Sexually 

Transmitted 

Disease 

Surveillance 

2003 

Division of STD Prevention 

September 2004 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for HIV, STD, and TB Prevention 

Division of STD Prevention 

Atlanta, Georgia 30333 

Centers for Disease Control and 

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

Director 

National Center for 

HIV, STD, and TB Prevention....................................Janet Collins, Ph.D. 

Acting Director 

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

Director 

Epidemiology and Surveillance 

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

Chief 

Surveillance and Special Studies 

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

Lead 

Statistics and Data Management 

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

Chief 

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

Deputy Branch Chief 

Rose Horsley 

Team Lead 

iii 
Copyright Information 

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

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

Suggested Citation 

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2003. 

Atlanta, GA: U.S. Department of Health and Human Services, September 2004. 

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

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

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

listed below. 

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

Related Websites 

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

• STD Surveillance 1993-2003: 

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

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

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

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

Supplemental Reports 

• 2002ChlamydiaPrevalenceMonitoringProject:http://www.cdc.gov/std/chlamydia2002/ 

• 2002 Gonococcal Isolate Surveillance Project: http://www.cdc.gov/std/gisp2002/ 

• 2002 Syphilis Surveillance Project: http://www.cdc.gov/std/syphilis2002/ 

iv 
Foreword 

“STDs are hidden epidemics of enormous health and economic consequence in the United 

States. They are hidden because many Americans are reluctant to address sexual health issues in an 

open way and because of the biologic and social characteristics of these diseases. All Americans 

have an interest in STD prevention because all communities are impacted by STDs and all individuals directly or indirectly pay for the costs of these diseases. STDs are public health problems that lack 

easy solutions because they are rooted in human behavior and fundamental societal problems. Indeed, there are many obstacles to effective prevention efforts. The first hurdle will be to confront the 

reluctance of American society to openly confront issues surrounding sexuality and STDs. Despite 

the barriers, there are existing individual- and community-based interventions that are effective and 

can be implemented immediately. That is why a multifaceted approach is necessary to both the 

individual and community levels. 

To successfully prevent STDs, many stakeholders need to redefine their mission, refocus their 

efforts, modify how they deliver services, and accept new responsibilities. In this process, 

strong leadership, innovative thinking, partnerships, and adequate resources will be required. 

The additional investment required to effectively prevent STDs may be considerable, but it is 

negligible when compared with the likely return on the investment. The process of preventing 

STDs must be a collaborative one. No one agency, organization, or sector can effectively do it 

alone; all members of the community must do their part. A successful national initiative to 

confront and prevent STDs requires widespread public awareness and participation and bold 

national leadership from the highest levels.”1 

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

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

v 
Preface 

Sexually Transmitted Disease Surveillance, 2003 presents statistics and trends for sexually transmitted diseases (STDs) in the United States through 2003. This annual publication is intended as a 

reference document for policy makers, program managers, health planners, researchers, and others 

who are concerned with the public health implications of these diseases. The figures and tables in

this edition supersede those in earlier publications of these data. 

The surveillance information in this report is based on the following sources of data: (1) case 

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

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

Projects, the Adolescent Women Reproductive Health Monitoring Project, the Men Who Have Sex 

With Men (MSM) Prevalence Monitoring Project, and the Indian Health Service; (3) sentinel 

surveillance of gonococcal antimicrobial resistance from the Gonococcal Isolate Surveillance 

Project (GISP); and (4) national surveys implemented by federal and private organizations. 

The STD surveillance systems operated by state and local STD control programs, which provide 

the case report data for chlamydia, gonorrhea, syphilis and chancroid are the sources of many of the 

figures and all of the statistical tables in this publication. These systems are an integral part of program management at all levels of STD prevention and control in the United States. Because of incomplete diagnosis and reporting, the number of STD cases reported to CDC is less than the actual 

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

available because they are not nationally notifiable diseases. 

Sexually Transmitted Disease Surveillance, 2003 consists of four parts. The National Profile 

contains figures that provide an overview of STD morbidity in the United States. The accompanying 

text identifies major findings and trends for selected STDs. The Special Focus Profiles contain 

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

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

the state, county, city, and national levels. The Appendix includes the sources and limitations of the 

data used to produce this report, Healthy People 2010 STD objectives, and STD surveillance case 

definitions. 

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

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

Table A1 displays progress made towards the HP2010 targets for STDs. These targets are used 

as reference points throughout this edition of Sexually Transmitted Disease Surveillance, 2003. 

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

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

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

Mailstop E-02, Atlanta, Georgia, 30333. 

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

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

Printing Office, November 2000. 

vi 
Acknowledgments 

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

and Territorial Health Departments and the Sexually Transmitted Disease Control Programs, 

the Regional Infertility Prevention Projects, the U.S. Department of Labor and the Indian 

Health Service, which provided surveillance data to the Centers for Disease Control and 

Prevention. 

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

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

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

Linda Webster Dicker, John Douglas, Alicia Edwards, Melinda Flock, LaZetta Grier, Samuel 

Groseclose, Alesia Harvey, James Heffelfinger, Rose Horsley, Kathleen Hutchins, Riduan Joesoef, 

Elvin Magee, Catherine McLean, Debra Mosure, Rob Nelson, Lori Newman, Katrina Park, LuEtta 

Schneider, Maya Sternberg, Katherine Stone, Emmett Swint, Kimberly Thomas, Susan Wang, Hillard 

Weinstock, Jennifer Wright, and Akbar Zaidi. 

vii 
Contents 

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

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

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

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

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

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

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

National Overview of Sexually Transmitted Diseases, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
 

National Profile 

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

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

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

Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
 

Other Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
 

Special Focus Profiles 

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
 

STDs in Women and Infants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
 

STDs in Adolescents and Young Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
 

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

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

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

Tables 

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

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

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

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

Chancroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
 

Selected STDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
 

Appendix 

Sources and Limitations of CDC Surveillance Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
 

Healthy People 2010 Table A1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
 

Reported Cases of STD by Sex and Reporting Source Table A2 . . . . . . . . . . . . . . . . . . . 144
 

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

Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
 

viii 
Figures in the National Profile 

Chlamydia 

Figure 1. Chlamydia — Number of states that require reporting of Chlamydia
 

trachomatis infections: United States, 1987–2003 . . . . . . . . . . . . . . . . . . . . . . 10
 

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

Figure 9. Chlamydia — Trends in positivity among 15- to 24-year-old women tested
 

Figure 2. Chlamydia — Rates: United States, 1984–2003. . . . . . . . . . . . . . . . . . . . . . . . 10
 

Figure 3. Chlamydia — Rates by state: United States and outlying areas, 2003 . . . . . . . 11
 

Figure 4. Chlamydia — Rates by county: United States, 2003 . . . . . . . . . . . . . . . . . . . . 11
 

Figure 5. Chlamydia — Rates by region: United States, 1984–2003 . . . . . . . . . . . . . . . . 12
 

Figure 6. Chlamydia — Rates by sex: United States, 1984–2003 . . . . . . . . . . . . . . . . . . 12
 

Figure 7. Chlamydia — Age- and sex-specific rates: United States, 2003 . . . . . . . . . . . . 13
 

planning clinics by state: United States and outlying areas, 2003 . . . . . . . . . . . 13
 

in family planning clinics by HHS regions, 1988–2003. . . . . . . . . . . . . . . . . . . 14
 

Gonorrhea 

Figure 10. Gonorrhea — Rates: United States, 1970–2003 and the Healthy People 

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

Figure 11. Gonorrhea — Reported cases by reporting source: United States, 

1984-2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
 

Figure 12. Gonorrhea — Rates by state: United States and outlying areas, 2003 . . . . . . . 21
 

Figure 13. Gonorrhea — Rates by county: United States, 2003 . . . . . . . . . . . . . . . . . . . . 21
 

Figure 14. Gonorrhea — Rates by region: United States, 1981–2003 and the 

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

Figure 15. Gonorrhea — Rates by sex: United States, 1981–2003 and the Healthy 

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

Figure 16. Gonorrhea — Rates by race and ethnicity: United States, 1981–2003 

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

Figure 17. Gonorrhea — Age- and sex-specific rates: United States, 2003 . . . . . . . . . . . . 23
 

Figure 18. Gonorrhea — Positivity among 15- to 24-year-old women tested in family 

planning clinics by state: United States and outlying areas, 2003 . . . . . . . . . . . 24
 

Figure 19. Gonococcal Isolate Surveillance Project (GISP) — Location of 

participating clinics and regional laboratories: United States, 2003. . . . . . . . . . 24
 

Figure 20. Gonococcal Isolate Surveillance Project (GISP) — Penicillin and 

tetracycline resistance among GISP isolates, 2003 . . . . . . . . . . . . . . . . . . . . . . 25
 

Figure 21. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria 

gonorrhoeae isolates with resistance or intermediate resistance to 

ciprofloxacin, 1990–2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
 

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

gonorrhoeae isolates with resistance to ciprofloxacin by sexual behavior, 

2001–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
 

Syphilis 

Figure 23. Syphilis — Reported cases by stage of infection: United States, 1941–2003. . . 31
 

Figure 24. Primary and secondary syphilis — Reported cases by reporting source:
 

United States, 1984-2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
 

ix 
Figure 25. Primary and secondary syphilis — Rates: United States, 1970–2003
 

and the Healthy People 2010 target. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
 

Figure 26. Primary and secondary syphilis — Rates by state: United States and
 

Figure 28. Primary and secondary syphilis — Rates by region: United States,
 

Figure 29. Primary and secondary syphilis — Rates by sex: United States, 1981–2003
 

Figure 30. Primary and secondary syphilis — Rates by race and ethnicity:
 

Figure 31. Primary and secondary syphilis — Male-to-female rate ratios:
 

Figure 32. Primary and secondary syphilis — Age- and sex-specific rates:
 

Figure 33. Congenital syphilis — Reported cases for infants <1 year of age and rates of
 

Figure 34. Congenital syphilis — Rates for infants <1 year of age: United States,
 

outlying areas, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
 

Figure 27. Primary and secondary syphilis — Rates by county: United States, 2003. . . . . 33
 

1981–2003 and the Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . 33
 

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

United States, 1981–2003 and the Healthy People 2010 target . . . . . . . . . . . . 34
 

United States, 1981–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
 

United States, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
 

primary and secondary syphilis among women: United States, 1970–2003 . . . 36
 

1981–2003 and the Healthy People 2010 target . . . . . . . . . . . . . . . . . . . . . . . 36
 

Other Sexually Transmitted Diseases 

Figure 35. Chancroid — Reported cases: United States, 1981–2003. . . . . . . . . . . . . . . . . 38
 

Figure 36. Genital herpes — Initial visits to physicians’ offices: United States,
 

1966–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
 

Figure 37. Genital warts — Initial visits to physicians’ offices: United States,
 

Figure 38. Trichomoniasis and other vaginal infections — Initial visits to physicians’
 

1966–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
 

offices: United States, 1966–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
 

Figures in the Special Focus Profiles 

STDs in Women and Infants 

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

areas, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
 

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

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

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

Figure E. Congenital syphilis — Cases by prenatal care utilization: United States,
 

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

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

areas, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
 

and outlying areas, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
 

and outlying areas, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
 

1995-2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
 

clinics by state: United States and outlying areas, 2003 . . . . . . . . . . . . . . . . . . 49
 

clinics by state: United States and outlying areas, 2003 . . . . . . . . . . . . . . . . . . 50
 

x 
Figure H. Ectopic pregnancy — Hospitalizations of women 15 to 44 years of age: United
 

States, 1980-2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
 

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

of age: United States, 1980–2002 

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

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
 

women 15 to 44 years of age: United States, 1980–2003 . . . . . . . . . . . . . . . . 51
 

STDs in Adolescents and Young Adults 

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

in family planning clinics by HHS regions, 1988–2003. . . . . . . . . . . . . . . . . . . 56
 

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

by age group: Region X, 1988–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
 

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

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

outlying areas, 2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
 

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

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

outlying areas, 2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
 

Figure O. Chlamydia — Adolescent Women Reproductive Health Monitoring Project 

chlamydia positivity in school-based clinics, 2003 . . . . . . . . . . . . . . . . . . . . . . 58
 

Figure P. Gonorrhea — Adolescent Women Reproductive Health Monitoring Project 

gonorrhea positivity in school-based clinics, 2003 . . . . . . . . . . . . . . . . . . . . . . 58
 

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

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

outlying areas, 2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
 

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

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

outlying areas, 2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
 

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

United States, 1981–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
 

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

United States, 1981–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
 

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

10 to 44 years of age: United States, 1981–2003. . . . . . . . . . . . . . . . . . . . . . . 61
 

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

10 to 44 years of age: United States, 1981–2003. . . . . . . . . . . . . . . . . . . . . . . 61
 

STDs in Racial and Ethnic Minorities 

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

by race and ethnicity: Region X, 1988–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . 66
 

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

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

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

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

Figure X. Chlamydia — Positivity among 15- to 30-year-old women tested in
 

Indian Health Service (IHS) Clinics by IHS areas, 2003 . . . . . . . . . . . . . . . . . . 66
 

United States, 1981–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
 

United States, 1981–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
 

by race and ethnicity: United States, 1981–2003 . . . . . . . . . . . . . . . . . . . . . . . 68
 

by race and ethnicity: United States, 1981–2003 . . . . . . . . . . . . . . . . . . . . . . . 68
 

xi 
Figure CC. Congenital syphilis — Rates among infants <1 year of age by mother’s
 

race and ethnicity: United States, 1991–2003 and the Healthy People 2010
 

target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
 

STDs in Men Who Have Sex with Men 

Figure DD. MSM Prevalence Monitoring Project — Syphilis serologic reactivity 

among men who have sex with men, STD clinics, 1999-2003 . . . . . . . . . . . . . 75
 

Figure EE. MSM Prevalence Monitoring Project — Gonorrhea positivity among 

men who have sex with men, STD clinics, 1999-2003 . . . . . . . . . . . . . . . . . . . 75
 

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

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

STD clinics, 2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
 

Figure GG.MSM Prevalence Monitoring Project — Test positivity for gonorrhea and 

chlamydia among men who have sex with men, by HIV status, STD 

clinics, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
 

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

cases that occurred among MSM, 1988-2003. . . . . . . . . . . . . . . . . . . . . . . . . . 77
 

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

gonorrhoeae isolates obtained from MSM attending STD clinics, 2001-2003 . . 77
 

STDs in Persons Entering Corrections Facilities 

Figure JJ. Chlamydia — Positivity in women entering juvenile and adult corrections
 

facilities, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
 

Figure KK. Chlamydia — Positivity in men entering juvenile and adult corrections
 

Figure LL. Gonorrhea — Positivity in women entering juvenile and adult corrections
 

Figure MM.Gonorrhea — Positivity in men entering juvenile and adult corrections
 

Figure NN. Syphilis serologic tests — Percent seroreactivity in women entering juvenile
 

Figure OO. Syphilis serologic tests — Percent seroreactivity in men entering juvenile
 

facilities, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
 

facilities, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
 

facilities, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
 

and adult corrections facilities, 2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
 

and adult corrections facilities, 2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
 

xii 
Tables in the National Profile 

National Summary 

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

and rates per 100,000 civilian population: United States, 1941–2003. . . . . . . 85
 

Chlamydia 

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

United States, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
 

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

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

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

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

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

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

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

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

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

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

in alphabetical order: United States and outlying areas, 1999–2003 . . . . . . . . 88
 

listed in alphabetical order: United States and outlying areas, 1999–2003 . . . . 89
 

listed in alphabetical order: United States and outlying areas, 1999–2003 . . . . 90
 

United States, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
 

alphabetical order: United States and outlying areas, 1999–2003 . . . . . . . . . . 92
 

in alphabetical order: United States and outlying areas, 1999–2003 . . . . . . . . 93
 

alphabetical order: United States and outlying areas, 1999–2003 . . . . . . . . . . 94
 

and sex: United States, 1999–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
 

United States, 1999–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
 

and sex: United States, 1999–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
 

Gonorrhea 

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

United States, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
 

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

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

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

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

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

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

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

in alphabetical order: United States and outlying areas, 1999–2003 . . . . . . . . 99
 

listed in alphabetical order: United States and outlying areas, 1999–2003 . . . 100
 

listed in alphabetical order: United States and outlying areas, 1999–2003 . . . 101
 

United States, 2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
 

alphabetical order: United States and outlying areas, 1999–2003 . . . . . . . . . 103
 

in alphabetical order: United States and outlying areas, 1999–2003 . . . . . . . 104
 

alphabetical order: United States and outlying areas, 1999–2003 . . . . . . . . . 105
 

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

and sex: United States, 1999–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
 

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

United States, 1999–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
 

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

and sex: United States, 1999–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
 

Syphilis 

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

listed in alphabetical order: United States and outlying areas, 1999–2003 . . . 110
 

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

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

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

alphabetical order: United States and outlying areas, 1999–2003 . . . . . . . . . 111
 

ranked by rates: United States, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
 

* 

by number of reported cases: United States, 2003 . . . . . . . . . . . . . . . . . . . . . 113
 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1999–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
 

areas, 1999–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
 

outlying areas, 1999–2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
 

cities, ranked by rates: United States, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . 117
 

listed in alphabetical order: United States and outlying areas, 1999–2003 . . . 118
 

1999–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
 

1999–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
 

population by age and sex: United States, 1999–2003. . . . . . . . . . . . . . . . . . 121
 

group and sex: United States, 1999–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
 

race/ethnicity, age group and sex: United States, 1999–2003. . . . . . . . . . . . . 123
 

listed in alphabetical order: United States and outlying areas, 1999–2003. . . 124
 

alphabetical order: United States and outlying areas, 1999–2003 . . . . . . . . . 125
 

1999–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
 

listed in alphabetical order: United States and outlying areas, 1999–2003 . . . 127
 

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

United States (excluding outlying areas), 1963–2003. . . . . . . . . . . . . . . . . . . 128
 

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

by state, ranked by rates: United States, 2003 . . . . . . . . . . . . . . . . . . . . . . . . 129
 

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

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

outlying areas, 1999–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
 

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

in selected cities, ranked by rates: United States, 2003. . . . . . . . . . . . . . . . . . 131
 

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

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

areas, 1999–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
 

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

by race/ethnicity of mother, 1999–2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
 

Chancroid 

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

order: United States and outlying areas, 1999–2003 . . . . . . . . . . . . . . . . . . . 134
 

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

order: United States and outlying areas, 1999–2003 . . . . . . . . . . . . . . . . . . . 135
 

Selected STDs 

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

United States, 1966–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
 

Sources and Limitations of CDC Surveillance Data 

Table A1. Healthy People 2010 Sexually Transmitted Diseases Objective Status . . . . . . 143
 

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

United States, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
 

xv 
Geographic Divisions of the United States 

West Midwest Northeast

South

West Midwest South Northeast 

Alaska Illinois Alabama Connecticut 

Arizona Indiana Arkansas Maine 

California Iowa Delaware Massachusetts 

Colorado Kansas District of Columbia New Hampshire 

Hawaii Michigan Florida New Jersey 

Idaho Minnesota Georgia New York 

Montana Missouri Kentucky Pennsylvania 

Nevada Nebraska Louisiana Rhode Island 

New Mexico North Dakota Maryland Vermont 

Oregon Ohio Mississippi 

Utah South Dakota North Carolina 

Washington Wisconsin Oklahoma 

Wyoming South Carolina 

Tennessee 

Texas 

Virginia 

West Virginia 

xvi 
National Overview of Sexually Transmitted Diseases, 2003 

The logo on the cover of Sexually Transmitted Disease Surveillance, 2003 is a reminder of 

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

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

prevention in improving health among women and infants and in promoting HIV prevention. 

Organized collaboration among interested, committed public and private organizations is the 

key to reducing STDs and their related health burdens in our population. As noted in the report of the Institute of Medicine, The Hidden Epidemic: Confronting Sexually Transmitted

Diseases,

1 surveillance is a key component of our efforts to prevent and control these diseases. 

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

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

2003 are worthy of note. 

Chlamydia

In 2003, 877,478 cases of genital Chlamydia trachomatisinfection were reported to CDC (Table 1). 

This case count corresponds to a rate of 304.3 cases per 100,000 population, an increase of 5.1% 

compared with the rate of 289.4 in 2002. Rates of reported chlamydia infections among women have 

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

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

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

of sexually active women 15 to 25 years of age who are provided medical care through managed care 

organizations.2 The increase in chlamydia case reports in 2003 most likely represents a continued increase in screening for this infection and also increased use of more sensitive chlamydia screening tests 

than in prior years. 

In 2003, the overall rate of chlamydia infection in the United States among women (466.9 

cases per 100,000 females) was over three times the rate among men (134.3 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 chlamydia infection. From 1999 through 2003, the chlamydia rate in men increased by 

46.6% (from 91.6 to 134.3 cases per 100,000 males) compared with an 18.2% increase in 

women over this period (from 395.1 to 466.9 cases per 100,000 females). 

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

useful in monitoring disease burden and guiding chlamydia screening programs. In 2003, the median 

state-specific chlamydia test positivity among women 15 to 24 years who were screened at selected 

family planning clinics in all states, the District of Columbia, Puerto Rico, and the Virgin Islands was 

5.9% (range 2.8% to 18.9%) (Figure 8), and at selected prenatal clinics in 27 states, Puerto Rico, and 

the Virgin Islands was 7.4% (range 2.4% to 19.7%) (Figure F). For economically-disadvantaged 

STD Surveillance 2003 Overview 1 
women 16 to 24 years of age who entered the National Job Training Program in 2003, from 39 

states and Puerto Rico, the median state-specific prevalence was 9.9% (range 3.4% to 16.0%) 

(Figure M). Among men entering the program from 38 states and Puerto Rico from July through 

December 2003, the median state-specific chlamydia prevalence was 7.8% (range 1.5% to 

12.7%) (Figure N). Among women 15 to 30 years of age screened at Indian Health Service (IHS) 

clinics in two IHS areas, the chlamydia prevalence was 11.0% (Figure X). For adolescent women 

entering 48 juvenile detention centers, the median chlamydia positivity by facility was 15.9% 

(range 2.7% to 33.5%) (Figure JJ). It was 11.3% among women attending school-based clinics 

(Figure O). Among adolescent men entering 64 juvenile detention centers, the median chlamydia 

positivity was 5.4% by facility (range 1.3% to 12.9%) (Figure KK). 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. 

During 1988-2003, among 15- to 24-year-old women participating in the screening programs in 

Health and Human Services (HHS) Region X family planning clinics, chlamydia test positivity declined 

52.3% (from 15.1% to 7.2%) (Figure 9). After adjusting trends in chlamydia positivity to account for 

changes in laboratory test methods and associated increases in test sensitivity, chlamydia test positivity 

decreased in 4 of 10 HHS regions from 2002 through 2003, increased in 5 regions, and remained the 

same in 1 region. Although chlamydia positivity has declined in the past year in some regions, most 

likely due to the effectiveness of screening and treating women, continued expansion of screening programs to populations with higher prevalence of disease may have contributed to the increases in 

positivity seen in other regions. See the Appendix (Sources and Limitations of Data) for the composition of the HHS regions. 

Gonorrhea

In 2003, 335,104 cases of gonorrhea were reported in the United States. Following a 74.3% 

decline in the rate of reported gonorrhea from 1975 (467.7 cases per 100,000 population) to 

1997 (120.2 cases per 100,000 population), overall rates increased slightly in 1998 (129.2 per 

100,000 population). Since 1999, the gonorrhea rate has decreased 10.1% to the current rate 

of 116.2 per 100,000 population (Table 1). Although this is the lowest gonorrhea rate the 

United States has ever reported, the 2003 rate for gonorrhea considerably exceeds the Healthy 

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

As in the past 7 years, there were minimal differences between sexes in gonorrhea rates in 2003 

(Figure 15). Since 1999, the rate of gonorrhea among 15- to 19-year-olds has decreased by 14.7%. 

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

men, are highest in the 20- to 24-year age group (Figure 17 and Table 20). Similar to previous years, 

in 2003, African-American 15- to 19-year-old females had the highest gonorrhea rate of any age 

and race/ethnic group (2,947.8 cases per 100,000 population) (Table 21B). However, gonorrhea 

rates among African-Americans of both sexes and all age groups decreased in 2003. 

In 2003, data on gonorrhea prevalence in defined populations were available from several 

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

some parts of the United States. Among 15- to 24-year-old women attending selected family planning clinics in 39 states, the District of Columbia, Puerto Rico, and the Virgin Islands, the median 

state-specific gonorrhea positivity was 0.8% (range 0.1% to 4.0%) (Figure 18). For women in this 

2 Overview STD Surveillance 2003 
age group attending selected prenatal clinics in 23 states, Puerto Rico, and the Virgin Islands, the 

median positivity was 1.0% (range 0.0% to 3.7%) (Figure G). However, for 16- to 24-year-old women 

entering the National Job Training Program in 34 states and Puerto Rico in 2003, the median 

state-specific gonorrhea prevalence was 2.1% (range 0.0% to 6.3%) in 2003 (Figure Q). Among men 

entering the program from 10 states from July through December 2003, the median state-specific 

gonorrhea prevalence was 2.8% (range 1.4% to 6.3%) (Figure R). 

Antimicrobial resistance in Neisseria gonorrhoeae remains a continuing concern. In the mid- to 

late 1990s, the prevalence of fluoroquinolone-resistant N. gonorrhoeae infections increased substantially in Asia and the Pacific Islands, including Hawaii; in 2002, increased numbers of 

fluoroquinolone-resistant N. gonorrhoeae infections were identified in California. Nationally in 

2003, 4.1% of N. gonorrhoeae isolates tested through the Gonoccocal Isolate Surveillance Project 

(GISP) demonstrated resistance to ciprofloxacin (a fluoroquinolone), compared to 2.2% in 2002 

and 0.7% in 2001. There is considerable geographic variation in the prevalence of 

fluoroquinolone-resistance within the United States. Outside of Hawaii and California, 1.2% of N.

gonorrhoeae isolates demonstrated resistance. In Honolulu, the proportion of GISP isolates that 

were resistant to ciprofloxacin remained high in 2003 at 13.3%. Also, in 2003, the proportion of 

GISP isolates that were resistant to ciprofloxacin remained high in California: (19.4% in Long 

Beach, 31.5% in Orange County, 13.2% in San Diego, 19.2% in San Francisco, and 12.4% in Los 

Angeles). The 2002 CDC STD Treatment Guidelines3 recommend that fluoroquinolones not be 

used for treatment of gonorrhea acquired in Asia, the Pacific Islands, including Hawaii, or in other 

areas with high levels of resistance such as California. The proportion of GISP isolates among men 

who have sex with men (MSM) that were resistant to ciprofloxacin more than doubled from 7.2% in 

2002 to 15% in 2003. The proportion among heterosexuals increased from 0.9% in 2002 to 1.5% 

in 2003. In 2004 CDC recommended that fluoroquinolones no longer be used to treat gonorrhea 

among MSM.4 See Appendix for a further description of GISP. 

Data on characteristics of patients in the GISP sample have been used to describe trends in the 

sexual orientation of male STD clinic patients with gonorrhea. In 2003, there was little change in the 

proportion of GISP isolates from MSM, with 19.6% of isolates from MSM compared with 20.7% in 

2002 and 17.2% in 2001 (Figure HH). In 1988, only 4.0% of isolates were from MSM. 

Syphilis

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

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

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

by the Surgeon General in October 1999.5 The rate of P&S syphilis in the United States declined by 

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

2001. Overall, increases have occurred only among men. 

Despite continued national progress toward syphilis elimination among women and AfricanAmericans, syphilis remains an important problem in the South and, increasingly, in some urban 

areas with large populations of MSM. Recently, outbreaks of syphilis among MSM have been 

reported, possibly reflecting increases in risky behavior in this population. 

P&S syphilis cases reported to CDC increased from 6,862 cases in 2002 to 7,177 in 2003. The 

overall rate of P&S syphilis in the United States in 2003 (2.5 cases per 100,000 population) was 

STD Surveillance 2003 Overview 3 
slightly higher than the rate in 2002 (2.4 cases per 100,000), and was considerably higher than the 

Healthy People 2010 (HP2010) target of 0.2 case per 100,000 population (Figure 25, Table 1). The 

rate of P&S syphilis among women decreased from 1.1 cases per 100,000 population in 2002 to 0.8 

cases per 100,000 population in 2003; among men, the rate increased from 3.7 to 4.2 cases per 

100,000 population (Figure 29 and Table 33). 

One factor that may facilitate syphilis elimination efforts is that this disease continues to be 

primarily reported from a limited number of counties in the country. In 2003, 2,530 (80.6%) 

of the 3,140 counties in the United States reported no cases of P&S syphilis (see Appendix

for details on county coding). Half of all the P&S syphilis cases were reported from only 18 counties 

and 1 city (0.6% of total number of U.S. counties) (Table 25). However, 2003 P&S syphilis rates 

were greater than the HP2010 target in 602 counties (19.2% of the total number of U.S. counties). 

These 602 counties accounted for 99.9% of all reported P&S syphilis cases in 2003. 

Between 2002 and 2003, the national rate of congenital syphilis decreased by 8.8%, from 11.3 to 

10.3 cases per 100,000 live births (Table 39). The continued decrease in congenital syphilis rates, 

which has occurred since the early 1990s, reflects the substantial and continuing reduction in the 

rate of P&S syphilis among women during the same period. In 2003, 30 states and 2 outlying areas 

had a rate of congenital syphilis that was greater than the HP2010 target of 1.0 case per 100,000 live 

births (Tables 40 and 41). 

Although wide disparities exist in the rates of STDs among racial and ethnic groups, there has been a 

reduction in these differences for syphilis over the past five years. The P&S syphilis rate for 2003 among 

African-Americans was 5 times the rate among whites, reflecting a substantial decline from 1999, when 

the rate among African-Americans was 29 times greater than that among whites (Table 34B). While this 

reflects decreasing rates among African-Americans, it also reflects significant increases among whites 

during the past 3 years. 

While syphilis elimination efforts have successfully focused on heterosexual minority populations 

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

reassessing and refining surveillance, prevention, and control strategies. 

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

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

1997. 

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

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

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

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

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

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

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

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

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

4 Overview STD Surveillance 2003 
NATIONALPROFILE
 

National Profile 

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

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

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

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

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

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

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

STD Surveillance 2003 National Profile 5 
Chlamydia 

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

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

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

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

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

chlamydia screening in a managed care setting suggest that such screening programs can lead to a 

reduction in the incidence of PID by as much as 60%.1 As with other inflammatory STDs, chlamydia 

infection can facilitate the transmission of HIV infection. In addition, pregnant women infected with 

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

ophthalmia and pneumonia. 

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

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

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

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

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

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

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

care through managed care organizations.2 To better monitor trends in disease burden in defined 

populations during the expansion of chlamydia screening activities, data on chlamydia positivity 

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

a reasonable approximation of prevalence.3 

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

requiring the reporting of chlamydia cases to CDC (Figure 1). 

• In 2003, 877,478 chlamydia infections were reported to CDC from 50 states and 

the District of Columbia (Table 1). This case count corresponds to a rate of 304.3 

cases per 100,000 population, an increase of 5.1% compared with the rate of 

289.4 in 2002. The reported number of chlamydia infections was more than two 

and one half times the number of reported cases of gonorrhea (335,104 

gonorrhea cases were reported in 2003) (Table 1). 

• From 1987 through 2003, the rates of reported chlamydia infection increased 

from 50.8 to 304.3 cases per 100,000 population (Figure 2, Table 1). The 

continuing increase in reported cases likely represents the further expansion of 

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

tests, and more complete national reporting. 

• For the years 1999-2001, the chlamydia rates in the Southern region of the 

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

(Figures 3-5, Table 3). Before 1996, chlamydia rates were highest in the West and 

Midwest, where substantial public resources had been committed for screening 

STD Surveillance 2003 National Profile Chlamydia 7 
programs in family planning clinics. For the years 2002-2003, overall rates were 

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

South. Rates have remained lowest in the Northeast. 

• In 2003, the overall rate of reported chlamydia infection among women in the 

United States (466.9 cases per 100,000 females) was over 3 times higher than the 

rate among men (134.3 cases per 100,000 males), likely reflecting a greater 

number of women screened for this infection (Figure 6, Tables 4 and 5). The 

lower rates among men suggest that many of the sex partners of women with 

chlamydia are not diagnosed or reported. However, with the advent of highly 

sensitive nucleic acid amplification tests that can be performed on urine, 

symptomatic and asymptomatic men are increasingly being diagnosed with 

chlamydia infection. From 1999 through 2003, the chlamydia infection rate in 

males increased by 46.6% (from 91.6 to 134.3 cases per 100,000 males) 

compared with a 18.2% increase in women over this period (from 395.1 to 466.9 

cases per 100,000 females) (Tables 4 and 5). 

• For women, the highest age-specific rates of reported chlamydia in 2003 were 

among 15- to 19-year-olds (2,687.3 per 100,000 females) and 20- to 

24-year-olds (2,564.4 per 100,000 females). These increased rates in women 

may be, in part, due to increased screening in this group. Age-specific rates 

among men, while substantially lower than the rates in women, were highest in 

the 20- to 24-year-olds (Figure 7, Table 10). 

• In 2003, the rate of chlamydia among African-American females in the United States 

was more than 7 times higher than the rate among white females (1,633.1 and 217.9 

per 100,000, respectively) (Table 11B). The chlamydia rate among 

African-American males was 11 times higher than that among white males (584.2 

and 52.9 per 100,000 respectively). 

• Chlamydia screening and prevalence monitoring activities were initiated in 

Health and Human Services (HHS) Region X in 1988 as a CDC-supported 

demonstration project. From 1988 through 2003, the screening programs in 

HHS Region X (Alaska, Idaho, Oregon, Washington) family planning clinics 

demonstrated a 52.3% decline in chlamydia positivity from 15.1% to 7.2% 

among 15- to 24-year-old women (Figure 9); chlamydia positivity was adjusted 

for changes in laboratory test methods and associated test sensitivity.4,5 

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

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

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

screening supplements local- and state-funded screening programs. 

• In 2003, the median state-specific chlamydia test positivity among 15- to 

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

clinics in all states and outlying areas was 5.9% (range 2.8% to 18.9%) (Figure 8). 

In nearly all states chlamydia positivity was greater than the HP2010 target of 

3.0%.6 See Appendix (Chlamydia, Gonorrhea, and Syphilis Prevalence 

Monitoring) for details. 

• After adjusting trends in chlamydia positivity to account for changes in laboratory 

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

chlamydia test positivity decreased in 4 of 10 HHS regions from 2002 through 

2003, increased in 5 regions, and remained the same in 1 region (Figure 9). 

8 Chlamydia National Profile STD Surveillance 2003 
Although chlamydia positivity has declined in the past year in some regions 

presumably due to the effectiveness of screening and treatment of women, 

continued expansion of screening programs to populations with higher 

prevalence of disease may have contributed to increases in positivity in other 

regions. 

• Additional information on chlamydia screening programs for women of 

reproductive age and chlamydia among adolescents and minority populations 

can be found in the Special Focus Profiles. 

1 Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic 

inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 1996;34(21): 1362-66. 

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

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

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

Transm Dis 1998;25:251-3. 

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

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

5 Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2003 

Supplement: Chlamydia Prevelance Monitoring Project Annual Report 2003. Atlanta, GA: U.S. 

Department of Health and Human Services (in press). 

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

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

Printing Office, November 2000. 

STD Surveillance 2003 National Profile Chlamydia 9 
Figure 1. Chlamydia — Number of states that require reporting of Chlamydia trachomatis 

infections: United States, 1987–2003 

No. of states

50

40

30

20

10

0

1987 88 89 90 91 92 93 94 95 96 97 98 99 2000 01 02 03

Figure 2. Chlamydia — Rates: United States, 1984–2003 

Rate (per 100,000 population)

350

280

210

140

70

0

1984 86 88 90 92 94 96 98 2000 02

10 Chlamydia National Profile STD Surveillance 2003 
Figure 3. Chlamydia — Rates by state: United States and outlying areas, 2003 

276.8

280.1 156.8 261.0

218.3 213.4

176.4 329.7 342.7 298.7 VT 171.9 192.5 324.1 NH 126.7

221.0 MA 175.8 302.3

268.2 274.1 RI 280.4 372.3 168.1 277.2 CT 271.4 383.3

334.4 289.3 143.5 NJ 188.2 266.5 266.9 327.4 DE 375.9 195.0 MD 308.4

314.7 351.5 234.9 315.2 Rate per 100,000 403.2 289.9 356.0
 

Guam 344.0 population
 

316.7 416.9 424.6 <=150.0 (n= 3) 317.7 150.1-300.0 (n= 26) 467.8 605.8 >300.0 (n= 24) 253.6

440.2

Puerto Rico 71.1

Virgin Is. 378.1

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

Virgin Islands) was 301.3 per 100,000 population. For further information on chlamydia 

reporting, see Appendix (Reporting of Chlamydia Cases). 

Figure 4. Chlamydia — Rates by county: United States, 2003 

Rate per 100,000

population

<=150.0 (N= 1,498)

150.1-300.0 (N= 939)

>300.0 (N= 703)

STD Surveillance 2003 National Profile Chlamydia 11 
Figure 5. Chlamydia — Rates by region: United States, 1984–2003 

Rate (per 100,000 population)

350

280

210

140

70

0

West

Midwest

Northeast

South

1984 86 88 90 92 94 96 98 2000 02

Figure 6. Chlamydia — Rates by sex: United States, 1984–2003 

Rate (per 100,000 population)
 

500
 

400
 

300
 

200
 

100
 

0
 

Men

Women

1984 86 88 90 92 94 96 98 2000 02

12 Chlamydia National Profile STD Surveillance 2003 
Figure 7. Chlamydia — Age- and sex-specific rates: United States, 2003 

Men Rate (per 100,000 population)population)population)population)population)population)population)population)population)population)population)population)population)population)population)population)population)population)population)population)population)population) Women

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

9.8 10-14 134.3

423.4 15-19 2,687.3

690.6 20-24 2,564.4

362.2 25-29 964.2

168.6 30-34 344.1

89.2 35-39 135.8

49.7 40-44 57.1

20.4 45-54 20.6

6.9 55-64 5.6

2.2 65+ 2.2

134.6 Total 468.1

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

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

clinics by state: United States and outlying areas, 2003 

Positivity (%)

<4.0

4.0-4.9

>=5.0

VT

NH

MA

RI

CT

NJ

DE

MD

DC

Puerto Rico 5.6

Virgin Is. 18.9

(n= 2)

(n= 9)

(n= 42)

6.8

6.6

6.7 6.2

6.0 6.4

4.7

9.4

8.4

5.5

7.3 7.2

4.5

5.6 3.7

9.2

4.0

7.0

5.0

9.4

6.8

5.5

4.7 4.6

7.6

6.4

5.9

5.8

7.7

5.4

4.2

5.8

7.0

6.4

6.8

8.7

5.3

6.7

7.0

2.8

8.4

5.9

4.2

4.2

5.2

5.6

5.4

8.1

5.9

5.9

4.7

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

women aged 15-24 years screened during 2003. 

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

for Disease Control and Prevention 

STD Surveillance 2003 National Profile	 Chlamydia 13 
Figure 9.	 Chlamydia — Trends in positivity among 15- to 24-year-old women tested in family 

planning clinics by HHS regions, 1988–2003 

15.111.811.4 9.5	 10.2 8.2	 9.2 8.8 8.7 9.0 8.0 8.2 6.1 5.7 5.6 6.0 6.1 6.2 6.7 7.2 7.5	 6.0 5.9 5.2 5.1 4.9 4.9 6.2 6.4 6.1 5.5

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

Region X	 Region V Region I

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

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

Region IX Region II

IX VII III

10.1 7.6 6.5 6.2 7.1 7.4 7.3	 8.1 7.3 7.7 8.0 8.4 7.9 7.2 6.9 5.9 6.6 6.7	 6.6 6.8 IV

VI 94 95 96 97 98	 99 00 01 02 03 94 95 96 97 98	 99 00 01 02 03

Region VIII Region III

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

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

Region VII	 Region VI Region IV

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

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

more information. No data on laboratory test method available for Region VII in 1995 and 

Regions IV and V in 1996. See Appendix for definition of Health and Human Services (HHS) 

regions. 

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

for Disease Control and Prevention 

14 Chlamydia	 National Profile STD Surveillance 2003 
Gonorrhea 

Gonorrhea is the second most commonly reported notifiable disease in the United States. Infections due to Neisseria gonorrhoeae, like those resulting from Chlamydia trachomatis, are a major 

cause of pelvic inflammatory disease (PID) in the United States. PID can lead to serious outcomes 

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

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

HIV infection.1 

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

the national gonorrhea control program in the mid-1970s (Table 1). After a small increase in 1998, the 

gonorrhea rate has decreased each year since 1999 (Figure 10 and Table 1). True increases or decreases 

may be masked by changes in screening practices (affected by simultaneous testing for chlamydia), use 

of diagnostic tests with different sensitivities, and changes in reporting practices.2 

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

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

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

infections may have been biased towards reporting of infections in persons of minority race or ethnicity, 

who are more likely to attend public STD clinics.2,4 For such reasons, supplemental data on gonorrhea 

prevalence in persons screened in a variety of different settings are useful in assessing disease burden in 

selected populations. 

• In 2003, 335,104 cases of gonorrhea were reported in the United States. The rate of 

reported gonorrhea in the United States was 116.2 cases per 100,000 population in 

2003 (Figure 10 and Table 1), which was the lowest rate of reported gonorrhea 

ever. 

• In 2003, 29.9% of gonorrhea cases were reported by STD clinics. This is a change 

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

11). In 2003, similar to previous years, a higher proportion of male gonorrhea 

cases were reported from STD clinics than were female cases (43.3% and 17.7% 

respectively). 

• As in 2002, in 2003 only 8 states and 1 outlying area had gonorrhea rates below 

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

population (Figure 12 and Table 12).5 

• In 2003, 1,319 (42.0%) 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 1,112 counties 

(35.4%), and greater than 100 in 709 counties (22.6%). The majority of counties 

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

(Figure 13). 

STD Surveillance 2003 National Profile Gonorrhea 15 
• As in previous years, in 2003 the South had the highest gonorrhea rate among the 

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

declined by 23% from a rate of 195.1 per 100,000 population in 1999 to 149.8 in 

2003. In contrast, the gonorrhea rate in the West has increased by 25% from 51.3 

cases per 100,000 population in 1999 to 64.0 in 2003. Rates in the Northeast 

(91.1 in 2003) and the Midwest (136.3 in 2003) have shown minimal change 

since 1999 (Figure 14 and Table 13). 

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

women. Since then, rates among women and men have remained similar (Figure 

15). In 2003 the gonorrhea rate among women was 118.8 and the rate among 

men was 113.0 cases per 100,000 population (Tables 14 and 15). 

• The overall gonorrhea rate in selected large cities was 208.1 cases per 100,000 

population in 2003. This rate has decreased slightly each year since 2000 when it 

was 244.7 cases per 100,000 population. All of these cities had rates higher than 

the HP2010 target of 19 cases per 100,000 population. In 2003, 44.1% of 

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

previous years, in 2003 the total gonorrhea rate among males in these selected 

large cities (215.9) remained higher than that among females (199.9) (Tables 18 

and 19). 

• Changes in gonorrhea rates from 1999 through 2003 differed by racial/ethnic 

group. Gonorrhea rates decreased by 18.9% during this time period for 

African-Americans from 808.4 to 655.8 cases per 100,000 population. Since 

1999, the gonorrhea rate among whites increased 22.5% (32.7 per 100,000 in 

2003), Asian/Pacific Islanders increased 17.5% (22.8 per 100,000 in 2003), 

Hispanics increased 11.0% (71.7 per 100,000 in 2003), and American 

Indian/Alaska Natives increased 5.5% (103.5 per 100,000 in 2003) (Figure 16 

and Table 21B). In 2003, the gonorrhea rate among African-Americans was 20 

times greater than the rate for whites, down from 30 times greater in 1999. The 

2003 gonorrhea rates for all racial/ethnic groups were above the HP2010 target of 

19 per 100,000 population. 

• In 2003 the gonorrhea rate was highest for 20- to 24-year-olds (529.0). Among 

females in 2003, 15- to 19- and 20- to 24-year-olds had the highest rates of 

gonorrhea (634.7 and 595.2, respectively); among males, 20- to 24-year-olds 

had the highest rate (465.9) (Figure 17 and Table 20). Since 1999 there has been 

a 14.7% decrease in the rate of gonorrhea among 15- to 19-year-olds, 11.7% 

among females and 21.0% among males. The decrease during this time period 

was greater for the 15- to 19-year-olds than any other age group (Table 20). 

• Increases in gonorrhea rates were largest among white men aged 35-54 years old 

between 1999 and 2003. For white men, rates increased 42.0% among 35- to 

39-year-olds, 56.8% among 40- to 44-year-olds, and 46.0% among 45- to 

54-year-olds (Table 21B). 

• As in recent years, the highest rates of gonorrhea were seen among 15- to 

19-year-old African-American women (2,947.8 per 100,000), 20- to 24-year-old 

African-American women (2,715.5 per 100,000), and 20- to 24-year-old 

African-American men (2,649.8 per 100,000). However, decreases in gonorrhea 

rates were seen among African-Americans of both sexes and all age groups (Table 

21B). 

16 Gonorrhea National Profile STD Surveillance 2003 
6,7,8

• Gonorrhea test positivity data are available from a variety of settings. In 2003, the 

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

screened in selected family planning clinics in 39 states, Puerto Rico, District of 

Columbia, and the Virgin Islands was 0.8% (range 0.1% to 4.0%) (Figure 18). For 

women in this age group attending selected prenatal clinics in 23 states, Puerto 

Rico, and the Virgin Islands, the median positivity was 1.0% (range 0.0% to 

3.7%) (Figure G). For 16- to 24-year-old women entering the National Job 

Training Program in 34 states and Puerto Rico in 2003, the median state-specific 

gonorrhea prevalence was 2.1% (range 0.0% to 6.3%) in 2003 (Figure Q). 

Among men entering the program from 10 states from July through December 

2003, the median state-specific gonorrhea positivity was 2.8% (range 1.4% to 

6.3%) (Figure R). The median positivity for gonorrhea in women entering 28 

juvenile corrections facilities was 5.7% (range 0.5% to 15.9%), and in men 

entering 35 juvenile corrections facilities was 1.3% (range 0.3% to 4.5%) (Figures 

LL and MM). See Special Focus Profiles. 

• Antimicrobial resistance remains an important consideration in the treatment of 

gonorrhea.6-8 Overall, 16.4% of isolates collected in 2003 in 30 STD clinics by the 

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

tetracycline, or both (Figure 20). 

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

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

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

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

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

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

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

clinics. 

• In Honolulu, the proportion of GISP isolates that were resistant to ciprofloxacin 

remained high in 2003 at 13.3%. This was higher than in 2002 (11.7%), but lower 

than in previous years (20.3% in 2001 and 14.3% in 2000). At Tripler Army 

Medical Center, in Hawaii, 4.2% of isolates tested demonstrated resistance to 

ciprofloxacin. This high proportion of ciprofloxacin-resistant isolates in Hawaii 

continues to reinforce the recommendation made by CDC in 2000 that 

fluoroquinolones not be used to treat gonococcal infections acquired in Hawaii.6 

• In California, significant increases in the proportions of GISP isolates resistant to 

ciprofloxacin were identified in 3 out of 5 California GISP sites (for Long Beach, 19.4% 

in 2003 compared with 7.2% in 2002; for Orange County, 31.5% for 2003 compared 

with 11.4% in 2002; for San Francisco, 19.2% in 2003 compared with 6.7% in 2002). 

San Diego saw a slight decrease in ciprofloxacin-resistant isolates, down to 13.2% in 

2003 from 16.5% in 2002. In 2003, Los Angeles reported to GISP for the first time and 

12.4% of isolates from that location were resistant to ciprofloxacin. In 2002, the 

California STD Program recommended that fluoroquinolones no longer be used for 

gonorrhea treatment in California. 

• The proportion of GISP isolates that were ciprofloxacin-resistant at other GISP 

clinics where such isolates were identified in 2003 were: Baltimore – 0.4%, Chicago 

– 2.1%, Cincinnati – 0.4%, Cleveland – 0.3%, Dallas – 2.0%, Denver - 0.7%, Las 

Vegas 2.5%, Miami – 2.1%, Minneapolis – 2.3%, New Orleans – 0.4%, 

Philadelphia – 1.3%, Phoenix – 2.6%, Portland – 3.0%, and Seattle 7.0%. Overall, 

STD Surveillance 2003 National Profile Gonorrhea 17 
outside of Hawaii and California, 1.2% of isolates were ciprofloxacin-resistant. 

Additional information on antimicrobial susceptibility data and treatment 

recommendations from state and local health departments may be found in the 

2003 GISP report7 or the GISP website (http://www.cdc.gov/std/gisp). 

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

from MSM more than doubled from 77 (7.2%) in 2002 to 188 (15%) in 2003. 

During the same time period, the number of QRNG isolates from heterosexuals 

doubled, from 38 (0.9%)in 2002 to 79 (1.5%) in 2003 (Figure 22). In 2004, CDC 

recommended that fluoroquinolones no longer be used to treat gonorrhea 

among MSM.9 

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

proportion of GISP isolates demonstrating decreased susceptibility to ceftriaxone 

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

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

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

decreased susceptibility to cefixime had not previously been identified in the 

United States.10 In 2003, no GISP isolates had decreased susceptibility to 

ceftriaxone. 

• The proportion of GISP isolates demonstrating elevated minimum inhibitory 

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

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

with azithromycin MIC ≥1.0 μg/ml but in 2003 there were 26 (0.4%) such isolates. 

• Additional information about gonorrhea in racial and ethnic minority 

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

populations can be found in the Special Focus Profiles. 

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

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

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

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

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

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

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

1981-1996: demographic and geographic trends. Sex Transm Dis 1998;25(7):386-93. 

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

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

Printing Office, November 2000. 

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

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

2000;49:833-837. 

7 Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2003 

Supplement: Gonococcal Isolate Surveillance Project (GISP) Annual Report 2003. Atlanta, GA: U.S. 

Department of Health and Human Services (in press). 

18 Gonorrhea National Profile STD Surveillance 2003 
8 Centers for Disease Control and Prevention. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae 

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

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

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

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

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

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

CID 2003;37:849-52. 

STD Surveillance 2003 National Profile Gonorrhea 19 
Figure 10. Gonorrhea — Rates: United States, 1970–2003 and the Healthy People 2010 

target 

Rate (per 100,000 population) 

500 

400 

300 

200 

100 

0 

Gonorrhea 

2010 Target 

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

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

Figure 11. Gonorrhea — Reported cases by reporting source: United States, 1984-2003 

Cases (in thousands) 

750 

600 

450 

300 

150 

0 

non-STD Clinic 

STD Clinic 

1984 86 88 90 92 94 96 98 2001 02 

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

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

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

electronically, the specific source of report (i.e., STD clinic) became available from an 

increasing number of states. 

20 Gonorrhea National Profile STD Surveillance 2003 
Figure 12. Gonorrhea — Rates by state: United States and outlying areas, 2003 

45.4 

13.4 16.2 18.0 

28.4 63.8 

5.1 29.7 104.1 115.7 VT 15.7 9.2 138.9 NH 9.8 

102.2 

17.8 

93.9 52.9 

173.1 108.5 197.3 

96.2 MA 

RI 

CT 

45.1 

91.0 

90.0 

73.9 63.3 97.5 155.0 87.4 

47.0 124.3 NJ 

DE 

MD 

92.5 

139.7 

147.2 

181.7 146.9 65.6 63.0 130.3 156.9 207.4 Rate per 100,000 

Guam 40.4 population 

220.4 207.4 206.6 

<=19.0 (n= 9) 112.9 19.1-100.0 (n= 21) 264.4 89.0 >100.0 (n= 23) 113.5 

101.5 

Puerto Rico 7.2 

Virgin Is. 82.7 

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

Virgin Islands) was 114.7 per 100,000 population. The Healthy People 2010 target is 19.0 

cases per 100,000 population. 

Figure 13. Gonorrhea — Rates by county: United States, 2003 

Rate per 100,000 

population 

<=19.0 (N= 1,319) 

19.1-100.0 (N= 1,112) 

>100.0 (N= 709) 

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

STD Surveillance 2003 National Profile Gonorrhea 21 
Figure 14. Gonorrhea — Rates by region: United States, 1981–2003 and the Healthy 

People 2010 target 

Rate (per 100,000 population)
 

600
 

480
 

360
 

240
 

120
 

0
 

West 

Midwest 

Northeast 

South 

2010 Target 

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

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

Figure 15. Gonorrhea — Rates by sex: United States, 1981–2003 and the Healthy 

People 2010 target 

Rate (per 100,000 population)
 

600
 

480
 

360
 

240
 

120
 

0
 

Male 

Female 

2010 Target 

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

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

22 Gonorrhea National Profile STD Surveillance 2003 
Figure 16. Gonorrhea — Rates by race and ethnicity: United States, 1981–2003 and the 

Healthy People 2010 target 

Rate (per 100,000 population) 

White 

Black 

Hispanic 

Asian/Pac Isl 

Am Ind/AK Nat 

2010 Target 

0 

500 

1,000 

1,500 

2,000 

2,500 

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

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

Figure 17. Gonorrhea — Age- and sex-specific rates: United States, 2003 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

6.7 10-14

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

262.4 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

465.9 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

304.6 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

179.9 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

126.2 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

88.3 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

45.3 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

15.7 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

4.2 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

113.3 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14 40.8 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

634.7 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

595.2 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

260.7 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

110.9 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

58.3 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

31.4 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

10.4 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

2.2 

Men Rate (per 100,000 population) Women

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

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

0.6 

Men Rate (per 100,000 population) Women 

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

Total 

65+ 

55-64 

45-54 

40-44 

35-39 

30-34 

25-29 

20-24 

15-19 

10-14 

119.0 

Note: See Table 20. 

STD Surveillance 2003 National Profile Gonorrhea 23 
Figure 18. Gonorrhea — Positivity among 15- to 24-year-old women tested in family planning 

clinics by state: United States and outlying areas, 2003 

Positivity (%) 

See* 

<1.0 

1.0-1.9 

>=2.0 

VT 0.3 

NH 0.1 

MA 

RI 

CT 0.6 

NJ 1.5 

DE 

MD 

DC 1.1 

Puerto Rico 0.3 

Virgin Is. 2.5 

(n= 11) 

(n= 24) 

(n= 12) 

(n= 6) 

1.5 

0.2 

1.2 

0.8 0.3 

0.7 

2.4 

0.8 

1.6 1.0 

0.4 

0.7 0.5 

2.2 

1.2 

0.7 

2.6 

0.9 

1.2 

0.6 0.8 

0.4 

0.6 

1.9 

0.7 

0.5 

1.3 

0.7 

1.4 

0.5 

1.0 

0.3 

2.6 

4.0 

0.1 

*States reported gonorrhea positivity data on less than 500 women aged 15-24 years during 2003. 

Note: Includes states that reported gonorrhea positivity data on at least 500 women aged 15-24 years 

screened during 2003 except for Minnesota which submitted gonorrhea positivity data for JulyDecember 2003 only. 

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

for Disease Control and Prevention 

Figure 19. Gonococcal Isolate Surveillance Project (GISP) — Location of participating 

clinics and regional laboratories: United States, 2003 

STD Clinics 

Clinics and 

Birmingham 

Anchorage 

Phoenix 

Long Beach Los Angeles 

Orange Co. 

San Diego 

San Francisco Denver 

Miami 

Atlanta 

Honolulu 

Tripler AMC 

Chicago 

New Orleans 

Baltimore 

Detroit Minneapolis 

St.Louis Las Vegas 

Albuquerque 

Greensboro 

Cincinnati 

Cleveland 

Oklahoma City 

Portland 

Philadelphia 

Dallas 

Salt Lake City 

Seattle 

Regional Labs 

24 Gonorrhea National Profile STD Surveillance 2003 
Figure 20. Gonococcal Isolate Surveillance Project (GISP) — Penicillin and tetracycline 

resistance among GISP isolates, 2003 

Susceptible 

PPNG 

TRNG 

PPNG/TRNG 

PenR 

TetR 

CMRNG 

83.6% 

1.0% 

3.7% 

0.4% 

1.3% 

6.2% 

3.8% 

Note: PPNG=penicillinase-producing N. gonorrhoeae; TRNG=plasmid-mediated tetracyclineresistant N. gonorrhoeae; PPNG-TRNG=plasmid-mediated penicillin and tetracycline-resistant 

N. gonorrhoeae; PenR=chromosomally mediated penicillin resistant N. gonorrhoeae; TetR= 

chromosomally mediated tetracycline-resistant N. gonorrhoeae; CMRNG=chromosomally 

mediated penicillin and tetracycline-resistant N. gonorrhoeae. 

Figure 21. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria 

gonorrhoeae isolates with resistance or intermediate resistance to 

ciprofloxacin, 1990–2003 

Percent 

7.5 

6.0 

4.5 

3.0 

1.5 

0.0 

Resistance 

Intermediate resistance 

1990 91 92 93 94 95 96 97 98 99 2000 01 02 03 

Note: Resistant isolates have ciprofloxacin MICs ≥ 1 μg/ml. Isolates 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 2003 National Profile Gonorrhea 25 
Figure 22. Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria 

gonorrhoeae isolates with resistance to ciprofloxacin by sexual behavior, 

2001–2003 

Percent resistant to ciprofloxacin 

20 

25 

Heterosexual 

Men who have sex with men (MSM) 

15 

10 

5 

0 

2001 2002 2003 

26 Gonorrhea National Profile STD Surveillance 2003 
4567891011

Syphilis 

Syphilis, a genital ulcerative disease, facilitates the transmission of HIV and may be important in 

contributing to HIV transmission in those parts of the country where rates of both infections are 

high. Untreated early syphilis in pregnant women results in perinatal death in up to 40% of cases 

and, if acquired during the four years preceding pregnancy, may lead to infection of the fetus in over 

70% of cases.1 

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

the 1990s; in 2000, the rate was the lowest since reporting began in 1941 (Figure 23). The low rate 

of infectious syphilis and the concentration of the majority of syphilis cases in a small number of geographic areas in the United States led to the development of the CDC’s National Plan to Eliminate 

Syphilis, which was announced by Surgeon General David Satcher in October 1999.2 Collaboration 

with diverse organizations, public health professionals, the private medical community, and other partners working in the fields of STD and HIV is essential for the successful elimination of syphilis in the 

United States.3 

Although the rate of P&S syphilis in the United States declined by 89.7% during 1990-2000, the 

rate of P&S syphilis remained unchanged between 2000 and 2001 and increased in 2002 and 

2003. Overall increases in rates during 2001-2003 were observed only among men. 

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

the South, syphilis remains an important problem in the South and in some urban areas in other regions of the country. Recently, several outbreaks of syphilis occurring among men who have sex with 

men (MSM) have been reported which have been characterized by high rates of HIV co-infection and 

high-risk sexual behavior. 4-11 

• In 2003, P&S syphilis cases reported to CDC increased to 7,177 from 6,862 in 

2002, an increase of 4.6%. The rate of P&S syphilis in the United States in 2003 

(2.5 cases per 100,000 population) was 4.2% higher than the rate in 2002 (2.4 

cases per 100,000 population), and it is greater than the Healthy People 2010 

(HP2010) target of 0.2 case per 100,000 population (Figure 25, Table 1).12 

• During 2002-2003, the number of cases of early latent syphilis reported to CDC 

decreased 0.8% (from 8,429 to 8,361) while the number of cases of late and late 

latent syphilis increased 6.7% (from 17,168 to 18,319) (Table 1). The total 

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

congenital syphilis) reported to CDC increased 4.1% (from 32,912 to 34,270) 

during 2002-2003 (Table 1). 

• The rate of P&S syphilis increased 13.5% among men (from 3.7 cases to 4.2 cases 

per 100,000 men) between 2002 and 2003 (Figure 29, Table 28). During this 

time, the rate declined 27.3% among women (from 1.1 to 0.8 cases per 100,000 

women) (Figure 29, Table 27). 

STD Surveillance 2003 National Profile Syphilis 27 
• The male-to-female rate ratio for P&S syphilis has risen steadily since 1996 when 

it was 1.2 (Figure 31), suggesting an increase in syphilis among MSM during this 

time. The male-to-female rate ratio in 2002 was 3.4; and in 2003 it was 5.2. 

• An increase in male-to-female rate ratio for P&S syphilis occurred among all 

racial and ethic groups during 2002-2003. The male-to-female rate ratio for P&S 

syphilis increased from 11.0 to 14.5 among non-Hispanic whites, from 2.1 to 2.8 

among African-Americans, from 5.1 to 6.2 among Hispanics, from 7.0 to 20.0 

among Asian/Pacific Islanders, and from 1.2 to 2.8 among American Indian/ 

Alaska Natives (Table 34B). 

• An increase in the male-to-female rate ratio for P&S syphilis occurred in the 

District of Columbia, Puerto Rico and in 19 (58%) of 33 states that reported at 

least 25 cases in 2003. 

• African-Americans accounted for 39.2% of cases of P&S syphilis in 2003 and 

49.8% in 2002. During 2002-2003, the rate of P&S syphilis declined 17.9% 

among African-Americans, reflecting a 9.9% decrease in the number of cases 

among men (from 2,226 to 2,005) and a 32.6% decrease among women (from 

1,195 to 805). The rate among non-Hispanic whites increased 25.0%; cases 

among men increased 32.0% (from 2,108 to 2,783) and cases among women 

increased 4.6% (from 217 to 227). The rate among Hispanics increased 20.0%; 

cases among men increased 21.6% (from 823 to 1,001), and cases among 

women increased 8.2% (from 147 to 159). The rate among Asian/Pacific 

Islanders increased 25.0%; cases among men increased (from 83 to 119), but 

decreased among women (from 11 to 8). The rate among American 

Indian/Alaska Natives increased 38.1%; cases among men increased (from 27 to 

50), but decreased among women (from 24 to 19). (Figure 30, Tables 34A and 

34B). 

• In 2003, the rate of P&S syphilis reported among African-Americans (7.8 cases 

per 100,000 population) was 5.2 times greater than the rate among non-Hispanic 

whites (1.5 cases per 100,000 population). This differential was less than that in 

2002, when the rate of P&S syphilis among African-Americans was 7.9 times 

greater than the rate among non-Hispanic whites (Table 34B). The decline in the 

difference in rates between African-Americans and non-Hispanic whites between 

2002 and 2003 is due to a decrease in the rate among African-Americans in 

conjunction with an increase in the rate among non-Hispanic whites. 

• The incidence of P&S syphilis was highest among women aged 20-24 years (2.4 

cases per 100,000 population) and among men aged 35-39 (11.8 cases per 

100,000 population) in 2003 (Figure 32, Table 34B). 

• The South accounted for 44.8% of P&S syphilis in 2003 and 45.8% in 2002. 

During 2002-2003, rates increased in all U.S. regions except the Midwest; rates 

increased 3.3% in the South (from 3.0 to 3.1 cases per 100,000 population), 

23.5% in the Northeast (from 1.7 to 2.1), and 22.7% in the West (from 2.2 to 2.7); 

the rate decreased 23.8% in the Midwest (from 2.1 to 1.6). The 2003 rates in all 

regions were greater than the HP2010 target of 0.2 case per 100,000 population 

(Figure 28, Table 26). 

• In 2003, P&S syphilis rates in 5 states were less than or equal to the HP2010 

national target of 0.2 case per 100,000 population (Figure 26, Table 24). Seven 

28 Syphilis National Profile STD Surveillance 2003 
states and two outlying areas reported five or fewer cases of P&S syphilis in 2003 

(Tables 24 and 26). 

• In 2003, 2,530 (80.6%) of 3,140 counties in the United States reported no cases 

of P&S syphilis compared with 2,534 (80.7%) counties reporting no cases in 

2002. Of 610 counties reporting at least one case of P&S syphilis in 2003, 8 

(1.3%) had rates at or below the HP2010 target of 0.2 case per 100,000 

population. Rates of P&S syphilis were above the HP2010 target for 602 counties 

in 2003 (Figure 27). These 602 counties (19.2% of the total number of counties in 

the United States) accounted for 99.9% of the total P&S syphilis cases reported in 

2003. 

• In 2003, half of the total number of P&S syphilis cases were reported from 18 

counties and 1 city (Table 25). 

• The overall rate of P&S syphilis in 2003 for 63 selected large U.S. cities (6.1 cases 

per 100,000 population) did not change from the rate in 2002 (Table 30). Rates 

exceeded the HP2010 target of 0.2 case per 100,000 population in all but 3 of the 

63 cities in 2003 (Table 29). 

• During 1990-2003, the proportion of P&S syphilis cases reported from sources 

other than STD clinics increased from 25.6% to 67.5% (Figure 24). During 

2000-2003, the number of cases reported from non-STD clinic sources increased 

each year and the number of cases reported from STD clinics decreased each 

year. 

• Between 2002 and 2003, the overall rate of congenital syphilis decreased 8.8% in 

the United States, from 11.3 to 10.3 cases per 100,000 live births (Figure 34, 

Table 39). The continuing decline in the rate of congenital syphilis (Figure 34) 

likely reflects the substantial reduction in the rate of P&S syphilis among women 

that has occurred during the last decade (Figure 33).13,14 

• During 1991-2003, the average yearly percentage decrease in the congenital 

syphilis rate was 17.2% (Table 39). The average yearly percentage decrease in 

the rate of P&S syphilis among women during 1991-2003 was 21.4%. 

• In 2003, 29 states, the District of Columbia, and two outlying areas had rates of 

congenital syphilis that exceeded the HP2010 target of 1.0 case per 100,000 live 

births (Tables 40-42). 

• Thirty-one (49.2%) of 63 selected cities in the United States had congenital 

syphilis rates greater than the HP2010 target of 1.0 case per 100,000 live births in 

2003 (Table 42). All of these cities had rates that were more than seven times the 

HP2010 target. 

• Additional information about syphilis and congenital syphilis in racial and ethnic 

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

populations can be found in the Special Focus Profiles. 

1 Ingraham NR. The value of penicillin alone in the prevention and treatment of congenital syphilis. Acta 

Derm Venereol 31 (suppl 24):60,1951. 

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

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

3 Centers for Disease Control and Prevention. Primary and secondary syphilis – United States, 1999. 

MMWR 2000;50:113-117. 

STD Surveillance 2003 National Profile Syphilis 29 
4 Centers for Disease Control and Prevention. Resurgent bacterial sexually transmitted disease among men 

who have sex with men – King County, Washington, 1997-1999. MMWR 1999;48:773-777. 

5 Centers for Disease Control and Prevention. Outbreak of syphilis among men who have sex with men – 

Southern California, 2000. MMWR 2001;50(7):117-20. 

6 Bronzan R, Echavarria L, Hermida J, Trepka M, Burns T, Fox, K. Syphilis among men who have sex with 

men (MSM) in Miami – Dade County, Florida [Abstract no. P135]. In: Program and abstracts of the 2002 

National STD Prevention Conference, San Diego, California, March 4-7, 2002. 

7 Centers for Disease Control and Prevention. Primary and secondary syphilis among men who have sex 

with men – New York City, 2001. MMWR 2002;51:853-6. 

8 Chen SY, Gibson S, Katz MH, Klausner JD, Dilley JW, Schwarcz SK, Kellogg TA, McFarland W. 

Continuing increases in sexual risk behavior and sexually transmitted diseases among men who have sex 

with men: San Francisco, California, 1999-2001 [Letter]. Am J Public Health 2002;92:1387-8. 

9 Ciesielski CA, Boghani S. HIV infection among men with infectious syphilis in Chicago, 1998-2000 

[Abstract no. 12]. In: Program and abstracts of the 9th Conference on Retroviruses and Opportunistic 

Infections, Seattle, Washington, February 24-28, 2002. 

10D'Souza G, Lee JH, Paffel JM. Outbreak of syphilis among men who have sex with men in Houston, 

Texas. Sex Transm Dis 2003;30:872-3. 

11Robinson BC, Chiliade PA, Lee C, Bautista J, Saenz G. Redirecting elimination efforts in response to the 

changing epidemiology of syphilis [Abstract 167]. In: Program and abstracts of the 2004 National STD 

Prevention Conference, Philadelphia, Pennsylvania, March 8-11, 2004. 

12U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and 

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

Printing Office, November 2000. 

13Centers for Disease Control and Prevention. Congenital syphilis – United States, 2002. MMWR 

2004;53:716-9. 

14Centers for Disease Control and Prevention. Primary and secondary syphilis – United States, 2002. 

MMWR 2003;52(46):1117-20. 

30 Syphilis National Profile STD Surveillance 2003 
Figure 23. Syphilis — Reported cases by stage of infection: United States, 1941–2003 

Cases (in thousands) 

600 

480 

360 

240 

120 

0 

P&S 

Early Latent 

Total Syphilis 

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

Figure 24. Primary and secondary syphilis — Reported cases by reporting source: 

United States, 1984-2003 

Cases (in thousands) 

50 

40 

30 

20 

10 

0 

non-STD Clinic 

STD Clinic 

1984 86 88 90 92 94 96 98 2001 02 

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

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

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

electronically, the specific source of report (i.e., STD clinic) became available from an 

increasing number of states. 

STD Surveillance 2003 National Profile Syphilis 31 
Figure 25. Primary and secondary syphilis — Rates: United States, 1970–2003 

and the Healthy People 2010 target 

Rate (per 100,000 population) 

25 

20 

15 

10 

5 

0 

P&S Syphilis 

2010 Target 

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

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

Figure 26. Primary and secondary syphilis — Rates by state: United States and outlying 

areas, 2003 

Rate per 100,000 

population 

<=0.2 

0.21-4.0 

>4.0 

VT 0.2 

NH 1.5 

MA 2.1 

RI 3.1 

CT 0.9 

NJ 2.0 

DE 0.9 

MD 5.7 

Guam 0.6 

(n= 5) 

(n= 44) 

(n= 4) 

2.5 

0.2 

3.4 1.9 

3.7 0.9 

3.9 

6.8 

1.1 

1.1 

3.0 0.8 

0.4 

0.9 0.8 

4.1 

0.6 

2.5 

0.9 

1.4 

1.1 

0.0 

0.6 0.6 

3.8 

3.0 

1.8 

0.3 

1.7 

1.8 

1.4 

1.3 

2.3 

0.3 

2.3 

3.0 

0.6 

1.1 

1.4 

0.1 

0.3 

0.0 

Puerto Rico 5.2 

Virgin Is. 2.7 

Note: The total rate of primary and secondary syphilis for the United States and outlying areas 

(Guam, Puerto Rico and Virgin Islands) was 2.5 per 100,000 population. The Healthy People 

2010 target is 0.2 case per 100,000 population. 

32 Syphilis National Profile STD Surveillance 2003 
Figure 27. Primary and secondary syphilis — Rates by county: United States, 2003 

Rate per 100,000 

population 

<=0.2 (N= 2,538) 

0.3-4.0 (N= 446) 

>4.0 (N= 156) 

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

Figure 28. Primary and secondary syphilis — Rates by region: United States, 1981–2003 

and the Healthy People 2010 target 

Rate (per 100,000 population) 

50 

West 

Midwest 

40 Northeast 

South 

2010 Target 

30 

20 

10 

0 

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

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

STD Surveillance 2003 National Profile Syphilis 33 
Figure 29. Primary and secondary syphilis — Rates by sex: United States, 1981–2003 

and the Healthy People 2010 target 

Rate (per 100,000 population) 

25 

20 

15 

10 

5 

0 

Male 

Female 

2010 Target 

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

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

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

1981–2003 and the Healthy People 2010 target 

Rate (per 100,000 population) 

150 

120 

90 

60 

30 

0 

White 

Black 

Hispanic 

Asian/Pac Isl 

Am Ind/AK Nat 

2010 Target 

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

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

34 Syphilis National Profile STD Surveillance 2003 
Figure 31. Primary and secondary syphilis — Male-to-female rate ratios: United States, 

1981–2003 

Male-Female rate ratio 

10:1 

8:1 

6:1 

4:1 

2:1 

0 

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

Figure 32. Primary and secondary syphilis — Age- and sex-specific rates: United States, 

2003 

Men Rate (per 100,000 population)population)population)population)population)population)population)population)population)population)population)population)population)population)population)population)population)population)population)population)population)population) Women 

12.0 9.6 7.2 4.8 2.4 0.0 Age 0.0 2.4 4.8 7.2 9.6 12.0 

0.0 

1.4 

6.0 

7.9 

9.7 

11.8 

8.9 

4.4 

1.5 

0.2 

4.2 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

Total 

0.1 

1.7 

2.4 

1.9 

1.6 

1.6 

1.2 

0.6 

0.1 

0.0 

0.8 

Note: See Table 33. 

STD Surveillance 2003 National Profile Syphilis 35 
Figure 33. Congenital syphilis — Reported cases for infants <1 year of age and rates of 

primary and secondary syphilis among women: United States, 1970–2003 

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

20 

16 

12 

8 

4 

0 

Kaufman Criteria 

CDC Surveillance 

Definition 

P&S Syphilis 

Congenital 

Syphilis 

7.5 

6.0 

4.5 

3.0 

1.5 

0.0 

1970 75 80 85 90 95 2000 

Note: The surveillance case definition for congenital syphilis changed in 1988. See Appendix 

(Reporting of Congenital Syphilis Cases). Case counts for congenital syphilis shown in this 

graph correspond to those listed in Table 39. 

Figure 34. Congenital syphilis — Rates for infants <1 year of age: United States, 

1981–2003 and the Healthy People 2010 target 

Rate (per 100,000 live births) 

Cong. Syphilis 

2010 Target 

0 

25 

50 

75 

100 

125 

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

Note: The Healthy People 2010 target for congenital syphilis is 1.0 case per 100,000 live births. 

The surveillance case definition for congenital syphilis changed in 1988. See Appendix 

(Reporting of Congenital Syphilis Cases). 

36 Syphilis National Profile STD Surveillance 2003 
Other Sexually Transmitted Diseases 

Since 1987, reported cases of chancroid have declined steadily until 2001 when 38 cases were reported (Figure 35, Table 1). In 2003, 54 cases of chancroid were reported in the United States. Only 

thirteen states and one outlying area reported one or more cases of chancroid in 2003 and one of 

these states (South Carolina) accounted for 24 (44%) of the 54 reported cases in 2003 (Table 45). 

Although the overall decline in reported chancroid cases most likely reflects a decline in the incidence 

of this disease, these data should be interpreted with caution in view of the fact that Haemophilus 

ducreyi, the causative organism of chancroid, is difficult to culture and, as a result, this condition may 

be substantially under diagnosed.1,2 

Case reporting data for genital herpes simplex virus (HSV), genital warts or other human 

papillomavirus infections, and trichomoniasis are not available. Trend data are limited to estimates 

of the office visits in physicians’ office practices provided by the National Disease and Therapeutic 

Index (NDTI) (Figures 36-38 and Table 47). 

For data on Pelvic Inflammatory Disease (PID), see the Special Focus Profile on Women and 

Infants. 

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. 

STD Surveillance 2003 National Profile Other Sexually Transmitted Diseases 37 
Figure 35. Chancroid — Reported cases: United States, 1981–2003 

Cases (in thousands)

5

4

3

2

1

0

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

Figure 36. Genital herpes — Initial visits to physicians’ offices: United States, 1966–2003 

Visits (in thousands)

250

200

150

100

50

0

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

Note: See Appendix (Other Data Sources) and Table 47. 

SOURCE: National Disease and Therapeutic Index (IMS Health) 

38 Other Sexually Transmitted Diseases National Profile STD Surveillance 2003 
Figure 37. Genital warts — Initial visits to physicians’ offices: United States, 1966–2003 

Visits (in thousands)

400

320

240

160

80

0

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

Note: See Appendix (Other Data Sources) and Table 47. 

SOURCE: National Disease and Therapeutic Index (IMS Health) 

Figure 38. Trichomoniasis and other vaginal infections — Initial visits to physicians’ 

offices: United States, 1966–2003 

Visits (in thousands)

4,500

3,600

2,700

1,800

900

0

Trichomonal

Other Vaginitis

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

Note: See Appendix (Other Data Sources) and Table 47. 

SOURCE: National Disease and Therapeutic Index (IMS Health) 

STD Surveillance 2003 National Profile Other Sexually Transmitted Diseases 39 

SPECIALFOCUSPROFILES
 

Special Focus Profiles 

The Special Focus Profiles highlight trends and distribution of sexually transmitted diseases

(STDs) in populations of particular interest for STD and HIV prevention programs in state and local

health departments. These populations are most vulnerable to STDs and their consequences:

women and infants, adolescents and young adults, minorities, men who have sex with men

(MSM), and persons entering corrections facilities. The Special Focus Profiles refer to figures

located in disease-specific sectionsin the National Profile and additional figures(Figures A-OO)

that highlight specific points made in the text.

STD Surveillance 2003 Special Focus Profiles 41 

4,5,6

STDs in Women and Infants
 

Public Health Impact 

Women and infants disproportionately bear the long term consequences of STDs. Women infected 

with Neisseria gonorrhoeae or Chlamydia trachomatis can develop pelvic inflammatory disease 

(PID), which, in turn, may lead to reproductive system morbidity such as ectopic pregnancy and tubal 

factor infertility. If not adequately treated, 20% to 40% of women infected with chlamydia1 and 10% 

to 40% of women infected with gonorrhea2 may develop PID. Among women with PID, tubal scarring 

will cause involuntary infertility in 20%, ectopic pregnancy in 9%, and chronic pelvic pain in 18%.3 

Approximately 70% of chlamydia infections and 50% of gonococcal infections in women are 

asymptomatic. 4-6 These infections are detected primarily through screening programs. The vague 

symptoms associated with chlamydial and gonococcal PID cause 85% of women to delay seeking 

medical care, thereby increasing the risk of infertility and ectopic pregnancy.7 Data from a randomized controlled trial of chlamydia screening in a managed care setting suggest that such screening 

programs can reduce the incidence of PID by as much as 60%.8 

Gonorrhea and chlamydia can also result in adverse outcomes of pregnancy, including neonatal 

ophthalmia and, in the case of chlamydia, neonatal pneumonia. Although topical prophylaxis of 

infants at delivery is effective for prevention of ophthalmia neonatorum, prevention of neonatal 

pneumonia requires prenatal detection and treatment. 

Human papillomavirus (HPV) infections are highly prevalent, especially among young sexually 

active women. While the great majority of HPV infections in women resolve within one year, they 

are a major concern because persistent infection with specific types (e.g., types 16, 18, 31, 33, 35, 

and 45), are causally related to cervical cancer; these types also cause Pap smear abnormalities. 

Other types (e.g., types 6 and 11) cause genital warts, low grade Pap smear abnormalities and, 

rarely, recurrent respiratory papillomatosis in infants born to infected mothers.9 

Genital infections with herpes simplex virus are extremely common, may cause painful outbreaks, and may have serious consequencesfor pregnant women including potentially fatal neonatal 

infections.10 

When a woman has a syphilis infection during pregnancy, she may transmit the infection to the fetus in 

utero. This may result in fetal death or an infant born with physical and mental developmental disabilities. 

Most cases of congenital syphilis are easily preventable if women are screened for syphilis and treated early 

during prenatal care.11 

Observations 

• Between 2002 and 2003, the rate of chlamydia infections in women increased 

from 445.0 to 466.9 per 100,000 females (Figure 6, Table 4). Chlamydia rates 

STD Surveillance 2003 Special Focus Profiles STDs in Women and Infants 43 
exceed gonorrhea rates among women in all states (Figures A and B, Tables 4 and 

14). 

• In 2003, the median state-specific chlamydia test positivity among 15- to 

24-year-old women screened in selected prenatal clinics in 27 states, Puerto Rico, 

and the Virgin Islands was 7.4% (range 2.4% to 19.7%) (Figure F). 

• In 2003, the median state-specific chlamydia test positivity among 15- to 

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

clinics in all states and outlying areas was 5.9% (range 2.8% to 18.9%) (Figure 8). 

• Gonorrhea rates among women were higher than the overall HP 2010 target of 

19.0 cases per 100,000 population12 in 42 states and two outlying areas in 2003 

(Figure B, Table 14). As in previous years, the highest rates of gonorrhea among 

women in 2003 occurred in the South (Figure B). 

• Like chlamydia, gonorrhea is often asymptomatic in women and can only be 

identified through screening. Large-scale screening programs for gonorrhea in 

women began in the 1970s. After an initial increase in cases detected through 

screening, gonorrhea rates for both women and men declined steadily 

throughout the 1980s and early 1990s (Figure 15, Tables 14 and 15). The 

gonorrhea rate for women in 2003 (118.8 per 100,000 females) showed a slight 

decline since 1999. In 2003, the gonorrhea rate among males declined to 113.0 

per 100,000 males, below the female gonorrhea rate (Figure 15). 

• In 2003, the median state-specific gonorrhea test positivity among 15- to 24-yearold women screened in selected prenatal clinics in 23 states, Puerto Rico, and the 

Virgin Islands was 1.0% (range 0.0% to 3.7%) (Figure G). 

• The HP2010 target for primary and secondary (P&S) syphilis is 0.2 case per 

100,000 population. In 2003, 30 states, the District of Columbia, and two 

outlying areas had rates of P&S syphilis for women that were greater than 0.2 

case per 100,000 population (Tables 27 and 31). 

• The HP2010 target for congenital syphilis is 1.0 case per 100,000 live births. In 

2003, 29 states, the District of Columbia, and two outlying areas had rates higher 

than this target (Figure 34, Tables 40-42). 

• The number of congenital syphilis cases closely follows the trend of P&S syphilis 

among women (Figure 33). Peaks in congenital syphilis usually occur one year 

after peaks in P&S syphilis among women. The congenital syphilis rate peaked in 

1991 at 107.3 cases per 100,000 live births, and declined by 90.4% to 10.3 cases 

per 100,000 live births in 2003 (Figure 34, Table 39). The rate of P&S syphilis 

among women declined 95.4% (from 17.3 to 0.8 cases per 100,000 females) 

during 1990-2003 (Figure 29). 

• The 2003 rate of congenital syphilis for the United States is currently 10 times 

higher than the HP2010 target of 1.0 case per 100,000 live births. This target is 

many times greater than the rate of congenital syphilis of most industrialized 

countries where syphilis and congenital syphilis have nearly been eliminated. 

• While most cases of congenital syphilis occur among infants whose mothers have 

had some prenatal care (Figure E), 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 

44 STDs in Women and Infants Special Focus Profiles STD Surveillance 2003 
• Accurate estimates of pelvic inflammatory disease (PID) and tubal factor infertility 

resulting from gonococcal and chlamydia infections are difficult to obtain. 

Definitive diagnosis of these conditions can be complex. 

• Hospitalizations for PID have declined steadily throughout the 1980s and early 

1990s, but have remained relatively constant between 1995 and 2002 (Figure I). 

A greater proportion of women diagnosed with PID in the 1990s have been 

treated in outpatient instead of inpatient settings when compared to women 

diagnosed with PID in the 1980s.14 

• The reported number of initial visits to physicians’ offices for PID through the 

National Disease and Therapeutic Index (NDTI) has generally declined from 

1993 through 2003 (Figure J and Table 47). In 2001, an estimated 187,781 cases 

of PID were diagnosed in emergency departments among women 15 to 44 years 

of age; a similar number were estimated in 2002, 189,662 (National Hospital 

Ambulatory Medical Care Survey, NCHS). 

• Evidence suggests that health care practices associated with ectopic pregnancy 

changed in the late 1980s and early 1990s. Before that time, treatment of ectopic 

pregnancy usually required admission to a hospital. Hospitalization statistics were 

therefore useful for monitoring trends in ectopic pregnancy. Beginning in 1989, 

hospitalizations for ectopic pregnancy have generally declined over time (Figure 

H). Data suggest that nearly half of all ectopic pregnancies are treated on an 

outpatient basis.15 

1	 Stamm WE, Guinan ME, Johnson C. Effect of treatment regimens for Neisseria gonorrhoeae on 

simultaneous infections with Chlamydia trachomatis. N Engl J Med 1984;310:545-9. 

2	 Platt R, Rice PA, McCormack WM. Risk of acquiring gonorrhea and prevalence of abnormal adnexal 

findings among women recently exposed to gonorrhea. JAMA 1983;250:3205-9. 

3	 Westrom L, Joesoef R, Reynolds G, et al. Pelvic inflammatory disease and fertility: a cohort study of 

1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopy. 

Sex Transm Dis 1992;9:185-92. 

4	 Hook EW III, Handsfield HH. Gonococcal infections in the adult. In: Holmes KK, Mardh PA, Sparling PF, 

et al, eds. Sexually Transmitted Diseases, 2nd edition. New York City: McGraw-Hill, Inc, 1990:149-65. 

5	 Stamm WE, Holmes KK. Chlamydia trachomatis infections in the adult. In: Holmes KK, Mardh PA, 

Sparling PF, et al, eds. Sexually Transmitted Diseases, 2nd edition. New York City: McGraw-Hill, Inc, 

1990:181-93. 

6	 Zimmerman HL, Potterat JJ, Dukes RL, et al. Epidemiologic differences between chlamydia and 

gonorrhea. Am J Public Health 1990;80:1338-42. 

7	 Hillis SD, Joesoef R, Marchbanks PA, et al. Delayed care of pelvic inflammatory disease as a risk factor for 

impaired fertility. Am J Obstet Gynecol 1993;168:1503-9. 

8	 Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic 

inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 1996;34(21):1362-6. 

9	 Division of STD Prevention. Prevention of Genital HPV Infection and Sequelae: Report of an External 

Consultants’ Meeting. National Center for HIV, STD, and TB Prevention, Centers for Disease Control 

and Prevention, Atlanta, December 1999. 

STD Surveillance 2003	 Special Focus Profiles STDs in Women and Infants 45 
10Handsfield HH, Stone KM, Wasserheit JN. Prevention agenda for genital herpes. Sex Transm Dis 

1999;26:228-231. 

11Centers for Disease Control. Guidelines for prevention and control of congenital syphilis. MMWR 

1988;37(No.S-1). 

12U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and 

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

Printing Office, November 2000. 

13Centers for Disease Control and Prevention. Congenital syphilis – United States, 2002. MMWR 

2004;53:716-9. 

14Rolfs RT, Galaid EI, Zaidi AA. Pelvic inflammatory disease: trends in hospitalization and office visits, 1979 

through 1988. Am J Obstet Gynecol 1992;166:983-90. 

15Centers for Disease Control and Prevention. Ectopic pregnancy in the United States, 1990-1992. MMWR 

1995;44:46-8. 

46 STDs in Women and Infants Special Focus Profiles STD Surveillance 2003 
Figure A. Chlamydia — Rates among women by state: United States and outlying areas, 2003 

405.2

408.7 218.6 342.3

315.2 310.6

263.3 486.6 466.6 443.2 VT 263.4 289.3 506.3 NH 184.7

400.2

241.3

392.3 328.8

564.9 418.6 571.7

432.7 MA

RI

CT

253.5

402.2

410.3

488.5 440.1 436.5 506.7 303.8

227.3 418.4 NJ

DE

MD

312.8

519.3

487.6

514.5 493.7 367.8 633.5 506.8 453.6 603.5 Rate per 100,000

Guam 565.8 population

710.5 560.0 667.7

<=150.0 (n= 1)

857.8

525.4

737.8

404.8

150.1-300.0

>300.0

(n= 8)

(n= 44)

662.5

Puerto Rico 118.7

Virgin Is. 594.5

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

(Guam, Puerto Rico and Virgin Islands) was 462.3 per 100,000 female population. 

Figure B. Gonorrhea — Rates among women by state: United States and outlying areas, 2003 

38.3

16.2 12.6 18.6

21.9 70.4

2.7 119.9 34.7 114.0 VT 15.3 11.3 152.9 NH 8.8

58.1 MA 40.4 104.3

99.6 105.5 RI 93.2 211.1 13.2 115.2 CT 107.2 181.0

67.7 68.4 50.2 NJ 103.0 129.5 110.9 164.7 DE 145.1 88.2 MD 147.8

174.2 143.5 59.9 144.4 Rate per 100,000 63.4 152.1 206.9

Guam 49.5 population

197.8 210.4 253.4 <=19.0 (n= 9) 115.4 19.1-100.0 (n= 15) 263.0 109.1 >100.0 (n= 29) 110.3

116.5

Puerto Rico 6.0

Virgin Is. 109.8

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

(Guam, Puerto Rico and Virgin Islands) was 117.2 per 100,000 female population. 

STD Surveillance 2003 Special Focus Profiles STDs in Women and Infants 47 
Figure C. Primary and secondary syphilis — Rates for women by state: United States and 

outlying areas, 2003 

0.1

0.0 0.0 0.0

0.2 0.2

0.7 0.0 0.0 0.3 VT 0.0 0.0 1.8 NH 0.0

0.3

0.3

0.1 0.1

0.7 0.5 0.7

0.5 MA

RI

CT

0.1

1.4

0.2

0.3 0.2 0.9 0.5 0.6

0.2 0.2 NJ

DE

MD

1.1

0.5

2.6

1.1 1.3 2.4 2.4 1.1 1.2 1.1 Rate per 100,000

Guam 0.0 population

1.3 2.1 1.6

<=0.2 (n= 21)

0.0

1.5

3.4

0.9

0.21-4.0

>4.0

(n= 31)

(n= 1)

0.0

Puerto Rico 4.6

Virgin Is. 3.4

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

Puerto Rico and Virgin Islands) was 0.9 per 100,000 female population. 

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

outlying areas, 2003 

0.0

0.0 0.0 0.0

0.0 0.0

19.1 0.0 0.0 16.7 VT 0.0 0.0 29.2 NH 0.0

0.0 MA 0.0 1.4

0.0 3.9 RI 0.0 2.0 0.0 17.6 CT 2.4 10.5

11.1 4.4 0.0 NJ 18.3 1.0 2.5 5.3 DE 0.0 1.8 MD 10.9

15.3 2.6 33.0 2.0 Rate per 100,000 21.6 5.3 20.2

Guam 31.1 live births

5.1 8.3 4.8 <=1.0 (n= 22) 20.7 1.0-10.0 (n= 15) 1.5 0.0 >10.0 (n= 16) 12.6

0.0

Puerto Rico 28.4

Virgin Is. 0.0

Note: The total rate of congenital syphilis for infants <1 year of age for the United States and outlying 

areas (Guam, Puerto Rico and Virgin Islands) was 10.5 per 100,000 live births. The Healthy 

People 2010 target is 1.0 case per 100,000 live births. 

48 STDs in Women and Infants Special Focus Profiles STD Surveillance 2003 
Figure E . Congenital syphilis — Cases by prenatal care utilization: United States, 1995-2003 

Cases

1,200

960

720

480

240

0

Prenatal

No prenatal

Unknown

1995 1996 1997 1998 1999 2000 2001 2002 2003

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

clinics by state: United States and outlying areas, 2003 

Positivity (%)

See*

<5.0

5.0-9.9

>=10.0

VT

NH

MA

RI

CT

NJ 9.7

DE 7.1

MD 2.4

DC

(n= 24)

(n= 5)

(n= 19)

(n= 5)

8.5

7.6

6.2

7.4 5.4

6.4

6.9 4.7

13.2

5.2

10.6

7.4

7.6 3.8

8.3

6.5

7.0

4.3

10.9

8.3

6.1

9.7

8.5 2.4

Puerto Rico 12.6

Virgin Is. 19.7

*States not reporting chlamydia positivity data in prenatal clinics. 

Note: Includes states and outlying areas that reported chlamydia positivity data on at least 100 

women aged 15-24 years during 2003. 

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

for Disease Control and Prevention 

STD Surveillance 2003 Special Focus Profiles STDs in Women and Infants 49 
Figure G. Gonorrhea — Positivity among 15- to 24-year-old women tested in prenatal 

clinics by state: United States and outlying areas, 2003 

VT

1.0 NH

0.9 MA 3.7 1.0 RI 0.0 CT 0.4 1.8 NJ 1.6 2.1 0.7 1.4 DE 0.5 0.8 MD

DC

2.1 0.5 0.2 1.4 1.4 Positivity (%)

0.8 2.0 See* (n= 28) 0.6 <1.0 (n= 11) 3.1 1.0-1.9 (n= 9) 0.7 >=2.0 (n= 5)

Puerto Rico 1.1

Virgin Is. 1.6

*States not reporting gonorrhea positivity data in prenatal clinics. 

Note: Includes states and outlying areas that reported gonorrhea positivity data on at least 100 

women aged 15-24 years during 2003. 

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

for Disease Control and Prevention 

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

States, 1980-2002 

Hospitalizations (in thousands)

100

80

60

40

20

0

1980 82 84 86 88 90 92 94 96 98 2000 02

Note: Some variations in 1981 and 1988 estimates may be due to changes in sampling 

procedures. The relative standard error for these estimates ranges from 8% to 12%. 

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

50 STDs in Women and Infants Special Focus Profiles STD Surveillance 2003 
Figure I.	 Pelvic inflammatory disease — Hospitalizations of women 15 to 44 years 

of age: United States, 1980–2002 

Hospitalizations (in thousands)
 

200
 

160
 

120
 

80
 

40
 

0
 

Acute, Unspec.

Chronic

1980 82 84 86 88 90 92 94 96 98 2000 02

Note: The relative standard error for the estimates of the overall total number of PID cases range 

from 6% to 18%. 

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

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

15 to 44 years of age: United States, 1980–2003 

Visits (in thousands)
 

500
 

400
 

300
 

200
 

100
 

0
 

1980 82 84 86 88 90 92 94 96 98 2000 02

Note: See Appendix (Other Data Sources) and Table 47. 

SOURCE: National Disease and Therapeutic Index (IMS Health) 

STD Surveillance 2003 Special Focus Profiles STDs in Women and Infants 51 

1,2

STDs in Adolescents and Young Adults
 

Public Health Impact 

Compared to older adults, adolescents (10- to 19-year-olds) and young adults (20- to 24-year-olds) 

are at higher risk for acquiring STDs for a number of reasons. In addition, for some STDs, for example 

Chlamydia trachomatis, adolescent women may have a physiologically increased susceptibility to infection due to increased cervical ectopy. 

The higher prevalence of STDs among adolescents also reflects multiple barriers to quality STD 

prevention services, including lack of insurance or other ability to pay, lack of transportation, discomfort with facilities and services designed for adults, and concerns about confidentiality. 

Observations 

• Numerous prevalence studies in various clinic populations have shown that 

sexually active adolescents have high rates of chlamydia infection. 1-3 The 

Regional Infertility Prevention Projects that routinely perform large scale 

screening for detecting chlamydia infections among women attending family 

planning clinics demonstrate that younger women consistently have higher 

positivity than older women, even when prevalence declines. An example is the 

Region X Chlamydia Project, which has screened women in family planning 

clinics since 1988 (Figure L). 

• After adjusting trends in chlamydia positivity to account for changes in laboratory 

test methods and associated increases in test sensitivity (see Appendix), for 15­

to 19-year-old women chlamydia test positivity decreased in 5 of 10 HHS regions 

from 2002 through 2003, increased in 4 regions, and remained the same in 1 

region (Figure K). Although chlamydia positivity has declined in the past year in 

some regions presumably due to the effectiveness of screening and treatment of 

women, continued expansion of screening programs to populations with higher 

prevalence of disease may have contributed to increases in positivity in other 

regions. 

• As in previous years, 15- to 19-year-old women had the highest rates of gonorrhea 

compared to women in all other age categories (Figure S and Table 20). Women 

aged 20-29 had the highest rates of primary and secondary syphilis in 2003 (Figure U 

and Table 33). Among men, 20- to 24-year-olds had the highest rate of gonorrhea 

(Figure T and Tables 20 and 33). 

• In 15- to 19-year-old women, the 2003 gonorrhea rate of 634.7 cases per 

100,000 females was an 11.7% decrease from the 1999 rate of 718.4. Among 

young women in the 20- to 24-year-old group, the rate of gonorrhea in 2003 

decreased only 3.3% from 615.6 in 1999 to 595.2 in 2003. Since 1999, the rates 

in these two age groups have been converging (Figure S, Table 20). 

STD Surveillance 2003 Special Focus Profiles STDs in Adolescents and Young Adults 53 
• Rates of gonorrhea among male adolescents generally decreased between the 

years 1991 and 2003 (Figure T, Table 20). Among 15- to 19-year-old males, the 

gonorrhea rate declined by 21.0% from 332.2 in 1999 to 262.4 in 2003. Among 

20- to 24-year-old males, the gonorrhea rate declined by 16.1% from 555.5 in 

1999 to 465.9 in 2003. 

• Since 1990, approximately 20,000 female National Job Training Program entrants 

have been screened each year for chlamydia. This program, administered by the 

U.S. Department of Labor at more than 100 sites throughout the country, is a job 

training program for economically-disadvantaged youth aged 16-24 years-old. 

• Chlamydia infection is widespread geographically and highly prevalent among 

economically-disadvantaged young women in the National Job Training 

Program.3 Among women entering the program from 39 states and Puerto Rico 

in 2003, based on their place of residence before program entry, the median 

state-specific chlamydia prevalence was 9.9% (range 3.4% to 16.0%) (Figure M). 

Among men entering the program from 38 states and Puerto Rico from July 

through December 2003, the median state-specific chlamydia prevalence was 

7.8% (range 1.5% to 12.7%) (Figure N). 

• Data from National Job Training Program centers that submit gonorrhea 

specimens from female students aged 16-24 years to a national contract 

laboratory indicates a high prevalence of gonococcal infection in this population. 

Specimens from at least 100 students from each of 34 states and Puerto Rico were 

tested by the contract laboratory; the median state-specific gonorrhea prevalence 

was 2.1% (range 0.0% to 6.3%) in 2003 (Figure Q). Among men entering the 

program from 10 states from July through December 2003, the median 

state-specific gonorrhea prevalence was 2.8% (range 1.4% to 6.3%) (Figure R). 

• The Adolescent Women Reproductive Health Monitoring Project was established 

in 1999 to monitor STD prevalence and reproductive health measures among 

adolescent women (less than 20 years old) in non-traditional venues, including 

school-based clinics, juvenile corrections facilities, drug treatment centers, and 

organizations serving street youth. In 2003, urine-based test results from this 

screening project identified a median site-specific chlamydia positivity of 11.3% 

(range 6.7% to 18.2%) (Figure O) and a median site-specific gonorrhea positivity 

of 1.9% (range 0.6% to 3.7%) (Figure P) at 25 school-based clinics. 

• Among adolescent women attending juvenile corrections facilities, data from the 

Adolescent Women Reproductive Health Monitoring Project and the Jail STD 

Prevalence Monitoring Project identified a median chlamydia positivity of 15.9% 

(range 2.7% to 33.5%) (Figure JJ) and a median gonorrhea positivity of 5.7% 

(range 0.5% to 15.9%) (Figure LL). See Special Focus Profiles (STDs in 

Persons Entering Corrections Facilities). 

• Syphilis rates in women in all age groups are similar and low (Figure U). In men 

rates in 15- to 19-year-olds remain low but increases have been observed in 20- to 

24-year-olds (Figure V). 

1 Centers for Disease Control and Prevention. Recommendations for the prevention and management of 

Chlamydia trachomatis infections, 1993. MMWR 1993;42(No. RR-12). 

54 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2003 
2 Lossick J, DeLisle S, Fine D, Mosure DJ, Lee V, Smith C. Regional program for widespread screening for 

Chlamydia trachomatis in family planning clinics. In: Bowie WR, Caldwell HD, Jones RP, et al., eds. 

Chlamydial Infections: Proceedings of the Seventh International Symposium of Human Chlamydial 

Infections, Cambridge, Cambridge University Press 1990, pp. 575-9. 

3 Mertz, KJ, Ransom RL, St. Louis ME, Groseclose SL, Hadgu A, Levine WC, Hayman C. Decline in the 

prevalence of genital chlamydia infection in young women entering a National Job Training Program, 

1990-1997. Am J Pub Health 2001;91(8):1287-1290. 

STD Surveillance 2003 Special Focus Profiles STDs in Adolescents and Young Adults 55 
Figure K. Chlamydia — Trends in positivity among 15- to 19-year-old women tested in family 

planning clinics by HHS regions, 1988–2003 

17.814.413.511.7 12.1 10.2 9.5 10.9 10.2 9.9 10.3 9.2 9.4 7.7 8.4 7.0 5.8 5.8 5.7 6.4 6.8 6.9 7.1 7.6 7.3 6.9 6.2 7.0 7.3 6.5 5.9

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

Region X Region V Region I

8.2 9.7 10.0 10.6 10.4 10.3 9.0 9.5 X 10.5 11.7 10.1 11.0 12.4 11.7 12.9

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

Region IX Region II

IX VII III

12.8

9.0 7.4 7.0 6.5 7.2 7.3 6.9 8.0 8.4 7.8 IV

10.3 9.1 9.4 9.7 10.1 9.4 8.7 8.3 8.3

VI 94 95 96 97 98 99 00 01 02 03 94 95 96 97 98 99 00 01 02 03

Region VIII Region III

15.5 15.7 16.2 14.4 14.2 13.9 14.4 13.9 13.8 14.9 13.5 12.4 12.3 12.2 11.8

7.7 7.1 7.4 7.2 7.5 7.2 7.5 7.3

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

Region VII Region VI Region IV

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

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

more information. No data on laboratory test method available for Region VII in 1995 and 

Regions IV and V in 1996. See Appendix for definition of Health and Human Services (HHS) 

regions. 

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

for Disease Control and Prevention 

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

age group: Region X, 1988–2003 

Percent

15

<18 Years

18-19 Years

12 20-24 Years

25-29 Years

30+ Years

9

6

3

0

1988 89 90 91 92 93 94 95 96 97 98 99 2000 01 02 03

Note: Women who met screening criteria were tested. Trends not adjusted for changes in 

laboratory test method and associated increases in test sensitivity in 1994 and 1999–2003. 

SOURCE: Regional Infertility Prevention Projects: Region X Chlamydia Project 

56 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2003 
Figure M. Chlamydia — Prevalence among 16- to 24-year-old women entering the National 

Job Training Program by state of residence: United States and outlying areas, 2003 

6.0

9.7 3.4

7.2 6.6

4.2 7.7 VT 3.6

8.7 NH

MA 6.8

11.2 9.2 10.5

9.1 RI

CT 6.9 6.6 9.3 7.0 NJ 11.2 8.5 10.1 7.7 7.8 12.5

11.4 12.4 DE

MD 10.3

DC

10.2 9.1 12.8 11.0 13.6 12.4

Prevalence (%)

16.0 11.1 10.5

See * (n= 13) 11.8

13.8 <10.0 (n= 20)

13.2 10.0-14.9 (n= 19)

>=15.0 (n= 1)

Puerto Rico 12.0

Virgin Is.

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

were screened for chlamydia in 2003. 

Note: The overall chlamydia prevalence among female students entering the National Job Training 

Program in 2003 was 9.9%. 

SOURCE: U.S. Department of Labor 

Figure N. Chlamydia — Prevalence among 16- to 24-year-old men entering the National Job 

Training Program by state of residence: United States and outlying areas, 2003 

4.2

2.1 3.7

4.8

2.8	 7.6 8.0 VT 3.5

10.2	 NH

MA 4.1 2.8 6.2 4.5 RI

10.8	 CT 11.3 1.5	 7.3 NJ 7.3 4.3	 2.6 10.9 10.8 DE 7.8 7.1 MD 10.0

DC 9.5

9.7 11.2 7.8	 7.6 11.4	 9.9

Prevalence (%) 11.8 12.4 12.7 See * (n= 14) 10.0 <10.0 (n= 26) 11.7

10.0-14.9 (n= 13) 9.2 >=15.0

Puerto Rico 5.7

Virgin Is.

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

screened for chlamydia in 2003. 

Note: The overall chlamydia prevalence among male students entering the National Job Training 

Program for the period July-December 2003 was 8.0%. 

SOURCE: U.S. Department of Labor 

STD Surveillance 2003 Special Focus Profiles STDs in Adolescents and Young Adults 57 
Figure O. Chlamydia — Adolescent Women Reproductive Health Monitoring Project 

chlamydia positivity in school-based clinics, 2003 

Percent

0

5

10

15

20

25

Chicago Colorado Connecticut NYC Wisconsin

(10 clinics) (11 clinics) (1 clinic) (1 clinic) (2 clinics)

Figure P. Gonorrhea — Adolescent Women Reproductive Health Monitoring Project 

gonorrhea positivity in school-based clinics, 2003 

Percent

0

1

2

3

4

5

Chicago Colorado Connecticut NYC Wisconsin

(10 clinics) (11 clinics) (1 clinic) (1 clinic) (2 clinics)

58 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2003 
Figure Q. Gonorrhea — Prevalence among 16- to 24-year-old women entering the National Job 

Training Program by state of residence: United States and outlying areas, 2003 

0.0 0.6

0.5 0.7

0.0 1.4 VT 0.0

2.6 NH

MA 0.4

1.3 1.0 2.7

1.9 RI

CT 2.3 2.2 3.1 NJ 3.1 1.1 4.8 4.5 DE 2.4 2.7 MD 2.1

DC

1.0 2.7 0.0 5.7 1.6

Prevalence (%)

3.3 3.6 3.5

See * (n= 18) 3.4

6.3 <2.0 (n= 17)

1.3 2.0-4.9 (n= 16)

>=5.0 (n= 2)

Puerto Rico 0.9 Virgin Is.

*Fewer than 100 women residing in these states and entering the National Job Training Program were screened 

for gonorrhea by the national contract laboratory in 2003. 

Note:	 Many training centers test female students for gonorrhea using local laboratories; these results are not 

available to CDC. For this map, gonorrhea test results for students at centers submitting specimens to the 

national contract laboratory were included if the number of gonorrhea tests submitted was greater than 

90% of the number of chlamydia tests submitted. The overall gonorrhea prevalence among female 

students entering the National Job Training Program in 2003 was 2.3%. 

SOURCE: U.S. Department of Labor 

Figure R. Gonorrhea — Prevalence among 16- to 24-year-old men entering the National Job 

Training Program by state of residence: United States and outlying areas, 2003 

VT

2.9	 NH

MA 3.6 RI 2.7 CT 2.5 NJ 1.4	 6.2 DE 3.8 MD

DC 1.9

6.3

Prevalence (%)

See * (n= 43)

<2.0 (n= 3)

2.0-4.9 (n= 5) 1.8 >=5.0 (n= 2)

Puerto Rico Virgin Is.

*Fewer than 100 men residing in these states and entering the National Job Training Program were screened for 

gonorrhea by the national contract laboratory in 2003. 

Note:	 Many training centers test male students for gonorrhea using local laboratories; these results are not 

available to CDC. For this map, gonorrhea test results for students at centers submitting specimens to the 

national contract laboratory were included if the number of gonorrhea tests submitted was greater than 

90% of the number of chlamydia tests submitted. The overall gonorrhea prevalence among male students 

entering the National Job Training Program for the period July-December 2003 was 2.8%. 

SOURCE: U.S. Department of Labor 

STD Surveillance 2003 Special Focus Profiles STDs in Adolescents and Young Adults 59 
Figure S. Gonorrhea — Age-specific rates among women 10 to 44 years of age: United 

States, 1981–2003 

Rate (per 100,000 population)

1,500

1,200

900

600

300

0

10-14

15-19

20-24

25-29

30-34

35-39

40-44

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

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

States, 1981–2003 

Rate (per 100,000 population)
 

2,000
 

1,600
 

1,200
 

800
 

400
 

0
 

10-14

15-19

20-24

25-29

30-34

35-39

40-44

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

60 STDs in Adolescents and Young Adults Special Focus Profiles STD Surveillance 2003 
Figure U. Primary and secondary syphilis — Age-specific rates among women 10 to 44 years 

of age: United States, 1981–2003 

Rate (per 100,000 population)

75

60

45

30

15

0

10-14

15-19

20-24

25-29

30-34

35-39

40-44

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

Figure V. Primary and secondary syphilis — Age-specific rates among men 10 to 44 years of 

age: United States, 1981–2003 

Rate (per 100,000 population)

75

60

45

30

15

0

10-14

15-19

20-24

25-29

30-34

35-39

40-44

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

STD Surveillance 2003 Special Focus Profiles STDs in Adolescents and Young Adults 61 

STDs in Racial and Ethnic Minorities
 

Public Health Impact 

Surveillance data show higher rates of reported STDs among some minority racial or ethnic 

groups when compared with rates among whites. Race and ethnicity in the United States are risk 

markers that correlate with other more fundamental determinants of health status such as poverty, 

access to quality health care, health care seeking behavior, illicit drug use, and living in communities 

with high prevalence of STDs. Acknowledging the disparity in STD rates by race or ethnicity is one 

of the first steps in empowering affected communities to organize and focus on this problem. 

Surveillance data are based on cases of STDs reported to state and local health departments (see 

Appendix). In many areas, reporting from public sources, (for example, STD clinics) is more complete 

than reporting from private sources. Since minority populations may utilize public clinics more than 

whites, differences in rates between minorities and whites may be increased by this reporting bias. 

Observations 

• Although chlamydia in women is a widely distributed STD among all racial and 

ethnic groups, trends in positivity in women screened in HHS Region X show 

consistently higher chlamydia positivity among minorities (Figure W). 

• In 2003, the rate of chlamydia among African-American females in the United States 

was more than 7 times higher than the rate among white females (1,633.1 and 217.9 

per 100,000, respectively) (Table 11B). The chlamydia rate among 

African-American males was 11 times higher than that among white males (584.2 

and 52.9 per 100,000 respectively). 

• In 2003, chlamydia positivity among sexually active 15- to 30-year-old women 

screened at clinics of the Indian Health Service (IHS) in two IHS areas was 11.0% 

(Figure X). 

• In 2003, 70.7% of the total number of cases of gonorrhea reported to CDC 

occurred among African-Americans (Table 21A). In 2003, the rate of gonorrhea 

among African-Americans was 655.8 cases per 100,000 population, among 

American Indian/Alaska Natives the rate was 103.5, and among Hispanics the 

rate was 71.7. These rates are 20, 3, and 2 times higher, respectively, than the rate 

among whites in 2003 of 32.7 cases per 100,000 population. The rate of 

gonorrhea among Asian/Pacific Islanders in 2003 was 22.8 cases per 100,000 

population (Figure 16, Table 21B). 

• Gonorrhea rates in 2003 were highest for African-Americans aged 15-24 years 

among all racial, ethnic, and age categories. In 2003, African-American women 

aged 15-19 years had a gonorrhea rate of 2,947.8 cases per 100,000 females. 

This rate is 14 times greater than the 2003 rate among white females of similar age 

(204.8). African-American men in the 15- to 19-year-old age category had a 2003 

STD Surveillance 2003 Special Focus Profiles STDs in Racial and Ethnic Minorities 63 
gonorrhea rate of 1,464.1 cases per 100,000 males, which was 39 times higher 

than the rate among 15- to 19-year-old white males of 37.7 per 100,000. Among 

20- to 24-year-olds in 2003, the gonorrhea rate among African-Americans was 

18 times greater than that among whites (2,683.1 and 152.0 cases per 100,000 

population, respectively) (Table 21B). 

• Although gonorrhea rates declined for most age and race/ethnic groups during the 

1980s, they did not decline for African-American adolescents. African-American 

females 15 to 19 years of age did not show a decline in rates until 1991 (Figure Y). 

Declines among African-American males aged 15-19 years did not begin until 

1992 (Figure Z). From 1999 through 2003, gonorrhea rates among 

African-Americans declined by 18.9% (808.4 and 655.8 cases per 100,000 

population, respectively). During the same period, gonorrhea rates increased by 

22.5% among whites, 17.5% among Asian/Pacific Islanders, 11% among 

Hispanics, and 5.5% among American Indian/Alaska Natives (Table 21B). 

• The syphilis epidemic in the late 1980s occurred primarily among heterosexual, 

minority populations.1 During the 1990s, the rate of primary and secondary 

(P&S) syphilis declined among all racial and ethnic groups (Figure 30). During 

2000-2003, the rate continued to decline among African-Americans, but the 

overall rate of P&S syphilis and rates among non-Hispanic whites, Hispanics, 

Asian/Pacific Islanders, and American Indian/Alaska Natives increased; increases 

in P&S syphilis occurred only among men and the most rapid rate of increase 

occurred among non-Hispanic white men during this time (Table 34B). Despite 

recent changes in the demographics of syphilis infection, the rates of P&S syphilis 

continue to be higher among African-Americans and Hispanics than among 

non-Hispanic whites. 

• In 2003, 39.2% of all cases of P&S syphilis reported to CDC occurred among 

African-Americans and 41.9% of all cases occurred among non-Hispanic whites 

(Table 34A). Although the rate of P&S syphilis among African-Americans 

declined from 9.5 to 7.8 cases per 100,000 population between 2002 and 2003, 

the 2003 rate was 5.2 times greater than the rate among non-Hispanic whites (1.5 

cases per 100,000 population). 

• The incidence of P&S syphilis among African-Americans was highest among 

women aged 20-24 years (11.1 cases per 100,000 population) and among men 

aged 35 to 39 (25.7 cases per 100,000 population) in 2003 (Table 34B). 

• Between 2002 and 2003, P&S syphilis rates for African-Americans aged 15-19 

years declined 18.1%; rates declined 31.8% among African-American females 

but increased 3.4% among African-American males in this age group (Figures AA 

and BB, Table 34B). The P&S syphilis rate among young African-American 

adults aged 20-24 years declined 13.7% between 2002 and 2003; rates declined 

30.6% among African-American females and 1.4% among African-American 

males in this age group (Table 34B). 

• In 2003, 16.2% of all cases of P&S syphilis reported to CDC occurred among 

Hispanics (Table 34A). The rate of P&S syphilis among Hispanics increased 

20.0% (from 2.5 to 3.0 cases per 100,000 population) between 2002 and 2003. 

The rate among Hispanics in 2003 was 2.0 times greater than the rate among 

non-Hispanic whites. 

64 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Surveillance 2003 
 

• The incidence of P&S syphilis among Hispanics was highest among women aged 

15- to 24-years (2.3 cases per 100,000 population) and among men aged 35 to 

39 (12.7 cases per 100,000 population) in 2003 (Table 34B). 

• In 2003, the rate of congenital syphilis (based on the mother’s race/ethnicity) was 

33.9 cases per 100,000 live births among African-Americans and 18.1 cases per 

100,000 live births among Hispanics. These rates are 26 and 14 times greater, 

respectively than the 2003 rate among non-Hispanic whites (1.3 cases per 

100,000 live births), respectively (Figure CC, Table 44). 

1 Nakashima AK, Rolfs RT, Flock ML, Kilmarx P, Greenspan JR. Epidemiology of syphilis in the United 

States, 1941 through 1993. Sex Transm Dis 1996;23:16-23. 

STD Surveillance 2003 Special Focus Profiles STDs in Racial and Ethnic Minorities 65 
Figure W. Chlamydia — Positivity among women tested in family planning clinics 

by race and ethnicity: Region X, 1988–2003 

Percent

15
 

12
 

9
 

6
 

3
 

0
 

White

Black

Hispanic

Asian/Pac Isl

Am Ind/AK Nat

1988 89 90 91 92 93 94 95 96 97 98 99 2000 01 02 03
 

Note: Women who met screening criteria were tested. Trends not adjusted for changes in 

laboratory test method and associated increases in test sensitivity in 1994, and 1999–2003. 

SOURCE: Regional Infertility Prevention Projects: Region X Chlamydia Project 

Figure X. Chlamydia — Positivity among 15- to 30-year-old women tested in Indian Health
 

Service (IHS) Clinics by IHS areas, 2003
 

Alaska Area*

Portland Area*

California Area*

Phoenix Area* Tucson Area*

Navajo Area*

Albuquerque Area* Oklahoma City Area*

11.0

Billings Area

11.1

Aberdeen Area

Bemidji Area*

Nashville Area*

*IHS areas not reporting chlamydia positivity data during 2003. See Appendix for definitions of IHS areas. 

SOURCE: Indian Health Service 

66 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Surveillance 2003
 
Figure Y. Gonorrhea — Rates among 15- to 19-year-old females by race and ethnicity: 

United States, 1981–2003 

Rate (per 100,000 population)
 

7,000
 

5,600
 

4,200
 

2,800
 

1,400
 

0
 

White

Black

Hispanic

Asian/Pac Isl

Am Ind/AK Nat

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

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

United States, 1981–2003 

Rate (per 100,000 population)
 

7,000
 

5,600
 

4,200
 

2,800
 

1,400
 

0
 

White

Black

Hispanic

Asian/Pac Isl

Am Ind/AK Nat

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

STD Surveillance 2003 Special Focus Profiles STDs in Racial and Ethnic Minorities 67 
Figure AA. Primary and secondary syphilis — Rates among 15- to 19-year-old females by 

race and ethnicity: United States, 1981–2003 

Rate (per 100,000 population)

250

200

150

100

50

0

White

Black

Hispanic

Asian/Pac Isl

Am Ind/AK Nat

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

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

race and ethnicity: United States, 1981–2003 

Rate (per 100,000 population)
 

125
 

100
 

75
 

50
 

25
 

0
 

White

Black

Hispanic

Asian/Pac Isl

Am Ind/AK Nat

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

68 STDs in Racial and Ethnic Minorities Special Focus Profiles STD Surveillance 2003 
Figure CC. Congenital syphilis — Rates among infants <1 year of age by mother’s race 

and ethnicity: United States, 1991–2003 and the Healthy People 2010 target 

Rate (per 100,000 live births)

450
 

360
 

270
 

180
 

90
 

0
 

White

Black

Hispanic

Asian/Pac Isl

Am Ind/AK Nat

2010 Target

1991 92 93 94 95 96 97 98 99 2000 01 02 03
 

Note: The Healthy People 2010 target for congenital syphilis is 1.0 case per 100,000 live births. 

Less than 5% of cases had missing race/ethnicity information and were excluded. Case 

counts for congenital syphilis shown in this graph correspond to those listed in Table 44. 

STD Surveillance 2003 Special Focus Profiles STDs in Racial and Ethnic Minorities 69
 

1,2,3,4,5

STDs in Men Who Have Sex with Men
 

Public Health Impact 

Data from several U.S. cities, including from syphilis outbreak investigations and the Gonococcal 

Isolate Surveillance Project (GISP), suggest that an increasing number of men who have sex with men 

(MSM) are acquiring STDs. 1-5 Increases in STDs among MSM are consistent with data suggesting that 

an increasing number of MSM are participating in sexual behaviors that place them at risk for STDs 

and HIV infection.6 Several factors may be contributing to this change, including the availability of 

highly active antiretroviral therapy (HAART).7 Because STDs and the behaviors associated with them 

increase the likelihood of acquiring and transmitting HIV infection,8 the rise in STDs among MSM may 

be associated with an increase in HIV incidence among MSM.9 

Observations 

• National notifiable STD surveillance data reported to CDC do not include 

information regarding sexual behaviors; therefore, national trends in STDs 

among MSM in the United States are not available. Data from enhanced 

surveillance projects are presented in this section to provide information 

regarding STDs in MSM. 

Monitoring Trends in Prevalence of STDs, Tuberculosis, and HIV Risk Behaviors among Men 

Who Have Sex with Men (MSM Prevalence Monitoring Project) 

• From 1999 through 2003, nine U.S. cities participating in the MSM Prevalence 

Monitoring Project submitted syphilis, gonorrhea, chlamydia, and HIV test data to 

CDC from 67,588 MSM visits to STD clinics. Overall, 57,570 MSM visits were 

submitted from six public STD clinics (Denver, Long Beach, New York City, 

Philadelphia, San Francisco, and Seattle) and 10,018 MSM visits were submitted from 

three STD clinics in community-based, gay men’s health clinics (Chicago, the District of 

Columbia, and Houston). In 2003, the nine participating sites submitted information 

from 18,783 MSM visits to STD clinics. In addition, in 2003, Fenway Community 

Health (Boston), a community-based, gay men’s primary care clinic also participating 

in the MSM Prevalence Monitoring Project, submitted syphilis, gonorrhea, and 

chlamydia test data to CDC from 22,673 primary care visits by men. The MSM 

Prevalence Monitoring Project includes data from culture and non-culture tests 

collected during routine care and reflects testing practices at participating clinics. 

City-specific medians and ranges were calculated for the proportion of tests done and 

STD and HIV test positivity among MSM visits. 

STD Surveillance 2003 Special Focus Profiles STDs in Men Who Have Sex with Men 71 
Syphilis, STD Clinics, 1999-2003 

• In 1999, 69% (range: 49-93%) of MSM visiting participating STD clinics had a 

nontreponemal serologic test for syphilis (STS) performed compared with 79% 

(range: 37-89%) in 2003. 

• Overall, median syphilis seroreactivity among MSM increased from 4.1% 

(range: 3.7-13.1%) in 1999 to 10.5% (range: 4.7-16.6%) in 2003 (Figure DD). 

Gonorrhea, STD Clinics, 1999-2003 

• Median gonorrhea positivity in MSM was 13.7% (range: 12.9-16.5%) in 

1999 and 15.3% (range: 13.7-17.2%) in 2003 (Figure EE). 

• In 2003, 76% (range: 46-90%) of MSM were tested for urethral gonorrhea, 

34% (range: 2-59%) were tested for rectal gonorrhea, and 46% (range: 

3-83%) were tested for pharyngeal gonorrhea. 

• In 2003, median urethral gonorrhea positivity in MSM was 13.3% (range: 

6.2-17.7%), median rectal gonorrhea positivity was 6.0% (range: 2.8-8.3%), 

and median pharyngeal gonorrhea positivity was 2.8% (range: 0.4-9.2%). 

• In 2003, urethral gonorrhea positivity was 11.5% (range: 6.3-17.2%) in whites, 

18.8%(range: 10.5-30.3%)inAfrican-Americans,and12.4%(range:5.3-21.9%) 

in Hispanics. Rectal gonorrhea positivity was 6.1% (range: 3.0-14.3%) in whites, 

5.6% (range: 2.9-10.1%) in African-Americans, and 4.3% (range: 2.5-6.7%) in 

Hispanics.Pharyngeal gonorrhea positivity was4.3% (range: 0.2-9.4%) in whites, 

5.3% (range: 1.4-10.7%) in African-Americans, and 5.9% (range: 1.3-8.7%) in 

Hispanics (Figure FF). 

• In 2003, gonorrhea positivity was higher in HIV-positive MSM compared 

with MSM who were HIV-negative or of unknown HIV status. Urethral 

gonorrhea positivity was 17.8% (range: 10.3-25.8%) in HIV-positive MSM 

and 12.1% (range 5.4-16.9%) in MSM who were HIV-negative or of 

unknown HIV status; rectal gonorrhea positivity was 11.0% (range: 

4.4-12.2%) in HIV-positive MSM and 6.1% (range: 2.5-11.1%) in MSM 

who were HIV-negative or of unknown HIV status; pharyngeal gonorrhea 

positivity was 5.8% (range: 3.2-9.2%) in HIV-positive MSM and 2.7% 

(range: 0.4-9.1%) in MSM who were HIV-negative or of unknown HIV 

status (Figure GG). 

HIV Infection, STD Clinics, 2003 

• In 2003, a median of 52% (range: 44-60%) of MSM visiting participating STD 

clinics and not previously known to be HIV-positive were tested for HIV; median 

HIV positivity was 3.9% (range: 2.1-6.4%). HIV positivity varied by race and 

ethnicity, but tended to be highest in African-American MSM. HIV positivity was 

3.5% (range: 1.7-4.1%) in whites, 8.6% (range 3.6-9.5%) in African-Americans, 

and 4.4% (range: 1.7-14.3%) in Hispanics (Figure FF). 

• In 2003, median HIV prevalence among MSM, including persons previously 

known to be HIV-positive and persons testing HIV-positive at their current visit, 

was 11.0% (range 2.8-19.0%). HIV prevalence was 9.0% (range: 2.5-14.0%) in 

72 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2003 
whites, 18.5% (range: 2.7-25.5%) in African-Americans, and 9.5% (range: 

2.3-35.7%) in Hispanics. 

Chlamydia, STD Clinics, 2003 

• In 2003, a median of 81% (range: 47-93%) of MSM visiting participating STD 

clinics were tested for urethral chlamydia; median urethral chlamydia positivity 

was 8.9% (range: 3.9-10.5%) (Figure FF). Median positivity was 7.9% (range: 

3.8-17.0%) in HIV-positive MSM and 6.7% (range: 3.9-10.0%) in MSM who 

were HIV-negative or of unknown HIV status (Figure GG). 

STD Testing and Positivity, Community-based, Gay Men’s Primary Care Clinic, 2003 

• Among men with a nontreponemal serologic test for syphilis, 5.8% had a 

reactive syphilis test result; 34.7% of men with reactive syphilis serologies 

were identified as new syphilis cases. Among men tested for gonorrhea, 

urethral positivity was 14.6%, rectal positivity was 10.1%, and pharyngeal 

positivity was 1.9%. Among men tested for urethral chlamydia, positivity 

was 5.4%. 

Nationally Reported Syphilis Surveillance Data 

• Primary and secondary (P&S) syphilis increased in the United States during 

2002-2003. Between 2002 and 2003, there was a 13% increase in the number of 

P&S syphilis cases among men and a 24% decrease in the number of cases 

among women (Tables 27 and 28). Trends in the syphilis male-to-female rate 

ratio, which are assumed to reflect syphilis trends among MSM, have been 

increasing in the United States during recent years (Figure 31). In 2003, the rate of 

reported P&S syphilis among men (4.2 cases per 100,000 males) was 5.2 times 

greater than the rate among women (0.8 cases per 100,000 females). The overall 

male-to-female syphilis rate ratio has risen steadily since 1996 when it was 1.2 

(Figure 31). The increase in the male-to-female rate ratio occurred among all 

racial and ethnic groups between 2002 and 2003. Additional information on 

syphilis can be found in the Syphilis section. 

Gonococcal Isolate Surveillance Project (GISP) 

• The Gonococcal Isolate Surveillance Project (GISP), a collaborative project 

among selected STD clinics, was established in 1986 to monitor trends in 

antimicrobial susceptibilities of strains of Neisseria gonorrhoeae in the United 

States. 

• GISP also reports the percentage of Neisseria gonorrhoeae isolates obtained from 

MSM.10 Overall, the proportion of isolates coming from MSM in GISP clinics 

increased from 4% in 1988 to 19.6% in 2003, with most of the increase occurring 

after 1993 (Figure HH). Additional information on GISP may be found in the 

Gonorrhea section. 

STD Surveillance 2003 Special Focus Profiles STDs in Men Who Have Sex with Men 73 
• The proportion of isolates coming from MSM varies geographically with the 

largest percentage on the west coast (Figure II). 

• Due to increases in the proportion of isolates from MSM that are 

fluoroquinolone-resistant (Figure 22), in 2004 CDC recommended that 

fluoroquinolones no longer be used to treat gonorrhea among MSM.11 

1 Centers for Disease Control and Prevention. Resurgent bacterial sexually transmitted disease among men 

who have sex with men – King County, Washington, 1997-1999. MMWR 1999;48:773-7. 

2 Centers for Disease Control and Prevention. Outbreak of syphilis among men who have sex with men – 

Southern California, 2000. MMWR 2001;50:117-20. 

3 Centers for Disease Control and Prevention. Gonorrhea among men who have sex with men – selected 

sexually transmitted disease clinics, 1993-1996. MMWR 1997;46:889-92. 

4 Fox KK, del Rio C, Holmes K, et. al. Gonorrhea in the HIV era: A reversal in trends among men who have 

sex with men. Am J Public Health 2001;91:959-964. 

5 Centers for Disease Control and Prevention. Primary and secondary syphilis among men who have sex 

with men – New York City, 2001. MMWR 2002;51:853-6. 

6 Stall R, Hays R, Waldo C, Ekstrand M, McFarland W. The gay ‘90s: a review of research in the 1990s on 

sexual behavior and HIV risk among men who have sex with men. AIDS 2000;14:S1-S14. 

7 Scheer S, Chu PL, Klausner JD, Katz MH, Schwarcz SK. Effect of highly active antiretroviral therapy on 

diagnoses of sexually transmitted diseases in people with AIDS. Lancet 2001;357:432-5. 

8 Fleming DT, Wasserheit JN. From epidemiologic synergy to public health policy and practice: the 

contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm 

Infect 1999;75:3-17. 

9 Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 2002;14. 

10Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2003 

Supplement: Gonococcal Isolate Surveillance Project (GISP) Annual Report 2003. Atlanta, GA: U.S. 

Department of Health and Human Services (in press). 

11Centers for Disease Control and Prevention. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae 

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

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

74 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2003 
Figure DD. MSM Prevalence Monitoring Project — Syphilis serologic reactivity among men 

who have sex with men, STD clinics, 1999-2003 

Seattle, WA New York City, NY

10.3 10.5

4.1 3.9 3.5 3.6 5.5

1999 2000 2001 2002 2003 2002 2003

San Francisco, CA Philadelphia, PA

7.2 9.0 10.6 13.1

6.9 8.7 12.1 13.4

3.7 3.3

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003

Long Beach, CA

15.8 District of Columbia

10.4 11.6 7.4 3.4 4.4 5.9 6.9

2000 2001 2002 2003 2000 2001 2002 2003

Denver, CO Houston, TX Chicago, IL

16.6

1.5 1.5 3.7 4.7 6.7 10.7

3.5 4.9 6.9 8.5

2000 2001 2002 2003 2001 2002 2003 2000 2001 2002 2003

Figure EE.	 MSM Prevalence Monitoring Project — Gonorrhea positivity among men who 

have sex with men, STD clinics, 1999-2003 

Seattle, WA	 New York City, NY

19.2 16.5	 15.3	 15.9 16.3 11.7 13.3

1999 2000 2001 2002 2003 2002 2003

San Francisco, CA Philadelphia, PA

20.7 18.3 17.6	 16.7 18.9 17.8 18.2 12.9 14.2	 13.7

1999 2000 2001 2002 2003	 1999 2000 2001 2002 2003

Long Beach, CA

District of Columbia

16.9 15.5 16.9

10.6 12.4 10.7 11.6 10.1

2000 2001 2002 2003 2000 2001 2002 2003

Denver, CO Houston, TX Chicago, IL

22.8 22.5 18.0 19.3	 19.2 17.4 14.2 13.6 13.0	 12.5 14.0

2000 2001 2002 2003 2001 2002 2003 2000 2001 2002 2003

STD Surveillance 2003 Special Focus Profiles STDs in Men Who Have Sex with Men 75 
Figure FF.	 MSM Prevalence Monitoring Project — Test positivity for gonorrhea, 

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

clinics, 2003 

Median positivity

Urethral Rectal Pharyngeal Urethral HIV*

gonorrhea gonorrhea gonorrhea chlamydia

White

Black

Hispanic

0

5

10

15

20

25

*Excludes persons previously known to be HIV-positive. 

Figure GG. MSM Prevalence Monitoring Project — Test positivity for gonorrhea and 

chlamydia among men who have sex with men, by HIV status, STD clinics, 2003 

Median positivity

Urethral Rectal Pharyngeal Urethral

gonorrhea gonorrhea gonorrhea chlamydia

HIV-positive

HIV-negative or unknown

0

5

10

15

20

25

76 STDs in Men Who Have Sex with Men Special Focus Profiles STD Surveillance 2003 
 

Figure HH. Gonococcal Isolate Surveillance Project (GISP) — Percent of gonorrhea cases 

that occurred among MSM, 1988-2003 

Percent

25

20

15

10

5

0

1988 89 90 91 92 93 94 95 96 97 98 99 2000 01 02 03

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

isolates obtained from MSM attending STD clinics, 2001-2003 

SDG 0%

50%

100%

'01 '02 '03

% of Isolates

from MSM

5/8"=100%

BHM

ANC

PHX

LBC

LAX

ORA

SFO DEN

MIA

ATL

HON

CHI

NOR

BAL

DTR

MIN

STL

LVG

ALB

GRB

CIN

CLE

OKC

POR

PHI

DAL

SLC

SEA

Note:	 Not all clinics participated in GISP for the last 3 years. Clinics include: ALB=Albuquerque, NM; 

ANC=Anchorage, AK; ATL=Atlanta, GA; BAL=Baltimore, MD; BHM=Birmingham, AL; CHI=Chicago, IL; 

CIN=Cincinnati, OH; CLE=Cleveland, OH; DAL=Dallas, TX; DEN=Denver, CO; DTR=Detroit, MI; 

HON=Honolulu, HI; LAX=Los Angeles, CA; LBC=Long Beach, CA; LVG=Las Vegas, NV; MIA=Miami, FL; 

MIN=Minneapolis, MN; GRB=Greensboro, NC; NOR=New Orleans, LA; OKC=Oklahoma City, OK; 

ORA=Orange County, CA; PHI=Philadelphia, PA; PHX=Phoenix, AZ; POR=Portland, OR; SLC=Salt Lake 

City, UT; STL=St Louis, MO; SDG=San Diego, CA; SEA=Seattle, WA; and SFO=San Francisco, CA. 

TRP=Tripler Army Medical Center, HI (does not provide sexual risk behavior data). 

STD Surveillance 2003 Special Focus Profiles STDs in Men Who Have Sex with Men 77 

1,2,3

STDs in Persons Entering Corrections Facilities
 

Public Health Impact 

Multiple studies and surveillance projects have demonstrated a high prevalence of STDs in persons entering jails and juvenile corrections facilities. 1-4 Screening for chlamydia, gonorrhea, and 

syphilis at intake offers an opportunity to identify infections, prevent complications, and reduce 

transmission in the community. A substantial proportion of all early syphilis cases are reported 

from corrections facilities.4 Collecting positivity data and analyzing trends in STD prevalence 

in this population can provide one method for monitoring trends in STD prevalence in the 

community.4 

Observations 

• In 2003, STD screening data from corrections facilities were reported from 34, 23, 

and 10 states on chlamydia, gonorrhea, and syphilis, respectively. These data 

were reported as part of the Jail STD Prevalence Monitoring Project, the 

Adolescent Women Reproductive Health Monitoring Project, the Syphilis 

Elimination Initiative, the Regional Infertility Prevention Program, or in response 

to CDC’s request for data. 

• The maps shown in this section represent approximately 114,000 chlamydia tests 

in men and 53,000 in women; 82,000 gonorrhea tests in men and 39,000 in 

women; and 186,000 syphilis tests in men and 38,000 in women entering 

corrections facilities during 2003. 

• Chlamydia positivity was higher in women screened in juvenile corrections 

facilities than in adult corrections facilities. In adolescent women entering 48 

juvenile corrections facilities, the median facility positivity for chlamydia was 

15.9% (range 2.7% to 33.5%); positivity was greater than 10% in 37 of 48 

facilities reporting data (Figure JJ). In adult women entering 36 corrections 

facilities, the median positivity for chlamydia was 6.3% (range 1.3% to 19.2%). 

• The median chlamydia positivity in adolescent men entering 64 juvenile 

corrections facilities was 5.4% (range 1.3% to 12.9%) (Figure KK). In adult men 

entering 37 corrections facilities, the median positivity was 6.4% (range 1.0% to 

27.1%). 

• The median positivity for gonorrhea in women entering 28 juvenile corrections 

facilities was 5.7% (range 0.5% to 15.9%); positivity was greater than 4% in 17 of 

28 juvenile corrections facilities (Figure LL). In adult women entering 22 

corrections facilities, the median positivity for gonorrhea was 1.8% (range 0.4% 

to 10.1%). 

• The median positivity for gonorrhea in adolescent men entering 35 juvenile 

corrections facilities was 1.3% (range 0.3% to 4.5%) (Figure MM). In adult men 

entering 20 facilities, the median positivity was 1.8% (range 0.3% to 10.2%). 

STD Surveillance 2003 Special Focus Profiles STDs in Persons Entering Corrections Facilities 79 
• The median percentage of reactive syphilis tests by facility was 7.5% (range 2.4% 

to 10.7%) for women entering 11 adult corrections facilities and 0.5% (range 

0.1% to 1.0%) for adolescent women entering 4 juvenile corrections facilities 

(Figure NN); the median percentage was 2.3% (range 0.2% to 8.3%) in men at 13 

adult corrections facilities and 0.3% in men at 6 juvenile facilities (Figure OO). 

The percentage of reactive syphilis tests representing cases of syphilis varied from 

facility to facility. 

1 Heimberger TS. Chang HG. Birkhead GS. DiFerdinando GD. Greenberg AJ. Gunn R. Morse DL. High 

prevalence of syphilis detected through a jail screening program. A potential public health measure to 

address the syphilis epidemic. Arch Intern Med 1993;153:1799-1804. 

2 Centers for Disease Control and Prevention. Syphilis screening among women arrestees at the Cook 

County Jail – Chicago, 1996. MMWR 1998;47:432-3. 

3 Mertz KJ, Schwebke JR, Gaydos CA, Beideinger HA, Tulloch SD, Levine WC. Screening women in jails for 

chlamydial and gonococcal infection using urine tests: Feasibility, acceptability, prevalence and treatment 

rates. Sex Transm Dis 2002;29:271-276. 

4 Kahn R, Voigt R, Swint E, Weinstock H. Early syphilis in the United States identified in corrections facilities, 

1999-2002. Sex Transm Diseases 2004;31:360-364. 

80 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2003 
Figure JJ. Chlamydia — Positivity in women entering juvenile and adult corrections 

facilities, 2003 

Adult Corrections Facility

Juvenile Corrections Facility

12.4

13.0

21.1

6.2

12.4 17.1

7.0

19.6

11.2

6.7

20.3

3.5

2.9

4.2

17.4

6.5

1.3

12.9

17.1 9.6

9.6

12.7

16.5

32.2

33.5

3.3

10.0

7.7

5.5

12.8

10.6

10.3

3.5

15.3

4.4

23.3

VT

NH

MA 3.8

MA 11.4

RI

CT

NJ 27.1

DE 5.2

MD 18.5

DC

Note: The median positivity is presented from facilities reporting >100 test results. Arizona, California, Hawaii, 

Illinois, Massachusetts, Nevada, New York, Pennsylvania, Texas, Utah, and Wisconsin submitted data 

from more than one adult corrections facility. Alabama, Arizona, California, Illinois, Michigan, New York, 

Texas and Washington submitted data from more than one juvenile corrections facility. 

SOURCE: Jail STD Prevalence Monitoring Project; Adolescent Women Reproductive Health Monitoring Project; Regional Infertility Prevention Projects; Local and State STD Control Programs; Centers for Disease Control and Prevention 

Figure KK. Chlamydia — Positivity in men entering juvenile and adult corrections 

facilities, 2003 

Adult Corrections Facility

Juvenile Corrections Facility

14.2

7.3

5.6

4.8 1.3

6.8

4.9

8.3

12.3

4.1

7.2

9.6

7.8 10.5

3.4

6.4

5.6

6.3

12.9

7.7

5.3

16.0

8.1

5.5

3.7

11.4

5.6

3.7

2.7

12.7

VT

NH

MA 5.3

MA 4.1

RI

CT 3.4

NJ 10.6

DE 6.5

MD 9.0

DC

Note: The median positivity is presented from facilities reporting >100 test results. Arizona, California, 

Massachusetts, Nebraska, Nevada, New York, Wisconsin, Pennsylvania, Utah, and West 

Virginia submitted data from more than one adult corrections facility. Arizona, California, Illinois, 

Kentucky, Maryland, Massachusetts, Michigan, New Jersey, New York, Oklahoma, Oregon, 

Texas, and Washington submitted data from more than one juvenile corrections facility. 

SOURCE: Jail STD Prevalence Monitoring Project; Regional Infertility Prevention Projects; Local and State STD Control Programs; Centers for Disease Control and Prevention 

STD Surveillance 2003 Special Focus Profiles STDs in Persons Entering Corrections Facilities 81 
Figure LL. Gonorrhea — Positivity in women entering juvenile and adult corrections 

facilities, 2003 

Adult Corrections Facility

Juvenile Corrections Facility

4.8

2.2

2.7 6.2

1.7

8.7

6.6

2.8

8.2

0.5

9.3

1.3

8.5

5.4

6.9

15.9

13.8

5.8

1.3

9.1

2.2

0.8

0.5

1.9

1.1

6.4

VT

NH

MA

RI

CT

NJ 11.3

DE

MD 5.3

DC

Note: The median positivity is presented from facilities reporting >100 test results. California, Hawaii, 

Illinois, Pennsylvania, Utah, and Wisconsin submitted data from more than one adult corrections 

facility. Alabama, California, Illinois, Michigan, Texas, and Washington submitted data from more 

than one juvenile corrections facility. 

SOURCE: Jail STD Prevalence Monitoring Project; Adolescent Women Reproductive Health Monitoring Project; Regional Infertility Prevention Projects; Local and State STD Control Programs; Centers for Disease Control and Prevention 

Figure MM. Gonorrhea — Positivity in men entering juvenile and adult corrections 

facilities, 2003 

Adult Corrections Facility

Juvenile Corrections Facility

1.7

0.6

1.0

1.4

2.5

3.0

1.7

1.6

5.2

1.9

0.5

1.3

3.3

3.2

6.6

1.5

0.3

3.4

1.6

4.7

VT

NH

MA

RI

CT

NJ

DE

MD

DC

1.4

0.6

Note: The median positivity is presented from facilities reporting >100 test results. California, 

Nebraska, West Virginia, and Wisconsin submitted data from more than one adult corrections 

facility. California, Illinois, Kentucky, Maryland, Michigan, New Jersey, New York, and 

Washington submitted data from more than one juvenile corrections facility. 

SOURCE: Jail STD Prevalence Monitoring Project; Regional Infertility Prevention Projects; Local and State STD Control Programs; Centers for Disease Control and Prevention 

82 STDs in Persons Entering Corrections Facilities Special Focus Profiles STD Surveillance 2003 
Figure NN. Syphilis serologic tests — Percent seroreactivity in women entering juvenile and 

adult corrections facilities, 2003 

Adult Corrections Facility

Juvenile Corrections Facility

9.2

3.0

0.5

3.4

1.0

10.4 9.0

8.7

VT

NH

MA 6.2

RI

CT

NJ 7.0

DE

MD 7.5

DC

Note: The median positivity is presented from facilities reporting >100 test results. California, and 

New Jersey submitted data from more than one adult corrections facility. California submitted 

data from more than one juvenile corrections facility. 

SOURCE: Jail STD Prevalence Monitoring Project; Local and State STD Control Programs; Centers for Disease Control and 

Prevention 

Figure OO.	 Syphilis serologic tests — Percent seroreactivity in men entering juvenile and 

adult corrections facilities, 2003 

Adult Corrections Facility

Juvenile Corrections Facility

2.3

2.5

0.3

0.9

0.3

4.2

4.5 3.4

1.9

DE

MD

DC

VT

NH

MA 3.9

RI

CT

NJ 2.4

2.2

Note: The median positivity is presented from facilities reporting >100 test results. California and New 

Jersey submitted data from more than one adult corrections facility. California and Mississippi 

submitted data from more than one juvenile corrections facility. 

SOURCE: Jail STD Prevalence Monitoring Project; Local and State STD Control Programs; Centers for Disease Control and 

Prevention 

STD Surveillance 2003 Special Focus Profiles STDs in Persons Entering Corrections Facilities 83 

Table 1. Cases of sexually transmitted diseases reported by state health departments and rates per 100,000 

civilian population: United States, 1941–2003 

Syphilis 

All Stages Chlamydia Gonorrhea Chancroid

Primary

and 

Secondary EarlyLatent 

Late and 

Late Latent† Neurosyphilis Congenital 

Year * Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate 

1941 485,560 368.2 68,231 51.7 109,018 82.6 202,984 153.9 NR . 17,600 13.4 NR . 193,468 146.7 3,384 2.5 

1942 479,601 363.4 75,312 57.0 116,245 88.0 202,064 153.1 NR . 16,918 12.8 NR . 212,403 160.9 5,477 4.1 

1943 575,593 447.0 82,204 63.8 149,390 116.0 251,958 195.7 NR . 16,164 12.6 NR . 275,070 213.6 8,354 6.4 

1944 467,755 367.9 78,443 61.6 123,038 96.7 202,848 159.6 NR . 13,578 10.7 NR . 300,676 236.5 7,878 6.1 

1945 359,114 282.3 77,007 60.5 101,719 79.9 142,187 111.8 NR . 12,339 9.7 NR . 287,181 225.8 5,515 4.3 

1946 363,647 271.7 94,957 70.9 107,924 80.6 125,248 93.6 NR . 12,106 9.0 NR . 368,020 275.0 7,091 5.2 

1947 355,592 252.3 93,545 66.4 104,124 73.9 122,089 86.6 NR . 12,200 8.7 NR . 380,666 270.0 9,515 6.7 

1948 314,313 218.2 68,174 47.3 90,598 62.9 123,312 85.6 NR . 13,931 9.7 NR . 345,501 239.8 7,661 5.3 

1949 256,463 175.3 41,942 28.7 75,045 51.3 116,397 79.5 NR . 13,952 9.5 NR . 317,950 217.3 6,707 4.6 

1950 217,558 146.0 23,939 16.7 59,256 39.7 113,569 70.2 NR . 13,377 9.0 NR . 286,746 192.5 4,977 3.3 

1951 174,924 116.1 14,485 9.6 43,316 28.7 98,311 65.2 NR . 11,094 7.4 NR . 254,470 168.9 4,233 2.8 

1952 167,762 110.2 10,449 6.9 36,454 24.0 105,238 69.1 NR . 8,553 5.6 NR . 244,957 160.8 3,738 2.5 

1953 148,573 95.9 8,637 5.6 28,295 18.3 98,870 63.8 NR . 7,675 5.0 NR . 238,340 153.9 3,338 2.2 

1954 130,687 82.9 7,147 4.5 23,861 15.1 89,123 56.5 NR . 6,676 4.2 NR . 242,050 153.5 3,003 1.9 

1955 122,392 76.2 6,454 4.0 20,054 12.5 86,526 53.8 NR . 5,354 3.3 NR . 236,197 147.0 2,649 1.7 

1956 130,201 78.7 6,392 3.9 19,783 12.0 95,097 57.5 NR . 5,491 3.3 NR . 224,346 135.7 2,135 1.3 

1957 123,758 73.5 6,576 3.9 17,796 10.6 91,309 54.2 NR . 5,288 3.1 NR . 214,496 127.4 1,637 1.0 

1958 113,884 66.4 7,176 4.2 16,556 9.7 83,027 48.4 NR . 4,866 2.8 NR . 232,386 135.6 1,595 0.9 

1959 120,824 69.2 9,799 5.6 17,025 9.8 86,740 49.7 NR . 5,130 2.9 NR . 240,254 137.6 1,537 0.9 

1960 122,538 68.8 16,145 9.1 18,017 10.1 81,798 45.9 NR . 4,416 2.5 NR . 258,933 145.4 1,680 0.9 

1961 124,658 68.8 19,851 11.0 19,486 10.8 79,304 43.8 NR . 4,163 2.3 NR . 264,158 145.8 1,438 0.8 

1962 126,245 68.7 21,067 11.5 19,585 10.7 79,533 43.3 NR . 4,070 2.2 NR . 263,714 143.6 1,344 0.7 

1963 124,137 66.6 22,251 11.9 18,235 9.8 78,076 41.9 NR . 4,031 2.2 NR . 278,289 149.2 1,220 0.7 

1964 114,325 60.4 22,969 12.1 17,781 9.4 68,629 36.3 NR . 3,516 1.9 NR . 300,666 159.0 1,247 0.7 

1965 112,842 58.9 23,338 12.2 17,458 9.1 67,317 35.1 NR . 3,564 1.9 NR . 324,925 169.6 982 0.5 

1966 105,159 54.4 21,414 11.1 15,950 8.2 63,541 32.9 NR . 3,170 1.6 NR . 351,738 181.9 838 0.4 

1967 102,581 52.5 21,053 10.8 15,554 8.0 61,975 31.7 NR . 2,894 1.5 NR . 404,836 207.3 784 0.4 

1968 96,271 48.8 19,019 9.6 15,150 7.7 58,564 29.7 NR . 2,381 1.2 NR . 464,543 235.7 845 0.4 

1969 92,162 46.3 19,130 9.6 15,402 7.7 54,587 27.4 NR . 2,074 1.0 NR . 534,872 268.6 1,104 0.6 

1970 91,382 45.3 21,982 10.9 16,311 8.1 50,348 24.9 NR . 1,953 1.0 NR . 600,072 297.2 1,416 0.7 

1971 95,997 46.9 23,783 11.6 19,417 9.5 49,993 24.4 NR . 2,052 1.0 NR . 670,268 327.2 1,320 0.6 

1972 91,149 43.9 24,429 11.8 20,784 10.0 43,456 20.9 NR . 1,758 0.8 NR . 767,215 369.7 1,414 0.7 

1973 87,469 41.7 24,825 11.8 23,584 11.3 37,054 17.7 NR . 1,527 0.7 NR . 842,621 402.0 1,165 0.6 

1974 83,771 39.6 25,385 12.0 25,124 11.9 31,854 15.1 NR . 1,138 0.5 NR . 906,121 428.2 945 0.4 

1975 80,356 37.6 25,561 12.0 26,569 12.4 27,096 12.7 NR . 916 0.4 NR . 999,937 467.7 700 0.3 

1976 71,761 33.2 23,731 11.0 25,363 11.7 21,905 10.1 NR . 626 0.3 NR . 1001994 464.1 628 0.3 

1977 64,621 29.6 20,399 9.4 21,329 9.8 22,313 10.2 NR . 463 0.2 NR . 1002219 459.5 455 0.2 

1978 64,875 29.4 21,656 9.8 19,628 8.9 23,038 10.4 NR . 434 0.2 NR . 1013436 459.7 521 0.2 

1979 67,049 30.1 24,874 11.2 20,459 9.2 21,301 9.6 NR . 332 0.1 NR . 1004058 450.3 840 0.4 

1980 68,832 30.5 27,204 12.1 20,297 9.0 20,979 9.3 NR . 277 0.1 NR . 1004029 445.1 788 0.3 

1981 72,799 32.0 31,266 13.7 21,033 9.2 20,168 8.9 NR . 287 0.1 NR . 990,864 435.2 850 0.4 

1982 75,579 32.9 33,613 14.6 21,894 9.5 19,799 8.6 NR . 259 0.1 NR . 960,633 417.9 1,392 0.6 

1983 74,637 32.1 32,698 14.1 23,738 10.2 17,896 7.7 NR . 239 0.1 NR . 900,435 387.6 847 0.4 

1984 69,872 29.6 28,607 12.1 23,131 9.8 17,829 7.6 NR . 305 0.1 7,594 6.5 878,556 372.5 665 0.3 

1985 67,563 28.4 27,131 11.4 21,689 9.1 18,414 7.7 NR . 329 0.1 25,848 17.4 911,419 383.0 2,067 0.9 

STD Surveillance 2003 National Summary Tables 85 
Table 1. Cases of sexually transmitted diseases reported by state health departments and rates per 100,000 

civilian population: United States, 1941–2003 (continued) 

Syphilis 

Primary


and
 Early Late and 

All Stages Secondary Latent Late Latent† Neurosyphilis Congenital Chlamydia Gonorrhea Chancroid 

Year * Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate 

1986 67,779 28.2 27,667 11.5 21,656 9.0 18,046 7.5 NR . 410 0.2 58,001 35.2 892,229 371.5 3,045 1.3 

1987 87,286 36.0 35,585 14.7 28,233 11.7 22,988 9.5 NR . 480 0.2 91,913 50.8 787,532 325.0 4,986 2.1 

1988 104,546 42.8 40,474 16.6 35,968 14.7 27,363 11.2 NR . 741 0.3 157,854 87.1 738,160 301.9 4,891 2.0 

1989 115,089 46.6 45,826 18.6 45,394 18.4 22,032 8.9 NR . 1,837 0.7 200,904 102.5 733,294 297.1 4,697 1.9 

1990 135,590 54.3 50,578 20.3 55,397 22.2 25,750 10.3 NR . 3,865 1.5 323,663 160.2 690,042 276.4 4,212 1.7 

1991 128,719 50.9 42,950 17.0 53,855 21.3 27,490 10.9 NR . 4,424 1.7 381,228 179.7 621,918 245.8 3,476 1.4 

1992 114,730 44.7 34,009 13.3 49,929 19.5 26,725 10.4 NR . 4,067 1.6 409,694 182.3 502,858 196.0 1,906 0.7 

1993 102,612 39.5 26,527 10.2 41,919 16.1 30,746 11.8 NR . 3,420 1.3 405,332 178.0 444,649 171.1 1,292 0.5 

1994 82,713 31.4 20,641 7.8 32,017 12.2 27,603 10.5 NR . 2,452 0.9 451,785 192.5 419,602 163.9 782 0.3 

1995 69,357 26.0 16,543 6.2 26,657 10.0 24,296 9.1 NR . 1,861 0.7 478,577 187.8 392,651 147.5 607 0.2 

1996 53,238 19.8 11,405 4.2 20,187 7.5 20,366 7.6 NR . 1,280 0.5 492,631 190.6 328,169 121.8 386 0.1 

1997 46,714 17.1 8,556 3.1 16,631 6.1 20,447 7.5 193 0.1 1,080 0.4 537,904 205.5 327,665 120.2 246 0.1 

1998 38,287 13.9 7,007 2.5 12,696 4.6 17,743 6.4 279 0.1 841 0.3 614,250 231.8 356,492 129.2 189 0.1 

1999 35,379 12.7 6,617 2.4 11,534 4.1 16,653 6.0 341 0.1 575 0.2 662,647 247.2 360,813 129.3 110 0.0 

2000 31,616 11.2 5,979 2.1 9,465 3.4 15,594 5.5 334 0.1 578 0.2 709,452 251.4 363,136 128.7 78 0.0 

2001 32,278 11.3 6,103 2.1 8,701 3.0 16,976 5.9 324 0.1 498 0.2 783,242 274.5 361,705 126.8 38 0.0 

2002 32,912 11.4 6,862 2.4 8,429 2.9 17,168 6.0 387 0.1 453 0.2 834,555 289.4 351,852 122.0 48 0.0 

2003 34,270 11.9 7,177 2.5 8,361 2.9 18,319 6.4 541 0.2 413 0.1 877,478 304.3 335,104 116.2 54 0.0 

*For 1941-1946, data were reported for the federal fiscal year ending June 30 of the year indicated. From 1947 to the present, data were reported for 

the calendar year ending December 31. For 1941-1958, data for Alaska and Hawaii were not included. 

†

Late and late latent syphilis includes cases of unknown duration, late syphilis with clinical manifestations, and neurosyphilis. 

§

For 1941-1994, rates include all cases of congenitally acquired syphilis per 100,000 population. As of 1995, rates of congenital syphilis <1 year of 

age per 100,000 population are reported. For rates of congenital syphilis <1 year of age per 100,000 live births see Tables 39-44. As of 1995, 

cases of congenital syphilis <1 year of age are obtained in hardcopy and electronic format based on case reporting form CDC 73.126. 

Note: Adjustments to the number of cases reported from state health departments were made for hardcopy forms and for electronic data submissions 

through April 30, 2004 (see Appendix). The number of cases and the rates shown here supersede those published in previous reports. Cases and 

rates shown in this table exclude the outlying areas of Guam, Puerto Rico and Virgin Islands. 

NR = No report 

86 National Summary Tables STD Surveillance 2003 
5

10

15

20

25

30

35

40

45

50

Table 2. Chlamydia — Reported cases and rates by state, ranked by rates: United States, 2003 

Rank* State Cases Rate per 100,000 Population 

1 Alaska 3,900 605.8 

2 Louisiana 20,970 467.8 

3 Hawaii 5,480 440.2 

4 Mississippi 12,193 424.6 

Georgia 35,686 416.9 

6 New Mexico 7,480 403.2 

7 Illinois 48,294 383.3 

8 Delaware 3,035 375.9 

9 Ohio 42,522 372.3 

South Carolina 14,623 356.0 

11 Tennessee 20,380 351.5 

12 South Dakota 2,608 342.7 

13 California 117,428 334.4 

14 Wisconsin 17,942 329.7 

Missouri 18,570 327.4 

16 Michigan 32,572 324.1 

17 Texas 69,200 317.7 

18 Alabama 14,209 316.7 

19 Oklahoma 11,013 315.2 

North Carolina 26,187 314.7 

21 Maryland 16,831 308.4 

U.S. TOTAL† 877,478 304.3 

22 Pennsylvania 37,291 302.3 

23 New York 57,222 298.7 

24 Arkansas 7,856 289.9 

Colorado 13,039 289.3 

26 Rhode Island 3,000 280.4 

27 Montana 2,547 280.1 

28 Indiana 17,075 277.2 

29 Washington 16,797 276.8 

Nebraska 4,739 274.1 

31 Connecticut 9,393 271.4 

32 Nevada 5,830 268.2 

33 Kansas 7,249 266.9 

34 Virginia 19,439 266.5 

North Dakota 1,655 261.0 

36 Florida 42,382 253.6 

37 Arizona 12,819 234.9 

38 Iowa 6,491 221.0 

39 Oregon 7,688 218.3 

Minnesota 10,714 213.4 

41 Kentucky 7,981 195.0 

42 Wyoming 960 192.5 

43 New Jersey 16,169 188.2 

44 Idaho 2,366 176.4 

Massachusetts 11,301 175.8 

46 Vermont 1,060 171.9 

47 Utah 3,893 168.1 

48 Maine 2,030 156.8 

49 West Virginia 2,585 143.5 

New Hampshire 1,616 126.7 

*

States were ranked in descending order by rate, number of cases, and alphabetically by state. 

†

Total includes cases reported by Washington, D.C., but excludes outlying areas (Guam with 554 cases and rate of 344.0, Puerto Rico with 2,746 

cases and rate of 71.1, and Virgin Islands with 416 cases and rate of 378.1). 

STD Surveillance 2003 Chlamydia Tables 87 
Table 3. Chlamydia — Reported cases and rates by state/area and region listed in alphabetical order: United 

States and outlying areas, 1999–2003 

State/Area 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 

Alabama 12,375 15,323 14,524 15,611 14,209 279.3 344.2 325.0 348.0 316.7 

Alaska 1,886 2,569 2,744 3,806 3,900 301.9 409.3 433.1 591.2 605.8 

Arizona 12,111 12,591 14,346 14,973 12,819 241.1 243.7 270.3 274.4 234.9 

Arkansas 5,865 6,219 7,280 7,312 7,856 221.2 232.2 270.2 269.8 289.9 

California 85,156 95,392 101,944 110,288 117,428 254.2 280.5 294.6 314.1 334.4 

Colorado* 10,848 12,000 13,239 14,028 13,039 256.7 277.3 298.8 311.3 289.3 

Connecticut 7,422 7,604 7,718 9,808 9,393 219.2 222.9 224.7 283.4 271.4 

Delaware 2,761 2,856 2,793 2,649 3,035 356.3 363.1 350.6 328.1 375.9 

Florida 31,410 33,390 37,625 42,058 42,382 199.3 208.0 229.8 251.6 253.6 

Georgia 30,368 29,359 33,840 33,998 35,686 377.4 356.5 402.6 397.2 416.9

Hawaii 3,165 3,547 4,031 4,521 5,480 261.5 292.5 328.5 363.2 440.2 

Idaho 1,778 1,907 2,023 2,503 2,366 139.4 146.7 153.2 186.6 176.4 

Illinois 36,409 40,350 43,716 48,101 48,294 294.6 324.3 349.2 381.7 383.3 

Indiana 11,734 14,063 15,258 17,100 17,075 194.1 230.8 249.0 277.6 277.2 

Iowa 5,511 5,987 5,699 6,195 6,491 188.9 204.4 194.4 210.9 221.0 

Kansas 6,093 6,056 6,050 6,784 7,249 227.5 224.9 223.9 249.8 266.9 

Kentucky 7,378 8,063 8,881 8,756 7,981 183.6 199.1 218.3 213.9 195.0 

Louisiana 16,635 17,846 17,840 18,442 20,970 372.9 399.3 399.1 411.4 467.8 

Maine 1,220 1,474 1,338 1,805 2,030 96.3 115.4 104.2 139.4 156.8 

Maryland 13,568 14,533 15,640 16,891 16,831 258.2 273.6 290.4 309.5 308.4

Massachusetts 8,776 10,967 10,402 10,914 11,301 138.9 172.4 162.5 169.8 175.8 

Michigan 23,107 26,237 31,090 32,272 32,572 233.5 263.5 310.7 321.1 324.1

Minnesota 7,450 8,102 8,323 10,107 10,714 152.9 164.2 167.0 201.3 213.4 

Mississippi 11,545 12,697 11,793 11,800 12,193 408.2 445.7 412.4 410.9 424.6

Missouri 13,355 13,448 13,949 16,181 18,570 240.1 239.9 247.4 285.2 327.4 

Montana 1,584 1,469 1,919 2,475 2,547 176.5 162.6 212.0 272.1 280.1 

Nebraska 3,616 3,791 3,206 4,779 4,739 212.1 221.3 186.4 276.4 274.1 

Nevada 3,086 4,019 4,831 5,936 5,830 159.5 199.1 230.3 273.1 268.2 

New Hampshire 976 1,130 1,383 1,557 1,616 79.9 91.1 109.8 122.1 126.7 

New Jersey 12,424 10,814 16,312 14,164 16,169 148.6 128.2 191.7 164.9 188.2

New Mexico 5,017 5,204 6,254 7,417 7,480 277.5 285.7 341.6 399.8 403.2 

New York† 26,766 31,494 46,393 51,123 57,222 336.8 165.8 243.1 266.9 298.7 

North Carolina 21,812 21,985 22,101 24,726 26,187 274.4 272.0 269.3 297.2 314.7 

North Dakota 947 909 1,062 1,256 1,655 147.0 141.8 166.8 198.1 261.0 

Ohio 29,398 31,190 37,653 38,032 42,522 259.3 274.5 330.6 333.0 372.3 

Oklahoma 8,195 9,331 10,478 10,804 11,013 238.4 270.1 302.0 309.2 315.2 

Oregon 6,127 7,107 7,454 7,009 7,688 180.5 207.1 214.6 199.0 218.3 

Pennsylvania 27,019 26,475 28,371 31,791 37,291 220.3 215.5 230.6 257.7 302.3

Rhode Island 2,345 2,632 2,912 2,832 3,000 225.4 250.5 274.8 264.7 280.4 

South Carolina 18,499 9,950 15,329 14,314 14,623 465.4 247.3 377.4 348.5 356.0 

South Dakota 1,544 1,834 1,821 2,215 2,608 205.8 242.7 240.1 291.0 342.7 

Tennessee 14,216 15,069 15,560 16,042 20,380 252.1 264.2 270.6 276.7 351.5 

Texas 62,958 68,814 69,752 69,521 69,200 306.2 328.4 326.4 319.2 317.7 

Utah 2,219 2,190 3,004 3,540 3,893 100.7 97.6 131.8 152.8 168.1 

Vermont 485 526 638 954 1,060 80.2 86.2 104.1 154.7 171.9 

Virginia 13,735 15,352 18,337 18,518 19,439 196.2 216.0 254.8 253.9 266.5

Washington 11,964 13,066 13,631 14,934 16,797 204.8 221.0 227.4 246.1 276.8 

West Virginia 1,820 2,144 2,346 2,464 2,585 100.5 118.6 130.3 136.7 143.5

Wisconsin 14,462 16,365 16,284 17,000 17,942 271.2 304.5 301.2 312.4 329.7 

Wyoming 787 807 839 944 960 160.0 163.3 169.9 189.3 192.5 

U.S. TOTAL§ 662,647 709,452 783,242 834,555 877,478 247.2 251.4 274.5 289.4 304.3 

Northeast 87,433 93,116 115,467 124,948 139,082 206.2 173.5 214.0 230.4 256.5 

Midwest 153,626 168,332 184,111 200,022 210,431 239.7 261.0 284.0 307.1 323.0 

South 275,860 286,136 307,405 317,211 327,738 278.2 284.5 301.5 306.9 317.1 

West 145,728 161,868 176,259 192,374 200,227 233.4 255.0 272.9 293.0 305.0 

Guam 

Puerto Rico 

Virgin Islands 

497 

1,445 

136 

525 

2,695 

131 

431 

2,748 

131 

550 

2,999 

207 

554 

2,746 

416 

303.9 

37.2 

120.5 

338.0 

70.6 

120.6 

272.2 

71.6 

119.7 

341.5 

77.7 

188.1 

344.0 

71.1 

378.1 

OUTLYING AREAS 2,078 3,351 3,310 3,756 3,716 49.9 82.1 80.6 90.9 90.0 

TOTAL 664,725 712,803 786,552 838,311 881,194 244.1 249.0 271.8 286.6 301.3 

*

The number of chlamydia cases occurring in the fourth quarter of 2000 for the State of Colorado was projected based on case counts from the first 

three quarters. 

†

New York City has been reporting chlamydia cases since 1984. The State of New York, with the exception of New York City, initiated chlamydia 

reporting during the year 2000. The number of chlamydia cases reported from 1999-2000 by the state of New York may be incomplete and the rate 

for New York State is underestimated. See Appendix (Reporting of Chlamydia Cases). 

§

Includes cases reported by Washington, D.C., and rates exclude population of states that did not report. 

88 Chlamydia Tables STD Surveillance 2003 
Table 4. Chlamydia — Women – Reported cases and rates by state/area and region listed in alphabetical 

order: United States and outlying areas, 1999–2003 

State/Area 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 

Alabama 11,524 13,746 13,375 13,988 12,977 502.5 596.9 579.0 603.6 560.0 

Alaska 1,456 1,863 1,981 2,576 2,665 483.3 614.6 647.0 829.2 857.8 

Arizona 9,497 10,008 11,193 11,665 10,043 377.1 386.8 421.3 427.2 367.8 

Arkansas 4,618 5,015 5,949 5,817 6,284 339.7 365.8 431.6 419.8 453.6 

California 66,334 72,178 76,261 81,218 85,967 394.8 423.0 439.5 461.5 488.5 

Colorado* 8,172 8,748 9,894 10,422 9,843 388.9 407.4 449.8 466.0 440.1 

Connecticut 6,053 6,238 6,260 7,738 7,309 346.5 354.7 353.8 434.4 410.3 

Delaware 2,268 2,271 2,125 2,034 2,155 568.8 561.2 518.8 490.1 519.3 

Florida 25,957 27,562 30,647 33,902 34,581 321.5 335.4 365.9 396.9 404.8 

Georgia 24,685 24,067 27,905 27,494 28,992 602.7 575.4 654.1 633.2 667.7

Hawaii 2,557 2,757 3,053 3,445 4,113 424.9 456.8 499.2 554.9 662.5 

Idaho 1,308 1,435 1,469 1,862 1,762 205.4 221.4 223.0 278.2 263.3 

Illinois 28,758 31,771 33,124 34,154 36,284 455.5 500.4 518.7 531.7 564.9 

Indiana 9,410 10,935 11,668 13,151 13,118 305.2 352.4 374.1 419.7 418.6 

Iowa 4,208 4,480 4,295 4,680 4,915 282.8 300.3 287.7 313.1 328.8 

Kansas 5,034 4,973 4,977 5,653 5,989 371.2 365.2 364.4 412.0 436.5 

Kentucky 5,891 6,466 7,081 7,043 6,353 286.5 312.3 340.6 336.8 303.8 

Louisiana 13,247 14,099 14,416 14,758 17,046 575.3 611.2 625.3 638.8 737.8 

Maine 991 1,143 1,040 1,337 1,452 152.3 174.3 157.7 201.3 218.6 

Maryland 11,351 12,099 12,863 13,851 13,746 417.8 440.5 462.1 491.3 487.6

Massachusetts 6,959 8,452 7,897 8,177 8,429 212.5 256.4 238.3 245.9 253.5 

Michigan 18,869 20,905 24,550 25,129 25,903 373.8 412.0 481.7 491.2 506.3

Minnesota 5,469 5,856 6,010 7,352 7,866 222.1 235.1 238.9 290.3 310.6 

Mississippi 9,953 11,005 10,258 10,274 10,536 679.6 746.9 694.4 692.8 710.5

Missouri 11,515 11,525 11,854 13,253 14,750 402.6 400.2 409.5 455.3 506.7 

Montana 1,192 1,097 1,466 1,840 1,865 264.6 242.0 322.7 403.2 408.7 

Nebraska 2,903 3,018 2,521 3,609 3,435 335.4 347.4 289.2 412.1 392.3 

Nevada 2,500 3,124 3,586 4,365 4,268 263.3 315.5 348.4 409.3 400.2 

New Hampshire 769 889 1,042 1,168 1,196 123.8 141.0 162.9 180.4 184.7 

New Jersey 11,123 9,486 14,352 12,183 13,813 258.4 218.5 327.8 275.9 312.8

New Mexico 4,177 4,171 4,891 5,918 5,973 454.7 450.4 525.4 627.6 633.5 

New York† 23,896 26,928 38,297 41,202 43,907 571.4 273.6 387.8 415.9 443.2 

North Carolina 18,416 18,625 18,628 20,384 21,807 453.3 451.8 445.2 480.9 514.5 

North Dakota 680 663 716 826 1,087 210.8 206.5 224.6 260.1 342.3 

Ohio 23,380 25,105 29,521 29,558 33,549 400.7 429.5 504.2 503.7 571.7 

Oklahoma 6,737 7,715 8,600 8,764 8,990 385.2 439.2 488.0 494.1 506.8 

Oregon 4,462 5,192 5,442 5,033 5,590 260.6 300.2 311.0 283.8 315.2 

Pennsylvania 22,470 21,389 22,521 23,546 27,557 354.0 336.7 354.3 369.7 432.7

Rhode Island 1,769 1,969 2,197 2,057 2,232 327.2 360.7 399.3 370.6 402.2 

South Carolina 16,669 8,721 13,528 12,468 12,745 814.9 421.4 647.8 590.4 603.5 

South Dakota 1,194 1,308 1,311 1,608 1,864 315.5 343.6 343.3 419.7 486.6 

Tennessee 11,084 11,648 12,105 12,625 14,669 382.5 398.1 410.7 424.9 493.7 

Texas 52,071 56,817 57,611 57,438 57,549 502.6 538.6 535.8 524.4 525.4 

Utah 1,618 1,610 2,119 2,494 2,787 147.1 143.9 186.5 216.0 241.3 

Vermont 414 432 523 746 828 134.2 138.9 167.3 237.3 263.4 

Virginia 11,556 12,976 15,177 15,102 15,535 323.7 358.5 414.0 406.8 418.4 

Washington 8,880 9,583 10,159 11,003 12,341 302.6 322.8 337.6 361.2 405.2 

West Virginia 1,585 1,790 1,969 2,072 2,102 170.1 192.8 212.9 224.0 227.3

Wisconsin 11,225 12,352 12,045 12,296 12,838 415.5 454.2 440.5 446.9 466.6 

Wyoming 649 667 679 755 717 265.4 271.7 276.8 304.7 289.3 

U.S. TOTAL§ 539,894 569,658 623,958 652,858 685,017 395.1 396.3 429.6 445.0 466.9 

Northeast 74,444 76,926 94,129 98,154 106,723 338.7 277.4 337.9 350.8 381.4 

Midwest 122,645 132,891 142,592 151,269 161,598 374.9 404.1 431.7 455.9 487.0 

South 230,003 237,408 255,044 260,839 268,762 453.8 462.3 490.3 495.0 510.0 

West 112,802 122,433 132,193 142,596 147,934 360.7 385.2 408.8 434.0 450.3 

Guam 

Puerto Rico 

Virgin Islands 

432 

1,147 

113 

430 

2,226 

108 

347 

2,313 

116 

463 

2,665 

188 

446 

2,378 

352 

562.1 

56.7 

219.1 

566.5 

112.5 

190.3 

448.1 

116.1 

199.4 

587.4 

133.1 

317.5 

565.8 

118.7 

594.5 

OUTLYING AREAS 1,692 2,764 2,776 3,316 3,176 78.7 130.9 130.5 154.9 148.3 

TOTAL 541,586 572,422 626,734 656,174 688,193 390.2 392.4 425.3 440.8 462.3 

*The number of chlamydia cases occurring in the fourth quarter of 2000 for the State of Colorado was projected based on case counts from the first 

three quarters. 

†

New York City has been reporting chlamydia cases since 1984. The State of New York, with the exception of New York City, initiated chlamydia 

reporting during the year 2000. The number of chlamydia cases reported from 1999-2000 by the state of New York may be incomplete and the rate 

for New York State is underestimated. See Appendix (Reporting of Chlamydia Cases). 

§

Includes cases reported by Washington, D.C., and rates exclude population of states that did not report. Cases reported with unknown sex are not 

included in this table. 

STD Surveillance 2003 Chlamydia Tables 89 
Table 5. Chlamydia — Men – Reported cases and rates by state/area and region listed in alphabetical order: 

United States and outlying areas, 1999–2003 

State/Area 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 

Alabama 795 1,432 1,124 1,579 1,201 37.2 66.6 52.1 72.8 55.4 

Alaska 430 706 763 1,230 1,235 132.9 217.5 233.0 369.2 370.7 

Arizona 2,614 2,583 3,153 3,308 2,772 104.3 100.1 119.0 121.4 101.7 

Arkansas 1,247 1,204 1,325 1,486 1,567 96.5 92.1 100.7 112.2 118.3 

California 18,236 22,759 24,930 28,400 31,238 109.2 134.3 144.5 162.1 178.3 

Colorado* 2,666 3,251 3,328 3,604 3,196 125.5 149.2 149.1 158.8 140.8 

Connecticut 1,369 1,366 1,445 2,070 2,084 83.5 82.6 86.8 123.3 124.1 

Delaware 493 585 668 615 880 131.0 153.2 172.6 156.7 224.3 

Florida 5,341 5,828 6,967 8,156 7,801 69.5 74.4 87.1 99.8 95.5 

Georgia 5,462 5,102 5,926 6,363 6,509 138.3 125.9 143.2 150.9 154.3

Hawaii 583 777 977 1,076 1,367 95.8 127.6 158.7 172.4 219.0 

Idaho 446 462 528 641 604 69.8 70.9 79.8 95.4 89.9 

Illinois 7,642 8,578 10,588 13,942 12,009 126.4 140.8 172.6 225.7 194.4 

Indiana 2,313 3,093 3,555 3,845 3,803 78.1 103.5 118.2 127.1 125.7 

Iowa 1,302 1,505 1,401 1,505 1,561 91.1 104.7 97.3 104.4 108.3 

Kansas 1,059 1,083 1,073 1,131 1,260 80.1 81.4 80.3 84.2 93.8 

Kentucky 1,328 1,513 1,779 1,706 1,613 67.7 76.5 89.4 85.2 80.6 

Louisiana 3,388 3,747 3,424 3,525 3,808 157.0 173.2 158.1 162.3 175.3 

Maine 229 331 297 468 577 37.2 53.3 47.5 74.3 91.6 

Maryland 2,196 2,379 2,777 3,029 3,068 86.5 92.7 106.7 114.8 116.3 

Massachusetts 1,817 2,515 2,502 2,724 2,848 59.7 82.1 81.1 87.8 91.8 

Michigan 4,237 5,331 6,540 7,143 6,669 87.4 109.2 133.2 144.8 135.2

Minnesota 1,981 2,246 2,313 2,755 2,848 82.2 91.9 93.7 110.8 114.5 

Mississippi 1,450 1,647 1,535 1,526 1,657 106.3 119.7 111.0 109.9 119.3

Missouri 1,840 1,923 2,095 2,928 3,820 68.1 70.6 76.4 106.0 138.3 

Montana 392 371 449 625 679 87.7 82.4 99.5 137.9 149.8 

Nebraska 712 769 680 1,128 1,244 84.8 91.1 80.1 132.2 145.8 

Nevada 586 893 1,239 1,558 1,552 59.5 86.8 115.9 140.7 140.2 

New Hampshire 207 241 341 389 420 34.5 39.5 55.0 62.0 66.9 

New Jersey 1,281 1,279 1,948 1,962 2,332 31.6 31.3 47.1 47.0 55.9 

New Mexico 839 1,001 1,237 1,464 1,485 94.3 111.8 137.4 160.5 162.8 

New York† 2,846 4,436 8,042 9,885 13,106 75.6 48.4 87.3 106.8 141.7 

North Carolina 3,396 3,359 3,473 4,340 4,379 87.4 84.8 86.4 106.3 107.3 

North Dakota 267 246 346 429 567 83.0 76.9 108.9 135.5 179.1 

Ohio 5,604 5,819 7,603 7,926 8,215 101.9 105.5 137.4 142.7 147.9 

Oklahoma 1,458 1,616 1,878 2,040 2,023 86.4 95.2 110.0 118.6 117.6 

Oregon 1,665 1,915 2,012 1,976 2,098 99.0 112.5 116.7 113.1 120.0 

Pennsylvania 4,549 5,086 5,850 8,244 9,682 76.9 85.7 98.4 138.2 162.3

Rhode Island 576 663 715 775 768 115.3 131.3 140.3 150.6 149.2 

South Carolina 1,679 1,127 1,731 1,800 1,813 87.0 57.7 87.7 90.2 90.9 

South Dakota 348 523 510 606 742 93.6 139.4 135.5 160.3 196.3 

Tennessee 3,132 3,421 3,455 3,417 5,711 114.3 123.2 123.3 120.9 202.1 

Texas 10,597 11,829 12,033 11,964 11,594 103.9 113.7 113.3 110.5 107.1 

Utah 601 580 882 1,044 1,103 54.5 51.6 77.2 89.9 95.0 

Vermont 71 94 115 208 232 24.0 31.5 38.3 68.8 76.8 

Virginia 2,177 2,359 3,107 3,416 3,868 63.5 67.7 88.0 95.4 108.0 

Washington 3,084 3,483 3,472 3,931 4,456 106.1 118.3 116.3 130.0 147.4 

West Virginia 233 350 371 386 472 26.5 39.8 42.3 44.0 53.8

Wisconsin 3,212 4,006 4,191 4,669 5,015 122.1 150.9 156.9 173.6 186.4 

Wyoming 138 140 160 189 243 55.8 56.3 64.4 75.3 96.9 

U.S. TOTAL§ 120,430 137,957 157,304 179,585 190,244 91.6 99.6 112.3 126.8 134.3 

Northeast 12,945 16,011 21,255 26,725 32,049 63.4 61.7 81.5 101.8 122.1 

Midwest 30,517 35,122 40,895 48,007 47,753 97.2 111.1 128.7 150.2 149.4 

South 44,688 47,903 52,024 55,807 58,414 92.2 97.3 104.2 110.2 115.3 

West 32,280 38,921 43,130 49,046 52,028 103.6 122.8 133.7 149.5 158.6 

Guam 

Puerto Rico 

Virgin Islands 

65 

298 

23 

95 

469 

23 

84 

435 

15 

87 

334 

19 

108 

368 

64 

75.0 

16.0 

37.5 

119.6 

25.5 

44.3 

103.8 

23.5 

29.3 

105.8 

18.0 

37.4 

131.3 

19.8 

126.0 

OUTLYING AREAS 386 587 534 440 540 19.2 29.8 27.0 22.1 27.1 

TOTAL 120,816 138,544 157,838 180,025 190,784 90.5 98.7 111.1 125.3 132.8 

*The number of chlamydia cases occurring in the fourth quarter of 2000 for the State of Colorado was projected based on case counts from the first 

three quarters. 

†

New York City has been reporting chlamydia cases since 1984. The State of New York, with the exception of New York City, initiated chlamydia 

reporting during the year 2000. The number of chlamydia cases reported from 1999-2000 by the state of New York may be incomplete and the rate 

for New York State is underestimated. See Appendix (Reporting of Chlamydia Cases). 

§

Includes cases reported by Washington, D.C., and rates exclude population of states that did not report. Cases reported with unknown sex are not 

included in this table. 

90 Chlamydia Tables STD Surveillance 2003 
Rank* † City Cases Rate per 100,000 Population 

1 Rochester, NY 3,026 1,219.6 

2 Philadelphia, PA 17,747 1,189.3 

3 Detroit, MI 10,405 1,102.2 

4 Richmond, VA 2,054 1,040.2 

5 St Louis, MO 3,502 1,035.0 

6 Baltimore, MD 6,413 1,004.2 

7 New Orleans, LA 4,675 987.0 

8 Kansas City, MO 4,351 954.3 

9 Milwaukee, WI 8,416 898.1 

10 Indianapolis, IN 6,565 760.3 

11 Chicago, IL 23,466 760.2 

12 Minneapolis, MN 2,847 737.5 

13 Newark, NJ 2,211 730.8 

14 Atlanta, GA 5,999 726.8 

15 Buffalo, NY 2,318 723.5 

16 Memphis, TN 6,468 714.2 

17 Denver, CO 3,743 667.9 

18 Boston, MA 3,751 627.1 

19 St Paul, MN 1,743 612.9 

20 Albuquerque, NM 3,390 590.9 

21 Oklahoma City, OK 2,509 579.3 

22 Dallas, TX 6,892 569.4 

23 Jacksonville, FL 4,566 566.4 

24 Washington, DC 3,168 554.9 

25 Fort Worth, TX 3,067 541.2 

26 Cincinnati, OH 4,471 536.3 

27 Norfolk, VA 1,263 528.4 

28 Omaha, NE 2,475 523.5 

29 San Antonio, TX 6,193 518.4 

30 Honolulu, HI 4,558 508.7 

31 Austin, TX 3,393 504.8 

32 Tulsa, OK 1,972 493.1 

33 Nashville, TN 2,653 464.8 

34 Houston, TX 9,119 453.7 

35 Corpus Christi, TX 1,241 445.6 

36 Portland, OR 2,363 442.0 

37 New York City, NY 35,369 437.5 

38 San Francisco, CA 3,332 436.1 

39 Charlotte, NC 3,046 412.8 

40 Sacramento, CA 5,326 408.1 

41 Birmingham, AL 2,698 408.1 

42 Toledo, OH 1,850 407.9 

43 Los Angeles, CA 37,363 407.1 

44 Cleveland, OH 5,447 395.0 

45 Wichita, KS 1,818 393.6 

46 Columbus, OH 4,155 382.3 

47 Jersey City, NJ 923 382.2 

48 Des Moines, IA 1,456 377.5 

49 El Paso, TX 2,145 371.4 

50 San Diego, CA 10,432 358.9 

51 Dayton, OH 1,939 349.7 

52 Oakland, CA 4,880 331.5 

53 Pittsburgh, PA 4,175 328.8 

54 Louisville, KY 2,084 298.5 

55 Seattle, WA 5,168 293.7 

56 Tampa, FL 3,071 291.4 

57 San Jose, CA 4,681 278.1 

58 Tucson, AZ 2,426 275.3 

59 Yonkers, NY 534 265.0 

60 St Petersburg, FL 2,325 250.9 

61 Akron, OH 1,316 240.9 

62 Phoenix, AZ 7,766 235.1 

63 Miami, FL 4,431 190.0 

Table 6. Chlamydia — Reported cases and rates in selected cities ranked by rates: United States, 2003 

*Cities were ranked in descending order by rate, number of cases, and alphabetically by state. 

†

Excludes cities in outlying areas (San Juan, PR, with 803 cases and rate of 78.3). 

STD Surveillance 2003 Chlamydia Tables 91 
Table 7. Chlamydia — Reported cases and rates in selected cities listed in alphabetical order: United States 

and outlying areas, 1999–2003 

City 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003
 1999 2000 2001 2002 2003 

Akron, OH 

Albuquerque, NM 

Atlanta, GA 

Austin, TX 

Baltimore, MD 

Birmingham, AL 

Boston, MA 

Buffalo, NY* 

Charlotte, NC 

Chicago, IL 

Cincinnati, OH 

Cleveland, OH 

Columbus, OH 

Corpus Christi, TX 

Dallas, TX 

Dayton, OH 

Denver, CO 

Des Moines, IA 

Detroit, MI 

El Paso, TX 

Fort Worth, TX 

Honolulu, HI 

Houston, TX 

Indianapolis, IN 

Jacksonville, FL 

Jersey City, NJ 

Kansas City, MO 

Los Angeles, CA 

Louisville, KY 

Memphis, TN 

Miami, FL 

Milwaukee, WI 

Minneapolis, MN 

Nashville, TN 

New Orleans, LA 

New York City, NY 

Newark, NJ 

Norfolk, VA 

Oakland, CA 

Oklahoma City, OK 

Omaha, NE 

Philadelphia, PA 

Phoenix, AZ 

Pittsburgh, PA 

Portland, OR 

Richmond, VA 

Rochester, NY* 

Sacramento, CA 

San Antonio, TX 

San Diego, CA 

San Francisco, CA 

San Jose, CA 

Seattle, WA 

St Louis, MO 

St Paul, MN 

St Petersburg, FL 

Tampa, FL 

Toledo, OH 

Tucson, AZ 

Tulsa, OK 

Washington, DC 

Wichita, KS 

Yonkers, NY* 

841 

1,674 

5,572 

2,795 

5,286 

2,209 

2,680 

NR 

1,669 

18,125 

3,801 

3,446 

3,997 

1,158 

9,355 

1,256 

3,371 

922 

7,753 

1,898 

3,752 

2,631 

10,511 

4,641 

2,703 

724 

2,738 

27,614 

1,447 

5,025 

4,010 

7,641 

2,584 

2,202 

3,651 

26,766 

1,881 

920 

4,111 

1,768 

1,808 

12,660 

7,660 

2,879 

2,018 

1,972 

NR 

4,469 

5,731 

7,591 

2,718 

3,428 

3,949 

3,090 

1,349 

1,760 

2,757 

1,043 

1,908 

1,636 

2,720 

1,532 

NR 

990 

2,368 

5,558 

3,113 

5,433 

3,601 

3,229 

722 

1,873 

19,792 

4,715 

3,961 

4,298 

1,525 

9,976 

1,176 

3,164 

1,075 

9,989 

2,225 

4,214 

2,932 

12,213 

5,506 

3,501 

624 

3,128 

31,074 

1,656 

4,967 

3,032 

9,018 

2,652 

2,403 

3,817 

26,170 

1,567 

1,093 

4,975 

2,060 

1,935 

13,584 

7,987 

2,885 

2,306 

2,230 

115 

4,599 

5,871 

8,591 

3,093 

3,908 

4,495 

2,711 

1,639 

1,834 

2,714 

1,646 

1,786 

1,770 

3,205 

1,457 

379 

1,162 

3,139 

6,426 

3,317 

5,405 

2,957 

2,935 

2,379 

1,936 

22,420 

4,594 

4,811 

4,850 

1,458 

10,249 

2,066 

4,186 

1,122 

11,552 

2,356 

4,142 

3,473 

11,289 

6,611 

3,551 

893 

2,747 

32,706 

1,952 

5,418 

3,800 

8,224 

2,614 

2,086 

3,871 

29,649 

2,408 

1,475 

4,682 

2,444 

1,719 

13,628 

8,953 

3,444 

2,355 

2,082 

1,064 

4,442 

5,749 

9,166 

3,030 

4,118 

4,295 

3,195 

1,506 

1,884 

2,535 

2,244 

2,700 

1,720 

3,286 

1,465 

373 

1,249 

3,531 

5,560 

3,678 

6,267 

3,650 

3,320 

2,217 

2,778 

24,673 

4,566 

4,924 

4,581 

1,433 

9,561 

1,723 

4,546 

1,322 

11,374 

2,287 

4,005 

3,801 

11,768 

6,593 

3,926 

678 

3,348 

35,544 

2,176 

5,548 

4,711 

8,553 

2,868 

2,157 

4,340 

33,063 

2,092 

1,350 

4,623 

2,622 

2,312 

14,458 

9,697 

4,145 

2,272 

2,108 

1,625 

4,749 

5,777 

10,286 

3,345 

4,360 

4,469 

3,206 

1,798 

2,294 

3,407 

2,465 

2,580 

1,885 

3,305 

1,602 

456 

1,316
 

3,390 

5,999
 

3,393
 

6,413
 

2,698 

3,751
 

2,318
 

3,046
 

23,466 

4,471
 

5,447
 

4,155
 

1,241 

6,892 

1,939 

3,743
 

1,456
 

10,405
 

2,145
 

3,067
 

4,558
 

9,119
 

6,565 

4,566 

923 

4,351 

37,363 

2,084 

6,468 

4,431
 

8,416
 

2,847
 

2,653
 

4,675
 

35,369 

2,211
 

1,263
 

4,880
 

2,509 

2,475 

17,747 

7,766 

4,175 

2,363
 

2,054
 

3,026
 

5,326
 

6,193
 

10,432 

3,332
 

4,681
 

5,168
 

3,502
 

1,743
 

2,325 

3,071 

1,850 

2,426 

1,972 

3,168 

1,818 

534 

155.2 

302.7 

690.1 

459.2 

804.0 

333.3 

448.6	 

. 

244.7 

588.5 

447.2 

246.2 

376.6 

416.0 

794.2 

223.5 

614.2 

248.8 

810.7 

339.0 

712.9 

299.3 

569.9 

541.2 

349.6 

303.5 

606.7 

312.6 

209.1 

562.2 

180.6 

812.4 

676.9 

388.2 

752.0 

336.8 

628.5 

394.0 

288.1 

417.7 

392.4 

832.9 

254.9 

223.7 

388.9 

990.2	 

. 

370.4 

505.7 

272.1 

350.8 

205.1 

228.4 

882.5 

475.7 

191.9 

279.9 

229.0 

230.2 

416.1 

477.0 

339.1	 

. 

182.1 

424.7 

679.8 

491.7 

837.4 

543.9 

539.7 

224.3 

267.4 

641.1 

558.6 

284.5 

401.0 

549.8 

835.8 

210.6 

568.5 

286.0 

1,050.9 

393.6 

782.8 

334.7 

651.1 

639.8 

449.0 

259.2 

691.4 

347.7 

238.6 

552.9 

134.1 

959.7 

689.6 

421.5 

789.2 

326.4 

521.6 

466.2 

342.9 

483.4 

416.5 

897.2 

257.9 

225.4 

441.8 

1,129.2 

46.5 

373.7 

510.9 

304.1 

398.1 

231.7 

258.5 

781.4 

575.3 

198.9 

270.5 

361.8 

210.4 

448.5 

560.7 

321.2 

190.4 

213.2 

557.8 

778.7 

507.9 

837.6 

447.0 

488.6 

741.3 

268.6 

725.6 

546.8 

347.2 

448.5 

526.7 

843.8 

371.6 

743.2 

294.8 

1,219.2 

412.2 

750.8 

392.8 

590.2 

765.4 

448.0 

368.2 

605.0 

361.1 

280.5 

601.8 

165.5 

876.3 

675.9 

365.2 

809.1 

367.8 

798.6 

626.5 

317.4 

570.2 

367.0 

907.5 

279.6 

270.3 

445.6 

1,052.8 

430.1 

350.3 

492.8 

319.4 

390.5 

242.8 

244.9 

932.1 

527.1 

203.7 

246.7 

493.8 

312.7 

433.3 

572.7 

320.6 

186.0 

228.6 

615.5 

673.6 

547.2 

981.3 

552.1 

555.0 

692.0 

376.4 

799.3 

547.7 

357.1 

421.5 

514.5 

789.8 

310.7 

811.2 

342.8 

1,204.8 

396.0 

706.8 

424.2 

585.5 

763.6 

487.0 

280.7 

734.3 

387.2 

311.7 

612.6 

202.0 

912.7 

742.9 

377.9 

916.2 

409.0 

691.4 

564.8 

314.0 

605.4 

489.1 

968.9 

293.5 

326.4 

425.0 

1,067.6 

655.0 

363.9 

483.6 

353.9 

437.8 

259.0 

254.0 

947.5 

632.2 

247.5 

323.3 

543.5 

292.8 

471.3 

578.9 

346.8 

226.3 

240.9 

590.9

726.8 

504.8 

1,004.2 

408.1

627.1 

723.5 

412.8 

760.2

536.3 

395.0 

382.3 

445.6

569.4 

349.7

667.9 

377.5 

1,102.2 

371.4 

541.2 

508.7 

453.7 

760.3

566.4 

382.2

954.3 

407.1

298.5 

714.2

190.0 

898.1 

737.5 

464.8 

987.0 

437.5

730.8 

528.4 

331.5 

579.3

523.5 

1,189.3

235.1 

328.8

442.0 

1,040.2 

1,219.6 

408.1 

518.4 

358.9

436.1 

278.1 

293.7 

1,035.0 

612.9 

250.9

291.4 

407.9 

275.3 

493.1 

554.9 

393.6 

265.0 

U.S. CITY TOTAL† 269,806 296,125 318,308 339,607 343,149 394.4 424.3 451.8 478.1 483.1 

San Juan, PR 501 966 1,076 1,058 803 47.6 94.6 105.2 103.2 78.3 

TOTAL 270,307 297,091 319,384 340,665 343,952 389.2 419.5 446.9 472.8 477.3 

*New York City has been reporting chlamydia cases since 1984. The State of New York, with the exception of New York City, initiated chlamydia 

reporting during the year 2000. Therefore, the number of chlamydia cases reported in 2000 by the cities of Buffalo, Rochester and Yonkers may be 

incomplete and their 2000 case rates may be underestimated. See Appendix (Reporting of Chlamydia Cases). 

†

Rates exclude population of cities that did not report. NR=No report 

92 Chlamydia Tables	 STD Surveillance 2003 
Table 8. Chlamydia — Women – Reported cases and rates in selected cities listed in alphabetical order: 

United States and outlying areas, 1999–2003 

City 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003
 1999 2000 2001 2002 2003 

Akron, OH 

Albuquerque, NM 

Atlanta, GA 

Austin, TX 

Baltimore, MD 

Birmingham, AL 

Boston, MA 

Buffalo, NY* 

Charlotte, NC 

Chicago, IL 

Cincinnati, OH 

Cleveland, OH 

Columbus, OH 

Corpus Christi, TX 

Dallas, TX 

Dayton, OH 

Denver, CO 

Des Moines, IA 

Detroit, MI 

El Paso, TX 

Fort Worth, TX 

Honolulu, HI 

Houston, TX 

Indianapolis, IN 

Jacksonville, FL 

Jersey City, NJ 

Kansas City, MO 

Los Angeles, CA 

Louisville, KY 

Memphis, TN 

Miami, FL 

Milwaukee, WI 

Minneapolis, MN 

Nashville, TN 

New Orleans, LA 

New York City, NY 

Newark, NJ 

Norfolk, VA 

Oakland, CA 

Oklahoma City, OK 

Omaha, NE 

Philadelphia, PA 

Phoenix, AZ 

Pittsburgh, PA 

Portland, OR 

Richmond, VA 

Rochester, NY* 

Sacramento, CA 

San Antonio, TX 

San Diego, CA 

San Francisco, CA 

San Jose, CA 

Seattle, WA 

St Louis, MO 

St Paul, MN 

St Petersburg, FL 

Tampa, FL 

Toledo, OH 

Tucson, AZ 

Tulsa, OK 

Washington, DC 

Wichita, KS 

Yonkers, NY* 

653 

1,401 

4,287 

2,367 

4,700 

2,086 

2,107 

NR 

1,373 

14,377 

3,211 

2,955 

2,907 

999 

7,143 

834 

2,468 

660 

6,343 

1,599 

2,933 

2,102 

8,740 

3,481 

2,091 

681 

2,413 

21,564 

1,136 

4,020 

3,282 

6,076 

1,756 

1,628 

2,794 

23,896 

1,684 

795 

3,212 

1,449 

1,437 

10,479 

5,787 

2,380 

1,379 

1,713 

NR 

3,452 

4,697 

5,839 

1,541 

2,636 

2,654 

2,736 

972 

1,446 

2,380 

815 

1,531 

1,331 

2,391 

1,218 

NR 

769 

1,815 

4,468 

2,432 

4,828 

2,792 

2,360 

528 

1,498 

15,631 

3,938 

3,183 

3,185 

1,292 

7,726 

863 

2,190 

789 

7,716 

1,881 

3,317 

2,239 

10,222 

3,896 

2,809 

605 

2,763 

23,056 

1,301 

3,943 

2,449 

7,077 

1,759 

1,758 

2,772 

22,663 

1,330 

964 

3,851 

1,686 

1,516 

10,724 

6,195 

2,398 

1,597 

1,900 

86 

3,391 

4,767 

6,371 

1,819 

2,948 

3,006 

2,362 

1,154 

1,511 

2,319 

1,348 

1,411 

1,485 

2,786 

1,134 

327 

916 

2,368 

5,152 

2,633 

4,825 

2,524 

2,086 

1,731 

1,484 

16,756 

3,740 

3,635 

3,336 

1,233 

8,083 

1,595 

2,962 

814 

9,137 

1,936 

3,277 

2,574 

9,473 

4,552 

2,865 

818 

2,396 

24,358 

1,511 

4,378 

3,079 

6,308 

1,716 

1,537 

2,958 

25,118 

2,117 

1,251 

3,562 

1,941 

1,346 

10,833 

6,841 

2,798 

1,651 

1,752 

807 

3,279 

4,632 

6,510 

1,723 

3,017 

2,905 

2,787 

1,098 

1,522 

2,112 

1,801 

2,058 

1,406 

2,807 

1,166 

326 

963 

2,788 

4,349 

2,923 

5,490 

2,833 

2,423 

1,637 

2,179 

16,589 

3,711 

3,718 

3,127 

1,210 

7,529 

1,244 

3,181 

968 

8,976 

1,966 

3,179 

2,829 

9,777 

4,633 

2,984 

618 

2,773 

25,587 

1,696 

4,546 

3,804 

6,323 

1,907 

1,604 

3,305 

27,177 

1,724 

1,172 

3,562 

2,007 

1,738 

10,308 

7,509 

3,204 

1,527 

1,723 

1,218 

3,583 

4,654 

7,285 

1,827 

3,150 

2,994 

2,665 

1,318 

1,844 

2,774 

1,944 

1,927 

1,561 

2,825 

1,315 

380 

939
 

2,659 

4,630
 

2,583
 

5,533
 

2,362 

2,634
 

1,749
 

2,487
 

17,264 

3,576
 

4,081
 

3,254
 

1,062 

5,536 

1,449 

2,648
 

1,047
 

8,832
 

1,843
 

2,484
 

3,350
 

7,532
 

4,770 

3,521 

858 

3,184 

26,645 

1,581 

4,944 

3,574
 

6,132
 

1,928
 

1,862
 

3,702
 

27,490 

1,884
 

1,068
 

3,770
 

1,985 

1,764 

12,812 

6,028 

3,179 

1,589
 

1,551
 

2,128
 

3,897
 

5,149
 

7,694 

1,659
 

3,366
 

3,434
 

2,955
 

1,267
 

1,887 

2,446 

1,464 

1,835 

1,613 

2,695 

1,507 

431 

232.4 

495.3 

1,042.6 

794.9 

1,340.0 

594.8 

681.2	 

. 

394.2 

904.2 

721.5 

399.9 

532.2 

702.4 

1,209.5 

285.4 

905.8 

345.5 

1,253.5 

551.6 

1,103.2 

481.3 

943.7 

784.4 

524.8 

560.6 

1,030.4 

483.0 

314.2 

860.2 

285.8 

1,238.7 

904.8 

554.8 

1,082.2 

571.4 

1,073.1 

697.1 

442.4 

664.4 

609.6 

1,287.7 

384.8 

350.9 

525.4 

1,605.4	 

. 

560.4 

806.7 

421.7 

404.1 

319.7 

305.4 

1,470.4 

661.0 

300.7 

473.1 

344.3 

361.4 

657.0 

792.3 

532.5	 

. 

272.9 

636.2 

1,076.4 

787.0 

1,394.8 

797.7 

762.0 

314.4 

420.2 

981.7 

891.6 

433.3 

577.9 

912.2 

1,293.4 

297.2 

795.6 

407.9 

1,535.3 

642.7 

1,220.6 

513.1 

1,085.9 

876.8 

699.7 

493.8 

1,178.4 

510.1 

359.2 

840.3 

209.6 

1,446.9 

901.2 

597.8 

1,078.6 

537.1 

845.0 

841.3 

521.7 

768.5 

639.0 

1,323.5 

400.2 

355.9 

605.9 

1,800.7 

67.1 

539.7 

807.9 

453.6 

475.6 

354.3 

343.9 

1,284.1 

781.6 

313.0 

452.7 

570.7 

325.4 

730.7 

921.0 

494.4 

314.9 

324.4 

823.0 

1,229.7 

826.2 

1,400.1 

722.0 

670.6 

1,034.6 

404.9 

1,052.0 

851.4 

497.6 

600.6 

871.5 

1,331.7 

552.0 

1,063.5 

415.9 

1,824.1 

653.8 

1,177.8 

583.5 

987.5 

1,020.9 

702.4 

663.0 

1,018.7 

532.1 

416.2 

930.8 

259.6 

1,291.8 

874.4 

521.3 

1,164.1 

592.7 

1,340.5 

1,089.4 

474.4 

880.6 

563.2 

1,349.0 

427.9 

417.6 

619.5 

1,655.6 

630.2 

506.7 

773.9 

455.9 

450.3 

360.5 

329.6 

1,533.6 

742.0 

314.6 

403.0 

764.2 

466.1 

688.9 

925.4 

504.5 

312.2 

340.3 

951.5 

1,037.3 

891.3 

1,608.1 

811.5 

781.9 

980.9 

581.6 

1,043.1 

852.0 

511.6 

560.6 

849.6 

1,246.5 

431.8 

1,148.3 

488.7 

1,798.6 

656.3 

1,113.6 

632.7 

970.7 

1,039.8 

719.9 

503.0 

1,174.7 

551.9 

465.9 

961.1 

316.1 

1,297.5 

973.8 

544.5 

1,313.7 

640.0 

1,088.5 

1,012.1 

475.2 

901.5 

721.4 

1,292.1 

455.7 

480.2 

567.0 

1,630.7 

949.3 

538.3 

759.8 

504.0 

484.0 

379.0 

338.5 

1,485.6 

895.5 

380.6 

516.7 

827.4 

427.4 

759.9 

937.8 

562.8 

362.6 

331.8 

907.4 

1,104.3 

787.6 

1,620.7 

676.6

850.0 

1,048.0 

663.8 

1,085.5

821.0 

561.5 

583.4 

745.7

916.5 

502.9

955.9 

528.6 

1,769.8 

615.2 

870.2 

749.2 

747.8 

1,070.6

849.5 

698.4

1,348.8 

574.8

434.3 

1,045.2

297.0 

1,258.3 

984.5 

632.1 

1,471.5 

647.4

1,189.5 

922.3 

502.9 

891.6

732.2 

1,606.0

365.8 

476.5

590.0 

1,467.9 

1,658.5 

585.5 

840.6 

532.3

439.5 

405.0 

388.2 

1,647.2 

860.8 

389.5

455.6 

623.1 

407.0 

785.2 

894.6 

645.0 

411.3 

U.S. CITY TOTAL† 217,017 232,899 247,912 258,284 260,782 618.2 650.5 686.4 709.7 716.6 

San Juan, PR 385 761 901 925 670 70.4 143.3 169.3 173.5 125.7 

TOTAL 217,402 233,660 248,813 259,209 261,452 609.8 643.1 678.8 702.0 708.0 

*New York City has been reporting chlamydia cases since 1984. The State of New York, with the exception of New York City, initiated chlamydia 

reporting during the year 2000. Therefore, the number of chlamydia cases reported in 2000 by the cities of Buffalo, Rochester and Yonkers may be 

incomplete and their 2000 case rates may be underestimated. See Appendix (Reporting of Chlamydia Cases). 

†

Rates exclude population of cities that did not report. Cases reported with unknown sex are not included in this table. NR = No report 

STD Surveillance 2003	 Chlamydia Tables 93 
Table 9. Chlamydia — Men – Reported cases and rates in selected cities listed in alphabetical order: United 

States and outlying areas, 1999–2003 

City 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003
 1999 2000 2001 2002 2003 

Akron, OH 

Albuquerque, NM 

Atlanta, GA 

Austin, TX 

Baltimore, MD 

Birmingham, AL 

Boston, MA 

Buffalo, NY* 

Charlotte, NC 

Chicago, IL 

Cincinnati, OH 

Cleveland, OH 

Columbus, OH 

Corpus Christi, TX 

Dallas, TX 

Dayton, OH 

Denver, CO 

Des Moines, IA 

Detroit, MI 

El Paso, TX 

Fort Worth, TX 

Honolulu, HI 

Houston, TX 

Indianapolis, IN 

Jacksonville, FL 

Jersey City, NJ 

Kansas City, MO 

Los Angeles, CA 

Louisville, KY 

Memphis, TN 

Miami, FL 

Milwaukee, WI 

Minneapolis, MN 

Nashville, TN 

New Orleans, LA 

New York City, NY 

Newark, NJ 

Norfolk, VA 

Oakland, CA 

Oklahoma City, OK 

Omaha, NE 

Philadelphia, PA 

Phoenix, AZ 

Pittsburgh, PA 

Portland, OR 

Richmond, VA 

Rochester, NY* 

Sacramento, CA 

San Antonio, TX 

San Diego, CA 

San Francisco, CA 

San Jose, CA 

Seattle, WA 

St Louis, MO 

St Paul, MN 

St Petersburg, FL 

Tampa, FL 

Toledo, OH 

Tucson, AZ 

Tulsa, OK 

Washington, DC 

Wichita, KS 

Yonkers, NY* 

183 

272 

1,262 

428 

565 

117 

573 

NR 

296 

3,744 

552 

469 

1,053 

158 

2,156 

415 

898 

262 

1,410 

296 

778 

515 

1,634 

1,157 

612 

43 

325 

6,020 

307 

1,005 

717 

1,556 

828 

574 

857 

2,846 

194 

125 

759 

319 

370 

2,181 

1,873 

499 

639 

259 

NR 

987 

1,032 

1,704 

1,177 

761 

1,295 

354 

377 

314 

377 

222 

377 

305 

316 

314 

NR 

216 

521 

1,079 

676 

550 

700 

869 

194 

375 

4,160 

748 

748 

1,071 

233 

2,151 

302 

974 

286 

2,273 

343 

888 

683 

1,971 

1,604 

692 

19 

365 

8,000 

352 

1,024 

583 

1,935 

893 

645 

1,045 

3,377 

234 

129 

1,075 

374 

416 

2,860 

1,792 

487 

709 

329 

29 

1,171 

1,096 

2,072 

1,274 

937 

1,489 

349 

485 

323 

395 

288 

375 

285 

405 

323 

52 

243 

654 

1,273 

683 

580 

433 

849 

648 

452 

5,660 

818 

1,145 

1,434 

225 

2,105 

460 

1,219 

307 

2,415 

420 

858 

898 

1,804 

2,045 

686 

72 

351 

8,307 

439 

1,040 

721 

1,881 

898 

549 

913 

4,477 

291 

222 

1,080 

503 

373 

2,795 

2,112 

646 

704 

329 

257 

1,101 

1,110 

2,232 

1,307 

1,065 

1,390 

408 

408 

362 

423 

430 

642 

314 

451 

299 

47 

271 

723 

1,185 

751 

777 

815 

896 

580 

599 

8,084 

820 

1,179 

1,396 

223 

2,001 

475 

1,363 

351 

2,398 

320 

813 

972 

1,981 

1,909 

942 

58 

575 

9,910 

477 

1,002 

907 

2,210 

961 

553 

972 

5,850 

366 

178 

1,050 

615 

569 

4,150 

2,188 

941 

745 

385 

407 

1,137 

1,121 

2,641 

1,499 

1,155 

1,475 

541 

480 

450 

633 

509 

653 

324 

459 

287 

76 

294
 

716 

1,337 

802 

880 

333 

1,111 

569 

559 

6,201 

857
 

1,336
 

861
 

179 

1,352 

484 

1,095
 

404
 

1,573
 

301
 

577
 

1,208
 

1,581
 

1,741 

1,045 

63 

1,167 

10,676 

499 

1,524 

857
 

2,222
 

919
 

791
 

957
 

7,670 

325
 

192
 

1,110
 

524 

704 

4,935 

1,737 

994 

774
 

501
 

898
 

1,396
 

1,043
 

2,715 

1,643 

1,299 

1,734 

547 

476 

438 

625 

379 

590 

359 

450 

311 

103 

70.2 

100.7 

318.5 

137.6 

184.2 

37.5 

198.9	 

. 

88.7 

251.3 

136.3 

71.0 

204.5 

116.0 

367.1 

153.9 

324.9 

145.9 

313.1 

109.6 

298.7 

116.5 

177.9 

279.7 

163.3 

36.7 

149.7 

137.8 

92.9 

235.6 

66.8 

345.8 

441.3 

209.6 

377.0 

75.6 

136.3 

104.6 

108.3 

155.5 

164.4 

308.8 

124.8 

81.9 

249.2 

280.2	 

. 

167.1 

187.3 

121.3 

299.2 

89.8 

150.6 

215.7 

276.1 

71.9 

78.2 

101.5 

93.0 

160.0 

117.7 

140.8	 

. 

82.5 

191.3 

268.1 

208.6 

181.7 

224.3 

301.1 

126.1 

109.0 

278.2 

185.9 

113.7 

205.6 

171.6 

360.8 

112.6 

346.2 

156.7 

507.4 

125.8 

333.1 

155.4 

210.9 

385.4 

182.9 

16.1 

167.5 

181.1 

106.1 

238.6 

53.3 

429.5 

471.5 

233.7 

461.0 

88.9 

163.6 

107.6 

150.8 

180.9 

183.0 

406.4 

115.7 

80.3 

274.4 

357.8 

24.3 

194.4 

196.0 

145.8 

323.0 

109.6 

172.1 

214.1 

353.3 

73.5 

80.4 

131.7 

90.3 

148.9 

150.5 

144.1 

54.6 

92.5 

237.8 

313.4 

204.2 

192.9 

138.8 

293.1 

421.9 

127.6 

378.0 

204.0 

174.8 

272.7 

166.3 

346.4 

172.3 

428.1 

166.0 

540.8 

152.4 

313.8 

202.7 

189.2 

489.3 

178.3 

60.4 

160.4 

185.4 

131.8 

241.9 

64.9 

417.8 

471.4 

198.7 

407.0 

117.1 

202.6 

184.1 

149.1 

241.6 

162.6 

400.0 

131.7 

106.9 

268.8 

357.8 

215.4 

177.3 

195.4 

154.8 

332.3 

124.0 

159.3 

253.4 

296.2 

82.1 

84.0 

196.6 

152.2 

162.8 

166.7 

132.4 

48.9 

102.9 

257.6 

291.7 

218.2 

261.4 

261.2 

310.8 

377.9 

164.9 

540.3 

206.0 

180.7 

263.9 

163.9 

329.9 

178.3 

480.9 

187.1 

538.9 

115.1 

289.1 

216.6 

197.6 

456.8 

240.5 

48.9 

261.5 

218.1 

142.8 

231.6 

80.3 

491.3 

505.2 

200.2 

437.7 

152.4 

253.9 

144.4 

145.3 

292.2 

245.5 

597.6 

132.1 

156.1 

280.8 

419.4 

339.7 

177.8 

192.6 

180.7 

387.7 

135.5 

168.6 

340.3 

349.9 

101.8 

122.4 

232.9 

151.7 

166.6 

170.2 

125.7 

78.6 

111.6 

255.1 

329.2 

233.0 

296.1 

106.7 

385.4 

370.7 

153.9 

414.4 

215.2 

204.8 

162.7 

131.5

222.9 

181.7

386.4 

215.3 

353.5 

108.3 

205.2 

269.1 

157.7 

416.6

266.8 

53.1

530.8 

235.0

149.4 

352.2 

75.9 

494.0 

483.1 

286.4 

430.9 

199.9

225.4 

155.8 

153.6 

249.0

303.7 

710.6 

104.9 

164.9

291.7 

545.8 

749.6 

218.3 

179.2 

185.8

425.0 

152.4 

198.1 

344.1 

346.9 

99.0 

120.9 

173.4 

137.1 

184.6 

166.9 

136.2 

106.5 

U.S. CITY TOTAL† 52,013 62,298 69,263 80,333 81,543 156.2 183.3 201.8 231.9 235.4 

San Juan, PR 116 205 175 133 133 23.0 41.8 35.6 27.0 27.0 

TOTAL 52,129 62,503 69,438 80,466 81,676 154.2 181.3 199.4 229.1 232.5 

*New York City has been reporting chlamydia cases since 1984. The State of New York, with the exception of New York City, initiated chlamydia 

reporting during the year 2000. Therefore, the number of chlamydia cases reported in 2000 by the cities of Buffalo, Rochester and Yonkers may be 

incomplete and their 2000 case rates may be underestimated. See Appendix (Reporting of Chlamydia Cases). 

†

Rates exclude population of cities that did not report. Cases reported with unknown sex are not included in this table. NR = No report 

94 Chlamydia Tables	 STD Surveillance 2003 
Table 10. Chlamydia — Reported cases and rates per 100,000 population by age and sex: United States, 

1999–2003 

Year Age 

Group 

Cases Rates 

Total Male Female Total Male Female 

1999 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

13,870 

259,742 

228,069 

88,114 

35,248 

17,269 

7,606 

4,661 

1,006 

915 

824 

32,366 

43,011 

21,548 

10,289 

5,957 

2,987 

2,036 

480 

302 

13,046 

227,376 

185,058 

66,566 

24,959 

11,312 

4,619 

2,625 

526 

613 

68.6 

1,293.2 

1,226.7 

450.1 

171.1 

75.5 

34.3 

12.7 

4.2 

2.6 

8.0 

313.5 

453.1 

218.1 

99.4 

52.2 

27.2 

11.3 

4.2 

2.1 

132.4 

2,329.3 

2,033.9 

686.5 

243.5 

98.6 

41.3 

14.1 

4.3 

3.0 

TOTAL 658,711 120,468 538,243 236.1 88.1 378.4 

2000 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

14,468 

266,583 

249,360 

94,263 

39,509 

18,935 

8,442 

5,601 

1,110 

997 

931 

35,415 

50,103 

24,507 

12,216 

6,791 

3,318 

2,499 

494 

339 

13,537 

231,167 

199,257 

69,756 

27,292 

12,144 

5,123 

3,102 

617 

658 

70.2 

1,318.6 

1,302.8 

489.3 

191.9 

83.7 

37.5 

14.7 

4.5 

2.8 

8.8 

340.8 

512.2 

251.4 

117.9 

60.2 

29.7 

13.4 

4.2 

2.3 

134.8 

2,352.5 

2,129.1 

732.8 

266.8 

107.1 

45.1 

16.0 

4.9 

3.2 

TOTAL 701,339 137,233 564,106 248.5 99.1 392.4 

2001 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

15,031 

288,333 

285,589 

106,914 

45,255 

21,516 

9,940 

6,415 

1,282 

919 

1,042 

39,064 

58,597 

27,896 

14,493 

7,953 

4,124 

2,943 

638 

313 

13,989 

249,269 

226,992 

79,018 

30,763 

13,563 

5,816 

3,472 

644 

606 

71.9 

1,422.4 

1,448.8 

562.0 

217.7 

96.4 

43.6 

16.4 

5.1 

2.6 

9.7 

374.8 

581.3 

289.1 

138.4 

71.4 

36.4 

15.3 

5.2 

2.1 

137.2 

2,531.3 

2,357.0 

842.8 

298.0 

121.4 

50.6 

17.4 

4.9 

2.9 

TOTAL 783,127 157,623 625,504 274.5 112.5 430.7 

2002 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

15,294 

299,863 

305,400 

116,422 

50,339 

23,411 

11,405 

7,644 

1,451 

812 

1,076 

42,433 

66,991 

32,497 

16,847 

9,298 

5,122 

3,652 

746 

296 

14,218 

257,429 

238,408 

83,925 

33,492 

14,113 

6,283 

3,992 

705 

516 

72.4 

1,471.6 

1,510.9 

613.7 

240.2 

106.8 

49.6 

19.1 

5.5 

2.3 

9.9 

405.2 

647.3 

337.1 

159.5 

84.9 

44.9 

18.6 

5.8 

2.0 

137.9 

2,599.0 

2,417.1 

899.3 

322.2 

128.8 

54.2 

19.6 

5.1 

2.5 

TOTAL 834,503 180,039 654,464 289.4 127.1 446.1 

2003 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

14,911 

310,505 

324,411 

124,890 

53,572 

24,658 

12,287 

8,214 

1,653 

776 

1,061 

44,331 

71,476 

34,916 

17,810 

9,772 

5,675 

4,012 

883 

323 

13,849 

266,175 

252,936 

89,974 

35,762 

14,886 

6,612 

4,202 

770 

453 

70.5 

1,523.9 

1,604.9 

658.3 

255.6 

112.5 

53.4 

20.5 

6.2 

2.2 

9.8 

423.4 

690.6 

362.2 

168.6 

89.2 

49.7 

20.4 

6.9 

2.2 

134.3 

2,687.3 

2,564.4 

964.2 

344.1 

135.8 

57.1 

20.6 

5.6 

2.2 

TOTAL 877,478 190,723 686,755 304.3 134.6 468.1 

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the distribution of cases 

for which age was known. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9 

year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

STD Surveillance 2003 Chlamydia Tables 95 
Table 11A. Chlamydia — Reported cases by race/ethnicity, age group and sex: United States, 1999–2003 

Age 

Group 

White, Non-Hispanic 

Total Male Female 

Black, Non-Hispanic 

Total Male Female Total 

Hispanic 

Male Female 

Asian/Pacific Islander 

Total Male Female 

American Indian/ 

Alaska Native 

Total Male Female 

10-14 3,180 114 3,066 7,050 449 6,601 1,885 163 1,721 159 12 147 279 13 266 

15-19 72,649 6,302 66,347 116,293 17,281 99,012 35,455 5,184 30,271 3,601 447 3,154 4,382 516 3,867 

20-24 61,460 10,419 51,041 96,754 20,598 76,156 36,102 6,894 29,207 3,879 629 3,250 3,536 492 3,044 

199925-29 

30-34 

35-39 

20,236 4,671 15,565 

7,427 2,256 5,170 

3,926 1,397 2,528 

36,134 10,266 25,868 

13,979 4,832 9,147 

6,773 2,887 3,886 

17,025 

7,316 

3,264 

3,704 

1,741 

823 

13,321 

5,575 

2,441 

2,084 473 1,611 

929 205 724 

470 121 349 

1,587 256 1,331 

688 135 553 

389 83 307 

40-44 1,834 776 1,058 2,917 1,448 1,468 1,262 341 921 246 77 169 200 41 159 

45-54 1,098 517 580 1,746 969 777 787 228 560 171 60 110 146 30 116 

55-64 239 152 87 373 194 179 129 44 85 42 11 31 34 15 20 

65+ 255 98 157 300 104 196 113 24 88 28 15 13 80 23 57 

TOTAL 172,815 26,857 145,958 283,370 59,335 224,035 103,667 19,264 84,403 11,648 2,063 9,585 11,345 1,609 9,736 

10-14 3,140 110 3,031 7,428 536 6,892 2,044 194 1,850 180 13 167 288 12 276 

15-19 74,657 6,965 67,691 117,722 18,296 99,426 39,526 5,986 33,540 3,865 484 3,381 4,634 597 4,037 

20-24 67,922 12,108 55,814 104,067 22,997 81,070 43,525 8,741 34,785 4,379 820 3,559 4,268 627 3,641 

200025-29 

30-34 

35-39 

21,679 5,274 16,406 

8,389 2,523 5,867 

4,249 1,621 2,628 

37,556 11,151 26,404 

15,044 5,620 9,424 

7,423 3,105 4,318 

20,619 

9,168 

3,782 

4,694 

2,237 

1,024 

15,925 

6,931 

2,758 

2,117 535 1,582 

1,141 270 871 

633 172 461 

1,784 313 1,470 

872 181 690 

497 105 393 

40-44 2,090 862 1,228 3,234 1,512 1,723 1,544 468 1,076 283 93 190 247 57 189 

45-54 1,385 689 696 2,068 1,140 927 968 279 689 231 86 145 183 41 141 

55-64 313 167 146 372 193 178 153 46 107 54 22 32 45 14 31 

65+ 295 114 181 378 131 247 137 39 99 31 21 10 14 2 12 

TOTAL 184,555 30,554 154,001 296,248 64,943 231,306 121,849 23,840 98,009 12,932 2,522 10,410 12,865 1,967 10,898 

10-14 3,203 122 3,081 7,271 523 6,748 2,176 225 1,951 134 7 127 245 12 233 

15-19 79,923 7,591 72,331 122,896 19,374 103,522 42,630 6,852 35,778 3,907 514 3,393 4,820 601 4,220 

20-24 79,134 14,649 64,485 115,191 26,365 88,827 49,029 10,255 38,774 4,815 905 3,910 4,255 683 3,572 

2001

25-29 

30-34 

35-39 

24,529 6,214 18,315 

9,779 3,137 6,642 

4,814 1,909 2,905 

41,444 12,463 28,981 

16,909 6,553 10,356 

8,034 3,577 4,457 

23,461 

10,347 

4,478 

5,493 

2,698 

1,193 

17,968 

7,649 

3,285 

2,364 536 1,828 

1,140 291 848 

639 213 426 

1,978 373 1,605 

878 150 728 

488 102 385 

40-44 2,369 1,057 1,311 3,795 1,904 1,892 1,833 536 1,297 286 85 202 247 59 189 

45-54 1,631 831 800 2,492 1,352 1,140 962 299 663 209 61 149 184 52 132 

55-64 371 191 179 479 291 188 169 62 107 44 17 28 24 8 17 

65+ 199 63 136 371 149 222 143 43 100 29 13 16 6 4 2 

TOTAL 206,348 35,882 170,467 319,667 72,769 246,898 135,617 27,792 107,824 13,590 2,646 10,943 13,164 2,049 11,115 

10-14 3,349 94 3,255 8,245 665 7,580 2,308 234 2,074 160 6 153 291 13 278 

15-19 87,116 8,455 78,660 138,051 22,908 115,143 48,145 7,609 40,536 3,927 479 3,448 5,158 698 4,461 

20-24 91,120 17,951 73,169 130,338 31,430 98,908 56,493 12,380 44,113 5,821 1,137 4,684 5,089 847 4,242 

200225-29 

30-34 

35-39 

29,455 7,780 21,674 

11,867 3,978 7,889 

5,723 2,500 3,223 

47,920 15,117 32,803 

20,437 8,111 12,326 

9,450 4,329 5,121 

27,621 

12,636 

5,554 

6,808 

3,259 

1,611 

20,813 

9,377 

3,943 

2,922 709 2,213 

1,621 446 1,176 

833 224 610 

2,175 434 1,741 

1,067 214 853 

574 146 428 

40-44 2,892 1,422 1,469 4,821 2,503 2,319 2,350 740 1,609 446 114 332 332 89 243 

45-54 2,129 1,165 964 3,142 1,690 1,452 1,404 435 970 384 130 253 198 57 141 

55-64 410 282 128 580 309 271 269 88 182 82 23 59 36 10 26 

65+ 226 68 158 376 166 210 141 37 104 20 7 13 10 4 7 

TOTAL 234,839 43,913 190,925 364,513 87,744 276,769 157,458 33,453 124,005 16,276 3,300 12,976 14,981 2,538 12,444 

10-14 3,336 116 3,219 8,320 721 7,600 2,210 166 2,044 145 7 139 302 19 283 

15-19 93,457 8,820 84,637 147,549 25,606 121,944 48,899 7,407 41,493 4,071 445 3,627 5,517 815 4,702 

20-24 103,138 20,467 82,671 138,950 34,080 104,871 58,996 12,572 46,424 6,046 1,156 4,890 5,428 1,001 4,427 

200325-29 

30-34 

35-39 

33,634 9,219 24,415 

13,149 4,309 8,839 

6,091 2,586 3,505 

52,640 16,408 36,232 

22,401 8,645 13,756 

10,340 4,799 5,541 

28,313 

13,001 

5,728 

6,876 

3,502 

1,644 

21,437 

9,499 

4,084 

3,120 810 2,310 

1,830 493 1,337 

876 252 624 

2,385 477 1,908 

1,066 238 828 

630 158 472 

40-44 3,331 1,689 1,642 5,339 2,859 2,480 2,355 733 1,622 434 124 310 339 75 264 

45-54 2,420 1,347 1,073 3,440 1,879 1,561 1,418 454 964 378 131 247 210 55 155 

55-64 524 326 198 635 361 273 293 113 180 89 33 56 51 15 36 

65+ 277 112 165 301 144 158 130 37 93 22 14 8 17 3 14 

TOTAL 259,808 49,115 210,693 390,660 95,741 294,918 161,629 33,576 128,053 17,042 3,469 13,573 15,964 2,859 13,105 

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 3-5 for sex-specific 

cases and rates and overall totals. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these 

variables were specified. For the following years the states listed did not report age and/or race/ethnicity for most cases and their case data and population 

denominators were excluded: 1999 (CO, DC, MI, NJ, NY); 2000 (CO, DC, MI, NY); 2001 (CO, DC, MD, NJ, NY); 2002 (MI, NJ); 2003 (CO, DC, NJ). Differences 

between total cases from this table and others in the report are due to different reporting formats and above listed exclusions. The 0 to 9 year age group is not 

shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

96 Chlamydia Tables STD Surveillance 2003 
Table 11B. Chlamydia — Rates per 100,000 population by race/ethnicity, age group and sex: United States, 

1999–2003 

Age 

Group 

White, Non-Hispanic 

Total Male Female 

Black, Non-Hispanic 

Total Male Female Total 

Hispanic 

Male Female 

Asian/Pacific Islander 

Total Male Female 

American Indian/ 

Alaska Native 

Total Male Female 

10-14 28.4 2.0 56.3 270.7 34.0 514.7 72.4 12.3 135.4 24.3 3.5 46.1 133.6 12.3 259.0 

15-19 649.5 110.1 1,214.8 4,659.1 1,369.3 8,023.9 1,338.5 367.4 2,445.7 515.0 125.5 919.7 2,209.6 510.8 3,970.3 

20-24 611.5 204.5 1,029.8 4,463.6 1,948.6 6,857.3 1,294.6 450.3 2,322.5 527.8 170.4 888.1 2,214.7 606.1 3,878.1 

25-29 

30-34 

35-39 

189.2 86.7 293.3 

63.7 38.4 89.2 

28.6 20.3 36.9 

1,693.7 1,009.3 2,317.2 

644.4 469.4 802.3 

288.7 261.4 313.1 

608.5 

281.6 

141.6 

244.3 

124.9 

68.1 

1,039.4 

463.0 

222.4 

242.3 112.7 365.7 

115.4 53.0 173.1 

59.4 31.7 85.1 

1,036.1 333.5 1,739.8 

1999

453.6 180.0 721.1 

228.6 100.0 350.0 

40-44 13.3 11.2 15.3 131.9 139.5 125.2 67.9 35.7 101.9 33.6 22.5 43.3 124.8 53.7 190.1 

45-54 4.6 4.4 4.8 54.0 64.6 44.9 31.9 18.6 45.1 14.6 11.2 17.5 59.5 25.4 91.2 

55-64 1.5 1.9 1.0 20.0 23.2 17.4 9.6 6.9 12.0 6.4 3.7 8.8 24.9 21.9 27.7 

65+ 1.0 0.9 1.1 13.1 11.8 13.9 8.1 4.2 11.0 4.1 5.1 3.3 66.8 44.8 83.0 

TOTAL 102.7 32.6 169.9 986.9 433.6 1,490.7 357.7 128.8 601.6 128.2 47.0 203.9 543.7 156.5 919.5 

10-14 27.0 1.8 53.7 266.9 38.0 502.6 71.2 13.2 132.0 25.5 3.6 48.7 133.0 10.6 259.8 

15-19 649.8 118.5 1,206.5 4,542.0 1,394.8 7,767.0 1,394.3 396.9 2,528.2 514.7 126.5 918.3 2,258.7 570.5 4,017.6 

20-24 645.8 227.5 1,074.5 4,485.4 2,031.1 6,824.7 1,418.8 515.4 2,535.6 549.4 205.5 894.2 2,529.5 733.8 4,369.2 

25-29 

30-34 

35-39 

204.4 98.7 312.0 

70.5 42.1 99.3 

30.7 23.4 38.0 

1,716.2 1,067.7 2,308.5 

666.2 524.3 794.5 

304.8 270.6 335.2 

675.8 

325.9 

149.6 

283.6 

148.3 

77.2 

1,140.8 

531.2 

229.6 

226.5 116.2 333.4 

125.5 60.9 186.9 

72.7 40.9 102.3 

1,148.5 402.7 1,896.7 

2000

556.1 232.4 877.2 

285.3 123.1 439.7 

40-44 14.5 12.0 17.1 137.5 136.6 138.3 74.7 44.0 107.3 35.0 24.3 44.6 145.8 70.5 215.1 

45-54 5.4 5.5 5.4 58.2 69.1 48.8 34.7 20.1 49.2 17.5 14.1 20.4 68.5 32.1 102.5 

55-64 1.8 2.0 1.7 18.5 21.4 16.1 10.2 6.5 13.5 7.3 6.4 8.2 29.8 19.6 39.3 

65+ 1.1 1.1 1.2 15.7 14.2 16.7 8.9 5.9 11.1 4.0 6.5 2.2 10.6 3.8 15.7 

TOTAL 105.9 35.8 173.1 978.2 449.8 1,459.6 384.7 145.7 639.8 129.2 52.1 201.5 590.2 183.0 986.1 

10-14 27.6 2.1 54.6 264.2 37.5 497.8 74.1 14.9 136.2 19.4 1.9 37.8 110.4 10.6 213.5 

15-19 693.7 128.4 1,289.5 4,870.0 1,510.8 8,340.6 1,544.1 471.6 2,735.5 546.9 141.2 967.9 2,270.1 554.2 4,058.5 

20-24 725.0 265.4 1,195.0 4,938.4 2,304.2 7,474.9 1,603.7 604.8 2,847.8 617.6 233.2 998.6 2,379.7 753.8 4,048.7 

25-29 

30-34 

35-39 

239.2 120.0 360.7 

83.0 52.9 113.6 

36.2 28.6 43.8 

1,983.4 1,245.4 2,661.9 

782.2 638.3 912.4 

351.1 331.2 368.9 

754.2 

359.5 

175.1 

323.1 

174.5 

88.3 

1,274.0 

574.4 

272.1 

260.6 120.9 394.1 

124.0 65.1 179.8 

75.1 51.7 97.1 

1,258.6 472.3 2,052.7 

2001

550.8 188.7 909.7 

281.0 120.3 435.3 

40-44 16.5 14.8 18.3 166.8 177.7 157.0 86.6 49.0 126.7 36.6 23.0 48.8 142.2 70.3 208.7 

45-54 6.3 6.5 6.1 70.1 81.7 60.0 33.4 20.8 46.2 16.0 10.1 21.0 65.5 38.4 90.7 

55-64 2.1 2.3 2.0 24.3 32.9 17.4 11.1 8.6 13.3 6.0 4.9 7.0 15.2 9.9 20.1 

65+ 0.8 0.6 0.9 15.8 16.5 15.4 9.1 6.4 11.1 3.7 3.9 3.4 4.2 6.1 2.7 

TOTAL 118.7 42.1 192.4 1,083.9 516.8 1,602.2 423.8 167.9 698.2 138.3 55.8 215.0 587.8 185.6 978.7 

10-14 27.4 1.5 54.7 266.2 42.3 496.7 67.9 13.5 125.0 20.2 1.6 39.7 128.8 11.3 249.7 

15-19 715.7 135.2 1,329.6 4,887.6 1,595.0 8,294.0 1,566.1 475.4 2,751.1 489.7 117.4 875.6 2,356.2 624.1 4,164.2 

20-24 772.3 300.6 1,255.8 4,847.2 2,371.6 7,252.9 1,626.9 645.4 2,838.4 647.3 255.0 1,033.5 2,665.7 874.5 4,512.4 

25-29 

30-34 

35-39 

274.7 144.0 407.6 

95.4 63.5 127.7 

41.9 36.5 47.3 

2,066.4 1,365.9 2,706.0 

831.5 697.2 952.2 

367.6 358.1 376.1 

765.5 

368.7 

184.3 

343.7 

177.3 

101.5 

1,278.6 

590.3 

276.4 

281.0 141.1 411.8 

144.0 81.7 202.5 

81.9 45.4 116.3 

1,346.7 534.8 2,167.7 

2002

647.3 260.2 1,032.3 

329.7 171.2 482.5 

40-44 19.0 18.7 19.3 185.2 205.0 167.6 92.7 56.7 131.0 47.6 25.6 67.6 183.8 102.2 259.6 

45-54 7.6 8.4 6.9 75.3 87.7 64.7 40.2 24.9 55.4 24.4 17.9 30.0 66.5 39.6 91.2 

55-64 2.1 3.0 1.3 24.5 29.4 20.6 14.3 9.8 18.3 9.0 5.4 12.1 20.5 11.6 28.7 

65+ 0.8 0.6 1.0 13.9 16.1 12.6 7.5 4.6 9.6 2.2 1.8 2.4 6.6 5.6 7.4 

TOTAL 126.9 48.4 202.2 1,087.8 550.3 1,575.9 423.4 174.3 688.8 140.4 59.1 216.0 644.8 221.6 1,056.2 

10-14 26.5 1.8 52.6 259.8 44.3 481.6 65.8 9.7 124.8 18.2 1.6 35.7 131.6 15.9 250.5 

15-19 748.1 137.4 1,393.8 5,071.3 1,731.5 8,523.2 1,611.0 468.7 2,851.7 503.9 108.2 914.1 2,485.5 719.3 4,328.3 

20-24 852.5 334.4 1,383.1 5,056.9 2,515.0 7,530.1 1,725.7 665.8 3,033.3 668.4 257.6 1,072.7 2,809.6 1,021.1 4,651.9 

25-29 

30-34 

35-39 

307.5 167.3 450.0 

103.5 67.4 140.1 

43.5 36.9 50.2 

2,207.4 1,442.3 2,905.4 

884.7 722.2 1,030.4 

392.5 387.9 396.5 

796.9 

384.8 

192.6 

352.7 

193.3 

105.0 

1,336.9 

606.3 

290.1 

297.8 159.9 426.6 

160.9 89.5 228.2 

85.4 50.6 118.2 

1,462.5 582.1 2,352.4 

2003

639.3 286.7 989.9 

357.7 183.2 525.8 

40-44 21.4 21.8 21.1 200.1 228.9 174.7 94.3 57.0 133.9 46.0 27.5 62.9 185.3 85.0 278.4 

45-54 8.5 9.5 7.5 80.3 94.9 67.7 41.2 26.5 55.9 24.0 18.0 29.1 69.6 38.2 98.5 

55-64 2.6 3.4 1.9 26.2 33.4 20.3 15.8 12.9 18.4 9.7 7.8 11.3 28.9 17.8 39.2 

65+ 1.0 1.0 1.0 10.9 13.6 9.2 7.0 4.7 8.7 2.3 3.4 1.5 11.1 5.2 15.5 

TOTAL 137.1 52.9 217.9 1,134.1 584.2 1,633.1 440.8 177.5 721.3 146.0 61.7 224.5 678.7 246.7 1,098.3 

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 3-5 for sex-specific 

cases and rates and overall totals. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables 

were specified. For the following years the states listed did not report age and/or race/ethnicity for most cases and their case data and population denominators were 

excluded: 1999 (CO, DC, MI, NJ, NY); 2000 (CO, DC, MI, NY); 2001 (CO, DC, MD, NJ, NY); 2002 (MI, NJ); 2003 (CO, DC, NJ). Differences between total rates from 

this table and others in the report are due to different reporting formats and above listed exclusions. The 0 to 9 year age group is not shown because some of these 

cases may not be due to sexual transmission; however, they are included in the totals. 

STD Surveillance 2003 Chlamydia Tables 97 
5

10

15

20

25

30

35

40

45

50

Table 12. Gonorrhea — Reported cases and rates by state/area, ranked by rates: United States, 2003 

Rank* State/Area Cases Rate per 100,000 Population 

1 Louisiana 11,850 264.4 

2 Mississippi 6,328 220.4 

3 Alabama 9,303 207.4 

4 South Carolina 8,518 207.4 

Georgia 17,686 206.6 

6 Ohio 22,537 197.3 

7 North Carolina 15,116 181.7 

8 Illinois 21,817 173.1 

9 Arkansas 4,251 156.9 

Missouri 8,792 155.0 

11 Maryland 8,032 147.2 

12 Tennessee 8,519 146.9 

13 Delaware 1,128 139.7 

14 Michigan 13,965 138.9 

Oklahoma 4,552 130.3 

16 Virginia 9,066 124.3 

U.S. TOTAL† 335,104 116.2 

17 New York 22,166 115.7 

18 Florida 18,974 113.5 

19 Texas 24,595 112.9 

Indiana 6,681 108.5 

21 Wisconsin 5,663 104.1 

22 Nevada 2,221 102.2 

23 Hawaii 1,263 101.5 

24 Kansas 2,647 97.5 

Pennsylvania 11,866 96.2 

26 Nebraska 1,623 93.9 

27 New Jersey 7,944 92.5 

28 Rhode Island 973 91.0 

29 Connecticut 3,114 90.0 

Alaska 573 89.0 

31 Kentucky 3,578 87.4 

32 California 25,963 73.9 

33 Arizona 3,580 65.6 

34 Minnesota 3,202 63.8 

Colorado 2,854 63.3 

36 New Mexico 1,169 63.0 

37 Iowa 1,554 52.9 

38 West Virginia 847 47.0 

39 Washington 2,753 45.4 

Massachusetts 2,901 45.1 

41 South Dakota 226 29.7 

42 Oregon 1,000 28.4 

YEAR 2010 TARGET 19.0 

43 Maine 233 18.0 

44 Utah 412 17.8 

North Dakota 103 16.2 

46 Vermont 97 15.7 

47 Montana 122 13.4 

48 New Hampshire 125 9.8 

49 Wyoming 46 9.2 

Idaho 68 5.1 

*States were ranked in descending order by rate, number of cases, and alphabetically by state. 

†

Total includes cases reported by Washington, D.C., but excludes outlying areas (Guam with 65 cases and rate of 40.4, Puerto Rico with 276 cases 

and rate of 7.2, and Virgin Islands with 91 cases and rate of 82.7). 

98 Gonorrhea Tables STD Surveillance 2003 
Table 13. Gonorrhea — Reported cases and rates by state/area and region listed in alphabetical order: United 

States and outlying areas, 1999–2003 

State/Area 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 

Alabama 10,888 12,063 11,182 10,118 9,303 245.8 271.0 250.2 225.5 207.4 

Alaska 302 361 457 641 573 48.3 57.5 72.1 99.6 89.0 

Arizona 4,293 4,130 3,920 3,795 3,580 85.5 79.9 73.9 69.6 65.6 

Arkansas 3,226 3,642 4,604 4,584 4,251 121.7 136.0 170.9 169.1 156.9 

California 18,672 21,619 23,296 24,606 25,963 55.7 63.6 67.3 70.1 73.9 

Colorado 2,526 3,112 3,190 3,511 2,854 59.8 71.9 72.0 77.9 63.3 

Connecticut 3,321 2,912 2,546 3,241 3,114 98.1 85.3 74.1 93.7 90.0 

Delaware 1,662 1,735 1,733 1,576 1,128 214.5 220.6 217.5 195.2 139.7 

Florida 22,794 22,781 21,531 21,348 18,974 144.6 141.9 131.5 127.7 113.5 

Georgia 21,244 20,265 18,920 18,383 17,686 264.0 246.1 225.1 214.7 206.6

Hawaii 463 483 604 740 1,263 38.3 39.8 49.2 59.4 101.5 

Idaho 89 98 76 94 68 7.0 7.5 5.8 7.0 5.1 

Illinois 24,136 24,812 24,025 24,026 21,817 195.3 199.4 191.9 190.7 173.1 

Indiana 6,092 6,525 6,972 7,395 6,681 100.8 107.1 113.8 120.1 108.5 

Iowa 1,365 1,392 1,418 1,480 1,554 46.8 47.5 48.4 50.4 52.9 

Kansas 2,665 2,795 2,669 2,744 2,647 99.5 103.8 98.8 101.0 97.5 

Kentucky 3,349 3,502 3,588 3,772 3,578 83.3 86.5 88.2 92.2 87.4 

Louisiana 13,189 13,245 12,253 11,387 11,850 295.7 296.3 274.1 254.0 264.4 

Maine 83 90 141 142 233 6.6 7.0 11.0 11.0 18.0 

Maryland 10,430 9,837 9,427 9,355 8,032 198.5 185.2 175.0 171.4 147.2 

Massachusetts 2,453 3,045 3,214 3,242 2,901 38.8 47.9 50.2 50.4 45.1 

Michigan 15,907 18,182 17,120 14,770 13,965 160.7 182.6 171.1 147.0 138.9

Minnesota 2,830 3,160 2,701 3,049 3,202 58.1 64.0 54.2 60.7 63.8 

Mississippi 10,411 9,217 7,759 6,875 6,328 368.1 323.5 271.3 239.4 220.4

Missouri 8,187 8,883 8,723 8,952 8,792 147.2 158.5 154.7 157.8 155.0 

Montana 53 60 104 123 122 5.9 6.6 11.5 13.5 13.4 

Nebraska 1,471 1,534 1,189 1,564 1,623 86.3 89.5 69.1 90.4 93.9 

Nevada 1,303 1,553 1,756 1,988 2,221 67.3 76.9 83.7 91.5 102.2 

New Hampshire 115 110 176 120 125 9.4 8.9 14.0 9.4 9.8 

New Jersey 7,852 7,232 8,921 7,894 7,944 93.9 85.8 104.8 91.9 92.5 

New Mexico 974 1,152 1,040 1,462 1,169 53.9 63.2 56.8 78.8 63.0 

New York 19,826 20,114 22,299 21,841 22,166 105.0 105.9 116.8 114.0 115.7 

North Carolina 19,428 17,823 16,583 15,531 15,116 244.4 220.5 202.1 186.7 181.7 

North Dakota 83 73 56 72 103 12.9 11.4 8.8 11.4 16.2 

Ohio 18,141 19,303 21,163 22,008 22,537 160.0 169.9 185.8 192.7 197.3 

Oklahoma 4,021 4,229 4,784 4,661 4,552 117.0 122.4 137.9 133.4 130.3 

Oregon 903 1,038 1,144 909 1,000 26.6 30.3 32.9 25.8 28.4 

Pennsylvania 13,295 13,607 14,244 13,294 11,866 108.4 110.8 115.8 107.8 96.2

Rhode Island 601 661 830 900 973 57.8 62.9 78.3 84.1 91.0 

South Carolina 15,037 8,383 10,805 9,152 8,518 378.3 208.3 266.0 222.8 207.4 

South Dakota 192 277 289 263 226 25.6 36.7 38.1 34.6 29.7 

Tennessee 11,366 11,876 10,145 9,348 8,519 201.6 208.2 176.5 161.2 146.9 

Texas 32,910 32,919 30,024 26,988 24,595 160.1 157.1 140.5 123.9 112.9 

Utah 254 231 219 374 412 11.5 10.3 9.6 16.1 17.8 

Vermont 52 65 76 98 97 8.6 10.7 12.4 15.9 15.7 

Virginia 9,402 10,175 11,095 10,462 9,066 134.3 143.2 154.2 143.4 124.3 

Washington 2,132 2,418 2,991 2,925 2,753 36.5 40.9 49.9 48.2 45.4 

West Virginia 584 645 732 974 847 32.2 35.7 40.6 54.1 47.0

Wisconsin 6,662 7,013 6,011 6,341 5,663 124.9 130.5 111.2 116.5 104.1 

Wyoming 43 53 77 65 46 8.7 10.7 15.6 13.0 9.2 

U.S. TOTAL* 360,813 363,136 361,705 351,852 335,104 129.3 128.7 126.8 122.0 116.2 

Northeast 47,598 47,836 52,447 50,772 49,419 89.2 89.1 97.2 93.6 91.1 

Midwest 87,731 93,949 92,336 92,664 88,810 136.9 145.7 142.5 142.2 136.3 

South 193,477 185,043 178,048 167,183 154,851 195.1 184.0 174.6 161.8 149.8 

West 32,007 36,308 38,874 41,233 42,024 51.3 57.2 60.2 62.8 64.0 

Guam 

Puerto Rico 

Virgin Islands 

59

321 

51 

62

527 

24 

48

589 

34 

49

411 

49 

65 

276 

91 

36.1 

8.3 

45.2 

39.9 

13.8 

22.1 

30.3 

15.3 

31.1 

30.4 

10.6 

44.5 

40.4 

7.2 

82.7 

OUTLYING AREAS 431 613 671 509 432 10.3 15.0 16.3 12.3 10.5 

TOTAL 361,244 363,749 362,376 352,361 335,536 127.6 127.0 125.2 120.5 114.7 

*Includes cases reported by Washington, D.C. 

STD Surveillance 2003 Gonorrhea Tables 99 
Table 14. Gonorrhea — Women – Reported cases and rates by state/area and region listed in alphabetical 

order: United States and outlying areas, 1999–2003 

State/Area 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 

Alabama 5,460 5,984 5,712 4,974 4,583 238.1 259.8 247.3 214.6 197.8 

Alaska 153 198 244 353 339 50.8 65.3 79.7 113.6 109.1 

Arizona 1,760 1,754 1,700 1,659 1,636 69.9 67.8 64.0 60.8 59.9 

Arkansas 1,576 1,807 2,404 2,388 2,108 115.9 131.8 174.4 172.4 152.1 

California 8,903 9,624 10,448 10,857 11,912 53.0 56.4 60.2 61.7 67.7 

Colorado 1,271 1,544 1,588 1,643 1,529 60.5 71.9 72.2 73.5 68.4 

Connecticut 1,796 1,621 1,411 1,910 1,910 102.8 92.2 79.7 107.2 107.2 

Delaware 912 987 1,002 858 602 228.7 243.9 244.6 206.7 145.1 

Florida 10,960 10,862 10,380 10,373 9,419 135.7 132.2 123.9 121.4 110.3 

Georgia 10,092 9,844 9,590 9,306 9,137 246.4 235.4 224.8 214.3 210.4

Hawaii 251 240 292 394 723 41.7 39.8 47.7 63.5 116.5 

Idaho 42 51 39 49 18 6.6 7.9 5.9 7.3 2.7 

Illinois 11,563 11,829 12,178 12,273 11,624 183.2 186.3 190.7 191.1 181.0 

Indiana 3,254 3,446 3,792 3,996 3,610 105.5 111.1 121.6 127.5 115.2 

Iowa 759 740 766 821 869 51.0 49.6 51.3 54.9 58.1 

Kansas 1,573 1,496 1,468 1,556 1,522 116.0 109.9 107.5 113.4 110.9 

Kentucky 1,626 1,725 1,812 1,936 1,845 79.1 83.3 87.2 92.6 88.2 

Louisiana 6,697 6,471 6,056 5,861 6,076 290.8 280.5 262.7 253.7 263.0 

Maine 40 29 55 44 84 6.1 4.4 8.3 6.6 12.6 

Maryland 4,749 4,577 4,591 4,592 4,166 174.8 166.7 164.9 162.9 147.8 

Massachusetts 1,207 1,568 1,591 1,579 1,342 36.9 47.6 48.0 47.5 40.4 

Michigan 7,771 9,190 9,057 7,974 7,823 153.9 181.1 177.7 155.9 152.9

Minnesota 1,495 1,681 1,461 1,688 1,784 60.7 67.5 58.1 66.7 70.4 

Mississippi 6,137 5,603 4,663 4,201 3,757 419.0 380.3 315.6 283.3 253.4

Missouri 4,459 4,489 4,540 4,810 4,794 155.9 155.9 156.8 165.2 164.7 

Montana 35 38 57 75 74 7.8 8.4 12.5 16.4 16.2 

Nebraska 814 849 671 909 924 94.0 97.7 77.0 103.8 105.5 

Nevada 480 618 761 965 1,062 50.6 62.4 73.9 90.5 99.6 

New Hampshire 61 53 96 51 57 9.8 8.4 15.0 7.9 8.8 

New Jersey 3,824 3,571 4,522 3,958 4,550 88.8 82.3 103.3 89.6 103.0 

New Mexico 528 573 472 740 598 57.5 61.9 50.7 78.5 63.4 

New York 10,639 10,691 11,873 11,141 11,296 108.8 108.6 120.2 112.5 114.0 

North Carolina 9,089 8,468 7,810 7,585 7,383 223.7 205.4 186.7 178.9 174.2 

North Dakota 46 36 30 40 59 14.3 11.2 9.4 12.6 18.6 

Ohio 9,707 10,311 11,257 11,944 12,390 166.4 176.4 192.2 203.5 211.1 

Oklahoma 2,240 2,433 2,670 2,566 2,562 128.1 138.5 151.5 144.7 144.4 

Oregon 433 486 448 357 389 25.3 28.1 25.6 20.1 21.9 

Pennsylvania 7,356 7,371 7,872 7,200 6,644 115.9 116.0 123.8 113.0 104.3 

Rhode Island 371 381 488 484 517 68.6 69.8 88.7 87.2 93.2 

South Carolina 5,874 4,057 5,126 4,357 4,369 287.2 196.0 245.5 206.3 206.9 

South Dakota 117 165 166 148 133 30.9 43.3 43.5 38.6 34.7 

Tennessee 4,965 5,343 4,808 4,564 4,263 171.4 182.6 163.1 153.6 143.5 

Texas 16,819 16,932 15,599 14,075 12,643 162.3 160.5 145.1 128.5 115.4 

Utah 100 99 95 150 153 9.1 8.8 8.4 13.0 13.2 

Vermont 22 33 42 56 48 7.1 10.6 13.4 17.8 15.3 

Virginia 4,566 4,856 5,485 5,445 4,809 127.9 134.1 149.6 146.7 129.5 

Washington 1,009 1,078 1,301 1,197 1,167 34.4 36.3 43.2 39.3 38.3 

West Virginia 357 375 418 567 464 38.3 40.4 45.2 61.3 50.2

Wisconsin 3,826 4,189 3,672 3,717 3,299 141.6 154.0 134.3 135.1 119.9 

Wyoming 26 31 43 38 28 10.6 12.6 17.5 15.3 11.3 

U.S. TOTAL* 179,319 181,668 183,863 179,648 174,230 126.1 126.4 126.6 122.5 118.8 

Northeast 25,316 25,318 27,950 26,423 26,448 91.8 91.3 100.3 94.4 94.5 

Midwest 45,384 48,421 49,058 49,876 48,831 138.7 147.2 148.5 150.3 147.2 

South 93,628 91,595 89,367 84,872 79,323 184.7 178.4 171.8 161.1 150.5 

West 14,991 16,334 17,488 18,477 19,628 47.9 51.4 54.1 56.2 59.7 

Guam 

Puerto Rico 

Virgin Islands 

28

132 

38 

23

238 

14 

22

279 

20 

26

230 

38 

39 

121 

65 

36.4 

6.5 

73.7 

30.3 

12.0 

24.7 

28.4 

14.0 

34.4 

33.0 

11.5 

64.2 

49.5 

6.0 

109.8 

OUTLYING AREAS 198 275 321 294 225 9.2 13.0 15.1 13.7 10.5 

TOTAL 179,517 181,943 184,184 179,942 174,455 124.3 124.7 125.0 120.9 117.2 

*Includes cases reported by Washington, D.C. 

NOTE: Cases reported with unknown sex are not included in this table. 

100 Gonorrhea Tables STD Surveillance 2003 
Table 15. Gonorrhea — Men – Reported cases and rates by state/area and region listed in alphabetical order: 

United States and outlying areas, 1999–2003 

State/Area 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 

Alabama 5,399 6,039 5,457 5,131 4,705 252.7 281.0 252.7 236.5 216.9 

Alaska 149 163 213 288 234 46.1 50.2 65.0 86.5 70.2 

Arizona 2,533 2,376 2,220 2,136 1,942 101.1 92.1 83.8 78.4 71.2 

Arkansas 1,650 1,832 2,191 2,194 2,141 127.7 140.1 166.5 165.6 161.6 

California 9,618 11,896 12,701 13,586 13,965 57.6 70.2 73.6 77.6 79.7 

Colorado 1,255 1,568 1,602 1,868 1,325 59.1 72.0 71.8 82.3 58.4 

Connecticut 1,525 1,291 1,132 1,331 1,204 93.0 78.1 68.0 79.3 71.7 

Delaware 750 748 731 718 526 199.3 195.9 188.9 183.0 134.1 

Florida 11,797 11,919 11,149 10,975 9,555 153.5 152.1 139.4 134.3 116.9 

Georgia 11,039 10,309 9,325 9,013 8,487 279.5 254.4 225.3 213.7 201.2

Hawaii 211 243 312 346 540 34.7 39.9 50.7 55.4 86.5 

Idaho 46 47 35 45 50 7.2 7.2 5.3 6.7 7.4 

Illinois 12,559 12,981 11,845 11,750 10,192 207.7 213.1 193.1 190.2 165.0 

Indiana 2,836 3,069 3,169 3,372 3,040 95.8 102.7 105.4 111.5 100.5 

Iowa 606 652 652 658 680 42.4 45.4 45.3 45.6 47.2 

Kansas 1,092 1,299 1,201 1,188 1,125 82.6 97.6 89.9 88.4 83.7 

Kentucky 1,669 1,751 1,769 1,834 1,727 85.1 88.5 88.9 91.6 86.3 

Louisiana 6,492 6,774 6,197 5,466 5,710 300.8 313.2 286.2 251.6 262.9 

Maine 43 61 86 98 149 7.0 9.8 13.8 15.6 23.6 

Maryland 5,669 5,196 4,836 4,756 3,858 223.4 202.5 185.8 180.2 146.2 

Massachusetts 1,246 1,477 1,622 1,663 1,552 41.0 48.2 52.5 53.6 50.0 

Michigan 8,136 8,992 8,063 6,796 6,141 167.8 184.2 164.2 137.7 124.5

Minnesota 1,335 1,479 1,240 1,361 1,418 55.4 60.5 50.2 54.7 57.0 

Mississippi 4,184 3,586 3,096 2,674 2,571 306.8 260.7 224.0 192.5 185.1

Missouri 3,728 4,394 4,183 4,142 3,998 138.0 161.2 152.5 150.0 144.8 

Montana 18 22 47 47 47 4.0 4.9 10.4 10.4 10.4 

Nebraska 657 681 516 653 695 78.3 80.6 60.8 76.5 81.4 

Nevada 822 935 993 1,022 1,158 83.4 90.9 92.9 92.3 104.6 

New Hampshire 54 57 80 69 68 9.0 9.3 12.9 11.0 10.8 

New Jersey 4,019 3,654 4,391 3,930 3,389 99.1 89.3 106.2 94.2 81.2 

New Mexico 445 572 555 716 567 50.0 63.9 61.7 78.5 62.2 

New York 9,176 9,378 10,397 10,688 10,813 100.8 102.4 112.9 115.5 116.9 

North Carolina 10,339 9,354 8,772 7,942 7,733 266.0 236.2 218.1 194.6 189.5 

North Dakota 37 37 26 32 44 11.5 11.6 8.2 10.1 13.9 

Ohio 8,245 8,837 9,679 9,819 9,856 149.9 160.1 174.9 176.8 177.5 

Oklahoma 1,781 1,796 2,114 2,095 1,990 105.5 105.8 123.8 121.8 115.7 

Oregon 470 552 696 552 611 27.9 32.4 40.4 31.6 35.0 

Pennsylvania 5,939 6,236 6,372 6,094 5,214 100.4 105.1 107.2 102.1 87.4 

Rhode Island 230 280 342 416 456 46.0 55.5 67.1 80.8 88.6 

South Carolina 9,052 4,256 5,640 4,766 4,118 469.2 217.8 285.7 238.9 206.4 

South Dakota 75 111 123 115 93 20.2 29.6 32.7 30.4 24.6 

Tennessee 6,401 6,533 5,337 4,784 4,256 233.5 235.2 190.5 169.3 150.6 

Texas 15,973 15,919 14,370 12,884 11,932 156.6 153.0 135.3 119.0 110.2 

Utah 154 132 124 223 259 14.0 11.7 10.9 19.2 22.3 

Vermont 30 32 34 42 49 10.1 10.7 11.3 13.9 16.2 

Virginia 4,832 5,307 5,574 5,017 4,237 140.9 152.2 157.9 140.1 118.3 

Washington 1,123 1,340 1,690 1,728 1,586 38.6 45.5 56.6 57.2 52.5 

West Virginia 227 269 313 406 380 25.8 30.6 35.7 46.3 43.3

Wisconsin 2,827 2,817 2,321 2,612 2,341 107.4 106.1 86.9 97.1 87.0 

Wyoming 17 22 34 27 18 6.9 8.9 13.7 10.8 7.2 

U.S. TOTAL* 180,524 180,701 177,194 171,504 160,106 132.0 130.5 126.5 121.1 113.0 

Northeast 22,262 22,466 24,456 24,331 22,894 86.4 86.6 93.7 92.7 87.2 

Midwest 42,133 45,349 43,018 42,498 39,623 134.2 143.5 135.3 133.0 124.0 

South 99,268 93,018 88,498 82,091 75,287 204.7 188.9 177.2 162.1 148.6 

West 16,861 19,868 21,222 22,584 22,302 54.1 62.7 65.8 68.9 68.0 

Guam 

Puerto Rico 

Virgin Islands 

31

189 

13 

39

289 

10 

26

310 

14 

23

181 

11 

26 

155 

26 

35.8 

10.1 

21.2 

49.1 

15.7 

19.3 

32.1 

16.8 

27.3 

28.0 

9.7 

21.6 

31.6 

8.3 

51.2 

OUTLYING AREAS 233 338 350 215 207 11.6 17.2 17.7 10.8 10.4 

TOTAL 180,757 181,039 177,544 171,719 160,313 130.2 128.9 125.0 119.5 111.6 

*Includes cases reported by Washington, D.C.
 

NOTE: Cases reported with unknown sex are not included in this table.
 

STD Surveillance 2003 Gonorrhea Tables 101 
Rank* † City Cases Rate per 100,000 Population 

1 St Louis, MO 2,545 752.2 

2 Rochester, NY 1,646 663.4 

3 Richmond, VA 1,249 632.5 

4 Baltimore, MD 3,965 620.9 

5 New Orleans, LA 2,899 612.0 

6 Detroit, MI 5,535 586.3 

7 Kansas City, MO 2,549 559.1 

8 Newark, NJ 1,483 490.2 

9 Atlanta, GA 3,838 465.0 

10 Norfolk, VA 1,061 443.9 

11 Buffalo, NY 1,413 441.0 

12 Washington, DC 2,508 439.3 

13 Milwaukee, WI 3,800 405.5 

14 Cincinnati, OH 3,347 401.5 

15 Chicago, IL 12,121 392.7 

16 Philadelphia, PA 5,731 384.1 

17 Indianapolis, IN 3,191 369.6 

18 Memphis, TN 3,286 362.8 

19 Minneapolis, MN 1,360 352.3 

20 Oklahoma City, OK 1,443 333.2 

21 Charlotte, NC 2,232 302.5 

22 Dallas, TX 3,661 302.4 

23 Birmingham, AL 1,970 298.0 

24 Jacksonville, FL 2,371 294.1 

25 Cleveland, OH 3,967 287.7 

26 Dayton, OH 1,531 276.1 

27 Fort Worth, TX 1,526 269.3 

28 Tulsa, OK 1,059 264.8 

29 Nashville, TN 1,492 261.4 

30 Omaha, NE 1,161 245.6 

31 San Francisco, CA 1,809 236.8 

32 Columbus, OH 2,558 235.4 

33 Denver, CO 1,308 233.4 

34 Toledo, OH 993 219.0 

35 Louisville, KY 1,439 206.1 

36 St Paul, MN 565 198.7 

37 Boston, MA 1,181 197.4 

38 Houston, TX 3,902 194.2 

39 Jersey City, NJ 468 193.8 

40 Wichita, KS 870 188.3 

41 Austin, TX 1,215 180.8 

42 San Antonio, TX 2,111 176.7 

43 New York City, NY 13,682 169.2 

44 Tampa, FL 1,643 155.9 

45 Akron, OH 807 147.7 

46 Corpus Christi, TX 409 146.9 

47 St Petersburg, FL 1,312 141.6 

48 Pittsburgh, PA 1,729 136.2 

49 Sacramento, CA 1,744 133.6 

50 Honolulu, HI 1,136 126.8 

51 Yonkers, NY 237 117.6 

52 Albuquerque, NM 636 110.9 

53 Oakland, CA 1,617 109.8 

54 Portland, OR 557 104.2 

55 Des Moines, IA 373 96.7 

56 Los Angeles, CA 8,174 89.1 

57 Miami, FL 1,912 82.0 

58 Phoenix, AZ 2,688 81.4 

59 Seattle, WA 1,351 76.8 

60 San Diego, CA 2,007 69.0 

61 Tucson, AZ 470 53.3 

62 El Paso, TX 263 45.5 

63 San Jose, CA 726 43.1 

YEAR 2010 TARGET 19.0 

Table 16. Gonorrhea — Reported cases and rates in selected cities ranked by rates: United States, 2003 

*Cities were ranked in descending order by rate, number of cases, and alphabetically by state. 

†

Excludes cities in outlying areas (San Juan, PR, with 130 cases and rate of 12.7). 

102 Gonorrhea Tables STD Surveillance 2003 
Table 17. Gonorrhea — Reported cases and rates in selected cities listed in alphabetical order: United States 

and outlying areas, 1999–2003 

City 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003
 1999 2000 2001 2002 2003 

Akron, OH 848 913 962 937 807
 156.5 168.0 176.5 171.5 147.7 

Albuquerque, NM 472 697 647 805 636 85.4 125.0 115.0 140.3 110.9 

Atlanta, GA 5,631 3,456 4,621 3,810 3,838
 697.5 422.7 560.0 461.6 465.0 

Austin, TX 1,562 1,518 1,536 1,401 1,215
 256.6 239.8 235.2 208.4 180.8 

Baltimore, MD 6,124 5,603 5,014 4,873 3,965
 931.5 863.7 777.0 763.1 620.9 

Birmingham, AL 2,492 3,018 2,600 2,489 1,970 376.0 455.8 393.0 376.5 298.0

Boston, MA 900 1,229 1,332 1,404 1,181
 150.6 205.4 221.7 234.7 197.4 

Buffalo, NY 1,233 1,572 2,194 1,653 1,413
 381.8 488.4 683.7 516.0 441.0 

Charlotte, NC 1,908 1,758 2,014 2,264 2,232
 279.7 250.9 279.4 306.8 302.5 

Chicago, IL 15,169 14,872 14,326 13,814 12,121 492.5 481.7 463.6 447.5 392.7

Cincinnati, OH 2,814 3,227 3,178 3,426 3,347
 331.1 382.3 378.2 410.9 401.5 

Cleveland, OH 3,391 3,497 3,854 4,115 3,967
 242.3 251.2 278.2 298.4 287.7 

Columbus, OH 3,120 3,386 3,349 2,844 2,558
 294.0 315.9 309.7 261.7 235.4 

Corpus Christi, TX 524 775 667 466 409 188.2 279.4 241.0 167.3 146.9

Dallas, TX 7,476 7,315 6,166 5,263 3,661 634.7 612.9 507.6 434.8 302.4 

Dayton, OH 932 1,015 1,428 1,505 1,531 165.9 181.8 256.9 271.4 276.1

Denver, CO 1,157 1,594 1,618 1,812 1,308
 210.8 286.4 287.3 323.3 233.4 

Des Moines, IA 333 380 270 359 373
 89.9 101.1 70.9 93.1 96.7 

Detroit, MI 7,900 9,610 8,220 6,845 5,535
 826.1 1,011.0 867.6 725.1 586.3 

El Paso, TX 156 209 291 336 263
 27.9 37.0 50.9 58.2 45.5 

Fort Worth, TX 2,847 2,787 2,291 1,967 1,526
 541.0 517.7 415.3 347.1 269.3 

Honolulu, HI 430 433 557 685 1,136
 48.9 49.4 63.0 76.4 126.8 

Houston, TX 5,939 5,918 5,489 5,235 3,902
 322.0 315.5 287.0 260.5 194.2 

Indianapolis, IN 3,045 3,206 3,383 3,510 3,191 355.1 372.6 391.6 406.5 369.6

Jacksonville, FL 2,972 3,640 2,731 2,895 2,371 384.4 466.8 344.5 359.1 294.1 

Jersey City, NJ 490 465 489 380 468 205.4 193.1 201.6 157.3 193.8

Kansas City, MO 1,956 2,688 2,161 2,625 2,549 433.4 594.1 475.9 575.7 559.1 

Los Angeles, CA 6,054 7,307 7,747 7,765 8,174 68.5 81.8 85.5 84.6 89.1

Louisville, KY 1,195 1,200 1,436 1,361 1,439 172.7 172.9 206.3 195.0 206.1 

Memphis, TN 5,038 4,941 4,420 4,074 3,286 563.6 550.0 490.9 449.8 362.8

Miami, FL 2,775 1,995 1,964 2,047 1,912
 124.9 88.2 85.5 87.8 82.0 

Milwaukee, WI 4,884 5,146 4,150 4,497 3,800
 519.3 547.6 442.2 479.9 405.5 

Minneapolis, MN 1,558 1,577 1,295 1,366 1,360
 408.2 410.1 334.9 353.8 352.3 

Nashville, TN 1,785 2,404 1,625 1,409 1,492
 314.7 421.7 284.5 246.9 261.4 

New Orleans, LA 2,687 3,015 3,160 2,685 2,899
 553.4 623.4 660.5 566.8 612.0 

New York City, NY 12,210 11,669 12,614 12,727 13,682 153.6 145.5 156.5 157.4 169.2

Newark, NJ 1,741 1,558 1,798 1,573 1,483
 581.7 518.6 596.3 519.9 490.2 

Norfolk, VA 1,291 1,490 1,450 1,463 1,061
 552.9 635.5 615.9 612.0 443.9 

Oakland, CA 1,700 1,793 2,039 1,949 1,617
 119.1 123.6 138.2 132.4 109.8 

Oklahoma City, OK 1,351 1,434 1,617 1,594 1,443 319.2 336.5 377.3 368.1 333.2

Omaha, NE 1,000 1,161 934 1,149 1,161 217.0 249.9 199.4 243.0 245.6 

Philadelphia, PA 7,775 8,198 8,096 7,006 5,731 511.5 541.5 539.1 469.5 384.1

Phoenix, AZ 3,586 3,195 2,826 2,991 2,688 119.3 103.2 88.3 90.5 81.4 

Pittsburgh, PA 1,573 1,494 1,916 2,133 1,729 122.2 116.7 150.4 168.0 136.2

Portland, OR 540 681 743 546 557
 104.1 130.5 140.6 102.1 104.2 

Richmond, VA 1,827 1,752 2,109 1,507 1,249
 917.4 887.2 1,066.4 763.2 632.5 

Rochester, NY 2,037 2,142 1,769 1,581 1,646
 826.3 866.4 715.1 637.2 663.4 

Sacramento, CA 1,236 1,295 1,171 1,442 1,744
 102.4 105.2 92.4 110.5 133.6 

San Antonio, TX 2,087 2,298 2,140 1,944 2,111
 184.2 200.0 183.4 162.7 176.7 

San Diego, CA 1,561 1,798 1,878 2,132 2,007 56.0 63.6 65.4 73.3 69.0

San Francisco, CA 1,606 2,161 2,053 2,136 1,809 207.3 278.2 264.6 279.6 236.8 

San Jose, CA 418 446 547 502 726 25.0 26.4 32.3 29.8 43.1 

Seattle, WA 922 1,221 1,556 1,462 1,351 53.3 70.2 88.7 83.1 76.8 

St Louis, MO 2,876 2,879 3,185 2,737 2,545 821.3 829.8 929.2 808.9 752.2 

St Paul, MN 545 703 560 584 565 192.2 246.7 196.0 205.4 198.7 

St Petersburg, FL 1,835 1,542 1,391 1,527 1,312 200.0 167.2 150.4 164.8 141.6 

Tampa, FL 1,783 1,653 1,517 1,912 1,643 181.0 164.8 147.7 181.4 155.9 

Toledo, OH 624 864 1,187 1,519 993 137.0 189.9 261.2 334.9 219.0 

Tucson, AZ 415 591 748 458 470 50.1 69.6 86.6 52.0 53.3 

Tulsa, OK 964 892 1,014 1,123 1,059 245.2 226.0 255.4 280.8 264.8 

Washington, DC 3,536 2,706 2,883 2,669 2,508 620.1 473.4 502.4 467.5 439.3 

Wichita, KS 771 675 837 852 870 170.6 148.8 183.2 184.4 188.3 

Yonkers, NY 102 109 143 160 237 51.6 54.8 71.3 79.4 117.6 

U.S. CITY TOTAL 165,709 170,766 167,906 162,300 147,832 239.6 244.7 238.3 228.5 208.1 

San Juan, PR 179 270 281 194 130 17.0 26.4 27.5 18.9 12.7 

TOTAL 165,888 171,036 168,187 162,494 147,962 236.2 241.5 235.3 225.5 205.3 

STD Surveillance 2003 Gonorrhea Tables 103 
Table 18. Gonorrhea — Women – Reported cases and rates in selected cities listed in alphabetical order: 

United States and outlying areas, 1999–2003 

City 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003
 1999 2000 2001 2002 2003 

Akron, OH 413 463 484 493 424
 147.0 164.3 171.4 174.2 149.8 

Albuquerque, NM 234 323 254 375 294 82.7 113.2 88.3 128.0 100.3 

Atlanta, GA 2,443 1,543 2,110 1,679 1,660
 594.1 371.7 503.6 400.5 395.9 

Austin, TX 768 712 722 670 514
 257.9 230.4 226.6 204.3 156.7 

Baltimore, MD 2,702 2,578 2,423 2,374 2,090
 770.3 744.8 703.1 695.4 612.2 

Birmingham, AL 1,229 1,552 1,420 1,231 959 350.5 443.4 406.2 352.6 274.7

Boston, MA 410 618 623 664 483
 132.5 199.6 200.3 214.3 155.9 

Buffalo, NY 725 914 1,212 872 762
 430.6 544.2 724.4 522.5 456.6 

Charlotte, NC 754 748 830 980 1,040
 216.5 209.8 226.5 261.6 277.6 

Chicago, IL 6,821 6,525 6,924 6,604 6,082 429.0 409.8 434.7 415.3 382.4

Cincinnati, OH 1,600 1,868 1,743 1,882 1,879
 359.5 422.9 396.8 432.1 431.4 

Cleveland, OH 1,779 1,697 1,816 1,976 1,906
 240.8 231.0 248.6 271.9 262.3 

Columbus, OH 1,575 1,798 1,696 1,505 1,310
 288.4 326.2 305.3 269.8 234.9 

Corpus Christi, TX 224 355 349 229 203 157.5 250.7 246.7 160.8 142.5

Dallas, TX 3,616 3,494 3,103 2,610 1,843 612.3 584.9 511.2 432.1 305.1 

Dayton, OH 393 430 722 757 838 134.5 148.1 249.9 262.8 290.9

Denver, CO 515 714 717 756 618
 189.0 259.4 257.4 272.9 223.1 

Des Moines, IA 161 200 144 205 197
 84.3 103.4 73.6 103.5 99.5 

Detroit, MI 3,706 4,737 4,336 3,618 2,966
 732.4 942.6 865.6 725.0 594.3 

El Paso, TX 78 96 148 167 164
 26.9 32.8 50.0 55.7 54.7 

Fort Worth, TX 1,405 1,346 1,153 1,025 771
 528.5 495.3 414.4 359.1 270.1 

Honolulu, HI 231 217 269 365 645
 52.9 49.7 61.0 81.6 144.2 

Houston, TX 2,699 2,986 2,674 2,526 1,798
 291.4 317.2 278.7 250.8 178.5 

Indianapolis, IN 1,601 1,516 1,751 1,776 1,583 360.8 341.2 392.7 398.6 355.3

Jacksonville, FL 1,238 1,599 1,200 1,316 1,081 310.7 398.3 294.2 317.5 260.8 

Jersey City, NJ 228 211 234 176 292 187.7 172.2 189.7 143.3 237.7

Kansas City, MO 1,045 1,242 1,039 1,283 1,294 446.2 529.7 441.7 543.5 548.1 

Los Angeles, CA 2,835 3,072 3,469 3,401 3,786 63.5 68.0 75.8 73.4 81.7

Louisville, KY 494 510 640 632 656 136.6 140.8 176.3 173.6 180.2 

Memphis, TN 2,163 2,225 2,070 1,963 1,619 462.9 474.2 440.1 415.0 342.3 

Miami, FL 1,152 750 775 855 831
 100.3 64.2 65.3 71.0 69.0 

Milwaukee, WI 2,783 3,057 2,540 2,612 2,190
 567.4 625.0 520.2 536.0 449.4 

Minneapolis, MN 781 725 625 662 628
 402.4 371.4 318.5 338.0 320.7 

Nashville, TN 736 1,016 752 621 697
 250.8 345.5 255.1 210.8 236.6 

New Orleans, LA 1,198 1,325 1,310 1,211 1,394
 464.0 515.6 515.6 481.3 554.1 

New York City, NY 6,402 6,051 6,671 6,418 6,774 153.1 143.4 157.4 151.1 159.5

Newark, NJ 806 692 881 716 829
 513.6 439.6 557.9 452.1 523.4 

Norfolk, VA 542 646 662 670 512
 475.2 563.8 576.5 578.6 442.1 

Oakland, CA 950 992 1,062 999 850
 130.8 134.4 141.5 133.3 113.4 

Oklahoma City, OK 721 839 909 861 800 330.6 382.4 412.4 386.8 359.4

Omaha, NE 546 626 518 672 673 231.6 263.9 216.8 278.9 279.3 

Philadelphia, PA 4,179 4,288 4,421 3,609 3,038 513.5 529.2 550.5 452.4 380.8 

Phoenix, AZ 1,434 1,325 1,169 1,261 1,189 95.3 85.6 73.1 76.5 72.2 

Pittsburgh, PA 920 826 1,045 1,243 1,002 135.6 122.6 156.0 186.3 150.2

Portland, OR 250 303 268 184 162
 95.2 115.0 100.6 68.3 60.2 

Richmond, VA 956 783 1,016 895 697
 896.0 742.1 960.1 847.1 659.7 

Rochester, NY 1,047 1,102 947 802 854
 820.1 860.2 739.5 625.0 665.6 

Sacramento, CA 692 702 619 777 888
 112.3 111.7 95.7 116.7 133.4 

San Antonio, TX 1,113 1,187 1,124 1,009 1,036
 191.1 201.2 187.8 164.7 169.1 

San Diego, CA 653 702 685 718 739 47.2 50.0 48.0 49.7 51.1

San Francisco, CA 381 412 360 374 246 99.9 107.7 94.1 99.1 65.2 

San Jose, CA 190 174 198 189 321 23.0 20.9 23.7 22.7 38.6 

Seattle, WA 331 448 572 438 394 38.1 51.3 64.9 49.5 44.5 

St Louis, MO 1,510 1,426 1,620 1,415 1,300 811.5 775.3 891.4 788.8 724.7 

St Paul, MN 276 411 335 343 334 187.7 278.4 226.4 233.0 226.9 

St Petersburg, FL 942 739 651 782 655 195.9 153.1 134.5 161.4 135.2 

Tampa, FL 942 823 758 859 739 187.2 160.7 144.6 160.0 137.7 

Toledo, OH 388 487 713 899 611 163.9 206.2 302.5 382.6 260.1 

Tucson, AZ 179 257 346 204 217 42.3 59.3 78.4 45.2 48.1 

Tulsa, OK 527 494 503 588 579 260.1 243.1 246.5 286.2 281.9 

Washington, DC 1,509 1,271 1,241 1,224 1,137 500.0 420.2 409.1 406.3 377.4 

Wichita, KS 452 358 473 508 529 197.6 156.1 204.7 217.4 226.4 

Yonkers, NY 73 64 81 90 137 70.9 61.6 77.6 85.9 130.7 

U.S. CITY TOTAL* 79,646 81,590 82,125 78,818 72,739 224.3 227.9 227.4 216.6 199.9 

San Juan, PR 73 105 114 89 42 13.3 19.8 21.4 16.7 7.9 

TOTAL 79,719 81,695 82,239 78,907 72,781 221.1 224.8 224.4 213.7 197.1 

*Cases reported with unknown sex are not included in this table. 

104 Gonorrhea Tables STD Surveillance 2003 
Table 19. Gonorrhea — Men – Reported cases and rates in selected cities listed in alphabetical order: 

United States and outlying areas, 1999–2003 

City 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003
 1999 2000 2001 2002 2003 

Akron, OH 429 446 474 435 340
 164.5 170.3 180.5 165.1 129.1 

Albuquerque, NM 237 367 380 427 339 87.7 134.8 138.2 152.1 120.8 

Atlanta, GA 3,172 1,910 2,510 2,126 2,169
 800.6 474.6 617.9 523.4 534.0 

Austin, TX 792 804 814 731 699
 254.7 248.1 243.4 212.4 203.1 

Baltimore, MD 3,410 2,961 2,591 2,499 1,875
 1,111.9 978.5 861.7 840.8 630.9 

Birmingham, AL 1,258 1,439 1,177 1,257 1,008 403.0 461.0 377.2 402.8 323.0

Boston, MA 490 611 709 740 697
 170.1 211.7 244.7 256.7 241.8 

Buffalo, NY 508 658 982 781 651
 328.7 427.6 639.3 508.8 424.1 

Charlotte, NC 1,154 1,010 1,184 1,283 1,192
 345.7 293.5 334.2 353.2 328.1 

Chicago, IL 8,338 8,346 7,400 7,208 6,039 559.7 558.2 494.3 481.7 403.6

Cincinnati, OH 1,193 1,343 1,417 1,514 1,444
 294.6 333.7 353.4 380.3 362.7 

Cleveland, OH 1,589 1,777 2,019 2,109 2,040
 240.4 270.2 308.3 323.3 312.7 

Columbus, OH 1,523 1,561 1,618 1,317 1,234
 295.7 299.7 307.7 248.9 233.2 

Corpus Christi, TX 300 420 318 237 206 220.3 309.4 235.0 174.2 151.4

Dallas, TX 3,834 3,775 3,028 2,642 1,817 652.8 633.2 498.3 435.6 299.6 

Dayton, OH 539 578 699 743 689 199.9 215.6 261.8 278.9 258.7

Denver, CO 642 880 901 1,056 690
 232.3 312.8 316.4 372.6 243.5 

Des Moines, IA 172 180 126 153 175
 95.8 98.7 68.1 81.6 93.3 

Detroit, MI 4,194 4,873 3,884 3,227 2,569
 931.3 1,087.8 869.7 725.2 577.3 

El Paso, TX 78 113 143 169 99
 28.9 41.4 51.9 60.8 35.6 

Fort Worth, TX 1,425 1,433 1,133 939 752
 547.2 537.6 414.4 333.9 267.4 

Honolulu, HI 199 216 288 320 491
 45.0 49.1 65.0 71.3 109.4 

Houston, TX 3,193 2,928 2,809 2,705 2,101
 347.7 313.3 294.7 269.8 209.6 

Indianapolis, IN 1,443 1,687 1,630 1,720 1,598 348.8 405.3 390.0 411.6 382.4

Jacksonville, FL 1,734 2,041 1,531 1,579 1,290 462.8 539.6 397.9 403.2 329.4 

Jersey City, NJ 262 254 255 203 175 223.7 214.8 214.0 171.1 147.5

Kansas City, MO 911 1,446 1,122 1,342 1,255 419.6 663.5 512.7 610.4 570.8 

Los Angeles, CA 3,218 4,228 4,264 4,350 4,374 73.7 95.7 95.2 95.7 96.3

Louisville, KY 699 688 793 728 782 211.6 207.4 238.1 217.9 234.1 

Memphis, TN 2,875 2,716 2,350 2,111 1,667 674.1 632.8 546.5 487.9 385.3 

Miami, FL 1,618 1,245 1,189 1,192 1,081
 150.8 113.9 107.1 105.6 95.7 

Milwaukee, WI 2,098 2,084 1,596 1,877 1,589
 466.2 462.5 354.5 417.3 353.3 

Minneapolis, MN 777 852 670 704 732
 414.1 449.9 351.7 370.1 384.8 

Nashville, TN 1,049 1,388 873 788 795
 383.1 502.9 316.0 285.3 287.8 

New Orleans, LA 1,489 1,690 1,850 1,463 1,500
 655.0 745.6 824.7 658.7 675.4 

New York City, NY 5,797 5,573 5,914 6,297 6,851 153.9 146.7 154.6 164.1 178.5

Newark, NJ 935 866 917 857 653 656.8 605.6 638.6 594.4 452.9 

Norfolk, VA 749 841 783 793 549 627.1 701.6 649.2 643.5 445.5 

Oakland, CA 667 783 960 945 766 95.1 109.8 132.5 130.8 106.0 

Oklahoma City, OK 630 595 708 733 643 307.1 287.8 340.1 348.3 305.5 

Omaha, NE 454 531 415 475 485 201.7 233.6 180.9 204.9 209.2 

Philadelphia, PA 3,596 3,910 3,675 3,397 2,693 509.1 555.6 526.0 489.2 387.8 

Phoenix, AZ 2,152 1,870 1,657 1,730 1,497 143.4 120.7 103.4 104.5 90.4 

Pittsburgh, PA 653 668 871 890 726 107.2 110.2 144.2 147.7 120.4

Portland, OR 290 378 475 362 395
 113.1 146.3 181.3 136.4 148.9 

Richmond, VA 870 968 1,083 612 549
 941.1 1,052.6 1,178.0 666.7 598.1 

Rochester, NY 990 1,040 822 779 792
 833.0 873.2 689.0 650.3 661.1 

Sacramento, CA 534 581 543 660 838
 90.4 96.5 87.5 103.2 131.0 

San Antonio, TX 974 1,110 1,015 935 1,075
 176.8 198.5 178.6 160.6 184.7 

San Diego, CA 896 1,066 1,109 1,336 1,256 63.8 75.0 76.9 91.4 85.9

San Francisco, CA 1,225 1,749 1,693 1,749 1,547 311.4 443.5 430.4 452.4 400.2 

San Jose, CA 224 270 349 303 401 26.4 31.6 40.6 35.5 47.0 

Seattle, WA 591 773 984 1,024 957 68.7 89.3 112.8 117.0 109.4 

St Louis, MO 1,366 1,453 1,565 1,322 1,245 832.5 891.4 971.8 831.7 783.2 

St Paul, MN 269 292 225 241 231 197.0 212.7 163.3 175.7 168.4 

St Petersburg, FL 893 803 740 745 657 204.6 182.7 167.8 168.5 148.6 

Tampa, FL 841 830 759 1,053 904 174.5 169.0 150.8 203.7 174.8 

Toledo, OH 235 370 466 613 381 107.4 169.2 213.0 280.5 174.3 

Tucson, AZ 236 334 402 254 253 58.2 80.5 95.3 59.0 58.8 

Tulsa, OK 437 398 511 535 480 229.3 207.9 264.9 275.0 246.8 

Washington, DC 2,014 1,430 1,627 1,436 1,361 750.3 531.3 601.5 532.5 504.7 

Wichita, KS 319 317 364 344 341 143.0 141.4 161.2 150.7 149.4 

Yonkers, NY 29 45 62 70 100 30.7 47.3 64.5 72.4 103.4 

U.S. CITY TOTAL* 85,708 88,792 85,421 83,165 74,780 254.6 261.2 248.8 240.1 215.9 

San Juan, PR 106 165 167 105 88 21.0 33.7 34.0 21.3 17.9 

TOTAL 85,814 88,957 85,588 83,270 74,868 251.1 258.0 245.8 237.0 213.1 

*Cases reported with unknown sex are not included in this table. 

STD Surveillance 2003 Gonorrhea Tables 105 
Table 20. Gonorrhea — Reported cases and rates per 100,000 population by age and sex: United States, 

1999–2003 

Year Age 

Group 

Cases Rates 

Total Male Female Total Male Female 

1999 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

5,954 

104,426 

108,741 

56,120 

32,344 

23,441 

14,007 

10,338 

2,356 

905 

825 

34,295 

52,735 

32,604 

20,690 

16,217 

10,652 

8,657 

2,122 

722 

5,129 

70,131 

56,007 

23,516 

11,654 

7,224 

3,355 

1,681 

233 

183 

29.5 

519.9 

584.9 

286.7 

157.0 

102.4 

63.1 

28.3 

9.9 

2.6 

8.0 

332.2 

555.5 

330.0 

199.8 

142.2 

96.9 

48.2 

18.6 

5.0 

52.0 

718.4 

615.6 

242.5 

113.7 

63.0 

30.0 

9.0 

1.9 

0.9 

TOTAL 359,716 179,913 179,803 128.9 131.5 126.4 

2000 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

5,925 

102,043 

112,313 

55,929 

31,814 

22,605 

13,526 

10,344 

2,299 

897 

830 

33,312 

54,195 

32,831 

20,603 

15,765 

10,234 

8,669 

2,077 

722 

5,094 

68,731 

58,119 

23,098 

11,211 

6,840 

3,292 

1,676 

222 

175 

28.8 

504.7 

586.8 

290.3 

154.5 

99.9 

60.0 

27.2 

9.4 

2.6 

7.9 

320.6 

554.1 

336.8 

198.8 

139.8 

91.6 

46.4 

17.7 

5.0 

50.7 

699.5 

621.0 

242.7 

109.6 

60.3 

29.0 

8.6 

1.7 

0.8 

TOTAL 358,779 179,651 179,128 127.1 129.7 124.6 

2001 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

6,041 

101,065 

116,207 

56,083 

32,537 

21,799 

13,605 

10,458 

2,255 

843 

862 

31,952 

54,604 

32,181 

21,050 

15,216 

10,072 

8,655 

2,003 

651 

5,179 

69,113 

61,603 

23,902 

11,487 

6,583 

3,533 

1,803 

252 

192 

28.9 

498.6 

589.5 

294.8 

156.5 

97.7 

59.6 

26.7 

8.9 

2.4 

8.0 

306.5 

541.7 

333.6 

201.1 

136.5 

89.0 

44.9 

16.5 

4.5 

50.8 

701.8 

639.7 

254.9 

111.3 

58.9 

30.7 

9.0 

1.9 

0.9 

TOTAL 361,758 177,531 184,227 126.8 126.7 126.8 

2002 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

5,449 

96,325 

112,449 

55,480 

32,081 

21,419 

13,791 

10,927 

2,284 

791 

784 

29,921 

52,130 

31,391 

20,560 

14,878 

10,254 

8,891 

2,019 

631 

4,665 

66,404 

60,318 

24,089 

11,521 

6,541 

3,536 

2,036 

266 

159 

25.8 

472.7 

556.3 

292.4 

153.1 

97.7 

60.0 

27.3 

8.6 

2.2 

7.2 

285.7 

503.7 

325.6 

194.6 

135.8 

89.8 

45.2 

15.8 

4.3 

45.2 

670.4 

611.5 

258.1 

110.8 

59.7 

30.5 

10.0 

1.9 

0.8 

TOTAL 351,836 171,839 179,997 122.0 121.3 122.7 

2003 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-54 

55-64 

65+ 

4,929 

90,340 

106,930 

53,692 

30,528 

20,212 

13,722 

11,018 

2,316 

745 

725 

27,473 

48,222 

29,368 

19,004 

13,824 

10,079 

8,905 

2,012 

617 

4,204 

62,867 

58,709 

24,325 

11,524 

6,388 

3,644 

2,113 

303 

128 

23.3 

443.4 

529.0 

283.0 

145.7 

92.2 

59.7 

27.5 

8.7 

2.1 

6.7 

262.4 

465.9 

304.6 

179.9 

126.2 

88.3 

45.3 

15.7 

4.2 

40.8 

634.7 

595.2 

260.7 

110.9 

58.3 

31.4 

10.4 

2.2 

0.6 

TOTAL 335,104 160,459 174,645 116.2 113.3 119.0 

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the distribution of cases 

for which age was known. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9 

year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

106 Gonorrhea Tables STD Surveillance 2003 
Table 21A. Gonorrhea — Reported cases by race/ethnicity, age group and sex: United States, 1999–2003 

Age 

Group 

White, Non-Hispanic 

Total Male Female 

Black, Non-Hispanic 

Total Male Female Total 

Hispanic 

Male Female 

Asian/Pacific Islander 

Total Male Female 

American Indian/ 

Alaska Native 

Total Male Female 

10-14 842 55 787 4,666 705 3,961 368 60 308 35 1 34 41 3 39 

15-19 14,882 2,437 12,445 81,913 29,452 52,460 6,359 2,151 4,208 562 133 429 714 121 592 

20-24 14,408 4,288 10,120 86,318 44,709 41,609 6,704 3,278 3,426 673 291 382 665 190 475 

199925-29 

30-34 

35-39 

7,859 3,397 4,462 

5,364 2,864 2,499 

4,319 2,563 1,756 

43,874 26,821 17,053 

24,390 16,279 8,110 

17,559 12,685 4,875 

3,773 

2,131 

1,272 

2,114 

1,306 

815 

1,659 

825 

457 

316 173 142 

240 138 102 

146 91 55 

298 103 195 

206 93 113 

139 57 82 

40-44 2,395 1,671 725 10,832 8,492 2,340 638 410 228 69 38 32 70 41 29 

45-54 1,817 1,387 430 7,954 6,877 1,076 432 310 122 63 43 20 69 39 31 

55-64 503 432 71 1,718 1,587 131 109 83 26 14 11 3 11 8 3 

65+ 193 151 42 634 517 116 62 48 15 6 1 4 9 3 6 

TOTAL 52,733 19,295 33,438 280,707 148,437 132,270 21,920 10,602 11,318 2,130 925 1,205 2,226 660 1,566 

10-14 769 50 719 4,649 689 3,960 419 82 336 38 1 37 48 7 41 

15-19 14,608 2,576 12,032 79,244 28,108 51,137 6,877 2,315 4,563 670 180 489 644 131 514 

20-24 15,597 4,831 10,766 87,435 44,977 42,459 7,757 3,762 3,995 884 431 454 655 207 448 

200025-29 

30-34 

35-39 

7,898 3,373 4,524 

5,802 3,190 2,612 

4,689 2,969 1,720 

42,931 26,572 16,359 

23,063 15,542 7,521 

16,039 11,591 4,448 

4,175 

2,347 

1,445 

2,417 

1,482 

933 

1,758 

865 

512 

565 351 214 

378 274 104 

251 181 70 

361 123 238 

219 114 105 

178 89 89 

40-44 2,724 1,840 884 9,909 7,796 2,114 668 449 219 126 96 30 96 52 44 

45-54 2,038 1,572 465 7,576 6,567 1,009 560 414 146 103 73 29 66 41 25 

55-64 495 436 59 1,636 1,513 123 115 91 24 30 19 11 22 17 5 

65+ 190 144 46 641 527 114 51 45 6 2 0 2 13 6 7 

TOTAL 54,964 21,039 33,925 273,928 144,191 129,737 24,512 12,030 12,481 3,056 1,609 1,447 2,319 793 1,526 

10-14 855 57 798 4,646 715 3,932 440 80 360 53 6 47 46 3 43 

15-19 14,961 2,611 12,351 77,554 26,692 50,862 7,095 2,312 4,783 763 205 559 692 130 562 

20-24 16,997 5,390 11,607 89,154 44,621 44,533 8,416 4,024 4,393 881 354 526 778 231 547 

2001

25-29 

30-34 

35-39 

8,535 3,610 4,924 

6,106 3,461 2,645 

4,720 3,026 1,694 

42,275 25,705 16,570 

23,242 15,644 7,597 

15,136 10,957 4,178 

4,418 

2,636 

1,630 

2,464 

1,646 

1,055 

1,954 

990 

575 

512 281 231 

327 205 122 

160 116 44 

344 124 219 

220 93 127 

149 59 90 

40-44 2,882 1,924 958 9,749 7,496 2,253 759 513 246 111 92 19 101 46 55 

45-54 2,364 1,796 568 7,386 6,356 1,030 542 398 144 84 60 25 79 45 34 

55-64 583 510 73 1,510 1,374 136 124 90 33 23 16 7 14 12 2 

65+ 207 163 44 554 443 111 57 29 28 17 11 6 7 3 4 

TOTAL 58,323 22,585 35,738 271,871 140,235 131,636 26,190 12,624 13,566 2,935 1,348 1,588 2,439 751 1,689 

10-14 786 50 736 4,181 665 3,516 412 57 355 28 4 24 41 7 34 

15-19 15,055 2,521 12,534 73,130 24,995 48,134 6,809 2,111 4,699 547 122 425 785 170 615 

20-24 18,044 5,714 12,330 84,159 41,703 42,456 8,648 4,176 4,473 772 304 468 843 244 599 

200225-29 

30-34 

35-39 

9,168 3,917 5,251 

6,450 3,628 2,822 

5,067 3,336 1,731 

40,777 24,593 16,184 

22,223 14,951 7,271 

14,263 10,190 4,073 

4,647 

2,820 

1,695 

2,470 

1,656 

1,132 

2,177 

1,164 

562 

501 263 238 

322 207 115 

214 130 84 

390 157 233 

260 117 143 

175 87 88 

40-44 3,386 2,393 993 9,226 7,098 2,128 957 637 320 109 66 44 109 58 51 

45-54 2,706 2,089 617 7,460 6,268 1,192 573 408 165 105 74 31 80 51 29 

55-64 664 574 90 1,467 1,336 132 125 95 29 23 10 13 4 3 2 

65+ 196 155 41 523 428 95 50 35 15 18 11 7 3 3 0 

TOTAL 61,671 24,429 37,243 257,986 132,498 125,488 26,829 12,822 14,007 2,646 1,196 1,450 2,704 905 1,800 

10-14 789 51 739 3,662 594 3,068 390 71 320 31 3 28 55 7 49 

15-19 15,541 2,532 13,009 66,553 22,572 43,980 7,011 2,086 4,924 533 116 417 700 163 537 

20-24 19,132 6,097 13,035 77,129 37,552 39,577 9,080 4,085 4,994 840 270 570 767 229 539 

200325-29 

30-34 

35-39 

9,891 4,159 5,732 

6,648 3,512 3,136 

5,126 3,314 1,812 

38,142 22,275 15,866 

20,459 13,498 6,961 

12,840 9,130 3,710 

4,787 

2,821 

1,823 

2,544 

1,704 

1,160 

2,243 

1,117 

663 

499 250 249 

381 206 175 

244 139 105 

375 146 229 

214 83 131 

174 80 94 

40-44 3,835 2,634 1,201 8,642 6,626 2,016 981 654 327 145 95 49 118 70 48 

45-54 2,917 2,169 748 7,268 6,172 1,096 660 467 192 105 64 41 66 32 33 

55-64 713 588 125 1,439 1,301 138 123 98 25 31 19 13 8 7 2 

65+ 239 196 43 443 379 64 44 29 15 11 7 4 8 6 2 

TOTAL 64,961 25,288 39,673 237,038 120,266 116,771 27,793 12,922 14,872 2,823 1,171 1,652 2,489 823 1,666 

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 20 for age-specific cases and rates and Tables 13-15 for sex-specific 

cases and rates and overall totals. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables 

were specified. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9 year age group is not 

shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

108 Gonorrhea Tables STD Surveillance 2003 
Table 21B. Gonorrhea — Rates per 100,000 population by race/ethnicity, age group and sex: United States, 

1999–2003 

Age 

Group 

White, Non-Hispanic 

Total Male Female 

Black, Non-Hispanic 

Total Male Female Total 

Hispanic 

Male Female 

Asian/Pacific Islander 

Total Male Female 

American Indian/ 

Alaska Native 

Total Male Female 

10-14 6.4 0.8 12.4 150.0 44.6 258.5 12.2 3.9 21.0 4.5 0.3 8.9 18.4 2.4 35.0 

15-19 114.4 36.6 196.1 2,761.0 1,964.8 3,574.2 207.2 131.8 292.8 67.8 31.5 105.6 334.0 111.4 564.8 

20-24 123.3 72.4 175.5 3,327.4 3,541.4 3,124.6 206.4 184.6 232.7 75.8 65.5 86.2 383.9 216.0 557.5 

25-29 

30-34 

35-39 

62.8 54.0 71.8 

39.0 41.4 36.6 

26.7 31.7 21.8 

1,696.9 2,185.2 1,255.6 

923.1 1,304.2 581.9 

618.0 950.7 323.4 

115.6 

69.8 

46.6 

120.1 

80.3 

57.4 

110.4 

57.9 

35.0 

30.0 33.8 26.5 

24.3 29.0 19.9 

15.1 19.5 11.0 

178.3 123.4 233.5 

1999

123.9 113.0 134.6 

74.6 63.3 85.2 

40-44 14.7 20.6 8.9 405.8 680.3 164.7 29.0 36.5 21.1 7.8 8.9 6.8 40.0 49.0 31.8 

45-54 6.5 10.0 3.0 202.0 378.9 50.7 14.6 21.2 8.2 4.5 6.5 2.7 25.9 30.1 22.0 

55-64 2.7 4.7 0.7 73.9 153.6 10.1 6.6 10.8 2.9 1.7 2.9 0.7 7.2 10.9 3.8 

65+ 0.7 1.2 0.2 22.6 48.4 6.7 3.8 6.9 1.5 0.7 0.4 0.9 7.0 5.3 8.3 

TOTAL 26.7 20.0 33.2 808.4 900.4 725.3 64.6 60.8 68.6 19.4 17.4 21.3 98.1 59.1 136.0 

10-14 5.8 0.7 11.2 145.1 42.4 250.8 13.1 5.0 21.5 4.8 0.3 9.5 20.6 5.9 36.0 

15-19 112.4 38.7 189.6 2,662.4 1,867.1 3,476.2 216.9 137.4 307.0 78.7 41.6 117.4 293.0 116.4 477.1 

20-24 130.9 80.1 182.9 3,264.8 3,448.8 3,090.2 225.3 198.4 258.2 96.0 93.5 98.4 360.1 225.1 498.4 

25-29 

30-34 

35-39 

65.6 55.6 75.7 

42.8 46.8 38.8 

29.8 37.7 21.9 

1,687.3 2,197.0 1,225.4 

874.7 1,246.2 541.3 

566.0 870.8 296.0 

121.9 

74.0 

50.5 

130.5 

87.5 

62.4 

111.7 

58.5 

37.5 

52.1 65.7 38.8 

35.9 53.2 19.3 

24.9 37.0 13.5 

215.2 146.2 284.6 

2000

128.4 134.2 122.6 

94.2 96.5 92.0 

40-44 16.7 22.5 10.8 362.8 608.6 145.8 28.5 37.5 19.1 13.5 21.7 6.1 52.5 59.5 46.1 

45-54 7.0 11.0 3.2 182.5 342.5 45.2 17.5 26.2 9.0 6.8 10.5 3.6 22.7 29.6 16.4 

55-64 2.6 4.7 0.6 68.3 141.8 9.2 6.6 11.1 2.6 3.5 4.7 2.5 13.7 22.3 5.7 

65+ 0.6 1.2 0.3 22.5 48.7 6.5 2.9 6.2 0.5 0.2 0.0 0.4 9.2 9.6 8.9 

TOTAL 27.8 21.8 33.6 778.1 862.0 702.1 68.7 65.5 72.1 26.7 28.9 24.5 98.6 68.4 128.0 

10-14 6.5 0.8 12.4 141.5 42.9 243.0 13.1 4.7 21.8 6.4 1.4 11.6 19.6 2.5 37.3 

15-19 114.8 39.0 194.8 2,586.9 1,753.8 3,446.0 223.7 138.7 317.9 89.9 47.3 134.3 309.3 113.9 513.1 

20-24 138.5 86.8 191.4 3,203.4 3,276.3 3,133.6 238.0 206.0 277.5 94.4 76.3 112.2 411.4 241.2 586.4 

25-29 

30-34 

35-39 

73.3 61.5 85.3 

45.3 51.0 39.5 

30.9 39.6 22.3 

1,683.5 2,148.2 1,260.6 

878.9 1,251.9 544.7 

537.7 828.4 280.0 

122.7 

78.3 

54.0 

125.7 

91.5 

66.6 

119.2 

63.3 

40.1 

46.3 52.2 40.7 

29.0 37.4 21.0 

15.2 22.7 8.2 

205.8 148.1 264.2 

2001

129.2 109.2 149.0 

80.2 65.2 94.8 

40-44 17.6 23.5 11.7 351.3 576.2 152.8 30.4 40.1 20.2 11.5 20.1 3.7 54.4 51.4 57.2 

45-54 8.0 12.2 3.8 170.4 317.6 44.2 15.8 23.4 8.4 5.3 8.1 2.9 26.3 31.3 21.6 

55-64 2.9 5.3 0.7 61.2 125.1 9.9 6.7 10.4 3.4 2.6 3.8 1.5 8.2 14.8 2.0 

65+ 0.7 1.3 0.3 19.2 40.3 6.2 3.1 3.8 2.6 1.8 2.9 1.0 4.6 5.0 4.3 

TOTAL 29.4 23.3 35.3 762.0 826.8 703.3 70.3 65.8 75.2 24.6 23.4 25.8 102.6 64.0 140.0 

10-14 6.0 0.7 11.5 124.9 39.1 213.2 11.6 3.1 20.6 3.4 1.0 5.9 17.4 5.9 29.2 

15-19 115.2 37.5 197.3 2,410.6 1,621.2 3,226.2 213.0 126.8 306.6 64.2 28.1 101.6 346.9 147.5 555.1 

20-24 143.4 89.7 198.3 2,927.7 2,942.8 2,913.0 239.8 209.6 277.0 81.4 64.7 97.9 427.4 244.0 616.6 

25-29 

30-34 

35-39 

80.1 67.9 92.6 

48.4 54.1 42.6 

34.4 45.3 23.6 

1,631.8 2,062.7 1,238.6 

834.8 1,187.4 518.3 

514.3 781.9 277.1 

123.8 

78.8 

53.7 

119.9 

86.3 

68.2 

128.5 

70.2 

37.6 

45.1 49.0 41.5 

26.6 35.3 18.4 

19.5 24.4 14.9 

233.3 186.1 281.2 

2002

152.3 137.3 167.3 

96.9 97.9 96.0 

40-44 20.7 29.3 12.1 329.1 540.7 142.7 36.1 46.7 24.9 10.9 13.7 8.3 58.0 64.4 52.0 

45-54 9.0 14.1 4.1 165.7 301.7 49.2 15.7 22.4 9.0 6.3 9.6 3.4 26.0 34.4 18.1 

55-64 3.2 5.6 0.8 57.2 116.9 9.2 6.3 10.2 2.8 2.3 2.1 2.5 2.4 3.2 1.7 

65+ 0.7 1.3 0.2 17.9 38.3 5.3 2.5 4.2 1.3 1.8 2.5 1.3 1.9 4.4 0.0 

TOTAL 31.0 25.1 36.7 713.7 770.7 662.1 69.2 64.1 74.6 21.4 20.0 22.6 112.5 76.3 147.6 

10-14 6.0 0.7 11.5 109.4 35.0 186.0 11.0 3.9 18.5 3.7 0.6 6.9 23.7 5.6 42.3 

15-19 118.9 37.7 204.8 2,193.8 1,464.1 2,947.8 219.3 125.3 321.3 62.5 26.7 99.6 309.2 141.1 484.6 

20-24 152.0 95.7 209.7 2,683.1 2,649.8 2,715.5 251.8 205.1 309.3 88.6 57.4 119.3 388.7 228.1 554.4 

25-29 

30-34 

35-39 

86.5 72.1 101.0 

49.9 52.3 47.4 

34.8 45.0 24.7 

1,526.3 1,868.3 1,214.2 

768.5 1,072.0 496.2 

463.0 700.6 252.4 

127.5 

78.9 

57.8 

123.5 

88.9 

69.8 

132.4 

67.3 

44.4 

45.0 46.7 43.4 

31.4 35.0 28.1 

22.3 26.2 18.6 

224.4 173.2 276.3 

2003

125.2 97.7 152.6 

96.4 90.2 102.4 

40-44 23.4 32.3 14.7 308.3 504.7 135.3 37.0 47.8 25.4 14.4 19.9 9.4 62.8 77.1 49.5 

45-54 9.7 14.6 5.0 161.4 297.0 45.2 18.1 25.6 10.5 6.3 8.2 4.6 21.2 21.9 20.6 

55-64 3.4 5.8 1.2 56.1 113.8 9.7 6.2 10.4 2.4 3.2 4.1 2.4 4.7 7.7 1.9 

65+ 0.8 1.6 0.3 15.2 34.0 3.5 2.3 3.5 1.3 1.1 1.7 0.7 4.8 8.5 2.1 

TOTAL 32.7 26.0 39.1 655.8 699.6 616.1 71.7 64.6 79.2 22.8 19.6 25.8 103.5 69.5 136.6 

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 20 for age-specific cases and rates and Tables 13-15 for 

sex-specific cases and rates and overall totals. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for 

which these variables were specified. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9 

year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

STD Surveillance 2003 Gonorrhea Tables 109 
Table 22. All stages of syphilis* — Reported cases and rates by state/area and region listed in alphabetical 

order: United States and outlying areas, 1999–2003 

State/Area 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 

Alabama 1,019 753 724 700 566 23.0 16.9 16.2 15.6 12.6 

Alaska 13 6 9 9 8 2.1 1.0 1.4 1.4

Arizona 833 848 1,147 1,085 1,106 16.6 16.4 21.6 19.9 20.3 

Arkansas 364 366 239 219 296 13.7 13.7 8.9 8.1 10.9 

California 2,859 3,354 3,053 3,917 4,202 8.5 9.9 8.8 11.2 12.0 

Colorado 91 63 149 174 144 2.2 1.5 3.4 3.9 3.2 

Connecticut 126 151 165 188 207 3.7 4.4 4.8 5.4 6.0 

Delaware 72 45 79 62 47 9.3 5.7 9.9 7.7 5.8 

Florida 2,690 2,770 2,915 3,280 3,282 17.1 17.3 17.8 19.6 19.6 

Georgia 1,974 1,640 1,988 1,896 2,152 24.5 19.9 23.7 22.1 25.1

Hawaii 11 22 41 59 59 0.9 1.8 3.3 4.7 4.7 

Idaho 13 11 11 23 45 1.0 0.8 0.8 1.7 3.4 

Illinois 1,966 1,638 1,547 1,593 1,376 15.9 13.2 12.4 12.6 10.9 

Indiana 802 751 529 319 375 13.3 12.3 8.6 5.2 6.1 

Iowa 37 55 44 54 46 1.3 1.9 1.5 1.8 1.6 

Kansas 95 67 88 77 77 3.5 2.5 3.3 2.8 2.8 

Kentucky 302 253 191 212 160 7.5 6.2 4.7 5.2 3.9 

Louisiana 1,423 973 793 775 1,576 31.9 21.8 17.7 17.3 35.2 

Maine 1 7 16 9 21 0.1 0.5 1.2 0.7 1.6 

Maryland 1,385 1,172 938 843 974 26.4 22.1 17.4 15.4 17.8 

Massachusetts 385 448 446 541 644 6.1 7.0 7.0 8.4 10.0 

Michigan 780 1,001 1,170 1,184 860 7.9 10.1 11.7 11.8 8.6 

Minnesota 71 77 132 148 195 1.5 1.6 2.6 2.9 3.9 

Mississippi 906 685 654 451 435 32.0 24.0 22.9 15.7 15.1 

Missouri 396 299 174 204 207 7.1 5.3 3.1 3.6 3.6 

Montana 3 0 0 5 0 0.3 0.0 0.0 0.5

Nebraska 24 7 16 25 27 1.4 0.4 0.9 1.4 1.6 

Nevada 92 52 62 113 149 4.8 2.6 3.0 5.2 6.9 

New Hampshire 17 19 20 24 37 1.4 1.5 1.6 1.9 2.9 

New Jersey 803 802 1,040 1,062 1,089 9.6 9.5 12.2 12.4 12.7 

New Mexico 80 101 76 115 205 4.4 5.5 4.2 6.2 11.1 

New York 4,094 2,947 3,610 3,885 4,360 21.7 15.5 18.9 20.3 22.8 

North Carolina 1,713 1,495 1,422 1,051 848 21.5 18.5 17.3 12.6 10.2 

North Dakota 0 1 2 0 2 0.0 0.2 0.3 0.0

Ohio 364 282 297 351 481 3.2 2.5 2.6 3.1 4.2 

Oklahoma 539 327 288 287 353 15.7 9.5 8.3 8.2 10.1 

Oregon 37 49 48 75 118 1.1 1.4 1.4 2.1 3.4 

Pennsylvania 932 685 726 689 706 7.6 5.6 5.9 5.6 5.7 

Rhode Island 55 38 39 67 90 5.3 3.6 3.7 6.3 8.4 

South Carolina 929 861 916 620 548 23.4 21.4 22.5 15.1 13.3 

South Dakota 3 1 1 0 5 0.4 0.1 0.1 0.0

Tennessee 1,737 1,709 1,478 1,082 876 30.8 30.0 25.7 18.7 15.1 

Texas 3,699 3,298 3,662 4,109 3,996 18.0 15.7 17.1 18.9 18.3 

Utah 49 59 25 71 72 2.2 2.6 1.1 3.1 3.1 

Vermont 3 0 8 2 1 0.5 0.0 1.3 0.3

Virginia 722 539 525 528 552 10.3 7.6 7.3 7.2 7.6 

Washington 205 171 174 158 239 3.5 2.9 2.9 2.6 3.9 

West Virginia 15 13 7 5 11 0.8 0.7 0.4 0.3 0.6 

Wisconsin 192 184 131 134 111 3.6 3.4 2.4 2.5 2.0 

Wyoming 0 5 4 1 4 0.0 1.0 0.8 0.2

U.S. TOTAL† 35,379 31,616 32,278 32,912 34,270 12.7 11.2 11.3 11.4 11.9 

Northeast 6,416 5,097 6,070 6,467 7,155 12.0 9.5 11.3 11.9 13.2 

Midwest 4,730 4,363 4,131 4,089 3,762 7.4 6.8 6.4 6.3 5.8 

South 19,947 17,415 17,278 16,551 17,002 20.1 17.3 16.9 16.0 16.5 

West 4,286 4,741 4,799 5,805 6,351 6.9 7.5 7.4 8.8 9.7 

Guam 

Puerto Rico 

Virgin Islands 

12 

1,463 

13 

9

1,340 

11 

30 

1,268 

9 

19 

1,393 

4 

16 

1,355 

14 

7.3 

37.6 

11.5 

5.8 

35.1 

10.1 

18.9 

33.0 

8.2 

11.8 

36.1 

3.6 

9.9 

35.1 

12.7 

OUTLYING AREAS 1,488 1,360 1,307 1,416 1,385 35.7 33.3 31.8 34.3 33.5 

TOTAL 36,867 32,976 33,585 34,328 35,655 13.0 11.5 11.6 11.7 12.2 

1.2 

0.0 

0.3 

0.7 

0.2 

0.8 

*See Appendix (Reporting of Syphilis Cases) for definition. 

†

Includes cases reported by Washington, D.C. 

110 Syphilis Tables STD Surveillance 2003 
Table 23. All stages of syphilis* — Reported cases and rates in selected cities listed in alphabetical order: 

United States and outlying areas, 1999–2003 

City 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003
 1999 2000 2001 2002 2003 

Akron, OH 6 2 4 5 5
 1.1 0.4 0.7 0.9

Albuquerque, NM 50 63 43 60 75 9.0 11.3 7.6 10.5 13.1 

Atlanta, GA 580 384 799 827 966 71.8 47.0 96.8 100.2 117.0 

Austin, TX 62 59 115 101 127 10.2 9.3 17.6 15.0 18.9 

Baltimore, MD 941 728 477 400 457 143.1 112.2 73.9 62.6 71.6 

Birmingham, AL 278 212 151 127 111 41.9 32.0 22.8 19.2 16.8 

Boston, MA 164 160 157 231 298 27.4 26.7 26.1 38.6 49.8 

Buffalo, NY 6 10 12 10 9 1.9 3.1 3.7 3.1 2.8 

Charlotte, NC 194 151 130 102 109 28.4 21.6 18.0 13.8 14.8 

Chicago, IL 1,322 1,090 1,094 1,149 946 42.9 35.3 35.4 37.2 30.6 

Cincinnati, OH 12 14 16 21 11 1.4 1.7 1.9 2.5 1.3 

Cleveland, OH 88 42 39 26 34 6.3 3.0 2.8 1.9 2.5 

Columbus, OH 109 90 140 189 217 10.3 8.4 12.9 17.4 20.0 

Corpus Christi, TX 20 10 10 12 26 7.2 3.6 3.6 4.3 9.3 

Dallas, TX 695 587 702 1,044 850 59.0 49.2 57.8 86.2 70.2 

Dayton, OH 16 17 18 9 13 2.8 3.0 3.2 1.6 2.3

Denver, CO 46 23 64 89 77
 8.4 4.1 11.4 15.9 13.7 

Des Moines, IA 7 18 15 19 16
 1.9 4.8 3.9 4.9 4.1 

Detroit, MI 569 771 925 880 624
 59.5 81.1 97.6 93.2 66.1 

El Paso, TX 79 92 106 119 110
 14.1 16.3 18.5 20.6 19.0 

Fort Worth, TX 177 191 267 374 224
 33.6 35.5 48.4 66.0 39.5 

Honolulu, HI 8 15 30 52 52
 0.9 1.7 3.4 5.8 5.8 

Houston, TX 1,111 850 922 1,034 991
 60.2 45.3 48.2 51.4 49.3 

Indianapolis, IN 553 521 306 134 130 64.5 60.5 35.4 15.5 15.1

Jacksonville, FL 74 125 139 69 125 9.6 16.0 17.5 8.6 15.5 

Jersey City, NJ 42 27 39 59 52 17.6 11.2 16.1 24.4 21.5 

Kansas City, MO 66 46 30 37 56 14.6 10.2 6.6 8.1 12.3 

Los Angeles, CA 1,189 1,857 1,339 1,626 1,752 13.5 20.8 14.8 17.7 19.1 

Louisville, KY 174 149 100 141 101 25.1 21.5 14.4 20.2 14.5 

Memphis, TN 927 882 896 541 477 103.7 98.2 99.5 59.7 52.7 

Miami, FL 795 829 1,044 1,297 1,167 35.8 36.7 45.5 55.6 50.0 

Milwaukee, WI 166 151 98 88 62 17.6 16.1 10.4 9.4 6.6 

Minneapolis, MN 28 34 63 79 73 7.3 8.8 16.3 20.5 18.9 

Nashville, TN 505 523 379 294 195 89.0 91.7 66.4 51.5 34.2 

New Orleans, LA 228 124 101 101 203 47.0 25.6 21.1 21.3 42.9 

New York City, NY 3,736 2,712 3,304 3,486 3,825 47.0 33.8 41.0 43.1 47.3 

Newark, NJ 172 265 377 343 360 57.5 88.2 125.0 113.4 119.0 

Norfolk, VA 84 85 83 47 48 36.0 36.3 35.3 19.7 20.1 

Oakland, CA 127 91 109 176 173 8.9 6.3 7.4 12.0 11.8 

Oklahoma City, OK 300 193 160 170 193 70.9 45.3 37.3 39.3 44.6 

Omaha, NE 10 6 3 15 21 2.2 1.3 0.6 3.2 4.4 

Philadelphia, PA 825 618 646 566 586 54.3 40.8 43.0 37.9 39.3 

Phoenix, AZ 722 737 957 855 829 24.0 23.8 29.9 25.9 25.1 

Pittsburgh, PA 7 7 15 26 30 0.5 0.5 1.2 2.0 2.4 

Portland, OR 19 30 29 48 64 3.7 5.7 5.5 9.0 12.0 

Richmond, VA 64 40 58 25 42 32.1 20.3 29.3 12.7 21.3 

Rochester, NY 16 7 4 13 24 6.5 2.8 1.6 5.2 9.7 

Sacramento, CA 20 25 33 38 31 1.7 2.0 2.6 2.9 2.4 

San Antonio, TX 228 287 364 306 213 20.1 25.0 31.2 25.6 17.8 

San Diego, CA 251 232 152 162 299 9.0 8.2 5.3 5.6 10.3 

San Francisco, CA 128 163 301 604 655 16.5 21.0 38.8 79.1 85.7 

San Jose, CA 56 43 92 93 135 3.4 2.5 5.4 5.5 8.0 

Seattle, WA 123 116 110 96 134 7.1 6.7 6.3 5.5 7.6 

St Louis, MO 165 115 63 80 51 47.1 33.1 18.4 23.6 15.1 

St Paul, MN 6 9 16 16 27 2.1 3.2 5.6 5.6 9.5 

St Petersburg, FL 38 64 40 81 128 4.1 6.9 4.3 8.7 13.8 

Tampa, FL 111 132 148 222 265 11.3 13.2 14.4 21.1 25.1 

Toledo, OH 21 18 3 18 18 4.6 4.0 0.7 4.0 4.0 

Tucson, AZ 42 36 72 91 125 5.1 4.2 8.3 10.3 14.2 

Tulsa, OK 109 32 22 30 35 27.7 8.1 5.5 7.5 8.8 

Washington, DC 458 516 459 431 330 80.3 90.3 80.0 75.5 57.8 

Wichita, KS 34 10 15 13 13 7.5 2.2 3.3 2.8 2.8 

Yonkers, NY 12 10 13 27 30 6.1 5.0 6.5 13.4 14.9 

U.S. CITY TOTAL 19,171 17,446 18,418 19,424 19,425 27.7 25.0 26.1 27.3 27.3 

San Juan, PR 682 545 483 443 579 64.8 53.4 47.2 43.2 56.5 

TOTAL 19,853 17,991 18,901 19,867 20,004 28.3 25.4 26.4 27.6 27.8 

0.9 

*See Appendix (Reporting of Syphilis Cases) for definition.
 

STD Surveillance 2003 Syphilis Tables 111
 
Table 24. Primary and secondary syphilis — Reported cases and rates by state/area, ranked by rates: 

United States, 2003 

Rank* State/Area Cases Rate per 100,000 Population 

1 Georgia 585 6.8 

2 Maryland 312 5.7 

3 Louisiana 183 4.1 

4 Florida 658 3.9 

5 New Mexico 71 3.8 

6 California 1,299 3.7 

7 Arizona 186 3.4 

8 Rhode Island 33 3.1 

9 Texas 654 3.0 

10 New York 584 3.0 

11 Illinois 374 3.0 

U.S. TOTAL† 7,177 2.5 

12 Michigan 249 2.5 

13 Alabama 114 2.5 

14 Tennessee 135 2.3 

15 South Carolina 94 2.3 

16 Massachusetts 133 2.1 

17 New Jersey 170 2.0 

18 Arkansas 51 1.9 

19 North Carolina 152 1.8 

20 Oklahoma 64 1.8 

21 Ohio 197 1.7 

22 New Hampshire 19 1.5 

23 Washington 82 1.4 

24 Oregon 48 1.4 

25 Mississippi 40 1.4 

26 Pennsylvania 159 1.3 

27 Virginia 82 1.1 

28 Missouri 61 1.1 

29 Idaho 15 1.1 

30 Hawaii 14 1.1 

31 Minnesota 47 0.9 

32 Colorado 39 0.9 

33 Connecticut 30 0.9 

34 Kansas 25 0.9 

35 Delaware 7 0.9 

36 Indiana 50 0.8 

37 Kentucky 33 0.8 

38 Utah 14 0.6 

39 Nevada 12 0.6 

40 Nebraska 10 0.6 

41 Maine 8 0.6 

42 Iowa 12 0.4 

43 Wisconsin 16 0.3 

44 North Dakota 2 0.3 

45 South Dakota 2 0.3 

46 Alaska 1 0.2 

47 Vermont 1 0.2 

YEAR 2010 TARGET 0.2 

48 West Virginia 2 0.1 

Montana 0 0.0 

Wyoming 0 0.0 

*States were ranked in descending order by rate, number of cases, and alphabetically by state. States with no cases were not ranked. †

Total includes cases reported by Washington, D.C., but excludes outlying areas (Guam with 1 case and rate of 0.6, Puerto Rico with 202 cases and 

rate of 5.2, and Virgin Islands with 3 cases and rate of 2.7). 

112 Syphilis Tables STD Surveillance 2003 
Table 25. Primary and secondary syphilis — Counties and independent cities* ranked by number of reported 

cases: United States, 2003 

† Rank County/Independent City Cases Rate per 100,000 Population Cumulative Percent 

1 Los Angeles County, CA 523 5.3 7 

2 San Francisco County, CA 332 43.5 11 

3 Cook County, IL 302 5.6 16 

4 Fulton County, GA 298 36.1 20 

5 New York County, NY 273 17.6 24 

6 Wayne County, MI 205 10.0 26 

7 Harris County, TX 196 5.5 29 

8 Dade County, FL 194 8.3 32 

9 Broward County, FL 179 10.5 34 

10 Dallas County, TX 165 7.2 37 

11 Baltimore (City), MD 153 24.0 39 

12 Maricopa County, AZ 132 4.0 41 

13 Franklin County, OH 116 10.7 42 

14 Kings County, NY 114 4.6 44 

15 San Diego County, CA 111 3.8 45 

16 De Kalb County, GA 108 16.0 47 

17 Philadelphia County, PA 98 6.6 48 

18 Essex County, NJ 76 9.5 49 

19 Shelby County, TN 76 8.4 50 

*Accounting for 50% of reported primary and secondary syphilis cases. 

†

Counties were ranked in descending order by number of cases. 

STD Surveillance 2003 Syphilis Tables 113 
Table 26. Primary and secondary syphilis — Reported cases and rates by state/area and region listed in 

alphabetical order: United States and outlying areas, 1999–2003 

State/Area 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 

Alabama 202 123 142 149 114 4.6 2.8 3.2 3.3 2.5 

Alaska 1 0 0 0 1 0.2 0.0 0.0 0.0

Arizona 212 189 180 200 186 4.2 3.7 3.4 3.7 3.4 

Arkansas 87 104 49 34 51 3.3 3.9 1.8 1.3 1.9 

California 283 325 545 1,033 1,299 0.8 1.0 1.6 2.9 3.7 

Colorado 8 11 23 64 39 0.2 0.3 0.5 1.4 0.9 

Connecticut 16 16 12 28 30 0.5 0.5 0.3 0.8 0.9 

Delaware 10 9 14 11 7 1.3 1.1 1.8 1.4 0.9 

Florida 343 413 484 617 658 2.2 2.6 3.0 3.7 3.9 

Georgia 430 402 414 439 585 5.3 4.9 4.9 5.1 6.8 

Hawaii 3 2 12 11 14 0.2 0.2 1.0 0.9 1.1 

Idaho 1 1 1 8 15 0.1 0.1 0.1 0.6

Illinois 422 412 409 479 374 3.4 3.3 3.3 3.8 3.0 

Indiana 450 351 151 62 50 7.4 5.8 2.5 1.0 0.8 

Iowa 9 11 5 8 12 0.3 0.4 0.2 0.3 0.4 

Kansas 14 6 25 20 25 0.5 0.2 0.9 0.7 0.9 

Kentucky 101 85 48 88 33 2.5 2.1 1.2 2.2 0.8 

Louisiana 306 209 173 152 183 6.9 4.7 3.9 3.4 4.1 

Maine 0 1 1 2 8 0.0 0.1 0.1 0.2

Maryland 343 300 266 228 312 6.5 5.6 4.9 4.2 5.7 

Massachusetts 37 68 46 99 133 0.6 1.1 0.7 1.5 2.1 

Michigan 249 330 428 486 249 2.5 3.3 4.3 4.8 2.5 

Minnesota 10 16 33 59 47 0.2 0.3 0.7 1.2 0.9 

Mississippi 194 137 140 49 40 6.9 4.8 4.9 1.7 1.4 

Missouri 96 29 26 34 61 1.7 0.5 0.5 0.6 1.1 

Montana 1 0 0 0 0 0.1 0.0 0.0 0.0

Nebraska 6 2 10 6 10 0.4 0.1 0.6 0.3 0.6 

Nevada 5 5 8 15 12 0.3 0.2 0.4 0.7 0.6 

New Hampshire 1 2 1 8 19 0.1 0.2 0.1 0.6

New Jersey 68 71 137 169 170 0.8 0.8 1.6 2.0 2.0 

New Mexico 12 16 19 39 71 0.7 0.9 1.0 2.1 3.8 

New York 150 132 304 478 584 0.8 0.7 1.6 2.5 3.0 

North Carolina 464 483 445 279 152 5.8 6.0 5.4 3.4 1.8 

North Dakota 0 0 0 0 2 0.0 0.0 0.0 0.0

Ohio 92 69 81 159 197 0.8 0.6 0.7 1.4 1.7 

Oklahoma 187 116 60 72 64 5.4 3.4 1.7 2.1 1.8 

Oregon 8 12 13 28 48 0.2 0.3 0.4 0.8 1.4 

Pennsylvania 84 77 100 105 159 0.7 0.6 0.8 0.9 1.3 

Rhode Island 3 4 9 13 33 0.3 0.4 0.8 1.2 3.1 

South Carolina 269 229 235 134 94 6.8 5.7 5.8 3.3 2.3 

South Dakota 0 0 1 0 2 0.0 0.0 0.1 0.0

Tennessee 641 532 331 168 135 11.4 9.3 5.8 2.9 2.3 

Texas 473 396 478 589 654 2.3 1.9 2.2 2.7 3.0 

Utah 2 2 11 7 14 0.1 0.1 0.5 0.3 0.6 

Vermont 3 0 3 2 1 0.5 0.0 0.5 0.3

Virginia 153 126 102 71 82 2.2 1.8 1.4 1.0 1.1 

Washington 77 66 57 70 82 1.3 1.1 1.0 1.2 1.4 

West Virginia 5 3 5 2 2 0.3 0.2 0.3 0.1

Wisconsin 41 48 22 30 16 0.8 0.9 0.4 0.6 0.3 

Wyoming 0 1 1 0 0 0.0 0.2 0.2 0.0

U.S. TOTAL* 6,617 5,979 6,103 6,862 7,177 2.4 2.1 2.1 2.4 2.5 

Northeast 362 371 613 904 1,137 0.7 0.7 1.1 1.7 2.1 

Midwest 1,389 1,274 1,191 1,343 1,045 2.2 2.0 1.8 2.1 1.6 

South 4,253 3,704 3,429 3,140 3,214 4.3 3.7 3.4 3.0 3.1 

West 613 630 870 1,475 1,781 1.0 1.0 1.3 2.2 2.7 

Guam 

Puerto Rico 

Virgin Islands 

2

146 

1 

1

175 

3 

12

244 

0 

6

270 

1 

1 

202 

3 

1.2 

3.8 

0.9 

0.6 

4.6 

2.8 

7.6 

6.4 

0.0 

3.7 

7.0 

0.9

0.6 

5.2 

OUTLYING AREAS 149 179 256 277 206 3.6 4.4 6.2 6.7 5.0 

TOTAL 6,766 6,158 6,359 7,139 7,383 2.4 2.2 2.2 2.4 2.5 

0.2 

1.1 

0.6 

0.0 

1.5 

0.3 

0.3 

0.2 

0.1 

0.0 

2.7 

*Includes cases reported by Washington, D.C. 

114 Syphilis Tables STD Surveillance 2003 
Table 27. Primary and secondary syphilis — Women – Reported cases and rates by state/area and region 

listed in alphabetical order: United States and outlying areas, 1999–2003 

State/Area 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 

Alabama 102 63 67 63 49 4.4 2.7 2.9 2.7 2.1 

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0

Arizona 65 80 50 74 66 2.6 3.1 1.9 2.7 2.4 

Arkansas 44 58 27 18 16 3.2 4.2 2.0 1.3 1.2 

California 76 51 42 39 52 0.5 0.3 0.2 0.2 0.3 

Colorado 6 1 5 2 5 0.3 0.0 0.2 0.1

Connecticut 6 7 2 3 3 0.3 0.4 0.1 0.2

Delaware 1 1 5 4 2 0.3 0.2 1.2 1.0

Florida 143 163 135 108 73 1.8 2.0 1.6 1.3 0.9 

Georgia 160 159 129 98 68 3.9 3.8 3.0 2.3 1.6 

Hawaii 2 1 0 2 0 0.3 0.2 0.0 0.3

Idaho 0 0 0 4 5 0.0 0.0 0.0 0.6

Illinois 180 181 91 81 48 2.9 2.9 1.4 1.3 0.7 

Indiana 225 196 71 18 16 7.3 6.3 2.3 0.6 0.5 

Iowa 6 6 1 4 2 0.4 0.4 0.1 0.3

Kansas 8 1 11 6 13 0.6 0.1 0.8 0.4 0.9 

Kentucky 45 42 17 43 13 2.2 2.0 0.8 2.1 0.6 

Louisiana 153 97 83 76 79 6.6 4.2 3.6 3.3 3.4 

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0

Maryland 164 115 113 53 74 6.0 4.2 4.1 1.9 2.6 

Massachusetts 15 19 4 12 3 0.5 0.6 0.1 0.4 0.1 

Michigan 95 141 161 192 93 1.9 2.8 3.2 3.8 1.8 

Minnesota 5 5 16 4 4 0.2 0.2 0.6 0.2 0.2 

Mississippi 93 70 69 31 20 6.3 4.8 4.7 2.1 1.3 

Missouri 49 11 8 10 14 1.7 0.4 0.3 0.3 0.5 

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0

Nebraska 3 1 8 2 1 0.3 0.1 0.9 0.2

Nevada 3 2 1 1 3 0.3 0.2 0.1 0.1

New Hampshire 1 0 0 0 0 0.2 0.0 0.0 0.0

New Jersey 32 23 44 48 49 0.7 0.5 1.0 1.1 1.1 

New Mexico 3 5 6 12 23 0.3 0.5 0.6 1.3 2.4 

New York 34 12 23 26 26 0.3 0.1 0.2 0.3 0.3 

North Carolina 202 234 191 115 47 5.0 5.7 4.6 2.7 1.1 

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0

Ohio 43 26 26 27 40 0.7 0.4 0.4 0.5 0.7 

Oklahoma 77 54 28 20 20 4.4 3.1 1.6 1.1 1.1 

Oregon 5 4 2 8 3 0.3 0.2 0.1 0.5

Pennsylvania 27 30 28 22 33 0.4 0.5 0.4 0.3 0.5 

Rhode Island 1 2 0 2 8 0.2 0.4 0.0 0.4

South Carolina 117 96 101 58 24 5.7 4.6 4.8 2.7 1.1 

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0

Tennessee 283 247 158 82 40 9.8 8.4 5.4 2.8 1.3 

Texas 182 152 169 192 162 1.8 1.4 1.6 1.8 1.5 

Utah 0 1 2 0 3 0.0 0.1 0.2 0.0

Vermont 2 0 0 0 0 0.6 0.0 0.0 0.0

Virginia 71 44 43 17 7 2.0 1.2 1.2 0.5 0.2 

Washington 3 8 7 1 4 0.1 0.3 0.2 0.0

West Virginia 3 1 1 1 2 0.3 0.1 0.1 0.1

Wisconsin 18 24 13 6 1 0.7 0.9 0.5 0.2 0.0 

Wyoming 0 1 1 0 0 0.0 0.4 0.4 0.0

U.S. TOTAL* 2,777 2,445 1,967 1,594 1,217 2.0 1.7 1.4 1.1 0.8 

Northeast 118 93 101 113 122 0.4 0.3 0.4 0.4 0.4 

Midwest 632 592 406 350 232 1.9 1.8 1.2 1.1 0.7 

South 1,864 1,606 1,344 988 699 3.7 3.1 2.6 1.9 1.3 

West 163 154 116 143 164 0.5 0.5 0.4 0.4 0.5 

Guam 

Puerto Rico 

Virgin Islands 

0

73 

1 

0

76 

2 

5

130 

0 

2

123 

0 

0 

93 

2 

0.0 

3.6 

1.9 

0.0 

3.8 

3.5 

6.5 

6.5 

0.0 

2.5

6.1 

0.0

4.6 

OUTLYING AREAS 74 78 135 125 95 3.4 3.7 6.3 5.8 4.4 

TOTAL 2,851 2,523 2,102 1,719 1,312 2.0 1.7 1.4 1.2 0.9 

0.0 

0.2 

0.2 

0.5 

0.0 

0.7 

0.1 

0.0 

0.0 

0.1 

0.3 

0.0 

0.0 

0.2 

1.4 

0.0 

0.3 

0.0 

0.1 

0.2 

0.0 

0.0 

3.4 

*Includes cases reported by Washington, D.C. 

NOTE: Cases reported with unknown sex are not included in this table. 

STD Surveillance 2003 Syphilis Tables 115 
Table 28. Primary and secondary syphilis — Men – Reported cases and rates by state/area and region listed 

in alphabetical order: United States and outlying areas, 1999–2003 

State/Area 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 

Alabama 100 60 75 86 65 4.7 2.8 3.5 4.0 3.0 

Alaska 1 0 0 0 1 0.3 0.0 0.0 0.0

Arizona 147 109 130 126 120 5.9 4.2 4.9 4.6 4.4 

Arkansas 43 46 22 16 35 3.3 3.5 1.7 1.2 2.6 

California 206 272 501 994 1,245 1.2 1.6 2.9 5.7 7.1 

Colorado 2 10 18 62 34 0.1 0.5 0.8 2.7 1.5 

Connecticut 10 9 10 25 27 0.6 0.5 0.6 1.5 1.6 

Delaware 9 8 9 7 5 2.4 2.1 2.3 1.8

Florida 199 250 349 509 585 2.6 3.2 4.4 6.2 7.2 

Georgia 269 243 285 340 517 6.8 6.0 6.9 8.1 12.3 

Hawaii 1 1 12 9 14 0.2 0.2 1.9 1.4 2.2 

Idaho 1 1 1 4 10 0.2 0.2 0.2 0.6

Illinois 242 231 318 398 326 4.0 3.8 5.2 6.4 5.3 

Indiana 225 155 80 44 34 7.6 5.2 2.7 1.5 1.1 

Iowa 3 5 4 4 10 0.2 0.3 0.3 0.3

Kansas 6 5 14 14 12 0.5 0.4 1.0 1.0 0.9 

Kentucky 56 43 31 45 19 2.9 2.2 1.6 2.2 0.9 

Louisiana 153 112 90 76 104 7.1 5.2 4.2 3.5 4.8 

Maine 0 1 1 2 8 0.0 0.2 0.2 0.3

Maryland 179 185 153 175 238 7.1 7.2 5.9 6.6 9.0 

Massachusetts 22 49 42 87 129 0.7 1.6 1.4 2.8 4.2 

Michigan 154 189 267 294 156 3.2 3.9 5.4 6.0 3.2 

Minnesota 5 11 17 55 43 0.2 0.5 0.7 2.2 1.7 

Mississippi 101 67 71 18 20 7.4 4.9 5.1 1.3 1.4 

Missouri 47 18 18 24 47 1.7 0.7 0.7 0.9 1.7 

Montana 1 0 0 0 0 0.2 0.0 0.0 0.0

Nebraska 3 1 2 4 9 0.4 0.1 0.2 0.5

Nevada 2 3 7 14 9 0.2 0.3 0.7 1.3 0.8 

New Hampshire 0 2 1 8 19 0.0 0.3 0.2 1.3

New Jersey 36 48 93 121 121 0.9 1.2 2.3 2.9 2.9 

New Mexico 9 11 13 27 48 1.0 1.2 1.4 3.0 5.3 

New York 116 120 281 452 558 1.3 1.3 3.1 4.9 6.0 

North Carolina 262 249 254 164 105 6.7 6.3 6.3 4.0 2.6 

North Dakota 0 0 0 0 2 0.0 0.0 0.0 0.0

Ohio 49 43 55 132 157 0.9 0.8 1.0 2.4 2.8 

Oklahoma 110 62 32 52 44 6.5 3.7 1.9 3.0 2.6 

Oregon 3 8 11 20 45 0.2 0.5 0.6 1.1 2.6 

Pennsylvania 57 47 72 83 126 1.0 0.8 1.2 1.4 2.1 

Rhode Island 2 2 9 11 25 0.4 0.4 1.8 2.1 4.9 

South Carolina 152 133 134 76 70 7.9 6.8 6.8 3.8 3.5 

South Dakota 0 0 1 0 2 0.0 0.0 0.3 0.0

Tennessee 358 285 173 86 95 13.1 10.3 6.2 3.0 3.4 

Texas 289 244 309 397 492 2.8 2.3 2.9 3.7 4.5 

Utah 2 1 9 7 11 0.2 0.1 0.8 0.6

Vermont 1 0 3 2 1 0.3 0.0 1.0 0.7

Virginia 82 82 59 54 75 2.4 2.4 1.7 1.5 2.1 

Washington 74 58 50 69 78 2.5 2.0 1.7 2.3 2.6 

West Virginia 2 2 4 1 0 0.2 0.2 0.5 0.1

Wisconsin 23 24 9 24 15 0.9 0.9 0.3 0.9 0.6 

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0

U.S. TOTAL* 3,835 3,532 4,134 5,267 5,956 2.8 2.6 3.0 3.7 4.2 

Northeast 244 278 512 791 1,014 0.9 1.1 2.0 3.0 3.9 

Midwest 757 682 785 993 813 2.4 2.2 2.5 3.1 2.5 

South 2,385 2,098 2,085 2,151 2,514 4.9 4.3 4.2 4.2 5.0 

West 449 474 752 1,332 1,615 1.4 1.5 2.3 4.1 4.9 

Guam 

Puerto Rico 

Virgin Islands 

2

73 

0 

1

99 

1 

7

114 

0 

4

147 

1 

1 

109 

1 

2.3 

3.9 

0.0 

1.3 

5.4 

1.9 

8.7 

6.2 

0.0 

4.9

7.9 

2.0

5.9 

OUTLYING AREAS 75 101 121 152 111 3.7 5.1 6.1 7.6 5.6 

TOTAL 3,910 3,633 4,255 5,419 6,067 2.8 2.6 3.0 3.8 4.2 

0.3 

1.3 

1.5 

0.7 

1.3 

0.0 

1.1 

3.0 

0.6 

0.5 

0.9 

0.3 

0.0 

0.0 

1.2 

2.0 

*Includes cases reported by Washington, D.C. 

NOTE: Cases reported with unknown sex are not included in this table. 

116 Syphilis Tables STD Surveillance 2003 
Table 29. Primary and secondary syphilis — Reported cases and rates in selected cities, ranked by rates: 

United States, 2003 

Rank* † City Cases Rate per 100,000 Population 

1 San Francisco, CA 332 43.5 

2 Atlanta, GA 298 36.1 

3 Baltimore, MD 153 24.0 

4 Detroit, MI 179 19.0 

5 Newark, NJ 57 18.8 

6 Boston, MA 69 11.5 

7 Oklahoma City, OK 48 11.1 

8 Dallas, TX 131 10.8 

9 Columbus, OH 106 9.8 

10 Fort Worth, TX 52 9.2 

11 Houston, TX 178 8.9 

12 Chicago, IL 267 8.7 

13 Memphis, TN 76 8.4 

14 Washington, DC 48 8.4 

15 Miami, FL 194 8.3 

16 New York City, NY 531 6.6 

17 Philadelphia, PA 98 6.6 

18 Albuquerque, NM 36 6.3 

19 Portland, OR 33 6.2 

20 St Petersburg, FL 51 5.5 

21 Minneapolis, MN 21 5.4 

22 New Orleans, LA 25 5.3 

23 St Louis, MO 18 5.3 

24 Los Angeles, CA 461 5.0 

25 Jersey City, NJ 12 5.0 

26 Tucson, AZ 40 4.5 

27 Denver, CO 25 4.5 

28 San Antonio, TX 52 4.4 

29 Austin, TX 28 4.2 

30 Kansas City, MO 19 4.2 

31 Tampa, FL 43 4.1 

32 Phoenix, AZ 132 4.0 

33 San Diego, CA 111 3.8 

34 Louisville, KY 26 3.7 

35 Nashville, TN 21 3.7 

36 Seattle, WA 60 3.4 

37 San Jose, CA 56 3.3 

38 Birmingham, AL 22 3.3 

39 Norfolk, VA 8 3.3 

40 Indianapolis, IN 25 2.9 

41 Rochester, NY 7 2.8 

42 Jacksonville, FL 21 2.6 

43 Richmond, VA 5 2.5 

44 Oakland, CA 33 2.2 

45 Charlotte, NC 16 2.2 

46 St Paul, MN 6 2.1 

47 Honolulu, HI 14 1.6 

48 Omaha, NE 7 1.5 

49 Sacramento, CA 17 1.3 

50 Pittsburgh, PA 17 1.3 

51 Tulsa, OK 5 1.3 

52 Cleveland, OH 16 1.2 

53 Milwaukee, WI 10 1.1 

54 Corpus Christi, TX 3 1.1 

55 Toledo, OH 3 0.7 

56 Buffalo, NY 2 0.6 

57 Akron, OH 3 0.5 

58 Yonkers, NY 1 0.5 

59 Wichita, KS 2 0.4 

60 El Paso, TX 2 0.3 

61 Cincinnati, OH 2 0.2 

YEAR 2010 TARGET 0.2 

Des Moines, IA 0 0.0 

Dayton, OH 0 0.0 

*Cities were ranked in descending order by rate, number of cases, and alphabetically by state. 

†

Excludes cities in outlying areas (San Juan, PR, with 88 cases and rate of 8.6). 

STD Surveillance 2003 Syphilis Tables 117 
Table 30. Primary and secondary syphilis — Reported cases and rates in selected cities listed in alphabetical 

order: United States and outlying areas, 1999–2003 

City 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003
 1999 2000 2001 2002 2003 

Akron, OH 0 0 1 2 3
 0.0 0.0 0.2 0.4

Albuquerque, NM 11 11 8 21 36 2.0 2.0 1.4 3.7 6.3 

Atlanta, GA 213 116 224 257 298 26.4 14.2 27.1 31.1 36.1 

Austin, TX 19 8 17 22 28 3.1 1.3 2.6 3.3 4.2 

Baltimore, MD 246 218 161 121 153 37.4 33.6 24.9 18.9 24.0 

Birmingham, AL 24 24 12 9 22 3.6 3.6 1.8 1.4 3.3 

Boston, MA 16 25 18 48 69 2.7 4.2 3.0 8.0 11.5 

Buffalo, NY 1 1 4 3 2 0.3 0.3 1.2 0.9

Charlotte, NC 53 45 29 28 16 7.8 6.4 4.0 3.8 2.2 

Chicago, IL 282 292 317 353 267 9.2 9.5 10.3 11.4 8.7 

Cincinnati, OH 1 0 2 6 2 0.1 0.0 0.2 0.7

Cleveland, OH 12 4 3 9 16 0.9 0.3 0.2 0.7 1.2 

Columbus, OH 43 40 54 96 106 4.1 3.7 5.0 8.8 9.8 

Corpus Christi, TX 1 1 1 2 3 0.4 0.4 0.4 0.7

Dallas, TX 151 100 121 191 131 12.8 8.4 10.0 15.8 10.8 

Dayton, OH 2 5 2 4 0 0.4 0.9 0.4 0.7

Denver, CO 4 4 15 41 25 0.7 0.7 2.7 7.3 4.5 

Des Moines, IA 0 1 1 5 0 0.0 0.3 0.3 1.3

Detroit, MI 189 274 351 384 179 19.8 28.8 37.0 40.7 19.0 

El Paso, TX 9 6 12 12 2 1.6 1.1 2.1 2.1 0.3 

Fort Worth, TX 22 22 40 106 52 4.2 4.1 7.3 18.7 9.2 

Honolulu, HI 3 1 10 10 14 0.3 0.1 1.1 1.1 1.6 

Houston, TX 77 70 103 112 178 4.2 3.7 5.4 5.6 8.9 

Indianapolis, IN 407 301 128 36 25 47.5 35.0 14.8 4.2 2.9 

Jacksonville, FL 7 24 38 16 21 0.9 3.1 4.8 2.0 2.6 

Jersey City, NJ 3 1 5 16 12 1.3 0.4 2.1 6.6 5.0 

Kansas City, MO 8 1 5 8 19 1.8 0.2 1.1 1.8

Los Angeles, CA 83 133 186 359 461 0.9 1.5 2.1 3.9 5.0 

Louisville, KY 67 57 19 77 26 9.7 8.2 2.7 11.0 3.7 

Memphis, TN 258 246 208 89 76 28.9 27.4 23.1 9.8 8.4 

Miami, FL 82 126 185 231 194 3.7 5.6 8.1 9.9 8.3 

Milwaukee, WI 39 43 18 16 10 4.1 4.6 1.9 1.7 1.1 

Minneapolis, MN 6 9 23 37 21 1.6 2.3 5.9 9.6 5.4 

Nashville, TN 250 200 76 26 21 44.1 35.1 13.3 4.6 3.7 

New Orleans, LA 51 22 24 9 25 10.5 4.5 5.0 1.9 5.3 

New York City, NY 130 117 282 435 531 1.6 1.5 3.5 5.4 6.6 

Newark, NJ 22 28 58 63 57 7.4 9.3 19.2 20.8 18.8 

Norfolk, VA 20 37 35 13 8 8.6 15.8 14.9 5.4 3.3 

Oakland, CA 10 11 23 49 33 0.7 0.8 1.6 3.3 2.2 

Oklahoma City, OK 114 82 35 52 48 26.9 19.2 8.2 12.0 11.1 

Omaha, NE 5 2 3 2 7 1.1 0.4 0.6 0.4

Philadelphia, PA 69 67 79 67 98 4.5 4.4 5.3 4.5 6.6 

Phoenix, AZ 195 172 148 155 132 6.5 5.6 4.6 4.7 4.0 

Pittsburgh, PA 2 3 7 7 17 0.2 0.2 0.5 0.6

Portland, OR 5 11 9 20 33 1.0 2.1 1.7 3.7 6.2 

Richmond, VA 13 5 9 3 5 6.5 2.5 4.6 1.5

Rochester, NY 0 1 2 4 7 0.0 0.4 0.8 1.6

Sacramento, CA 2 1 4 11 17 0.2 0.1 0.3 0.8 1.3 

San Antonio, TX 31 67 71 45 52 2.7 5.8 6.1 3.8 4.4 

San Diego, CA 25 27 27 37 111 0.9 1.0 0.9 1.3 3.8 

San Francisco, CA 29 53 139 315 332 3.7 6.8 17.9 41.2 43.5 

San Jose, CA 3 2 10 30 56 0.2 0.1 0.6 1.8 3.3 

Seattle, WA 65 50 41 50 60 3.8 2.9 2.3 2.8 3.4 

St Louis, MO 51 11 15 13 18 14.6 3.2 4.4 3.8 5.3 

St Paul, MN 2 2 5 5 6 0.7 0.7 1.7 1.8

St Petersburg, FL 4 7 11 22 51 0.4 0.8 1.2 2.4 5.5 

Tampa, FL 15 20 15 33 43 1.5 2.0 1.5 3.1 4.1 

Toledo, OH 6 2 1 12 3 1.3 0.4 0.2 2.6 0.7 

Tucson, AZ 8 8 22 28 40 1.0 0.9 2.5 3.2 4.5 

Tulsa, OK 45 8 5 7 5 11.4 2.0 1.3 1.8 1.3 

Washington, DC 45 37 43 58 48 7.9 6.5 7.5 10.2 8.4 

Wichita, KS 7 2 4 3 2 1.5 0.4 0.9 0.6

Yonkers, NY 1 1 1 2 1 0.5 0.5 0.5 1.0

U.S. CITY TOTAL 3,564 3,265 3,525 4,303 4,334 5.2 4.7 5.0 6.1 6.1 

San Juan, PR 61 68 68 78 88 5.8 6.7 6.6 7.6 8.6 

TOTAL 3,625 3,333 3,593 4,381 4,422 5.2 4.7 5.0 6.1 6.1 

1.1 

0.0 

1.3 

0.5 

0.6 

0.2 

0.0 

4.2 

1.5 

2.5 

2.8 

2.1 

0.4 

0.5 

118 Syphilis Tables STD Surveillance 2003 
Table 31. Primary and secondary syphilis — Women – Reported cases and rates in selected cities listed in 

alphabetical order: United States and outlying areas, 1999–2003 

City 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003
 1999 2000 2001 2002 2003 

Akron, OH 0 0 0 0 1
 0.0 0.0 0.0 0.0

Albuquerque, NM 3 3 1 6 12 1.1 1.1 0.3 2.0

Atlanta, GA 85 37 67 57 39 20.7 8.9 16.0 13.6 9.3 

Austin, TX 2 2 3 3 2 0.7 0.6 0.9 0.9

Baltimore, MD 112 92 77 33 50 31.9 26.6 22.3 9.7 14.6 

Birmingham, AL 10 15 8 4 3 2.9 4.3 2.3 1.1 0.9 

Boston, MA 5 5 1 6 1 1.6 1.6 0.3 1.9

Buffalo, NY 0 1 0 0 1 0.0 0.6 0.0 0.0

Charlotte, NC 18 24 12 13 2 5.2 6.7 3.3 3.5 0.5 

Chicago, IL 116 129 61 43 30 7.3 8.1 3.8 2.7 1.9 

Cincinnati, OH 0 0 2 2 0 0.0 0.0 0.5 0.5

Cleveland, OH 3 2 2 3 7 0.4 0.3 0.3 0.4

Columbus, OH 21 14 17 10 16 3.8 2.5 3.1 1.8 2.9 

Corpus Christi, TX 1 1 1 1 0 0.7 0.7 0.7 0.7

Dallas, TX 57 36 49 76 48 9.7 6.0 8.1 12.6 7.9 

Dayton, OH 0 1 1 0 0 0.0 0.3 0.3 0.0

Denver, CO 3 0 2 0 1 1.1 0.0 0.7 0.0

Des Moines, IA 0 1 0 2 0 0.0 0.5 0.0 1.0

Detroit, MI 74 121 136 168 73 14.6 24.1 27.2 33.7 14.6 

El Paso, TX 2 1 2 4 0 0.7 0.3 0.7 1.3

Fort Worth, TX 4 7 16 45 25 1.5 2.6 5.8 15.8 8.8 

Honolulu, HI 2 0 0 1 0 0.5 0.0 0.0 0.2

Houston, TX 30 27 28 16 15 3.2 2.9 2.9 1.6 1.5 

Indianapolis, IN 204 170 60 10 7 46.0 38.3 13.5 2.2 1.6 

Jacksonville, FL 3 11 18 8 9 0.8 2.7 4.4 1.9 2.2 

Jersey City, NJ 0 1 2 1 1 0.0 0.8 1.6 0.8

Kansas City, MO 5 0 2 1 7 2.1 0.0 0.9 0.4

Los Angeles, CA 25 19 9 18 24 0.6 0.4 0.2 0.4 0.5 

Louisville, KY 30 26 9 39 12 8.3 7.2 2.5 10.7 3.3 

Memphis, TN 126 123 106 51 26 27.0 26.2 22.5 10.8 5.5 

Miami, FL 24 40 40 33 23 2.1 3.4 3.4 2.7 1.9 

Milwaukee, WI 17 21 12 4 1 3.5 4.3 2.5 0.8 0.2 

Minneapolis, MN 3 3 12 2 1 1.5 1.5 6.1 1.0 0.5 

Nashville, TN 102 83 29 10 4 34.8 28.2 9.8 3.4 1.4 

New Orleans, LA 24 8 11 3 9 9.3 3.1 4.3 1.2 3.6 

New York City, NY 28 10 19 18 22 0.7 0.2 0.4 0.4 0.5 

Newark, NJ 10 9 21 26 26 6.4 5.7 13.3 16.4 16.4 

Norfolk, VA 7 14 20 4 2 6.1 12.2 17.4 3.5 1.7 

Oakland, CA 2 3 1 0 0 0.3 0.4 0.1 0.0

Oklahoma City, OK 42 39 18 10 14 19.3 17.8 8.2 4.5 6.3 

Omaha, NE 2 1 1 1 1 0.8 0.4 0.4 0.4

Philadelphia, PA 21 25 24 14 15 2.6 3.1 3.0 1.8 1.9 

Phoenix, AZ 62 75 39 59 44 4.1 4.8 2.4 3.6 2.7 

Pittsburgh, PA 0 2 1 2 4 0.0 0.3 0.1 0.3

Portland, OR 3 4 1 5 1 1.1 1.5 0.4 1.9

Richmond, VA 7 2 3 1 2 6.6 1.9 2.8 0.9

Rochester, NY 0 0 1 1 1 0.0 0.0 0.8 0.8

Sacramento, CA 1 1 1 0 1 0.2 0.2 0.2 0.0

San Antonio, TX 10 23 24 12 6 1.7 3.9 4.0 2.0 1.0 

San Diego, CA 6 6 6 6 4 0.4 0.4 0.4 0.4

San Francisco, CA 1 5 2 4 3 0.3 1.3 0.5 1.1

San Jose, CA 0 0 1 1 4 0.0 0.0 0.1 0.1

Seattle, WA 2 4 1 0 1 0.2 0.5 0.1 0.0

St Louis, MO 28 3 6 4 3 15.0 1.6 3.3 2.2 1.7 

St Paul, MN 1 1 1 0 1 0.7 0.7 0.7 0.0

St Petersburg, FL 2 3 2 2 1 0.4 0.6 0.4 0.4

Tampa, FL 7 10 6 8 5 1.4 2.0 1.1 1.5 0.9 

Toledo, OH 5 0 0 4 0 2.1 0.0 0.0 1.7

Tucson, AZ 1 2 5 7 17 0.2 0.5 1.1 1.6

Tulsa, OK 22 4 1 5 0 10.9 2.0 0.5 2.4 0.0 

Washington, DC 24 10 8 9 3 8.0 3.3 2.6 3.0 1.0 

Wichita, KS 4 1 1 1 0 1.7 0.4 0.4 0.4

Yonkers, NY 0 0 0 1 0 0.0 0.0 0.0 1.0

U.S. CITY TOTAL* 1,409 1,281 1,010 878 631 4.0 3.6 2.8 2.4 1.7 

San Juan, PR 34 32 38 31 44 6.2 6.0 7.1 5.8 8.3 

TOTAL 1,443 1,313 1,048 909 675 4.0 3.6 2.9 2.5 1.8 

4.1 

0.0 

0.0 

0.8 

0.6 

0.3 

0.2 

0.4 

0.6 

0.3 

0.6 

0.0 

1.0 

0.4 

0.0 

0.0 

0.0 

3.0 

0.0 

0.4 

0.4 

1.9 

0.8 

0.2 

0.8 

0.5 

0.1 

0.7 

0.0 

3.8 

0.0 

0.0 

*Cases reported with unknown sex are not included in this table. 

STD Surveillance 2003 Syphilis Tables 119 
Table 32. Primary and secondary syphilis — Men – Reported cases and rates in selected cities listed in 

alphabetical order: United States and outlying areas, 1999–2003 

City 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003
 1999 2000 2001 2002 2003 

Akron, OH 0 0 1 2 2
 0.0 0.0 0.4 0.8

Albuquerque, NM 8 8 7 15 24 3.0 2.9 2.5 5.3 8.6 

Atlanta, GA 128 79 157 199 259 32.3 19.6 38.7 49.0 63.8 

Austin, TX 16 6 14 19 26 5.1 1.9 4.2 5.5 7.6 

Baltimore, MD 134 126 84 88 103 43.7 41.6 27.9 29.6 34.7 

Birmingham, AL 14 9 4 5 19 4.5 2.9 1.3 1.6 6.1 

Boston, MA 11 20 17 42 68 3.8 6.9 5.9 14.6 23.6 

Buffalo, NY 1 0 4 3 1 0.6 0.0 2.6 2.0

Charlotte, NC 35 21 17 15 14 10.5 6.1 4.8 4.1 3.9 

Chicago, IL 166 163 256 310 237 11.1 10.9 17.1 20.7 15.8 

Cincinnati, OH 1 0 0 4 2 0.2 0.0 0.0 1.0

Cleveland, OH 9 2 1 6 9 1.4 0.3 0.2 0.9

Columbus, OH 22 26 37 86 90 4.3 5.0 7.0 16.3 17.0 

Corpus Christi, TX 0 0 0 1 3 0.0 0.0 0.0 0.7

Dallas, TX 94 64 72 115 83 16.0 10.7 11.8 19.0 13.7 

Dayton, OH 2 4 1 4 0 0.7 1.5 0.4 1.5

Denver, CO 1 4 13 41 24 0.4 1.4 4.6 14.5 8.5 

Des Moines, IA 0 0 1 3 0 0.0 0.0 0.5 1.6

Detroit, MI 115 153 215 216 106 25.5 34.2 48.1 48.5 23.8 

El Paso, TX 7 5 10 8 2 2.6 1.8 3.6 2.9 0.7 

Fort Worth, TX 18 15 24 61 27 6.9 5.6 8.8 21.7 9.6 

Honolulu, HI 1 1 10 9 14 0.2 0.2 2.3 2.0 3.1 

Houston, TX 47 43 75 96 163 5.1 4.6 7.9 9.6 16.3 

Indianapolis, IN 203 131 68 26 18 49.1 31.5 16.3 6.2 4.3 

Jacksonville, FL 4 13 20 8 12 1.1 3.4 5.2 2.0 3.1 

Jersey City, NJ 3 0 3 15 11 2.6 0.0 2.5 12.6 9.3 

Kansas City, MO 3 1 3 7 12 1.4 0.5 1.4 3.2

Los Angeles, CA 57 112 175 341 436 1.3 2.5 3.9 7.5 9.6 

Louisville, KY 37 31 10 38 13 11.2 9.3 3.0 11.4 3.9 

Memphis, TN 132 123 102 38 50 30.9 28.7 23.7 8.8 11.6 

Miami, FL 58 86 145 198 171 5.4 7.9 13.1 17.5 15.1 

Milwaukee, WI 22 22 6 12 9 4.9 4.9 1.3 2.7 2.0 

Minneapolis, MN 3 6 11 35 20 1.6 3.2 5.8 18.4 10.5 

Nashville, TN 148 117 47 16 17 54.1 42.4 17.0 5.8 6.2 

New Orleans, LA 27 14 13 6 16 11.9 6.2 5.8 2.7 7.2 

New York City, NY 102 107 263 417 509 2.7 2.8 6.9 10.9 13.3 

Newark, NJ 12 19 37 37 31 8.4 13.3 25.8 25.7 21.5 

Norfolk, VA 13 23 15 9 6 10.9 19.2 12.4 7.3 4.9 

Oakland, CA 8 8 22 49 33 1.1 1.1 3.0 6.8 4.6 

Oklahoma City, OK 72 43 17 42 34 35.1 20.8 8.2 20.0 16.2 

Omaha, NE 3 1 2 1 6 1.3 0.4 0.9 0.4

Philadelphia, PA 48 42 55 53 83 6.8 6.0 7.9 7.6 12.0 

Phoenix, AZ 133 97 109 96 88 8.9 6.3 6.8 5.8 5.3 

Pittsburgh, PA 2 1 6 5 13 0.3 0.2 1.0 0.8

Portland, OR 2 7 8 15 32 0.8 2.7 3.1 5.7 12.1 

Richmond, VA 6 3 6 2 3 6.5 3.3 6.5 2.2

Rochester, NY 0 1 1 3 6 0.0 0.8 0.8 2.5

Sacramento, CA 1 0 3 11 16 0.2 0.0 0.5 1.7 2.5 

San Antonio, TX 20 44 47 33 46 3.6 7.9 8.3 5.7 7.9 

San Diego, CA 19 21 21 31 107 1.4 1.5 1.5 2.1 7.3 

San Francisco, CA 28 48 137 311 328 7.1 12.2 34.8 80.4 84.8 

San Jose, CA 3 2 9 29 52 0.4 0.2 1.0 3.4 6.1 

Seattle, WA 63 46 40 50 59 7.3 5.3 4.6 5.7 6.7 

St Louis, MO 23 8 9 9 15 14.0 4.9 5.6 5.7 9.4 

St Paul, MN 1 1 4 5 5 0.7 0.7 2.9 3.6

St Petersburg, FL 2 4 9 20 50 0.5 0.9 2.0 4.5 11.3 

Tampa, FL 8 10 9 25 38 1.7 2.0 1.8 4.8 7.3 

Toledo, OH 1 2 1 8 3 0.5 0.9 0.5 3.7

Tucson, AZ 7 6 17 21 23 1.7 1.4 4.0 4.9 5.3 

Tulsa, OK 23 4 4 2 5 12.1 2.1 2.1 1.0 2.6 

Washington, DC 21 27 35 49 45 7.8 10.0 12.9 18.2 16.7 

Wichita, KS 3 1 3 2 2 1.3 0.4 1.3 0.9

Yonkers, NY 1 1 1 1 1 1.1 1.1 1.0 1.0

U.S. CITY TOTAL* 2,152 1,982 2,513 3,424 3,700 6.4 5.8 7.3 9.9 10.7 

San Juan, PR 27 36 30 47 44 5.3 7.3 6.1 9.6 8.9 

TOTAL 2,179 2,018 2,543 3,471 3,744 6.4 5.9 7.3 9.9 10.7 

2.2 

0.0 

2.2 

0.8 

0.7 

0.5 

1.4 

0.0 

5.5 

2.6 

3.3 

5.0 

3.6 

1.4 

0.9 

1.0 

*Cases reported with unknown sex are not included in this table. 

120 Syphilis Tables STD Surveillance 2003 
Table 33. Primary and secondary syphilis — Reported cases and rates per 100,000 population by age and sex: 

United States, 1999–2003 

Year Age 

Group 

Cases Rates 

Total Male Female Total Male Female 

10-14 25 2 23 0.1 0.0 0.2 

15-19 522 183 340 2.6 1.8 3.5 

20-24 963 510 452 5.2 5.4 5.0 

25-29 992 508 483 5.1 5.1 5.0 

1999 

30-34 

35-39 

40-44 

1,084 

1,153 

808 

589 

676 

537 

495 

477 

271 

5.3 

5.0 

3.6 

5.7 

5.9 

4.9 

4.8 

4.2 

2.4 

45-54 753 572 181 2.1 3.2 1.0 

55-64 228 188 40 1.0 1.6 0.3 

65+ 74 65 9 0.2 0.5 0.0 

TOTAL 6,613 3,833 2,780 2.4 2.8 2.0 

10-14 23 4 19 0.1 0.0 0.2 

15-19 457 162 295 2.3 1.6 3.0 

20-24 881 419 462 4.6 4.3 4.9 

25-29 902 527 376 4.7 5.4 3.9 

30-34 957 553 404 4.7 5.3 4.0 

2000 35-39 

40-44 

1,006 

782 

606 

502 

400 

280 

4.4 

3.5 

5.4 

4.5 

3.5 

2.5 

45-54 706 528 178 1.9 2.8 0.9 

55-64 179 157 22 0.7 1.3 0.2 

65+ 76 68 8 0.2 0.5 0.0 

TOTAL 5,973 3,528 2,445 2.1 2.5 1.7 

10-14 19 2 17 0.1 0.0 0.2 

15-19 387 142 245 1.9 1.4 2.5 

20-24 836 482 354 4.2 4.8 3.7 

25-29 876 583 293 4.6 6.0 3.1 

30-34 964 660 304 4.6 6.3 2.9 

2001 35-39 

40-44 

1,146 

808 

818 

587 

328 

221 

5.1 

3.5 

7.3 

5.2 

2.9 

1.9 

45-54 805 632 173 2.1 3.3 0.9 

55-64 193 167 26 0.8 1.4 0.2 

65+ 64 57 7 0.2 0.4 0.0 

TOTAL 6,100 4,132 1,968 2.1 2.9 1.4 

10-14 15 4 11 0.1 0.0 0.1 

15-19 351 135 216 1.7 1.3 2.2 

20-24 842 533 309 4.2 5.2 3.1 

25-29 895 668 227 4.7 6.9 2.4 

2002 

30-34 

35-39 

40-44 

45-54 

1,097 

1,367 

1,023 

982 

877 

1,121 

845 

825 

220 

246 

178 

157 

5.2 

6.2 

4.4 

2.5 

8.3 

10.2 

7.4 

4.2 

2.1 

2.2 

1.5 

0.8 

55-64 217 196 21 0.8 1.5 0.2 

65+ 67 59 8 0.2 0.4 0.0 

TOTAL 6,862 5,268 1,594 2.4 3.7 1.1 

10-14 11 1 10 0.1 0.0 0.1 

15-19 322 150 172 1.6 1.4 1.7 

20-24 860 620 240 4.3 6.0 2.4 

25-29 941 760 181 5.0 7.9 1.9 

2003 

30-34 

35-39 

40-44 

45-54 

1,187 

1,460 

1,157 

991 

1,023 

1,290 

1,021 

871 

164 

170 

136 

119 

5.7 

6.7 

5.0 

2.5 

9.7 

11.8 

8.9 

4.4 

1.6 

1.6 

1.2 

0.6 

55-64 205 187 18 0.8 1.5 0.1 

65+ 42 36 6 0.1 0.2 0.0 

TOTAL 7,177 5,959 1,218 2.5 4.2 0.8 

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the distribution of cases 

for which age was known. Differences between total cases from this table and others in the report are due to different reporting formats. The 0 to 9 

year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

STD Surveillance 2003 Syphilis Tables 121 
Table 34A. Primary and secondary syphilis — Reported cases by race/ethnicity, age group and sex: United States, 

1999–2003 

Age 

Group 

White, Non-Hispanic 

Total Male Female 

Black, Non-Hispanic 

Total Male Female Total 

Hispanic 

Male Female 

Asian/Pacific Islander 

Total Male Female 

American Indian/ 

Alaska Native 

Total Male Female 

10-14 3 1 2 21 1 20 1 0 1 0 0 0 0 0 0 

15-19 49 16 32 421 139 282 44 24 19 1 1 0 8 2 6 

20-24 120 46 74 717 381 336 110 75 35 5 3 2 10 5 5 

199925-29 

30-34 

35-39 

137 67 70 

168 98 70 

189 112 77 

741 364 376 

801 411 390 

883 501 382 

94 

97 

69 

67 

73 

56 

26 

24 

12 

7 7 0 

12 6 6 

4 4 0 

11 2 9 

6 1 5 

8 3 5 

40-44 142 98 44 601 390 211 56 46 9 8 3 4 2 0 2 

45-54 139 96 43 561 430 130 42 36 6 5 5 0 6 4 2 

55-64 53 41 12 151 129 22 22 16 5 1 0 1 1 1 0 

65+ 24 22 2 46 39 7 4 4 0 0 0 0 0 0 0 

TOTAL 1,026 598 428 4,950 2,788 2,163 538 399 139 43 30 13 54 18 36 

10-14 2 0 2 20 4 16 0 0 0 0 0 0 1 0 1 

15-19 47 11 35 365 129 236 41 21 19 1 0 1 4 1 3 

20-24 110 40 70 653 310 344 101 66 35 4 1 3 13 3 10 

200025-29 

30-34 

35-39 

146 93 53 

182 119 62 

216 143 72 

631 338 293 

665 350 314 

664 374 291 

108 

94 

113 

82 

72 

81 

27 

22 

32 

8 7 1 

12 10 2 

5 4 1 

9 7 2 

5 2 3 

7 3 4 

40-44 173 118 55 550 341 209 51 38 13 2 2 0 5 3 2 

45-54 145 114 31 511 375 136 43 32 11 4 4 0 4 4 0 

55-64 42 40 2 124 106 18 11 10 1 0 0 0 2 1 1 

65+ 21 19 2 50 44 6 3 3 0 1 1 0 1 1 0 

TOTAL 1,083 698 385 4,233 2,369 1,864 567 405 162 37 29 8 52 26 26 

10-14 0 0 0 17 1 16 2 1 1 0 0 0 0 0 0 

15-19 32 13 19 290 97 193 59 29 29 2 1 1 4 2 2 

20-24 114 72 42 562 296 266 138 105 34 6 5 1 15 4 11 

2001

25-29 

30-34 

35-39 

152 121 31 

236 192 44 

332 281 51 

554 323 231 

563 330 233 

653 397 255 

140 

137 

134 

115 

117 

120 

26 

20 

13 

13 13 0 

12 12 0 

15 14 1 

18 11 6 

17 9 7 

13 5 7 

40-44 227 193 34 505 335 170 59 48 11 2 2 0 15 10 5 

45-54 220 196 24 513 377 137 61 52 9 4 3 1 6 4 2 

55-64 51 48 3 121 100 21 18 16 2 2 2 0 2 2 0 

65+ 23 22 1 36 30 6 4 4 0 0 0 0 1 1 0 

TOTAL 1,387 1,138 249 3,813 2,286 1,527 754 607 146 55 51 4 90 49 41 

10-14 2 1 1 10 2 8 2 1 1 1 0 1 0 0 0 

15-19 33 9 24 253 89 164 62 37 25 2 0 2 1 0 1 

20-24 129 89 40 546 313 233 146 117 29 13 9 4 8 5 3 

200225-29 

30-34 

35-39 

224 189 36 

404 373 31 

576 541 35 

485 323 163 

476 310 166 

568 385 183 

165 

192 

200 

138 

172 

178 

26 

20 

22 

17 16 1 

22 21 1 

15 14 1 

4 3 1 

3 1 2 

8 3 5 

40-44 452 429 23 448 305 142 102 93 8 15 14 1 7 4 3 

45-54 393 370 23 482 370 112 83 69 15 8 8 0 16 8 7 

55-64 95 91 4 110 94 16 10 10 0 0 0 0 2 1 1 

65+ 15 15 0 42 35 7 9 8 1 0 0 0 1 1 0 

TOTAL 2,325 2,108 217 3,421 2,226 1,195 971 823 147 94 83 11 51 27 24 

10-14 0 0 0 5 1 4 5 0 5 0 0 0 1 0 1 

15-19 48 24 24 205 93 112 63 28 35 6 5 1 0 0 0 

20-24 195 154 41 471 309 161 178 142 36 13 11 2 3 3 0 

200325-29 

30-34 

35-39 

301 265 36 

524 485 39 

743 703 40 

408 293 115 

416 316 100 

451 335 116 

195 

213 

222 

173 

190 

211 

23 

23 

11 

28 25 3 

20 20 0 

28 28 0 

8 4 4 

14 12 2 

16 14 2 

40-44 588 563 26 382 288 94 158 146 12 20 19 1 9 5 3 

45-54 489 472 17 373 287 86 107 97 9 10 8 1 13 6 6 

55-64 104 100 4 81 68 13 13 12 1 2 2 0 4 4 0 

65+ 17 16 1 18 16 2 5 2 3 0 0 0 1 1 0 

TOTAL 3,010 2,783 227 2,811 2,005 805 1,160 1,001 159 127 119 8 69 50 19 

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 33 for age-specific cases and rates and Tables 26-28 for 

sex-specific cases and rates and overall totals. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for 

which these variables were specified. For 1999, NH did not report age and/or race/ethnicity for most cases and their case data and population denominators 

were excluded. Differences between total cases from this table and others in the report are due to different reporting formats and above listed exclusion. The 

0 to 9 year age group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

122 Syphilis Tables STD Surveillance 2003 
Table 34B. Primary and secondary syphilis — Rates per 100,000 population by race/ethnicity, age group and sex: 

United States, 1999–2003 

Age 

Group 

White, Non-Hispanic 

Total Male Female 

Black, Non-Hispanic 

Total Male Female Total 

Hispanic 

Male Female 

Asian/Pacific Islander 

Total Male Female 

American Indian/ 

Alaska Native 

Total Male Female 

10-14 0.0 0.0 0.0 0.7 0.1 1.3 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 

15-19 0.4 0.2 0.5 14.2 9.3 19.2 1.4 1.5 1.3 0.1 0.2 0.0 3.9 1.9 6.0 

20-24 1.0 0.8 1.3 27.6 30.2 25.2 3.4 4.2 2.4 0.6 0.7 0.5 6.0 5.8 6.2 

25-29 

30-34 

35-39 

1.1 1.1 1.1 

1.2 1.4 1.0 

1.2 1.4 1.0 

28.7 29.7 27.7 

30.3 32.9 28.0 

31.1 37.6 25.3 

2.9 

3.2 

2.5 

3.8 

4.5 

4.0 

1.8 

1.7 

1.0 

0.7 1.4 0.0 

1.2 1.3 1.1 

0.4 0.9 0.0 

6.8 2.5 11.2 

1999

3.8 1.3 6.3 

4.5 3.4 5.5 

40-44 0.9 1.2 0.5 22.5 31.2 14.9 2.5 4.1 0.9 0.8 0.7 1.0 1.2 0.0 2.3 

45-54 0.5 0.7 0.3 14.2 23.7 6.1 1.4 2.5 0.4 0.4 0.8 0.0 2.3 3.2 1.5 

55-64 0.3 0.5 0.1 6.5 12.5 1.7 1.3 2.1 0.6 0.1 0.0 0.3 0.7 1.4 0.0 

65+ 0.1 0.2 0.0 1.6 3.7 0.4 0.2 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 

TOTAL 0.5 0.6 0.4 14.3 16.9 11.9 1.6 2.3 0.8 0.4 0.6 0.2 2.4 1.7 3.1 

10-14 0.0 0.0 0.0 0.6 0.2 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.4 0.0 0.9 

15-19 0.4 0.2 0.6 12.3 8.5 16.1 1.3 1.3 1.3 0.1 0.0 0.2 1.8 0.9 2.8 

20-24 0.9 0.7 1.2 24.4 23.7 25.0 2.9 3.5 2.3 0.4 0.2 0.7 7.2 3.3 11.2 

25-29 

30-34 

35-39 

1.2 1.5 0.9 

1.3 1.8 0.9 

1.4 1.8 0.9 

24.8 27.9 22.0 

25.2 28.1 22.6 

23.4 28.1 19.4 

3.2 

3.0 

3.9 

4.4 

4.3 

5.4 

1.7 

1.5 

2.3 

0.8 1.4 0.2 

1.1 1.8 0.4 

0.5 0.9 0.2 

5.5 8.6 2.4 

2000

3.0 2.5 3.6 

3.8 3.4 4.2 

40-44 1.1 1.4 0.7 20.1 26.6 14.4 2.2 3.2 1.2 0.2 0.5 0.0 2.8 3.5 2.1 

45-54 0.5 0.8 0.2 12.3 19.5 6.1 1.3 2.0 0.7 0.3 0.6 0.0 1.4 2.9 0.0 

55-64 0.2 0.4 0.0 5.2 9.9 1.4 0.6 1.2 0.1 0.0 0.0 0.0 1.2 1.3 1.2 

65+ 0.1 0.2 0.0 1.7 4.0 0.3 0.2 0.4 0.0 0.1 0.3 0.0 0.7 1.7 0.0 

TOTAL 0.5 0.7 0.4 12.0 14.2 10.1 1.6 2.2 0.9 0.3 0.5 0.1 2.2 2.2 2.2 

10-14 0.0 0.0 0.0 0.5 0.1 1.0 0.1 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 

15-19 0.2 0.2 0.3 9.7 6.4 13.1 1.8 1.8 1.9 0.2 0.2 0.2 1.8 1.8 1.8 

20-24 0.9 1.2 0.7 20.2 21.8 18.7 3.9 5.4 2.1 0.7 1.1 0.2 8.1 4.2 12.1 

25-29 

30-34 

35-39 

1.3 2.1 0.5 

1.8 2.8 0.7 

2.2 3.7 0.7 

22.1 27.0 17.6 

21.3 26.4 16.7 

23.2 30.0 17.1 

3.9 

4.1 

4.4 

5.8 

6.5 

7.6 

1.6 

1.3 

0.9 

1.1 2.3 0.0 

1.0 2.1 0.0 

1.4 2.7 0.2 

10.6 13.7 7.4 

2001

9.8 11.2 8.4 

6.7 5.9 7.6 

40-44 1.4 2.4 0.4 18.2 25.7 11.6 2.4 3.7 0.9 0.2 0.5 0.0 7.9 10.6 5.3 

45-54 0.7 1.3 0.2 11.8 18.8 5.9 1.8 3.1 0.5 0.3 0.4 0.1 2.1 2.9 1.3 

55-64 0.3 0.5 0.0 4.9 9.1 1.5 0.9 1.8 0.2 0.2 0.5 0.0 1.2 2.5 0.0 

65+ 0.1 0.2 0.0 1.2 2.7 0.3 0.2 0.5 0.0 0.0 0.0 0.0 0.7 1.5 0.0 

TOTAL 0.7 1.2 0.2 10.7 13.5 8.2 2.0 3.2 0.8 0.5 0.9 0.1 3.8 4.2 3.4 

10-14 0.0 0.0 0.0 0.3 0.1 0.5 0.1 0.1 0.1 0.1 0.0 0.2 0.0 0.0 0.0 

15-19 0.3 0.1 0.4 8.3 5.8 11.0 1.9 2.2 1.6 0.2 0.0 0.5 0.4 0.0 0.9 

20-24 1.0 1.4 0.6 19.0 22.1 16.0 4.0 5.9 1.8 1.4 2.0 0.9 4.2 5.2 3.2 

25-29 

30-34 

35-39 

2.0 3.3 0.6 

3.0 5.6 0.5 

3.9 7.3 0.5 

19.4 27.1 12.5 

17.9 24.6 11.8 

20.5 29.5 12.5 

4.4 

5.4 

6.3 

6.7 

9.0 

10.7 

1.6 

1.2 

1.5 

1.5 2.9 0.2 

1.8 3.5 0.2 

1.4 2.7 0.2 

2.5 3.8 1.2 

2002

1.9 1.3 2.4 

4.6 3.7 5.5 

40-44 2.8 5.3 0.3 16.0 23.2 9.6 3.8 6.8 0.7 1.5 2.8 0.2 3.9 4.6 3.2 

45-54 1.3 2.5 0.2 10.7 17.8 4.6 2.3 3.8 0.8 0.5 1.1 0.0 5.1 5.7 4.5 

55-64 0.5 0.9 0.0 4.3 8.2 1.1 0.5 1.1 0.0 0.0 0.0 0.0 1.1 1.2 1.1 

65+ 0.0 0.1 0.0 1.4 3.1 0.4 0.5 1.0 0.1 0.0 0.0 0.0 0.7 1.5 0.0 

TOTAL 1.2 2.2 0.2 9.5 13.0 6.3 2.5 4.1 0.8 0.8 1.4 0.2 2.1 2.3 1.9 

10-14 0.0 0.0 0.0 0.1 0.1 0.2 0.1 0.0 0.3 0.0 0.0 0.0 0.4 0.0 0.9 

15-19 0.4 0.4 0.4 6.8 6.0 7.5 2.0 1.7 2.3 0.7 1.2 0.2 0.0 0.0 0.0 

20-24 1.5 2.4 0.7 16.4 21.8 11.1 4.9 7.1 2.3 1.4 2.4 0.4 1.6 3.1 0.0 

25-29 

30-34 

35-39 

2.6 4.6 0.6 

3.9 7.2 0.6 

5.1 9.5 0.6 

16.3 24.6 8.8 

15.6 25.1 7.1 

16.3 25.7 7.9 

5.2 

5.9 

7.0 

8.4 

9.9 

12.7 

1.3 

1.4 

0.8 

2.5 4.6 0.5 

1.7 3.5 0.0 

2.6 5.3 0.0 

5.0 5.1 5.0 

2003

8.1 13.8 2.4 

8.7 15.4 2.3 

40-44 3.6 6.9 0.3 13.6 21.9 6.3 6.0 10.7 1.0 1.9 3.9 0.2 4.5 6.0 3.2 

45-54 1.6 3.2 0.1 8.3 13.8 3.5 2.9 5.3 0.5 0.6 1.1 0.1 4.1 4.3 3.9 

55-64 0.5 1.0 0.0 3.2 6.0 0.9 0.7 1.3 0.1 0.2 0.5 0.0 2.4 5.1 0.0 

65+ 0.1 0.1 0.0 0.6 1.5 0.1 0.3 0.3 0.3 0.0 0.0 0.0 0.7 1.6 0.0 

TOTAL 1.5 2.9 0.2 7.8 11.7 4.2 3.0 5.0 0.8 1.0 2.0 0.1 2.9 4.2 1.5 

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 33 for age-specific cases and rates and Tables 26-28 for sex-specific 

cases and rates and overall totals. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables 

were specified. For 1999, NH did not report age and/or race/ethnicity for most cases and their case data and population denominators were excluded. Differences 

between total rates from this table and others in the report are due to different reporting formats and above listed exclusion. The 0 to 9 year age group is not shown 

because some of these cases may not be due to sexual transmission; however, they are included in the totals. 

STD Surveillance 2003 Syphilis Tables 123 
Table 35. Early latent syphilis — Reported cases and rates by state/area and region listed in alphabetical 

order: United States and outlying areas, 1999–2003 

State/Area 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 

Alabama 367 219 192 211 140 8.3 4.9 4.3 4.7 3.1 

Alaska 1 1 0 1 0 0.2 0.2 0.0 0.2

Arizona 290 248 266 200 232 5.8 4.8 5.0 3.7 4.3 

Arkansas 123 117 60 51 71 4.6 4.4 2.2 1.9 2.6 

California 591 353 408 716 820 1.8 1.0 1.2 2.0 2.3 

Colorado 6 7 14 22 20 0.1 0.2 0.3 0.5 0.4 

Connecticut 12 9 20 13 13 0.4 0.3 0.6 0.4 0.4 

Delaware 16 10 18 9 11 2.1 1.3 2.3 1.1 1.4 

Florida 1,085 1,165 947 949 988 6.9 7.3 5.8 5.7 5.9 

Georgia 729 521 703 701 720 9.1 6.3 8.4 8.2 8.4

Hawaii 1 3 7 21 6 0.1 0.2 0.6 1.7 0.5 

Idaho 1 0 0 4 8 0.1 0.0 0.0 0.3

Illinois 639 382 386 528 350 5.2 3.1 3.1 4.2 2.8 

Indiana 172 184 120 53 58 2.8 3.0 2.0 0.9 0.9 

Iowa 4 8 6 8 5 0.1 0.3 0.2 0.3

Kansas 19 9 18 13 19 0.7 0.3 0.7 0.5 0.7 

Kentucky 81 62 38 49 43 2.0 1.5 0.9 1.2 1.1 

Louisiana 404 231 194 183 197 9.1 5.2 4.3 4.1 4.4 

Maine 0 0 3 1 7 0.0 0.0 0.2 0.1

Maryland 610 518 362 181 211 11.6 9.8 6.7 3.3 3.9 

Massachusetts 65 83 64 95 136 1.0 1.3 1.0 1.5 2.1 

Michigan 302 406 368 255 122 3.1 4.1 3.7 2.5 1.2 

Minnesota 9 18 16 23 45 0.2 0.4 0.3 0.5 0.9 

Mississippi 553 409 329 149 173 19.6 14.4 11.5 5.2 6.0 

Missouri 99 52 33 51 46 1.8 0.9 0.6 0.9 0.8 

Montana 2 0 0 0 0 0.2 0.0 0.0 0.0

Nebraska 6 1 1 0 1 0.4 0.1 0.1 0.0

Nevada 28 9 7 12 35 1.4 0.4 0.3 0.6 1.6 

New Hampshire 1 0 2 1 4 0.1 0.0 0.2 0.1

New Jersey 99 109 234 220 326 1.2 1.3 2.7 2.6 3.8 

New Mexico 2 25 18 23 53 0.1 1.4 1.0 1.2 2.9 

New York 700 467 566 756 1,019 3.7 2.5 3.0 3.9 5.3 

North Carolina 740 618 483 333 261 9.3 7.6 5.9 4.0 3.1 

North Dakota 0 1 0 0 0 0.0 0.2 0.0 0.0

Ohio 168 119 100 84 92 1.5 1.0 0.9 0.7 0.8 

Oklahoma 249 128 121 124 77 7.2 3.7 3.5 3.5 2.2 

Oregon 6 19 9 18 27 0.2 0.6 0.3 0.5 0.8 

Pennsylvania 414 278 260 237 216 3.4 2.3 2.1 1.9 1.8 

Rhode Island 1 1 1 9 7 0.1 0.1 0.1 0.8

South Carolina 407 394 394 202 180 10.2 9.8 9.7 4.9 4.4 

South Dakota 1 0 0 0 3 0.1 0.0 0.0 0.0

Tennessee 647 627 553 390 228 11.5 11.0 9.6 6.7 3.9 

Texas 1,273 1,171 964 1,149 1,065 6.2 5.6 4.5 5.3 4.9 

Utah 5 10 0 8 7 0.2 0.4 0.0 0.3 0.3 

Vermont 0 0 1 0 0 0.0 0.0 0.2 0.0

Virginia 212 140 133 94 74 3.0 2.0 1.8 1.3 1.0 

Washington 17 20 19 23 36 0.3 0.3 0.3 0.4 0.6 

West Virginia 3 3 1 1 2 0.2 0.2 0.1 0.1

Wisconsin 90 72 43 66 54 1.7 1.3 0.8 1.2 1.0 

Wyoming 0 0 0 0 1 0.0 0.0 0.0 0.0

U.S. TOTAL* 11,534 9,465 8,701 8,429 8,361 4.1 3.4 3.0 2.9 2.9 

Northeast 1,292 947 1,151 1,332 1,728 2.4 1.8 2.1 2.5 3.2 

Midwest 1,509 1,252 1,091 1,081 795 2.4 1.9 1.7 1.7 1.2 

South 7,783 6,571 5,711 4,968 4,593 7.8 6.5 5.6 4.8 4.4 

West 950 695 748 1,048 1,245 1.5 1.1 1.2 1.6 1.9 

Guam 

Puerto Rico 

Virgin Islands 

0

680 

12 

1

663 

5 

2

600 

8 

3

702 

1 

1 

748 

6 

0.0 

17.5 

10.6 

0.6 

17.4 

4.6 

1.3 

15.6 

7.3 

1.9

18.2 

0.9 

19.4 

5.5 

OUTLYING AREAS 692 669 610 706 755 16.6 16.4 14.9 17.1 18.3 

TOTAL 12,226 10,134 9,311 9,135 9,116 4.3 3.5 3.2 3.1 3.1 

0.0 

0.6 

0.2 

0.5 

0.0 

0.1 

0.3 

0.0 

0.7 

0.4 

0.0 

0.1 

0.2 

0.6 

*Includes cases reported by Washington, D.C. 

124 Syphilis Tables STD Surveillance 2003 
Table 36. Early latent syphilis — Reported cases and rates in selected cities listed in alphabetical order: 

United States and outlying areas, 1999–2003 

City 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003
 1999 2000 2001 2002 2003 

Akron, OH 6 1 2 1 1
 1.1 0.2 0.4 0.2

Albuquerque, NM 2 19 8 10 15 0.4 3.4 1.4 1.7 2.6 

Atlanta, GA 241 173 398 406 464 29.9 21.2 48.2 49.2 56.2 

Austin, TX 23 27 31 23 35 3.8 4.3 4.7 3.4 5.2 

Baltimore, MD 472 384 257 124 161 71.8 59.2 39.8 19.4 25.2 

Birmingham, AL 103 62 35 27 23 15.5 9.4 5.3 4.1 3.5 

Boston, MA 41 29 26 50 64 6.9 4.8 4.3 8.4 10.7 

Buffalo, NY 1 1 0 2 2 0.3 0.3 0.0 0.6

Charlotte, NC 99 63 69 40 24 14.5 9.0 9.6 5.4 3.3 

Chicago, IL 521 292 298 439 296 16.9 9.5 9.6 14.2 9.6 

Cincinnati, OH 5 2 2 0 0 0.6 0.2 0.2 0.0

Cleveland, OH 63 29 31 10 3 4.5 2.1 2.2 0.7 0.2 

Columbus, OH 34 32 33 48 35 3.2 3.0 3.1 4.4 3.2 

Corpus Christi, TX 9 3 1 1 10 3.2 1.1 0.4 0.4

Dallas, TX 384 361 247 351 298 32.6 30.2 20.3 29.0 24.6 

Dayton, OH 5 2 4 1 3 0.9 0.4 0.7 0.2

Denver, CO 4 1 4 12 13 0.7 0.2 0.7 2.1 2.3 

Des Moines, IA 2 6 4 5 2 0.5 1.6 1.1 1.3

Detroit, MI 223 328 293 172 90 23.3 34.5 30.9 18.2 9.5 

El Paso, TX 9 11 14 32 27 1.6 1.9 2.4 5.5 4.7 

Fort Worth, TX 66 80 60 115 58 12.5 14.9 10.9 20.3 10.2 

Honolulu, HI 1 1 4 16 6 0.1 0.1 0.5 1.8 0.7 

Houston, TX 248 134 137 136 150 13.4 7.1 7.2 6.8 7.5 

Indianapolis, IN 102 125 82 30 22 11.9 14.5 9.5 3.5 2.5 

Jacksonville, FL 37 46 54 25 35 4.8 5.9 6.8 3.1 4.3 

Jersey City, NJ 1 1 6 15 13 0.4 0.4 2.5 6.2 5.4 

Kansas City, MO 16 4 1 5 15 3.5 0.9 0.2 1.1 3.3 

Los Angeles, CA 330 187 203 349 384 3.7 2.1 2.2 3.8 4.2 

Louisville, KY 38 40 20 33 26 5.5 5.8 2.9 4.7 3.7 

Memphis, TN 338 325 356 202 154 37.8 36.2 39.5 22.3 17.0 

Miami, FL 294 329 221 295 345 13.2 14.5 9.6 12.6 14.8 

Milwaukee, WI 84 55 35 51 34 8.9 5.9 3.7 5.4 3.6 

Minneapolis, MN 7 11 8 17 23 1.8 2.9 2.1 4.4 6.0 

Nashville, TN 201 173 137 109 25 35.4 30.3 24.0 19.1 4.4 

New Orleans, LA 65 32 31 39 36 13.4 6.6 6.5 8.2 7.6 

New York City, NY 659 447 548 726 958 8.3 5.6 6.8 9.0 11.9 

Newark, NJ 23 58 74 74 121 7.7 19.3 24.5 24.5 40.0 

Norfolk, VA 34 23 25 14 11 14.6 9.8 10.6 5.9 4.6 

Oakland, CA 22 4 12 12 28 1.5 0.3 0.8 0.8 1.9 

Oklahoma City, OK 147 86 73 74 53 34.7 20.2 17.0 17.1 12.2 

Omaha, NE 2 1 0 0 0 0.4 0.2 0.0 0.0

Philadelphia, PA 394 261 248 214 194 25.9 17.2 16.5 14.3 13.0 

Phoenix, AZ 266 220 243 150 161 8.9 7.1 7.6 4.5 4.9 

Pittsburgh, PA 1 1 4 6 5 0.1 0.1 0.3 0.5

Portland, OR 5 12 7 17 16 1.0 2.3 1.3 3.2 3.0 

Richmond, VA 34 18 28 11 16 17.1 9.1 14.2 5.6 8.1 

Rochester, NY 2 0 1 2 6 0.8 0.0 0.4 0.8

Sacramento, CA 3 2 5 8 3 0.2 0.2 0.4 0.6

San Antonio, TX 72 102 120 105 62 6.4 8.9 10.3 8.8 5.2 

San Diego, CA 23 10 16 34 41 0.8 0.4 0.6 1.2 1.4 

San Francisco, CA 14 18 47 173 191 1.8 2.3 6.1 22.6 25.0 

San Jose, CA 11 4 12 11 20 0.7 0.2 0.7 0.7 1.2 

Seattle, WA 6 16 14 10 24 0.3 0.9 0.8 0.6 1.4 

St Louis, MO 40 21 15 23 12 11.4 6.1 4.4 6.8 3.5 

St Paul, MN 1 1 4 2 8 0.4 0.4 1.4 0.7

St Petersburg, FL 15 23 6 19 40 1.6 2.5 0.6 2.1 4.3 

Tampa, FL 51 56 51 57 98 5.2 5.6 5.0 5.4 9.3 

Toledo, OH 5 3 1 3 7 1.1 0.7 0.2 0.7

Tucson, AZ 14 14 8 29 46 1.7 1.6 0.9 3.3 5.2 

Tulsa, OK 40 8 5 16 6 10.2 2.0 1.3 4.0 1.5 

Washington, DC 284 238 219 192 152 49.8 41.6 38.2 33.6 26.6 

Wichita, KS 11 1 7 3 4 2.4 0.2 1.5 0.6

Yonkers, NY 2 0 0 1 5 1.0 0.0 0.0 0.5

U.S. CITY TOTAL 6,256 5,017 4,905 5,177 5,180 9.0 7.2 7.0 7.3 7.3 

San Juan, PR 296 250 232 210 343 28.1 24.5 22.7 20.5 33.5 

TOTAL 6,552 5,267 5,137 5,387 5,523 9.3 7.4 7.2 7.5 7.7 

3.6 

0.5 

0.4 

0.2 

0.6 

0.0 

0.5 

0.0 

2.4 

0.2 

2.8 

1.5 

0.9 

2.5 

STD Surveillance 2003 Syphilis Tables 125 
State/Area 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 

Alabama 443 403 380 334 309 10.0 9.1 8.5 7.4 6.9 

Alaska 11 5 9 8 7 1.8 0.8 1.4 1.2

Arizona 307 385 672 666 659 6.1 7.5 12.7 12.2 12.1 

Arkansas 140 130 124 124 172 5.3 4.9 4.6 4.6 6.3 

California 1,897 2,590 2,038 2,107 2,024 5.7 7.6 5.9 6.0 5.8 

Colorado 76 45 111 86 82 1.8 1.0 2.5 1.9 1.8 

Connecticut 97 125 131 147 163 2.9 3.7 3.8 4.2 4.7 

Delaware 46 26 47 42 29 5.9 3.3 5.9 5.2 3.6 

Florida 1,231 1,150 1,446 1,686 1,610 7.8 7.2 8.8 10.1 9.6 

Georgia 799 695 850 743 836 9.9 8.4 10.1 8.7 9.8 

Hawaii 7 17 22 27 39 0.6 1.4 1.8 2.2 3.1 

Idaho 11 10 10 11 18 0.9 0.8 0.8 0.8 1.3 

Illinois 851 794 706 546 633 6.9 6.4 5.6 4.3 5.0 

Indiana 173 212 245 196 252 2.9 3.5 4.0 3.2 4.1 

Iowa 24 36 33 38 29 0.8 1.2 1.1 1.3 1.0 

Kansas 62 50 43 44 32 2.3 1.9 1.6 1.6 1.2 

Kentucky 120 103 104 72 83 3.0 2.5 2.6 1.8 2.0 

Louisiana 701 526 426 439 1,195 15.7 11.8 9.5 9.8 26.7 

Maine 1 6 12 6 6 0.1 0.5 0.9 0.5 0.5 

Maryland 405 338 305 415 443 7.7 6.4 5.7 7.6 8.1 

Massachusetts 283 296 334 346 375 4.5 4.7 5.2 5.4 5.8 

Michigan 207 232 347 408 451 2.1 2.3 3.5 4.1 4.5 

Minnesota 52 43 83 65 103 1.1 0.9 1.7 1.3 2.1 

Mississippi 147 125 175 247 220 5.2 4.4 6.1 8.6 7.7 

Missouri 191 215 110 118 96 3.4 3.8 2.0 2.1 1.7 

Montana 0 0 0 4 0 0.0 0.0 0.0 0.4

Nebraska 12 4 5 19 15 0.7 0.2 0.3 1.1 0.9 

Nevada 59 38 47 86 102 3.0 1.9 2.2 4.0 4.7 

New Hampshire 14 17 17 15 14 1.1 1.4 1.3 1.2 1.1 

New Jersey 587 599 637 637 572 7.0 7.1 7.5 7.4 6.7 

New Mexico 66 57 36 48 75 3.7 3.1 2.0 2.6 4.0 

New York 3,201 2,308 2,701 2,620 2,715 17.0 12.1 14.2 13.7 14.2 

North Carolina 490 375 475 424 417 6.2 4.6 5.8 5.1 5.0 

North Dakota 0 0 2 0 0 0.0 0.0 0.3 0.0

Ohio 98 89 115 105 189 0.9 0.8 1.0 0.9 1.7 

Oklahoma 94 82 102 89 211 2.7 2.4 2.9 2.5 6.0 

Oregon 23 18 26 29 43 0.7 0.5 0.7 0.8 1.2 

Pennsylvania 427 321 362 342 329 3.5 2.6 2.9 2.8 2.7 

Rhode Island 51 33 29 45 50 4.9 3.1 2.7 4.2 4.7 

South Carolina 230 206 268 269 263 5.8 5.1 6.6 6.5 6.4 

South Dakota 1 1 0 0 0 0.1 0.1 0.0 0.0

Tennessee 439 525 580 514 511 7.8 9.2 10.1 8.9 8.8 

Texas 1,885 1,659 2,145 2,299 2,200 9.2 7.9 10.0 10.6 10.1 

Utah 42 46 14 56 51 1.9 2.1 0.6 2.4 2.2 

Vermont 0 0 4 0 0 0.0 0.0 0.7 0.0

Virginia 354 266 287 362 395 5.1 3.7 4.0 5.0 5.4 

Washington 110 85 98 63 121 1.9 1.4 1.6 1.0 2.0 

West Virginia 7 7 1 2 7 0.4 0.4 0.1 0.1

Wisconsin 52 60 64 38 41 1.0 1.1 1.2 0.7 0.8 

Wyoming 0 4 3 1 3 0.0 0.8 0.6 0.2

U.S. TOTAL* 16,653 15,594 16,976 17,168 18,319 6.0 5.5 5.9 6.0 6.4 

Northeast 4,661 3,705 4,227 4,158 4,224 8.7 6.9 7.8 7.7 7.8 

Midwest 1,723 1,736 1,753 1,577 1,841 2.7 2.7 2.7 2.4 2.8 

South 7,660 6,853 7,910 8,241 9,030 7.7 6.8 7.8 8.0 8.7 

West 2,609 3,300 3,086 3,192 3,224 4.2 5.2 4.8 4.9 4.9 

Guam 

Puerto Rico 

Virgin Islands 

10 

614 

0 

7 

485 

3 

15 

402 

0 

9 

398 

2 

13 

390 

5 

6.1 

15.8 

0.0 

4.5 

12.7 

2.8 

9.5 

10.5 

0.0 

5.6 

10.3 

1.8

8.1 

10.1 

OUTLYING AREAS 624 495 417 409 408 15.0 12.1 10.2 9.9 9.9 

TOTAL 17,277 16,089 17,393 17,577 18,727 6.1 5.6 6.0 6.0 6.4 

0.4 

Table 37. Late and late latent syphilis — Reported cases and rates by state/area and region listed in 

alphabetical order: United States and outlying areas, 1999–2003 

1.1 

0.0 

0.0 

0.0 

0.0 

0.6 

4.5 

*Includes cases reported by Washington, D.C. 

126 Syphilis Tables STD Surveillance 2003 
Table 38. Late and late latent syphilis — Reported cases and rates in selected cities listed in alphabetical 

order: United States and outlying areas, 1999–2003 

City 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003
 1999 2000 2001 2002 2003 

Akron, OH 0 1 1 2 1
 0.0 0.2 0.2 0.4

Albuquerque, NM 37 33 26 29 23 6.7 5.9 4.6 5.1 4.0 

Atlanta, GA 119 88 168 159 201 14.7 10.8 20.4 19.3 24.4 

Austin, TX 20 24 64 52 63 3.3 3.8 9.8 7.7 9.4 

Baltimore, MD 202 111 57 145 138 30.7 17.1 8.8 22.7 21.6 

Birmingham, AL 149 124 101 89 65 22.5 18.7 15.3 13.5 9.8 

Boston, MA 107 106 113 133 165 17.9 17.7 18.8 22.2 27.6 

Buffalo, NY 4 8 7 5 5 1.2 2.5 2.2 1.6

Charlotte, NC 39 40 31 33 67 5.7 5.7 4.3 4.5 9.1 

Chicago, IL 475 468 444 325 369 15.4 15.2 14.4 10.5 12.0 

Cincinnati, OH 6 12 12 15 9 0.7 1.4 1.4 1.8 1.1 

Cleveland, OH 11 7 5 5 15 0.8 0.5 0.4 0.4 1.1 

Columbus, OH 30 18 52 45 76 2.8 1.7 4.8 4.1 7.0 

Corpus Christi, TX 10 6 8 9 13 3.6 2.2 2.9 3.2 4.7 

Dallas, TX 156 120 326 493 413 13.2 10.1 26.8 40.7 34.1 

Dayton, OH 9 10 12 4 10 1.6 1.8 2.2 0.7 1.8 

Denver, CO 37 18 45 36 38 6.7 3.2 8.0 6.4 6.8 

Des Moines, IA 5 11 10 9 14 1.3 2.9 2.6 2.3 3.6 

Detroit, MI 136 145 257 294 319 14.2 15.3 27.1 31.1 33.8 

El Paso, TX 60 73 78 74 77 10.7 12.9 13.6 12.8 13.3 

Fort Worth, TX 87 85 159 149 112 16.5 15.8 28.8 26.3 19.8 

Honolulu, HI 4 13 16 26 32 0.5 1.5 1.8 2.9 3.6 

Houston, TX 755 614 661 748 642 40.9 32.7 34.6 37.2 31.9 

Indianapolis, IN 38 92 87 65 74 4.4 10.7 10.1 7.5 8.6 

Jacksonville, FL 30 53 47 28 68 3.9 6.8 5.9 3.5 8.4 

Jersey City, NJ 38 22 26 26 27 15.9 9.1 10.7 10.8 11.2 

Kansas City, MO 41 39 24 24 21 9.1 8.6 5.3 5.3 4.6 

Los Angeles, CA 740 1,496 923 890 879 8.4 16.7 10.2 9.7 9.6 

Louisville, KY 69 51 61 31 48 10.0 7.3 8.8 4.4 6.9 

Memphis, TN 321 297 324 247 245 35.9 33.1 36.0 27.3 27.1 

Miami, FL 409 356 628 766 619 18.4 15.7 27.3 32.8 26.5 

Milwaukee, WI 36 49 43 21 18 3.8 5.2 4.6 2.2 1.9 

Minneapolis, MN 15 14 32 24 29 3.9 3.6 8.3 6.2 7.5 

Nashville, TN 54 145 162 154 149 9.5 25.4 28.4 27.0 26.1 

New Orleans, LA 108 70 46 53 142 22.2 14.5 9.6 11.2 30.0 

New York City, NY 2,907 2,115 2,442 2,300 2,306 36.6 26.4 30.3 28.5 28.5 

Newark, NJ 115 170 237 194 172 38.4 56.6 78.6 64.1 56.8 

Norfolk, VA 30 22 22 20 29 12.8 9.4 9.3 8.4 12.1 

Oakland, CA 92 75 71 114 108 6.4 5.2 4.8 7.7 7.3 

Oklahoma City, OK 34 25 50 43 92 8.0 5.9 11.7 9.9 21.2 

Omaha, NE 3 3 0 13 14 0.7 0.6 0.0 2.7 3.0 

Philadelphia, PA 355 281 315 280 292 23.4 18.6 21.0 18.8 19.6 

Phoenix, AZ 245 324 546 536 519 8.2 10.5 17.1 16.2 15.7 

Pittsburgh, PA 4 3 4 13 8 0.3 0.2 0.3 1.0 0.6 

Portland, OR 9 7 13 11 15 1.7 1.3 2.5 2.1 2.8 

Richmond, VA 17 17 20 11 21 8.5 8.6 10.1 5.6 10.6 

Rochester, NY 13 6 1 7 11 5.3 2.4 0.4 2.8 4.4 

Sacramento, CA 13 20 24 19 11 1.1 1.6 1.9 1.5 0.8 

San Antonio, TX 121 113 167 155 96 10.7 9.8 14.3 13.0 8.0 

San Diego, CA 196 195 103 87 139 7.0 6.9 3.6 3.0 4.8 

San Francisco, CA 84 91 114 116 132 10.8 11.7 14.7 15.2 17.3 

San Jose, CA 40 36 68 47 55 2.4 2.1 4.0 2.8 3.3 

Seattle, WA 51 50 55 36 50 2.9 2.9 3.1 2.0 2.8 

St Louis, MO 69 82 30 44 21 19.7 23.6 8.8 13.0 6.2 

St Paul, MN 3 6 7 9 13 1.1 2.1 2.4 3.2

St Petersburg, FL 18 34 23 40 37 2.0 3.7 2.5 4.3 4.0 

Tampa, FL 41 55 76 130 121 4.2 5.5 7.4 12.3 11.5 

Toledo, OH 10 13 1 3 7 2.2 2.9 0.2 0.7 1.5 

Tucson, AZ 20 14 42 34 39 2.4 1.6 4.9 3.9 4.4 

Tulsa, OK 23 16 12 6 24 5.8 4.1 3.0 1.5 6.0 

Washington, DC 129 237 195 180 129 22.6 41.5 34.0 31.5 22.6 

Wichita, KS 16 7 4 7 7 3.5 1.5 0.9 1.5

Yonkers, NY 9 9 12 23 24 4.6 4.5 6.0 11.4 11.9 

U.S. CITY TOTAL 9,024 8,845 9,710 9,686 9,678 13.0 12.7 13.8 13.6 13.6 

San Juan, PR 322 222 178 152 147 30.6 21.7 17.4 14.8 14.3 

TOTAL 9,346 9,067 9,888 9,838 9,825 13.3 12.8 13.8 13.7 13.6 

0.2 

1.6 

4.6 

1.5 

STD Surveillance 2003 Syphilis Tables 127 
Table 39. Congenital syphilis — Reported cases and rates in infants <1 year of age: United States (excluding 

outlying areas), 1963–2003 

Year Cases Rate per 100,000 Live Births 

1963* 367 9.2 

1964* 336 8.7 

1965* 335 8.9 

1966* 333 8.8 

1967 156 4.1 

1968 274 7.3 

1969 264 7.0 

1970 323 8.6 

1971 422 11.9 

1972 360 11.0 

1973 295 9.4 

1974 250 7.9 

1975 169 5.3 

1976 160 5.1 

1977 134 4.0 

1978 104 3.0 

1979 123 3.5 

1980 107 3.0 

1981 160 4.4 

1982 159 4.3 

1983 158 4.3 

1984 247 6.7 

1985 266 7.1 

1986 357 9.5 

1987 444 11.7 

1988 658 16.8 

1989 1,807 44.7 

1990 3,816 91.8 

1991 4,410 107.3 

1992 4,024 99.0 

1993 3,395 84.9 

1994 2,435 61.6 

1995 1,861 47.7 

1996 1,280 32.9 

1997 1,080 27.8 

1998 841 21.3 

1999 575 14.5 

2000 578 14.2 

2001 498 12.4 

2002 453 11.3 

2003 413 10.3 

*For 1963 to 1966 data were reported for the federal fiscal year ending June 30 of the year indicated. 

NOTE: The surveillance case definition for congenital syphilis changed in 1988. As of 1995, cases of congenital syphilis <1 year of age are obtained 

using case reporting form CDC 73.126. For the period 1995 through 2003, yearly case counts in this table correspond to confirmed diagnoses of 

congenital syphilis among those known to be less than one year of age. As a result, the case counts in this table are a subset of those listed in Table 1 

for the years prior to 1995. 

128 Syphilis Tables STD Surveillance 2003 
Table 40. Congenital syphilis — Reported cases and rates in infants <1 year of age by state, ranked 

by rates: United States, 2003 

Rank* State† Cases Rate per 100,000 Live Births 

1 Arizona 29 33.0 

2 Michigan 38 29.2 

3 New Mexico 6 21.6 

4 Texas 77 20.7 

5 South Carolina 11 20.2 

6 Idaho 4 19.1 

7 New Jersey 21 18.3 

8 Indiana 15 17.6 

9 New York 42 16.7 

10 North Carolina 18 15.3 

11 Florida 26 12.6 

12 California 59 11.1 

13 Maryland 8 10.9 

14 Illinois 19 10.5 

U.S. TOTAL§ 413 10.3 

15 Georgia 11 8.3 

16 Missouri 4 5.3 

17 Arkansas 2 5.3 

18 Alabama 3 5.1 

19 Mississippi 2 4.8 

20 Colorado 3 4.4 

21 Nebraska 1 3.9 

22 Tennessee 2 2.6 

23 Kansas 1 2.5 

24 Connecticut 1 2.4 

25 Ohio 3 2.0 

26 Oklahoma 1 2.0 

27 Kentucky 1 1.8 

28 Louisiana 1 1.5 

29 Pennsylvania 2 1.4 

30 Virginia 1 1.0 

YEAR 2010 TARGET 1.0 

Alaska 0 0.0 

Delaware 0 0.0 

Hawaii 0 0.0 

Iowa 0 0.0 

Maine 0 0.0 

Massachusetts 0 0.0 

Minnesota 0 0.0 

Montana 0 0.0 

Nevada 0 0.0 

New Hampshire 0 0.0 

North Dakota 0 0.0 

Oregon 0 0.0 

Rhode Island 0 0.0 

South Dakota 0 0.0 

Utah 0 0.0 

Vermont 0 0.0 

Washington 0 0.0 

West Virginia 0 0.0 

Wisconsin 0 0.0 

Wyoming 0 0.0 

*States were ranked in descending order by rate, number of cases, and alphabetically by state. States with no cases were not ranked. †

Mother’s state of residence used to assign case. 

§

Total includes cases reported by Washington, D.C. but excludes outlying areas (Guam with 1 case and rate of 31.1, Puerto Rico with 15 cases and 

rate of 28.4, and Virgin Islands with 0 cases and rate of 0.0). 

STD Surveillance 2003 Syphilis Tables 129 
Table 41. Congenital syphilis — Reported cases and rates in infants <1 year of age by state/area and region 

listed in alphabetical order: United States and outlying areas, 1999–2003 

State/Area* 

Cases Rates per 100,000 Live Births 

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 

Alabama 7 8 10 6 3 11.3 12.6 16.5 10.2 5.1 

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0

Arizona 24 26 29 19 29 29.6 30.5 33.9 21.6 33.0 

Arkansas 14 15 6 10 2 38.1 39.7 16.2 26.7 5.3 

California 88 86 62 61 59 17.0 16.2 11.7 11.5 11.1 

Colorado 1 0 1 2 3 1.6 0.0 1.5 2.9

Connecticut 1 1 2 0 1 2.3 2.3 4.7 0.0

Delaware 0 0 0 0 0 0.0 0.0 0.0 0.0

Florida 31 42 38 28 26 15.7 20.6 18.5 13.6 12.6 

Georgia 16 22 21 13 11 12.6 16.6 15.7 9.8 8.3 

Hawaii 0 0 0 0 0 0.0 0.0 0.0 0.0

Idaho 0 0 0 0 4 0.0 0.0 0.0 0.0 19.1 

Illinois 54 50 46 40 19 29.7 27.0 25.0 22.1 10.5 

Indiana 7 4 13 8 15 8.1 4.6 15.0 9.4 17.6 

Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0

Kansas 0 2 2 0 1 0.0 5.0 5.1 0.0

Kentucky 0 3 1 3 1 0.0 5.4 1.8 5.5

Louisiana 12 7 0 1 1 17.9 10.3 0.0 1.5 1.5 

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0

Maryland 27 16 5 19 8 37.5 21.5 6.8 25.9 10.9 

Massachusetts 0 1 2 1 0 0.0 1.2 2.5 1.2

Michigan 22 33 27 35 38 16.5 24.2 20.2 26.9 29.2 

Minnesota 0 0 0 1 0 0.0 0.0 0.0 1.5

Mississippi 12 14 10 6 2 28.1 31.8 23.7 14.5 4.8 

Missouri 10 3 5 1 4 13.3 3.9 6.6 1.3 5.3 

Montana 0 0 0 1 0 0.0 0.0 0.0 9.1

Nebraska 0 0 0 0 1 0.0 0.0 0.0 0.0

Nevada 0 0 0 0 0 0.0 0.0 0.0 0.0

New Hampshire 1 0 0 0 0 7.1 0.0 0.0 0.0

New Jersey 49 23 32 36 21 42.9 19.9 27.6 31.4 18.3 

New Mexico 0 3 3 5 6 0.0 11.0 11.1 18.0 21.6 

New York 43 40 39 31 42 16.8 15.5 15.4 12.3 16.7 

North Carolina 19 19 19 15 18 16.7 15.8 16.1 12.8 15.3 

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0

Ohio 6 5 1 3 3 3.9 3.2 0.7 2.0

Oklahoma 9 1 5 2 1 18.4 2.0 10.0 4.0 2.0 

Oregon 0 0 0 0 0 0.0 0.0 0.0 0.0

Pennsylvania 7 9 4 5 2 4.8 6.2 2.8 3.5

Rhode Island 0 0 0 0 0 0.0 0.0 0.0 0.0

South Carolina 23 32 19 15 11 41.9 57.0 34.1 27.5 20.2 

South Dakota 1 0 0 0 0 9.5 0.0 0.0 0.0

Tennessee 10 25 14 10 2 12.9 31.4 17.9 12.9 2.6 

Texas 68 72 75 72 77 19.5 19.8 20.5 19.3 20.7 

Utah 0 1 0 0 0 0.0 2.1 0.0 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0

Virginia 3 7 3 1 1 3.1 7.1 3.0 1.0

Washington 1 0 0 2 0 1.3 0.0 0.0 2.5

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0

Wisconsin 9 4 2 0 0 13.2 5.8 2.9 0.0 0.0 

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0

U.S. TOTAL† 575 578 498 453 413 14.5 14.2 12.4 11.3 10.3 

Northeast 101 74 79 73 66 14.7 10.7 11.5 10.8 9.7 

Midwest 109 101 96 88 81 12.4 11.2 10.8 10.0 9.2 

South 251 287 228 202 165 17.5 19.3 15.4 13.6 11.1 

West 114 116 95 90 101 12.0 11.8 9.7 9.1 10.3 

Guam 

Puerto Rico 

Virgin Islands 

0

23 

0 

0

17 

0 

1

22 

1 

1

23 

0 

1 

15 

0 

0.0 

38.6 

0.0 

0.0 

28.7 

0.0 

28.1 

39.4 

59.9 

31.1 

43.6 

0.0 

31.1 

28.4 

0.0 

OUTLYING AREAS 23 17 24 24 16 35.2 26.3 39.3 41.7 27.8 

TOTAL 598 595 522 477 429 14.9 14.4 12.8 11.7 10.5 

0.0 

4.4 

2.4 

0.0 

0.0 

0.0 

2.5 

1.8 

0.0 

0.0 

0.0 

0.0 

3.9 

0.0 

0.0 

0.0 

2.0 

0.0 

1.4 

0.0 

0.0 

0.0 

0.0 

1.0 

0.0 

0.0 

0.0 

*Mother’s state of residence used to assign case. 

†

Includes cases reported by Washington, D.C. 

130 Syphilis Tables STD Surveillance 2003 
Table 42. Congenital syphilis — Reported cases and rates in infants <1 year of age in selected cities, ranked 

by rates: United States, 2003 

Rank* City† Cases Rate per 100,000 Live Births 

1 Detroit, MI 36 250.3 

2 Newark, NJ 10 215.4 

3 Miami, FL 9 69.6 

4 Phoenix, AZ 17 67.5 

5 Indianapolis, IN 9 63.4 

6 Oakland, CA 4 61.7 

7 Baltimore, MD 5 51.9 

8 Houston, TX 21 46.6 

9 Los Angeles, CA 28 44.2 

10 San Diego, CA 8 43.3 

11 Tampa, FL 3 37.9 

12 Atlanta, GA 3 33.3 

13 Dallas, TX 8 32.3 

14 El Paso, TX 4 31.1 

15 Chicago, IL 14 29.2 

16 New York City, NY 30 25.4 

17 San Jose, CA 4 24.7 

18 Birmingham, AL 1 24.6 

19 Toledo, OH 1 21.2 

20 Charlotte, NC 2 18.8 

21 Memphis, TN 2 18.2 

22 Fort Worth, TX 2 17.5 

23 Louisville, KY 1 14.0 

24 Kansas City, MO 1 13.6 

25 Washington, DC 1 13.3 

26 San Antonio, TX 3 12.9 

27 Albuquerque, NM 1 11.9 

28 Philadelphia, PA 2 9.3 

29 Jacksonville, FL 1 8.8 

30 Denver, CO 1 8.7 

31 Austin, TX 1 7.8 

YEAR 2010 TARGET 1.0 

Tucson, AZ 0 0.0 

Sacramento, CA 0 0.0 

San Francisco, CA 0 0.0 

St Petersburg, FL 0 0.0 

Honolulu, HI 0 0.0 

Des Moines, IA 0 0.0 

Wichita, KS 0 0.0 

New Orleans, LA 0 0.0 

Boston, MA 0 0.0 

Minneapolis, MN 0 0.0 

St Paul, MN 0 0.0 

St Louis, MO 0 0.0 

Omaha, NE 0 0.0 

Jersey City, NJ 0 0.0 

Buffalo, NY 0 0.0 

Rochester, NY 0 0.0 

Yonkers, NY 0 0.0 

Akron, OH 0 0.0 

Cincinnati, OH 0 0.0 

Cleveland, OH 0 0.0 

Columbus, OH 0 0.0 

Dayton, OH 0 0.0 

Oklahoma City, OK 0 0.0 

Tulsa, OK 0 0.0 

Portland, OR 0 0.0 

Pittsburgh, PA 0 0.0 

Nashville, TN 0 0.0 

Corpus Christi, TX 0 0.0 

Norfolk, VA 0 0.0 

Richmond, VA 0 0.0 

Seattle, WA 0 0.0 

Milwaukee, WI 0 0.0 

*Cities were ranked in descending order by rate, number of cases, and alphabetically by state. Cities with no cases were not ranked. Excludes 

outlying areas (San Juan, PR, with 1 case and rate of 16.9). 

†

Mother's city of residence used to assign case. 

STD Surveillance 2003 Syphilis Tables 131 
Table 43. Congenital syphilis — Reported cases and rates in infants <1 year of age in selected cities listed in 

alphabetical order: United States and outlying areas, 1999–2003 

City* 

Cases Rates per 100,000 Live Births 

1999 2000 2001 2002 2003
 1999 2000 2001 2002 2003 

Akron, OH 0 0 0 0 0
 0.0 0.0 0.0 0.0

Albuquerque, NM 0 0 1 0 1 0.0 0.0 12.5 0.0 11.9 

Atlanta, GA 7 7 9 5 3 78.2 73.9 96.5 55.4 33.3 

Austin, TX 0 0 3 4 1 0.0 0.0 23.3 31.4 7.8 

Baltimore, MD 21 15 2 10 5 203.9 146.9 20.4 103.7 51.9 

Birmingham, AL 2 2 3 2 1 44.6 43.9 69.7 49.2 24.6 

Boston, MA 0 0 0 0 0 0.0 0.0 0.0 0.0

Buffalo, NY 0 0 1 0 0 0.0 0.0 22.8 0.0 0.0 

Charlotte, NC 3 3 1 1 2 31.0 28.1 9.6 9.4 18.8 

Chicago, IL 44 38 35 32 14 87.1 74.8 70.6 66.7 29.2 

Cincinnati, OH 0 0 0 0 0 0.0 0.0 0.0 0.0

Cleveland, OH 2 2 0 2 0 23.4 23.2 0.0 26.1 0.0 

Columbus, OH 2 0 1 0 0 18.7 0.0 9.4 0.0 0.0 

Corpus Christi, TX 0 0 0 0 0 0.0 0.0 0.0 0.0

Dallas, TX 4 6 8 9 8 16.8 24.5 31.7 36.4 32.3 

Dayton, OH 0 0 0 0 0 0.0 0.0 0.0 0.0

Denver, CO 1 0 0 0 1 9.8 0.0 0.0 0.0

Des Moines, IA 0 0 0 0 0 0.0 0.0 0.0 0.0

Detroit, MI 21 24 24 30 36 132.9 151.1 156.6 208.6 250.3 

El Paso, TX 1 2 2 1 4 7.9 15.4 15.4 7.8 31.1 

Fort Worth, TX 2 4 8 4 2 19.2 36.8 70.6 34.9 17.5 

Honolulu, HI 0 0 0 0 0 0.0 0.0 0.0 0.0

Houston, TX 31 32 21 38 21 72.0 71.4 47.5 84.3 46.6 

Indianapolis, IN 6 3 9 3 9 43.6 21.1 64.4 21.1 63.4 

Jacksonville, FL 0 2 0 0 1 0.0 17.5 0.0 0.0 8.8 

Jersey City, NJ 0 3 2 2 0 0.0 75.6 51.6 53.1 0.0 

Kansas City, MO 1 2 0 0 1 13.7 27.2 0.0 0.0 13.6 

Los Angeles, CA 36 41 27 28 28 55.5 62.7 41.8 44.2 44.2 

Louisville, KY 0 1 0 0 1 0.0 14.1 0.0 0.0 14.0 

Memphis, TN 10 14 8 3 2 87.7 122.9 71.3 27.3 18.2 

Miami, FL 10 18 10 5 9 76.5 131.7 73.7 38.6 69.6 

Milwaukee, WI 7 4 2 0 0 62.2 35.9 17.9 0.0 0.0 

Minneapolis, MN 0 0 0 1 0 0.0 0.0 0.0 16.0 0.0 

Nashville, TN 0 5 4 5 0 0.0 56.9 46.5 58.1 0.0 

New Orleans, LA 4 0 0 0 0 52.1 0.0 0.0 0.0 0.0 

New York City, NY 40 33 32 25 30 33.5 27.3 26.8 21.1 25.4 

Newark, NJ 12 9 8 12 10 245.7 183.0 161.8 258.5 215.4 

Norfolk, VA 0 3 1 0 0 0.0 75.0 24.8 0.0 0.0 

Oakland, CA 3 1 3 1 4 47.5 14.8 44.4 15.4 61.7 

Oklahoma City, OK 5 0 2 1 0 66.3 0.0 25.1 11.9 0.0 

Omaha, NE 0 0 0 0 0 0.0 0.0 0.0 0.0

Philadelphia, PA 7 9 4 5 2 32.2 41.1 18.9 23.3 9.3 

Phoenix, AZ 16 21 20 14 17 66.4 83.6 79.3 55.6 67.5 

Pittsburgh, PA 0 0 0 0 0 0.0 0.0 0.0 0.0

Portland, OR 0 0 0 0 0 0.0 0.0 0.0 0.0

Richmond, VA 0 0 1 0 0 0.0 0.0 31.9 0.0 0.0 

Rochester, NY 1 0 0 0 0 25.8 0.0 0.0 0.0 0.0 

Sacramento, CA 2 2 0 0 0 18.9 18.3 0.0 0.0 0.0 

San Antonio, TX 4 5 6 1 3 18.3 22.6 27.2 4.3 12.9 

San Diego, CA 7 0 6 4 8 37.8 0.0 32.3 21.7 43.3 

San Francisco, CA 1 1 1 0 0 12.3 11.5 12.1 0.0 0.0 

San Jose, CA 2 1 2 5 4 12.5 5.9 12.1 30.9 24.7 

Seattle, WA 1 0 0 0 0 13.6 0.0 0.0 0.0 0.0 

St Louis, MO 5 1 3 0 0 90.5 18.4 56.6 0.0 0.0 

St Paul, MN 0 0 0 0 0 0.0 0.0 0.0 0.0

St Petersburg, FL 1 0 0 0 0 29.5 0.0 0.0 0.0 0.0 

Tampa, FL 4 1 6 2 3 47.5 11.8 72.5 25.2 37.9 

Toledo, OH 0 0 0 0 1 0.0 0.0 0.0 0.0 21.2 

Tucson, AZ 0 0 0 0 0 0.0 0.0 0.0 0.0

Tulsa, OK 1 0 0 1 0 15.2 0.0 0.0 15.3 0.0 

Washington, DC 0 4 2 1 1 0.0 52.2 26.2 13.3 13.3 

Wichita, KS 0 0 0 0 0 0.0 0.0 0.0 0.0

Yonkers, NY 0 0 0 1 0 0.0 0.0 0.0 35.6 0.0 

U.S. CITY TOTAL 327 319 278 258 233 40.9 39.0 34.4 32.2 29.1 

San Juan, PR 3 5 5 3 1 43.2 77.3 80.4 50.6 16.9 

TOTAL 330 324 283 261 234 40.9 39.3 34.7 32.3 29.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

8.7 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

*Mother’s city of residence used to assign case. 

132 Syphilis Tables STD Surveillance 2003 
Table 44. Congenital syphilis — Reported cases and rates in infants <1 year of age by race/ethnicity of 

mother: United States, 1999–2003 

Year of Birth Race/Ethnicity Cases Rate per 100,000 Live Births 

1999 

White, Non-Hispanic 

Black, Non-Hispanic 

Hispanic 

Asian/Pacific Islander 

Native American/Alaskan Native 

Other 

47 

350 

148 

8

6 

4 

2.0 

59.1 

19.4 

4.5 

15.9 

NA 

Unknown 12 NA 

Total 575 14.5 

2000 

White, Non-Hispanic 

Black, Non-Hispanic 

Hispanic 

Asian/Pacific Islander 

Native American/Alaskan Native 

Other 

37 

331 

171 

11 

6 

3 

1.5 

54.5 

21.0 

5.6

15.4 

NA 

Unknown 19 NA 

Total 578 14.2 

2001 

White, Non-Hispanic 

Black, Non-Hispanic 

Hispanic 

Asian/Pacific Islander 

Native American/Alaskan Native 

Other 

48 

261 

162 

5 

7 

2 

2.0 

44.1 

19.0 

2.5

18.0 

NA 

Unknown 13 NA 

Total 498 12.4 

2002 

White, Non-Hispanic 

Black, Non-Hispanic 

Hispanic 

Asian/Pacific Islander 

Native American/Alaskan Native 

Other 

35 

256 

143 

9 

3 

1 

1.5 

44.1 

16.3 

4.4

7.6 

NA 

Unknown 6 NA 

Total 453 11.3 

2003 

White, Non-Hispanic 

Black, Non-Hispanic 

Hispanic 

Asian/Pacific Islander 

Native American/Alaskan Native 

Other 

31 

197 

159 

11 

2 

3 

1.3 

33.9 

18.1 

5.3

5.1 

NA 

Unknown 10 NA 

Total 413 10.3 

NA = Not applicable 

STD Surveillance 2003 Syphilis Tables 133 
Table 45. Chancroid — Reported cases and rates by state/area listed in alphabetical order: United States and 

outlying areas, 1999–2003 

State/Area 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003 1999 2000 2001 2002 2003 

Alabama 1 1 0 0 0 0.0 0.0 0.0 0.0

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0

Arizona 0 0 0 0 2 0.0 0.0 0.0 0.0

Arkansas 0 0 0 0 0 0.0 0.0 0.0 0.0

California 7 3 2 2 0 0.0 0.0 0.0 0.0

Colorado 0 1 0 0 0 0.0 0.0 0.0 0.0

Connecticut 0 0 0 0 0 0.0 0.0 0.0 0.0

Delaware 0 0 0 0 0 0.0 0.0 0.0 0.0

Florida 2 0 2 7 2 0.0 0.0 0.0 0.0

Georgia 1 0 0 0 0 0.0 0.0 0.0 0.0

Hawaii 0 0 0 0 0 0.0 0.0 0.0 0.0

Idaho 0 0 0 0 0 0.0 0.0 0.0 0.0

Illinois 0 0 0 0 0 0.0 0.0 0.0 0.0

Indiana 0 0 0 0 0 0.0 0.0 0.0 0.0

Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0

Kansas 0 0 0 0 0 0.0 0.0 0.0 0.0

Kentucky 0 0 0 0 1 0.0 0.0 0.0 0.0

Louisiana 9 6 0 2 0 0.2 0.1 0.0 0.0

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0

Maryland 0 0 0 0 1 0.0 0.0 0.0 0.0

Massachusetts 1 2 2 3 3 0.0 0.0 0.0 0.0

Michigan 0 0 0 0 0 0.0 0.0 0.0 0.0

Minnesota 1 0 0 0 0 0.0 0.0 0.0 0.0

Mississippi 0 0 0 0 0 0.0 0.0 0.0 0.0

Missouri 0 0 0 0 0 0.0 0.0 0.0 0.0

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0

Nebraska 0 0 0 0 0 0.0 0.0 0.0 0.0

Nevada 0 0 0 0 0 0.0 0.0 0.0 0.0

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0

New Jersey 0 0 4 0 0 0.0 0.0 0.0 0.0

New Mexico 0 0 0 0 0 0.0 0.0 0.0 0.0

New York 39 26 3 2 10 0.2 0.1 0.0 0.0 0.1 

North Carolina 7 5 3 0 2 0.1 0.1 0.0 0.0

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0

Ohio 0 1 0 0 0 0.0 0.0 0.0 0.0

Oklahoma 0 0 0 0 0 0.0 0.0 0.0 0.0

Oregon 1 0 0 0 2 0.0 0.0 0.0 0.0

Pennsylvania 0 0 0 0 1 0.0 0.0 0.0 0.0

Rhode Island 1 0 0 0 0 0.1 0.0 0.0 0.0

South Carolina 16 10 15 24 24 0.4 0.2 0.4 0.6 0.6 

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0

Tennessee 0 0 0 0 0 0.0 0.0 0.0 0.0

Texas 16 19 6 5 3 0.1 0.1 0.0 0.0 0.0 

Utah 0 0 1 0 2 0.0 0.0 0.0 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0

Virginia 3 2 0 1 0 0.0 0.0 0.0 0.0

Washington 0 0 0 1 0 0.0 0.0 0.0 0.0

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0

Wisconsin 4 2 0 1 0 0.1 0.0 0.0 0.0

Wyoming 1 0 0 0 1 0.2 0.0 0.0 0.0

U.S. TOTAL* 110 78 38 48 54 0.0 0.0 0.0 0.0 0.0 

Guam 

Puerto Rico 

Virgin Islands 

0

1 

0 

0

3 

1 

0

4 

0 

0

2 

0 

0 

4 

0 

0.0 

0.0 

0.0 

0.0 

0.1 

0.9 

0.0 

0.1 

0.0 

0.0

0.1

0.0

OUTLYING AREAS 1 4 4 2 4 0.0 0.1 0.1 0.0

TOTAL 111 82 42 50 58 0.0 0.0 0.0 0.0 0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.1 

0.0 

0.0 

0.0 

0.0 

0.1 

0.0 

0.0 

0.0 

0.0 

0.0 

0.2 

0.0 

0.1 

0.0 

0.1 

*Includes cases reported by Washington, D.C. 

134 Chancroid Tables STD Surveillance 2003 
Table 46. Chancroid — Reported cases and rates in selected cities listed in alphabetical order: United States 

and outlying areas, 1999–2003 

City 

Cases Rates per 100,000 Population 

1999 2000 2001 2002 2003
 1999 2000 2001 2002 2003 

Akron, OH 0 0 0 0 0
 0.0 0.0 0.0 0.0

Albuquerque, NM 0 0 0 0 0 0.0 0.0 0.0 0.0

Atlanta, GA 0 0 0 0 0 0.0 0.0 0.0 0.0

Austin, TX 0 0 0 0 0 0.0 0.0 0.0 0.0

Baltimore, MD 0 0 0 0 1 0.0 0.0 0.0 0.0

Birmingham, AL 0 0 0 0 0 0.0 0.0 0.0 0.0

Boston, MA 0 0 0 1 0 0.0 0.0 0.0 0.2

Buffalo, NY 0 0 0 0 0 0.0 0.0 0.0 0.0

Charlotte, NC 1 0 1 0 0 0.1 0.0 0.1 0.0

Chicago, IL 0 0 0 0 0 0.0 0.0 0.0 0.0

Cincinnati, OH 0 0 0 0 0 0.0 0.0 0.0 0.0

Cleveland, OH 0 0 0 0 0 0.0 0.0 0.0 0.0

Columbus, OH 0 0 0 0 0 0.0 0.0 0.0 0.0

Corpus Christi, TX 1 0 0 1 0 0.4 0.0 0.0 0.4

Dallas, TX 4 6 1 1 1 0.3 0.5 0.1 0.1

Dayton, OH 0 0 0 0 0 0.0 0.0 0.0 0.0

Denver, CO 0 0 0 0 0 0.0 0.0 0.0 0.0

Des Moines, IA 0 0 0 0 0 0.0 0.0 0.0 0.0

Detroit, MI 0 0 0 0 0 0.0 0.0 0.0 0.0

El Paso, TX 0 1 0 0 0 0.0 0.2 0.0 0.0

Fort Worth, TX 2 2 0 0 0 0.4 0.4 0.0 0.0

Honolulu, HI 0 0 0 0 0 0.0 0.0 0.0 0.0

Houston, TX 7 3 1 3 0 0.4 0.2 0.1 0.1

Indianapolis, IN 0 0 0 0 0 0.0 0.0 0.0 0.0

Jacksonville, FL 0 0 1 0 0 0.0 0.0 0.1 0.0

Jersey City, NJ 0 0 0 0 0 0.0 0.0 0.0 0.0

Kansas City, MO 0 0 0 0 0 0.0 0.0 0.0 0.0

Los Angeles, CA 1 1 0 0 0 0.0 0.0 0.0 0.0

Louisville, KY 0 0 0 0 0 0.0 0.0 0.0 0.0

Memphis, TN 0 0 0 0 0 0.0 0.0 0.0 0.0

Miami, FL 0 0 0 0 0 0.0 0.0 0.0 0.0

Milwaukee, WI 2 0 0 1 0 0.2 0.0 0.0 0.1

Minneapolis, MN 1 0 0 0 0 0.3 0.0 0.0 0.0

Nashville, TN 0 0 0 0 0 0.0 0.0 0.0 0.0

New Orleans, LA 4 6 0 0 0 0.8 1.2 0.0 0.0

New York City, NY 39 26 3 2 9 0.5 0.3 0.0 0.0 0.1 

Newark, NJ 0 0 1 0 0 0.0 0.0 0.3 0.0

Norfolk, VA 1 0 0 0 0 0.4 0.0 0.0 0.0

Oakland, CA 1 0 1 0 0 0.1 0.0 0.1 0.0

Oklahoma City, OK 0 0 0 0 0 0.0 0.0 0.0 0.0

Omaha, NE 0 0 0 0 0 0.0 0.0 0.0 0.0

Philadelphia, PA 0 0 0 0 0 0.0 0.0 0.0 0.0

Phoenix, AZ 0 0 0 0 2 0.0 0.0 0.0 0.0

Pittsburgh, PA 0 0 0 0 0 0.0 0.0 0.0 0.0

Portland, OR 0 0 0 0 0 0.0 0.0 0.0 0.0

Richmond, VA 0 0 0 0 0 0.0 0.0 0.0 0.0

Rochester, NY 0 0 0 0 0 0.0 0.0 0.0 0.0

Sacramento, CA 0 0 0 0 0 0.0 0.0 0.0 0.0

San Antonio, TX 0 1 0 0 0 0.0 0.1 0.0 0.0

San Diego, CA 0 0 0 0 0 0.0 0.0 0.0 0.0

San Francisco, CA 0 0 1 0 0 0.0 0.0 0.1 0.0

San Jose, CA 0 0 0 0 0 0.0 0.0 0.0 0.0

Seattle, WA 0 0 0 0 0 0.0 0.0 0.0 0.0

St Louis, MO 0 0 0 0 0 0.0 0.0 0.0 0.0

St Paul, MN 0 0 0 0 0 0.0 0.0 0.0 0.0

St Petersburg, FL 0 0 0 0 0 0.0 0.0 0.0 0.0

Tampa, FL 0 0 0 0 0 0.0 0.0 0.0 0.0

Toledo, OH 0 0 0 0 0 0.0 0.0 0.0 0.0

Tucson, AZ 0 0 0 0 0 0.0 0.0 0.0 0.0

Tulsa, OK 0 0 0 0 0 0.0 0.0 0.0 0.0

Washington, DC 0 0 0 0 0 0.0 0.0 0.0 0.0

Wichita, KS 0 0 0 0 0 0.0 0.0 0.0 0.0

Yonkers, NY 0 0 0 0 0 0.0 0.0 0.0 0.0

U.S. CITY TOTAL 64 46 10 9 13 0.1 0.1 0.0 0.0 0.0 

San Juan, PR 1 2 1 1 4 0.1 0.2 0.1 0.1

TOTAL 65 48 11 10 17 0.1 0.1 0.0 0.0 0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.2 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.1 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.1 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.4 

STD Surveillance 2003 Chancroid Tables 135 
Table 47. Selected STDs and complications — Initial visits to physicians' offices: United States, 1966–2003 

Genital Genital Vaginal Other Pelvic Inflammatory 

Year Herpes Warts Trichomoniasis Vaginitis Disease 

1966 19,000 56,000 579,000 1,155,000 NA 

1967 15,000 72,000 515,000 1,277,000 NA 

1968 16,000 87,000 463,000 1,460,000 NA 

1969 15,000 61,000 421,000 1,390,000 NA 

1970 17,000 119,000 529,000 1,500,000 NA 

1971 49,000 128,000 484,000 1,281,000 NA 

1972 26,000 165,000 574,000 1,810,000 NA 

1973 51,000 198,000 466,000 1,858,000 NA 

1974 75,000 202,000 427,000 1,907,000 NA 

1975 36,000 181,000 500,000 1,919,000 NA 

1976 57,000 217,000 473,000 1,690,000 NA 

1977 116,000 221,000 324,000 1,713,000 NA 

1978 76,000 269,000 329,000 2,149,000 NA 

1979 83,000 200,000 363,000 1,662,000 NA 

1980 57,000 218,000 358,000 1,670,000 423,000 

1981 133,000 191,000 369,000 1,742,000 283,000 

1982 134,000 256,000 268,000 1,859,000 374,000 

1983 106,000 203,000 424,000 1,932,000 424,000 

1984 157,000 224,000 381,000 2,450,000 381,000 

1985 124,000 263,000 291,000 2,728,000 425,000 

1986 136,000 275,000 338,000 3,118,000 457,000 

1987 102,000 351,000 293,000 3,087,000 403,000 

1988 163,000 290,000 191,000 3,583,000 431,000 

1989 148,000 220,000 165,000 3,374,000 413,000 

1990 172,000 275,000 213,000 4,474,000 358,000 

1991 235,000 282,000 198,000 3,822,000 377,000 

1992 139,000 218,000 182,000 3,428,000 335,000 

1993 172,000 167,000 207,000 3,755,000 407,000 

1994 142,000 239,000 199,000 4,123,000 332,000 

1995 160,000 253,000 141,000 3,927,000 262,000 

1996 208,000 191,000 245,000 3,472,000 286,000 

1997 176,000 145,000 176,000 3,100,000 260,000 

1998 188,000 211,000 164,000 3,200,000 233,000 

1999 224,000 240,000 171,000 3,077,000 250,000 

2000 179,000 220,000 222,000 3,470,000 254,000 

2001 157,000 233,000 210,000 3,365,000 244,000 

2002 216,000 266,000 150,000 3,315,000 197,000 

2003 203,000 264,000 179,000 3,516,000 123,000 

NA = Not available
 

SOURCE: National Drug and Therapeutic Index (IMS Health). See Appendix (Other Sources) for more information.
 

136 Selected STDs Table STD Surveillance 2003 
APPENDIX
 

Sources and Limitations of CDC Surveillance Data 

Much of the information in this document is based on cases of nationally notifiable sexually transmitted diseases (STDs) reported to the Division of STD Prevention (DSTDP), National Center for HIV, 

STD, and TB Prevention (NCHSTP), Centers for Disease Control and Prevention (CDC), by the STD 

control programs and health departments in the 50 states, the District of Columbia, selected cities, 

3,140 U.S. counties, U.S. dependencies and possessions, and independent nations in free association 

with the United States. Included among the dependencies, possessions, and independent nations are 

Guam, Puerto Rico, and the Virgin Islands. These entities are identified as “outlying areas” of the 

United States in selected figures and tables. 

In the past, STD data were submitted to CDC on a variety of hardcopy summary reporting forms 

(monthly, quarterly, and annually). As of December 31, 2003, all 50 states and Washington, DC 

(with the exception of outlying areas Guam, Puerto Rico and Virgin Islands) had converted from 

summary hardcopy reporting to electronic submission of line-listed (i.e., case-specific) STD data via 

the National Electronic Telecommunications System for Surveillance (NETSS). Data reported 

through NETSS comprise the notifiable disease information that is published in the Morbidity and 

Mortality Weekly Report (MMWR). 

The data through 2002 used in this report are based on a combination of aggregated final NETSS 

electronic data and summary hardcopy reporting forms. Monthly hardcopy reporting forms (CDC 

73.998) include summary data for syphilis by county and state. Quarterly hardcopy reporting forms 

(CDC 73.688) include summary data for early syphilis, gonorrhea, chlamydia, and other STDs by 

sex and source of report (STD clinic or non-STD clinic) for the 50 states, 64 selected cities (including 

San Juan, PR) and outlying areas of the United States. Annual hardcopy reporting forms (CDC 

73.2638) include summary data for P&S syphilis, gonorrhea, and chlamydia by age, race, and sex 

for the 50 states and 6 large cities. 

Areas differ in their ability to resolve differences in total cases derived from hardcopy monthly, 

quarterly, and annual reports (as well as electronically submitted line-listed data). Thus, depending 

on the database used, there may be discrepancies in the total number of cases among the figures 

and tables for earlier years. In most instances, these discrepancies are less than 5% of total reported 

cases and have minimal impact on national case totals and rates. However, for a specific area, the 

discrepancies may be larger. 

Reports and corrections sent to CDC on hardcopy forms and for NETSS electronic

data through April 30, 2004 have been included in this report. Data received after

this date will appear in subsequent issues. The data in the figures and tables in this

document supersede those in all earlier publications.

STD Surveillance 2003 Appendix Sources and Limitations of CDC Surveillance Data 137 
Population Denominators and Rate Calculations 

Crude incidence rates (new cases/population) were calculated on an annual basis per 

100,000 population. In this report, the 2003 rates for the United States, all states, cities and 

outlying areas were calculated by dividing the number of cases reported from each area in 

2003 by the estimated area-specific 2002 population (the most current detailed population file 

available at time of publication). For the United States, rates were calculated using Bureau of the 

Census population estimates for 1981 through 1989 (Bureau of the Census; United States Population Estimates by Age, Sex and Race: 1980-1989 [Series P-25, No. 1045]; Washington: U.S. Government Printing Office, 1990; and United States Population Estimates by Age, Sex and Race: 1989 

[Series P-25, No. 1057]; Washington: U.S. Government Printing Office, 1990). Rates for states and 

counties were calculated using published intercensal estimates based on Bureau of the Census population estimates for 1980-1989 (Irwin R; 1980-1989 Intercensal Population Estimates by Race, Sex, and 

Age; Alexandria, [VA]: Demo-Detail, 1992; machine-readable data file). The National Center for Health 

Statistics released bridged race population counts for 2000-2002 resident population based on the Census 2000 counts. These estimates resulted from bridging the 31 race categories used in Census 2000, as 

specified in the 1997 Office of Management and Budget (OMB) standards, to the four race groups specified under the 1977 OMB standards. The files were prepared under a collaborative arrangement with 

the U.S. Census Bureau. The population counts for 1990-1999 were also updated to incorporate the 

bridged single-race estimates of the April 1, 2000 resident population. These files were prepared by the U.S. 

Census Bureau with support from the National Cancer Institute. Due to the updated population,rates

for the period 1990-2002 may be different from prior Surveillance Reports. 

Many cities do not have a separate health jurisdiction that collects and reports cases of STDs. For 

these cities, case numbers and crude incidence rates are equal to those of the county, a proportion of 

county, or a combination of counties in which the city is located. These city population numbers are 

updated yearly, based on estimates from the Bureau of Census, and verified by the city STD project 

areas. 

Population estimates for 1980-1988 for areas outside the United States were obtained from the Bureau 

of the Census (Bureau of the Census; population estimates for Puerto Rico and the outlying areas: 1980 to 

1988; Current Population Reports [Series P-25, No. 1049]; Washington: U.S. Government Printing Office, 

1989). After 1988, population estimates for outlying areas were obtained from various sources located in 

these areas. Population estimates for Guam were obtained from the Guam Bureau of Statistics and Plans, 

estimates for Puerto Rico were obtained from the Bureau of Census, and estimates for the Virgin Islands 

were obtained from the University of the Virgin Islands. The 2002-2003 rates were calculated using the 

2002 population estimates. 

The percentage of reported cases for which race/ethnicity and age information was missing differed substantially by year, area and disease. States were excluded from comparison across 

race/ethnicity categories if race/ethnicity data were missing from 50% or more of the state’s reported 

cases (these exclusions, if any, are described in the footnote in the race-specific tables). Similarly, 

states in which age information was missing from the majority of reported cases were excluded from 

comparison across age categories. Missing values for race/ethnicity and age were imputed for records missing these data from states in which more than half of the reported cases contained 

race/ethnicity and age information. In previous years, missing age and race/ethnicity information 

was not imputed if a record was missing either of these pieces of information. Beginning in 2000, the 

imputation method was altered so that missing data were not imputed only for records missing both 

age and sex information. 

138 Sources and Limitations of CDC Surveillance Data Appendix STD Surveillance 2003 
Rates of congenital syphilis for 1989-2003 were calculated using live births from the National Center for 

Health Statistics (NCHS) (Vital Statistics: Natality Tapes 1989-2002 or Vital Statistics Reports, United 

States 1999, Vol. 48 No.10-Natality). Race-specific rates for 2002-2003 were calculated using live births 

for 2002. Rates before 1989 were calculated using published live birth data (NCHS; Vital Statistics Report, 

United States, 1988 [Vol.1–Natality]). 

Reporting Practices 

Although most areas generally adhere to the case definitions for STDs found in Case Definitions for 

Infectious Conditions under Public Health Surveillance,

1 there may be differences in the policies and 

systems for collecting surveillance data. Thus, comparisons of case numbers and rates among areas 

should be interpreted with caution. However, since case definitions and surveillance activities within a 

given area remain relatively stable, trends should be minimally affected by these differences. In many 

areas, the reporting from publicly supported institutions (e.g., STD clinics) has been more complete 

than from other sources (e.g., private practitioners). Thus, trends may not be representative of all 

segments of the population. Since many cities do not have a separate health jurisdiction that collects 

and reports cases of STDs, the definition for a selected city can depend on a particular county code, 

city code, and/or locally-assigned site code from the NETSS record. 

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 (Job Corps), school-based clinics, mental 

health providers, Indian Health Service, military, and other unspecified sources. Limited data analysis 

of the data reported electronically after 1996 confirmed that the new STD clinic source of report data 

corresponded to the earlier reporting source category, public (clinic) source. Therefore, source of case 

report data for the period 1984-2003 are presented as STD clinic or non-STD clinic only. 

Reporting of Chlamydia Cases 

Trends in chlamydia morbidity reporting from many areas are more reflective of changes in 

diagnosis and reporting of cases rather than actual trends in disease incidence. Cases and rates of reported chlamydia in sex-specific tables are underestimated due to some reported cases with unknown 

sex. Despite problems with under-reporting, it is important to publish available data to emphasize the 

large numbers of cases of chlamydia being detected in the United States. As areas develop 

chlamydia prevention and control programs, including improved surveillance systems to monitor 

trends, the data should improve and become more representative of true trends in disease. 

New York City has been reporting chlamydia cases since 1984. However, the State of New York, 

with the exception of New York City, initiated chlamydia reporting during the year 2000. As a result, 

the number of chlamydia cases reported by the state of New York (including the cities of Buffalo, 

Rochester and Yonkers) prior to the year 2001 may be incomplete, and the rate for New York State is 

underestimated. To be consistent with the practice used in earlier years, New York State chlamydia 

morbidity data were included in the calculation of overall national chlamydia rates. The number of 

STD Surveillance 2003 Appendix Sources and Limitations of CDC Surveillance Data 139 
chlamydia cases occurring in the fourth quarter of 2000 for the State of Colorado was projected 

based on case counts from the first three quarters. 

Reporting of Syphilis Cases 

“Total syphilis” or “all stages of syphilis” includes primary, secondary, early latent, late (including 

neurosyphilis, late latent, late with clinical manifestations, and unknown latent), and congenital 

syphilis. Cases of latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical 

manifestations are included in late and late latent syphilis totals. 

Reporting of Congenital Syphilis Cases 

In 1988, the surveillance case definition for congenital syphilis was changed. This case definition has 

greater sensitivity than the former definition.2 In addition, many areas have greatly enhanced active 

case finding for congenital syphilis since 1988. For these reasons, the number of reported cases increased dramatically during 1989-1991. As a result of this change in surveillance activity a period of 

transition during which trends cannot be clearly interpreted has resulted; however, all reporting areas 

had implemented the new case definition for reporting congenital syphilis by January 1, 1992. Therefore, the reliability of trends is expected to have stabilized after this date. 

In addition to changing the case definition for congenital syphilis, CDC introduced a new data 

collection form (CDC 73.126) in 1990 (revised October 2003). Since 1995, the data collected on 

this form have been used for reporting congenital syphilis reported cases and associated rates. This 

form is used to collect individual case information which allows more thorough analysis of case 

characteristics. For the purpose of analyses by race/ethnicity, if either the race or ethnicity question 

was answered, the case was included. For example, if “white” race was marked, but ethnicity was 

left blank, the individual was counted as “non-Hispanic white”. Congenital syphilis cases were reported by state and city of residence of the mother for the period of 1995 through 2003. 

Chlamydia, Gonorrhea, and Syphilis Prevalence Monitoring 

Chlamydia and gonorrhea test positivity and syphilis seroreactivity were calculated for the following: 

women attending family planning clinics, prenatal clinics, Indian Health Service clinics, the National Job 

Training Program, men attending STD clinics and a large primary care clinic participating in the MSM 

Prevalence Monitoring Project, adolescent women attending organizations participating in the Adolescent 

Women Reproductive Health Monitoring Project, and men and women entering corrections facilities. 

Positivitywascalculatedbydividingthenumberofpositivetestsforchlamydia,gonorrhea,orsyphilis (numerator) 

by the total number of positive and negative tests for each disease (denominator) and was expressed as a percentage. Except for the National Job Training Program screening data, the denominators for these data 

sources may include more than one test from the same individual if that person was tested more than once 

during a year. Various laboratory test methods were used for all of these data sources except the National 

Job Training Program and, for most of the figures shown, no adjustments of test positivity were made 

based on laboratory test type and sensitivity. However, for Figure 9 and Figure K, the chlamydia test 

results for each test type were weighted to reflect the sensitivity of the test used.3 The weights used in 

this adjustment are the reciprocals of the sensitivities of the laboratory test methods used. These 

test-specific sensitivities were defined as estimates from published evaluations of chlamydia screening tests.4,5 Limitations of this adjustment include: unknown dates when laboratories changed tests, 

missing information on the test method, variation of test sensitivity within a technology type, and no 

adjustment for supplemental testing such as negative grey zone testing. 

140 Sources and Limitations of CDC Surveillance Data Appendix STD Surveillance 2003 
For more details on chlamydia prevalence, refer to the following annual publication: Centers for 

Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2003 Supplement: 

Chlamydia Prevalence Monitoring Project Annual Report 2003. Atlanta, GA: U.S. Department of 

Health and Human Services (in press). 

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 2003 Supplement: Gonococcal Isolate Surveillance Project (GISP) Annual Report 2003. Atlanta, GA: U.S. Department of Health and Human 

Services (in press). 

In the MSM Prevalence Monitoring Project the 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. 

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, U.S. Department of Labor, and the Indian Health Service. 

Definition of HHS Regions 

The ten Health and Human Services (HHS) regions referred to in the text and figures are as follows: 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. 

Definition of IHS Areas 

The 12 Indian Health Service (IHS) Areas referred to in the text and figures are as follows, with 

overlap in some states: Aberdeen Area (Iowa, North Dakota, Nebraska, and South Dakota); Alaska 

Area (Alaska); Albuquerque Area (Colorado and New Mexico); Bemidji Area (Illinois, Indiana, 

Michigan, Minnesota, and Wisconsin); Billings Area (Montana and Wyoming); California Area 

(California); Nashville Area (Alabama, Connecticut, Florida, Louisiana, Maine, Maryland, 

Massachusetts, Mississippi, New York, North Carolina, Rhode Island, South Carolina, and 

Tennessee); Navajo Area (Arizona, New Mexico, and Utah); Oklahoma City Area (Kansas, 

Oklahoma, and Texas); Phoenix Area (Arizona, Nevada and Utah); Portland Area (Idaho, 

Oregon, and Washington); and Tucson Area (Arizona). 

STD Surveillance 2003 Appendix Sources and Limitations of CDC Surveillance Data 141 
Other Data Sources 

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 2003). For more information on this database, contact IMS Health, 660 W. Germantown Pike, Plymouth Meeting, PA 

19462; Telephone: (800) 523-5333. 

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 1980-2002), an ongoing nationwide sample survey of short-stay hospitals in the United 

States, conducted by the National Center for Health Statistics. For more information, see Graves EJ; 

1988 Summary: National Hospital Discharge Survey; Advance data No. 185; Hyattsville (MD): National Center for Health Statistics, 1990. The National Hospital Ambulatory Medical Care Survey 

(NHAMCS-ER) (machine-readable files for 1995-2002) was used to obtain estimates of the number 

of emergency room visits for pelvic inflammatory disease among women ages 15 to 44. The estimates generated using these data sources (NHDS and NHAMCS) are based on statistical surveys 

and therefore have sampling variability associated with the estimates. 

Healthy People 2010 Objectives 

In January 2000, CDC released objectives for Healthy People 2010 (HP2010).6 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 3.0% 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 (Table 

A1). 

1	 Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health 

surveillance, 1997. MMWR 1997;46(No. RR-10;1). 

2	 Kaufman RE, Jones, OG, Blount, JH, Wiesner PJ. Questionnaire survey of reported early congenital 

syphilis: problems in diagnosis, prevention, and treatment. Sex Transm Dis 1977;4:135-9. 

3	 Webster Dicker L, Mosure DJ, Levine WC, Black CM, Berman SM. The impact of switching laboratory 

tests on reported trends in Chlamydia trachomatis infections. Am J Epidemiol 2000;151:430-435. 

4	 Newhall WJ, DeLisle, S, Fine D, et al. Head-to-head evaluation of five different non-culture chlamydia 

tests relative to a quality-assured culture standard. Sex Transm Dis 1994;21:S165-6. 

5	 Black CM, Marrazzo J, Johnson RE, et al. Head-to-head multicenter comparision of DNA probe and 

nucleic acid amplification tests for Chlamydia trachomatis infection in women performed with an 

improved reference standard. J Clin Micro 2002;40:3757-3763. 

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

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

Printing Office, November 2000. 

142 Sources and Limitations of CDC Surveillance Data Appendix STD Surveillance 2003 
Table A1. Healthy People 2010 Sexually Transmitted Diseases Objective Status 

HP 2010 Objectives 

Baseline 

Year Baseline 1997 1998 1999 2000 2001 2002 2003 

HP 2010 

Target 

25-1 Reduce the proportion of 

adolescents and young adults 

with Chlamydia trachomatis 

infections 

a. Females aged 15 to 24 years attending family planning

clinics 

b. Females aged 15 to 24 years attending STD clinics 

c. Males aged 15 to 24 years attending STD clinics 

1997 

1997 

1997 

5.0% 

12.2% 

15.7% 

5.0%* 

12.2%* 

15.7%* 

6.1%* 

13.5%* 

16.9%* 

5.6%* 

13.7%* 

17.0%* 

5.9%* 

13.5%* 

16.4%* 

5.8%* 

13.3%* 

17.0%* 

6.0%* 

13.5%* 

17.5%* 

6.4%* 

14.1%* 

19.3%* 

3.0% 

3.0% 

3.0% 

25-2 Reduce gonorrhea (cases per 

100,000 population) 

1997 123.0 120.2 129.2 129.3 128.7 126.8 122.0 116.2 19.0 

25-3 Eliminate sustained domestic 

transmission of primary and 

secondary syphilis (cases per 

100,000 population) 

1997 3.2 3.1 2.5 2.4 2.1 2.1 2.4 2.5 0.2 

25-4 Reduce the proportion of adults 

aged 20 to 29 years with genital 

herpes infection 

1988-94 17.0% NA NA NA NA NA NA NA 14.0% 

25-6 Reduce the proportion of females 

aged 15 to 44 years who have 

ever required treatment for 

pelvic inflammatory disease 

(PID) 

1995 8.0% NA NA NA NA NA NA NA 5.0% 

25-7 Reduce the proportion of 

childless females with fertility 

problems who have had a 

sexually transmitted disease or 

who have required treatment for 

pelvic inflammatory disease 

(PID) 

1995 27.0% NA NA NA NA NA NA NA 15.0% 

25-9 Reduce congenital syphilis (cases 

per 100,000 live births) 

1997 27.0 27.8 21.3 14.5 14.2 12.4 11.3 10.3 1.0 

HP 2010 Objective Data Source 

25-1 STD Surveillance System, CDC, NCHSTP. 

25-2 STD Surveillance System, CDC, NCHSTP. 

25-3 STD Surveillance System, CDC, NCHSTP. 

25-4 National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. 

25-6 National Survey of Family Growth (NSFG), CDC, NCHS. 

25-7 National Survey of Family Growth (NSFG), CDC, NCHS. 

25-9 STD Surveillance System, CDC, NCHSTP. 

*Overall positivity not adjusted for changes in laboratory test method and associated increases in test sensitivity.
 

NOTE: Healthy People 2010 developmental objectives are not addressed in this report.
 

NA=Not available
 

STD Surveillance 2003 Appendix Healthy People 2010 143 
Table A2. Reported cases of sexually transmitted disease by sex and reporting source: United States, 2003 

Non-STD Clinic STD Clinic Total* 

Disease Male Female Total Male Female Total Male Female Total 

Chlamydia 114,814 555,957 672,073 66,354 88,444 154,944 190,244 685,017 877,478 

Gonorrhea 82,627 131,780 214,819 69,335 30,766 100,173 160,106 174,230 335,104 

Primary Syphilis 1,081 122 1,205 751 99 851 1,863 229 2,095 

Secondary Syphilis 2,898 619 3,517 1,135 345 1,480 4,093 988 5,082 

Early Latent Syphilis 3,692 1,695 5,393 1,892 962 2,854 5,664 2,691 8,361 

Late and Late Latent Syphilis† 7,016 5,071 12,124 3,357 2,369 5,739 10,666 7,601 18,319 

Neurosyphilis 387 117 504 25 3 28 420 121 541 

Chancroid 8 7 15 17 18 35 25 29 54 

*Totals include unknown sex and reporting source. 

†

Late and late latent syphilis includes cases of unknown duration, late syphilis with clinical manifestations, and neurosyphilis. 

See Appendix (Reporting Sources). 

144 STD Reporting Source Appendix STD Surveillance 2003 
STD Surveillance Case Definitions 

PART 1. CASE DEFINITIONS1 FOR NATIONALLY NOTIFIABLE INFECTIOUS DISEASES 

Chancroid (Revised 9/96)

Clinical description

A sexually transmitted disease characterized by painful genital ulceration and inflammatory inguinal adenopathy. The disease is caused by infection with Haemophilus ducreyi. 

Laboratory criteria for diagnosis

• Isolation of H. ducreyi from a clinical specimen 

Case classification

Probable: a clinically compatible case with both a) no evidence of Treponema pallidum infection by 

darkfield microscopic examination of ulcer exudate or by a serologic test for syphilis performed ≥7 

days after onset of ulcers and b) either a clinical presentation of the ulcer(s) not typical of disease 

caused by herpes simplex virus (HSV) or a culture negative for HSV. 

Confirmed: a clinically compatible case that is laboratory confirmed 

Chlamydia trachomatis, Genital Infections (Revised 9/96)

Clinical description

Infection with Chlamydia trachomatis may result in urethritis, epididymitis, cervicitis, acute 

salpingitis, or other syndromes when sexually transmitted; however, the infection is often asymptomatic in women. Perinatal infections may result in inclusion conjunctivitis and pneumonia in newborns. Other syndromes caused by C. trachomatis include lymphogranuloma venereum (see 

Lymphogranuloma Venereum) and trachoma. 

Laboratory criteria for diagnosis

• Isolation of C. trachomatis by culture or 

• Demonstration of C. trachomatis in a clinical specimen by detection of antigen or
 

nucleic acid
 

Case classification

Confirmed: a case that is laboratory confirmed 

Gonorrhea (Revised 9/96)

Clinical description

A sexually transmitted infection commonly manifested by urethritis, cervicitis, or salpingitis. 

Infection may be asymptomatic. 

Laboratory criteria for diagnosis

• Isolation of typical gram-negative, oxidase-positive diplococci (presumptive 

Neisseria gonorrhoeae) from a clinical specimen, or 

STD Surveillance 2003 Appendix STD Surveillance Case Definitions 145 
• Demonstration of N. gonorrhoeae in a clinical specimen by detection of antigen or 

nucleic acid, or 

• Observation of gram-negative intracellular diplococci in a urethral smear obtained 

from a male 

Case classification

Probable: a) demonstration of gram-negative intracellular diplococci in an endocervical smear obtained from a female or b) a written morbidity report of gonorrhea submitted by a physician 

Confirmed: a case that is laboratory confirmed 

Syphilis (All Definitions Revised 9/96)

Syphilis is a complex sexually transmitted disease that has a highly variable clinical course. Classification by a clinician with expertise in syphilis may take precedence over the following case definitions developed for surveillance purposes. 

Syphilis, primary

Clinical description

A stage of infection with Treponema pallidum characterized by one or more chancres (ulcers); 

chancres might differ considerably in clinical appearance. 

Laboratory criteria for diagnosis

• Demonstration of T. pallidum in clinical specimens by darkfield microscopy, direct 

fluorescent antibody (DFA-TP), or equivalent methods 

Case classification

Probable: a clinically compatible case with one or more ulcers (chancres) consistent with primary 

syphilis and a reactive serologic test (nontreponemal: Venereal Disease Research Laboratory 

[VDRL] or rapid plasma reagin [RPR]; treponemal: fluorescent treponemal antibody absorbed 

[FTA-ABS] or microhemagglutination assay for antibody to T. pallidum [MHA-TP]) 

Confirmed: a clinically compatible case that is laboratory confirmed 

Syphilis, secondary

Clinical description

A stage of infection caused by T. pallidum and characterized by localized or diffuse 

mucocutaneous lesions, often with generalized lymphadenopathy. The primary chancre may still 

be present. 

Laboratory criteria for diagnosis

• Demonstration of T. pallidum in clinical specimens by darkfield microscopy, DFATP, 

or equivalent methods 

Case classification

Probable: a clinically compatible case with a nontreponemal (VDRL or RPR) titer ≥4 

Confirmed: a clinically compatible case that is laboratory confirmed 

146 STD Surveillance Case Definitions Appendix STD Surveillance 2003 
Syphilis, latent

Clinical description

A stage of infection caused by T. pallidum in which organisms persist in the body of the infected 

person without causing symptoms or signs. Latent syphilis is subdivided into early, late, and unknown categories based on the duration of infection. 

Case classification

Probable: no clinical signs or symptoms of syphilis and the presence of one of the following: 

• No past diagnosis of syphilis, a reactive nontreponemal test (i.e., VDRL or RPR), and 

a reactive treponemal test (i.e., FTA-ABS or MHA-TP) 

• A past history of syphilis therapy and a current nontreponemal test titer demonstrating 

fourfold or greater increase from the last nontreponemal test titer 

Syphilis, early latent

Clinical description

A subcategory of latent syphilis. When initial infection has occurred within the previous 12 

months, latent syphilis is classified as early latent. 

Case classification

Probable: latent syphilis (see Syphilis, latent) in a person who has evidence of having acquired the 

infection within the previous 12 months based on one or more of the following criteria: 

• Documented seroconversion or fourfold or greater increase in titer of a 

nontreponemal test during the previous 12 months 

• A history of symptoms consistent with primary or secondary syphilis during the 

previous 12 months 

• A history of sexual exposure to a partner who had confirmed or probable primary or 

secondary syphilis or probable early latent syphilis (documented independently as 

duration <1 year) 

• Reactive nontreponemal and treponemal tests from a person whose only possible 

exposure occurred within the preceding 12 months 

Syphilis, late latent

Clinical description

A subcategory of latent syphilis. When initial infection has occurred >1 year previously, latent 

syphilis is classified as late latent. 

Case classification

Probable: latent syphilis (see Syphilis, latent) in a patient who has no evidence of having acquired 

the disease within the preceding 12 months (see Syphilis, early latent) and whose age and titer do 

not meet the criteria specified for latent syphilis of unknown duration. 

Syphilis, latent, of unknown duration

Clinical description

A subcategory of latent syphilis. When the date of initial infection cannot be established as having 

occurred within the previous year and the patient’s age and titer meet criteria described below, latent syphilis is classified as latent syphilis of unknown duration. 

STD Surveillance 2003 Appendix STD Surveillance Case Definitions 147 
Case classification

Probable: latent syphilis (see Syphilis, latent) that does not meet the criteria for early latent syphilis, and the patient is aged 13–35 years and has a nontreponemal titer ≥32 

Neurosyphilis

Clinical description

Evidence of central nervous system infection with T. pallidum

Laboratory criteria for diagnosis

• A reactive serologic test for syphilis and reactive VDRL in cerebrospinal fluid (CSF)
 

Case classification
 

Case classification

Probable: syphilis of any stage, a negative VDRL in CSF, and both the following: 

• Elevated CSF protein or leukocyte count in the absence of other known causes of
 

these abnormalities
 

• Clinical symptoms or signs consistent with neurosyphilis without other known causes
 

for these clinical abnormalities
 

Confirmed: syphilis of any stage that meets the laboratory criteria for neurosyphilis 

Syphilis, late, with clinical manifestations other than neurosyphilis (late benign syphilis

and cardiovascular syphilis)

Clinical description

Clinical manifestations of late syphilis other than neurosyphilis may include inflammatory lesions 

of the cardiovascular system, skin, and bone. Rarely, other structures (e.g., the upper and lower respiratory tracts, mouth, eye, abdominal organs, reproductive organs, lymph nodes, and skeletal 

muscle) may be involved. Late syphilis usually becomes clinically manifest only after a period of 

15–30 years of untreated infection. 

Laboratory criteria for diagnosis

Demonstration of T. pallidum in late lesions by fluorescent antibody or special stains (although organisms are rarely visualized in late lesions) 

Case classification

Probable: characteristic abnormalities or lesions of the cardiovascular system, skin, bone, or 

other structures with a reactive treponemal test, in the absence of other known causes of these abnormalities, and without CSF abnormalities and clinical symptoms or signs consistent with 

neurosyphilis 

Confirmed: a clinically compatible case that is laboratory confirmed 

Comment

Analysis of CSF for evidence of neurosyphilis is necessary in the evaluation of late syphilis with 

clinical manifestations. 

148 STD Surveillance Case Definitions Appendix STD Surveillance 2003 
Syphilitic Stillbirth

Clinical description

A fetal death that occurs after a 20-week gestation or in which the fetus weighs >500 g and the 

mother had untreated or inadequately treated* syphilis at delivery 

Comment

For reporting purposes, syphilitic stillbirths should be reported as cases of congenital syphilis. 

Syphilis, Congenital (Revised 9/96)

Clinical description

A condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity 

exists, and only severe cases are clinically apparent at birth. An infant or child (aged <2 years) may 

have signs such as hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or edema (nephrotic syndrome and/or malnutrition). An older child 

may have stigmata (e.g., interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades, or Clutton joints). 

Laboratory criteria for diagnosis

Demonstration of T. pallidum by darkfield microscopy, fluorescent antibody, or other specific 

stains in specimens from lesions, placenta, umbilical cord, or autopsy material 

Case classification

Probable: a condition affecting an infant whose mother had untreated or inadequately treated* 

syphilis at delivery, regardless of signs in the infant, or an infant or child who has a reactive 

treponemal test for syphilis and any one of the following: 

• Any evidence of congenital syphilis on physical examination 

• Any evidence of congenital syphilis on radiographs of long bones 

• A reactive cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL) 

• An elevated CSF cell count or protein (without other cause) 

• A reactive fluorescent treponemal antibody absorbed—19S-IgM antibody test or IgM
 

enzyme-linked immunosorbent assay
 

Confirmed: a case that is laboratory confirmed 

Comment

Congenital and acquired syphilis may be difficult to distinguish when a child is seropositive after 

infancy. Signs of congenital syphilis may not be obvious, and stigmata may not yet have developed. 

Abnormal values for CSF VDRL, cell count, and protein, as well as IgM antibodies, may be found in 

either congenital or acquired syphilis. Findings on radiographs of long bones may help because radiographic changes in the metaphysis and epiphysis are considered classic signs of congenitally acquired syphilis. The decision may ultimately be based on maternal history and clinical judgment. In 

a young child, the possibility of sexual abuse should be considered as a cause of acquired rather 

than congenital syphilis, depending on the clinical picture. For reporting purposes, congenital syphilis includes cases of congenitally acquired syphilis among infants and children as well as syphilitic 

stillbirths. 

*Inadequate treatment consists of any nonpenicillin therapy or penicillin administered <30 days before delivery. 

STD Surveillance 2003 Appendix STD Surveillance Case Definitions 149 
PART 2. CASE DEFINITIONS1 FOR NON-NOTIFIABLE INFECTIOUS DISEASES 

Genital Herpes (Herpes Simplex Virus) (Revised 9/96)

Clinical description

A condition characterized by visible, painful genital or anal lesions 

Laboratory criteria for diagnosis

• Isolation of herpes simplex virus from cervix, urethra, or anogenital lesion, or 

• Demonstration of virus by antigen detection technique in clinical specimens from 

cervix, urethra, or anogenital lesion, or 

• Demonstration of multinucleated giant cells on a Tzanck smear of scrapings from an 

anogenital lesion 

Case classification

Probable: a clinically compatible case (in which primary and secondary syphilis have been excluded by appropriate serologic tests and darkfield microscopy, when available) with either a diagnosis of genital herpes based on clinical presentation (without laboratory confirmation) or a history 

of one or more previous episodes of similar genital lesions 

Confirmed: a clinically compatible case that is laboratory confirmed 

Comment

Genital herpes should be reported only once per patient. The first diagnosis for a patient with no 

previous diagnosis should be reported. 

Genital Warts (Revised 9/96)

Clinical description

An infection characterized by the presence of visible, exophytic (raised) growths on the internal or 

external genitalia, perineum, or perianal region 

Laboratory criteria for diagnosis

• Histopathologic changes characteristic of human papillomavirus infection in 

specimens obtained by biopsy or exfoliative cytology or 

• Demonstration of virus by antigen or nucleic acid detection in a lesion biopsy 

Case classification

Probable: a clinically compatible case without histopathologic diagnosis and without microscopic or 

serologic evidence that the growth is the result of secondary syphilis 

Confirmed: a clinically compatible case that is laboratory confirmed 

Comment

Genital warts should be reported only once per patient. The first diagnosis for a patient with no 

previous diagnosis should be reported. 

Granuloma Inguinale

Clinical description

A slowly progressive ulcerative disease of the skin and lymphatics of the genital and perianal area 

caused by infection with Calymmatobacterium granulomatis. A clinically compatible case would 

have one or more painless or minimally painful granulomatous lesions in the anogenital area. 

150 STD Surveillance Case Definitions Appendix STD Surveillance 2003 
Laboratory criteria for diagnosis

• Demonstration of intracytoplasmic Donovan bodies in Wright or Giemsa-stained 

smears or biopsies of granulation tissue 

Case classification

Confirmed: a clinically compatible case that is laboratory confirmed 

Lymphogranuloma Venereum

Clinical description

Infection with L1, L2, or, L3 serovars of Chlamydia trachomatis may result in a disease characterized by genital lesions, suppurative regional lymphadenopathy, or hemorrhagic proctitis. The infection is usually sexually transmitted. 

Laboratory criteria for diagnosis

•	 Isolation of C. trachomatis, serotype L1, L2, or L3 from clinical specimen, or 

• Demonstration by immunofluorescence of inclusion bodies in leukocytes of an 

inguinal lymph node (bubo) aspirate, or 

• Positive microimmunofluorescent serologic test for a lymphogranuloma venereum 

strain of C. trachomatis

Case classification

Probable: a clinically compatible case with one or more tender fluctuant inguinal lymph nodes or 

characteristic proctogenital lesions with supportive laboratory findings of a single C. trachomatis

complement fixation titer of >64 

Confirmed: a clinically compatible case that is laboratory confirmed 

Mucopurulent Cervicitis (Revised 9/96)

Clinical description

Cervical inflammation that is not the result of infection with Neisseria gonorrhoeae or 

Trichomonas vaginalis. Cervical inflammation is defined by the presence of one of the following 

criteria: 

• Mucopurulent secretion (from the endocervix) that is yellow or green when viewed on
 

a white, cotton-tipped swab (positive swab test)
 

•	 Induced endocervical bleeding (bleeding when the first swab is placed in the 

endocervix) 

Laboratory criteria for diagnosis

• No evidence of N. gonorrhoeae by culture, Gram stain, or antigen or nucleic acid 

detection, and no evidence of T. vaginalis on wet mount 

Case classification

Confirmed: a clinically compatible case in a female who does not have either gonorrhea or 

trichomoniasis 

Comment

Mucopurulent cervicitis (MPC) is a clinical diagnosis of exclusion. The syndrome may result from 

infection with any of several agents (see Chlamydia trachomatis, Genital Infections). If gonorrhea, 

trichomoniasis, and chlamydia are excluded, a clinically compatible illness should be classified as 

STD Surveillance 2003	 Appendix STD Surveillance Case Definitions 151 
MPC. An illness in a female that meets the case definition of MPC and C. trachomatis infection 

should be classified as chlamydia. 

Nongonococcal Urethritis (Revised 9/96)

Clinical description

Urethral inflammation that is not the result of infection with Neisseria gonorrhoeae. Urethral inflammation may be diagnosed by the presence of one of the following criteria: 

• A visible abnormal urethral discharge, or 

• A positive leukocyte esterase test from a male aged <60 years who does not have a
 

history of kidney disease or bladder infection, prostate enlargement, urogenital
 

anatomic anomaly, or recent urinary tract instrumentation, or
 

• Microscopic evidence of urethritis (≥5 white blood cells per high-power field) on a
 

Gram stain of a urethral smear
 

Laboratory criteria for diagnosis

• No evidence of N. gonorrhoeae infection by culture, Gram stain, or antigen or nucleic
 

acid detection
 

Case classification

Confirmed: a clinically compatible case in a male in whom gonorrhea is not found, either by culture, 

Gram stain, or antigen or nucleic acid detection 

Comment

Nongonococcal urethritis (NGU) is a clinical diagnosis of exclusion. The syndrome may result 

from infection with any of several agents (see Chlamydia trachomatis, Genital Infection). If gonorrhea and chlamydia are excluded, a clinically compatible illness should be classified as NGU. An illness in a male that meets the case definition of NGU and C. trachomatis infection should be 

classified as chlamydia. 

Pelvic Inflammatory Disease (Revised 9/96)

Clinical case definition

A clinical syndrome resulting from the ascending spread of microorganisms from the vagina and 

endocervix to the endometrium, fallopian tubes, and/or contiguous structures. In a female who has 

lower abdominal pain and who has not been diagnosed as having an established cause other than 

pelvic inflammatory disease (PID) (e.g., ectopic pregnancy, acute appendicitis, and functional 

pain), all the following clinical criteria must be present: 

• Lower abdominal tenderness, and 

• Tenderness with motion of the cervix, and 

• Adnexal tenderness 

In addition to the preceding criteria, at least one of the following findings must also be present: 

• Meets the surveillance case definition of C. trachomatis infection or gonorrhea 

• Temperature >100.4 F (>38.0 C) 

• Leukocytosis >10,000 white blood cells/mm3 

• Purulent material in the peritoneal cavity obtained by culdocentesis or laparoscopy 

152 STD Surveillance Case Definitions Appendix STD Surveillance 2003 
• Pelvic abscess or inflammatory complex detected by bimanual examination or by 

sonography 

• Patient is a sexual contact of a person known to have gonorrhea, chlamydia, or 

nongonococcal urethritis 

Case classification

Confirmed: a case that meets the clinical case definition 

Comment

For reporting purposes, a clinician’s report of PID should be counted as a case. 

1 Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health 

surveillance, 1997. MMWR 1997;46(No. RR-10;1). 

STD Surveillance 2003 Appendix STD Surveillance Case Definitions 153 
STD Project Directors, STD Program Managers, and State and Territorial Epidemiologists 

We gratefully acknowledge the contributions of state STD project directors, STD program managers, and state and territorial 

epidemiologists to this report. The persons listed were in the positions shown as of August 24, 2004. 

STD Project Directors STD Program Managers State Epidemiologists 

Alabama Charles H. Woernle Maxie Fleming John Lofgren (Acting) 

Alaska Wendy Crator Donna Cecere John P. Middaugh 

Arizona Victorio Vax Ashraf Lasee Bob England 

Arkansas Mark Barnes Kaleemulla Sayyed Frank Wilson 

California Gail Bolan Romni Neiman Gilberto Chavez 

Los Angeles Peter Kerndt Mary Hayes Gilberto Chavez 

San Francisco Jeffrey Klausner Wendy Wolf Gilberto Chavez 

Colorado Maureen Bush Terry Tiller-Taylor Ned Calonge 

Connecticut James L. Hadler Heidi Jenkins James L. Hadler 

Delaware James C. Welch Catherine Mosley A. LeRoy Hathcock 

District of Columbia Karen Berry John Heath John Davies-Cole 

Florida Landis Crockett Karla Schmitt Landis Crockett 

Georgia Kathleen Toomey Vacant Paul Blake 

Hawaii Peter Whiticar Roy Ohye Paul Effler 

Idaho Russell Duke Anne Williamson Christine G. Hahn 

Illinois Charlie Rabins Ed Renier Mark Dworkin 

Chicago Janice Johnson Dawn Broussard Mark Dworkin 

Indiana Michael Butler Jim Beall Robert Teclaw 

Iowa Julie McMahon Jim Goodrich Patricia Quinlisk 

Kansas Sharon Patnode R. Allen Mayer Gail Hansen 

Kentucky Barry Wainscott David Raines Kraig Humbaugh 

Louisiana Lisa Ann Longfellow Dennis Dorst Raoult Ratard 

Maine Sally Lou Patterson Charles Dwyer Kathleen F. Gensheimer 

Maryland Tory Ameree Scott Tulloch David Blythe 

Baltimore Claude Jacob Glen Oltoff David Blythe 

Massachusetts Thomas Bertrand Thomas Bertrand Alfred DeMaria 

Michigan Loretta Davis-Satterla Mark A. Miller Matthew L. Boulton 

Minnesota Julia Ashley Julia Ashley Harry Hull 

Mississippi Craig Thompson Vacant Mills McNeill 

Missouri Mary Menges Nyla DeArmitt Bao-Ping Zhu 

Montana Amy Kelly Laurie Kops Todd A. Damrow 

Nebraska Phil Medina Phil Medina Thomas J. Safranek 

Nevada Richard Whitley Jennifer Stoll-Hadayia Randall Todd 

New Hampshire Heather Hauck Drew Thomits Jesse Greenblatt 

New Jersey Janet DeGraaf Jerry Carolina Eddy A. Bresnitz 

New Mexico Don Torres Al Chowning C. Mack Sewell 

New York F. Bruce Coles Steve Brooks Perry F. Smith 

New York City Susan Blank Steve Rubin Marcelle Layton 

North Carolina Evelyn M. Foust Evelyn M. Foust Jeffrey Engel 

North Dakota Larry Shireley Kirby Kruger Larry Shireley 

Ohio Jeff Vasiloff Timothy Bahns Forrest W. Smith 

Oklahoma William R. Pierson Mark Turner Kristy Bradley 

Oregon Vacant Doug Harger Melvin Kohn 

Pennsylvania Weston Ruhrig Steve Kowalewski James T. Rankin, Jr. 

Philadelphia Caroline Johnson Martin Goldberg James T. Rankin, Jr. 

Rhode Island Linda Mouradjian Nancy Walsh Utpala Bandy 

South Carolina Lynda Kettinger Robert Ray James J. Gibson 

South Dakota Laurie Gill David Morgan Lon Kightlinger 

Tennessee Keith Williams Robert Burke Allen Craig 

Texas Mark Canfield Jim Lee Dennis M. Perrotta 

Utah Teresa Garrett Tim Lane Robert T. Rolfs 

Vermont Marilyn Richards-Proulx Marilyn Richards-Proulx Cortland Lohff 

Virginia Casey Riley Casey Riley John Marr 

Washington Larry Klopfenstein Larry Klopfenstein Jo Hofmann 

West Virginia Loretta E. Haddy Margaret Taylor Loretta E. Haddy 

Wisconsin Herb Bostrom Anthony Wade Jeffrey Davis 

Wyoming Jimm Murray Roger Burr Karl Musgrave 

American Samoa Joseph Tufa Tai Ripley Joseph Tufa 

Federated States of 

Micronesia Jefferson Benjamin Louisa Helgenberger Eliuel Preprick 

Government of the 

Marshall Islands Justina Langidrik Altina Anien Helen Jetnil 

Guam Josie O'Mallan Bernadette Schumann Robert L. Haddock 

Puerto Rico Alberto Carrera Baquero Bruce Heath Francisco Alvarado-Ramy 

Republic of Palau Stevenson Kuartei Johana Ngiruchelbad Julie Erb-Alvarez 

Virgin Islands Darlene Carty Cheryl Brown Mavis Matthew 

154 Contributors Appendix STD Surveillance 2003