,632 78.8 91.8 101.7 98.0 91.3

Colorado 1,325 1,398 1,605 1,816 1,569 57.7 60.2 68.1 75.9 65.6

Connecticut 1,204 1,106 1,160 1,132 955 71.2 65.1 68.0 66.3 56.0

Delaware 526 386 398 656 594 132.1 95.4 96.8 158.4 143.4

District of Columbia 1,361 1,269 1,113 1,072 1,284 511.5 484.9 426.2 393.2 470.9

Florida 9,555 9,209 10,021 11,546 11,527 114.6 108.0 114.9 130.0 129.7

Georgia 8,487 7,596 7,885 9,510 8,401 198.0 174.0 175.7 206.2 182.2

Hawaii 540 513 405 409 364 85.6 81.4 63.7 63.6 56.6

Idaho 50 60 60 92 112 7.3 8.6 8.4 12.5 15.2

Illinois 10,192 9,087 9,020 9,260 9,501 164.1 145.5 143.8 146.6 150.4

Indiana 3,040 3,270 3,616 3,895 3,880 99.8 106.6 117.1 125.2 124.7

Iowa 680 511 721 787 807 47.0 35.1 49.4 53.4 54.8

Kansas 1,125 977 960 883 881 83.3 71.9 70.4 64.4 64.2

Kentucky 1,727 1,338 1,399 1,561 1,559 85.6 65.8 68.2 75.7 75.6

Louisiana 5,710 5,029 4,744 5,186 5,201 261.6 229.2 215.7 248.6 249.4

Maine 149 126 81 83 73 23.4 19.6 12.5 12.8 11.3

Maryland 3,858 3,969 3,410 3,461 3,238 144.7 147.5 125.7 127.4 119.2

Massachusetts 1,552 1,524 1,216 1,212 1,412 49.9 49.1 39.2 38.9 45.3

Michigan 6,141 7,762 7,468 6,738 6,447 124.0 156.2 150.1 135.6 129.7

Minnesota 1,418 1,245 1,573 1,489 1,529 56.5 49.2 61.7 58.0 59.5

Mississippi 2,571 2,801 2,937 3,111 3,413 184.1 198.8 207.0 220.7 242.2

Missouri 3,998 4,079 4,121 4,452 4,395 143.7 145.1 145.3 156.0 154.0

Montana 47 33 56 71 47 10.3 7.1 12.0 15.0 9.9

Nebraska 695 488 467 552 583 80.9 56.5 53.7 63.0 66.5

Nevada 1,158 1,658 1,535 1,533 1,291 101.4 139.5 124.9 120.8 101.7

New Hampshire 68 79 80 83 75 10.7 12.3 12.4 12.8 11.6

New Jersey 3,389 3,089 2,645 2,657 3,014 80.6 72.9 62.3 62.3 70.7

New Mexico 567 557 668 730 822 61.5 59.5 70.4 75.7 85.2

New York 10,813 8,985 8,680 8,976 9,363 116.6 96.6 93.1 95.9 100.1

North Carolina 7,733 7,810 7,527 8,594 7,725 187.2 186.0 176.2 198.0 177.9

North Dakota 44 38 52 67 50 13.9 12.0 16.4 21.0 15.7

Ohio 9,856 9,046 9,035 8,493 9,164 177.1 162.1 161.7 151.7 163.7

Oklahoma 1,990 1,982 2,210 2,171 2,221 114.9 113.9 126.0 123.0 125.9

Oregon 611 735 901 852 672 34.5 41.1 49.8 46.3 36.5

Pennsylvania 5,214 4,941 4,950 5,247 5,757 87.1 82.2 82.1 86.8 95.2

Rhode Island 456 338 211 235 232 88.0 64.8 40.6 45.5 44.9

South Carolina 4,118 4,136 3,925 4,899 4,665 204.0 202.2 189.2 232.9 221.8

South Dakota 93 126 155 152 107 24.5 32.9 40.2 38.9 27.4

Tennessee 4,256 4,148 4,209 4,590 4,317 149.2 143.7 144.1 155.5 146.3

Texas 11,932 11,902 12,269 14,812 15,819 108.4 106.3 107.7 126.4 135.0

Utah 259 337 408 519 476 21.9 28.1 32.9 40.5 37.1

Vermont 49 33 34 33 34 16.1 10.8 11.1 10.7 11.1

Virginia 4,237 3,904 3,939 3,187 2,895 116.7 106.3 105.8 84.8 77.1

Washington 1,586 1,581 2,117 2,293 1,795 51.9 51.1 67.4 71.9 56.3

West Virginia 380 421 343 465 426 43.0 47.4 38.6 52.2 47.8

Wisconsin 2,341 2,087 2,431 2,870 2,673 86.5 76.5 88.7 104.0 96.8

Wyoming 18 20 33 49 40 7.1 7.8 12.9 18.8 15.3

U.S. TOTAL 160,106 157,303 161,117 170,508 167,684 111.9 108.8 110.4 115.6 113.7

Northeast 22,894 20,221 19,057 19,658 20,915 86.8 76.4 71.8 73.9 78.6

Midwest 39,623 38,716 39,619 39,638 40,017 123.3 119.8 122.1 121.5 122.7

South 75,287 72,530 73,444 81,621 79,961 146.7 139.3 138.9 152.3 149.2

West 22,302 25,836 28,997 29,591 26,791 67.1 76.7 84.9 85.3 77.2

Guam 26 44 35 49 75 31.1 51.9 40.7 56.2 86.1

Puerto Rico 155 117 134 150 158 8.3 6.3 7.1 8.0 8.4

Virgin Islands 26 27 12 11 18 50.0 52.0 23.1 21.2 34.7

OUTLYING AREAS 207 188 181 210 251 10.3 9.4 9.0 10.4 12.4

TOTAL 160,313 157,491 161,298 170,718 167,935 110.5 107.5 109.0 114.2 112.3

Table 15. Gonorrhea — Men – Reported cases and rates by state/area and region listed in alphabetical order:

United States and outlying areas, 2003–2007

 NOTE: Cases reported with unknown sex are not included in this table.
116 Gonorrhea Tables STD Surveillance 2007

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Atlanta-Sandy Springs-Marietta, GA 8,825 7,355 7,838 10,223 9,060 191.4 156.2 159.4 199.0 176.3

Austin-Round Rock, TX 1,458 1,472 1,706 2,446 2,075 105.8 104.2 117.5 161.6 137.1

Baltimore-Towson, MD 5,382 5,256 4,779 4,653 4,156 205.7 199.2 180.0 175.0 156.3

Birmingham-Hoover, AL 2,212 2,377 2,381 2,444 3,129 206.2 219.6 218.4 222.2 284.4

Boston-Cambridge-Quincy, MA-NH 1,818 1,998 1,684 1,542 1,770 40.9 45.2 38.2 34.6 39.7

Buffalo-Cheektowaga-Tonawanda, NY 1,809 1,670 1,926 2,068 2,289 156.0 144.7 167.8 181.8 201.2

Charlotte-Gastonia-Concord, NC-SC 3,130 2,998 3,330 3,388 2,388 217.8 203.3 218.9 214.0 150.9

Chicago-Naperville-Joliet, IL-IN-WI 17,080 15,684 14,857 15,127 14,979 183.0 167.0 157.3 159.1 157.6

Cincinnati-Middletown, OH-KY-IN 4,206 3,455 3,927 3,862 4,583 205.4 167.9 189.7 183.5 217.8

Cleveland-Elyria-Mentor, OH 5,338 4,472 4,641 4,663 4,286 249.5 209.3 218.3 220.6 202.7

Columbus, OH 2,963 3,004 3,445 3,303 4,136 176.9 177.3 201.6 191.4 239.7

Dallas-Fort Worth-Arlington, TX 7,570 7,119 8,416 8,365 10,064 135.4 124.9 144.6 139.3 167.6

Denver-Aurora, CO 2,136 2,232 2,147 2,253 2,238 92.8 95.8 91.0 93.5 92.9

Detroit-Warren-Livonia, MI 7,173 9,299 10,766 8,535 8,554 160.0 207.0 239.9 191.0 191.4

Hartford-West Hartford-East Hartford, CT 1,030 933 993 988 920 87.4 78.8 83.6 83.1 77.4

Houston-Baytown-Sugar Land, TX 5,191 5,525 5,213 7,318 7,757 102.3 106.7 98.7 132.1 140.0

Indianapolis, IN 3,349 3,510 4,142 4,410 4,543 209.9 216.5 252.5 264.7 272.7

Jacksonville, FL 2,574 2,197 2,578 2,954 3,113 214.0 179.3 206.5 231.1 243.6

Kansas City, MO-KS 3,694 3,832 3,769 3,822 3,683 193.9 199.0 193.5 194.3 187.2

Las Vegas-Paradise, NV 1,968 2,645 2,487 2,478 2,112 124.8 160.2 145.4 139.4 118.8

Los Angeles-Long Beach-Santa Ana, CA 9,753 11,103 12,697 12,210 11,059 76.0 85.9 98.2 94.3 85.4

Louisville, KY-IN 1,617 1,484 1,551 1,749 1,908 135.9 123.6 128.3 143.1 156.1

Memphis, TN-MS-AR 3,764 3,832 3,782 4,665 4,756 303.7 306.5 299.9 366.0 373.1

Miami-Fort Lauderdale-Miami Beach, FL 4,455 4,622 4,497 5,356 5,152 84.2 86.2 82.9 98.0 94.3

Milwaukee-Waukesha-West Allis, WI 3,998 3,311 4,031 5,006 4,960 264.0 218.4 266.4 331.5 328.5

Minneapolis-St. Paul-Bloomington, MN-WI 2,781 2,439 2,920 2,780 2,834 90.2 78.3 92.9 87.6 89.3

Nashville-Davidson-Murfreesboro, TN 1,888 1,602 1,474 1,734 1,692 137.7 114.8 103.6 119.2 116.3

New Orleans-Metairie-Kenner, LA 3,956 3,316 2,609 1,962 2,713 300.3 251.3 197.7 191.5 264.8

New York-Newark-Edison, NY-NJ-PA 20,480 16,915 15,533 14,949 15,396 109.9 90.4 82.9 79.4 81.8

Oklahoma City, OK 2,050 2,153 2,548 2,315 2,373 181.0 188.1 220.3 197.5 202.4

Orlando, FL 2,165 2,285 2,848 3,393 2,743 120.1 122.7 147.3 170.9 138.2

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 8,502 7,818 7,719 8,163 8,669 147.3 134.8 132.6 140.1 148.8

Phoenix-Mesa-Scottsdale, AZ 2,795 3,161 3,133 4,260 3,333 77.8 85.1 81.1 105.5 82.5

Pittsburgh, PA 2,035 1,799 2,157 2,057 2,599 84.4 74.9 90.4 86.8 109.6

Portland-Vancouver-Beaverton, OR-WA 858 1,173 1,393 1,128 1,053 42.1 56.8 66.5 52.8 49.3

Providence-New Bedford-Fall River, RI-MA 1,136 1,048 650 693 621 70.0 64.3 40.1 43.0 38.5

Richmond, VA 2,319 2,160 2,361 1,778 2,199 203.7 187.1 200.8 148.9 184.2

Riverside-San Bernardino-Ontario, CA 2,512 2,631 3,012 2,994 3,166 69.0 69.4 77.0 74.4 78.6

Rochester, NY 1,897 1,900 1,899 1,457 1,207 182.2 182.4 182.8 140.7 116.6

Sacramento-Arden-Arcade-Roseville, CA 1,859 2,066 2,450 2,235 2,315 94.1 102.4 120.0 108.1 112.0

Salt Lake City, UT 276 371 460 623 573 27.5 36.4 44.5 58.3 53.7

San Antonio, TX 2,333 2,183 2,300 2,701 2,601 128.1 117.7 121.7 139.1 133.9

San Diego-Carlsbad-San Marcos, CA 2,007 2,379 2,695 2,767 2,385 68.5 81.1 91.9 94.1 81.1

San Francisco-Oakland-Fremont, CA 4,394 4,967 5,713 6,029 5,695 105.7 119.6 137.6 144.2 136.2

San Jose-Sunnyvale-Santa Clara, CA 740 1,084 1,055 1,065 893 42.7 62.2 60.1 59.6 50.0

Seattle-Tacoma-Bellevue, WA 2,027 1,883 2,704 3,079 2,572 64.5 59.5 84.4 94.3 78.8

St. Louis, MO-IL 5,600 5,719 6,391 6,547 6,483 204.7 206.9 230.0 234.1 231.8

Tampa-St. Petersburg-Clearwater, FL 3,160 2,801 2,910 3,667 3,819 124.8 108.2 109.9 135.9 141.6

Virginia Beach-Norfolk-Newport News, VA-NC 4,201 3,812 3,355 2,544 2,504 256.6 231.8 203.7 154.2 151.8

Washington-Arlington-Alexandria, DC-VA-MD-WV 5,262 5,803 4,497 4,358 4,665 103.4 112.9 86.2 82.4 88.2

U.S. MSA TOTAL 199,726 194,853 202,369 209,106 208,773 127.8 123.4 126.9 129.6 129.4

Table 16. Gonorrhea — Reported cases and rates in selected metropolitan statistical areas* (MSAs) listed in

alphabetical order: United States, 2003–2007

*MSAs selected based on largest population in 2000 U.S. census.
STD Surveillance 2007 Gonorrhea Tables 117

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Atlanta-Sandy Springs-Marietta, GA 4,177 3,563 3,567 5,026 4,515 179.6 150.3 144.1 193.5 173.8

Austin-Round Rock, TX 644 692 830 1,134 992 95.4 100.1 116.6 153.3 134.1

Baltimore-Towson, MD 2,793 2,710 2,426 2,470 2,179 206.0 198.2 176.5 179.2 158.1

Birmingham-Hoover, AL 1,100 1,060 1,133 1,511 1,761 197.9 189.2 200.9 265.4 309.3

Boston-Cambridge-Quincy, MA-NH 771 937 793 728 773 33.7 41.2 35.0 31.8 33.7

Buffalo-Cheektowaga-Tonawanda, NY 974 920 1,079 1,153 1,258 161.7 153.4 181.2 195.5 213.3

Charlotte-Gastonia-Concord, NC-SC 1,492 1,413 1,604 1,584 1,188 204.4 188.6 207.8 196.9 147.7

Chicago-Naperville-Joliet, IL-IN-WI 8,804 8,546 7,948 7,853 7,813 185.1 178.7 165.3 162.7 161.8

Cincinnati-Middletown, OH-KY-IN 2,371 2,038 2,274 2,465 2,884 226.0 193.3 214.8 229.0 267.9

Cleveland-Elyria-Mentor, OH 2,620 2,192 2,264 2,277 2,180 235.3 197.2 204.8 207.4 198.6

Columbus, OH 1,569 1,475 1,896 1,758 2,142 184.5 171.8 219.0 201.2 245.2

Dallas-Fort Worth-Arlington, TX 3,822 3,547 4,135 4,129 4,905 136.9 124.7 142.6 138.1 164.1

Denver-Aurora, CO 1,091 1,144 996 1,044 1,128 95.2 98.7 84.9 87.0 94.0

Detroit-Warren-Livonia, MI 3,807 4,850 6,079 4,613 4,721 165.5 210.5 264.4 201.8 206.5

Hartford-West Hartford-East Hartford, CT 614 533 520 521 522 101.2 87.3 85.0 85.4 85.5

Houston-Baytown-Sugar Land, TX 2,509 2,813 3,016 3,806 3,805 98.8 108.6 114.2 137.5 137.4

Indianapolis, IN 1,659 1,698 2,163 2,297 2,385 204.1 205.7 259.1 271.1 281.4

Jacksonville, FL 1,201 1,083 1,240 1,506 1,532 195.1 173.0 194.5 230.8 234.8

Kansas City, MO-KS 1,890 2,027 2,035 2,099 2,040 194.6 206.8 205.5 209.6 203.7

Las Vegas-Paradise, NV 931 1,206 1,163 1,123 954 120.2 148.7 138.4 128.4 109.1

Los Angeles-Long Beach-Santa Ana, CA 4,371 4,997 5,687 5,657 5,001 67.6 76.6 87.2 86.7 76.7

Louisville, KY-IN 767 720 740 887 1,026 125.6 116.9 119.6 141.6 163.8

Memphis, TN-MS-AR 1,860 1,926 1,990 2,548 2,789 289.8 297.6 305.6 386.0 422.6

Miami-Fort Lauderdale-Miami Beach, FL 2,114 2,307 2,317 2,708 2,444 77.6 83.5 83.0 96.4 87.0

Milwaukee-Waukesha-West Allis, WI 2,295 1,906 2,298 2,923 2,972 295.0 244.9 295.8 378.4 384.8

Minneapolis-St. Paul-Bloomington, MN-WI 1,508 1,373 1,548 1,486 1,500 96.8 87.3 97.7 93.0 93.8

Nashville-Davidson-Murfreesboro, TN 873 742 661 794 800 125.4 104.9 91.8 107.6 108.5

New Orleans-Metairie-Kenner, LA 1,961 1,606 1,287 965 1,322 286.0 234.0 187.8 181.7 248.9

New York-Newark-Edison, NY-NJ-PA 10,650 8,821 7,784 7,015 6,979 110.2 91.0 80.2 72.1 71.7

Oklahoma City, OK 1,138 1,181 1,486 1,275 1,202 197.7 203.8 253.5 214.2 201.9

Orlando, FL 1,039 1,063 1,286 1,688 1,377 113.8 112.9 131.6 168.5 137.5

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 4,593 4,189 4,219 4,257 4,416 153.5 139.5 140.0 141.4 146.7

Phoenix-Mesa-Scottsdale, AZ 1,254 1,373 1,456 2,014 1,497 70.3 74.5 76.0 100.7 74.8

Pittsburgh, PA 1,192 1,063 1,216 1,174 1,530 94.9 85.0 97.9 95.3 124.2

Portland-Vancouver-Beaverton, OR-WA 331 491 551 436 446 32.3 47.4 52.4 40.7 41.6

Providence-New Bedford-Fall River, RI-MA 603 607 365 374 282 71.7 72.0 43.5 44.9 33.8

Richmond, VA 1,260 1,187 1,256 824 1,122 214.6 199.7 207.8 134.4 183.0

Riverside-San Bernardino-Ontario, CA 1,289 1,323 1,572 1,602 1,705 70.8 69.8 80.5 79.6 84.7

Rochester, NY 982 919 1,006 748 608 183.5 172.0 188.9 141.0 114.6

Sacramento-Arden-Arcade-Roseville, CA 942 1,049 1,307 1,164 1,190 93.9 102.3 125.9 110.7 113.2

Salt Lake City, UT 91 143 183 246 229 18.3 28.4 35.8 46.7 43.5

San Antonio, TX 1,152 1,109 1,155 1,412 1,279 124.0 117.2 119.8 142.3 128.9

San Diego-Carlsbad-San Marcos, CA 739 936 1,108 1,158 961 50.8 64.2 76.3 79.3 65.8

San Francisco-Oakland-Fremont, CA 1,578 1,580 2,052 2,122 2,174 75.2 75.4 97.9 100.9 103.4

San Jose-Sunnyvale-Santa Clara, CA 328 467 457 488 385 38.4 54.6 53.1 55.8 44.1

Seattle-Tacoma-Bellevue, WA 732 717 1,060 1,300 1,205 46.5 45.2 66.1 79.6 73.8

St. Louis, MO-IL 3,037 3,213 3,638 3,718 3,539 214.5 225.0 253.5 257.5 245.1

Tampa-St. Petersburg-Clearwater, FL 1,498 1,474 1,542 2,064 1,973 114.7 110.6 113.3 149.0 142.5

Virginia Beach-Norfolk-Newport News, VA-NC 2,111 1,990 1,717 1,305 1,355 254.6 239.1 205.6 154.9 160.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,520 2,973 2,269 2,048 2,268 96.6 113.1 85.1 75.6 83.7

U.S. MSA TOTAL 99,647 97,892 102,374 105,497 105,253 125.2 121.8 126.2 128.7 128.4

Table 17. Gonorrhea — Women – Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2003–2007

*MSAs selected based on largest population in 2000 U.S. census.
118 Gonorrhea Tables STD Surveillance 2007

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Atlanta-Sandy Springs-Marietta, GA 4,616 3,750 4,183 5,083 4,484 202.0 160.4 171.3 200.1 176.5

Austin-Round Rock, TX 811 768 870 1,310 1,081 115.4 106.5 117.4 169.2 139.7

Baltimore-Towson, MD 2,588 2,546 2,352 2,180 1,976 205.3 200.1 183.6 170.3 154.4

Birmingham-Hoover, AL 1,108 1,316 1,243 932 1,367 214.4 252.1 236.2 175.6 257.6

Boston-Cambridge-Quincy, MA-NH 1,045 1,060 890 812 996 48.6 49.4 41.5 37.5 46.0

Buffalo-Cheektowaga-Tonawanda, NY 835 750 847 913 1,031 149.9 135.2 153.4 166.7 188.3

Charlotte-Gastonia-Concord, NC-SC 1,638 1,583 1,726 1,804 1,199 231.5 218.1 230.4 231.7 154.0

Chicago-Naperville-Joliet, IL-IN-WI 8,265 7,122 6,900 7,267 7,161 180.6 154.5 148.8 155.4 153.1

Cincinnati-Middletown, OH-KY-IN 1,804 1,375 1,616 1,373 1,674 180.8 136.9 159.7 133.6 162.9

Cleveland-Elyria-Mentor, OH 2,683 2,236 2,329 2,366 2,091 261.5 218.0 228.2 232.8 205.7

Columbus, OH 1,380 1,509 1,531 1,537 1,985 167.4 180.6 181.6 180.4 233.0

Dallas-Fort Worth-Arlington, TX 3,742 3,560 4,276 4,230 5,123 133.7 124.7 146.5 140.3 170.0

Denver-Aurora, CO 1,045 1,088 1,151 1,209 1,110 90.5 92.9 97.0 100.0 91.8

Detroit-Warren-Livonia, MI 3,365 4,449 4,657 3,890 3,786 154.1 203.2 212.7 178.2 173.4

Hartford-West Hartford-East Hartford, CT 416 400 473 467 398 72.8 69.7 82.1 80.7 68.8

Houston-Baytown-Sugar Land, TX 2,672 2,707 2,194 3,504 3,930 105.3 104.5 83.1 126.4 141.8

Indianapolis, IN 1,680 1,808 1,972 2,106 2,150 214.7 227.1 244.8 257.3 262.6

Jacksonville, FL 1,373 1,114 1,338 1,448 1,581 233.8 185.9 219.1 231.5 252.7

Kansas City, MO-KS 1,804 1,805 1,734 1,723 1,643 193.3 191.0 181.1 178.4 170.1

Las Vegas-Paradise, NV 1,036 1,436 1,322 1,354 1,158 129.1 171.0 152.0 149.9 128.2

Los Angeles-Long Beach-Santa Ana, CA 5,364 6,084 6,985 6,505 6,023 84.4 95.0 109.1 101.2 93.7

Louisville, KY-IN 848 761 811 858 881 146.3 130.0 137.6 144.0 147.8

Memphis, TN-MS-AR 1,904 1,906 1,792 2,117 1,967 318.7 316.1 293.9 344.4 320.0

Miami-Fort Lauderdale-Miami Beach, FL 2,341 2,315 2,180 2,648 2,706 91.3 89.1 82.9 99.7 101.9

Milwaukee-Waukesha-West Allis, WI 1,682 1,405 1,731 2,080 1,975 228.5 190.6 235.2 282.0 267.8

Minneapolis-St. Paul-Bloomington, MN-WI 1,273 1,066 1,372 1,294 1,334 83.4 69.0 88.1 82.1 84.6

Nashville-Davidson-Murfreesboro, TN 1,015 860 813 940 892 150.4 125.0 115.8 131.0 124.3

New Orleans-Metairie-Kenner, LA 1,988 1,684 1,299 981 1,352 314.6 265.9 204.9 198.8 274.0

New York-Newark-Edison, NY-NJ-PA 9,769 8,063 7,744 7,929 8,406 108.9 89.4 85.6 87.2 92.5

Oklahoma City, OK 912 972 1,062 1,040 1,171 163.7 172.1 186.1 180.2 202.9

Orlando, FL 1,126 1,222 1,562 1,704 1,366 126.5 132.8 163.4 173.3 138.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 3,907 3,629 3,500 3,904 4,250 140.5 129.7 124.5 138.6 150.9

Phoenix-Mesa-Scottsdale, AZ 1,539 1,787 1,676 2,242 1,834 85.0 95.4 85.9 110.0 90.0

Pittsburgh, PA 841 736 941 883 1,069 72.8 63.9 82.2 77.5 93.8

Portland-Vancouver-Beaverton, OR-WA 527 682 842 692 607 51.9 66.3 80.6 64.9 57.0

Providence-New Bedford-Fall River, RI-MA 532 441 285 318 338 68.0 56.1 36.4 40.8 43.4

Richmond, VA 1,054 971 1,105 954 1,074 191.3 173.4 193.4 164.2 184.9

Riverside-San Bernardino-Ontario, CA 1,221 1,308 1,440 1,390 1,450 67.1 68.9 73.5 69.0 72.0

Rochester, NY 915 981 893 709 599 180.8 193.4 176.3 140.4 118.6

Sacramento-Arden-Arcade-Roseville, CA 897 1,002 1,123 1,046 1,098 92.4 101.1 111.8 103.0 108.1

Salt Lake City, UT 185 228 277 377 344 36.4 44.2 52.9 69.6 63.5

San Antonio, TX 1,181 1,073 1,145 1,289 1,322 132.5 118.2 123.7 135.7 139.2

San Diego-Carlsbad-San Marcos, CA 1,256 1,417 1,500 1,531 1,415 85.1 96.1 101.3 103.4 95.5

San Francisco-Oakland-Fremont, CA 2,797 3,367 3,644 3,882 3,493 135.9 163.7 177.2 186.9 168.2

San Jose-Sunnyvale-Santa Clara, CA 408 617 597 570 506 46.3 69.7 66.8 62.4 55.4

Seattle-Tacoma-Bellevue, WA 1,295 1,166 1,644 1,779 1,367 82.6 73.8 102.7 109.1 83.8

St. Louis, MO-IL 2,563 2,506 2,753 2,829 2,944 194.1 187.6 204.9 209.2 217.7

Tampa-St. Petersburg-Clearwater, FL 1,662 1,327 1,368 1,602 1,842 135.5 105.7 106.3 122.0 140.3

Virginia Beach-Norfolk-Newport News, VA-NC 2,077 1,816 1,636 1,237 1,148 257.0 223.7 201.4 153.3 142.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,724 2,822 2,220 2,291 2,385 109.7 112.4 87.1 88.8 92.4

U.S. MSA TOTAL 99,709 96,596 99,544 103,129 103,082 130.1 124.6 127.0 130.0 129.9

Table 18. Gonorrhea — Men – Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2003–2007

*MSAs selected based on largest population in 2000 U.S. census.
STD Surveillance 2007 Gonorrhea Tables 119

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percent

1 Cook County, IL 12,338 233.3 3

2 Los Angeles County, CA 10,063 101.2 6

3 Wayne County, MI 7,012 355.6 8

4 Harris County, TX 6,362 163.7 10

5 Dallas County, TX 6,180 263.4 11

6 Philadelphia County, PA 5,246 362.2 13

7 Milwaukee County, WI 4,882 533.5 14

8 Marion County, IN 4,286 495.2 15

9 Shelby County, TN 4,076 447.2 16

10 Cuyahoga County, OH 3,970 302.1 18

11 Franklin County, OH 3,909 356.8 19

12 Kings County, NY 3,802 151.5 20

13 Hamilton County, OH 3,781 459.6 21

14 Maricopa County, AZ 3,172 84.2 22

15 Fulton County, GA 3,083 321.1 23

16 Baltimore (City), MD 3,027 479.4 23

17 Jefferson County, AL 2,859 435.4 24

18 Duval County, FL 2,822 336.8 25

19 Tarrant County, TX 2,763 165.3 26

20 St Louis (City), MO 2,577 742.3 27

21 Jackson County, MO 2,558 385.2 27

22 DeKalb County, GA 2,504 346.0 28

23 Bexar County, TX 2,463 158.3 29

24 San Diego County, CA 2,385 81.1 29

25 Bronx County, NY 2,384 175.1 30

26 Washington, D.C. 2,373 408.1 31

27 Alameda County, CA 2,324 159.5 31

28 St. Louis County, MO 2,307 230.6 32

29 Broward County, FL 2,289 128.0 33

30 Allegheny County, PA 2,161 176.6 33

31 Sacramento County, CA 2,147 156.2 34

32 New York County, NY 2,137 132.6 34

33 Clark County, NV 2,112 118.8 35

34 Orange County, FL 2,090 200.3 36

35 Oklahoma County, OK 2,074 300.0 36

36 Hillsborough County, FL 2,064 178.3 37

37 Erie County, NY 2,026 219.9 37

38 San Francisco County, CA 2,007 269.7 38

39 Miami-Dade County, FL 1,988 82.8 38

40 San Bernardino County, CA 1,832 91.6 39

41 Queens County, NY 1,802 79.9 39

42 Essex County, NJ 1,786 227.2 40

43 Genesee County, MI 1,728 391.0 40

44 Guilford County, NC 1,703 376.8 41

45 Travis County, TX 1,682 182.6 41

46 Jefferson County, KY 1,652 235.5 42

47 Hennepin County, MN 1,651 147.1 42

48 Montgomery County, OH 1,645 303.4 43

49 Orleans County, LA 1,529 684.5 43

50 Pinellas County, FL 1,509 163.2 44

51 Caddo County, LA 1,496 591.0 44

52 Mobile County, AL 1,449 358.5 44

53 Montgomery County, AL 1,434 641.4 45

54 Hinds County, MS 1,429 573.9 45

55 Prince George’s County, MD 1,409 167.5 46

56 Richland County, SC 1,402 402.6 46

57 King County, WA 1,377 75.4 46

58 Riverside County, CA 1,334 65.8 47

59 Davidson County, TN 1,288 222.6 47

60 Cumberland County, NC 1,278 427.3 48

61 Charleston County, SC 1,252 377.2 48

62 East Baton Rouge County, LA 1,229 286.4 48

63 Wake County, NC 1,189 151.2 49

64 Richmond (City), VA 1,183 613.2 49

65 Mecklenburg County, NC 1,173 141.8 49

66 Denver County, CO 1,146 202.1 50

67 Monroe County, NY 1,133 155.0 50

68 Kent County, MI 1,120 186.8 50

69 Kern County, CA 1,111 142.4 50

Table 19. Gonorrhea — Counties and independent cities* ranked by number of reported cases:

United States, 2007

*Accounting for 50% of reported gonorrhea cases.

†Counties and independent cities were ranked in descending order by number of cases reported in 2007. 
120 Gonorrhea Tables STD Surveillance 2007

 Age

Group

Cases Rates

Year Total Male Female Total Male Female

2003

10–14 4,929 725 4,204 23.3 6.7 40.7

15–19 90,340 27,473 62,867 441.1 261.2 631.2

20–24 106,930 48,222 58,709 515.9 452.2 583.4

25–29 53,692 29,368 24,325 280.1 300.5 258.9

30–34 30,528 19,004 11,524 147.4 181.9 112.4

35–39 20,212 13,824 6,388 94.4 128.9 59.8

40–44 13,722 10,079 3,644 59.8 88.4 31.5

45–54 11,018 8,905 2,113 27.0 44.4 10.2

55–64 2,316 2,012 303 8.3 15.0 2.1

65+ 745 617 128 2.1 4.1 0.6

TO TAL 335,104 160,459 174,645 115.2 112.2 118.2

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

TO TAL 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

TO TAL 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

TO TAL 358,366 170,902 187,464 119.7 115.9 123.4

10–14 3,958 623 3,335 19.2 5.9 33.1

2007

15–19 98,579 31,269 67,310 462.3 286.0 647.9

20–24 111,788 49,101 62,687 529.5 450.1 614.5

25–29 61,364 32,296 29,068 296.3 305.1 287.1

30–34 30,294 18,114 12,180 153.7 181.5 125.2

35–39 19,094 12,724 6,370 90.1 119.5 60.5

40–44 13,184 9,704 3,480 58.6 86.6 30.8

45–54 13,346 10,690 2,656 30.8 50.2 12.1

55–64 3,179 2,692 487 10.1 17.7 3.0

65+ 710 620 89 1.9 4.0 0.4

TO TAL 355,991 168,011 187,980 118.9 113.9 123.8

Table 20. Gonorrhea — Reported cases and rates per 100,000 population by age group and sex: United

States, 2003–2007

 NOTE: This ta ble should be used only for age com par i sons. If age was not speci fied, cases were pro rated ac cord ing to the dis tri bu tion of cases

for which age was known. Dif fer ences be tween to tal cases from this ta ble and oth ers in the re port are due to dif fer ent re port ing formats. The 0 to 9

year age group is not shown because some of these cases may not be due to sex ual trans mis sion; how ever, they are in cluded in the to tals.
This page in ten tion ally left blank.
122 Gonorrhea Tables STD Surveillance 2007

Age 

Group 

 White, Non-His panic Black, Non-His panic His panic Asian/Pa cific Is lander 

Amer i can In dian/

 Alaska Na tive 

To tal Male Fe male To tal Male Fe male To tal Male Fe male To tal Male Fe male To tal Male Fe male

3

0

0

2

10–14 789 51 739 3,662 594 3,068 390 71 320 31 3 28 55 7 49

15–19 15,541 2,532 13,009 66,553 22,572 43,980 7,011 2,086 4,924 533 116 417 700 163 537

20–24 19,132 6,097 13,035 77,129 37,552 39,577 9,080 4,085 4,994 840 270 570 767 229 539

25–29 9,891 4,159 5,732 38,142 22,275 15,866 4,787 2,544 2,243 499 250 249 375 146 229

30–34 6,648 3,512 3,136 20,459 13,498 6,961 2,821 1,704 1,117 381 206 175 214 83 131

35–39 5,126 3,314 1,812 12,840 9,130 3,710 1,823 1,160 663 244 139 105 174 80 94

40–44 3,835 2,634 1,201 8,642 6,626 2,016 981 654 327 145 95 49 118 70 48

45–54 2,917 2,169 748 7,268 6,172 1,096 660 467 192 105 64 41 66 32 33

55–64 713 588 125 1,439 1,301 138 123 98 25 31 19 13 8 7 2

65+ 239 196 43 443 379 64 44 29 15 11 7 4 8 6 2

TO TAL 64,961 25,288 39,673 237,038 120,266 116,771 27,793 12,922 14,872 2,823 1,171 1,652 2,489 823 1,666

4

0

0

2

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

TO TAL 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

5

0

0

2

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

TO TAL 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

6

0

0

2

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

TO TAL 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

7

0

0

2

10–14 475 20 454 3,068 537 2,531 364 64 300 22 0 22 30 3 27

15–19 15,635 2,700 12,935 74,237 25,856 48,380 7,538 2,442 5,096 498 122 376 666 147 519

20–24 20,830 6,346 14,484 79,555 37,665 41,890 9,761 4,544 5,218 767 297 470 884 256 628

25–29 12,482 4,994 7,488 42,000 23,645 18,355 5,880 3,188 2,692 519 285 234 485 186 299

30–34 6,515 3,005 3,510 20,078 12,995 7,083 3,120 1,822 1,297 354 207 146 227 85 143

35–39 4,983 2,778 2,206 11,916 8,578 3,338 1,843 1,171 673 187 120 67 164 78 86

40–44 3,680 2,451 1,229 8,238 6,433 1,804 1,049 710 339 119 82 37 98 28 70

45–54 3,788 2,809 978 8,539 7,174 1,365 824 594 230 114 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+ 274 243 31 367 319 49 50 44 6 13 10 3 4 4 0

TO TAL 69,767 26,207 43,559 250,245 125,006 125,238 30,680 14,733 15,947 2,643 1,221 1,422 2,657 850 1,808

Ta ble 21A. Gonorrhea — Re ported cases by race/eth nic ity, age group and sex: United States, 2003–2007

NOTE: These ta bles should be used only for race/eth nic ity com par i sons. See Ta ble 20 for age-spe cific cases and rates and Ta bles 13-15 for total and

sex-spe cific cases and rates. If age or race/eth nic ity was not speci fied, cases were pro rated ac cord ing to the dis tri bu tion of cases for which these vari ables were 

spec i fied. In 2005, HI did not re port age and/or race/eth nic ity for most cases and their case data and pop u la tion de nom i na tors were excluded. Dif fer ences be -

tween to tal cases from this ta ble and oth ers in the re port are due to different re port ing formats. The 0 to 9 year age group is not shown be cause some of these

cases may not be due to sex ual trans mis sion; how ever, they are in cluded in the to tals.
STD Surveillance 2007 Gonorrhea Tables 123

Age 

Group

 White, Non-His panic Black, Non-His panic His panic Asian/Pa cific Is lander 

Amer i can In dian/

 Alaska Na tive 

To tal Male Fe male To tal Male Fe male To tal Male Fe male To tal Male Fe male To tal Male Fe male

10–14 6.0 0.8 11.6 108.3 34.6 184.4 10.7 3.8 17.9 3.7 0.6 6.9 23.9 5.7 42.7

2

0

0

3

15–19 118.9 37.7 204.7 2,165.6 1,447.2 2,905.9 215.9 123.8 315.1 62.2 26.3 100.1 307.6 140.7 481.1

20–24 149.1 93.5 206.3 2,614.5 2,558.2 2,670.3 242.4 197.0 298.6 84.8 54.0 116.2 372.7 218.5 532.1

25–29 85.8 71.4 100.4 1,504.2 1,831.3 1,202.6 126.0 121.6 131.5 44.2 45.1 43.4 220.8 170.4 272.0

30–34 51.0 53.5 48.4 771.9 1,074.6 499.2 78.8 88.6 67.4 30.3 33.4 27.3 125.6 98.0 153.2

35–39 36.0 46.4 25.5 472.6 713.9 258.0 57.4 69.0 44.4 22.0 25.8 18.4 99.4 92.8 105.8

40–44 23.7 32.6 14.8 308.0 504.5 135.1 35.8 46.0 24.7 14.0 19.2 9.2 62.8 76.8 49.7

45–54 9.6 14.4 4.9 156.6 287.9 43.9 17.3 24.5 10.1 6.0 7.8 4.4 20.7 21.4 20.0

55–64 3.3 5.5 1.1 53.6 108.9 9.3 5.9 9.8 2.3 3.0 3.9 2.3 4.4 7.3 1.8

65+ 0.8 1.6 0.2 15.0 33.5 3.5 2.2 3.4 1.3 1.1 1.6 0.6 4.6 8.1 2.0

TO TAL 32.6 25.9 39.1 649.3 691.8 610.6 69.7 62.7 77.1 22.1 18.9 25.2 102.5 68.8 135.2

10–14 5.3 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

2

0

0

4

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

TO TAL 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

2

0

0

5

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

TO TAL 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

2

0

0

6

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

TO TAL 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 3.8 0.3 7.6 95.1 32.7 159.4 9.2 3.2 15.6 2.4 0.0 4.9 14.2 2.6 26.1

2

0

0

7

15–19 118.0 39.7 200.6 2,237.2 1,537.8 2,955.7 208.1 130.7 290.3 55.3 26.4 86.1 288.0 125.1 455.7

20–24 158.8 94.4 226.6 2,618.3 2,451.3 2,789.2 260.2 223.0 304.3 77.9 59.3 97.2 400.4 228.2 578.7

25–29 100.9 80.2 121.8 1,494.7 1,732.0 1,270.4 141.3 137.3 146.2 44.2 49.4 39.3 259.5 197.3 322.9

30–34 55.5 50.9 60.2 792.9 1,081.0 532.5 79.4 85.4 72.3 26.2 31.5 21.2 139.3 104.0 174.7

35–39 36.7 40.8 32.7 449.9 687.6 238.3 52.2 62.1 40.8 14.6 19.2 10.2 98.3 94.4 102.2

40–44 24.2 32.2 16.1 294.8 492.0 121.4 33.5 43.3 22.8 10.4 14.7 6.3 53.9 31.3 75.6

45–54 12.0 18.0 6.2 170.5 310.3 50.6 18.2 26.0 10.3 5.9 7.0 4.8 24.1 30.0 18.7

55–64 4.1 7.0 1.4 61.1 120.7 13.2 7.7 10.9 4.8 3.8 5.5 2.3 6.8 12.5 1.6

65+ 0.9 1.9 0.2 11.8 26.6 2.5 2.1 4.3 0.5 1.1 1.9 0.4 2.3 5.3 0.0

TO TAL 34.7 26.6 42.6 662.9 694.6 634.0 69.2 64.3 74.5 18.8 17.9 19.7 107.1 69.5 143.4

Ta ble 21B. Gon or rhea — Rates per 100,000 pop u la tion by race/eth nic ity, age group and sex: United States,

2003–2007

NOTE: These ta bles should be used only for race/eth nic ity com par i sons. See Ta ble 20 for age-spe cific cases and rates and Ta bles 13-15 for total and

sex-spe cific cases and rates. If age or race/eth nic ity was not speci fied, cases were pro rated ac cord ing to the dis tri bu tion of cases for which these vari ables

were spec i fied. In 2005, HI did not re port age and/or race/eth nic ity for most cases and their case data and pop u la tion de nom i na tors were excluded. Dif fer ences

be tween to tal rates from this ta ble and oth ers in the re port are due to different re port ing for mats. The 0 to 9 year age group is not shown be cause some of these

cases may not be due to sex ual trans mis sion; how ever, they are in cluded in the to tals.
124 Syphilis Tables STD Surveillance 2007

Cases Rates per 100,000 Population

State/Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Alabama 567 639 551 931 1,006 12.6 14.1 12.1 20.2 21.9

Alaska 8 15 22 25 16 1.2 2.3 3.3 3.7 2.4

Arizona 1,106 974 792 926 1,245 19.8 17.0 13.3 15.0 20.2

Arkansas 296 249 231 246 371 10.9 9.0 8.3 8.8 13.2

California 4,207 4,590 5,340 6,046 6,323 11.9 12.8 14.8 16.6 17.3

Colorado 144 179 144 182 157 3.2 3.9 3.1 3.8 3.3

Connecticut 207 169 166 197 148 5.9 4.8 4.7 5.6 4.2

Delaware 47 61 35 74 63 5.7 7.3 4.1 8.7 7.4

District of Columbia 330 357 365 314 416 58.5 64.5 66.3 54.0 71.5

Florida 3,283 2,964 2,888 2,945 3,918 19.3 17.0 16.2 16.3 21.7

Georgia 2,152 1,589 1,924 1,933 2,254 24.8 18.0 21.2 20.6 24.1

Hawaii 61 36 57 66 58 4.9 2.9 4.5 5.1 4.5

Idaho 45 78 54 12 14 3.3 5.6 3.8 0.8 1.0

Illinois 1,377 1,348 1,608 1,473 1,220 10.9 10.6 12.6 11.5 9.5

Indiana 367 273 288 250 217 5.9 4.4 4.6 4.0 3.4

Iowa 46 36 28 68 65 1.6 1.2 0.9 2.3 2.2

Kansas 77 87 88 87 97 2.8 3.2 3.2 3.1 3.5

Kentucky 160 151 129 188 153 3.9 3.6 3.1 4.5 3.6

Louisiana 1,581 1,646 1,239 1,390 1,807 35.2 36.5 27.4 32.4 42.1

Maine 21 7 6 22 21 1.6 0.5 0.5 1.7 1.6

Maryland 975 1,002 1,005 1,038 1,170 17.7 18.0 17.9 18.5 20.8

Massachusetts 644 517 398 378 399 10.0 8.1 6.2 5.9 6.2

Michigan 860 806 488 384 472 8.5 8.0 4.8 3.8 4.7

Minnesota 195 145 208 189 186 3.9 2.8 4.1 3.7 3.6

Mississippi 435 404 371 520 707 15.1 13.9 12.7 17.9 24.3

Missouri 207 269 372 430 484 3.6 4.7 6.4 7.4 8.3

Montana 0 4 7 2 8 0.0 0.4 0.7 0.2 0.8

Nebraska 27 15 18 34 30 1.6 0.9 1.0 1.9 1.7

Nevada 149 254 343 389 396 6.6 10.9 14.2 15.6 15.9

New Hampshire 37 26 33 35 52 2.9 2.0 2.5 2.7 4.0

New Jersey 1,089 826 813 799 926 12.6 9.5 9.3 9.2 10.6

New Mexico 205 251 183 237 180 10.9 13.2 9.5 12.1 9.2

New York 4,360 4,472 3,853 4,586 4,999 22.7 23.3 20.0 23.8 25.9

North Carolina 850 747 713 962 1,093 10.1 8.7 8.2 10.9 12.3

North Dakota 2 0 1 3 2 0.3 0.0 0.2 0.5 0.3

Ohio 481 571 502 491 549 4.2 5.0 4.4 4.3 4.8

Oklahoma 353 168 159 251 216 10.1 4.8 4.5 7.0 6.0

Oregon 118 108 109 99 59 3.3 3.0 3.0 2.7 1.6

Pennsylvania 706 574 712 889 844 5.7 4.6 5.7 7.1 6.8

Rhode Island 90 104 64 71 76 8.4 9.6 5.9 6.7 7.1

South Carolina 552 524 549 397 411 13.3 12.5 12.9 9.2 9.5

South Dakota 5 0 4 29 12 0.7 0.0 0.5 3.7 1.5

Tennessee 881 804 917 1,015 1,212 15.1 13.6 15.4 16.8 20.1

Texas 3,996 4,205 4,289 4,956 5,506 18.1 18.7 18.8 21.1 23.4

Utah 72 78 50 68 45 3.1 3.3 2.0 2.7 1.8

Vermont 1 3 1 7 11 0.2 0.5 0.2 1.1 1.8

Virginia 552 610 655 701 736 7.5 8.2 8.7 9.2 9.6

Washington 239 336 359 423 367 3.9 5.4 5.7 6.6 5.7

West Virginia 11 18 18 30 27 0.6 1.0 1.0 1.6 1.5

Wisconsin 111 128 138 170 170 2.0 2.3 2.5 3.1 3.1

Wyoming 4 6 1 1 6 0.8 1.2 0.2 0.2 1.2

U.S. TOTAL 34,289 33,423 33,288 36,959 40,920 11.8 11.4 11.2 12.3 13.7

Northeast 7,155 6,698 6,046 6,984 7,476 13.2 12.3 11.1 12.8 13.7

Midwest 3,755 3,678 3,743 3,608 3,504 5.7 5.6 5.7 5.4 5.3

South 17,021 16,138 16,038 17,891 21,066 16.3 15.2 14.9 16.4 19.3

West 6,358 6,909 7,461 8,476 8,874 9.6 10.2 10.9 12.2 12.8

Guam 16 13 19 13 37 9.8 7.8 11.3 7.6 21.6

Puerto Rico 1,357 1,154 1,223 1,068 1,267 35.0 29.6 31.3 27.2 32.3

Virgin Islands 14 17 13 5 5 12.9 15.6 12.0 4.6 4.6

OUTLYING AREAS 1,387 1,184 1,255 1,086 1,309 33.4 28.4 30.0 25.8 31.1

TOTAL 35,676 34,607 34,543 38,045 42,229 12.1 11.6 11.5 12.5 13.9

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

order: United States and outlying areas, 2003–2007

*See Appendix (Syphilis Morbidity Reporting) for definition.
STD Surveillance 2007 Syphilis Tables 125

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Atlanta-Sandy Springs-Marietta, GA 1,702 1,315 1,626 1,641 1,904 36.9 27.9 33.1 31.9 37.1

Austin-Round Rock, TX 152 200 193 212 234 11.0 14.2 13.3 14.0 15.5

Baltimore-Towson, MD 648 647 679 642 650 24.8 24.5 25.6 24.1 24.5

Birmingham-Hoover, AL 122 117 243 561 483 11.4 10.8 22.3 51.0 43.9

Boston-Cambridge-Quincy, MA-NH 568 410 339 329 324 12.8 9.3 7.7 7.4 7.3

Buffalo-Cheektowaga-Tonawanda, NY 11 24 14 42 26 0.9 2.1 1.2 3.7 2.3

Charlotte-Gastonia-Concord, NC-SC 167 154 235 303 301 11.6 10.4 15.4 19.1 19.0

Chicago-Naperville-Joliet, IL-IN-WI 1,341 1,296 1,541 1,386 1,117 14.4 13.8 16.3 14.6 11.8

Cincinnati-Middletown, OH-KY-IN 18 54 55 58 77 0.9 2.6 2.7 2.8 3.7

Cleveland-Elyria-Mentor, OH 62 84 52 53 83 2.9 3.9 2.4 2.5 3.9

Columbus, OH 266 254 227 229 222 15.9 15.0 13.3 13.3 12.9

Dallas-Fort Worth-Arlington, TX 1,505 1,374 1,495 1,678 1,643 26.9 24.1 25.7 27.9 27.4

Denver-Aurora, CO 116 135 111 141 120 5.0 5.8 4.7 5.9 5.0

Detroit-Warren-Livonia, MI 751 679 390 284 338 16.7 15.1 8.7 6.4 7.6

Hartford-West Hartford-East Hartford, CT 70 46 57 65 51 5.9 3.9 4.8 5.5 4.3

Houston-Baytown-Sugar Land, TX 1,256 1,289 1,188 1,570 2,048 24.7 24.9 22.5 28.3 37.0

Indianapolis, IN 142 128 134 121 95 8.9 7.9 8.2 7.3 5.7

Jacksonville, FL 135 218 151 165 198 11.2 17.8 12.1 12.9 15.5

Kansas City, MO-KS 118 101 193 228 268 6.2 5.2 9.9 11.6 13.6

Las Vegas-Paradise, NV 123 225 300 355 364 7.8 13.6 17.5 20.0 20.5

Los Angeles-Long Beach-Santa Ana, CA 2,166 2,483 3,159 3,594 3,581 16.9 19.2 24.4 27.8 27.7

Louisville, KY-IN 126 115 102 101 77 10.6 9.6 8.4 8.3 6.3

Memphis, TN-MS-AR 547 519 585 612 761 44.1 41.5 46.4 48.0 59.7

Miami-Fort Lauderdale-Miami Beach, FL 1,911 1,687 1,444 1,455 1,863 36.1 31.5 26.6 26.6 34.1

Milwaukee-Waukesha-West Allis, WI 74 85 77 100 127 4.9 5.6 5.1 6.6 8.4

Minneapolis-St. Paul-Bloomington, MN-WI 173 125 187 161 170 5.6 4.0 6.0 5.1 5.4

Nashville-Davidson-Murfreesboro, TN 220 194 189 194 240 16.0 13.9 13.3 13.3 16.5

New Orleans-Metairie-Kenner, LA 264 449 350 352 560 20.0 34.0 26.5 34.4 54.7

New York-Newark-Edison, NY-NJ-PA 5,101 4,918 4,318 4,924 5,503 27.4 26.3 23.0 26.2 29.2

Oklahoma City, OK 253 110 87 116 114 22.3 9.6 7.5 9.9 9.7

Orlando, FL 318 267 413 403 583 17.6 14.3 21.4 20.3 29.4

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 785 678 583 774 778 13.6 11.7 10.0 13.3 13.4

Phoenix-Mesa-Scottsdale, AZ 914 754 595 757 866 25.4 20.3 15.4 18.7 21.4

Pittsburgh, PA 57 32 112 152 122 2.4 1.3 4.7 6.4 5.1

Portland-Vancouver-Beaverton, OR-WA 103 84 94 74 51 5.0 4.1 4.5 3.5 2.4

Providence-New Bedford-Fall River, RI-MA 127 137 75 92 100 7.8 8.4 4.6 5.7 6.2

Richmond, VA 114 85 87 106 129 10.0 7.4 7.4 8.9 10.8

Riverside-San Bernardino-Ontario, CA 313 319 399 376 340 8.6 8.4 10.2 9.3 8.4

Rochester, NY 33 41 36 90 76 3.2 3.9 3.5 8.7 7.3

Sacramento-Arden-Arcade-Roseville, CA 35 64 39 136 117 1.8 3.2 1.9 6.6 5.7

Salt Lake City, UT 43 53 35 41 35 4.3 5.2 3.4 3.8 3.3

San Antonio, TX 231 361 458 473 420 12.7 19.5 24.2 24.4 21.6

San Diego-Carlsbad-San Marcos, CA 299 356 448 572 788 10.2 12.1 15.3 19.4 26.8

San Francisco-Oakland-Fremont, CA 901 917 719 741 783 21.7 22.1 17.3 17.7 18.7

San Jose-Sunnyvale-Santa Clara, CA 137 113 121 94 159 7.9 6.5 6.9 5.3 8.9

Seattle-Tacoma-Bellevue, WA 174 273 285 356 309 5.5 8.6 8.9 10.9 9.5

St. Louis, MO-IL 150 189 173 186 252 5.5 6.8 6.2 6.7 9.0

Tampa-St. Petersburg-Clearwater, FL 407 303 326 428 612 16.1 11.7 12.3 15.9 22.7

Virginia Beach-Norfolk-Newport News, VA-NC 148 198 246 245 232 9.0 12.0 14.9 14.9 14.1

Washington-Arlington-Alexandria, DC-VA-MD-WV 836 896 894 928 1,162 16.4 17.4 17.1 17.5 22.0

U.S. MSA TOTAL 26,233 25,555 25,859 28,696 31,456 16.8 16.2 16.2 17.8 19.5

Table 23. All stages of syphilis* — Reported cases and rates in selected metropolitan statistical areas†

(MSAs) listed in alphabetical order: United States, 2003–2007

*See Appendix (Syphilis Morbidity Reporting) for definition.

†MSAs selected based on largest population in 2000 U.S. census.
126 Syphilis Tables STD Surveillance 2007

Rank* State Cases Rate per 100,000 Population

1 Louisiana 533 12.4

2 Alabama 380 8.3

3 Georgia 680 7.3

4 Maryland 345 6.1

5 Tennessee 367 6.1

6 California 2,038 5.6

7 New York 1,068 5.5

8 Florida 913 5.0

9 Texas 1,160 4.9

10 Arizona 296 4.8

11 Mississippi 133 4.6

12 Nevada 111 4.4

13 Arkansas 122 4.3

14 Missouri 239 4.1

U.S. TOTAL†11,466 3.8

15 North Carolina 323 3.6

16 Illinois 464 3.6

17 Rhode Island 36 3.4

18 Virginia 230 3.0

19 New Jersey 227 2.6

20 Massachusetts 155 2.4

21 Washington 154 2.4

22 New Mexico 46 2.4

23 New Hampshire 30 2.3

24 Pennsylvania 263 2.1

25 Delaware 18 2.1

26 South Carolina 91 2.1

27 Oklahoma 65 1.8

28 Ohio 194 1.7

29 Vermont 10 1.6

30 Kentucky 56 1.3

31 Michigan 123 1.2

32 Colorado 57 1.2

33 Wisconsin 66 1.2

34 Minnesota 59 1.1

35 Connecticut 39 1.1

36 Alaska 7 1.0

37 Kansas 28 1.0

38 South Dakota 7 0.9

39 Indiana 54 0.9

40 Montana 8 0.8

41 Utah 20 0.8

42 Wyoming 4 0.8

43 Iowa 21 0.7

44 Hawaii 9 0.7

45 Maine 9 0.7

46 Oregon 18 0.5

47 West Virginia 6 0.3

48 Nebraska 4 0.2

YEAR 2010 TARGET 0.2

49 North Dakota 1 0.2

50 Idaho 1 0.1

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

United States, 2007

*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 178 cases and a rate of 30.6, but excludes outlying areas (Guam with 8 cases and rate

of 4.7, Puerto Rico with 169 cases and rate of 4.3, and Virgin Islands with 0 case and rate of 0.0).
STD Surveillance 2007 Syphilis Tables 127

Cases Rates per 100,000 Population

State/Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Alabama 114 165 169 319 380 2.5 3.6 3.7 6.9 8.3

Alaska 1 8 9 11 7 0.2 1.2 1.4 1.6 1.0

Arizona 186 157 175 203 296 3.3 2.7 2.9 3.3 4.8

Arkansas 51 47 52 77 122 1.9 1.7 1.9 2.7 4.3

California 1,299 1,356 1,585 1,835 2,038 3.7 3.8 4.4 5.0 5.6

Colorado 39 63 46 69 57 0.9 1.4 1.0 1.5 1.2

Connecticut 30 45 58 64 39 0.9 1.3 1.7 1.8 1.1

Delaware 7 9 11 20 18 0.9 1.1 1.3 2.3 2.1

District of Columbia 48 69 114 116 178 8.5 12.5 20.7 19.9 30.6

Florida 658 728 724 719 913 3.9 4.2 4.1 4.0 5.0

Georgia 585 549 645 581 680 6.7 6.2 7.1 6.2 7.3

Hawaii 14 8 11 18 9 1.1 0.6 0.9 1.4 0.7

Idaho 15 24 20 3 1 1.1 1.7 1.4 0.2 0.1

Illinois 374 386 525 431 464 3.0 3.0 4.1 3.4 3.6

Indiana 50 60 62 93 54 0.8 1.0 1.0 1.5 0.9

Iowa 12 5 9 19 21 0.4 0.2 0.3 0.6 0.7

Kansas 25 24 19 27 28 0.9 0.9 0.7 1.0 1.0

Kentucky 33 47 52 73 56 0.8 1.1 1.2 1.7 1.3

Louisiana 183 332 278 342 533 4.1 7.4 6.1 8.0 12.4

Maine 8 2 1 9 9 0.6 0.2 0.1 0.7 0.7

Maryland 312 380 313 300 345 5.7 6.8 5.6 5.3 6.1

Massachusetts 133 114 125 124 155 2.1 1.8 2.0 1.9 2.4

Michigan 249 192 105 118 123 2.5 1.9 1.0 1.2 1.2

Minnesota 47 27 70 47 59 0.9 0.5 1.4 0.9 1.1

Mississippi 40 59 49 86 133 1.4 2.0 1.7 3.0 4.6

Missouri 61 94 147 168 239 1.1 1.6 2.5 2.9 4.1

Montana 0 4 7 1 8 0.0 0.4 0.7 0.1 0.8

Nebraska 10 7 4 7 4 0.6 0.4 0.2 0.4 0.2

Nevada 12 40 109 137 111 0.5 1.7 4.5 5.5 4.4

New Hampshire 19 5 16 13 30 1.5 0.4 1.2 1.0 2.3

New Jersey 170 150 133 173 227 2.0 1.7 1.5 2.0 2.6

New Mexico 71 82 56 79 46 3.8 4.3 2.9 4.0 2.4

New York 584 727 705 736 1,068 3.0 3.8 3.7 3.8 5.5

North Carolina 152 192 274 309 323 1.8 2.2 3.2 3.5 3.6

North Dakota 2 0 1 1 1 0.3 0.0 0.2 0.2 0.2

Ohio 197 237 211 184 194 1.7 2.1 1.8 1.6 1.7

Oklahoma 64 25 44 70 65 1.8 0.7 1.2 2.0 1.8

Oregon 48 29 41 29 18 1.3 0.8 1.1 0.8 0.5

Pennsylvania 159 118 199 264 263 1.3 1.0 1.6 2.1 2.1

Rhode Island 33 26 24 14 36 3.1 2.4 2.2 1.3 3.4

South Carolina 94 116 84 66 91 2.3 2.8 2.0 1.5 2.1

South Dakota 2 0 2 13 7 0.3 0.0 0.3 1.7 0.9

Tennessee 135 130 217 249 367 2.3 2.2 3.6 4.1 6.1

Texas 654 827 873 1,064 1,160 3.0 3.7 3.8 4.5 4.9

Utah 14 13 10 21 20 0.6 0.5 0.4 0.8 0.8

Vermont 1 1 1 3 10 0.2 0.2 0.2 0.5 1.6

Virginia 82 116 143 190 230 1.1 1.6 1.9 2.5 3.0

Washington 82 150 152 182 154 1.3 2.4 2.4 2.8 2.4

West Virginia 2 3 3 11 6 0.1 0.2 0.2 0.6 0.3

Wisconsin 16 29 41 68 66 0.3 0.5 0.7 1.2 1.2

Wyoming 0 3 0 0 4 0.0 0.6 0.0 0.0 0.8

U.S. TOTAL 7,177 7,980 8,724 9,756 11,466 2.5 2.7 2.9 3.3 3.8

Northeast 1,137 1,188 1,262 1,400 1,837 2.1 2.2 2.3 2.6 3.4

Midwest 1,045 1,061 1,196 1,176 1,260 1.6 1.6 1.8 1.8 1.9

South 3,214 3,794 4,045 4,592 5,600 3.1 3.6 3.8 4.2 5.1

West 1,781 1,937 2,221 2,588 2,769 2.7 2.9 3.3 3.7 4.0

Guam 1 0 2 3 8 0.6 0.0 1.2 1.8 4.7

Puerto Rico 202 182 224 150 169 5.2 4.7 5.7 3.8 4.3

Virgin Islands 3 5 1 1 0 2.8 4.6 0.9 0.9 0.0

OUTLYING AREAS 206 187 227 154 177 5.0 4.5 5.4 3.7 4.2

TOTAL 7,383 8,167 8,951 9,910 11,643 2.5 2.7 3.0 3.3 3.8

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

alphabetical order: United States and outlying areas, 2003–2007
128 Syphilis Tables STD Surveillance 2007

Cases Rates per 100,000 Population

State/Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Alabama 49 52 69 116 143 2.1 2.2 2.9 4.9 6.0

Alaska 0 0 1 2 1 0.0 0.0 0.3 0.6 0.3

Arizona 66 42 49 33 64 2.4 1.5 1.7 1.1 2.1

Arkansas 16 18 21 35 50 1.1 1.3 1.5 2.4 3.5

California 52 63 121 128 115 0.3 0.4 0.7 0.7 0.6

Colorado 5 7 2 5 2 0.2 0.3 0.1 0.2 0.1

Connecticut 3 3 2 2 2 0.2 0.2 0.1 0.1 0.1

Delaware 2 1 2 4 1 0.5 0.2 0.5 0.9 0.2

District of Columbia 3 4 11 6 5 1.0 1.4 3.8 1.9 1.6

Florida 73 98 100 98 153 0.8 1.1 1.1 1.1 1.7

Georgia 68 45 47 41 53 1.5 1.0 1.0 0.9 1.1

Hawaii 0 0 0 1 1 0.0 0.0 0.0 0.2 0.2

Idaho 5 11 6 2 1 0.7 1.6 0.8 0.3 0.1

Illinois 48 55 47 37 39 0.7 0.9 0.7 0.6 0.6

Indiana 16 6 10 10 8 0.5 0.2 0.3 0.3 0.2

Iowa 2 1 1 6 3 0.1 0.1 0.1 0.4 0.2

Kansas 13 7 2 2 6 0.9 0.5 0.1 0.1 0.4

Kentucky 13 6 3 7 9 0.6 0.3 0.1 0.3 0.4

Louisiana 79 123 112 123 209 3.4 5.3 4.8 5.6 9.5

Maine 0 0 0 2 0 0.0 0.0 0.0 0.3 0.0

Maryland 74 92 88 61 47 2.6 3.2 3.0 2.1 1.6

Massachusetts 3 5 4 7 10 0.1 0.2 0.1 0.2 0.3

Michigan 93 61 20 26 27 1.8 1.2 0.4 0.5 0.5

Minnesota 4 3 2 4 1 0.2 0.1 0.1 0.2 0.0

Mississippi 20 19 12 36 35 1.3 1.3 0.8 2.4 2.3

Missouri 14 12 12 19 27 0.5 0.4 0.4 0.6 0.9

Montana 0 1 1 0 2 0.0 0.2 0.2 0.0 0.4

Nebraska 1 4 0 1 0 0.1 0.5 0.0 0.1 0.0

Nevada 3 8 24 34 12 0.3 0.7 2.0 2.8 1.0

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 49 38 17 12 16 1.1 0.9 0.4 0.3 0.4

New Mexico 23 36 16 22 15 2.4 3.7 1.6 2.2 1.5

New York 26 32 28 29 32 0.3 0.3 0.3 0.3 0.3

North Carolina 47 48 58 67 60 1.1 1.1 1.3 1.5 1.3

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 40 61 40 43 28 0.7 1.0 0.7 0.7 0.5

Oklahoma 20 9 17 19 24 1.1 0.5 0.9 1.0 1.3

Oregon 3 1 2 0 2 0.2 0.1 0.1 0.0 0.1

Pennsylvania 33 16 34 34 34 0.5 0.3 0.5 0.5 0.5

Rhode Island 8 10 6 0 2 1.4 1.8 1.1 0.0 0.4

South Carolina 24 25 17 11 10 1.1 1.2 0.8 0.5 0.5

South Dakota 0 0 0 5 2 0.0 0.0 0.0 1.3 0.5

Tennessee 40 34 64 73 113 1.3 1.1 2.1 2.4 3.7

Texas 162 179 243 261 297 1.5 1.6 2.1 2.2 2.5

Utah 3 3 1 3 0 0.3 0.3 0.1 0.2 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 7 6 19 23 16 0.2 0.2 0.5 0.6 0.4

Washington 4 6 5 4 6 0.1 0.2 0.2 0.1 0.2

West Virginia 2 1 0 1 2 0.2 0.1 0.0 0.1 0.2

Wisconsin 1 2 3 3 6 0.0 0.1 0.1 0.1 0.2

Wyoming 0 1 0 0 1 0.0 0.4 0.0 0.0 0.4

U.S. TOTAL 1,217 1,255 1,339 1,458 1,692 0.8 0.8 0.9 1.0 1.1

Northeast 122 104 91 86 96 0.4 0.4 0.3 0.3 0.3

Midwest 232 212 137 156 147 0.7 0.6 0.4 0.5 0.4

South 699 760 883 982 1,227 1.3 1.4 1.6 1.8 2.2

West 164 179 228 234 222 0.5 0.5 0.7 0.7 0.6

Guam 0 0 1 1 4 0.0 0.0 1.2 1.2 4.8

Puerto Rico 93 62 81 46 56 4.6 3.1 4.0 2.3 2.7

Virgin Islands 2 3 0 0 0 3.5 5.3 0.0 0.0 0.0

OUTLYING AREAS 95 65 82 47 60 4.4 3.0 3.8 2.2 2.7

TOTAL 1,312 1,320 1,421 1,505 1,752 0.9 0.9 0.9 1.0 1.1

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, 2003–2007

 NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2007 Syphilis Tables 129

Cases Rates per 100,000 Population

State/Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Alabama 65 113 100 203 237 3.0 5.1 4.5 9.1 10.6

Alaska 1 8 8 9 6 0.3 2.4 2.3 2.6 1.7

Arizona 120 115 125 166 230 4.3 4.0 4.2 5.4 7.5

Arkansas 35 29 31 42 72 2.6 2.2 2.3 3.0 5.2

California 1,245 1,291 1,463 1,706 1,921 7.0 7.2 8.1 9.4 10.5

Colorado 34 56 44 64 55 1.5 2.4 1.9 2.7 2.3

Connecticut 27 42 56 62 37 1.6 2.5 3.3 3.6 2.2

Delaware 5 8 9 16 17 1.3 2.0 2.2 3.9 4.1

District of Columbia 45 65 103 110 173 16.9 24.8 39.4 40.3 63.4

Florida 585 630 624 621 760 7.0 7.4 7.2 7.0 8.6

Georgia 517 504 598 540 626 12.1 11.5 13.3 11.7 13.6

Hawaii 14 8 11 17 8 2.2 1.3 1.7 2.6 1.2

Idaho 10 13 14 1 0 1.5 1.9 2.0 0.1 0.0

Illinois 326 331 478 394 425 5.2 5.3 7.6 6.2 6.7

Indiana 34 54 52 83 46 1.1 1.8 1.7 2.7 1.5

Iowa 10 3 8 13 18 0.7 0.2 0.5 0.9 1.2

Kansas 12 17 17 25 22 0.9 1.3 1.2 1.8 1.6

Kentucky 19 41 49 66 47 0.9 2.0 2.4 3.2 2.3

Louisiana 104 209 166 219 324 4.8 9.5 7.5 10.5 15.5

Maine 8 2 1 7 9 1.3 0.3 0.2 1.1 1.4

Maryland 238 288 225 239 298 8.9 10.7 8.3 8.8 11.0

Massachusetts 129 109 121 117 145 4.1 3.5 3.9 3.8 4.7

Michigan 156 131 85 92 96 3.2 2.6 1.7 1.9 1.9

Minnesota 43 24 68 43 58 1.7 0.9 2.7 1.7 2.3

Mississippi 20 40 37 50 98 1.4 2.8 2.6 3.5 7.0

Missouri 47 82 135 149 212 1.7 2.9 4.8 5.2 7.4

Montana 0 3 6 1 6 0.0 0.6 1.3 0.2 1.3

Nebraska 9 3 4 6 4 1.0 0.3 0.5 0.7 0.5

Nevada 9 32 85 103 99 0.8 2.7 6.9 8.1 7.8

New Hampshire 19 5 16 13 30 3.0 0.8 2.5 2.0 4.6

New Jersey 121 112 116 161 211 2.9 2.6 2.7 3.8 5.0

New Mexico 48 46 40 57 31 5.2 4.9 4.2 5.9 3.2

New York 558 695 677 707 1,036 6.0 7.5 7.3 7.6 11.1

North Carolina 105 144 216 242 263 2.5 3.4 5.1 5.6 6.1

North Dakota 2 0 1 1 1 0.6 0.0 0.3 0.3 0.3

Ohio 157 176 171 141 166 2.8 3.2 3.1 2.5 3.0

Oklahoma 44 16 27 51 41 2.5 0.9 1.5 2.9 2.3

Oregon 45 28 39 29 16 2.5 1.6 2.2 1.6 0.9

Pennsylvania 126 102 165 230 229 2.1 1.7 2.7 3.8 3.8

Rhode Island 25 16 18 14 34 4.8 3.1 3.5 2.7 6.6

South Carolina 70 91 67 55 81 3.5 4.4 3.2 2.6 3.9

South Dakota 2 0 2 8 5 0.5 0.0 0.5 2.0 1.3

Tennessee 95 96 153 176 254 3.3 3.3 5.2 6.0 8.6

Texas 492 648 630 803 863 4.5 5.8 5.5 6.9 7.4

Utah 11 10 9 18 20 0.9 0.8 0.7 1.4 1.6

Vermont 1 1 1 3 10 0.3 0.3 0.3 1.0 3.3

Virginia 75 110 124 167 214 2.1 3.0 3.3 4.4 5.7

Washington 78 144 147 178 148 2.6 4.7 4.7 5.6 4.6

West Virginia 0 2 3 10 4 0.0 0.2 0.3 1.1 0.4

Wisconsin 15 27 38 65 60 0.6 1.0 1.4 2.4 2.2

Wyoming 0 2 0 0 3 0.0 0.8 0.0 0.0 1.1

U.S. TOTAL 5,956 6,722 7,383 8,293 9,769 4.2 4.7 5.1 5.6 6.6

Northeast 1,014 1,084 1,171 1,314 1,741 3.8 4.1 4.4 4.9 6.5

Midwest 813 848 1,059 1,020 1,113 2.5 2.6 3.3 3.1 3.4

South 2,514 3,034 3,162 3,610 4,372 4.9 5.8 6.0 6.7 8.2

West 1,615 1,756 1,991 2,349 2,543 4.9 5.2 5.8 6.8 7.3

Guam 1 0 1 2 4 1.2 0.0 1.2 2.3 4.6

Puerto Rico 109 120 143 104 113 5.8 6.4 7.6 5.5 6.0

Virgin Islands 1 2 1 1 0 1.9 3.9 1.9 1.9 0.0

OUTLYING AREAS 111 122 145 107 117 5.5 6.1 7.2 5.3 5.8

TOTAL 6,067 6,844 7,528 8,400 9,886 4.2 4.7 5.1 5.6 6.6

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, 2003–2007

 NOTE: Cases reported with unknown sex are not included in this table.
130 Syphilis Tables STD Surveillance 2007

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Atlanta-Sandy Springs-Marietta, GA 516 508 598 529 608 11.2 10.8 12.2 10.3 11.8

Austin-Round Rock, TX 31 56 44 84 74 2.3 4.0 3.0 5.5 4.9

Baltimore-Towson, MD 224 276 244 213 211 8.6 10.5 9.2 8.0 7.9

Birmingham-Hoover, AL 23 33 101 244 189 2.1 3.0 9.3 22.2 17.2

Boston-Cambridge-Quincy, MA-NH 121 84 106 117 131 2.7 1.9 2.4 2.6 2.9

Buffalo-Cheektowaga-Tonawanda, NY 2 9 7 18 11 0.2 0.8 0.6 1.6 1.0

Charlotte-Gastonia-Concord, NC-SC 23 46 103 121 103 1.6 3.1 6.8 7.6 6.5

Chicago-Naperville-Joliet, IL-IN-WI 346 373 510 416 427 3.7 4.0 5.4 4.4 4.5

Cincinnati-Middletown, OH-KY-IN 2 22 24 13 34 0.1 1.1 1.2 0.6 1.6

Cleveland-Elyria-Mentor, OH 32 40 22 18 29 1.5 1.9 1.0 0.9 1.4

Columbus, OH 120 109 109 107 76 7.2 6.4 6.4 6.2 4.4

Dallas-Fort Worth-Arlington, TX 265 279 305 320 265 4.7 4.9 5.2 5.3 4.4

Denver-Aurora, CO 32 55 38 56 46 1.4 2.4 1.6 2.3 1.9

Detroit-Warren-Livonia, MI 218 153 77 82 91 4.9 3.4 1.7 1.8 2.0

Hartford-West Hartford-East Hartford, CT 16 13 14 23 15 1.4 1.1 1.2 1.9 1.3

Houston-Baytown-Sugar Land, TX 227 235 279 396 501 4.5 4.5 5.3 7.1 9.0

Indianapolis, IN 25 34 35 47 26 1.6 2.1 2.1 2.8 1.6

Jacksonville, FL 21 72 50 41 44 1.7 5.9 4.0 3.2 3.4

Kansas City, MO-KS 43 35 89 112 149 2.3 1.8 4.6 5.7 7.6

Las Vegas-Paradise, NV 8 38 103 132 102 0.5 2.3 6.0 7.4 5.7

Los Angeles-Long Beach-Santa Ana, CA 562 551 806 945 1,061 4.4 4.3 6.2 7.3 8.2

Louisville, KY-IN 28 38 46 41 32 2.4 3.2 3.8 3.4 2.6

Memphis, TN-MS-AR 90 99 138 145 208 7.3 7.9 10.9 11.4 16.3

Miami-Fort Lauderdale-Miami Beach, FL 409 434 395 369 414 7.7 8.1 7.3 6.8 7.6

Milwaukee-Waukesha-West Allis, WI 11 19 22 38 53 0.7 1.3 1.5 2.5 3.5

Minneapolis-St. Paul-Bloomington, MN-WI 43 26 68 43 57 1.4 0.8 2.2 1.4 1.8

Nashville-Davidson-Murfreesboro, TN 26 17 34 40 84 1.9 1.2 2.4 2.7 5.8

New Orleans-Metairie-Kenner, LA 28 101 88 90 168 2.1 7.7 6.7 8.8 16.4

New York-Newark-Edison, NY-NJ-PA 709 816 773 811 1,208 3.8 4.4 4.1 4.3 6.4

Oklahoma City, OK 56 20 23 24 36 4.9 1.7 2.0 2.0 3.1

Orlando, FL 70 69 106 94 145 3.9 3.7 5.5 4.7 7.3

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 135 95 127 173 205 2.3 1.6 2.2 3.0 3.5

Phoenix-Mesa-Scottsdale, AZ 134 106 113 157 193 3.7 2.9 2.9 3.9 4.8

Pittsburgh, PA 38 22 69 91 60 1.6 0.9 2.9 3.8 2.5

Portland-Vancouver-Beaverton, OR-WA 47 26 39 25 11 2.3 1.3 1.9 1.2 0.5

Providence-New Bedford-Fall River, RI-MA 42 30 28 18 44 2.6 1.8 1.7 1.1 2.7

Richmond, VA 12 11 13 28 38 1.1 1.0 1.1 2.3 3.2

Riverside-San Bernardino-Ontario, CA 91 103 121 108 95 2.5 2.7 3.1 2.7 2.4

Rochester, NY 7 12 6 14 16 0.7 1.2 0.6 1.4 1.5

Sacramento-Arden-Arcade-Roseville, CA 19 19 16 32 59 1.0 0.9 0.8 1.5 2.9

Salt Lake City, UT 6 5 9 15 19 0.6 0.5 0.9 1.4 1.8

San Antonio, TX 52 116 129 136 157 2.9 6.3 6.8 7.0 8.1

San Diego-Carlsbad-San Marcos, CA 111 138 194 235 347 3.8 4.7 6.6 8.0 11.8

San Francisco-Oakland-Fremont, CA 406 422 331 363 308 9.8 10.2 8.0 8.7 7.4

San Jose-Sunnyvale-Santa Clara, CA 56 56 44 52 56 3.2 3.2 2.5 2.9 3.1

Seattle-Tacoma-Bellevue, WA 70 138 125 160 138 2.2 4.4 3.9 4.9 4.2

St. Louis, MO-IL 51 71 50 65 112 1.9 2.6 1.8 2.3 4.0

Tampa-St. Petersburg-Clearwater, FL 96 89 85 110 195 3.8 3.4 3.2 4.1 7.2

Virginia Beach-Norfolk-Newport News, VA-NC 23 50 60 84 88 1.4 3.0 3.6 5.1 5.3

Washington-Arlington-Alexandria, DC-VA-MD-WV 168 199 233 250 377 3.3 3.9 4.5 4.7 7.1

U.S. MSA TOTAL 5,891 6,368 7,149 7,845 9,116 3.8 4.0 4.5 4.9 5.7

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

areas* (MSAs) listed in alphabetical order: United States, 2003–2007

*MSAs selected based on largest population in 2000 U.S. census.
STD Surveillance 2007 Syphilis Tables 131

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Atlanta-Sandy Springs-Marietta, GA 57 36 36 33 40 2.5 1.5 1.5 1.3 1.5

Austin-Round Rock, TX 2 3 3 11 12 0.3 0.4 0.4 1.5 1.6

Baltimore-Towson, MD 63 70 84 53 40 4.6 5.1 6.1 3.8 2.9

Birmingham-Hoover, AL 4 11 35 94 80 0.7 2.0 6.2 16.5 14.1

Boston-Cambridge-Quincy, MA-NH 2 5 1 7 10 0.1 0.2 0.0 0.3 0.4

Buffalo-Cheektowaga-Tonawanda, NY 1 1 0 2 0 0.2 0.2 0.0 0.3 0.0

Charlotte-Gastonia-Concord, NC-SC 3 12 20 28 20 0.4 1.6 2.6 3.5 2.5

Chicago-Naperville-Joliet, IL-IN-WI 44 55 50 43 31 0.9 1.1 1.0 0.9 0.6

Cincinnati-Middletown, OH-KY-IN 0 2 0 5 6 0.0 0.2 0.0 0.5 0.6

Cleveland-Elyria-Mentor, OH 13 3 1 2 5 1.2 0.3 0.1 0.2 0.5

Columbus, OH 17 31 22 30 11 2.0 3.6 2.5 3.4 1.3

Dallas-Fort Worth-Arlington, TX 99 73 100 112 93 3.5 2.6 3.4 3.7 3.1

Denver-Aurora, CO 3 6 1 3 1 0.3 0.5 0.1 0.3 0.1

Detroit-Warren-Livonia, MI 81 49 17 20 22 3.5 2.1 0.7 0.9 1.0

Hartford-West Hartford-East Hartford, CT 3 0 0 1 1 0.5 0.0 0.0 0.2 0.2

Houston-Baytown-Sugar Land, TX 26 39 61 65 108 1.0 1.5 2.3 2.3 3.9

Indianapolis, IN 7 2 4 1 3 0.9 0.2 0.5 0.1 0.4

Jacksonville, FL 9 32 20 11 11 1.5 5.1 3.1 1.7 1.7

Kansas City, MO-KS 20 5 5 17 25 2.1 0.5 0.5 1.7 2.5

Las Vegas-Paradise, NV 1 8 21 32 11 0.1 1.0 2.5 3.7 1.3

Los Angeles-Long Beach-Santa Ana, CA 28 40 63 72 58 0.4 0.6 1.0 1.1 0.9

Louisville, KY-IN 13 6 3 3 2 2.1 1.0 0.5 0.5 0.3

Memphis, TN-MS-AR 30 33 50 52 87 4.7 5.1 7.7 7.9 13.2

Miami-Fort Lauderdale-Miami Beach, FL 33 41 43 40 60 1.2 1.5 1.5 1.4 2.1

Milwaukee-Waukesha-West Allis, WI 1 1 1 2 5 0.1 0.1 0.1 0.3 0.6

Minneapolis-St. Paul-Bloomington, MN-WI 3 3 3 3 1 0.2 0.2 0.2 0.2 0.1

Nashville-Davidson-Murfreesboro, TN 6 2 2 2 13 0.9 0.3 0.3 0.3 1.8

New Orleans-Metairie-Kenner, LA 10 27 23 25 51 1.5 3.9 3.4 4.7 9.6

New York-Newark-Edison, NY-NJ-PA 65 58 37 31 42 0.7 0.6 0.4 0.3 0.4

Oklahoma City, OK 19 7 9 6 13 3.3 1.2 1.5 1.0 2.2

Orlando, FL 17 10 14 14 13 1.9 1.1 1.4 1.4 1.3

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 23 16 13 6 14 0.8 0.5 0.4 0.2 0.5

Phoenix-Mesa-Scottsdale, AZ 45 25 23 18 29 2.5 1.4 1.2 0.9 1.4

Pittsburgh, PA 17 7 25 28 25 1.4 0.6 2.0 2.3 2.0

Portland-Vancouver-Beaverton, OR-WA 2 0 0 0 1 0.2 0.0 0.0 0.0 0.1

Providence-New Bedford-Fall River, RI-MA 9 10 7 0 2 1.1 1.2 0.8 0.0 0.2

Richmond, VA 2 1 1 1 3 0.3 0.2 0.2 0.2 0.5

Riverside-San Bernardino-Ontario, CA 5 1 12 10 4 0.3 0.1 0.6 0.5 0.2

Rochester, NY 1 0 1 0 1 0.2 0.0 0.2 0.0 0.2

Sacramento-Arden-Arcade-Roseville, CA 1 0 0 3 2 0.1 0.0 0.0 0.3 0.2

Salt Lake City, UT 1 1 1 1 0 0.2 0.2 0.2 0.2 0.0

San Antonio, TX 6 20 34 32 35 0.6 2.1 3.5 3.2 3.5

San Diego-Carlsbad-San Marcos, CA 4 10 25 12 12 0.3 0.7 1.7 0.8 0.8

San Francisco-Oakland-Fremont, CA 4 2 8 7 12 0.2 0.1 0.4 0.3 0.6

San Jose-Sunnyvale-Santa Clara, CA 4 4 2 7 4 0.5 0.5 0.2 0.8 0.5

Seattle-Tacoma-Bellevue, WA 2 6 4 2 4 0.1 0.4 0.2 0.1 0.2

St. Louis, MO-IL 12 9 5 3 9 0.8 0.6 0.3 0.2 0.6

Tampa-St. Petersburg-Clearwater, FL 6 3 8 15 52 0.5 0.2 0.6 1.1 3.8

Virginia Beach-Norfolk-Newport News, VA-NC 3 4 15 18 10 0.4 0.5 1.8 2.1 1.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 13 16 13 11 12 0.5 0.6 0.5 0.4 0.4

U.S. MSA TOTAL 840 806 926 994 1,106 1.1 1.0 1.1 1.2 1.3

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

statistical areas* (MSAs) listed in alphabetical order: United States, 2003–2007

*MSAs selected based on largest population in 2000 U.S. census.
132 Syphilis Tables STD Surveillance 2007

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Atlanta-Sandy Springs-Marietta, GA 459 472 562 496 567 20.1 20.2 23.0 19.5 22.3

Austin-Round Rock, TX 29 53 41 73 62 4.1 7.4 5.5 9.4 8.0

Baltimore-Towson, MD 161 206 160 160 171 12.8 16.2 12.5 12.5 13.4

Birmingham-Hoover, AL 19 22 66 150 109 3.7 4.2 12.5 28.3 20.5

Boston-Cambridge-Quincy, MA-NH 119 79 105 110 121 5.5 3.7 4.9 5.1 5.6

Buffalo-Cheektowaga-Tonawanda, NY 1 8 7 16 11 0.2 1.4 1.3 2.9 2.0

Charlotte-Gastonia-Concord, NC-SC 20 34 83 93 83 2.8 4.7 11.1 11.9 10.7

Chicago-Naperville-Joliet, IL-IN-WI 302 318 460 373 396 6.6 6.9 9.9 8.0 8.5

Cincinnati-Middletown, OH-KY-IN 2 20 24 8 28 0.2 2.0 2.4 0.8 2.7

Cleveland-Elyria-Mentor, OH 19 37 21 16 24 1.9 3.6 2.1 1.6 2.4

Columbus, OH 103 78 87 77 65 12.5 9.3 10.3 9.0 7.6

Dallas-Fort Worth-Arlington, TX 166 206 205 208 172 5.9 7.2 7.0 6.9 5.7

Denver-Aurora, CO 29 49 37 53 45 2.5 4.2 3.1 4.4 3.7

Detroit-Warren-Livonia, MI 137 104 60 62 69 6.3 4.8 2.7 2.8 3.2

Hartford-West Hartford-East Hartford, CT 13 13 14 22 14 2.3 2.3 2.4 3.8 2.4

Houston-Baytown-Sugar Land, TX 201 196 218 331 393 7.9 7.6 8.3 11.9 14.2

Indianapolis, IN 18 32 31 46 23 2.3 4.0 3.8 5.6 2.8

Jacksonville, FL 12 40 30 30 33 2.0 6.7 4.9 4.8 5.3

Kansas City, MO-KS 23 30 84 95 124 2.5 3.2 8.8 9.8 12.8

Las Vegas-Paradise, NV 7 30 82 100 91 0.9 3.6 9.4 11.1 10.1

Los Angeles-Long Beach-Santa Ana, CA 533 511 743 873 1,002 8.4 8.0 11.6 13.6 15.6

Louisville, KY-IN 14 32 43 38 30 2.4 5.5 7.3 6.4 5.0

Memphis, TN-MS-AR 60 66 88 93 121 10.0 10.9 14.4 15.1 19.7

Miami-Fort Lauderdale-Miami Beach, FL 376 393 352 329 354 14.7 15.1 13.4 12.4 13.3

Milwaukee-Waukesha-West Allis, WI 10 18 21 36 48 1.4 2.4 2.9 4.9 6.5

Minneapolis-St. Paul-Bloomington, MN-WI 40 23 65 40 56 2.6 1.5 4.2 2.5 3.6

Nashville-Davidson-Murfreesboro, TN 20 15 32 38 71 3.0 2.2 4.6 5.3 9.9

New Orleans-Metairie-Kenner, LA 18 74 65 65 117 2.8 11.7 10.3 13.2 23.7

New York-Newark-Edison, NY-NJ-PA 644 758 736 780 1,166 7.2 8.4 8.1 8.6 12.8

Oklahoma City, OK 37 13 14 18 23 6.6 2.3 2.5 3.1 4.0

Orlando, FL 53 59 92 80 132 6.0 6.4 9.6 8.1 13.4

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 112 79 114 167 191 4.0 2.8 4.1 5.9 6.8

Phoenix-Mesa-Scottsdale, AZ 89 81 89 136 162 4.9 4.3 4.6 6.7 7.9

Pittsburgh, PA 21 15 44 63 35 1.8 1.3 3.8 5.5 3.1

Portland-Vancouver-Beaverton, OR-WA 45 26 39 25 10 4.4 2.5 3.7 2.3 0.9

Providence-New Bedford-Fall River, RI-MA 33 20 21 18 42 4.2 2.5 2.7 2.3 5.4

Richmond, VA 10 10 12 27 35 1.8 1.8 2.1 4.6 6.0

Riverside-San Bernardino-Ontario, CA 86 102 108 98 90 4.7 5.4 5.5 4.9 4.5

Rochester, NY 6 12 5 14 15 1.2 2.4 1.0 2.8 3.0

Sacramento-Arden-Arcade-Roseville, CA 18 19 16 29 57 1.9 1.9 1.6 2.9 5.6

Salt Lake City, UT 5 4 8 14 19 1.0 0.8 1.5 2.6 3.5

San Antonio, TX 46 96 95 104 122 5.2 10.6 10.3 10.9 12.8

San Diego-Carlsbad-San Marcos, CA 107 128 169 223 335 7.3 8.7 11.4 15.1 22.6

San Francisco-Oakland-Fremont, CA 401 419 323 355 296 19.5 20.4 15.7 17.1 14.3

San Jose-Sunnyvale-Santa Clara, CA 52 52 42 45 52 5.9 5.9 4.7 4.9 5.7

Seattle-Tacoma-Bellevue, WA 68 132 121 158 134 4.3 8.3 7.6 9.7 8.2

St. Louis, MO-IL 39 62 45 62 103 3.0 4.6 3.3 4.6 7.6

Tampa-St. Petersburg-Clearwater, FL 90 86 77 95 143 7.3 6.9 6.0 7.2 10.9

Virginia Beach-Norfolk-Newport News, VA-NC 20 46 45 66 78 2.5 5.7 5.5 8.2 9.7

Washington-Arlington-Alexandria, DC-VA-MD-WV 155 183 220 239 365 6.2 7.3 8.6 9.3 14.1

U.S. MSA TOTAL 5,048 5,561 6,221 6,847 8,005 6.6 7.2 7.9 8.6 10.1

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

statistical areas* (MSAs) listed in alphabetical order: United States, 2003–2007

*MSAs selected based on largest population in 2000 U.S. census.
STD Surveillance 2007 Syphilis Tables 133

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percent

1 Los Angeles County, CA 919 9.2 8

2 Harris County, TX 454 11.7 11

3 New York County, NY 394 24.4 15

4 Cook County, IL 391 7.4 18

5 San Diego County, CA 347 11.8 21

6 Fulton County, GA 293 30.5 24

7 Kings County, NY 255 10.2 26

8 Miami-Dade County, FL 210 8.7 28

9 San Francisco County, CA 202 27.1 30

10 Shelby County, TN 191 21.0 31

11 Maricopa County, AZ 190 5.0 33

12 Washington, D.C. 178 30.6 35

13 Broward County, FL 178 10.0 36

14 Jefferson County, AL 166 25.3 38

15 Bexar County, TX 155 10.0 39

16 Dallas County, TX 152 6.5 40

17 DeKalb County, GA 142 19.6 42

18 Orange County, CA 142 4.7 43

19 Baltimore (City), MD 140 22.2 44

20 Queens County, NY 138 6.1 45

21 Philadelphia County, PA 136 9.4 46

22 Orange County, FL 119 11.4 47

23 Orleans County, LA 117 52.4 48

24 Bronx County, NY 116 8.5 49

25 Hillsborough County, FL 115 9.9 50

26 King County, WA 112 6.1 51

27 Jackson County, MO 107 16.1 52

28 Madison County, AL 104 34.2 53

29 Clark County, NV 102 5.7 54

30 Prince George’s County, MD 94 11.2 55

31 Mecklenburg County, NC 93 11.2 56

32 Tarrant County, TX 87 5.2 57

33 Wayne County, MI 85 4.3 57

34 Riverside County, CA 80 3.9 58

35 Pima County, AZ 78 8.2 59

36 Suffolk County, MA 73 10.6 59

37 Pinellas County, FL 72 7.8 60

38 East Baton Rouge County, LA 70 16.3 61

39 Davidson County, TN 70 12.1 61

40 Franklin County, OH 68 6.2 62

41 Travis County, TX 67 7.3 62

42 Essex County, NJ 64 8.1 63

43 Sacramento County, CA 59 4.3 63

44 Cobb County, GA 57 8.4 64

45 Lafayette County, LA 56 27.6 64

46 Santa Clara County, CA 55 3.2 65

47 Allegheny County, PA 54 4.4 65

48 St Louis (City), MO 51 14.7 66

49 Hudson County, NJ 49 8.2 66

50 Milwaukee County, WI 49 5.4 67

51 Alameda County, CA 49 3.4 67

52 Gwinnett County, GA 46 6.1 67

53 Tangipahoa County, LA 42 37.1 68

54 Hennepin County, MN 41 3.7 68

55 Duval County, FL 40 4.8 69

56 Jefferson County, TX 39 16.0 69

57 Knox County, TN 39 9.5 69

58 Clayton County, GA 37 13.6 70

59 Jefferson County, LA 36 8.3 70

60 Pulaski County, AR 35 9.5 70

61 St. Louis County, MO 35 3.5 70

Table 31. Primary and secondary syphilis — Counties and independent cities* ranked by number of reported

cases: United States, 2007

*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 2007.
134 Syphilis Tables STD Surveillance 2007

 Age

Group

Cases Rates

Year Total Male Female Total Male Female

2003

10–14 11 1 10 0.1 0.0 0.1

15–19 322 150 172 1.6 1.4 1.7

20–24 860 620 240 4.2 5.8 2.4

25–29 941 760 181 4.9 7.8 1.9

30–34 1,187 1,023 164 5.7 9.8 1.6

35–39 1,460 1,290 170 6.8 12.0 1.6

40–44 1,157 1,021 136 5.0 8.9 1.2

45–54 991 871 119 2.4 4.3 0.6

55–64 205 187 18 0.7 1.4 0.1

65+ 42 36 6 0.1 0.2 0.0

TO TAL 7,177 5,959 1,218 2.5 4.2 0.8

2004

10–14 9 2 7 0.0 0.0 0.1

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

TO TAL 7,980 6,725 1,255 2.7 4.7 0.8

2005

10–14 10 2 8 0.0 0.0 0.1

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

TO TAL 8,724 7,385 1,339 2.9 5.1 0.9

2006

10–14 13 2 11 0.1 0.0 0.1

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

TO TAL 9,756 8,297 1,459 3.3 5.6 1.0

2007

10–14 13 5 8 0.1 0.0 0.1

15–19 664 416 248 3.1 3.8 2.4

20–24 1,818 1,462 356 8.6 13.4 3.5

25–29 1,841 1,576 265 8.9 14.9 2.6

30–34 1,500 1,306 193 7.6 13.1 2.0

35–39 1,721 1,530 191 8.1 14.4 1.8

40–44 1,745 1,553 192 7.8 13.9 1.7

45–54 1,664 1,464 200 3.8 6.9 0.9

55–64 409 379 30 1.3 2.5 0.2

65+ 91 82 9 0.2 0.5 0.0

TO TAL 11,466 9,773 1,693 3.8 6.6 1.1

Table 32. Primary and secondary syphilis — Reported cases and rates per 100,000 population by age group

and sex: United States, 2003–2007

 NOTE: This ta ble should be used only for age com par i sons. If age was not speci fied, cases were pro rated ac cord ing to the dis tri bu tion of cases

for which age was known. Dif fer ences be tween to tal cases from this ta ble and oth ers in the re port are due to dif fer ent re port ing formats. The 0 to 9

year age group is not shown because some of these cases may not be due to sex ual trans mis sion; how ever, they are in cluded in the to tals.
This page in ten tion ally left blank.
136 Syphilis Tables STD Surveillance 2007

Age 

Group 

 White, Non-His panic Black, Non-His panic His panic Asian/Pa cific Is lander 

Amer i can In dian/

 Alaska Na tive 

To tal Male Fe male To tal Male Fe male To tal Male Fe male To tal Male Fe male To tal Male Fe male

3

0

0

2

10–14 0 0 0 5 1 4 5 0 5 0 0 0 1 0 1

15–19 48 24 24 205 93 112 63 28 35 6 5 1 0 0 0

20–24 195 154 41 471 309 161 178 142 36 13 11 2 3 3 0

25–29 301 265 36 408 293 115 195 173 23 28 25 3 8 4 4

30–34 524 485 39 416 316 100 213 190 23 20 20 0 14 12 2

35–39 743 703 40 451 335 116 222 211 11 28 28 0 16 14 2

40–44 588 563 26 382 288 94 158 146 12 20 19 1 9 5 3

45–54 489 472 17 373 287 86 107 97 9 10 8 1 13 6 6

55–64 104 100 4 81 68 13 13 12 1 2 2 0 4 4 0

65+ 17 16 1 18 16 2 5 2 3 0 0 0 1 1 0

TO TAL 3,010 2,783 227 2,811 2,005 805 1,160 1,001 159 127 119 8 69 50 19

4

0

0

2

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

TO TAL 3,203 2,947 256 3,266 2,452 814 1,280 1,142 138 153 142 11 77 42 35

5

0

0

2

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

TO TAL 3,524 3,254 270 3,615 2,764 850 1,370 1,182 188 156 145 11 60 40 20

6

0

0

2

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

TO TAL 3,744 3,443 301 4,215 3,253 962 1,543 1,381 162 173 163 10 80 57 24

7

0

0

2

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

25–29 487 432 54 953 783 170 352 319 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 51 620 488 132 187 171 16 23 23 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

TO TAL 4,050 3,669 381 5,273 4,169 1,104 1,887 1,719 167 171 164 7 85 52 33

Ta ble 33A. Pri mary and sec ond ary syph i lis — Re ported cases by race/eth nic ity, age group and sex: United States,

2003–2007

NOTE: These ta bles should be used only for race/eth nic ity com par i sons. See Ta ble 32 for age-spe cific cases and rates and Ta bles 25-27 for total

and sex-spe cific cases and rates. If age or race/eth nic ity was not spec i fied, cases were pro rated ac cord ing to the dis tri bu tion of cases for which these

vari ables were speci fied. In 2007, ID did not re port race/eth nic ity and their case data and pop u la tion de nom i na tors were excluded. Dif fer ences be tween to tal

cases from this ta ble and oth ers in the re port are due to different re port ing for mats and above listed ex clu sion. The 0 to 9 year age group is not shown be -

cause some of these cases may not be due to sex ual trans mis sion; how ever, they are included in the to tals.
STD Surveillance 2007 Syphilis Tables 137

Age 

Group

 White, Non-His panic Black, Non-His panic His panic Asian/Pa cific Is lander 

Amer i can In dian/

 Alaska Na tive 

To tal Male Fe male To tal Male Fe male To tal Male Fe male To tal Male Fe male To tal Male Fe male

10–14 0.0 0.0 0.0 0.1 0.1 0.2 0.1 0.0 0.3 0.0 0.0 0.0 0.4 0.0 0.9

2

0

0

3

15–19 0.4 0.4 0.4 6.7 5.9 7.4 1.9 1.7 2.2 0.7 1.2 0.2 0.0 0.0 0.0

20–24 1.5 2.4 0.6 16.0 21.1 10.9 4.8 6.8 2.2 1.4 2.3 0.4 1.5 3.0 0.0

25–29 2.6 4.6 0.6 16.1 24.1 8.7 5.1 8.3 1.3 2.5 4.4 0.5 4.9 5.0 4.9

30–34 4.0 7.4 0.6 15.7 25.2 7.2 5.9 9.9 1.4 1.6 3.3 0.0 8.1 13.8 2.4

35–39 5.2 9.8 0.6 16.6 26.2 8.1 7.0 12.5 0.8 2.6 5.3 0.0 9.0 15.9 2.3

40–44 3.6 7.0 0.3 13.6 21.9 6.3 5.8 10.3 0.9 1.9 3.7 0.2 4.5 6.0 3.2

45–54 1.6 3.1 0.1 8.0 13.4 3.4 2.8 5.1 0.5 0.5 1.0 0.1 4.0 4.2 3.8

55–64 0.5 0.9 0.0 3.0 5.7 0.9 0.6 1.2 0.1 0.2 0.5 0.0 2.3 4.8 0.0

65+ 0.1 0.1 0.0 0.6 1.4 0.1 0.3 0.3 0.3 0.0 0.0 0.0 0.7 1.5 0.0

TO TAL 1.5 2.8 0.2 7.7 11.5 4.2 2.9 4.9 0.8 1.0 1.9 0.1 2.8 4.2 1.5

10–14 0.0 0.0 0.0 0.2 0.1 0.4 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0

2

0

0

4

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

TO TAL 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

2

0

0

5

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

TO TAL 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

2

0

0

6

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

TO TAL 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

2

0

0

7

15–19 0.7 0.7 0.7 14.2 17.8 10.4 2.5 3.5 1.5 0.0 0.0 0.0 3.2 1.8 4.5

20–24 2.6 4.1 1.1 37.0 57.5 16.0 8.8 14.2 2.3 1.5 2.5 0.4 6.1 5.6 6.6

25–29 4.0 7.0 0.9 33.9 57.4 11.7 8.5 13.8 1.8 3.0 5.8 0.2 7.9 7.9 7.8

30–34 4.3 7.8 0.9 24.2 41.9 8.1 8.3 14.0 1.5 2.8 5.3 0.4 11.7 18.2 5.1

35–39 5.2 9.6 0.7 25.8 44.8 8.9 8.3 14.9 0.8 2.4 5.0 0.0 8.9 11.7 6.2

40–44 5.6 10.4 0.8 21.7 37.2 8.0 8.5 15.5 0.8 2.3 4.6 0.2 3.5 4.9 2.2

45–54 2.6 5.0 0.3 12.4 21.1 4.9 4.1 7.5 0.7 1.2 2.6 0.0 2.8 4.7 1.2

55–64 0.9 1.8 0.0 4.9 9.3 1.4 1.6 3.1 0.2 0.2 0.4 0.0 0.0 0.0 0.0

65+ 0.2 0.4 0.0 1.2 2.6 0.4 0.2 0.5 0.0 0.1 0.2 0.0 0.0 0.0 0.0

TO TAL 2.0 3.7 0.4 14.0 23.2 5.6 4.3 7.5 0.8 1.2 2.4 0.1 3.4 4.3 2.6

Ta ble 33B. Pri mary and sec ond ary syphilis — Rates per 100,000 population by race/eth nic ity, age group and sex:

United States, 2003–2007

NOTE: These ta bles should be used only for race/eth nic ity com par i sons. See Ta ble 32 for age-spe cific cases and rates and Ta bles 25-27 for total and

sex-spe cific cases and rates. If age or race/eth nic ity was not speci fied, cases were pro rated ac cord ing to the dis tri bu tion of cases for which these vari ables were

spec i fied. In 2007, ID did not re port race/eth nic ity and their case data and pop u la tion de nom i na tors were excluded. Dif fer ences be tween to tal rates from this ta ble

and oth ers in the re port are due to different re port ing for mats and above listed ex clu sion. The 0 to 9 year age group is not shown be cause some of these cases may

not be due to sex ual trans mis sion; how ever, they are in cluded in the to tals.
138 Syphilis Tables STD Surveillance 2007

Cases Rates per 100,000 Population

State/Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Alabama 140 231 184 341 363 3.1 5.1 4.0 7.4 7.9

Alaska 0 1 8 6 3 0.0 0.2 1.2 0.9 0.4

Arizona 232 219 134 186 269 4.2 3.8 2.3 3.0 4.4

Arkansas 71 56 48 67 115 2.6 2.0 1.7 2.4 4.1

California 820 873 1,153 1,369 1,421 2.3 2.4 3.2 3.8 3.9

Colorado 20 24 27 38 35 0.4 0.5 0.6 0.8 0.7

Connecticut 13 16 19 27 20 0.4 0.5 0.5 0.8 0.6

Delaware 11 25 9 16 14 1.3 3.0 1.1 1.9 1.6

District of Columbia 152 113 103 77 84 26.9 20.4 18.7 13.2 14.4

Florida 988 856 726 760 1,155 5.8 4.9 4.1 4.2 6.4

Georgia 720 333 380 366 423 8.3 3.8 4.2 3.9 4.5

Hawaii 6 3 4 2 11 0.5 0.2 0.3 0.2 0.9

Idaho 8 26 13 3 3 0.6 1.9 0.9 0.2 0.2

Illinois 350 322 397 267 224 2.8 2.5 3.1 2.1 1.7

Indiana 58 45 42 46 39 0.9 0.7 0.7 0.7 0.6

Iowa 5 12 6 6 6 0.2 0.4 0.2 0.2 0.2

Kansas 19 12 18 18 25 0.7 0.4 0.7 0.7 0.9

Kentucky 43 24 23 36 34 1.0 0.6 0.6 0.9 0.8

Louisiana 197 316 252 481 722 4.4 7.0 5.6 11.2 16.8

Maine 7 0 2 7 5 0.5 0.0 0.2 0.5 0.4

Maryland 211 213 289 193 320 3.8 3.8 5.2 3.4 5.7

Massachusetts 136 96 105 82 116 2.1 1.5 1.6 1.3 1.8

Michigan 122 121 69 43 73 1.2 1.2 0.7 0.4 0.7

Minnesota 45 21 46 58 55 0.9 0.4 0.9 1.1 1.1

Mississippi 173 130 162 197 269 6.0 4.5 5.5 6.8 9.2

Missouri 46 58 108 93 120 0.8 1.0 1.9 1.6 2.1

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 1 0 2 1 3 0.1 0.0 0.1 0.1 0.2

Nevada 35 24 64 119 174 1.6 1.0 2.7 4.8 7.0

New Hampshire 4 0 0 2 13 0.3 0.0 0.0 0.2 1.0

New Jersey 326 344 289 314 343 3.8 4.0 3.3 3.6 3.9

New Mexico 53 69 53 85 66 2.8 3.6 2.7 4.3 3.4

New York 1,019 744 1,084 993 1,149 5.3 3.9 5.6 5.1 6.0

North Carolina 261 261 215 294 247 3.1 3.1 2.5 3.3 2.8

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 92 184 136 115 135 0.8 1.6 1.2 1.0 1.2

Oklahoma 77 62 64 121 115 2.2 1.8 1.8 3.4 3.2

Oregon 27 29 16 19 6 0.8 0.8 0.4 0.5 0.2

Pennsylvania 216 183 204 286 309 1.7 1.5 1.6 2.3 2.5

Rhode Island 7 15 5 6 10 0.7 1.4 0.5 0.6 0.9

South Carolina 180 204 222 174 143 4.3 4.9 5.2 4.0 3.3

South Dakota 3 0 0 6 4 0.4 0.0 0.0 0.8 0.5

Tennessee 228 206 203 233 304 3.9 3.5 3.4 3.9 5.0

Texas 1,065 1,069 1,013 1,312 1,467 4.8 4.8 4.4 5.6 6.2

Utah 7 5 7 7 2 0.3 0.2 0.3 0.3 0.1

Vermont 0 0 0 2 1 0.0 0.0 0.0 0.3 0.2

Virginia 74 108 148 165 177 1.0 1.4 2.0 2.2 2.3

Washington 36 51 63 81 76 0.6 0.8 1.0 1.3 1.2

West Virginia 2 9 3 6 9 0.1 0.5 0.2 0.3 0.5

Wisconsin 54 55 58 60 91 1.0 1.0 1.0 1.1 1.6

Wyoming 1 0 0 0 0 0.2 0.0 0.0 0.0 0.0

U.S. TOTAL 8,361 7,768 8,176 9,186 10,768 2.9 2.6 2.8 3.1 3.6

Northeast 1,728 1,398 1,708 1,719 1,966 3.2 2.6 3.1 3.1 3.6

Midwest 795 830 882 713 775 1.2 1.3 1.3 1.1 1.2

South 4,593 4,216 4,044 4,839 5,961 4.4 4.0 3.8 4.4 5.5

West 1,245 1,324 1,542 1,915 2,066 1.9 2.0 2.3 2.8 3.0

Guam 1 0 0 3 3 0.6 0.0 0.0 1.8 1.8

Puerto Rico 748 353 432 368 408 19.3 9.1 11.0 9.4 10.4

Virgin Islands 6 8 7 0 1 5.5 7.4 6.4 0.0 0.9

OUTLYING AREAS 755 361 439 371 412 18.2 8.7 10.5 8.8 9.8

TOTAL 9,116 8,129 8,615 9,557 11,180 3.1 2.7 2.9 3.1 3.7

Table 34. Early latent syphilis — Reported cases and rates by state/area and region listed in alphabetical

order: United States and outlying areas, 2003–2007
STD Surveillance 2007 Syphilis Tables 139

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Atlanta-Sandy Springs-Marietta, GA 614 281 314 293 363 13.3 6.0 6.4 5.7 7.1

Austin-Round Rock, TX 42 59 59 51 66 3.0 4.2 4.1 3.4 4.4

Baltimore-Towson, MD 189 167 211 136 185 7.2 6.3 7.9 5.1 7.0

Birmingham-Hoover, AL 24 42 82 220 196 2.2 3.9 7.5 20.0 17.8

Boston-Cambridge-Quincy, MA-NH 117 70 84 65 95 2.6 1.6 1.9 1.5 2.1

Buffalo-Cheektowaga-Tonawanda, NY 2 4 3 14 6 0.2 0.3 0.3 1.2 0.5

Charlotte-Gastonia-Concord, NC-SC 51 58 71 98 63 3.5 3.9 4.7 6.2 4.0

Chicago-Naperville-Joliet, IL-IN-WI 344 322 395 269 209 3.7 3.4 4.2 2.8 2.2

Cincinnati-Middletown, OH-KY-IN 0 8 13 7 12 0.0 0.4 0.6 0.3 0.6

Cleveland-Elyria-Mentor, OH 7 33 21 11 21 0.3 1.5 1.0 0.5 1.0

Columbus, OH 44 72 41 55 47 2.6 4.3 2.4 3.2 2.7

Dallas-Fort Worth-Arlington, TX 488 380 381 532 468 8.7 6.7 6.5 8.9 7.8

Denver-Aurora, CO 17 22 22 32 30 0.7 0.9 0.9 1.3 1.2

Detroit-Warren-Livonia, MI 112 103 59 34 47 2.5 2.3 1.3 0.8 1.1

Hartford-West Hartford-East Hartford, CT 2 5 7 10 8 0.2 0.4 0.6 0.8 0.7

Houston-Baytown-Sugar Land, TX 237 246 207 291 468 4.7 4.7 3.9 5.3 8.4

Indianapolis, IN 23 24 19 18 20 1.4 1.5 1.2 1.1 1.2

Jacksonville, FL 40 75 56 56 51 3.3 6.1 4.5 4.4 4.0

Kansas City, MO-KS 31 23 51 41 70 1.6 1.2 2.6 2.1 3.6

Las Vegas-Paradise, NV 28 19 57 112 170 1.8 1.2 3.3 6.3 9.6

Los Angeles-Long Beach-Santa Ana, CA 434 445 666 851 893 3.4 3.4 5.2 6.6 6.9

Louisville, KY-IN 34 16 16 18 12 2.9 1.3 1.3 1.5 1.0

Memphis, TN-MS-AR 177 170 171 174 222 14.3 13.6 13.6 13.7 17.4

Miami-Fort Lauderdale-Miami Beach, FL 578 477 302 304 440 10.9 8.9 5.6 5.6 8.1

Milwaukee-Waukesha-West Allis, WI 41 37 36 46 65 2.7 2.4 2.4 3.0 4.3

Minneapolis-St. Paul-Bloomington, MN-WI 41 19 43 52 54 1.3 0.6 1.4 1.6 1.7

Nashville-Davidson-Murfreesboro, TN 31 30 29 42 56 2.3 2.1 2.0 2.9 3.8

New Orleans-Metairie-Kenner, LA 48 85 68 127 222 3.6 6.4 5.2 12.4 21.7

New York-Newark-Edison, NY-NJ-PA 1,259 1,012 1,281 1,178 1,360 6.8 5.4 6.8 6.3 7.2

Oklahoma City, OK 62 47 36 74 65 5.5 4.1 3.1 6.3 5.5

Orlando, FL 117 90 124 91 160 6.5 4.8 6.4 4.6 8.1

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 256 220 171 280 310 4.4 3.8 2.9 4.8 5.3

Phoenix-Mesa-Scottsdale, AZ 165 165 97 166 165 4.6 4.4 2.5 4.1 4.1

Pittsburgh, PA 11 8 28 43 45 0.5 0.3 1.2 1.8 1.9

Portland-Vancouver-Beaverton, OR-WA 22 23 12 9 5 1.1 1.1 0.6 0.4 0.2

Providence-New Bedford-Fall River, RI-MA 11 25 10 9 12 0.7 1.5 0.6 0.6 0.7

Richmond, VA 24 18 24 29 45 2.1 1.6 2.0 2.4 3.8

Riverside-San Bernardino-Ontario, CA 34 40 64 64 49 0.9 1.1 1.6 1.6 1.2

Rochester, NY 8 4 13 8 5 0.8 0.4 1.3 0.8 0.5

Sacramento-Arden-Arcade-Roseville, CA 5 11 11 23 16 0.3 0.5 0.5 1.1 0.8

Salt Lake City, UT 4 5 3 5 2 0.4 0.5 0.3 0.5 0.2

San Antonio, TX 66 79 144 172 115 3.6 4.3 7.6 8.9 5.9

San Diego-Carlsbad-San Marcos, CA 41 84 117 123 156 1.4 2.9 4.0 4.2 5.3

San Francisco-Oakland-Fremont, CA 230 235 220 220 200 5.5 5.7 5.3 5.3 4.8

San Jose-Sunnyvale-Santa Clara, CA 20 13 18 18 25 1.2 0.7 1.0 1.0 1.4

Seattle-Tacoma-Bellevue, WA 30 42 60 74 70 1.0 1.3 1.9 2.3 2.1

St. Louis, MO-IL 28 31 34 30 57 1.0 1.1 1.2 1.1 2.0

Tampa-St. Petersburg-Clearwater, FL 142 103 101 177 294 5.6 4.0 3.8 6.6 10.9

Virginia Beach-Norfolk-Newport News, VA-NC 21 45 78 74 54 1.3 2.7 4.7 4.5 3.3

Washington-Arlington-Alexandria, DC-VA-MD-WV 195 182 208 171 265 3.8 3.5 4.0 3.2 5.0

U.S. MSA TOTAL 6,547 5,774 6,338 6,997 8,034 4.2 3.7 4.0 4.3 5.0

Table 35. Early latent syphilis — Reported cases and rates in selected metropolitan statistical areas* (MSAs)

listed in alphabetical order: United States, 2003–2007

*MSAs selected based on largest population in 2000 U.S. census.
140 Syphilis Tables STD Surveillance 2007

Cases Rates per 100,000 Population

State/Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Alabama 309 232 193 262 254 6.9 5.1 4.2 5.7 5.5

Alaska 7 6 5 8 6 1.1 0.9 0.8 1.2 0.9

Arizona 659 572 455 521 650 11.8 10.0 7.7 8.4 10.5

Arkansas 172 142 124 92 122 6.3 5.2 4.5 3.3 4.3

California 2,024 2,293 2,527 2,773 2,777 5.7 6.4 7.0 7.6 7.6

Colorado 82 90 70 73 63 1.8 2.0 1.5 1.5 1.3

Connecticut 163 108 88 106 87 4.7 3.1 2.5 3.0 2.5

Delaware 29 26 15 38 31 3.5 3.1 1.8 4.5 3.6

District of Columbia 129 174 148 120 153 22.9 31.4 26.9 20.6 26.3

Florida 1,610 1,364 1,422 1,445 1,830 9.5 7.8 8.0 8.0 10.1

Georgia 836 701 898 977 1,142 9.6 7.9 9.9 10.4 12.2

Hawaii 39 25 42 46 38 3.1 2.0 3.3 3.6 3.0

Idaho 18 25 21 6 10 1.3 1.8 1.5 0.4 0.7

Illinois 633 614 663 760 522 5.0 4.8 5.2 5.9 4.1

Indiana 252 164 182 111 121 4.1 2.6 2.9 1.8 1.9

Iowa 29 19 13 43 37 1.0 0.6 0.4 1.4 1.2

Kansas 32 49 51 41 44 1.2 1.8 1.9 1.5 1.6

Kentucky 83 79 54 78 63 2.0 1.9 1.3 1.9 1.5

Louisiana 1,195 979 696 551 516 26.6 21.7 15.4 12.9 12.0

Maine 6 5 3 6 7 0.5 0.4 0.2 0.5 0.5

Maryland 443 399 387 526 482 8.0 7.2 6.9 9.4 8.6

Massachusetts 375 307 168 172 128 5.8 4.8 2.6 2.7 2.0

Michigan 451 470 297 210 262 4.5 4.6 2.9 2.1 2.6

Minnesota 103 96 89 83 72 2.0 1.9 1.7 1.6 1.4

Mississippi 220 212 160 237 305 7.6 7.3 5.5 8.1 10.5

Missouri 96 114 114 166 124 1.7 2.0 2.0 2.8 2.1

Montana 0 0 0 1 0 0.0 0.0 0.0 0.1 0.0

Nebraska 15 8 12 26 23 0.9 0.5 0.7 1.5 1.3

Nevada 102 189 169 117 104 4.6 8.1 7.0 4.7 4.2

New Hampshire 14 21 17 20 9 1.1 1.6 1.3 1.5 0.7

New Jersey 572 319 375 297 345 6.6 3.7 4.3 3.4 4.0

New Mexico 75 97 68 66 62 4.0 5.1 3.5 3.4 3.2

New York 2,715 2,979 2,054 2,833 2,766 14.1 15.5 10.7 14.7 14.3

North Carolina 417 285 213 352 516 5.0 3.3 2.5 4.0 5.8

North Dakota 0 0 0 2 1 0.0 0.0 0.0 0.3 0.2

Ohio 189 148 153 192 219 1.7 1.3 1.3 1.7 1.9

Oklahoma 211 79 50 58 33 6.0 2.2 1.4 1.6 0.9

Oregon 43 50 52 51 33 1.2 1.4 1.4 1.4 0.9

Pennsylvania 329 273 308 335 264 2.7 2.2 2.5 2.7 2.1

Rhode Island 50 62 35 51 30 4.6 5.7 3.3 4.8 2.8

South Carolina 263 194 239 155 176 6.3 4.6 5.6 3.6 4.1

South Dakota 0 0 2 10 1 0.0 0.0 0.3 1.3 0.1

Tennessee 511 459 493 527 537 8.7 7.8 8.3 8.7 8.9

Texas 2,200 2,244 2,336 2,501 2,780 9.9 10.0 10.2 10.6 11.8

Utah 51 59 33 38 23 2.2 2.5 1.3 1.5 0.9

Vermont 0 2 0 2 0 0.0 0.3 0.0 0.3 0.0

Virginia 395 380 361 343 328 5.3 5.1 4.8 4.5 4.3

Washington 121 135 144 160 135 2.0 2.2 2.3 2.5 2.1

West Virginia 7 6 12 13 11 0.4 0.3 0.7 0.7 0.6

Wisconsin 41 43 37 42 12 0.7 0.8 0.7 0.8 0.2

Wyoming 3 3 1 1 2 0.6 0.6 0.2 0.2 0.4

U.S. TOTAL 18,319 17,300 16,049 17,644 18,256 6.3 5.9 5.4 5.9 6.1

Northeast 4,224 4,076 3,048 3,822 3,636 7.8 7.5 5.6 7.0 6.6

Midwest 1,841 1,725 1,613 1,686 1,438 2.8 2.6 2.4 2.5 2.2

South 9,030 7,955 7,801 8,275 9,279 8.6 7.5 7.3 7.6 8.5

West 3,224 3,544 3,587 3,861 3,903 4.9 5.3 5.3 5.6 5.6

Guam 13 13 16 7 24 7.9 7.8 9.5 4.1 14.0

Puerto Rico 390 608 554 535 682 10.1 15.6 14.2 13.6 17.4

Virgin Islands 5 4 5 4 4 4.6 3.7 4.6 3.7 3.7

OUTLYING AREAS 408 625 575 546 710 9.8 15.0 13.7 13.0 16.9

TOTAL 18,727 17,925 16,624 18,190 18,966 6.3 6.0 5.5 6.0 6.2

Table 36. Late and late latent syphilis — Reported cases and rates by state/area and region listed in

alphabetical order: United States and outlying areas, 2003–2007
STD Surveillance 2007 Syphilis Tables 141

Cases Rates per 100,000 Population

Metropolitan Statistical Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Atlanta-Sandy Springs-Marietta, GA 566 522 714 814 929 12.3 11.1 14.5 15.8 18.1

Austin-Round Rock, TX 78 85 89 74 94 5.7 6.0 6.1 4.9 6.2

Baltimore-Towson, MD 229 195 209 283 236 8.8 7.4 7.9 10.6 8.9

Birmingham-Hoover, AL 74 40 57 94 93 6.9 3.7 5.2 8.5 8.5

Boston-Cambridge-Quincy, MA-NH 330 256 149 147 98 7.4 5.8 3.4 3.3 2.2

Buffalo-Cheektowaga-Tonawanda, NY 7 11 4 7 9 0.6 1.0 0.3 0.6 0.8

Charlotte-Gastonia-Concord, NC-SC 87 45 61 83 133 6.1 3.1 4.0 5.2 8.4

Chicago-Naperville-Joliet, IL-IN-WI 630 576 611 687 469 6.7 6.1 6.5 7.2 4.9

Cincinnati-Middletown, OH-KY-IN 16 24 18 37 31 0.8 1.2 0.9 1.8 1.5

Cleveland-Elyria-Mentor, OH 23 11 9 24 33 1.1 0.5 0.4 1.1 1.6

Columbus, OH 102 72 76 67 99 6.1 4.3 4.4 3.9 5.7

Dallas-Fort Worth-Arlington, TX 735 701 792 809 881 13.1 12.3 13.6 13.5 14.7

Denver-Aurora, CO 64 56 51 51 43 2.8 2.4 2.2 2.1 1.8

Detroit-Warren-Livonia, MI 383 400 238 155 187 8.5 8.9 5.3 3.5 4.2

Hartford-West Hartford-East Hartford, CT 52 28 35 32 27 4.4 2.4 2.9 2.7 2.3

Houston-Baytown-Sugar Land, TX 768 783 685 856 1,032 15.1 15.1 13.0 15.5 18.6

Indianapolis, IN 93 68 80 56 49 5.8 4.2 4.9 3.4 2.9

Jacksonville, FL 73 70 41 63 102 6.1 5.7 3.3 4.9 8.0

Kansas City, MO-KS 41 40 53 75 49 2.2 2.1 2.7 3.8 2.5

Las Vegas-Paradise, NV 87 167 139 95 85 5.5 10.1 8.1 5.3 4.8

Los Angeles-Long Beach-Santa Ana, CA 1,137 1,451 1,649 1,759 1,588 8.9 11.2 12.8 13.6 12.3

Louisville, KY-IN 63 60 40 42 33 5.3 5.0 3.3 3.4 2.7

Memphis, TN-MS-AR 278 242 272 287 326 22.4 19.4 21.6 22.5 25.6

Miami-Fort Lauderdale-Miami Beach, FL 909 769 742 773 997 17.2 14.3 13.7 14.1 18.2

Milwaukee-Waukesha-West Allis, WI 22 28 18 16 9 1.5 1.8 1.2 1.1 0.6

Minneapolis-St. Paul-Bloomington, MN-WI 89 79 74 65 59 2.9 2.5 2.4 2.0 1.9

Nashville-Davidson-Murfreesboro, TN 158 145 126 112 100 11.5 10.4 8.9 7.7 6.9

New Orleans-Metairie-Kenner, LA 187 259 190 133 157 14.2 19.6 14.4 13.0 15.3

New York-Newark-Edison, NY-NJ-PA 3,077 3,058 2,241 2,905 2,913 16.5 16.3 12.0 15.4 15.5

Oklahoma City, OK 135 42 28 18 12 11.9 3.7 2.4 1.5 1.0

Orlando, FL 129 106 183 217 277 7.2 5.7 9.5 10.9 14.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 392 361 284 315 253 6.8 6.2 4.9 5.4 4.3

Phoenix-Mesa-Scottsdale, AZ 589 468 363 424 486 16.4 12.6 9.4 10.5 12.0

Pittsburgh, PA 8 2 15 18 17 0.3 0.1 0.6 0.8 0.7

Portland-Vancouver-Beaverton, OR-WA 34 35 43 40 34 1.7 1.7 2.1 1.9 1.6

Providence-New Bedford-Fall River, RI-MA 74 81 37 65 44 4.6 5.0 2.3 4.0 2.7

Richmond, VA 77 56 50 49 46 6.8 4.9 4.3 4.1 3.9

Riverside-San Bernardino-Ontario, CA 184 174 208 203 194 5.1 4.6 5.3 5.0 4.8

Rochester, NY 18 25 17 68 55 1.7 2.4 1.6 6.6 5.3

Sacramento-Arden-Arcade-Roseville, CA 11 33 8 78 40 0.6 1.6 0.4 3.8 1.9

Salt Lake City, UT 33 42 23 21 14 3.3 4.1 2.2 2.0 1.3

San Antonio, TX 109 164 178 156 142 6.0 8.8 9.4 8.0 7.3

San Diego-Carlsbad-San Marcos, CA 139 124 133 202 273 4.7 4.2 4.5 6.9 9.3

San Francisco-Oakland-Fremont, CA 260 258 165 156 263 6.3 6.2 4.0 3.7 6.3

San Jose-Sunnyvale-Santa Clara, CA 57 39 56 22 76 3.3 2.2 3.2 1.2 4.3

Seattle-Tacoma-Bellevue, WA 74 93 100 122 99 2.4 2.9 3.1 3.7 3.0

St. Louis, MO-IL 69 85 86 89 82 2.5 3.1 3.1 3.2 2.9

Tampa-St. Petersburg-Clearwater, FL 166 110 139 140 119 6.6 4.3 5.2 5.2 4.4

Virginia Beach-Norfolk-Newport News, VA-NC 104 100 105 85 89 6.4 6.1 6.4 5.2 5.4

Washington-Arlington-Alexandria, DC-VA-MD-WV 470 511 453 496 514 9.2 9.9 8.7 9.4 9.7

U.S. MSA TOTAL 13,490 13,150 12,137 13,585 13,990 8.6 8.3 7.6 8.4 8.7

Table 37. Late and late latent syphilis — Reported cases and rates in selected metropolitan statistical areas*

(MSAs) listed in alphabetical order: United States, 2003–2007

*MSAs selected based on largest population in 2000 U.S. census..
142 Syphilis Tables STD Surveillance 2007

 Rank* State† Cases Rate per 100,000 Live Births

1 Louisiana 36 55.1

2 Arizona 30 32.0

3 Arkansas 12 31.1

4 Maryland 23 30.8

5 Texas 99 26.0

6 New Mexico 6 21.1

7 Nevada 7 19.9

8 California 87 16.0

9 Alabama 9 15.1

10 Michigan 14 10.8

U.S. TOTAL‡430 10.5

11 New Jersey 11 9.5

12 Florida 20 9.2

13 Georgia 9 6.5

14 New York 16 6.4

15 Oklahoma 3 5.8

16 North Carolina 7 5.8

17 Illinois 10 5.5

18 Pennsylvania 8 5.5

19 Tennessee 4 5.0

20 West Virginia 1 4.8

21 Connecticut 2 4.8

22 Oregon 2 4.4

23 Indiana 3 3.4

24 Colorado 2 2.9

25 Iowa 1 2.6

26 Washington 2 2.4

27 South Carolina 1 1.8

28 Wisconsin 1 1.4

29 Missouri 1 1.3

YEAR 2010 TARGET 1.0

30 Virginia 1 1.0

31 Ohio 1 0.7

Alaska 0 0.0

Delaware 0 0.0

Hawaii 0 0.0

Idaho 0 0.0

Kansas 0 0.0

Kentucky 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

Rhode Island 0 0.0

South Dakota 0 0.0

Utah 0 0.0

Vermont 0 0.0

Wyoming 0 0.0

Table 38. Congenital syphilis — Reported cases and rates in infants < 1 year of age by state, ranked

by rates: United States, 2007

*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 1 case and a rate of 12.6, but excludes outlying areas (Guam with 2 cases and rate of

58.6, Puerto Rico with 8 cases and rate of 15.6, and Virgin Islands with 0 cases and rate of 0.0).
STD Surveillance 2007 Syphilis Tables 143

Cases Rates per 100,000 Live Births

State/Area* 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

Alabama 4 11 5 9 9 6.7 18.5 8.4 15.1 15.1

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 29 26 28 16 30 31.9 27.8 29.9 17.1 32.0

Arkansas 2 4 7 10 12 5.3 10.4 18.1 25.9 31.1

California 64 68 75 69 87 11.8 12.5 13.8 12.7 16.0

Colorado 3 2 1 2 2 4.3 2.9 1.5 2.9 2.9

Connecticut 1 0 1 0 2 2.3 0.0 2.4 0.0 4.8

Delaware 0 1 0 0 0 0.0 8.8 0.0 0.0 0.0

District of Columbia 1 1 0 1 1 13.1 12.6 0.0 12.6 12.6

Florida 27 16 16 21 20 12.7 7.3 7.3 9.6 9.2

Georgia 11 6 1 9 9 8.1 4.3 0.7 6.5 6.5

Hawaii 2 0 0 0 0 11.0 0.0 0.0 0.0 0.0

Idaho 4 3 0 0 0 18.3 13.3 0.0 0.0 0.0

Illinois 20 26 23 15 10 11.0 14.4 12.7 8.3 5.5

Indiana 7 4 2 0 3 8.1 4.6 2.3 0.0 3.4

Iowa 0 0 0 0 1 0.0 0.0 0.0 0.0 2.6

Kansas 1 2 0 1 0 2.5 5.0 0.0 2.5 0.0

Kentucky 1 1 0 1 0 1.8 1.8 0.0 1.8 0.0

Louisiana 6 19 13 16 36 9.2 29.1 19.9 24.5 55.1

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 9 10 16 19 23 12.0 13.4 21.4 25.5 30.8

Massachusetts 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Michigan 38 23 17 13 14 29.0 17.7 13.1 10.0 10.8

Minnesota 0 1 3 1 0 0.0 1.4 4.2 1.4 0.0

Mississippi 2 3 0 0 0 4.7 7.0 0.0 0.0 0.0

Missouri 4 3 3 3 1 5.2 3.9 3.9 3.9 1.3

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 1 0 0 0 0 3.9 0.0 0.0 0.0 0.0

Nevada 0 1 1 16 7 0.0 2.8 2.8 45.5 19.9

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 21 13 16 15 11 18.0 11.3 13.9 13.0 9.5

New Mexico 6 3 6 7 6 21.6 10.6 21.1 24.7 21.1

New York 42 22 10 24 16 16.6 8.8 4.0 9.6 6.4

North Carolina 20 9 11 7 7 16.9 7.5 9.2 5.8 5.8

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 3 2 2 0 1 2.0 1.3 1.3 0.0 0.7

Oklahoma 1 2 1 2 3 2.0 3.9 1.9 3.9 5.8

Oregon 0 0 0 0 2 0.0 0.0 0.0 0.0 4.4

Pennsylvania 2 0 1 4 8 1.4 0.0 0.7 2.8 5.5

Rhode Island 0 1 0 0 0 0.0 7.8 0.0 0.0 0.0

South Carolina 15 10 4 2 1 27.0 17.7 7.1 3.5 1.8

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 7 9 4 6 4 8.9 11.3 5.0 7.5 5.0

Texas 77 65 67 79 99 20.4 17.0 17.6 20.7 26.0

Utah 0 1 0 2 0 0.0 2.0 0.0 3.9 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 1 6 3 3 1 1.0 5.8 2.9 2.9 1.0

Washington 0 0 0 0 2 0.0 0.0 0.0 0.0 2.4

West Virginia 0 0 0 0 1 0.0 0.0 0.0 0.0 4.8

Wisconsin 0 1 2 0 1 0.0 1.4 2.9 0.0 1.4

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 432 375 339 373 430 10.6 9.1 8.2 9.1 10.5

Northeast 66 36 28 43 37 9.6 5.3 4.1 6.3 5.5

Midwest 74 62 52 33 31 8.3 7.0 5.8 3.7 3.5

South 184 173 148 185 226 12.2 11.3 9.7 12.1 14.8

West 108 104 111 112 136 10.7 10.2 10.9 11.0 13.4

Guam 1 0 1 0 2 30.5 0.0 29.3 0.0 58.6

Puerto Rico 17 11 13 15 8 33.5 21.5 25.4 29.3 15.6

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 18 11 14 15 10 32.4 19.6 24.9 26.7 17.8

TOTAL 450 386 353 388 440 10.9 9.3 8.5 9.3 10.6

Table 39. 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, 2003–2007

*Mother’s state of residence used to assign case.
144 Syphilis Tables STD Surveillance 2007

 Year of Birth Race/Ethnicity Cases Rate per 100,000 Live Births

2003

White, Non-Hispanic 35 1.5

Black, Non-Hispanic 201 34.7

Hispanic 166 18.2

Asian/Pacific Islander 14 6.5

American Indian/Alaska Native 2 5.1

Other 3 NA

Unknown 11 NA

Total 432 10.6

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 9.1

2005

White, Non-Hispanic 31 1.3

Black, Non-Hispanic 156 26.8

Hispanic 124 13.1

Asian/Pacific Islander 15 6.8

American Indian/Alaska Native 5 12.4

Other 2 NA

Unknown 6 NA

Total 339 8.2

2006

White, Non-Hispanic 39 1.7

Black, Non-Hispanic 151 26.9

Hispanic 151 16.0

Asian/Pacific Islander 10 4.5

American Indian/Alaska Native 5 12.4

Other 5 NA

Unknown 12 NA

Total 373 9.1

2007

White, Non-Hispanic 54 2.3

Black, Non-Hispanic 188 32.3

Hispanic 145 15.3

Asian/Pacific Islander 19 8.6

American Indian/Alaska Native 8 19.9

Other 4 NA

Unknown 12 NA

Total 430 10.5

Table 40. Congenital syphilis — Reported cases and rates in infants < 1 year of age by race/ethnicity of

mother: United States, 2003–2007

NA = Not applicable
STD Surveillance 2007 Chancroid Tables 145

Cases Rates per 100,000 Population

State/Area 2003 2004 2005 2006 2007 2003 2004 2005 2006 2007

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 2 1 0 0 0.0 0.0 0.0 0.0 0.0

Arkansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

California 0 1 1 0 1 0.0 0.0 0.0 0.0 0.0

Colorado 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Connecticut 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Delaware 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

District of Columbia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Florida 2 1 1 1 3 0.0 0.0 0.0 0.0 0.0

Georgia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Hawaii 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Idaho 0 2 0 0 0 0.0 0.1 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 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Louisiana 0 2 4 1 4 0.0 0.0 0.1 0.0 0.1

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Massachusetts 3 3 1 0 1 0.0 0.0 0.0 0.0 0.0

Michigan 0 2 0 1 0 0.0 0.0 0.0 0.0 0.0

Minnesota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Mississippi 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Missouri 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nevada 0 1 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 10 4 1 5 5 0.1 0.0 0.0 0.0 0.0

North Carolina 2 1 5 5 2 0.0 0.0 0.1 0.1 0.0

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 0 0 1 0 0 0.0 0.0 0.0 0.0 0.0

Oklahoma 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Oregon 2 1 0 0 0 0.1 0.0 0.0 0.0 0.0

Pennsylvania 1 1 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 24 4 0 0 0 0.6 0.1 0.0 0.0 0.0

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 0 1 0 0 0 0.0 0.0 0.0 0.0 0.0

Texas 3 3 1 5 5 0.0 0.0 0.0 0.0 0.0

Utah 2 1 0 0 0 0.1 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 0 1 0 0.0 0.0 0.0 0.0 0.0

Washington 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wisconsin 0 0 0 0 2 0.0 0.0 0.0 0.0 0.0

Wyoming 1 0 1 0 0 0.2 0.0 0.2 0.0 0.0

U.S. TOTAL 54 30 17 19 23 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 4 1 3 0 0 0.1 0.0 0.1 0.0 0.0

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 4 1 3 0 0 0.1 0.0 0.1 0.0 0.0

TOTAL 58 31 20 19 23 0.0 0.0 0.0 0.0 0.0

Table 41. Chancroid — Reported cases and rates by state/area listed in alphabetical order: United States and

outlying areas, 2003–2007
146 Selected STDs Table STD Surveillance 2007

Table 42. Selected STDs and complications — Initial visits to physicians' offices, National Disease and

Therapeutic Index: United States, 1966–2007

*Women only.

†Women 15-44 only. NA = Not available.

NOTE: Standard errors for estimates under 100,000 are not available. The relative standard error for estimates 100,000-300,000 are between 20%

and 30%; 300,000–600,000 are between 16% and 20%; 600,000–1,000,000 are 13% and 15%; and 1,000,000–5,000,000 are between 9% and 13%.

SOURCE: National Disease and Therapeutic Index (IMS Health). See Appendix (Other Data Sources) for more information.

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
XI DNEPPA
XI DNEPPA
Interpreting STD Surveillance Data

Sexually Transmitted Disease Surveillance,

2007 presents surveillance information

derived from the official statistics for the

reported occurrence of nationally notifiable

sexually transmitted diseases 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 (DSTDP), National Center for

HIV/AIDS, Viral Hepatitis, STD, and TB

Prevention (NCHHSTP), Centers for

Disease Control and Prevention (CDC).

Included among the dependencies,

possessions, and independent nations are

Guam, Puerto Rico, and the Virgin Islands.

These entities are identified as “outlying

areas” of the United States in selected

figures and tables.

Reporting Formats

STD morbidity data presented in this report 

are compiled from a combination of data

reported on standardized 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:

genital 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

STD Sur veil lance 2007 Appendix Interpreting STD Surveillance Data 147
Francisco, and Washington, D.C.), and

outlying areas of the United States. Note:

genital 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 case-specific data for congenital

syphilis in some reporting areas.

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 (41 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 on hardcopy forms and for

NETSS electronic data through June

25, 2008 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—2007 Rates and Population

The National Center for Health Statistics

released bridged race population counts for 

2000–2006 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 2006–2007 rates for

outlying areas were calculated using the

2006 population estimates.

Due to use of the updated population data, 

rates for the period 2000–2006 may be

different from prior Surveillance Reports.

1990—1999 Rates and Population

The population counts for 1990–1999

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.

148 Interpreting STD Surveillance Data Appendix STD Sur veil lance 2007
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 1941–1980 are based on

population estimates from the Bureau of

Census and currently maintained by the

Division of STD Prevention.

1941—2007 Congenital Syphilis Rates

and Live Births

Congenital syphilis (CS) data in Table 1 of

Sexually Transmitted Disease Surveillance

2007 represent the number of congenital

syphilis cases per 100,000 live births for all

years during the period 1941 through

2007. Previous publications presented

congenital syphilis rates per 100,000

population for 1941–1994 and rates for

cases diagnosed at < 1 year of age per

100,000 live births for 1995–2005. To

allow for trends in CS rates to be compared 

over the period 1941–2007, live births are

used as the denominator for CS and case

counts are no longer limited to those

diagnosed within the first year of life. CS

morbidity (i.e., case reports) is assigned by

year of birth. Rates of congenital syphilis for 

1963–1988 were calculated using published 

live birth data (NCHS; Vital Statistics

Report, United States, 1988

[Vol.1-Natality]). Congenital syphilis rates

for 1989–2003 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 2004–2007 were

calculated using live birth data for 2004.

Reporting Practices

Although most areas generally adhere to

the national notifiable STD case definitions

collaboratively developed by the Council of 

State and Territorial Epidemiologists

(CSTE) 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 areas, the

reporting from publicly supported

institutions (e.g., STD clinics) has been

more complete than from other sources

(e.g., private practitioners). Thus, trends

may not be representative of all segments

of the population.

Reporting of Metropolitan Statistical

Area-specific Surveillance Data

Sexually Transmitted Disease Surveillance,

2007 continues the presentation of STD

incidence data and rates for the fifty

Metropolitan Statistical Areas (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 city-specific morbidity

reports, MSAs (described below) were

chosen as a geographic unit smaller than a

state or territory for presentation of STD

morbidity data.

Metropolitan Statistical Areas are defined

by the Office of Management and Budget

STD Sur veil lance 2007 Appendix Interpreting STD Surveillance Data 149
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.

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/metro-city/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).

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 > 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 the period

1984–2007 are presented as STD clinic or

non-STD clinic only (Table A2).

150 Interpreting STD Surveillance Data Appendix STD Sur veil lance 2007
Definition of DHHS Regions

The ten U.S. Department of Health and

Human Services (DHHS) regions referred 

to in the text and figures include the

following jurisdictions: Region I =

Connecticut, Maine, Massachusetts, New

Hampshire, Rhode Island, and Vermont;

Region II = New Jersey, New York, Puerto

Rico, and U.S. Virgin Islands; Region III =

Delaware, District of Columbia, Maryland,

Pennsylvania, Virginia, and West Virginia;

Region IV = Alabama, Florida, Georgia,

Kentucky, Mississippi, North Carolina,

South Carolina, and Tennessee; Region V= 

Illinois, Indiana, Michigan, Minnesota,

Ohio, and Wisconsin; Region VI =

Arkansas, Louisiana, New Mexico,

Oklahoma, and Texas; Region VII = Iowa,

Kansas, Missouri, and Nebraska; Region

VIII = Colorado, Montana, North Dakota,

South Dakota, Utah, and Wyoming; Region 

IX = Arizona, California, Guam, Hawaii,

and Nevada; and Region X = Alaska,

Idaho, Oregon, and Washington.

Chlamydia Morbidity Reporting

Trends in chlamydia morbidity reporting

from many areas are more reflective of

changes in diagnosis, 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 areas

increase their usage of more sensitive

nucleic acid amplification tests. As areas

develop chlamydia prevention and control

programs, including improved surveillance

systems to monitor trends, the data should

improve and become more representative

of true trends in disease.

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. The Division of

STD Prevention is reviewing these data

collection and reporting changes to

determine their impact on syphilis

surveillance case definitions.

Congenital Syphilis Morbidity

Reporting

In 1988, the surveillance case definition for

congenital syphilis was changed. This case

definition has greater sensitivity than the

former definition.2 In addition, many areas

have greatly enhanced active case finding

for congenital syphilis since 1988. For these 

reasons, the number of reported cases

increased dramatically during 1989–1991.

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

STD Sur veil lance 2007 Appendix Interpreting STD Surveillance Data 151
city of residence of the mother for the

period 1995 through 2007.

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

and syphilis seroreactivity were calculated

for the following: women attending family

planning clinics and prenatal clinics, men

and women entering the National Job

Training Program, women attending Indian

Health Service clinics, men attending STD

clinics and primary care clinics participating 

in the MSM Prevalence Monitoring Project,

and men and women entering corrections

facilities. Positivity was calculated by

dividing the number of positive tests for

chlamydia, gonorrhea, or syphilis

(numerator) by the total number of positive 

and negative tests for each disease

(denominator) and was expressed as a

percentage. Except for the National Job

Training Program screening data, 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 those 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. 

For more details on chlamydia prevalence,

refer to the following annual publication:

Centers for Disease Control and

Prevention. Sexually Transmitted Disease

Surveillance 2007 Supplement: Chlamydia

Prevalence Monitoring Project Annual

Report 2007. Atlanta, GA: U.S. Department 

of Health and Human Services (available

first quarter 2009).

In the MSM Prevalence Monitoring Project,

the syphilis seroreactivity data in most

instances do not reflect confirmatory testing 

and thus biologic false positive test results

were not systematically excluded. The

extent to which these data reflect

prevalence of active syphilis infection varies 

by site. Similarly, in the Corrections

Prevalence Monitoring Project, syphilis

seroreactivity test results were not

confirmed. Only a few juvenile corrections

sites submitted data to CDC, making

overall interpretation difficult due to the

small sample size. Because only selected

corrections facilities participated in the

Corrections Prevalence Monitoring Project,

state-specific positivity for syphilis,

chlamydia, and gonorrhea may not be

representative of all corrections facilities in

the state.

152 Interpreting STD Surveillance Data Appendix STD Sur veil lance 2007
Prevalence data for region- and

state-specific figures were published with

permission from the Regional Infertility

Prevention Program, 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 the Gonococcal Isolate

Surveillance Project (GISP), a sentinel

system of 30 STD clinics and five regional

laboratories located throughout the United

States. For more details on findings from

GISP gonorrhea surveillance activities, refer 

to the following annual publication: Centers 

for Disease Control and Prevention.

Sexually Transmitted Disease Surveillance

2007 Supplement: Gonococcal Isolate

Surveillance Project (GISP) Annual Report

2007 (available first quarter, 2009). Atlanta, 

GA: U.S. Department of Health and

Human Services, 2008.

Other Surveillance Data Sources

National Health and Nutrition 

Examination Survey (NHANES)

NHANES is composed of a series of

cross-sectional surveys designed to provide

national statistics on the health and

nutritional status of the general household

population 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

sexually transmitted diseases was based on

analysis of data from the National Disease

and Therapeutic Index (NDTI)

(machine-readable files or summary

statistics for the period 1966 through

2007).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 

pelvic inflammatory disease or ectopic

pregnancy was based on analysis of data

from the National Hospital Discharge

Survey (machine-readable files for years

1980–2006), 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.

National Hospital Ambulatory Medical

Care Survey (NHAMCS-ER)

The National Hospital Ambulatory Medical

Care Survey (NHAMCS-ER)

(machine-readable files for 1995–2006)

was used to obtain estimates of the number 

of emergency room visits for pelvic

inflammatory disease among women ages

15 to 44 years. The estimates generated

using these data sources (NHDS and

NHAMCS-ER) are based on statistical

STD Sur veil lance 2007 Appendix Interpreting STD Surveillance Data 153
surveys and therefore have sampling

variability associated with the estimates.

Healthy People 2010 Objectives

Healthy People 20103 (HP2010)is a set of

health objectives for the U.S. to achieve

over the first decade of the new century. It

is used by people, States, communities,

professional organizations, and others to

help develop programs to improve health.

HP2010 builds on initiatives pursued over

the past two decades. The 1979 Surgeon

General’s Report, Healthy People, and

Healthy People 2000: National Health

Promotion and Disease Prevention

Objectives established national health

objectives and served as the basis for the

development of State and community

plans. Like its predecessors, Healthy People 

2010 was developed through a broad

consultation process, built on the best

scientific knowledge and designed to

measure programs over time. Healthy

People 2010 is organized into 28 focus

areas, each with objectives and measures

designed to drive action that will support

two overarching goals: 1) increasing the

quality and years of healthy life and 2)

eliminating health disparities.

Focus area 25 of Healthy People 2010 —

Sexually Transmitted Diseases, — contains

objectives and measures related to STDs.

The baselines, HP2010 targets and annual

progress toward the targets are reported in

Table A3. The year 2010 targets for the

diseases addressed in this report are:

primary and secondary syphilis — 0.2 case

per 100,000 population; congenital syphilis 

— 1.0 case per 100,000 live births; and

gonorrhea — 19.0 cases per 100,000

population. An additional target established 

in the HP2010 objectives is to reduce the

Chlamydia trachomatis test positivity to 3%

among females aged 15 to 24 years who

attend family planning and STD clinics and

among males aged 15 to 24 who attend

STD clinics.

Government Performance and

Results Act of 1993 (GPRA) Goals

The Government Performance and

Results Act of 1993 (GPRA) was enacted

by Congress to increase the confidence of 

citizens in the capability of the federal

government, to increase the effectiveness

and accountability of federal programs, to 

improve service delivery, to provide

agencies a uniform tool for internal

management and to assist Congressional

decision making. GPRA requires each

agency to have a performance plan with

long-term outcomes and annual,

measurable performance goals and to

report on these plans annually,

comparing results with annual goals.

There are two STD GPRA goals: 1)

reduction in pelvic inflammatory disease

(PID) and 2) elimination of syphilis. Each

of these goals has measures. The

long-term goals and measures of progress 

are reported in Table A4.

154 Interpreting STD Surveillance Data Appendix STD Sur veil lance 2007

1 Of fice of Man age ment and Bud get. Stan dards

for De fin ing Met ro pol i tan and Micropolitan

Sta tis ti cal Ar eas: No tice Fed eral Reg is ter

De cem ber 27, 2000; 65(249):82228-38.

2

Kaufman RE, Jones OG, Blount JH, Wiesner

PJ. Ques tion naire sur vey of re ported early

con gen i tal syph i lis: prob lems in di ag no sis,

pre ven tion, and treat ment. Sex u ally Trans mit ted 

Dis eases 1977;4:135-9.

3 U.S. Department of Health and Human

Services. Healthy People 2010. 2nd ed. With

Understanding and Improving Health and

Objectives for Improving Health. 2 vols.

Washington, DC: U.S. Government Printing

Office, November 2000.
STD Surveillance 2007 Appendix Percentage Unknown 155

Primary and Secondary Syphilis Gonorrhea Chlamydia

State 

Percent

Unknown

Race/

Ethnicity

Percent

Unknown

Age

Percent

Unknown

Sex

Percent

Unknown

Sex of

Partners

Percent

Unknown

Race/

Ethnicity

Percent

Unknown

Age

Percent

Unknown

Sex

Percent

Unknown

Race/

Ethnicity

Percent

Unknown

Age

Percent

Unknown

Sex

Alabama 1.8 0.0 0.0 4.5 24.7 0.3 0.0 28.0 0.3 0.0

Alaska* 0.0 0.0 0.0 100.0 0.0 0.0 0.0 0.0 0.0 0.0

Arizona 22.6 0.0 0.7 80.1 27.9 0.0 0.0 34.8 0.0 0.1

Arkansas 2.5 0.0 0.0 40.2 5.2 0.4 0.1 5.9 0.2 0.0

California 2.4 0.1 0.1 9.7 33.0 0.5 0.4 33.7 0.5 0.4

Colorado 7.0 0.0 0.0 8.8 31.9 0.0 0.0 55.5 0.1 0.0

Connecticut 2.6 0.0 0.0 2.6 26.6 0.5 0.0 35.4 0.8 0.0

Delaware 5.6 0.0 0.0 100.0 1.8 0.0 0.0 3.1 0.0 0.0

District of Columbia 1.1 0.0 0.0 21.3 29.0 0.7 0.5 41.4 0.6 0.4

Florida 7.8 0.0 0.0 13.4 12.5 0.1 0.0 15.8 0.1 0.0

Georgia 2.4 0.1 0.1 20.0 37.1 0.9 0.6 43.9 0.9 0.6

Hawaii* 0.0 0.0 0.0 0.0 37.0 0.2 0.0 52.1 0.1 0.0

Idaho* 100.0 0.0 0.0 0.0 27.1 0.0 1.9 26.0 0.1 0.9

Illinois 4.1 0.0 0.0 8.4 8.9 0.0 0.0 12.3 0.0 0.0

Indiana 3.7 0.0 0.0 0.0 14.7 0.0 0.3 18.0 0.0 0.5

Iowa 4.8 0.0 0.0 9.5 7.5 0.1 0.0 11.8 0.2 0.0

Kansas 0.0 0.0 0.0 7.1 23.8 0.2 0.0 35.9 0.4 0.0

Kentucky 3.6 0.0 0.0 7.1 18.8 0.1 0.1 22.9 0.2 0.1

Louisiana 2.1 0.0 0.0 100.0 15.0 0.3 1.0 22.6 0.5 1.4

Maine* 0.0 0.0 0.0 11.1 7.6 0.8 0.0 21.1 0.4 0.1

Maryland 2.0 0.0 0.0 13.0 22.7 0.4 0.0 28.6 0.4 0.1

Massachusetts 7.1 0.0 0.0 9.7 31.0 0.7 0.0 40.1 0.8 0.1

Michigan 0.8 0.0 0.0 17.1 40.2 0.3 0.3 44.6 0.3 0.4

Minnesota 6.8 0.0 0.0 0.0 14.2 0.0 0.0 15.4 0.0 0.0

Mississippi 0.8 0.8 0.0 9.0 17.4 0.1 0.0 19.3 0.1 0.0

Missouri 0.0 0.0 0.0 2.5 15.9 0.1 0.0 21.7 0.1 0.0

Montana* 25.0 0.0 0.0 62.5 32.0 0.0 0.0 30.3 0.4 0.3

Nebraska* 25.0 0.0 0.0 0.0 23.3 0.0 0.3 28.7 0.1 0.3

Nevada 11.7 0.0 0.0 2.7 29.4 0.3 0.0 37.8 0.4 0.1

New Hampshire 0.0 0.0 0.0 3.3 8.0 0.0 0.0 14.3 0.0 0.0

New Jersey 0.9 0.0 0.0 17.6 34.0 0.6 0.0 47.4 0.7 0.1

New Mexico 10.9 0.0 0.0 4.3 16.0 0.2 0.0 11.8 0.3 0.0

New York 11.5 0.0 0.0 20.5 32.8 0.5 0.1 41.7 0.5 0.1

North Carolina 0.0 0.0 0.0 100.0 1.6 0.0 0.0 2.2 0.0 0.0

North Dakota* 0.0 0.0 0.0 0.0 10.3 0.0 0.0 11.1 0.3 0.1

Ohio 2.1 0.0 0.0 5.7 25.3 1.2 0.6 31.1 1.4 0.9

Oklahoma 0.0 0.0 0.0 15.4 1.6 0.0 0.0 2.2 0.0 0.0

Oregon 0.0 0.0 0.0 100.0 6.5 0.0 0.0 12.0 0.0 0.0

Pennsylvania 6.1 0.0 0.0 2.7 20.3 0.1 0.0 23.6 0.0 0.1

Rhode Island 2.8 0.0 0.0 0.0 11.2 0.0 0.2 20.3 0.2 0.1

South Carolina 0.0 0.0 0.0 3.3 26.7 0.6 0.2 29.3 0.3 0.3

South Dakota* 0.0 0.0 0.0 0.0 1.5 2.3 0.4 2.2 1.8 0.0

Tennessee 0.0 0.0 0.0 1.4 4.7 0.1 0.0 7.2 0.1 0.0

Texas 0.3 0.0 0.0 2.3 9.8 0.3 0.2 9.5 0.2 0.2

Utah 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0

Vermont 0.0 0.0 0.0 30.0 3.1 0.0 0.0 1.1 0.0 0.0

Virginia 0.0 0.0 0.0 3.5 6.0 0.1 0.1 11.8 0.1 0.0

Washington 8.4 0.0 0.0 23.4 21.1 1.1 0.0 20.7 1.2 0.0

West Virginia* 0.0 0.0 0.0 0.0 13.1 0.3 0.0 14.5 0.2 0.0

Wisconsin 0.0 0.0 0.0 4.5 26.1 0.0 0.2 28.7 0.0 0.1

Wyoming* 50.0 0.0 0.0 0.0 23.5 0.0 0.0 23.0 0.9 0.0

U.S. TOTAL 4.1 0.0 0.0 19.5 20.3 0.3 0.2 25.7 0.4 0.2

*Percentages for P&S syphilis are based on less than 10 cases.

NOTE: "Un known" in cludes un known, miss ing, or in valid data val ues.

Table A1. Selected STDs — Percentage of unknown, missing, or invalid values for selected variables by state

and by nationally notifiable STD, 2007
156 STD Reporting Source Appendix STD Surveillance 2007

Non-STD Clinic STD Clinic Total*

Disease Male Female Total Male Female Total Male Female Total

Chlamydia 165,128 658,503 825,160 92,906 98,382 191,495 280,337 825,660 1,108,374

Gonorrhea 90,669 137,261 228,359 62,320 32,495 94,891 167,684 187,595 355,991

Primary Syphilis 1,742 177 1,919 1,018 120 1,138 2,837 303 3,140

Secondary Syphilis 4,860 841 5,703 1,834 497 2,334 6,932 1,389 8,326

Early Latent Syphilis 5,092 1,886 6,982 2,265 995 3,260 7,751 3,013 10,768

Late and Late Latent Syphilis†8,646 4,927 13,582 2,375 1,378 3,755 11,637 6,604 18,256

Chancroid 5 8 13 1 2 3 8 15 23

Table A2. Reported cases of sexually transmitted disease by reporting source and sex: United States, 2007

*Totals include 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.

See Appendix (Classification of STD Morbidity Reporting Sources).
STD Surveillance 2007 Appendix Healthy People 2010 157

HP 2010 Objectives

Baseline

Year Baseline 2003 2004 2005 2006 2007

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% 6.4%* 6.9%* 6.9%* 7.1%* 7.5%* 3.0%

b. Females aged 15 to 24 years attending STD clinics 1997 12.2% 14.1%* 15.3%* 15.4%* 14.8%* 15.3%* 3.0%

c. Males aged 15 to 24 years attending STD clinics 1997 15.7% 19.3%* 20.8%* 20.5%* 20.8%* 22.4%* 3.0%

d. Females aged 24 years or less enrolled in National

Job Training Program

2002 10.1% 9.9% 10.3% 9.2% 13.1% 13.2% 6.8%

25–2 Reduce the incidence of gonorrhea (new cases per

100,000 population)

a. Reduce gonorrhea incidence per 100,000 population 1997 123.0 115.2 112.4 114.6 119.7 118.9 19.0

b. Females aged 15 to 44 years 2002 279.0 270.0 267.0 275.0 290.0 290.0 42.0

25–3 Eliminate sustained domestic transmission of

primary and secondary syphilis (cases per 100,000

population)

1997 3.2 2.5 2.7 2.9 3.3 3.8 0.2

25–4 Reduce the proportion of adults aged 20 to 29 years

with genital herpes infection

1988–94 17.0% NA 10.0%† 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% 5.0%‡ 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% 22.0%‡ NA NA NA NA 15.0%

25–9 Reduce congenital syphilis (cases per 100,000 live

births)

1997 27.0 10.6 9.1 8.2 9.3 10.5 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 53.0 NA 53.0 NA 52.0 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 26.0 NA 27.0 NA 27.0 30.0

c. Increase the proportion of adolescents (grades 9

through 12) who used condoms at last intercourse

1999 58.0 63.0 NA 63.0 NA 62.0 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

2002 25.0 30.0 32.0 35.0 37.0 38.0 62.0

b. Females aged 25 years and under enrolled in

Medicaid MCOs

2002 41.0 45.0 47.0 51.0 52.0 52.0 62.0

Table A3. Healthy People 2010 Sexually Transmitted Diseases Objective Status

HP 2010 Ob jec tive Data Source

25–1 a, b, c

25–1 d

25–2 a, b

25–3

25–4

25–6

25–7

25–9

25–11 a, b, c

25–13

25–16 a, b

STD Surveillance System (STDSS), CDC, NCHHSTP.

Na tional Job Train ing Program.

STD Surveil lance System (STDSS), CDC, NCHHSTP.

STD Surveil lance System (STDSS), CDC, NCHHSTP.

Na tional Health and Nu tri tion Ex am i na tion Sur vey (NHANES), CDC, NCHS.

Na tional Survey of Family Growth (NSFG), CDC, NCHS.

Na tional Survey of Family Growth (NSFG), CDC, NCHS.

STD Surveil lance Sys tem, CDC, NCHHSTP, Na tional Vi tal Sta tis tics Sys tem- Na tal ity (NVSS-N), CDC, NCHS.

Youth Risk Be hav ior Sur veil lance Sys tem (YRBSS), CDC, NCCDPHP.

Sur vey of STD Pro grams, Na tional Co ali tion of STD Direc tors (NCSD); IHS.

Healthcare Ef fec tive ness Data and In for ma tion Set (HEDIS), Na tional Com mit tee for Qual ity As sur ance (NCQA).

*Over all positivity not ad justed for changes in lab o ra tory test method and as so ci ated in creases in test sen si tiv ity.

†Data for years 1999–2004.

‡Data shown are for 2002, the most recent year these data were released. Be gin ning in 2009, data will be re leased ev ery 2 years.

NOTE: Healthy Peo ple 2010 de vel op men tal ob jec tives are not ad dressed in this re port.

NA=Not avail able.
158 GPRA Goals Appendix STD Surveillance 2007

GPRA Goals Baseline Actual Performance

Long-Term

 Goal 

2002 2006 2007 2010

Goal 1: Re duc tion in PID (as mea sured by ini tial vis its to phy si cians in women

15–44-years of age) 197,000 106,000 146,000 168,000

a. Prevalence of Chlamydia in high-risk women 25 years 10.1%* 13.1%* 13.2%* 15.1%

b. Prevalence of Chlamydia in women 25 years in family planning clinics 5.6%* 6.7%* 6.9%* 7.4%

c. Incidence of Gonorrhea/100,000 population in women 15–44 years of age 279 290 290 296

Goal 2: Elimination of Syphilis (as measured by incidence of P&S

Syphilis/100,000 population)

2.4 3.3 3.8 2.2

a. Incidence of P&S Syphilis/100,000 population - men 3.8 5.6 6.6 7.2

b. Incidence of P&S Syphilis/100,000 population - women 1.1 1.0 1.1 1.2

c. Incidence of Congenital Syphilis/100,000 live births 10.2 9.3 10.5 9.4 

d. Black:white rate ratio of P&S Syphilis 8:1 5.9:1 7:1 6.7:1

GPRA Goals Data Source

1 

1–a

1–b

1–c

2 

2–a

2–b

2–c

2–d

Na tional Dis ease and Ther a peu tic In dex (IMS Health).

Na tional Job Train ing Pro gram.

Re gional In fer til ity Pre ven tion Pro jects (IPP). 

STD Surveil lance System (STDSS), CDC, NCHHSTP.

STD Surveil lance System (STDSS), CDC, NCHHSTP.

STD Surveil lance System (STDSS), CDC, NCHHSTP.

STD Surveil lance System (STDSS), CDC, NCHHSTP.

STD Surveil lance System (STDSS), CDC, NCHHSTP.

STD Surveil lance System (STDSS), CDC, NCHHSTP.

*Me dian state-spe cific chlamydia prev a lence among women was not ad justed for changes in lab o ra tory test method and as so ci ated in creases in test

sen si tiv ity.

Table A4. Government Performance Results Act (GPRA) Sexually Transmitted Diseases Goals and Measures
STD Sur veil lance Case Def i ni tions

PART 1. CASE DEF I NI TIONS1FOR NA TION ALLY NO TI FI ABLE IN FEC TIOUS DIS EASES

Chancroid (Re vised 9/96)

Clin i cal de scrip tion

A sex u ally trans mit ted dis ease char ac ter ized by pain ful gen i tal ul cer ation and in flam ma tory in -

gui nal adenopathy. The dis ease is caused by in fec tion with Haemophilus ducreyi.

Lab o ra tory cri te ria for di ag no sis

• Iso la tion of H. ducreyi from a clin i cal spec i men

Case clas si fi ca tion

Prob a ble: a clin i cally com pat i ble case with both a) no ev i dence of Treponema pallidum in fec tion by

darkfield mi cro scopic ex am i na tion of ul cer exudate or by a se ro logic test for syph i lis performed 7

days af ter on set of ul cers and b) ei ther a clin i cal pre sen ta tion of the ul cer(s) not typi cal of dis ease

caused by her pes sim plex vi rus (HSV) or a culture neg a tive for HSV.

Con firmed: a clin i cally com pat i ble case that is lab o ra tory con firmed

Chlamydia trachomatis, Gen i tal In fec tions (Re vised 9/96)

Clin i cal de scrip tion

In fec tion with Chlamydia trachomatis may re sult in ure thri tis, epididymitis, cervicitis, acute

salpingitis, or other syn dromes when sex u ally trans mit ted; how ever, the in fec tion is of ten asymp -

tom atic in women. Perinatal in fec tions may re sult in in clu sion con junc ti vi tis and pneu mo nia in new -

borns. Other syn dromes caused by C. trachomatis in clude lymphogranuloma venereum (see

Lymphogranuloma Venereum) and tra choma.

Lab o ra tory cri te ria for di ag no sis

• Iso la tion of C. trachomatis by cul ture or

• Dem on stra tion of C. trachomatis in a clin i cal spec i men by de tec tion of an ti gen or

nu cleic acid

Case clas si fi ca tion

Con firmed: a case that is lab o ra tory con firmed

Gon or rhea (Re vised 9/96)

Clin i cal de scrip tion

A sex u ally trans mit ted in fec tion com monly man i fested by ure thri tis, cervicitis, or salpingitis.

In fec tion may be asymp tom atic.

Lab o ra tory cri te ria for di ag no sis

• Iso la tion of typ i cal gram-neg a tive, oxidase-pos i tive diplococci (pre sump tive

Neisseria gonorrhoeae) from a clin i cal spec i men, or

STD Sur veil lance 2007 Appendix STD Sur veil lance Case Def i ni tions 159
• Dem on stra tion of N. gonorrhoeae in a clin i cal spec i men by de tec tion of an ti gen or

nu cleic acid, or

• Ob ser va tion of gram-neg a tive intracellular diplococci in a ure thral smear ob tained

from a male

Case clas si fi ca tion

Prob a ble: a) dem on stra tion of gram-neg a tive intracellular diplococci in an endocervical smear ob -

tained from a fe male or b) a writ ten mor bid ity re port of gon orrhea sub mit ted by a phy si cian

Con firmed: a case that is lab o ra tory con firmed

Syph i lis (All Def i ni tions Re vised 9/96)

Syph i lis is a com plex sex u ally trans mit ted dis ease that has a highly vari able clin i cal course. Clas si -

fi ca tion by a cli ni cian with ex pertise in syph i lis may take pre ce dence over the fol low ing case def i ni -

tions de vel oped for sur veil lance pur poses.

Syph i lis, pri mary

Clin i cal de scrip tion

A stage of in fec tion with Treponema pallidum char ac ter ized by one or more chan cres (ul cers);

chan cres might dif fer con sid er ably in clin i cal ap pear ance.

Lab o ra tory cri te ria for di ag no sis

• Dem on stra tion of T. pallidum in clin i cal spec i mens by darkfield mi cros copy, di rect

flu o res cent an ti body (DFA-TP), or equiv a lent meth ods

Case clas si fi ca tion

Prob a ble: a clin i cally com pat i ble case with one or more ul cers (chan cres) con sis tent with pri mary

syph i lis and a re ac tive se ro logic test (nontreponemal: Ve ne real Dis ease Re search Lab o ra tory

[VDRL] or rapid plasma reagin [RPR]; treponemal: flu o res cent treponemal an ti body absorbed

[FTA-ABS] or microhemagglutination as say for anti body to T. pallidum [MHA-TP])

Con firmed: a clin i cally com pat i ble case that is lab o ra tory con firmed

Syph i lis, sec ond ary

Clin i cal de scrip tion

A stage of in fec tion caused by T. pallidum and char ac ter ized by lo cal ized or dif fuse

mucocutaneous le sions, of ten with gen er al ized lymphadenopathy. The pri mary chan cre may still

be pres ent.

Lab o ra tory cri te ria for di ag no sis

• Dem on stra tion of T. pallidum in clin i cal spec i mens by darkfield mi cros copy, DFATP,

or equiv a lent meth ods

Case clas si fi ca tion

Prob a ble: a clin i cally com pat i ble case with a nontreponemal (VDRL or RPR) ti ter 4

Con firmed: a clin i cally com pat i ble case that is lab o ra tory con firmed

160 STD Sur veil lance Case Def i ni tions Appendix STD Sur veil lance 2007
Syph i lis, la tent

Clin i cal de scrip tion

A stage of in fec tion caused by T. pallidum in which or gan isms per sist in the body of the in fected

per son with out caus ing symp toms or signs. La tent syph i lis is sub di vided into early, late, and un -

known cat e go ries based on the du ra tion of in fec tion.

Case clas si fi ca tion

Prob a ble: no clin i cal signs or symp toms of syph i lis and the pres ence of one of the follow ing:

• No past di ag no sis of syph i lis, a re ac tive nontreponemal test (i.e., VDRL or RPR), and

a re ac tive treponemal test (i.e., FTA-ABS or MHA-TP)

• A past his tory of syph i lis ther apy and a current nontreponemal test ti ter dem on strat ing 

four fold or greater in crease from the last nontreponemal test ti ter

Syph i lis, early la tent

Clin i cal de scrip tion

A sub cat e gory of la tent syph i lis. When ini tial in fec tion has oc curred within the pre vi ous 12

months, la tent syph i lis is clas si fied as early la tent.

Case clas si fi ca tion

Prob a ble: la tent syph i lis (see Syph i lis, la tent) in a per son who has evi dence of hav ing ac quired the 

in fec tion within the pre vi ous 12 months based on one or more of the fol low ing cri te ria:

• Doc u mented seroconversion or four fold or greater in crease in ti ter of a

nontreponemal test dur ing the pre vi ous 12 months

• A his tory of symp toms con sis tent with pri mary or sec ond ary syph i lis dur ing the

pre vi ous 12 months

• A his tory of sexual ex po sure to a part ner who had con firmed or prob a ble pri mary or

sec ond ary syph i lis or prob a ble early la tent syph i lis (doc u mented in de pend ently as

du ra tion 1 year)

• Re ac tive nontreponemal and treponemal tests from a per son whose only pos si ble

ex po sure oc curred within the pre ced ing 12 months

Syph i lis, late la tent

Clin i cal de scrip tion

A sub cat e gory of la tent syph i lis. When ini tial in fec tion has oc curred > 1 year pre vi ously, la tent

syph i lis is clas si fied as late la tent.

Case clas si fi ca tion

Prob a ble: la tent syph i lis (see Syph i lis, la tent) in a pa tient who has no ev i dence of hav ing ac quired

the dis ease within the pre ced ing 12 months (see Syph i lis, early la tent) and whose age and ti ter do

not meet the cri te ria spec i fied for la tent syph i lis of un known du ra tion.

Syph i lis, la tent, of un known du ra tion

Clin i cal de scrip tion

A sub cat e gory of la tent syph i lis. When the date of ini tial in fec tion can not be es tab lished as hav ing

oc curred within the pre vi ous year and the pa tient’s age and ti ter meet cri te ria de scribed be low, la -

tent syph i lis is clas si fied as la tent syph i lis of un known du ra tion.

STD Sur veil lance 2007 Appendix STD Sur veil lance Case Def i ni tions 161
Case clas si fi ca tion

Prob a ble: la tent syph i lis (see Syph i lis, la tent) that does not meet the cri te ria for early la tent syph i -

lis, and the pa tient is aged 13–35 years and has a nontreponemal ti ter 32

Neurosyphilis

Note

Since neurosyphilis can oc cur at al most any stage of syph i lis, be tween 1996 and 2005, it was clas -

si fied and re ported as one of sev eral mu tu ally ex clu sive stages of syph i lis. In 2005, the Di vi sion of

STD Pre ven tion re quested that STD con trol pro grams dis con tinue clas si fy ing and re port ing

neurosyphilis as a dis tinct stage of syph i lis. Since 2005, if the pa tient has con firmed or prob a bly

neurosyphilis, the case should be re ported as the ap pro pri ate state of syph i lis and neu ro log i cal

man i fes ta tions should be noted.

Clin i cal de scrip tion

Ev i dence of cen tral ner vous sys tem in fec tion with T. pallidum

Lab o ra tory cri te ria for di ag no sis

• A re ac tive se ro logic test for syph i lis and re ac tive VDRL in cerebrospinal fluid (CSF)

Case clas si fi ca tion

Prob a ble: syph i lis of any stage, a nega tive VDRL in CSF, and both the follow ing:

• El e vated CSF pro tein or leu ko cyte count in the ab sence of other known causes of

these ab nor mal i ties

• Clin i cal symp toms or signs con sis tent with neurosyphilis with out other known causes

for these clin i cal ab nor mal i ties

Con firmed: syph i lis of any stage that meets the lab o ra tory cri te ria for neurosyphilis

Syph i lis, late, with clin i cal man i fes ta tions other than neurosyphilis (late be nign syph i lis

and car dio vas cu lar syph i lis)

Clin i cal de scrip tion

Clin i cal man i fes ta tions of late syph i lis other than neurosyphilis may in clude in flam ma tory le sions

of the car dio vas cu lar system, skin, and bone. Rarely, other struc tures (e.g., the up per and lower re -

spi ra tory tracts, mouth, eye, ab dom i nal or gans, re pro duc tive or gans, lymph nodes, and skel e tal

mus cle) may be in volved. Late syph i lis usu ally be comes clin i cally man i fest only af ter a pe riod of

15–30 years of un treated in fec tion.

Lab o ra tory cri te ria for di ag no sis

Dem on stra tion of T. pallidum in late le sions by flu o res cent an ti body or spe cial stains (al though organ isms are rarely vi su al ized in late le sions)

Case clas si fi ca tion

Prob a ble: char ac ter is tic ab nor mal i ties or le sions of the car dio vas cu lar sys tem, skin, bone, or

other struc tures with a re ac tive treponemal test, in the absence of other known causes of these ab -

nor mal i ties, and with out CSF ab nor mal i ties and clin i cal symp toms or signs con sis tent with

neurosyphilis

Con firmed: a clin i cally com pat i ble case that is lab o ra tory con firmed

Com ment

Anal y sis of CSF for ev i dence of neurosyphilis is nec es sary in the eval u a tion of late syph i lis with

clin i cal man i fes ta tions.

162 STD Sur veil lance Case Def i ni tions Appendix STD Sur veil lance 2007
Syph i litic Still birth

Clin i cal de scrip tion

A fe tal death that oc curs af ter a 20-week ges ta tion or in which the fe tus weighs > 500 g and the

mother had un treated or in ad e quately treated* syph i lis at de liv ery

Com ment

For re port ing pur poses, syph i litic still births should be re ported as cases of con gen i tal syph i lis.

Syph i lis, Con gen i tal (Re vised 9/96)

Clin i cal de scrip tion

A con di tion caused by in fec tion in utero with Treponema pallidum. A wide spec trum of se ver ity

ex ists, and only se vere cases are clin i cally ap parent at birth. An in fant or child (aged < 2 years) may

have signs such as hepatosplenomegaly, rash, condyloma lata, snuf fles, jaun dice (nonviral hep a ti -

tis), pseudoparalysis, ane mia, or edema (nephrotic syn drome and/or mal nu tri tion). An older child

may have stig mata (e.g., in ter sti tial keratitis, nerve deaf ness, an te rior bow ing of shins, fron tal boss -

ing, mul berry mo lars, Hutch in son teeth, sad dle nose, rhagades, or Clutton joints).

Lab o ra tory cri te ria for di ag no sis

Dem on stra tion of T. pallidum by darkfield mi cros copy, flu o res cent an ti body, or other spe cific

stains in spec i mens from le sions, pla centa, um bil i cal cord, or au topsy ma te rial

Case clas si fi ca tion

Prob a ble: a con di tion af fect ing an in fant whose mother had un treated or in ad e quately treated*

syph i lis at de liv ery, re gardless of signs in the in fant, or an in fant or child who has a re ac tive

treponemal test for syph i lis and any one of the fol low ing:

• Any ev i dence of con gen i tal syph i lis on phys i cal ex am i na tion

• Any ev i dence of con gen i tal syph i lis on ra dio graphs of long bones

• A re ac tive cerebrospinal fluid (CSF) ve ne real dis ease re search lab o ra tory (VDRL)

• An el e vated CSF cell count or protein (with out other cause)

• A re ac tive flu o res cent treponemal an ti body ab sorbed—19S-IgM an ti body test or IgM

en zyme-linked immunosorbent as say

Con firmed: a case that is lab o ra tory con firmed

Com ment

Con gen i tal and ac quired syph i lis may be dif fi cult to dis tin guish when a child is se ro pos i tive af ter

in fancy. Signs of con gen i tal syph i lis may not be ob vi ous, and stig mata may not yet have de vel oped.

Ab normal values for CSF VDRL, cell count, and pro tein, as well as IgM an ti bod ies, may be found in

ei ther con gen i tal or ac quired syph i lis. Find ings on ra dio graphs of long bones may help be cause ra -

dio graphic changes in the metaphysis and epiph y sis are con sid ered clas sic signs of con gen i tally ac -

quired syph i lis. The de ci sion may ul ti mately be based on ma ternal his tory and clin i cal judg ment. In

a young child, the pos si bil ity of sex ual abuse should be con sid ered as a cause of ac quired rather

than con gen i tal syph i lis, de pend ing on the clin i cal pic ture. For re port ing pur poses, con gen i tal syph i -

lis in cludes cases of con gen i tally ac quired syph i lis among in fants and chil dren as well as syph i litic

still births.

*In ad e quate treat ment con sists of any nonpenicillin ther apy or pen i cil lin ad min is tered 30 days be -

fore de liv ery.

STD Sur veil lance 2007 Appendix STD Sur veil lance Case Def i ni tions 163
PART 2. CASE DEF I NI TIONS1

FOR NON-NO TI FI ABLE IN FEC TIOUS DIS EASES

Gen i tal Her pes (Her pes Sim plex Vi rus) (Re vised 9/96)

Clin i cal de scrip tion

A con di tion char ac ter ized by vis i ble, pain ful gen i tal or anal le sions

Lab o ra tory cri te ria for di ag no sis

• Iso la tion of her pes sim plex vi rus from cer vix, ure thra, or anogenital le sion, or

• Dem on stra tion of vi rus by an ti gen de tec tion tech nique in clin i cal spec i mens from

cer vix, ure thra, or anogenital le sion, or

• Dem on stra tion of multinucleated gi ant cells on a Tzanck smear of scrap ings from an

anogenital le sion

Case clas si fi ca tion

Prob a ble: a clin i cally com pat i ble case (in which pri mary and sec ond ary syph i lis have been ex -

cluded by ap pro pri ate se ro logic tests and darkfield mi cros copy, when avail able) with ei ther a di ag -

no sis of gen i tal her pes based on clin i cal pre sen ta tion (with out lab o ra tory con fir ma tion) or a his tory

of one or more pre vi ous ep i sodes of simi lar gen i tal le sions

Con firmed: a clin i cally com pat i ble case that is lab o ra tory con firmed

Com ment

Gen i tal her pes should be re ported only once per pa tient. The first di ag no sis for a pa tient with no

pre vi ous di ag no sis should be re ported.

Gen i tal Warts (Re vised 9/96)

Clin i cal de scrip tion

An in fec tion char ac ter ized by the pres ence of vis i ble, exophytic (raised) growths on the in ternal or 

ex ter nal gen i ta lia, per i neum, or perianal re gion

Lab o ra tory cri te ria for di ag no sis

• Histopathologic changes char ac ter is tic of hu man papillomavirus in fec tion in

spec i mens ob tained by biopsy or exfoliative cy tol ogy or

• Dem on stra tion of vi rus by an ti gen or nu cleic acid de tec tion in a le sion bi opsy

Case clas si fi ca tion

Prob a ble: a clin i cally com pat i ble case with out histopathologic di ag no sis and with out mi cro scopic or 

se ro logic ev i dence that the growth is the re sult of sec ond ary syph i lis

Con firmed: a clin i cally com pat i ble case that is lab o ra tory con firmed

Com ment

Gen i tal warts should be re ported only once per pa tient. The first di ag no sis for a pa tient with no

pre vi ous di ag no sis should be re ported.

Granuloma Inguinale

Clin i cal de scrip tion

A slowly progres sive ul cer ative dis ease of the skin and lymphatics of the gen i tal and perianal area

caused by in fec tion with Calymmatobacterium granulomatis. A clin i cally com pat i ble case would

have one or more pain less or min i mally pain ful granulomatous le sions in the anogenital area.

164 STD Sur veil lance Case Def i ni tions Appendix STD Sur veil lance 2007
Lab o ra tory cri te ria for di ag no sis

• Dem on stra tion of intracytoplasmic Don o van bodies in Wright or Giemsa-stained

smears or bi op sies of gran u la tion tis sue

Case clas si fi ca tion

Con firmed: a clin i cally com pat i ble case that is lab o ra tory con firmed

Lymphogranuloma Venereum

Clin i cal de scrip tion

In fec tion with L1, L2, or, L3 serovars of Chlamydia trachomatis may re sult in a dis ease char ac ter -

ized by gen i tal le sions, sup pu ra tive re gional lymphadenopathy, or hemorrhagic proctitis. The in fec -

tion is usu ally sex u ally trans mit ted.

Lab o ra tory cri te ria for di ag no sis

• Iso la tion of C. trachomatis, serotype L1, L2, or L3 from clin i cal spec i men, or

• Dem on stra tion by immunofluorescence of in clu sion bod ies in leu ko cytes of an

in gui nal lymph node (bubo) as pi rate, or

• Pos i tive microimmunofluorescent se ro logic test for a lymphogranuloma venereum

strain of C. trachomatis

Case clas si fi ca tion

Prob a ble: a clin i cally com pat i ble case with one or more ten der fluctuant in gui nal lymph nodes or

char ac ter is tic proctogenital le sions with sup port ive lab o ra tory find ings of a sin gle C. trachomatis

com ple ment fix a tion ti ter of > 64

Con firmed: a clin i cally com pat i ble case that is lab o ra tory con firmed

Mucopurulent Cervicitis (Re vised 9/96)

Clin i cal de scrip tion

Cervi cal in flam ma tion that is not the re sult of in fec tion with Neisseria gonorrhoeae or

Trichomonas vaginalis. Cervi cal in flam ma tion is de fined by the pres ence of one of the follow ing

cri te ria:

• Mucopurulent se cre tion (from the endocervix) that is yel low or green when viewed on 

a white, cot ton-tipped swab (pos i tive swab test)

• In duced endocervical bleed ing (bleed ing when the first swab is placed in the

endocervix)

Lab o ra tory cri te ria for di ag no sis

• No ev i dence of N. gonorrhoeae by cul ture, Gram stain, or an ti gen or nu cleic acid

de tec tion, and no ev i dence of T. vaginalis on wet mount

Case clas si fi ca tion

Con firmed: a clin i cally com pat i ble case in a fe male who does not have ei ther gon orrhea or

trichomoniasis

Com ment

Mucopurulent cervicitis (MPC) is a clin i cal di ag no sis of ex clu sion. The syn drome may re sult from

in fec tion with any of sev eral agents (see Chlamydia trachomatis, Gen i tal In fec tions). If gon or rhea,

trichomoniasis, and chlamydia are ex cluded, a clin i cally com pat i ble ill ness should be clas si fied as

STD Sur veil lance 2007 Appendix STD Sur veil lance Case Def i ni tions 165
MPC. An ill ness in a fe male that meets the case def i ni tion of MPC and C. trachomatis in fec tion

should be clas si fied as chlamydia.

Nongonococcal Ure thri tis (Re vised 9/96)

Clin i cal de scrip tion

Ure thral in flam ma tion that is not the re sult of in fec tion with Neisseria gonorrhoeae. Ure thral in -

flam ma tion may be di ag nosed by the pres ence of one of the fol low ing cri te ria:

• A vis i ble ab nor mal ure thral dis charge, or

• A pos i tive leu ko cyte esterase test from a male aged 60 years who does not have a

his tory of kid ney dis ease or blad der in fec tion, pros tate en large ment, uro gen i tal

an a tomic anom aly, or re cent uri nary tract in stru men ta tion, or

• Mi cro scopic ev i dence of ure thri tis ( 5 white blood cells per high-power field) on a

Gram stain of a ure thral smear

Lab o ra tory cri te ria for di ag no sis

• No ev i dence of N. gonorrhoeae in fec tion by cul ture, Gram stain, or an ti gen or nu cleic

acid de tec tion

Case clas si fi ca tion

Con firmed: a clin i cally com pat i ble case in a male in whom gon orrhea is not found, ei ther by culture, 

Gram stain, or an ti gen or nu cleic acid de tec tion

Com ment

Nongonococcal ure thri tis (NGU) is a clin i cal di ag no sis of ex clu sion. The syn drome may re sult

from in fec tion with any of sev eral agents (see Chlamydia trachomatis, Gen i tal In fec tion). If gon orrhea and chlamydia are ex cluded, a clin i cally com pat i ble ill ness should be clas si fied as NGU. An ill -

ness in a male that meets the case def i ni tion of NGU and C. trachomatis in fec tion should be

clas si fied as chlamydia.

Pel vic In flam ma tory Dis ease (Re vised 9/96)

Clin i cal case def i ni tion

A clin i cal syn drome re sult ing from the as cend ing spread of mi cro or gan isms from the va gina and

endocervix to the endometrium, fal lo pian tubes, and/or con tig u ous struc tures. In a fe male who has

lower ab dom i nal pain and who has not been di ag nosed as hav ing an es tab lished cause other than

pel vic in flam ma tory dis ease (PID) (e.g., ectopic preg nancy, acute ap pen di ci tis, and func tional

pain), all the fol low ing clin i cal cri te ria must be pres ent:

• Lower ab dom i nal ten der ness, and

• Ten der ness with mo tion of the cer vix, and

• Adnexal ten der ness

In ad di tion to the pre ced ing cri te ria, at least one of the fol low ing find ings must also be pres ent:

• Meets the sur veil lance case def i ni tion of C. trachomatis in fec tion or gon or rhea

• Tem per a ture > 100.4 F (> 38.0 C)

• Leukocytosis > 10,000 white blood cells/mm3

• Pu ru lent ma te rial in the peritoneal cav ity ob tained by culdocentesis or lap a ros copy

166 STD Sur veil lance Case Def i ni tions Appendix STD Sur veil lance 2007
• Pel vic ab scess or in flam ma tory com plex de tected by bimanual ex am i na tion or by

sonography

• Pa tient is a sex ual con tact of a per son known to have gon or rhea, chlamydia, or

nongonococcal ure thri tis

Case clas si fi ca tion

Con firmed: a case that meets the clin i cal case def i ni tion

Com ment

For re port ing pur poses, a cli ni cian’s re port of PID should be counted as a case.

STD Sur veil lance 2007 Appendix STD Sur veil lance Case Def i ni tions 167

1 Centers for Disease Control and Prevention.

Case definitions for infectious conditions under

public health surveillance, 1997. MMWR

1997;46(No. RR-10;1).
STD Project Directors, STD Program Managers, State and Territorial Epidemiologists and Laboratory Directors

We grate fully acknowl edge the con tri bu tions of state STD pro ject di rec tors, STD pro gram man ag ers, state and ter ri to rial

epidemiologists and laboratory directors. The per sons listed were in the po si tions shown as of November 4, 2008.

State/City/Outlying Area STD Project Directors STD Program Managers State Epidemiologists Laboratory Directors

Al a bama Charles Woernle Sandra Langston Charles Woernle William Callan

Alaska Mollie Rosier Donna Cecere Joe McLaughlin Bernard Jilly

Arizona Judy Norton Alfonso Urquidi Kenneth Komatsu Victor Waddell

Arkansas Kellye McCartney 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 Jeffrey Klausner Wendy Wolf Gilberto Chavez Sally Liska

Colorado Maureen Bush Ralph Wilmoth Ken Gershman David Butcher

Connecticut James Hadler Heidi Jenkins Matthew Cartter John Fontana

Delaware James Welch Catherine Mosley Ashley Love Jane Getchell

District of Columbia John Heath John Heath John Davies-Cole Maurice Knuckles

Florida Russell Eggert Karla Schmitt Richard Hopkins Max Salfinger

Georgia Vacant Russ Cantrell John Horan Elizabeth Franko

Hawaii Peter Whiticar Roy Ohye Sarah Park A. Christian Whelen

Idaho Richard Armstrong Kathy Cohen Christine G. Hahn Richard Hudson

Illinois Charlie Rabins Ed Renier Craig Conover (Acting) Tom Johnson

Chicago Will Wong John Paffel Craig Conover (Acting) Susan Gerber

Indiana Jerry Burkman Dawne Rekas James Howell Judith Lovchik

Iowa Mary Jones Karen Thompson Patricia Quinlisk Christopher Atchison

Kansas Brenda Walker Derek Coppedge Charles Hunt Patrick Williams

Kentucky Robert Brawley Sheri White Kraig Humbaugh Stephanie Gibson

Louisiana Lisa Ann Longfellow Lisa Ann Longfellow Raoult Ratard Stephen Martin

Maine Bob Woods Jennah Godo Kathleen Gensheimer John Krueger

Maryland Barbara Conrad Glen Oltoff David Blythe Jack DeBoy

Baltimore Laura Herrera Victoria Stovall David Blythe Jack DeBoy

Massachusetts Thomas Bertrand Thomas Bertrand Alfred DeMaria Mary Gilchrist

Michigan Mark Miller Mark Miller Corrine Miller Frances Downes

Minnesota Julia Ashley Julia Ashley Ruth Lynfield Joanne Bartkus

Mississippi Craig Thompson Craig Thompson Mary Currier K. Mills McNeill

Missouri Michael Herbert Michael Herbert Sarah Patrick Eric Blank

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 Janet DeGraaf Patricia Masou Christina Tan Dennis Flynn

New Mexico Daryl Smith Daryl Smith 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 Jeffrey Engel Leslie Wolf

North Dakota Kimberly Weis Julie Goplin Kirby Kruger Myra Kosse

Ohio Bill Tiedemann Amy LaGesse Forrest Smith Tammy Bannerman

Oklahoma Michael Harmon Chang Lee Kristy Bradley Garry McKee

Oregon Vada Latin Doug Harger Melvin Kohn 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 Dorothy Waln (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 Felipe Rocha Jim Lee Vincent Fonseca Susan Neill

Utah Jennifer Brown Tim Lane Robert Rolfs Patrick Luedtke

Vermont Daniel Daltry Daniel Daltry Patsy Kelso Mary Celotti

Virginia Kathryn Hafford Kathryn Hafford (Acting) Carl Armstrong James Pearson

Washington Mark Aubin Mark Aubin Marcia Goldoft 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 Utoofili Maga Sarona Maae Sharmain Edwards Utoofili Mago

Federated States of Micronesia Vita Skilling Johnny Hebel Nena Nena

Government of the Marshall Islands Justina Langidrik Zachraias Zachraias Paul Lalita

Northern Marianas (CNMI) Joseph Villagomz John Moreno James Hosfschneider Stephanie Hart-Gouleau

Guam Josie O'Mallan Bernadette Schumann Robert Haddock Josie O'Mallan

Puerto Rico Greduvel Duran-Guzman Trinidad Garcia Enid Garcia Francisco Toro

Republic of Palau Victor Yano Johana Ngiruchelbad Julie Erb-Alvarez Francis Permeteet

Virgin Islands Darlene Carty Taetia Phillips-Dorsett Darlene Carty Joseph Mark

168 Contributors Appendix STD Surveillance 2007