Sexually 

Transmitted 

Disease 

Surveillance 

2012

Division of STD Prevention 

January 2014

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

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

Division of STD Prevention 

Atlanta, Georgia 30333
ii STD Surveillance 2012

Acknowledgments

Publication of this report would not have been possible without the contributions of the state and territorial 

health departments, sexually transmitted disease control programs, and public health laboratories that provided 

surveillance data to CDC.

This report was prepared by the following CDC staff: 

Jim Braxton, Delicia Carey, Darlene Davis, Alison Footman, Elaine Flagg, LaZetta Grier, Alesia Harvey, 

Kathleen Hutchins, Sarah Kidd, Jennine Kinsey, Robert Kirkcaldy, Eloisa Llata, Rob Nelson, Fred Rivers, Mark 

Stenger, John Su, Elizabeth Torrone, Hillard Weinstock, the Surveillance and Data Management Branch of the 

Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
STD Surveillance 2012 iii

Copyright Information

All material contained in this report is in the public domain and may be used and reprinted without special 

permission; however, citation as to source is appreciated.

Suggested Citation

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2012. Atlanta: U.S. 

Department of Health and Human Services; 2013.

Web Site

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

Selected STD Surveillance and Prevention References and Web Sites

STD Surveillance Reports 1993–2011

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

STD Data in the NCHHSTP Atlas

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

STD Data on Wonder

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

STD Data Management & Information Technology

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

STD Fact Sheets

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

STD Treatment Guidelines

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

STD Program Evaluation Guidelines

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

STD Program Operation Guidelines

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

Recommendations for Public Health Surveillance of Syphilis in the United States

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

Behavioral Surveillance

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

National Survey of Family Growth

http://www.cdc.gov/nchs/nsfg/abc_list_p.htm#pelvic

STD Surveillance 2012 v

Foreword

“STDs are hidden epidemics of enormous health and 

economic consequence in the United States. They 

are hidden because many Americans are reluctant 

to address sexual health issues in an open way and 

because of the biologic and social characteristics of 

these diseases. All Americans have an interest in STD 

prevention because all communities are impacted 

by STDs and all individuals directly or indirectly 

pay for the costs of these diseases. STDs are public 

health problems that lack easy solutions because 

they are rooted in human behavior and fundamental 

societal problems. Many of the strongest predictors of 

health, including sexual health, are social, economic, 

and environmental. Providing information about 

personal health and health services can empower 

people to make healthier choices to protect their 

health. Indeed, there are many obstacles to effective 

prevention efforts. The first hurdle will be to confront 

the reluctance of American society to openly confront 

issues surrounding sexuality and STDs. Despite the 

barriers, there are existing individual- and communitybased interventions that are effective and can be 

implemented immediately. That is why a multifaceted 

approach is necessary at both the individual and 

community levels.

To successfully prevent STDs, many stakeholders 

need to redefine their mission, refocus their efforts, 

modify how they deliver services, and accept new 

responsibilities. In this process, strong leadership, 

innovative thinking, partnerships, and adequate 

resources will be required. The additional investment 

required to effectively prevent STDs may be 

considerable, but it is negligible when compared with 

the likely return on the investment. The process of 

preventing STDs must be a collaborative one. No one 

agency, organization, or sector can effectively do it 

alone; all members of the community must do their 

part. A successful national initiative to confront and 

prevent STDs requires widespread public awareness 

and participation and bold national leadership from 

the highest levels.”1

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

Washington (DC): National Academy Press; 1997. p. 43.
vi STD Surveillance 2012

Preface

Sexually Transmitted Disease Surveillance 2012 presents 

statistics and trends for sexually transmitted diseases (STDs) 

in the United States through 2012. This annual publication 

is intended as a reference document for policy makers, 

program managers, health planners, researchers, and others 

who are concerned with the public health implications 

of these diseases. The figures and tables in this edition 

supersede those in earlier publications of these data. 

The surveillance information in this report is based 

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

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

that monitor STD positivity and prevalence in various 

settings, including the National Job Training Program, 

the STD Surveillance Network, and the Gonococcal 

Isolate Surveillance Project; and (3) other national surveys 

implemented by federal and private organizations.

The STD surveillance systems operated by state and local 

STD control programs, which provide the case report 

data for chlamydia, gonorrhea, syphilis, and chancroid, 

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

statistical tables in this publication. These systems are an 

integral part of program management at all levels of STD 

prevention and control in the United States. Because of 

incomplete diagnosis and reporting, the number of STD 

cases reported to the Centers for Disease Control and 

Prevention is less than the actual number of cases occurring 

in the U.S. population. National summary data of case 

reports for other STDs are not available because they are 

not nationally notifiable diseases.

Prior to the publication of Sexually Transmitted Disease 

Surveillance 2010, when the percentage of unknown, 

missing, or invalid values for age group, race/ethnicity, 

and sex exceeded 50% for any state, the state’s incidence 

and population data were excluded from the tables that 

presented data stratified by one or more of these variables. 

For the states for which 50% or more of their data were 

valid for age group, race/ethnicity, and sex, the values for 

unknown, missing, or invalid data were redistributed on the 

basis of the state’s distribution of known age group, race/

ethnicity, and sex data. Beginning with the publication of 

Sexually Transmitted Disease Surveillance 2010, redistribution 

methodology is not applied to any of the data. The counts 

presented in this report are summations of all valid data 

reported in reporting year 2012. Because missing data are 

excluded from calculations of rates by age group, race/

ethnicity, and sex, incidence rates by these characteristics, 

particularly by race/ethnicity for chlamydia and gonorrhea, 

appear somewhat lower than in reports before 2010. 

The collection of information on race/ethnicity has been 

standardized since 1997 in the United States from the 

Office of Management and Budget (OMB). Following a 

revision in the National Electronic Telecommunication 

System for Surveillance (NETSS) implementation guide 

in April 2008, jurisdictions reporting STD data were to 

collect race according to the current standard categories: 

American Indian or Alaska Native, Asian, Black or African 

American, Hispanic or Latino, Native Hawaiian or Other 

Pacific Islander, White and multirace. Beginning with 

this publication, Sexually Transmitted Disease Surveillance 

2012, data on race/ ethnicity are displayed in compliance 

with the OMB standards.While 48 jurisdictions (47 states 

and the District of Columbia) collect and report data in 

formats compliant with these standards as of 2012, some 

jurisdictions only recently adopted this standard and used 

previous standards to report their case data to CDC in past 

years. Subsequently, historical trend and rate data by race/

ethnicity displayed in figures and interpreted in this report 

for 2008–2012 include only those jurisdictions (38 states 

plus the District of Columbia) reporting in the current 

standard consistently for 2008 through 2012.

Sexually Transmitted Disease Surveillance 2012 consists 

of four sections: the National Profile, the Special Focus 

Profiles, the Tables, and the Appendix. The National Profile 

section contains figures that provide an overview of STD 

morbidity in the United States. The accompanying text 

identifies major findings and trends for selected STDs. 

The Special Focus Profiles section contains figures and 

text that describe STDs in selected populations that are a 

focus of national and state prevention efforts. The Tables 

section provides statistical information about STDs at 

county, metropolitan statistical area, regional, state, and 

national levels. The Appendix includes information on how 

to interpret the STD surveillance data used to produce 

this report, as well as information about Healthy People 

2020 STD objectives and progress toward meeting these 

objectives, Government Performance and Results Act 

goals and progress toward meeting these goals, and STD 

surveillance case definitions.

Any comments and suggestions that would improve future 

publications are appreciated and should be sent to

Director, Division of STD Prevention

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

TB Prevention

Centers for Disease Control and Prevention

1600 Clifton Road, Mailstop E-02

Atlanta, Georgia 30333
STD Surveillance 2012 vii

Guide to Acronyms

CDC Centers for Disease Control and Prevention

CSF cerebrospinal fluid

DSTDP Division of STD Prevention

GISP Gonococcal Isolate Surveillance Project 

HEDIS Healthcare Effectiveness Data and Information Set

HHS U.S. Department of Health and Human Services

HMOs health maintenance organizations

HIV human immunodeficiency virus

HP2020 Healthy People 2020 

HPV human papillomavirus

HSV herpes simplex virus

MICs minimum inhibitory concentrations

MPC mucopurulent cervicitis 

MSA metropolitan statistical area

MSM men who have sex with men

MSW men who have sex with women only

NAATs nucleic acid amplification tests

NDTI National Disease and Therapeutic Index

NGU nongonococcal urethritis

NHANES National Health and Nutrition Examination Survey

NHDS National Hospital Discharge Survey

NJTP National Job Training Program

OMB Office of Management and Budget

P&S primary and secondary

PID pelvic inflammatory disease

QRNG quinolone-resistant Neisseria gonorrhoeae

RPR rapid plasma reagin

SSuN STD Surveillance Network 

STD sexually transmitted disease

VDRL Venereal Disease Research Laboratory

STD Surveillance 2012 ix

Contents

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

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

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

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

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

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

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

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

National Overview of Sexually Transmitted Diseases (STDs), 2012.................................................................1

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

Chlamydia...............................................................................................................................................5

Gonorrhea .............................................................................................................................................14

Syphilis..................................................................................................................................................28

Other Sexually Transmitted Diseases......................................................................................................40

Special Focus Profiles............................................................................................................. 49

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

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

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

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

Tables

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

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

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

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

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

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

Appendix

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

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

Selected Variables by State and by Nationally Notifiable STD, 2012 .............................. 136

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2012 .................. 137

Table A3. Healthy People 2020 (HP2020) Sexually Transmitted Diseases Objectives....................... 138

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

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

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

Contributors........................................................................................................................................148
x STD Surveillance 2012

Figures in the National Profile

Chlamydia

Figure 1. Chlamydia—Rates by Sex, United States, 1992–2012........................................................ 9

Figure 2. Chlamydia—Rates by Region, United States, 2003–2012.................................................. 9

Figure 3. Chlamydia—Rates by State, United States and Outlying Areas, 2012 .............................. 10

Figure 4. Chlamydia—Rates by County, United States, 2012 ......................................................... 10

Figure 5. Chlamydia—Rates by Age and Sex, United States, 2012 .................................................. 11

Figure 6. Chlamydia—Rates by Race/Ethnicity, United States, 2008–2012 .................................... 11

Figure 7. Chlamydia—Cases by Reporting Source and Sex, United States, 2003–2012................... 12

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

Sources, United States, 2012 ............................................................................................ 12

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

Sexual Behavior, STD Surveillance Network (SSuN), 2012.............................................. 13

Figure 10. Chlamydia—Prevalence Among Persons Aged14–39 Years by Sex, 

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

2005–2008....................................................................................................................... 13

Gonorrhea

Figure 11. Gonorrhea—Rates by Year, United States, 1941–2012..................................................... 19

Figure 12. Gonorrhea—Rates by Sex, United States, 1992–2012...................................................... 19

Figure 13. Gonorrhea—Rates by Region, United States, 2003–2012 ................................................ 20

Figure 14. Gonorrhea—Rates by State, United States and Outlying Areas, 2012 .............................. 20

Figure 15. Gonorrhea—Rates by County, United States, 2012 ......................................................... 21

Figure 16. Gonorrhea—Rates by Age and Sex, United States, 2012 .................................................. 21

Figure 17. Gonorrhea—Rates by Age Among Women Aged15–44 Years, United States, 

2003–2012....................................................................................................................... 22

Figure 18. Gonorrhea—Rates by Age Among Men Aged15–44 Years, United States, 2003–2012..... 22

Figure 19. Gonorrhea—Rates by Race/Ethnicity, United States, 2008–2012 .................................... 23

Figure 20. Gonorrhea—Cases by Reporting Source and Sex, United States, 2003–2012................... 23

Figure 21. Gonorrhea—Percentage of Reported Cases by Sex and Selected Reporting 

Sources, United States, 2012 ............................................................................................ 24

Figure 22. Estimated Proportion of MSM, MSW, and Women Among Interviewed Gonorrhea 

Cases by Site, STD Surveillance Network (SSuN), 2012 .................................................. 24

Figure 23. Location of Participating Sentinel Sites and Regional Laboratories, Gonoccoccal 

Isolate Surveillance Project (GISP), United States, 2012................................................... 25

Figure 24. Percentage of Neisseria gonorrhoeae Isolates with Elevated Ceftriaxone 

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

Surveillance Project (GISP), 2005–2012 .......................................................................... 25

Figure 25. Percentage of Neisseria gonorrhoeae Isolates with Elevated Cefixime Minimum 

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

Surveillance Project (GISP), 2005–2012 .......................................................................... 26

Figure 26. Percentage of Neisseria gonorrhoeae Isolates with Elevated Azithromycin 

Minimum Inhibitory Concentrations (MICs) (≥2.0 μg/ml), 

Gonococcal Isolate Surveillance Project (GISP), 2005–2012............................................ 26

Figure 27. Penicillin, Tetracycline, and Ciprofloxacin Resistance Among Neisseria 

gonorrhoeae Isolates, Gonococcal Isolate Surveillance Project (GISP), 2012 ...................... 27

Figure 28. Antimicrobial Drugs Used to Treat Gonorrhea Among Participants, Gonococcal 

Isolate Surveillance Project (GISP), 1988–2012 ............................................................... 27
STD Surveillance 2012 xi

Syphilis

Figure 29. Syphilis—Reported Cases by Stage of Infection, United States, 1941–2012..................... 32

Figure 30. Primary and Secondary Syphilis—by Sex and Sexual Behavior, 33 areas, 2007–2012....... 32

Figure 31. Primary and Secondary Syphilis—Rates by Sex and Male-to-Female Rate 

Ratios, United States, 1990–2012 .................................................................................... 33

Figure 32. Primary and Secondary Syphilis—Rates by Region, United States, 2003–2012................ 33

Figure 33. Primary and Secondary Syphilis—Rates by State, United States and Outlying 

Areas, 2012 ...................................................................................................................... 34

Figure 34. Primary and Secondary Syphilis—Rates by County, United States, 2012 ......................... 34

Figure 35. Primary and Secondary Syphilis—Rates by Age and Sex, United States, 2012.................. 35

Figure 36. Primary and Secondary Syphilis—Rates by Age Among Women Aged 15–44 

Years, United States, 2003–2012 ...................................................................................... 35

Figure 37. Primary and Secondary Syphilis—Rates by Age Among Men Aged 15–44 Years, 

United States, 2003–2012................................................................................................ 36

Figure 38. Primary and Secondary Syphilis—Rates by Race/Ethnicity, United States, 2008–2012 .... 36

Figure 39. Primary and Secondary Syphilis—Reported Cases by Stage, Sex, and Sexual 

Behavior, 2012 ................................................................................................................. 37

Figure 40. Primary and Secondary Syphilis—Reported Cases by Sex, Sexual Behavior, and 

Race/Ethnicity, United States, 2012 ................................................................................. 37

Figure 41. Primary and Secondary Syphilis—Reported Cases by Reporting Source and 

Sex, United States, 2003–2012......................................................................................... 38

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

Behavior, and Selected Reporting Sources, 2012............................................................... 38

Figure 43. Congenital Syphilis—Reported Cases Among Infants by Year of Birth and Rates 

of Primary and Secondary Syphilis Among Women, United States, 2003–2012............... 39

Other Sexually Transmitted Diseases

Figure 44. Chancroid—Reported Cases by Year, United States, 1981–2012...................................... 43

Figure 45. Human Papillomavirus—Prevalence of High-risk and Low-risk Types Among Females 

Aged 14–59 Years, National Health and Nutrition Examination Survey, 2003–2006 ....... 43

Figure 46. Genital Warts—Initial Visits to Physicians’ Offices, United States, 1966–2012................ 44

Figure 47. Genital Warts—Prevalence Among STD Clinic Patients by Sex, Sex of Partners, 

and Site, STD Surveillance Network (SSuN), 2012.......................................................... 44

Figure 48. Genital Herpes—Initial Visits to Physicians’ Offices, United States, 1966–2012.............. 45

Figure 49. Herpes Simplex Virus Type 2—Seroprevalence Among Non-Hispanic Whites 

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

Examination Survey, 1976–1980, 1988–1994, 1999–2004, 2005–2008.......................... 46

Figure 50. Trichomoniasis and Other Vaginal Infections—Women—Initial Visits to Physicians’ 

Offices, United States, 1966–2012 ................................................................................... 47
xii STD Surveillance 2012

Figures in the Special Focus Profiles

STDs in Women and Infants

Figure A. Chlamydia—Women—Rates by State, United States and Outlying Areas, 2012.............. 55

Figure B. Gonorrhea—Women—Rates by State, United States and Outlying Areas, 2012 .............. 55

Figure C. Primary and Secondary Syphilis—Women—Rates by State, United States and 

Outlying Areas, 2012 ....................................................................................................... 56

Figure D. Congenital Syphilis—Infants—Rates by Year of Birth and State, United States 

and Outlying Areas, 2012 ................................................................................................ 56

Figure E. Pelvic Inflammatory Disease—Hospitalizations of Women Aged 15–44 Years, 

United States, 2001–2010................................................................................................ 57

Figure F. Pelvic Inflammatory Disease—Initial Visits to Physicians’ Offices by Women 

Aged 15–44 Years, United States, 2003–2012 .................................................................. 57

Figure G. Ectopic Pregnancy—Hospitalizations of Women Aged 15–44 Years, United States, 

2001–2010....................................................................................................................... 58

STDs in Adolescents and Young Adults

Figure H. Chlamydia—Prevalence Among Women Aged 16–24 Years Entering the National Job 

Training Program, by State of Residence, United States and Outlying Areas, 2012........... 62

Figure I. Chlamydia—Prevalence Among Men Aged 16–24 Years Entering the National Job 

Training Program, by State of Residence, United States and Outlying Areas, 2012........... 62

Figure J. Gonorrhea—Prevalence Among Women Aged 16–24 Years Entering the National Job 

Training Program, by State of Residence, United States and Outlying Areas, 2012........... 63

Figure K. Gonorrhea—Prevalence Among Men Aged 16–24 Years Entering the National Job 

Training Program, by State of Residence, United States and Outlying Areas, 2012........... 63

STDs in Racial and Ethnic Minorities

Figure L. Chlamydia—Rates by Race/Ethnicity and Sex, 2012........................................................ 69

Figure M. Gonorrhea—Rate Ratios by Race/Ethnicity, United States, 2008–2012........................... 69

Figure N. Gonorrhea—Rates by Race/Ethnicity and Sex, United States, 2012 ................................. 70

Figure O. Gonorrhea—Rate Ratios by Race/Ethnicity and Region, United States, 2012.................. 70

Figure P. Primary and Secondary Syphilis—Rates by Race/Ethnicity and Sex, United States, 2012 .... 71

Figure Q. Primary and Secondary Syphilis—Rates Among Females Aged 15–19 Years by 

Race/Ethnicity, United States, 2008–2012 ....................................................................... 71

Figure R. Primary and Secondary Syphilis—Rates Among Males Aged 15–19 Years by 

Race/Ethnicity, United States, 2008–2012 ....................................................................... 72

Figure S. Congenital Syphilis—Infants—Rates by Year of Birth and Mother’s Race/Ethnicity, 

United States, 2003–2012................................................................................................ 72

STDs in Men Who Have Sex with Men

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

Positive for Gonorrhea and Chlamydia, STD Surveillance Network (SSuN), 2012 .......... 76

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

Clinics with Primary and Secondary Syphilis Who are Co-infected with HIV, 

STD Surveillance Network (SSuN), 2012 ........................................................................ 76

Figure V. Proportion of MSM Attending STD Clinics with Primary and Secondary Syphilis, 

Gonorrhea or Chlamydia by HIV Status, STD Surveillance Network (SSuN), 2012........ 77

Figure W. Percentage of Urethral Neisseria gonorrhoeae Isolates Obtained from MSM Attending 

STD Clinics, Gonococcal Isolate Surveillance Project (GISP), 1990–2012 ...................... 77

Figure X. Percentage of Urethral Neisseria gonorrhoeae Isolates Obtained from MSM Attending 

STD Clinics, by Site, Gonococcal Isolate Surveillance Project (GISP), 2009–2012.......... 78
STD Surveillance 2012 xiii

Tables in the National Profile

National Summary

Table 1. Cases of Sexually Transmitted Diseases Reported by State Health Departments 

and Rates per 100,000 Population, United States, 1941–2012......................................... 79

Chlamydia

Table 2. Chlamydia—Reported Cases and Rates by State, Ranked by Rates, United States, 2012.. 81

Table 3. Chlamydia—Reported Cases and Rates by State/Area and Region in Alphabetical 

Order, United States and Outlying Areas, 2008–2012...................................................... 82

Table 4. Chlamydia—Women—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2008–2012 ................................. 83

Table 5. Chlamydia—Men—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2008–2012 ................................. 84

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

(MSAs) in Alphabetical Order, United States, 2008–2012 ............................................... 85

Table 7. Chlamydia—Women—Reported Cases and Rates in Selected Metropolitan 

Statistical Areas (MSAs) in Alphabetical Order, United States, 2008–2012 ...................... 86

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2008–2012 ...................... 87

Table 9. Chlamydia—Reported Cases and Rates in Counties and Independent Cities 

Ranked by Number of Reported Cases, United States, 2012 ............................................ 88

Table 10. Chlamydia—Reported Cases and Rates per 100,000 Population 

by Age Group and Sex, United States, 2008–2012 ........................................................... 89

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

United States, 2012.......................................................................................................... 90

Table 11B. Chlamydia—Rates per 100,000 Population by Race/Ethnicity, Age Group, 

and Sex, United States, 2012............................................................................................ 91

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

United States, 2008–2012................................................................................................ 92

Gonorrhea

Table 13. Gonorrhea—Reported Cases and Rates by State, Ranked by Rates, United States, 2012 ..... 93

Table 14. Gonorrhea—Reported Cases and Rates by State/Area and Region in Alphabetical 

Order, United States and Outlying Areas, 2008–2012...................................................... 94

Table 15. Gonorrhea—Women—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2008–2012 ................................. 95

Table 16. Gonorrhea—Men—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2008–2012 ................................. 96

Table 17. Gonorrhea—Reported Cases and Rates in Selected Metropolitan Statistical Areas 

(MSAs) in Alphabetical Order, United States, 2008–2012 ............................................... 97

Table 18. Gonorrhea—Women—Reported Cases and Rates in Selected Metropolitan 

Statistical Areas (MSAs) in Alphabetical Order, United States, 2008–2012 ...................... 98

Table 19. Gonorrhea—Men—Reported Cases and Rates in Selected Metropolitan 

Statistical Areas (MSAs) in Alphabetical Order, United States, 2008–2012 ...................... 99

Table 20. Gonorrhea—Reported Cases and Rates in Counties and Independent Cities 

Ranked by Number of Reported Cases, United States, 2012 .......................................... 100

Table 21. Gonorrhea—Reported Cases and Rates per 100,000 Population by 

Age Group and Sex, United States, 2008–2012.............................................................. 101

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

United States, 2012........................................................................................................ 102
xiv STD Surveillance 2012

Table 22B. Gonorrhea—Rates per 100,000 Population by Race/Ethnicity, Age Group, 

and Sex, United States, 2012.......................................................................................... 103

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

United States, 2008–2012.............................................................................................. 104

Syphilis

Table 24. All Stages of Syphilis—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2008–2012 ............................... 105

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2008–2012 .................... 106

Table 26. Primary and Secondary Syphilis—Reported Cases and Rates by State, Ranked 

by Rates, United States, 2012......................................................................................... 107

Table 27. Primary and Secondary Syphilis—Reported Cases and Rates by State/Area and 

Region in Alphabetical Order, United States and Outlying Areas, 2008–2012 ............... 108

Table 28. Primary and Secondary Syphilis—Women—Reported Cases and Rates by State/Area 

and Region in Alphabetical Order, United States and Outlying Areas, 2008–2012......... 109

Table 29. Primary and Secondary Syphilis—Men—Reported Cases and Rates by State/Area 

and Region in Alphabetical Order, United States and Outlying Areas, 2008–2012......... 110

Table 30. Primary and Secondary Syphilis—Reported Cases and Rates in Selected Metropolitan 

Statistical Areas (MSAs) in Alphabetical Order, United States, 2008–2012 .................... 111

Table 31. Primary and Secondary Syphilis—Women—Reported Cases and Rates in 

Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2008–2012.............................................................................................. 112

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

Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2008–2012.............................................................................................. 113

Table 33. Primary and Secondary Syphilis—Reported Cases and Rates in Counties and 

Independent Cities Ranked by Number of Reported Cases, United States, 2012............ 114

Table 34. Primary and Secondary Syphilis—Reported Cases and Rates Among Men and 

Women and Male-To-Female Rate Ratios in the Counties and Independent Cities 

Ranked in the Top 30 for Cases in 2012, United States, 2011–2012.............................. 115

Table 35. Primary and Secondary Syphilis—Reported Cases and Rates per 100,000 Population 

by Age Group and Sex, United States, 2008–2012 ......................................................... 116

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

and Sex, United States, 2012.......................................................................................... 118

Table 36B. Primary and Secondary Syphilis—Rates per 100,000 Population by Race/Ethnicity, 

Age Group, and Sex, United States, 2012....................................................................... 119

Table 37. Early Latent Syphilis—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2008–2012 ............................... 120

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2008–2012 .................... 121

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

in Alphabetical Order, United States and Outlying Areas, 2008–2012 ........................... 122

Table 40. Late and Late Latent Syphilis—Reported Cases and Rates in Selected Metropolitan 

Areas (MSAs) in Alphabetical Order, United States, 2008–2012 .................................... 123

Table 41. Congenital Syphilis—Reported Cases and Rates in Infants by Year of Birth, 

by State, Ranked by Rates, United States, 2012.............................................................. 124

Table 42. Congenital Syphilis—Reported Cases and Rates in Infants by Year of Birth, 

by State/Area and Region in Alphabetical Order, United States, 2008–2012 .................. 125

Table 43. Congenital Syphilis—Reported Cases and Rates per 100,000 Live Births 

in Infants by Year of Birth and Race/Ethnicity of Mother, United States, 2008–2012 .... 126
STD Surveillance 2012 xv

Chancroid

Table 44. Chancroid—Reported Cases and Rates by State/Area in Alphabetical Order, 

United States and Outlying Areas, 2008–2012............................................................... 127

Selected STDs

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

Disease and Therapeutic Index, United States, 1966–2012............................................. 128

Interpreting STD Surveillance Data

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

Variables by State and by Nationally Notifiable STD, 2012............................................ 136

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2012 .................. 137

Table A3. Healthy People 2020 (HP2020) Sexually Transmitted Diseases Objectives....................... 138

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

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

STD Surveillance 2012 xvii

Census Regions of the United States

West Midwest Northeast

South

West Midwest South Northeast

Alaska Illinois Alabama Connecticut

Arizona Indiana Arkansas Maine

California Iowa Delaware Massachusetts

Colorado Kansas District of Columbia New Hampshire

Hawaii Michigan Florida New Jersey

Idaho Minnesota Georgia New York

Montana Missouri Kentucky Pennsylvania

Nevada Nebraska Louisiana Rhode Island

New Mexico North Dakota Maryland Vermont

Oregon Ohio Mississippi

Utah South Dakota North Carolina

Washington Wisconsin Oklahoma

Wyoming South Carolina

Tennessee

Texas

Virginia

West Virginia

STD Surveillance 2012 Overview 1

National Overview of Sexually 

Transmitted Diseases (STDs), 2012

All Americans should have the opportunity to make 

choices that lead to health and wellness. Working 

together, interested, committed public and private 

organizations, communities, and individuals can take 

action to prevent sexually transmitted diseases (STDs) 

and their related health burdens. In addition to federal, 

state, and local public support for STD prevention, 

local community leaders can promote STD prevention 

education. Health providers can assess their patients’ risks 

and talk to them about testing. Parents can better educate 

their children about STDs and sexual health. Individuals 

can use condoms consistently and correctly, and openly 

discuss ways to protect their health with partners and 

providers. As noted in the Institute of Medicine report, 

The Hidden Epidemic: Confronting Sexually Transmitted 

Diseases, surveillance is a key component of all our efforts 

to prevent and control these diseases.1

This overview summarizes national surveillance data 

for 2012 on the three notifiable diseases for which 

there are federally funded control programs: chlamydia, 

gonorrhea, and syphilis. Several observations for 2012 

are worthy of note. During the mid-1990s to 2011, 

chlamydia and gonorrhea positivity among women 

screened in correctional facilities and in family planning 

and prenatal care clinics participating in infertility 

prevention activities were sent to Centers for Disease 

Control and Prevention (CDC) to monitor prevalence 

for those conditions. As the infertility prevention 

program expanded, trends in prevalence have become 

increasingly difficult to interpret2

 and are no longer 

included in this report. For the first time, the data 

presented here by race and ethnicity are categorized 

according to the revised Office of Management and 

Budget standards. However, data for all jurisdictions by 

race/ethnicity using these categories are not available; 

consequently, absolute rates by race/ethnicity and 

comparisons between racial/ethnic groups may not 

match those provided in previous reports. 

Chlamydia

In 2012, a total of 1,422,976 cases of Chlamydia 

trachomatis infection were reported to the CDC 

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

reported to CDC for any condition. This case count 

corresponds to a rate of 456.7 cases per 100,000 

population, an increase of only 0.7% compared with 

the rate in 2011, the smallest annual increase since 

nationwide reporting for chlamydia began. For the 

first time since nationwide reporting of chlamydia 

began, the rate in women did not increase. The rate in 

men increased 3.2%.

In 2012, the overall rate of chlamydial infection in the 

United States among women (643.3 cases per 100,000 

females) was over two times the rate among men 

(262.6 cases per 100,000 males), reflecting the larger 

number of women screened for this infection (Tables 

4 and 5). However, with the increased availability 

of urine testing, men are increasingly being tested 

for chlamydial infection. During 2008–2012, the 

chlamydia rate in men increased 25%, compared with 

an 11% increase in women during this period. Rates 

also varied among different racial and ethnic minority 

populations. For example, in 2012, the chlamydia rate 

in blacks was 6.8 times the rate in whites.

Gonorrhea

Following a 74% decline in the rate of reported 

gonorrhea during 1975–1997, overall gonorrhea rates 

plateaued for 10 years. After the decline halted for 

several years, gonorrhea rates decreased further to 98.1 

cases per 100,000 population in 2009, the lowest rate 

since recording of gonorrhea rates began. Since 2009, 

the gonorrhea rate has increased slightly each year to 

107.5 cases per 100,000 population in 2012, a 9.6% 

increase overall. In 2012, there were 334,826 cases 

of gonorrhea reported in the United States. The 4% 

increase between 2011 and 2012 was observed in all 

regions except for the South where rates are still the 

highest of any region in the country. In 2012, rates 

increased in all age groups except those aged 15–19. 

Since 2001, the rates in women have been somewhat 

higher than rates in men (Figure 12). In 2012, the 

gonorrhea rate in women was 108.7 cases per 100,000 

population compared with a rate of 105.8 in men. 

During 2011–2012 the gonorrhea rate among women 

increased only 0.6% (4% since 2009) while it increased 

8.3% among men (17.7% since 2009). As with 
2 Overview STD Surveillance 2012

chlamydia, gonorrhea rates in women were highest 

among those aged 15–24 years with the highest rate 

being in women 19 years of age (761 cases per 100,000 

population, Table 23). In men, they were highest among 

those aged 20–24 years (Figure 16). However, the 

largest observed increases in 2012 were in women aged 

40–44 years old and in men aged 30–34. In 2012, the 

gonorrhea rate in blacks was 15 times the rate in whites 

(Table 22B). As with chlamydia, data on gonorrhea 

prevalence in defined populations were available from 

several sources in 2012. These data showed a continuing 

high burden of disease in some adolescents and young 

adults in parts of the United States.

Antimicrobial resistance remains an important 

consideration in the treatment of gonorrhea. With 

increased resistance to the fluoroquinolones and the 

declining susceptibility to cefixime, dual therapy with 

ceftriaxone and either azithromycin or doxycycline 

is now the only CDC recommended treatment for 

gonorrhea.3

 Continued monitoring of susceptibility 

patterns to these antibiotics is critical. One isolate with 

decreased susceptibility to ceftriaxone was seen in 2012 

in CDC’s sentinel surveillance system, the Gonococcal 

Isolate Surveillance Project (GISP). No increases in 

Minimum Inhibitory Concentration (MIC) trends for 

cephalosporins were observed in 2012 (Figures 24 and 

25). 

Syphilis

The rate of primary and secondary (P&S) syphilis 

reported in the United States decreased during the 

1990s, and in 2000, it was the lowest since reporting 

began in 1941. The low rate of syphilis and the 

concentration of most 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 1999 and updated in 2006.4

 The overall 

rate of P&S syphilis in the United States declined 

89.7% during 1990–2000, then increased each year 

from 2001 through 2009. In 2010, the overall rate 

decreased for the first time in 10 years. But, in 2011 

this rate remained unchanged, and in 2012, the rate 

increased 11.1% from that in 2011. This increase was 

solely among men in whom rates increased 14.8% 

overall. (Figure 31). In 33 areas where sex of partner 

data were available for at least 70% of cases each year 

during 2007-2012, cases among men who have sex 

with men (MSM) increased 15% between 2011 and 

2012; in men who have sex with women only, cases 

increased 4% (Figure 30). In the US as a whole, rates 

in women remained unchanged between 2011 and 

2012. In 2012, a total of 15,667 cases of P&S syphilis 

were reported to CDC, 1,697 more cases than were 

reported in 2011. Approximately 75% of cases were in 

MSM. 

The 2012 rate of congenital syphilis (7.8 cases per 

100,000 live births) marks the lowest rate of congenital 

syphilis recorded since 1988, when the case definition 

was changed. The rate of congenital syphilis decreased 

10% between 2011 and 2012 and 26% since 2008. 

There were 322 cases of congenital syphilis reported in 

2012. 

Significant race and ethnic disparities in STD rates 

persist. In 2012, the P&S syphilis rate among blacks 

was six times the rate among whites. (Figure 38) In 

some subgroups, however, these disparities are much 

higher. The 2012 rate among blacks aged 15–19 years 

was 16 times the rate for whites of that age. While rates 

in congenital syphilis have decreased in recent years, 

the rates are still 14 times higher in blacks than whites 

and almost 4 times higher in Hispanics than whites 

(Table 43). 

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

hidden epidemic: confronting sexually transmitted diseases. 

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

2 Satterwhite CL, Grier L, Patzer R, Weinstock H, Howards P, 

Kleinbaum D. Chlamydia positivity trends among women 

attending family planning clinics: United States, 2004-2008. Sex 

Transm Dis 2011;38 (11): 989-994.

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

sexually transmitted diseases treatment guidelines, 2010. 

Oral cephalosporins no longer a recommended treatment 

for gonococcal infection. MMWR Morb Mortal Wkly Rep. 

2012;61(31):590-594.

4 Centers for Disease Control and Prevention. The national plan 

to eliminate syphilis from the United States. Atlanta: U.S. 

Department of Health and Human Services; 2006. 
NATIONAL PROFILE
NATIONAL PROFILE
STD Surveillance 2012 National Profile 3

National Profile

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

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

States.

STD Surveillance 2012 National Profile: Chlamydia 5

Chlamydia

Background

C. trachomatis infection is the most commonly reported 

notifiable disease in the United States. It is among 

the most prevalent of all STDs, and since 1994, has 

comprised the largest proportion of all STDs reported 

to CDC (Table 1). Studies also demonstrate the high 

prevalence of chlamydial infections in the general U.S. 

population. Based on estimates from national surveys 

conducted from 1999–2008, chlamydia prevalence is 

6.8% among sexually active females aged 14–19 years.1

Chlamydial infections in women are usually 

asymptomatic. However, these can result in pelvic 

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

infertility, ectopic pregnancy, and chronic pelvic pain. 

Data from a randomized controlled trial of chlamydia 

screening in a managed care setting suggested that 

screening programs can lead to as much as a 60% 

reduction in the incidence of PID.2

 As with other 

inflammatory STDs, chlamydial infection might 

facilitate the transmission of human immunodeficiency 

virus (HIV) infection.3 In addition, pregnant women 

infected with chlamydia can pass the infection to their 

infants during delivery, potentially resulting in neonatal 

ophthalmia and pneumonia. Because of the large 

burden of disease and risks associated with infection, 

CDC recommends that all sexually active women 

younger than age 26 years receive annual chlamydia 

screening.4

The Healthcare Effectiveness Data and Information 

Set (HEDIS) contains a measure which assesses 

chlamydia screening coverage of sexually active young 

women who receive medical care through commercial 

or Medicaid managed care organizations.5 Among 

sexually-active women aged 16–24 years in commercial 

plans, chlamydia screening increased from 23.1% in 

2001 to 45.0% in 2011. During the same time period, 

the screening rate among sexually-active women aged 

16–24 years covered by Medicaid increased from 

40.4% to 58.0%.6 Although chlamydia screening is 

expanding, many women who are at risk are still not 

being tested—reflecting, in part, the lack of awareness 

among some health care providers and the limited 

resources available to support these screenings.

The increase in reported chlamydial infections 

during the last 20 years reflects the expansion of 

chlamydia screening activities, the use of increasingly 

sensitive diagnostic tests, an increased emphasis on 

case reporting from providers and laboratories, and 

improvements in the information systems used for 

reporting. To supplement case report data, chlamydia 

positivity and prevalence among people screened in a 

variety of settings are monitored. 

Chlamydia—United States

In 2012, a total of 1,422,976 chlamydial infections 

were reported to CDC in 50 states and the District of 

Columbia (Table 1). This case count corresponds to 

a rate of 456.7 cases per 100,000 population, only a 

0.7% increase compared with the rate of 453.4 in 2011. 

During 1992–2012, the rate of reported chlamydial 

infection increased from 182.3 to 456.7 cases per 

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

Chlamydia by Region

During 2003–2012, chlamydia rates increased in 

all regions (Figure 2). In 2012, rates were highest in 

the South (496.9 per 100,000 population), followed 

by the Midwest (452.1), the West (426.5), and the 

Northeast (417.8) (Table 3). 

Chlamydia by State

In 2012, chlamydia rates by state ranged from 233.0 

cases per 100,000 population in New Hampshire to 

774.0 cases in Mississippi (Figure 3, Table 2); the rate 

in the District of Columbia was 1,101.6 cases per 

100,000 (Table 3).

Chlamydia by Metropolitan 

Statistical Area 

In 2012, the chlamydia rate per 100,000 population 

in the 50 most populous metropolitan statistical areas 

(MSAs) was similar to the rate in 2011 (481.1 and 

480.9 cases, respectively) (Table 6). In 2012, 56.8% 

of chlamydia cases were reported by these MSAs. 

Among women in these MSAs, the 2012 rate of 661.8 

cases per 100,000 females was similar to the 2011 

rate of 667.6 cases per 100,000 females (Table 7). 

Among men, the 2012 rate (291.3 per 100,000 males) 

increased 2.6% from the 2011 rate (284.0 cases per 

100,000 males) (Table 8). 
6 National Profile: Chlamydia STD Surveillance 2012

Chlamydia by County

Counties in the United States with the highest 

chlamydia case rates per 100,000 population were 

located primarily in the Southeast and West, including 

Alaska (Figure 4). In 2012, 927 (29.5%) of 3,142 

counties had rates higher than 400.0 cases per 100,000 

population. Seventy counties and independent cities 

reported 44% of all chlamydia cases in 2012 (Table 9). 

Chlamydia by Sex

During 1995–2011, chlamydia rates among females 

increased each year (Figure 1). In 2012, the overall rate 

of reported chlamydial infection among women in all 

50 states and the District of Columbia (643.3 cases 

per 100,000 females) was similiar to the reported case 

rate in 2011 (643.4 cases per 100,000 females). This 

is the first time since nationwide reporting began in 

1995 that chlamydia case rates among females did not 

increase. 

The overall case rate among males increased 3.2% 

during 2011–2012 (254.4 to 262.6 cases per 100,000 

males). As in previous years, the reported case rate 

among females was about two times the case rate 

among men in 2012, likely reflecting a larger number 

of women screened for this infection (Figure 1, Tables 

4 and 5). The lower rates among men also suggest that 

many of the sex partners of women with chlamydia 

are not receiving a diagnosis of chlamydia or being 

reported as having chlamydia. 

However, with the advent of highly sensitive 

nucleic acid amplification tests (NAATs) that can 

be performed on urine, chlamydial infection is 

increasingly being diagnosed in symptomatic and 

asymptomatic men. During 2008–2012, the reported 

chlamydial infection rate among men increased 

25.5% (from 209.3 to 262.6 cases per 100,000 males) 

compared with a 11.0% increase among women 

during the same period (from 579.4 to 643.3 cases per 

100,000 females).

Chlamydia by Age

Chlamydia rates are highest among adolescents and 

young adults aged 15–24 years (Table 10). Among 

those aged 15–19 years, rates increased 8.9% during 

2008–2011 (1,947.7 to 2,120.8 cases per 100,000 

population) and then decreased 5.6% during 

2011–2012 (2,120.8 to 2,001.7 cases per 100,000 

population). Among those aged 20–24 years, rates 

increased 18.1% during 2008–2011 (2,075.9 to 

2,450.8 cases per 100,000) and then increased slightly 

(2.1%) during 2011–2012 (2,450.8 to 2,501.5 cases 

per 100,000). 

Among women, the highest age-specific rates of 

reported chlamydia in 2012 were among those aged 

15–19 years (3,291.5 cases per 100,000 females) and 

20–24 years (3,695.5 cases per 100,000 females) 

(Figure 5, Table 10). Within these age ranges, 

reported rates were highest among women aged 18 

years (4,666.3 cases per 100,000 females), aged 19 

years (4,921.1 cases per 100,000 females), and aged 

20 years (4,647.5 cases per 100,000 females) (Table 

12). After increasing steadily from 2000 to 2011, 

during 2011–2012, rates among women aged 15–19 

years decreased 5.6% (3,485.2 to 3,291.5 cases per 

100,000 females). Rates increased slightly (1.8%) 

among women aged 20–24 years (3,630.0 to 3,695.5 

cases per 100,000 females) during 2011–2012.

Age-specific rates among men, although substantially 

lower than the rates among women, were highest in 

those aged 20–24 years (1,350.4 cases per 100,000 

males) (Figure 5, Table 10). Similar to trends in 

women, after increasing for the last decade, during 

2011–2012 reported case rates among men aged 

15–19 years decreased 5.1% (816.3 to 774.8 cases 

per 100,000 males). During 2011–2012, reported 

cases among men aged 20–24 years increased slightly 

(1,307.8 to 1350.4 cases per 100,000 males).

Chlamydia by Race/Ethnicity

Among the 48 jurisdictions (47 states and the District 

of Columbia) that submitted data in the new race and 

ethnicity categories in 2012 according to the revised 

OMB standards, chlamydia rates were highest among 

black men and women (Figure L, Table 11B). The rate 

of chlamydia among blacks was almost seven times 

the rate among whites (1,229.4 and 179.6 cases per 

100,000 population, respectively). The rate among 

American Indians/Alaska Natives (728.2 cases per 

100,000) was 4.1 times the rate among whites. The 

rate among Hispanics (380.3 cases per 100,000) was 

2.1 times the rate among whites. The rate among 

Native Hawaiians/Other Pacific Islanders (590.4 cases 

per 100,000) was 3.3 times the rate among whites. 

The rate among Asians was lower than the rate among 

whites (112.9 cases and 179.6 cases per 100,000, 

respectively).
STD Surveillance 2012 National Profile: Chlamydia 7

Among the 39 jurisdictions (38 states and the District 

of Columbia) that submitted data in the new race and 

ethnicity categories from 2008–2012 according to the 

OMB standards, rates among blacks increased 3.7% 

(from 1,186.5 to 1,230.6 cases per 100,000). Among 

whites, rates increased 38.5% (from 134.4 to 186.2 

cases per 100,000) (Figure 6). 

Chlamydia by Reporting Source

Most chlamydia cases reported in 2012 were from 

venues outside of STD clinics (Figure 8 and Table 

A2). Over time, the proportion of cases reported from 

non-STD clinic sites has continued to increase (Figure 

7). In 2012, among women, only 6.9% of chlamydia 

cases were reported through an STD clinic (Figure 8). 

Most cases among women were reported from private 

physicians/health maintenance organizations (HMOs) 

(38.5%). Among men, 21.4% of chlamydia cases were 

reported from an STD clinic in 2012 and 27.7% were 

reported from private physicians/HMOs.

Chlamydia Prevalence in the 

Population

The National Health and Nutrition Examination 

Survey (NHANES) is a nationally representative 

survey of the U.S. civilian, non-institutionalized 

population aged 14–39 years that provides an 

important measure of chlamydia disease burden. 

From 1999–2000 to 2007–08, there was an estimated 

40% reduction (95% Confidence Interval [CI]: 

8%, 61%) in prevalence among persons aged 14–39 

years.7 During 2005–2008, the overall prevalence of 

chlamydia among persons aged 14–39 years was 1.5% 

(95% CI: 1.2%, 1.9%). Prevalence was highest among 

non-Hispanic blacks (5.9%, 95% CI: 4.5%, 7.7%) 

(Figure 10). 

Chlamydia Positivity in Selected 

Populations

In 2005, the STD Surveillance Network (SSuN) was 

established to improve the capacity of national, state, and 

local STD programs to detect, monitor, and respond to 

trends in STDs. In 2012, a total of 42 STD clinics at 

12 sites collected enhanced behavioral information on 

patients who presented for care to these clinics. More 

detailed information about SSuN methodology can be 

found in the STD Surveillance Network section of the 

Appendix, Interpreting STD Surveillance Data.

In 2012, the proportion of STD clinic patients testing 

positive for chlamydia varied by age, sex, and sexual 

behavior. Adolescent men who have sex with women 

(MSW) had the highest prevalence (26.4%). Among 

MSW and women, prevalence among those tested 

decreased with age. The variation in prevalence by age 

was not as pronounced for men who have sex with 

men (MSM) (Figure 9). 

During the mid-1990s to 2011, chlamydia positivity 

among women screened in family planning and 

prenatal care clinics participating in infertility 

prevention activities were sent to CDC to monitor 

chlamydia prevalence. As the national infertility 

prevention program expanded, these data became 

difficult to interpret as trends were influenced by 

changes in screening coverage, screening criteria, and 

test technologies, as well as demographic changes in 

patients attending clinics reporting data to CDC. 

These issues could not be addressed with the limited 

variables that were collected at the national level. 

Chlamydia positivity data continue to be useful locally 

to inform clinic-based screening recommendations and 

to identify at-risk populations in need of prevention 

interventions, but are no longer collected to monitor 

national trends in chlamydia.

Chlamydia Among Special Populations

More information on chlamydia among women of 

reproductive age, adolescents and young adults, men 

who have sex with men, and minority populations is 

presented in the Special Focus Profiles.

Chlamydia Summary

Chlamydia continues to be the most commonly 

reported nationally notifiable disease with 1,422,976 

cases reported in 2012. For the first time since 1995, 

chlamydia case rates among females did not increase. 

For the first time since 2000, chlamydia case rates 

decreased among both males and females aged 15–19 

years. However, both test positivity and the number 

of reported cases of C. trachomatis infections remain 

high among most age groups, racial/ethnic groups, 

geographic areas, and both sexes. Racial differences also 

persist; reported case rates and prevalence estimates 

among blacks continue to be substantially higher than 

among other racial/ethnic groups.
8 National Profile: Chlamydia STD Surveillance 2012

1 Centers for Disease Control and Prevention. CDC Grand Rounds: 

Chlamydia prevention: challenges and strategies for reducing 

disease burden and sequelae. MMWR Morb Mortal Wkly Rep. 

2011;60(12):370-3.

2 Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, 

Stamm WE. Prevention of pelvic inflammatory disease by screening 

for cervical chlamydial infection. N Engl J Med. 1996;34(21):1362-6.

3 Fleming DT, Wasserheit JN. From epidemiological synergy to 

public health policy and practice: the contribution of other sexually 

transmitted diseases to sexual transmission of HIV infection. Sex 

Transm Infect. 1999;75:3-17.

4 Centers for Disease Control and Prevention. Sexually transmitted 

diseases treatment guidelines, 2010; No.59(RR-12):1-110. Erratum 

in: MMWR Recomm Rep. 2011;60(1):18.

5 National Committee for Quality Assurance. HEDIS 2013: 

technical specifications. Washington (DC): National Committee 

for Quality Assurance; 2012. p. 90-93. 

6 National Committee for Quality Assurance. The state of 

healthcare quality 2012. Washington (DC): National Committee 

for Quality Assurance; 2011. p. 84-86.

7 Datta SD, Torrone E, Kruszon-Moran D, Berman S, Johnson 

R, Satterwhite CL, Papp J, Weinstock H. Chlamydia trachomatis

trends in the United States among persons 14 to 39 years of age, 

1999-2008. Sex Transm Dis. 2012 Feb;39(2):92-6.
STD Surveillance 2012 National Profile: Chlamydia 9

Figure 1. 

NOTE: 

 0

150

300

450

600

750

Year

1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012

Rate (per 100,000 population)

Men

Women

Total

Figure 2. 

 0

100

200

300

400

500

Year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Rate (per 100,000 population)

West

Midwest

Northeast

South

Figure 2. Chlamydia — Rates by Region, United States, 2003 – 2012

Figure 1. Chlamydia — Rates by Sex, United States, 1992 – 2012

NOTE: As of January 2000, all 50 states and the District of Columbia have regulations that require the reporting of chlamydia cases.
10 National Profile: Chlamydia STD Surveillance 2012

Figure 3. 

NOTE:

Rate per 100,000

population

Guam 646 

Puerto Rico 168 

Virgin Islands 758 

<=300

300.1-400

>400

(n= 7)

(n= 12)

(n= 35)

VT 275

NH 233

MA 358

RI 410

CT 365

NJ 309

DE 489

MD 455

DC 1102

638

756

470 565

445 423

407

534

461

287

526 453

372

388 395

598

257

482

338

774

463

383

366 409

571

517

524

425

460

444

348

432

580

476

508

495

270

432

360

258

415

370

Figure 4. 

Rate per 100,000

population

<=300.0 (n= 1,721)

300.1-400.0 (n= 494)

>400.0 (n= 927)

Figure 4. Chlamydia — Rates by County, United States, 2012

Figure 3. Chlamydia — Rates by State, United States and Outlying Areas, 2012

NOTE: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 453.5 per 100,000 population. 
STD Surveillance 2012 National Profile: Chlamydia 11

Figure 5. 

Men Rate (per 100,000 population) Women

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

15.6 10-14 125.3

774.8 15-19 3291.5

1350.4 20-24 3695.5

721.7 25-29 1388.4

369.7 30-34 582.7

187.2 35-39 257.4

110.8 1 40-44 15.8

51.5 45-54 39.5

15.2 55-64 11.0

3.4 2 65+ .2

262.6 6 Total 43.3

Figure 6. Chlamydia—Rates by Race/Ethnicity, United States, 2001–2010

 0

 300

 600

 900

1200

1500

Year

2008 2009 2010 2011 2012

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

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

Figure 6. Chlamydia — Rates by Race/Ethnicity, United States 2008 – 2012

Figure 5. Chlamydia — Rates by Age and Sex, United States, 2012

* AI/AN= American Indians/Alaska Natives; NHOPI= Native Hawaiian and Other Pacific Islanders. 

NOTE: Includes 38 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats during 

2008–2012 (see Appendix “Interpreting STD Surveillance Data”).
12 National Profile: Chlamydia STD Surveillance 2012

Figure 7. 

 0

 200

 400

 600

 800

1,000

Year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Cases (in thousands)

Non-STD Clinic, Men

Non-STD Clinic, Women

STD Clinic, Men

STD Clinic, Women

Figure 8. 

*

NOTE:

Percentage

Private Physician/HMO*

STD Clinic

Other HD* Clinic

Family Planning Clinic

Emergency Room

 0

 10

 20

 30

 40

Men Women

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

United States, 2012

Figure 7. Chlamydia — Cases by Reporting Source and Sex, United States, 2003 – 2012

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

NOTE: Of all cases, 11.4% had a missing or unknown reporting source. Among cases with a known reporting source, the categories presented represent 

69.8% of cases; 30.2% were reported from sources other than those shown.
STD Surveillance 2012 National Profile: Chlamydia 13

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

Age Group, National Health and Nutrition Examination Survey, 2005 – 2008

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

Behavior, STD Surveillance Network (SSuN), 2012

* Only includes patients tested for chlamydia

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

NOTE: Error bars indicate 95% confidence intervals.

Figure 10. 

NOTE: 

Prevalence, %

0

2

4

6

8

Overall Men

 Sex

Women NonHispanic

Whites

NonHispanic

Blacks

Race/Ethnicity

Mexican

Americans 14-25

 Age

26-39 Men

14-25

Women

14-25

Age and Sex 

Figure 9.

NOTE:

SOURCE: 

Percentage

Age

MSM†

MSW†

Women

0

10

20

30

40

<=19 20-24 25-29 30-39 >=40
14 National Profile: Gonorrhea STD Surveillance 2012

Gonorrhea

Background

Gonorrhea is the second most commonly reported 

notifiable disease in the United States. Infections 

due to Neisseria gonorrhoeae, like those resulting 

from C. trachomatis, are a major cause of pelvic 

inflammatory disease (PID) in the United States. 

PID can lead to serious outcomes in women, such as 

tubal infertility, ectopic pregnancy, and chronic pelvic 

pain. In addition, epidemiologic and biologic studies 

provide evidence that gonococcal infections facilitate 

the transmission of HIV infection.1 Although an 

individual’s sexual behavior can increase the risk of 

acquiring gonorrhea, social determinants of health, 

such as socioeconomic status, may contribute to the 

burden of gonorrhea in a community.2

During 1975–1997, the national gonorrhea rate 

declined 74% after implementation of the national 

gonorrhea control program in the mid-1970s 

(Figure 11). After the decline halted for several years, 

gonorrhea rates decreased further to 98.1 cases per 

100,000 population in 2009. This was the lowest rate 

since recording of gonorrhea rates began. Since 2009, 

the rate has increased slightly each year, to 100.2 in 

2010, 103.3 in 2011, and to 107.5 cases per 100,000 

population in 2012, with a total of 334,826 cases 

reported in the United States in 2012 (Figure 11 and 

Table 1). 

The increase in gonorrhea rates during 2011–2012 was 

observed among both men and women (Figure 12). 

Gonorrhea rates increased in the Northeast, Midwest, 

and West, but decreased in the South (Figure 13). 

Rates increased among persons aged 20 years or older, 

but decreased among those aged 15–19 years (Figures 

17 and 18). 

Although gonorrhea case reporting is useful for 

monitoring disease trends, the number of gonorrhea 

cases reported to CDC is affected by many factors 

in addition to the actual occurrence of the infection 

within the population. Changes in the burden of 

gonorrhea may be masked by changes in screening 

practices (e.g., screening for chlamydia with tests that 

also detect N. gonorrhoeae infections and broader 

use of nucleic acid amplification tests [NAATs] at 

non-genital anatomic sites), the use of diagnostic 

tests with different test performance, and changes in 

reporting practices. As with other STDs, the reporting 

of gonorrhea cases to CDC is incomplete.3

 For these 

reasons, supplemental data on gonorrhea prevalence 

in persons screened in a variety of settings are useful in 

assessing the burden of disease in selected populations. 

Neisseria gonorrhoeae has progressively developed 

resistance to each of the antibiotics used for treatment 

of gonorrhea. In the last decade, the development 

of fluoroquinolone resistance has resulted in the 

availability of only a single class of antibiotics that 

meet CDC’s efficacy standards—the cephalosporins.4,5

Most recently, declining susceptibility to cefixime 

resulted in a change in the CDC treatment guidelines, 

so that dual therapy with ceftriaxone and either 

azithromycin or doxycycline is now the only CDCrecommended treatment regimen for gonorrhea.6

 The 

emerging threat of cephalosporin resistance highlights 

the need for continued surveillance of N. gonorrhoeae

antibiotic susceptibility. 

The combination of persistently high gonorrhea 

morbidity in some populations and threat of 

cephalosporin-resistant gonorrhea reinforces the need 

to better understand the epidemiology of gonorrhea. 

Gonorrhea—United States

In 2012, a total of 334,826 cases of gonorrhea were 

reported in the United States, yielding a rate of 107.5 

cases per 100,000 population (Table 1). The rate 

increased 4.1% since 2011; however, the rate decreased 

2.9% overall during 2008–2012.

Gonorrhea by Region

In 2012, as in previous years, the South had the highest 

gonorrhea rate (131.9 cases per 100,000 population) 

among the four regions of the United States, followed 

by the Midwest (114.6), Northeast (92.6), and West 

(73.3) (Table 14). During 2011–2012, rates increased 

19.4% in the West, 8.4% in the Northeast, and 3.4% in 

the Midwest; rates decreased 1.4% in the South (Figure 

13, Table 14). 

Gonorrhea by State

In 2012, gonorrhea rates per 100,000 population 

ranged by state from 7.7 in Wyoming to 230.8 in 

Mississippi; the gonorrhea rate in the District of 
STD Surveillance 2012 National Profile: Gonorrhea 15

Columbia was 388.7 (Figure 14, Tables 13 and 14). 

During 2011–2012, gonorrhea rates increased in 70% 

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

states and in the District of Columbia (Table 14).

Gonorrhea by Metropolitan 

Statistical Area (MSA)

The overall gonorrhea rate in the 50 most populous 

MSAs was 121.5 cases per 100,000 population in 2012 

(Table 17), representing a 4.2% rate increase from 

2011 (116.6). In 2012, 60.9% of gonorrhea cases were 

reported by these MSAs. The total gonorrhea rate among 

women in these MSAs in 2012 (114.3) was lower than 

rates among men (128.7) (Tables 18 and 19).

Gonorrhea by County

In 2012, 52% of reported gonorrhea cases occurred 

in just 70 counties or independent cities (Table 20). 

In 2012, 1,192 counties (37.9%) in the United States 

had a rate less than or equal to 19 cases per 100,000 

population (Figure 15). Rates ranged from 19.1 to 100 

per 100,000 population in 1,300 counties (41.4%) 

and more than 100 cases per 100,000 population in 

650 counties (20.7%). Most counties with more than 

100 cases per 100,000 population were located in the 

South. 

Gonorrhea by Sex

Gonorrhea rates among women have been slightly 

higher than those among men since 2001 (Figure 

12). During 2011–2012, the gonorrhea rate among 

women increased 0.6%, to 108.7 cases per 100,000 

population, and the rate among men increased 8.3%, 

to 105.8 per 100,000 population (Tables 15 and 16). 

The magnitude of the increase among men compared 

to women is suggestive of either increased transmission 

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

extra-genital screening) among men who have sex 

with men (MSM). However, most jurisdictions do not 

routinely report sex of sex partners or site of infection 

for gonorrhea cases, so trends in gonorrhea rates 

among MSM cannot be assessed.

Gonorrhea by Age

In 2012, gonorrhea rates were highest among 

adolescents and young adults. In 2012, the highest 

rates were observed among women aged 20–24 years 

(578.5) and 15–19 years (521.2). Among men, the 

rate was highest among those aged 20–24 years (462.8) 

(Figure 16, Table 21). 

In 2012, persons aged 15–44 years accounted for 

95.0% of reported gonorrhea cases with known age. 

During 2011–2012, gonorrhea rates increased among 

most age groups within this age range: the gonorrhea 

rate increased 3.1% among those aged 20–24 years, 

9.8% among those aged 25–29 years, 15.7% among 

those aged 30–34 years, 14.7% among those aged 

35–39 years, and 13.0% among those aged 40–44 

years (Table 21). The gonorrhea rate decreased 7.5% 

among those aged 15–19 years.

Among women aged 15–44, the largest increase was 

among those aged 40–44 years (14.1%) (Figure 17). 

Among men aged 15–44, the largest increase was 

among those aged 30–34 years (18.1%) (Figure 18). 

Gonorrhea by Race/Ethnicity 

In 2012, among the 48 jurisdictions (47 states and 

the District of Columbia) that submitted data in the 

new race and ethnic categories according to the revised 

Office of Management and Budget (OMB) standards, 

gonorrhea rates remained highest among blacks (462.0 

cases per 100,000 population) (Table 22B). The rate 

among blacks was 14.9 times the rate among whites 

(31.0 per 100,000 population). The gonorrhea rate 

among American Indians/Alaska Natives (124.9) 

was 4.0 times that of whites, the rate among Native 

Hawaiians/Other Pacific Islanders (87.8) was 2.8 times 

that of whites, the rate among Hispanics (60.4) was 1.9 

times that of whites, and the rate among Asians (16.9) 

was 0.5 times that of whites (Table 22B).

During 2008–2012, among the 39 jurisdictions (38 

states and the District of Columbia) that submitted 

data in the new race and ethnic categories for all five 

years during that period, gonorrhea rates increased 

among American Indians/Alaska Natives (61.8%), 

Native Hawaiians/Pacific Islanders (33.5%), whites 

(22.9%), and Asians (14.5%). During this same time 

period, the gonorrhea rate decreased among blacks 

(15.5%) (Figure 19).

More information on gonorrhea rates among racial/

ethnicity groups can be found in the Special Focus 

Profiles.

Gonorrhea by Region and Sex

During 2011–2012, gonorrhea rates among women 

and among men increased in the Northeast, Midwest, 

and West (Tables 15 and 16). In the South, the 

gonorrhea rate among men increased, but the gonorrhea 
16 National Profile: Gonorrhea STD Surveillance 2012

rate among women decreased. In 2012, women in the 

South (138.5), women in the Midwest (127.1) and men 

in the South (124.5) had the highest gonorrhea rates. 

Gonorrhea by Race/Ethnicity and Sex

Among the 48 jurisdictions (47 states and the District 

of Columbia) that submitted data in the new race 

and ethnic categories according to the revised OMB 

standards, gonorrhea rates were higher in women 

than men among American Indians/Alaska Natives, 

Native Hawaiians/Other Pacific Islanders, and whites 

in 2012 (Figure N, Table 22B). Gonorrhea rates were 

higher in men than women among Asians, blacks, 

and Hispanics. Overall, gonorrhea rates were highest 

among black men (467.7) and black women (456.3). 

Gonorrhea by Reporting Source

The number of gonorrhea cases reported by STD 

clinics declined during 2003–2012 (Figure 20). 

In 2012, 17.3% of gonorrhea cases with known 

reporting source were reported by STD clinics (Table 

A2). This is a decrease from 2011, when 18.6% of 

gonorrhea cases were reported by STD clinics. In 

2012, among women, private physicians or health 

maintenance organizations (HMOs) (30.2%) were the 

most common reporting source, followed by family 

planning clinics (11.3%), STD clinics (10.6%), other 

health department clinics (6.8%), and emergency 

rooms (5.7%) (Figure 21). Among men, STD clinics 

were the most common reporting source (24.5%) 

(Figure 21). Other common reporting sources for 

males were private physicians/HMOs (22.9%), other 

health department clinics (8.8%), emergency rooms 

(5.8%), and family planning clinics (5.8%). 

STD Surveillance Network

The STD Surveillance Network (SSuN) is a network 

of 12 states and independently funded cities collecting 

enhanced information on a representative sample 

of gonorrhea cases reported to the state or city 

health department from all reporting sources. This 

project provides more complete estimates of case 

characteristics often missing on routine case reports—

such as gender of sex partners—which is essential for 

better targeting of gonorrhea control efforts. In 2012, 

SSuN collaborators interviewed 6,228 gonorrhea 

cases representing 8.2% of total morbidity across 

participating jurisdictions. Additional information 

about SSuN methodology can be found in the STD 

Surveillance Network section of the Appendix, 

Interpreting STD Surveillance Data.

Based on these enhanced interviews, the burden of 

disease represented by MSM, men who have sex with 

women only (MSW), and women varied substantially 

across collaborating sites (Figure 22). San Francisco 

County had the highest proportion of estimated 

MSM cases (87.8%), while the lowest proportion of 

morbidity estimated to be attributed to MSM was 

found in Jefferson County (Birmingham), Alabama at 

10.9%. Across all SSuN jurisdictions in 2012, 26.6% 

of gonorrhea cases were estimated to be among MSM, 

29.4% among MSW, and 44.1% among women. 

Gonococcal Isolate Surveillance 

Project 

Antimicrobial resistance remains an important 

consideration in the treatment of gonorrhea.4–9 In 

1986, the Gonococcal Isolate Surveillance Project 

(GISP), a national sentinel surveillance system, 

was established to monitor trends in antimicrobial 

susceptibilities of urethral N. gonorrhoeae strains 

in the United States.10 Data are collected from 

selected STD clinic sentinel sites and from regional 

laboratories (Figure 23).

Information on the antimicrobial susceptibility 

criteria used in GISP can be found in the Gonococcal 

Isolate Surveillance Project section of the Appendix, 

Interpreting STD Surveillance Data. More 

information about GISP and additional data can be 

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

Susceptibility to Ceftriaxone

Susceptibility testing for ceftriaxone began in 1987. 

The percentage of GISP isolates that exhibited elevated 

ceftriaxone minimum inhibitory concentrations 

(MICs), defined as ≥0.125 μg/ml, increased from 

0.1% in 2008 to 0.4% in 2011, and decreased slightly 

to 0.3% in 2012 (Figure 24).

One isolate with decreased susceptibility to ceftriaxone 

(MIC = 0.5 μg/ml) was identified in 2012. The 

isolate was collected in Oklahoma City, Oklahoma 

from a heterosexual man; the isolate exhibited 

penicillin resistance (MIC = 2.0 μg/ml), intermediate 

susceptibility to tetracycline (MIC = 1.0 μg/ml), and 

decreased susceptibility to cefixime (MIC = 1.0 μg/

ml). Four isolates with decreased susceptibility to 
STD Surveillance 2012 National Profile: Gonorrhea 17

ceftriaxone (MIC = 0.5 μg/ml) have been previously 

identified in GISP: one from San Diego, California 

(1987), two from Cincinnati, Ohio (1992 and 1993), 

and one from Philadelphia, Pennsylvania (1997). 

Susceptibility to Cefixime

Susceptibility testing for cefixime began in 1992, was 

discontinued in 2007, and was restarted in 2009. The 

percentage of isolates with elevated cefixime MICs 

(≥0.25 μg/ml) increased from 0.1% in 2006 to 1.4% 

in 2010 and 2011, and declined to 1.0% in 2012 

(Figure 25).

In 2012, two isolates had cefixime MICs of 0.5 μg/

ml (from Chicago, Illinois and Orange County, 

California), and one had an MIC of 1.0 μg/ml (from 

Oklahoma City, Oklahoma).

Susceptibility to Cefpodoxime

Monitoring of cefpodoxime susceptibility in GISP 

began in 2009. Of 5,495 GISP isolates tested for 

cefpodoxime susceptibility in 2012, 0.8% had MICs 

of 0.5 μg/ml, 1.3% had MICs of 1.0 μg/ml, and 0.4% 

had MICs of 2.0 μg/ml. 

Susceptibility to Azithromycin

Susceptibility testing for azithromycin began in 1992. 

The proportion of GISP isolates with azithromycin 

MICs of ≥2.0 μg/ml decreased from 0.5% in 2010 

to 0.3% in 2012 (Figure 26). In 2012, two (0.04%) 

isolates had azithromycin MICs of 8.0 μg/ml, 

four (0.1%) isolates had MICs of 16.0 μg/ml, and 

one isolate, collected from a heterosexual man in 

Honolulu, Hawaii had an MIC ≥256 μg/ml.

Susceptibility to Spectinomycin

All isolates were susceptible to spectinomycin in 2012. 

A spectinomycin-resistant isolate was last identified in 

GISP in 1994 (West Palm Beach, Florida).

Susceptibility to Ciprofloxacin

The proportion of GISP isolates with ciprofloxacin 

resistance (MIC ≥1 μg/ml) peaked in 2007 at 14.8%. 

Following a decline in 2008 and 2009, the proportion 

increased from 9.6% in 2009 to 14.7% in 2012. In 

2012, 27.1% of isolates from MSM and 8.7% of 

isolates from MSW exhibited ciprofloxacin resistance.

Other Antimicrobial Susceptibility Testing

In 2012, 33.4% of isolates collected from GISP sites 

were resistant to penicillin, tetracycline, ciprofloxacin, 

or some combination of those antimicrobials (Figure 

27). Although these antimicrobials are no longer 

recommended for treatment of gonorrhea, the 

resistance phenotypes remain common. Conversely, 

66.6% of isolates were susceptible to all three of these 

antimicrobials.

Antimicrobial Treatments Given for 

Gonorrhea

The antimicrobial agents given to GISP patients 

for gonorrhea therapy are shown in Figure 28. The 

proportion of patients treated with ceftriaxone 250 mg 

increased from 84.0% in 2011 to 93.9% in 2012. The 

proportion treated with cefixime decreased from 5.3% 

in 2011 to 1.6% in 2012. 

In 2012, 3.2% of patients were treated with 

azithromycin 2 grams as monotherapy, and 0.1% 

of patients were treated with a fluoroquinolone 

(ciprofloxacin or ofloxacin). 

Among patients treated with ceftriaxone 250 mg 

or cefixime 400 mg, 83.1% were also treated with 

azithromycin one gram, 16.7% were also treated 

with doxycycline, and 0.2% did not receive a second 

antimicrobial.

Gonorrhea Among Special Populations

More information about gonorrhea in racial/ethnic 

groups, women of reproductive age, adolescents, 

MSM, and other populations at higher risk can be 

found in the Special Focus Profiles.

Gonorrhea Summary

The national gonorrhea rate declined dramatically 

during 1975–1997. After 1997, the gonorrhea rate 

fluctuated but generally trended downwards until it 

reached an all-time low in 2009. However, during 

2009–2012 the gonorrhea rate has increased each year. 

High rates persist in some geographic areas, among 

adolescents and young adults, and in some racial/

ethnic groups.

The GISP continues to monitor for the emergence 

of decreased susceptibility and resistance to 

cephalosporins and azithromycin.
18 National Profile: Gonorrhea STD Surveillance 2012

1 Fleming DT, Wasserheit JN. From epidemiological synergy 

to public health policy and practice: the contribution of other 

sexually transmitted diseases to sexual transmission of HIV 

infection. Sex Transm Infect. 1999;75(1):3-17.

2 Sullivan AB, Gesink DC, Brown P, Zhou L, Kaufman JS, Fitch 

M, et al. Are neighborhood sociocultural factors influencing the 

spatial pattern of gonorrhea in North Carolina? Ann Epidemiol 

2011; 21:245-252.

3 American Social Health Association. Sexually transmitted diseases 

in America: how many cases and at what cost? Menlo Park (CA): 

Kaiser Family Foundation; 1998.

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

sexually transmitted diseases treatment guidelines, 2006: 

fluoroquinolones no longer recommended for treatment of 

gonococcal infections. MMWR Morb Mortal Wkly Rep. 

2007;56:332-6.

5 Centers for Disease Control and Prevention. Sexually transmitted 

diseases treatment guidelines, 2010. MMWR Recomm Rep. 

2010;59(No.RR-12).

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

sexually transmitted diseases treatment guidelines, 2010: 

Oral cephalosporins no longer a recommended treatment 

for gonococcal infections. MMWR Morb Mortal Wkly Rep. 

2012;61(31):590-594.

7 Centers for Disease Control and Prevention. Neisseria 

gonorrhoeae with reduced susceptibility to azithromycin — San 

Diego County, California, 2009. MMWR Morb Mortal Wkly 

Rep. 2011;60:579-81.

8 Centers for Disease Control and Prevention. Cephalosporin 

susceptibility among Neisseria gonorrhoeae isolates—United 

States, 2000–2010. MMWR Morb Mortal Wkly Rep. 

2011;60:873-7.

9 Kirkcaldy RD, Ballard RC, Dowell D. Gonococcal Resistance: 

Are Cephalosporins Next? Curr Infect Dis Rep. 2011;13: 196-

204.

10 Schwarcz S, Zenilman J, Schnell D, Knapp JS, Hook EW 

3rd, Thompson S, et al. National surveillance of antimicrobial 

resistance in Neisseria gonorrhoeae. JAMA. 1990;264:1413-7.
STD Surveillance 2012 National Profile: Gonorrhea 19

Figure 12. 

NOTE: 

 0

 50

100

150

200

250

Year

1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012

Rate (per 100,000 population)

Men

Women

Total

Figure 11.

NOTE:

SOURCE: 

 0

100

200

300

400

500

Year

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

Rate (per 100,000 population)

Figure 12. Gonorrhea — Rates by Sex, United States, 1992 – 2012

Figure 11. Gonorrhea — Rates by Year, United States, 1941 – 2012
20 National Profile: Gonorrhea STD Surveillance 2012

* 

NOTE:

Figure 14.

Rate per 100,000

population

Guam 57.6 

Puerto Rico 9.3 

Virgin Islands 128.6 

<=19.0

19.1-100.0

>100.0

(n= 7)

(n= 26)

(n= 21)

VT 15.8

NH 11.2

MA 39.9

RI 48.2

CT 59.6

NJ 84.9

DE 99.1

MD 97.6

DC 388.7

193.0

100.5

89.6 146.6

89.1 55.2

102.1

156.1

59.3

10.5

141.0 112.6

65.5

77.6 98.0

194.0

34.3

127.4

57.7

230.8

131.2

10.8

77.6 83.1

90.4

116.0

148.3

49.0

142.9

117.1

37.8

120.8

163.2

85.8

142.1

126.5

17.0

85.0

47.4

44.8

82.4

7.7

Figure 13.

NOTE:

 0

 50

100

150

200

250

Year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Rate (per 100,000 population)

West

Midwest

Northeast

South

Figure 14. Gonorrhea — Rates by State, United States and Outlying Areas, 2012

Figure 13. Gonorrhea — Rates by Region, United States, 2003 – 2012

NOTE: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 106.3 per 100,000 population.
STD Surveillance 2012 National Profile: Gonorrhea 21

Figure 15.

NOTE:

Rate per 100,000

population

<=19.0 (n= 1,192)

19.1-100.0 (n= 1,300)

>100.0 (n= 650)

Figure 15. Gonorrhea — Rates by County, United States, 2012

Figure 16.

Men Rate (per 100,000 population) Women

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

5.4 10-14 25.3

239.0 15-19 521.2

462.8 20-24 578.5

293.9 25-29 254.1

184.2 30-34 121.6

107.5 35-39 57.7

75.1 40-44 29.2

44.4 45-54 11.4

14.4 55-64 3.0

3.0 65+ 0.4

105.8 Total 108.7

Figure 16. Gonorrhea — Rates by Age and Sex, United States, 2012
22 National Profile: Gonorrhea STD Surveillance 2012

Figure 17.

 0

 150

 300

 450

 600

 750

Year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Rate (per 100,000 population) Age Group

15-19

20-24

25-29

30-34

35-39

40-44

Figure 17. Gonorrhea — Rates by Age Among Women Aged 15 – 44 Years, United States, 2003 – 2012

Figure 18.

 0

 120

 240

 360

 480

 600

Year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Rate (per 100,000 population)

Age Group

15-19

20-24

25-29

30-34

35-39

40-44

Figure 18. Gonorrhea — Rates by Age Among Men Aged 15 – 44 Years, United States, 2003 – 2012
STD Surveillance 2012 National Profile: Gonorrhea 23

NOTE: .

 0

 120

 240

 360

 480

 600

Year

2008 2009 2010 2011 2012

Rate (per 100,000 population)

AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

Figure 19. Gonorrhea — Rates by Race/Ethnicity, United States, 2008 – 2012

* AI/AN= American Indians/Alaska Natives; NHOPI= Native Hawaiian and Other Pacific Islanders. 

NOTE: Includes 38 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats during 

2008–2012 (see Appendix “Interpreting STD Surveillance Data”).

Figure 20.

 0

 40

 80

120

160

200

Year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Cases (in thousands)

Non-STD Clinic, Men

Non-STD Clinic, Women

STD Clinic, Men

STD Clinic, Women

Figure 20. Gonorrhea — Cases by Reporting Source and Sex, United States, 2003 – 2012
24 National Profile: Gonorrhea STD Surveillance 2012

Figure 21.

Percentage

Private Physician/HMO*

STD Clinic

Other HD* Clinic

Family Planning Clinic

Emergency Room

 0

 10

 20

 30

 40

Men Women

Figure 21. Gonorrhea—Percentage of Reported Cases by Sex and Selected Reporting Sources, 

United States, 2012

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

NOTE: Of all cases, 11.7% had a missing or unknown reporting source. Among cases with a known reporting source, the categories presented represent 

66.2% of cases; 33.8% were reported from sources other than those shown.

Figure 22.

Percentage

MSM*

MSW*

Women

 0

 20

 40

 60

 80

100

San

Francisco

California‡  

Washington

Colorado  

Chicago

Louisiana  

Alabama

Virginia  

Baltimore

Philadelphia New York

City

Connecticut

Figure 22. Estimated Proportion of MSM*, MSW*, and Women Among Gonorrhea Cases† by Site, 

STD Surveillance Network (SSuN), 2012

* MSM = men who have sex with men; MSW = men who have sex with women only. † Estimate based on interviews (n=6,228) conducted from a random sample of reported cases of gonorrhea in 2012; cases weighted for analysis by county 

and to adjust for non-response.

‡ California data excludes San Francisco County (shown separately).

NOTE: See Appendix for jurisdictions included in each project area.
STD Surveillance 2012 National Profile: Gonorrhea 25

Figure 23. 

Sentinel Sites

Sites and 

Regional Labs

 Birmingham Phoenix

 Los Angeles

 Orange Co.

 San Diego

 San Francisco Denver

 Miami

 Atlanta

 Honolulu

 Tripler AMC

 Chicago

 New Orleans

 Baltimore

 Pontiac Minneapolis

 Kansas City

 Las Vegas

 Albuquerque

 New York City

 Greensboro

 Cleveland

 Columbus

 Oklahoma City

 Portland

 Philadelphia

 Austin

 Dallas

 Richmond

 Seattle

Figure 23. Location of Participating Sentinel Sites and Regional Laboratories, Gonococcal Isolate 

Surveillance Project (GISP), United States, 2012

NOTE: Austin is a regional laboratory only.

Figure 24.

Percentage

Year

 0.0

 0.1

 0.2

 0.3

 0.4

 0.5

2005 2006 2007 2008 2009 2010 2011 2012

Figure 24. Percentage of Neisseria gonorrhoeae Isolates with Elevated Ceftriaxone Minimum 

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

(GISP), 2005 – 2012
26 National Profile: Gonorrhea STD Surveillance 2012

Figure 25.

Percentage

Year

 0.0

 0.3

 0.6

 0.9

 1.2

 1.5

2005 2006 2007* 2008* 2009 2010 2011 2012

Figure 25. Percentage of Neisseria gonorrhoeae Isolates with Elevated Cefixime Minimum Inhibitory 

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

2005 – 2012

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

Figure 26.

* 

NOTE:

Percentage

Year

 0.0

 0.1

 0.2

 0.3

 0.4

 0.5

 0.6

2005 2006 2007 2008 2009 2010 2011 2012

Figure 26. Percentage of Neisseria gonorrhoeae Isolates with Elevated Azithromycin Minimum 

Inhibitory Concentrations (MICs) (≥2.0 μg/ml), Gonococcal Isolate Surveillance Project 

(GISP), 2005 – 2012
STD Surveillance 2012 National Profile: Gonorrhea 27

Figure 27.

Susceptible

PenR

TetR

QRNG

PenR/TetR

PenR/QRNG

TetR/QRNG

PenR/TetR/QRNG

66.6%

4.5%

11.8%

4.4%

2.3%

0.9%

4.0%

5.4%

Figure 27. Penicillin, Tetracycline, and Ciprofloxacin Resistance Among Neisseria gonorrhoeae

Isolates, Gonococcal Isolate Surveillance Project (GISP), 2012

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

plasmid mediated tetracycline-resistant N. gonorrhoeae; and QRNG=quinolone-resistant N. gonorrhoeae.

Figure 28.

* 

0

20

40

60

80

100

Year

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

Other Cephalosporins

Ceftriaxone 125 mg Spectinomycin

Ceftriaxone 250 mg

Cexime

Penicillins

Ciprooxacin

Tetracyclines

Ooxacin

Other

Percentage

Figure 28. Antimicrobial Drugs Used to Treat Gonorrhea Among Participants, Gonococcal Isolate 

Surveillance Project (GISP), 1988 – 2012

NOTE: For 2012, “Other” includes no therapy (1.1%), azithromycin 2g (3.2%), and other less frequently used drugs (0.1%).
28 National Profile: Syphilis STD Surveillance 2012

Syphilis

Background

Syphilis, a genital ulcerative disease, causes significant 

complications if untreated and facilitates the 

transmission of HIV infection. Untreated early syphilis 

in pregnant women results in perinatal death in up to 

40% of cases and, if acquired during the 4 years before 

pregnancy, can lead to infection of the fetus in 80% of 

cases.1

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

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

the lowest since reporting began in 1941 (Figure 29). 

The low rate of P&S 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 CDC’s National Plan to Eliminate 

Syphilis, which was announced by the Surgeon General 

in October 1999 and revised in May 2006.2

Although the rate of P&S syphilis in the United States 

declined 89.7% during 1990–2000, the rate increased 

annually during 2001–2009 before decreasing in 

2010 and remaining unchanged during 2011. During 

2012, rates again increased (to 5.0 cases per 100,000 

population). Overall increases in rates were observed 

primarily among men (increasing from 8.1 cases (in 

2011) to 9.3 cases (in 2012) per 100,000 population). 

After persistent declines during 1992–2003, the rate 

among women increased from 0.8 cases (in 2004) to 

1.5 cases (in 2008) per 100,000 population, declining 

to 0.9 cases per 100,000 population in 2011 and 2012.

Syphilis remains a major health problem with increases 

persisting among men who have sex with men (MSM). 

Cases among MSM have been characterized by 

high rates of HIV co-infection and high-risk sexual 

behaviors.3–7 The estimated proportion of P&S syphilis 

cases attributable to MSM increased from 7% in 2000 

to 64% in 2004.8,9 In 2005, CDC requested that all 

state health departments report the sex of sex partners 

for persons with syphilis. Of reported male cases with 

P&S syphilis, sex of sex partner information in 2012 

was available for 82%. In 2012, 49 states and the 

District of Columbia provided information about 

sex of sex partners. Among cases of P&S syphilis for 

whom sex of partner was known, MSM accounted for 

75% of P&S syphilis cases.

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

Late, Late Latent, and Congenital)

During 2011–2012, the number of cases of early 

latent syphilis reported to CDC increased 10.4% 

(from 13,136 cases to 14,503 cases), and the number 

of cases of late and late latent syphilis increased 4.5% 

(from 18,576 cases to 19,411 cases) (Tables 1, 37, 

and 39). The total number of cases of syphilis (P&S, 

early latent, late, late latent, and congenital) reported 

to CDC increased 8.4% (from 46,040 cases to 49,903 

cases) during 2011–2012 (Table 1).

P&S Syphilis—United States

P&S syphilis cases reported to CDC increased from 

13,970 in 2011 to 15,667 in 2012, an increase of 

12.1%. The rate of P&S syphilis in the United States 

increased from 4.5 to 5.0 (an 11.1% increase) during 

2011– 2012 (Table 1). 

P&S Syphilis by Region

The South accounted for 43.5% of P&S syphilis cases 

in 2012 and 44.1% in 2011. During 2011–2012, rates 

increased 11.3% in the South (from 5.3 to 5.9 cases 

per 100,000 population), 15.8% in the Northeast 

(from 3.8 to 4.4 cases), 3.1% in the Midwest (from 

3.2 to 3.3 cases), and 18.4% in the West (from 4.9 to 

5.8 cases) (Figure 33, Table 27).

P&S Syphilis by State

In 2012, the 15 states and areas (including the District 

of Columbia) with the highest rates of P&S syphilis 

accounted for 70% of all U.S. cases of P&S syphilis. 

The rate of P&S syphilis in 11 of these 15 states and 

areas (including the District of Columbia) exceeded 

the national rate of 5.0 cases per 100,000 population; 

9 of these 15 states and areas (including the District of 

Columbia) were in the South (Figure 33, Table 26). 

P&S Syphilis by Metropolitan 

Statistical Area 

The rate of P&S syphilis in 2012 for the 50 most 

populous MSAs (7.2 cases per 100,000 population) 

(Table 30) exceeded the overall rate for the United 

States (5.0 cases) (Table 27). The rate increased in 31 

of these 50 MSAs (62%) during 2011–2012. 
STD Surveillance 2012 National Profile: Syphilis 29

P&S Syphilis by County

In 2012, 2,123 of 3,142 counties (67.6%) in the United 

States reported no cases of P&S syphilis, compared 

with 2,154 counties (68.5%) in 2011 (Figure 34). In 

2012, half of the total number of P&S syphilis cases was 

reported from 26 counties and two cities (Table 33).

P&S Syphilis by Sex

The rate of P&S syphilis increased 14.8% among 

men (from 8.1 to 9.3 cases per 100,000 men) during 

2011–2012 (Figure 31, Table 29). During this same 

period, the rate among women remained unchanged 

(0.9 cases per 100,000 women) (Figure 31, Table 28).

P&S Syphilis by Age Group

In 2012, the rate of P&S syphilis was highest among 

persons aged 20–24 years and 25–29 years (14.8 and 

13.7 cases per 100,000 population, respectively) 

(Table 35).

Rates were highest among men 20–29 years, increasing 

11.0% (from 22.8 to 25.3 cases) among men 20–24 

years and 15.6% (from 21.2 to 24.5 cases) among men 

25–29 years during 2012 (Figures 35 and 37, Table 35). 

This marks the fifth consecutive year that rates of P&S 

syphilis among men have been highest among men 

aged 20–29 years (Table 35). During this time period 

(2008–2012), rates have increased among men aged 

20–24 years by 46.2% (from 17.3 to 25.3 cases) and 

among men aged 25–29 years by 45.0% (from 16.9 to 

24.5 cases). These data indicate a shift since 2006, when 

the highest rates were in men aged 35–39 years. 

Rates increased among women aged 20–24 years and 

45–54 years (from 3.7 to 3.9 and from 0.5 to 0.6 cases 

per 100,000 population, respectively). Rates remained 

the same or decreased for women of all other age 

groups. Rates remained highest among women aged 

20–24 years (Figures 35 and 36, Table 35).

P&S Syphilis by Race/Ethnicity

In 2012, among the 48 jurisdictions (47 states and 

the District of Columbia) that submitted data in the 

new race and ethnic categories according to the revised 

Office of Management and Budget (OMB) standards, 

rates of P&S syphilis remained highest among blacks 

(16.4 cases per 100,000 population) (Table 36B). The 

rate among blacks was 6.1 times the rate among whites 

(2.7 cases per 100,000 population). The rate among 

American Indians/Alaska Natives (2.9) was 1.1 times 

that of whites, the rate among Native Hawaiians/Other 

Pacific Islanders (8.4) was 3.1 times that of whites, 

the rate among Hispanics (5.7) was 2.1 times that of 

whites, and the rate among Asians (2.0) was 0.7 times 

that of whites (Table 36B).

During 2008–2012, among the 39 jurisdictions (38 

states and the District of Columbia) that submitted data 

in the new race and ethnic categories for all five years 

during that period, the rate of P&S syphilis increased 

40.9% among Hispanics (from 4.2 to 5.9 cases per 

100,000 population), 21.4% among non-Hispanic 

whites (from 2.4 to 2.9 cases per 100,000 population), 

17.8% among American Indians/Alaska Natives (from 

2.9 to 3.4 cases per 100,000 population), 55.6% 

among Asians (from 1.4 to 2.1 cases per 100,000 

population), 57.6% among Native Hawaiian or Other 

Pacific Islanders (from 5.4 to 8.5 cases per 100,000 

population), and 188.9% among Multirace individuals 

(from 0.7 to 1.9 cases per 100,000 population) 

(Figure 38). The rate decreased 0.7% among nonHispanic blacks (from 17.1 to 16.9 cases per 100,000 

population). Non-Hispanic blacks, non-Hispanic 

whites, and Hispanics comprised 94.5% of reported 

cases in 2008 and 93.8% of reported cases in 2012.

P&S Syphilis by Sex and Sex Behavior

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

rose steeply during 2000–2003 (from 1.5 to 5.3), and 

again during 2008–2012 (from 5.0 to 10.3), reflecting 

higher rates in men than women (Figure 31). In 2012, 

this ratio was almost double the ratio of 2003, and 

almost seven times the ratio of 2000.

In 2005, CDC began collecting information on the 

sex partners of patients with P&S syphilis. In 2012, 

this information was available for 82% of male cases. 

During 2007–2012, 33 areas reported sex of partner 

data for at least 70% of cases each year during this time 

period (Figure 30). During 2007–2008 in these areas, 

increases in cases occurred among women, men having 

sex with women only (MSW), and MSM. During 

2008–2012 in these areas, cases among women and 

MSW declined 24% (from 1,364 to 1,034 cases) and 

15% (from 1,884 to 1,600 cases), respectively, while 

cases among MSM increased 46% (from 5,872 to 

8,553 cases). During 2011–2012 in these areas, cases 

increased very slightly among MSW (4%) and women 

(1%), while cases among MSM increased 15% (from 

7,422 cases in 2011 to 8,553 cases in 2012)—a larger 

increase than in previous years. (In these areas, cases 

among MSM increased 6% during 2008–2009 (from 

5,872 to 6,243), 10% during 2009–2010 (from 6,243 

to 6,870 cases), and 8% during 2010–2011 (from 

6,870 to 7,422 cases).) In 2012, among MSW with 
30 National Profile: Syphilis STD Surveillance 2012

P&S syphilis, 39.2% had primary syphilis, and 60.8% 

had secondary syphilis. Among women with P&S 

syphilis, 18.6% had primary syphilis, and 81.4% had 

secondary syphilis. Among MSM, 27.2% had primary 

syphilis, and 72.8% had secondary syphilis (Figure 

39).Among women with P&S syphilis, 18.1% were 

white, 65.2% were black, 13.2% were Hispanic, and 

2.5% were of other races/ethnicities. Among MSW, 

20.4% were white, 55.9% were black, 19.2% were 

Hispanic, and 2.8% were of other races/ethnicities. 

Among MSM, 37.9% were white, 34.4% were black, 

21.1% were Hispanic, and 4.5% were of other races/

ethnicities (Figure 40).

P&S Syphilis by Race/Ethnicity and Sex

In 2012, among the 48 jurisdictions (47 states and 

the District of Columbia) that submitted data in the 

new race and ethnic categories according to OMB 

standards, rates of P&S syphilis among men were 

highest among non-Hispanic black men (28.9 cases 

per 100,000 population), followed by Native Hawaiian 

or Other Pacific Islander (14.9 cases per 100,000 

population), Hispanic (10.4 cases per 100,000 

population), American Indians/Alaska Natives (5.3 

cases per 100,000 population), non-Hispanic white 

(5.1 cases per 100,000 population), Asian (4.0 cases 

per 100,000 population) and Multirace (3.8 cases per 

100,000 population) men (Figure P, Table 36B).

In 2012, among the 48 jurisdictions (47 states and 

the District of Columbia) that submitted data in the 

new race and ethnic categories according to OMB 

standards, rates of P&S syphilis among women were 

highest among non-Hispanic black women (4.9 

cases per 100,000 population), followed by Native 

Hawaiian or Other Pacific Islander (1.6 cases per 

100,000 population), Hispanic (0.8 cases per 100,000 

population), American Indian/Alaska Native (0.7 cases 

per 100,000 population), non-Hispanic white (0.3 

cases per 100,000 population), Multirace (0.2 cases per 

100,000 population) and Asian (0.1 cases per 100,000 

population) women (Figure P, Table 36B).

P&S Syphilis by Race/Ethnicity, Age, 

and Sex 

In 2012, among the 48 jurisdictions (47 states and 

the District of Columbia) that submitted data in the 

new race and ethnic categories according to OMB 

standards, the rate of P&S syphilis among nonHispanic blacks remained highest among women aged 

20–24 years (19.1 cases per 100,000 women) and 

among men aged 20–24 years and 25–29 years (96.7 

and 89.2 cases per 100,000 men, respectively). For 

Hispanics, the rate was highest among women aged 

20–24 years and 25–29 years (2.1 and 2.0 cases per 

100,000 women, respectively), and among men aged 

20–24 years and 25–29 years (24.3 and 23.2 cases per 

100,000 men, respectively). For non-Hispanic whites, 

the rate was highest among women aged 20–24 years 

(1.1 cases per 100,000 women) and among men aged 

25–29 years and 30–34 years (10.8 cases per 100,000 

men for both groups) (Table 36B).

For Asians, the rate was highest among women aged 

15–19 years and 20–24 years (0.8 cases per 100,000 

women for both groups) and among men aged 25–29 

years (10.3 cases per 100,000 men). For American 

Indians/Alaska Natives, the rate was highest among 

women aged 20–24 years (3.5 cases per 100,000 

women) and among men aged 20–24 years (17.9 cases 

per 100,000 men). For Native Hawaiian or Other 

Pacific Islanders, the rate was highest among women 

aged 20–24 years (9.0 cases per 100,000 women) 

and among men aged 25–29 years (34.8 cases per 

100,000 men). For Multirace individuals, rates were 

highest among women aged 35–39 years (1.5 cases per 

100,000 women) and among men aged 30–34 years 

(11.7 cases per 100,000 men) (Table 36B).

In some age groups, particularly young men aged 

20–24 years and 25–29 years, wide disparities in 

rates of P&S syphilis have occurred in recent years.9,10

During 2007–2011, rates among black men aged 

20–24 years increased from 54.9 to 96.2 cases per 

100,000 population (75%). In 2012, rates among men 

aged 20–24 years and 25–29 years remained highest 

among blacks (96.7 cases and 89.2 cases per 100,000 

population, respectively). These rates were 10.6 and 

8.3 times (respectively) the rate of white men of the 

same age groups. The 2012 rate among Hispanic 

men aged 20–24 years is almost double the 2007 

rate (24.3 versus 14.4 cases per 100,000 population, 

respectively), and is 2.7 times the rate of white men 

aged 20–24 years (9.1 cases per 100,000 population).

These disparities in syphilis rates among young 

men are of particular concern given data indicating 

increasing HIV incidence among young men.11, 12

P&S Syphilis by Reporting Source

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

from sources other than STD clinics; this figure 

increased to 39.2% in 1998. During 1998–2012, the 

proportion of cases reported from sources other than 

STD clinics increased from 39.2% to 68.1% (Figure 

41, Table A2). During 2003–2012, the number of 
STD Surveillance 2012 National Profile: Syphilis 31

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

and treatment of congenital syphilis. Acta Derm Venereol. 

1951:31(Suppl 24):60-88.

2 Centers for Disease Control and Prevention. The national plan 

to eliminate syphilis from the United States. Atlanta: U.S. 

Department of Health and Human Services; 2006.

3 Centers for Disease Control and Prevention. Resurgent bacterial 

sexually transmitted disease among men who have sex with 

men — King County, Washington, 1997–1999. MMWR Morb 

Mortal Wkly Rep. 1999;48:773-7.

4 Centers for Disease Control and Prevention. Outbreak of syphilis 

among men who have sex with men — Southern California, 

2000. MMWR Morb Mortal Wkly Rep. 2001;50(7):117-20.

5 Centers for Disease Control and Prevention. Primary and secondary 

syphilis among men who have sex with men — New York City, 

2001. MMWR Morb Mortal Wkly Rep. 2002;51:853-6.

6 Chen SY, Gibson S, Katz MH, Klausner JD, Dilley JW, Schwarcz 

SK, et al. Continuing increases in sexual risk behavior and sexually 

transmitted diseases among men who have sex with men: San 

Francisco, California, 1999–2001 [Letter] Am J Public Health. 

2002;92:1387-8.

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

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

2003;30:872-3.

8 Centers for Disease Control and Prevention. Primary and 

secondary syphilis — United States, 2003–2004. MMWR Morb 

Mortal Wkly Rep. 2006;55:269-73.

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

in primary and secondary syphilis among men who have sex with 

men in the United States. Am J Public Health. 2007;97:1076-83.

10 Su JR, Beltrami JF, Zaidi AA, Weinstock HS. Primary and 

secondary syphilis among black and Hispanic men who have 

sex with men: case report data from 27 States. Ann Intern Med. 

2011;155(3):145-51.

11 Centers for Disease Control and Prevention. Trends in HIV/AIDS 

diagnoses among men who have sex with men — 33 States, 2000–

2006. MMWR Morb Mortal Wkly Rep. 2008; 57:681–686.

12 Brewer TH, Schillinger J, Lewis FM, Blank S, Pathela P, Jordahl L, 

et al. Infectious syphilis among adolescent and young adult men: 

implications for human immunodeficiency virus transmission 

and public health interventions. Sex Transm Dis. 2011 

May;38(5):367-71.

cases among males reported from non-STD clinic 

sources increased steadily, while the number reported 

from STD clinics increased slightly by comparison 

(Figure 41).

In 2012, patients with P&S syphilis usually sought 

care from private physicians or STD clinics. Similar 

proportions of cases among women and MSM 

were reported from private physicians and STD 

clinics, while substantially more cases among MSW 

were reported from STD clinics than from private 

physicians (Figure 42). 

Congenital Syphilis—United States

After an 18% increase in the rate of congenital syphilis 

during 2006–2008, the rate of congenital syphilis 

decreased 25% during 2008–2012 (from 10.4 to 7.8 

cases per 100,000 live births) (Table 42). In 2012, a 

total of 322 cases were reported, a decrease from 358 

cases in 2011, 387 cases in 2010, and 431 cases in 

2009. This recent decrease in the rate of congenital 

syphilis is associated with the decrease in the rate of 

P&S syphilis among women that has occurred since 

2008 (Figure 43). The 2012 rate of congenital syphilis 

(7.8 cases per 100,000 live births) marks the lowest 

rate of congenital syphilis recorded since 1988, when 

the case definition was changed.

Syphilis among Special Populations

More information about syphilis and congenital 

syphilis in racial and ethnic minority populations, 

adolescents, MSM, and other populations at higher 

risk can be found in the Special Focus Profiles.

Syphilis Summary

In recent years, young MSM have accounted for an 

increasing proportion of syphilis cases in the United 

States.9, 10 According to information reported from 

49 states and the District of Columbia, 75% of 

P&S syphilis cases are among MSM. Although the 

majority of U.S. syphilis cases have occurred among 

MSM, transmission among MSW and women 

continues to occur in certain jurisdictions.
32 National Profile: Syphilis STD Surveillance 2012

Figure 29.

 0

120

240

360

480

600

Year

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

Cases (in thousands)

Primary and Secondary

Early Latent

Total Syphilis

Figure 29. Syphilis—Reported Cases by Stage of Infection, United States, 1941 – 2012

Figure 30.

 0

 2,000

 4,000

 6,000

 8,000

10,000

Year

2007 2008 2009 2010 2011 2012

Cases

†

† MSM

MSW

Women

Figure 30. Primary and Secondary Syphilis — by Sex and Sexual Behavior, 33 areas*, 2007 – 2012

* 32 states and Washington, DC reported sex of partner data for ≥70% of reported cases of P&S syphilis for each year during 2007–2012.

† MSM = men who have sex with men; MSW = men who have sex with women only.
STD Surveillance 2012 National Profile: Syphilis 33

Figure 31.

NOTE: Isolates were not tested for cexime susceptibility in 2007 and 2008.

 0

 5

 10

 15

 20

 25

Year

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

1:1

2:1

4:1

8:1

16:1

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

Male Rate

Female Rate

Total Rate

Male-to-Female Rate Ratio

Figure 31. Primary and Secondary Syphilis — Rates by Sex and Male-to-Female Rate Ratios, United 

States, 1990 – 2012

Figure 32.

 0

 2

 4

 6

 8

10

Year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Rate (per 100,000 population)

West

Midwest

Northeast

South

Figure 32. Primary and Secondary Syphilis—Rates by Region, United States, 2003 – 2012
34 National Profile: Syphilis STD Surveillance 2012

Figure 33.

NOTE:

Rate per 100,000

population

Guam 3.8 

Puerto Rico 8.3 

Virgin Islands 0.0 

<=0.2

0.21-2.2

>2.2

(n= 2)

(n= 16)

(n= 36)

VT 1.0

NH 2.7

MA 4.8

RI 4.2

CT 1.5

NJ 2.6

DE 4.2

MD 7.4

DC 26.7

4.5

1.5

3.1 5.9

7.8 4.1

7.2

9.5

1.7

1.6

6.2 3.4

2.3

0.8 3.4

7.4

1.3

3.0

2.2

5.0

2.6

0.2

0.4 4.1

4.9

6.3

3.6

0.6

3.7

2.2

5.5

3.9

4.8

2.2

4.2

6.3

1.5

3.5

4.4

0.4

1.6

0.7

Figure 33. Primary and Secondary Syphilis—Rates by State, United States and Outlying Areas, 2012

NOTE: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 5.1 per 100,000 

population.

Figure 34.

NOTE:

Rate per 100,000

population

<=0.2 (n= 2,123)

0.21-2.2 (n= 373)

>2.2 (n= 646)

Figure 34. Primary and Secondary Syphilis—Rates by County, United States, 2012

NOTE: In 2012, 2,123 (67.6%) of 3,142 counties in the United States reported no cases of primary and secondary syphilis.
STD Surveillance 2012 National Profile: Syphilis 35

Figure 35.

Men Rate (per 100,000 population) Women

25 20 15 10 5 0 Age 0 5 10 15 20 25

0.0 0 10-14 .0

5.8 2 15-19 .3

25.3 20-24 3.9

24.5 25-29 2.5

19.7 30-34 1.8

14.8 35-39 1.2

14.8 40-44 0.7

10.5 0 45-54 .6

3.2 0 55-64 .1

0.7 0 65+ .0

9.3 0 Total .9

Figure 35. Primary and Secondary Syphilis—Rates by Age and Sex, United States, 2012

Figure 36.

 0

 2

 4

 6

 8

 10

Year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Rate (per 100,000 population)

Age Group

15-19

20-24

25-29

30-34

35-39

40-44

Figure 36. Primary and Secondary Syphilis — Rates by Age Among Women Aged 15 – 44 Years, 

United States, 2003 – 2012
36 National Profile: Syphilis STD Surveillance 2012

Figure 38.

 0

 4

 8

 12

 16

 20

Year

2008 2009 2010 2011 2012

Rate (per 100,000 population)

AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

Figure 38. Primary and Secondary Syphilis — Rates by Race/Ethnicity, United States, 2008 – 2012

* AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiian and Other Pacific Islanders.

NOTE: Includes 38 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats during 

2008–2012 (see Appendix “Interpreting STD Surveillance Data”).

Figure 37.

 0

 6

 12

 18

 24

 30

Year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Rate (per 100,000 population)

Age Group

15-19

20-24

25-29

30-34

35-39

40-44

Figure 37. Primary and Secondary Syphilis — Rates by Age Among Men Aged 15 – 44 Years, United 

States, 2003 – 2012
STD Surveillance 2012 National Profile: Syphilis 37

Figure 39.

Cases

† †

Primary

Secondary

 0

 1600

 3200

 4800

 6400

MSW Women MSM

Figure 39. Primary and Secondary Syphilis — Reported Cases* by Stage, Sex, and Sexual Behavior, 

2012

* Of the reported male cases of primary and secondary syphilis, 17.4% were missing sex of sex partner information.

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

Figure 40.

NOTE:

Cases

† †

Whites

Blacks

Hispanics

Other

 0

 750

 1500

 2250

 3000

 3750

MSW Women MSM

Figure 40. Primary and Secondary Syphilis—Reported Cases* by Sex, Sexual Behavior, and Race/

Ethnicity, United States, 2012

* Of the reported male cases of primary and secondary syphilis, 17.4% were missing sex of sex partner information; 2.0% of reported male cases with sex 

of sex partner data were missing race/ethnicity data. † MSW = men who have sex with women only; MSM = men who have sex with men.
38 National Profile: Syphilis STD Surveillance 2012

Figure 42.

Percentage, %

† †

†

Correctional Facility

HIV Counseling and Testing Site

Private Physician/HMO

STD Clinic

 0

 10

 20

 30

 40

MSW Women MSM

Figure 42. Primary and Secondary Syphilis — Percentage of Reported Cases* by Sex, Sexual 

Behavior, and Selected Reporting Sources, 2012

* Of the reported male cases of primary and secondary syphilis, 17.4% were missing sex of sex partner information, and 6.2% of reported male cases with 

sex of sex partner data were missing source of information data. † HMO = health maintenance organization; MSM = men who have sex with men; MSW = men who have sex with women only.

Figure 41.

NOTE:

 0

 2

 4

 6

 8

 10

Year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Cases (in thousands)

Non-STD Clinic, Men

Non-STD Clinic, Women

STD Clinic, Men

STD Clinic, Women

Figure 41. Primary and Secondary Syphilis — Reported Cases by Reporting Source and Sex, United 

States, 2003 – 2012
STD Surveillance 2012 National Profile: Syphilis 39

Figure 43.

CS* Cases (in thousands) P&S* Rate (per 100,000 women)

P&S Rate

CS Cases

0.0

0.2

0.4

0.6

0.8

Year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

0

1

2

3

4

 

Figure 43. Congenital Syphilis — Reported Cases Among Infants by Year of Birth and Rates of 

Primary and Secondary Syphilis Among Women, United States, 2003 – 2012

* CS = congenital syphilis; P&S = primary and secondary syphilis.
40 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2012

Other Sexually Transmitted Diseases 

Chancroid

Reported cases of chancroid declined steadily between 

1987 and 2001. Since then, the number of reported 

cases has fluctuated (Figure 44, Table 1). In 2012, a 

total of 15 cases of chancroid were reported in the 

United States. Only eight states reported one or more 

cases of chancroid in 2012 (Table 44). 

Although the overall decline in reported chancroid cases 

most likely reflects a decline in the incidence of this 

disease, these data should be interpreted with caution 

because Haemophilus ducreyi, the causative organism 

of chancroid, is difficult to culture; as a result, this 

condition may be substantially underdiagnosed.1,2

Human Papillomavirus 

In June 2006, a quadrivalent HPV vaccine was licensed 

for use in the United States in females aged 9–26 years;3

in October 2009, this vaccine also was licensed for 

use in males aged 9–26 years.4 This vaccine provides 

protection against HPV types 6, 11, 16, and 18. HPV 

6 and 11 are responsible for about 90% of anogenital 

warts,5,6 while HPV 16 and 18 are high-risk oncogenic 

types that cause approximately 70% of cervical cancers 

worldwide.7,8 In October 2009, a bivalent HPV vaccine 

that provides protection against types 16 and 18 was 

licensed for use in females aged 10–25 years.9

HPV vaccine uptake in the US is relatively low. In 

2012, a national survey found that 54% of girls aged 

13-17 years had received at least 1 dose of the HPV 

vaccine series, but only 33% had received all 3 doses in 

the series.10 Vaccine uptake is very low among boys.11

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

56, 58, 59, or 68 was conducted from 2003 through 

2005 in 26 STD, family planning, and primary 

care clinics in 6 locations (Boston, Baltimore, New 

Orleans, Denver, Seattle, and Los Angeles). Testing was 

performed using a commercially available test for highrisk HPV DNA (Hybrid Capture 2, Qiagen). Overall 

prevalence of high-risk HPV was 23% (95% confidence 

interval [CI]: 22-24). Age- and city-adjusted prevalence 

was 26% (95% CI: 24-29) in STD clinics, 24% (95% 

CI: 22-26) in family planning clinics, and 17% (95% CI: 

16-20) in primary care clinics. Prevalence by age group 

was 35% (95% CI: 32-38) in women aged 14–19 years, 

29% (95% CI: 28-30) in those aged 20–29, 13% (95% 

CI: 12-15) in those aged 30–39, 11% (95% CI: 9-13) in 

those aged 40–49, and 6% (95% CI: 4-8) in those aged 

50–65.12

National population-based data were obtained 

from NHANES to examine the prevalence of both 

high-risk HPV and low-risk HPV in the civilian, 

non-institutionalized female population during 

2003–2006 (Figure 45). HPV detection and typing 

were performed using the Research Use Only Linear 

Array genotyping assay (Roche Diagnostics), resulting 

in higher HPV prevalence than previously reported for 

NHANES 2003–2004 data. The overall prevalence 

of high- and low-risk HPV was 42.5% (95% CI: 

40.3–44.7) among females aged 14–59 years.13 HPV 

vaccine-preventable low-risk types 6 or 11 or highrisk types 16 or 18 were detected in 8.8% of female 

participants: HPV 6 in 2.8% (95% CI: 2.2–3.6), HPV 

11 in 0.3% (95% CI: 0.2–0.7), HPV 16 in 4.7% 

(95% CI: 4.0–5.5), and HPV 18 in 1.9% (95% CI: 

1.4–2.5).14 Prevalence of quadrivalent vaccine-type 

HPV decreased from 11.5% (95% CI: 9.2-14.4) in 

2003-2006 to 5.1% (95% CI: 3.8-6.6) in 2007-2010 

among females aged 14-19 years, the age group most 

likely to be affected by introduction of the HPV 

vaccine, despite low vaccine uptake.15

Data from the National Disease and Therapeutic Index 

(NDTI) suggest that cases of genital warts (Figure 46, 

Table 45), as measured by initial visits to physicians’ 

offices, may have increased during the late 1990s 

through 2011; although cases appear to have decreased 

in 2012, more years of data are needed to discern 

whether genital warts are declining. Prevalence of 

genital warts in a large US cohort of individuals with 

private health insurance significantly declined in 2007 

to 2010 among girls aged 15-19.16 NHANES data for 

1999–2004 indicated that 5.6% (95% CI: 4.9–6.4) of 

sexually active adults aged 18–59 years self-reported a 

history of a genital wart diagnosis.17

For data reported in Figure 47, enhanced behavioral 

and demographic information on patients who 

presented for care in 2012 at the 42 clinics 

participating in the STD Surveillance Network (SSuN) 

was used. Genital warts were identified by provider 
STD Surveillance 2012 National Profile: Other Sexually Transmitted Diseases 41

diagnosis or by documentation from the physical 

examination. Men who have sex with men (MSM) 

and men who have sex with women only (MSW) 

were defined by self-report or by sex of reported sex 

partners. More detailed information about SSuN 

methodology can be found in the STD Surveillance 

Network section of the Appendix, Interpreting STD 

Surveillance Data. The prevalence of genital warts in 

2012 is presented separately for MSM, MSW, and 

women by SSuN site. Prevalence was lowest in women 

for all sites. Among women the median prevalence of 

genital warts was 1.6% (range 0.5 to 2.3) across all 

sites compared to 4.8% (range 2.5 to 7.4) for MSM 

and 6.0% (range 1.9 to 9.5) for MSW.

Pelvic Inflammatory Disease 

For data on pelvic inflammatory disease, see Special 

Focus Profiles, STDs in Women and Infants. 

Herpes Simplex Virus 

Case reporting data for genital herpes simplex virus 

(HSV) are not available. Trend data are based on 

estimates of initial visits to physicians’ offices for this 

condition from the NDTI (Figure 48, Table 45).

National trend data on the seroprevalence of HSV-2 

among those aged 14–49 years from NHANES 2005–

2008 were compared with NHANES survey years 

1988–1994 and 1999–2004. Seroprevalence decreased 

from 21.0% (95% CI: 19.1–23.1) in 1988–199418

to 17.0% (95% CI: 15.8–18.3) in 1999–200418

and 16.2% (95% CI: 14.6–17.9) in 2005–2008.19

These data, along with data from NHANES survey 

years 1976–1980,18 indicate that blacks had higher 

seroprevalence than whites for each survey period and 

age group (Figure 49). 

Although HSV-2 seroprevalence is decreasing, most 

persons with HSV-2 have not received a diagnosis. 

During 2005–2008, the percentage of NHANES 

survey participants aged 20–49 years infected with 

HSV-2 who reported a diagnosis of genital herpes was 

18.9%.19 An overall increase in the number of visits for 

genital herpes over time, as suggested by NDTI data, 

may indicate increased recognition of infection.

Trichomoniasis

Trend data for this infection are limited to estimates of 

initial physician office visits from the NDTI (Figure 

50, Table 45). NHANES data from 2001–2004 

indicated an overall prevalence of 3.1% (95% CI: 

2.3–4.3), with the highest prevalence observed among 

blacks (13.3%) (95% CI: 10.0–17.7).20
42 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2012

1 Schulte JM, Martich FA, Schmid GP. Chancroid in the United 

States, 1981–1990: evidence for underreporting of cases. MMWR 

Morb Mortal Wkly Rep. 1992;41(SS-3):57-61.

2 Mertz KJ, Trees D, Levine WC, Lewis JS, Litchfield B, Pettus 

KS, et al. Etiology of genital ulcers and prevalence of human 

immunodeficiency virus coinfection in 10 US cities. J Infect Dis. 

1998;178(6):1795-1798.

3 Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson 

H, Unger ER. Quadrivalent human papillomavirus vaccine. 

Recommendations of the Advisory Committee on Immunization 

Practices (ACIP). MMWR Morb Mortal Wkly Rep. 

2007;56(RR02):1-24.

4 Centers for Disease Control and Prevention. FDA licensure of 

quadrivalent human papillomavirus vaccine (HPV4, Gardasil) 

for use in males and guidance from the Advisory Committee on 

Immunization Practices (ACIP). MMWR Morb Mortal Wkly 

Rep. 2010;59(20):630-632.

5 Garland SM, Steben M, Sings HL, James M, Lu S, Railkar R, 

et al. Natural history of genital warts: analysis of the placebo 

arm of 2 randomized phase III trials of a quadrivalent human 

papillomavirus (types 6, 11, 16, and 18) vaccine. J Infect Dis. 

2009;199(6):805-814.

6 Gissmann L, Wolnik L, Ikenberg H, Koldovsky U, Schnurch 

HG, zur Hausen H. Human papillomavirus types 6 and 11 DNA 

sequences in genital and laryngeal papillomas and in some cervical 

cancers. Proc Natl Acad Sci USA. 1983;80(2):560-563.

7 Clifford GM, Smith JS, Plummer M, Munoz N, Franceschi 

S. Human papillomavirus types in invasive cervical cancer 

worldwide: a meta-analysis. Br J Cancer. 2003;88(1):63-73.

8 Bosch FX, Manos MM, Munoz N, Sherman M, Jansen AM, Peto 

J, et al. Prevalence of human papillomavirus in cervical cancer: a 

worldwide perspective. J Natl Cancer Inst. 1995;87(11):796-802.

9 Centers for Disease Control and Prevention. FDA licensure of 

bivalent human papillomavirus vaccine (HPV2, Cervarix) for use 

in females and updated HPV vaccination recommendations from 

the Advisory Committeee on Immunization Practices (ACIP). 

MMWR Morb Mortal Wkly Rep. 2010;59(20):626-629. 

10 Centers for Disease Control and Prevention. Human 

papillomavirus vaccination coverage among adolescent girls, 

2007–2012, and postlicensure vaccine safety monitoring, 

2006–2013 - United States. MMWR Morb Mortal Wkly Rep. 

2013;62(29):591-595. 

11 Centers for Disease Control and Prevention. National and 

state vaccination coverage among adolescents aged 13–17 

years - United States, 2011. MMWR Morb Mortal Wkly Rep. 

2012;61(34):671-677.

12 Datta SD, Koutsky LA, Ratelle S, Unger ER, Shlay J, McClain 

T, et al. Human papillomavirus infection and cervical cytology in 

women screened for cervical cancer in the United States, 2003–

2005. Ann Intern Med. 2008;148(7):493-500.

13 Hariri S, Unger ER, Sternberg M, Dunne EF, Swan D, Patel S, et 

al. Prevalence of genital human papillomavirus among females in 

the United States, the National Health and Nutrition Examination 

Survey, 2003–2006. J Infect Dis. 2011;204(4):566-573.

14 Dunne EF, Sternberg M, Markowitz LE, McQuillan G, Swan D, 

Patel S, et al. Human papillomavirus (HPV) 6, 11, 16, and 18 

prevalence among females in the United States–National Health 

and Nutrition Examination Survey, 2003–2006: opportunity to 

measure HPV vaccine impact? J Infect Dis. 2011;204(4):562-565.

15 Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, McQuillan 

G, et al. Reduction in human papillomavirus (HPV) prevalence 

among young women following HPV vaccine introduction in 

the United States, National Health and Nutrition Examination 

Surveys, 2003–2010. J Infect Dis. 2013;208(3):385-393. 

16 Flagg EW, Schwartz R, Weinstock H. Prevalence of anogenital 

warts among participants in private health plans in the United 

States, 2003–2010: potential impact of human papillomavirus 

vaccination. Am J Public Health. 2013;103(8):1428-1435. 

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

among 18- to 59-year-olds in the United States, National Health 

and Nutrition Examination Survey, 1999–2004. Sex Transm Dis. 

2008;35(4):357-360.

18 Xu F, Sternberg MR, Kottiri BJ, McQuillan GM, Lee FK, 

Nahmias AJ, et al. Trends in herpes simplex virus type 1 and type 

2 seroprevalence in the United States. JAMA. 2006;296(8):964-

973.

19 Centers for Disease Control and Prevention. Seroprevalence of 

herpes simplex virus type 2 among persons aged 14 49 years - 

United States, 2005–2008. MMWR Morb Mortal Wkly Rep. 

2010;59(15):456-459.

20 Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman S, 

Markowitz L. The prevalence of Trichomonas vaginalis infection 

among reproductive-age women in the United States, 2001–2004. 

Clin Infect Dis. 2007;45(10):1319-1326.
STD Surveillance 2012 National Profile: Other Sexually Transmitted Diseases 43

Figure 41. Primary and Secondary Syphilis—Rates by Age Among Men Aged 15–44 Years, 

United States, 2001–2010

 0

 1

 2

 3

 4

 5

Year

1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011

Cases (in thousands)

Figure 44. Chancroid — Reported Cases by Year, United States, 1981 – 2012

Figure 45.

Prevalence, %

Age

Low-risk HPV*

High-risk HPV*

0

10

20

30

40

50

60

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

Figure 45. Human Papillomavirus — Prevalence of High-risk and Low-risk Types Among Females 

Aged 14 – 59 Years, National Health and Nutrition Examination Survey, 2003 – 2006

* HPV = human papillomavirus.

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

SOURCE: Hariri S, Unger ER, Sternberg M, Dunne EF, Swan D, Patel S, et al. Prevalence of genital human papillomavirus among females in the United States, 

the National Health and Nutrition Examination Survey, 2003–2006. J Infect Dis. 2011;204(4):566-73.
44 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2012

Figure 47.

* 

Prevalence, %

MSM*

MSW*

Women

 0

 3

 6

 9

 12

 15

San

Francisco

Los

Angeles

Seattle   DenverChicago New

Orleans

Birmingham  

Richmond

Baltimore  

Philadelphia

New York

City

Hartford/

New Haven

Figure 47. Genital Warts — Prevalence Among STD Clinic Patients by Sex, Sex of Partners, and Site, 

STD Surveillance Network (SSuN), 2012 

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

 0

100

200

300

400

500

Year

1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Visits (in thousands)

Figure 46.

* 

Figure 46. Genital Warts — Initial Visits to Physicians’ Offices, United States, 1966 – 2012

NOTE: The relative standard errors for genital warts estimates of more than 100,000 range from 18% to 30%. See Other Surveillance Data Sources in the 

Appendix and Table 45.

SOURCE: IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966 – 2012.
STD Surveillance 2012 National Profile: Other Sexually Transmitted Diseases 45

Figure 48.

 0

 80

160

240

320

400

Year

1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Visits (in thousands)

Figure 48. Genital Herpes — Initial Visits to Physicians’ Offices, United States, 1966 – 2012

NOTE: The relative standard errors for genital herpes estimates of more than 100,000 range from 18% to 30%. See Other Surveillance Data Sources in the 

Appendix and Table 45.

SOURCE: IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966 – 2012.
46 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2012

Figure 49.

Non-Hispanic Whites

Percentage

Age

0

20

40

60

80

100

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

Non-Hispanic Blacks

Percentage

Age

0

20

40

60

80

100

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

1976 - 1980 1988 - 1994

1999 - 2004 2005 - 2008

Figure 49. Herpes Simplex Virus Type 2 — Seroprevalence Among Non-Hispanic Whites and NonHispanic Blacks by Age Group, National Health and Nutrition Examination Survey, 1976 – 

1980, 1988 – 1994, 1999 – 2004, 2005 – 2008

* Age-adjusted by using the 2000 U.S. Census civilian, non-institutionalized population aged 14–49 years as the standard.

NOTE: Error bars indicate 95% confidence interval.
STD Surveillance 2012 National Profile: Other Sexually Transmitted Diseases 47

Figure 50.

* CS = congenital syphilis; P&S = primary and secondary syphilis.

 0

 900

1,800

2,700

3,600

4,500

Year

1966 1971 1976 1981 1986 1991 1996 2001 2006 2011

Visits (in thousands)

Trichomoniasis

Other Vaginitis

Figure 50. Trichomoniasis and Other Vaginal Infections—Women—Initial Visits to Physicians’ 

Offices, United States, 1966 – 2012

NOTE: The relative standard errors for trichomoniasis estimates range from 16% to 27% and for other vaginitis estimates range from 8% to 13%. See Other 

Surveillance Data Sources in the Appendix and Table 45.

SOURCE: IMS Health, Integrated Promotional ServicesTM, IMS Health Report, 1966–2012.
48 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2012
SPECIAL FOCUS PROFILES
SPECIAL FOCUS PROFILES
STD Surveillance 2012 Special Focus Profiles 49

Special Focus Profiles

The Special Focus Profiles highlight trends and distribution of STDs in populations of particular interest 

for STD and HIV prevention programs in state and local health departments. These populations are most 

vulnerable to STDs and their consequences often lack adequate access to healthcare services in general. For 

example, in 2011 the majority of the U.S. uninsured were low income. Young adults (19-34) were the age 

group most likely to be uninsured. One in seven full-time workers (15.3%) was uninsured, and uninsured 

rates were higher among part-time workers and the unemployed. In 2011, approximately 30% of persons of 

Hispanic origin were uninsured, and Blacks were more likely to be uninsured than non-Hispanic whites, with 

19.5% of this group lacking insurance.* They include women and infants, adolescents and young adults, racial 

and ethnic minorities, and MSM. The figures cited in this section are located in disease-specific sections of the 

National Profile, as well as throughout this section.

* U.S. Census Burea. Income poverty and health insurance coverage in the United States: 2011. [Accessed November 5, 2013].

Available at: http://aspe.hhs.gov/health/reports/2012/uninsuredintheUS/ib.shtml
50 Special Focus Profiles STD Surveillance 2012
STD Surveillance 2012 Special Focus Profiles: STDs in Women and Infants 51

STDs in Women and Infants

Public Health Impact

Women and infants bear significant long-term 

consequences of STDs. In addition to biological and 

social factors such as poverty and access to quality 

STD services, a woman’s inability to negotiate safer 

sexual practices, such as condom use, can significantly 

affect her sexual health and subsequently the health 

of her unborn baby.1,2 A woman’s relationship 

status with her male partner, in particular, has been 

identified as an important predictor of her sexual 

health.3

 For example, a perceived shortage of available 

men in a community, can cause women to be 

more accepting of their partners’ concurrent sexual 

relationships, and partner concurrency is a factor 

associated with increased risk for STDs.4

 A number 

of studies have found significant associations between 

condom use and socio-demographic characteristics, 

including age, income, education, and acculturation.5 

Because it may be the behavior of her male partner, 

rather than the woman’s own behavior, that increases 

a woman’s risk for STDs, even a woman who has only 

one partner may be obliged to practice safer sex such 

as using condoms.6

Women infected with C. trachomatis or N. 

gonorrhoeae can develop PID, which, in turn, can 

lead to reproductive system morbidity such as ectopic 

pregnancy and tubal factor infertility. An estimated 

10%–20% of women with chlamydia or gonorrhea 

may develop PID if they do not receive adequate 

treatment.7,8 Among women with PID, tubal scarring 

can cause infertility in 8% of women, ectopic 

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

About 80%–90% of chlamydial infections10 and 

up to 80% of gonococcal infections11 in women are 

asymptomatic.These infections are detected primarily 

through screening. The symptoms associated with 

PID are vague so 85% of women with PID delay 

seeking medical care, thereby increasing the risk for 

infertility and ectopic pregnancy.12 Data from two 

randomized controlled trials of chlamydia screening 

suggest that such screening programs reduce PID 

incidence. 13,14

HPV infections are highly prevalent in the United 

States, especially among young sexually active women. 

Although most HPV infections in women resolve 

within 1 year, they are a major concern because 

persistent infection with specific types of the virus are 

causally related to cervical cancer; these types also cause 

Papanicolaou (Pap) smear abnormalities. Other types 

cause genital warts, low-grade Pap smear abnormalities, 

and, rarely, recurrent respiratory papillomatosis in 

infants born to infected mothers.15

Direct Impact on Pregnancy

Chlamydia and gonorrhea can result in adverse 

outcomes of pregnancy, including neonatal ophthalmia 

and, in the case of chlamydia, neonatal pneumonia. 

Although topical prophylaxis of infants at delivery 

is effective for prevention of gonococcal ophthalmia 

neonatorum, prevention of neonatal pneumonia 

requires prenatal detection and treatment.

Genital infections with HSV are extremely common, 

can cause painful outbreaks, and can have serious 

consequences for pregnant women and their infants.16

When a woman has a syphilis infection during 

pregnancy, she can transmit the infection to the fetus 

in utero. Transmission can result in fetal death or an 

infant born with physical and mental developmental 

disabilities. Most cases of congenital syphilis are easily 

preventable if women are screened for syphilis and 

treated early during prenatal care.17

Observations

Chlamydia—United States 

Chlamydial infections in women are usually 

asymptomatic and screening is necessary to identify 

most infections.18 Routine chlamydia screening of 

sexually-active young women has been recommended 

by CDC since 1993.19 Increases in reported cases 

among women since the early 1990s likely reflect 

expanded screening coverage (Figure 1). In 2012, there 

were 1,018,272 cases reported among women for a rate 

of 643.3 per 100,000 females. This rate is similar to the 

rate of 643.4 per 100,000 females in 2011.
52 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2012

Chlamydia rates are highest among young women, 

the population targeted for screening (Figure 5, Table 

10). Within the young age group, rates were highest in 

2012 among 19 year old females (4,921.1 per 100,000 

females) although this was a slight decrease from the 

2011 rate of 5,122.1 per 100,000 females (Table 12). 

Regionally, chlamydia case rates are highest among 

women in the South, with a rate of 715.4 per 100,000 

females in 2012 (Table 4). Chlamydia rates exceeded 

gonorrhea rates among women in all states (Figures A 

and B, Tables 4 and 15).

Gonorrhea—United States 

Like chlamydia, gonorrhea is often asymptomatic in 

women. Thus, gonorrhea screening is an important 

strategy for the identification of gonorrhea among 

women. Large-scale screening programs for 

gonorrhea in women began in the 1970s. After an 

initial increase in cases detected through screening, 

gonorrhea rates for both women and men declined 

steadily throughout the 1980s and early 1990s and 

then declined more gradually in the late 1990s and 

the 2000s (Figure 11). After reaching an all-time 

low in 2009 (104.5 cases per 100,000 females), the 

gonorrhea rate for women has increased slightly each 

year, and was 108.7 cases per 100,000 females in 

2012 (Figure 12, Table 15).

The gonorrhea rate among women has been slightly 

higher than the rate among men since 2001 (Figure 

12, Tables 15 and 16).Gonorrhea rates are highest 

among young women (Figure 16, Table 21). Within 

the young age group, rates were highest in 2012 

among 19 year old females (761.3 per 100,000 

females) (Table 23). 

Positivity in Selected Populations

During the mid-1990s to 2011, chlamydia and 

gonorrhea positivity among young women screened 

in prenatal care clinics participating in infertility 

prevention activities were reported to CDC to 

monitor chlamydia and gonorrhea prevalence 

in women. As the national infertility prevention 

program expanded, these data became difficult 

to interpret as trends were influenced by changes 

in screening coverage, screening criteria, and test 

technologies, as well as demographic changes in 

patients attending clinics reporting data to CDC. 

These issues could not be addressed with the limited 

variables that were collected at the national level. 

Positivity data continue to be useful locally to inform 

clinic-based screening recommendations and to 

identify at-risk populations in need of prevention 

interventions, but are no longer collected to monitor 

national trends in chlamydia and gonorrhea.

Congenital Syphilis

Trends in congenital syphilis usually follow trends in 

P&S syphilis among women, with a lag of 1–2 years 

(Figure 43). The rate of P&S syphilis among women 

declined 95.4% (from 17.3 to 0.8 cases per 100,000 

females) during 1990–2004 (Figure 31). The rate of 

congenital syphilis declined by 92.4% (from a peak of 

107.6 cases to 8.2 cases per 100,000 live births) during 

1991–2005 (Table 1). Rates of both female P&S and 

congenital syphilis increased during 2005–2008. During 

2009-2012, rates of both female P&S and congenital 

syphilis declined (from 1.4 to 1.1 cases per 100,000 

population and from 10.4 to 7.8 cases per 100,000 

live births, respectively) (Tables 28 and 42). The rate 

of congenital syphilis was 7.8 cases per 100,000 live 

births in 2012, the lowest rate since 1988, when the case 

definition was changed (Table 42). 

The highest rates of P&S syphilis among women and 

congenital syphilis were observed in the South (Figures 

C and D, Table 42).

Although most cases of congenital syphilis occur among 

infants whose mothers have had some prenatal care, 

late or limited prenatal care has been associated with 

congenital syphilis. Failure of health care providers to 

adhere to maternal syphilis screening recommendations 

also contributes to the occurrence of congenital syphilis.20

Pelvic Inflammatory Disease 

Accurate estimates of PID and tubal factor infertility 

resulting from chlamydial and gonococcal infections are 

difficult to obtain, in part because definitive diagnoses 

of these conditions can be complex. Published data 

suggest overall declining rates of women diagnosed 

with PID in the United States in both hospital and 

ambulatory settings.21-23

During 2001-2010, hospitalizations for acute PID 

overall have shown modest declines, although 

hospitalizations for acute PID increased by 44.3% 

(from 36.3 to 52.4 per 100,000) between 2009 and 

2010 (Figure G). Hospitalizations for chronic PID have 

also shown modest declines, remaining relatively stable 

between 2007 and 2010 (Figure G). The National 
STD Surveillance 2012 Special Focus Profiles: STDs in Women and Infants 53

Hospital Discharge Survey (NHDS) was discontinued 

in 2010. In 2011, a new survey, the National Hospital 

Care Survey (NHCS), was launched that integrates 

inpatient data formerly collected by the NHDS with 

emergency department, outpatient department, and 

ambulatory surgery center data previously collected 

by the National Hospital Ambulatory Medical Care 

Survey. 

The estimated number of initial visits to physicians’ 

offices for PID from NDTI declined during 2003–

2012 (Figure F, Table 45).

Racial disparities in diagnosed PID have been observed 

in both ambulatory and hospitalized settings. 21 Using 

data from three nationally representative surveys 

conducted by the National Center for Health Statistics 

(NCHS), disease rates were two to three times higher 

among black women than among white women. 

These disparities are consistent with the marked racial 

disparities observed for chlamydia and gonorrhea. 

However, because of the subjective methods by which 

PID is diagnosed, racial disparity data should be 

interpreted with caution.

Ectopic Pregnancy

The incidence of ectopic pregnancy in the United 

States during the 1970’s and 1980’s was marked 

by significant increases. This surveillance who also 

relied on the NHDS, which collected information 

on discharged hospital inpatients in the United 

States. Since the late 1980s, the ability to ascertain 

the number of ectopic pregnancies occurring in the 

United States has been affected by changing health 

care practices, including technological advances that 

permit early, accurate diagnosis of pregnancy and 

ectopic pregnancy, and pharmacological and technical 

advances in treatment of ectopic pregnancy. Data from 

the NHDS suggest that hospitalizations for ectopic 

pregnancy have decreased from 33.0 per 100,000 

in 2001 to 21.6 per 100,000 in 2010 (Figure I). 

However, this likely does not reflect a decrease in the 

actual public health burden of ectopic pregnancy given 

that administrative data from the middle of the decade 

show that the proportion of cases being treated with 

nonsurgical intervention is increasing.24 In the future 

years, data on ectopic pregnancy will be available from 

NHCS.
54 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2012

1 Pulerwitz J, Amaro H, De Jong W, Gortmaker SL, Rudd R. 

Relationship power, condom use and HIV risk among women in 

the USA. AIDS Care. 2002;14(6):789-800.

2 McCree DH, Rompalo A. Biological and behavioral risk factors 

associated with STDs/HIV in women: implications for behavioral 

interventions, In: Aral SO, Douglas JM,Lipshutz JA (editors). 

Behavioral Interventions for Prevention and Control of Sexually 

Transmitted Diseases (p. 310-324). New York, NY: Springer. 

3 El-Bassel N, Gilbert L, Krishnan S, Schilling R, Gaeta T, Purpura 

S, et al. Partner violence and sexual HIV-Risk behaviors among 

women in an inner-city emergency department. Violence Vict. 

1998;13(4):377-393.

4 Hogben M, Leichliter JS. Social determinants and sexually 

transmitted disease disparities. Sex Transm Dis. 35(12) S13 S18.

5 Manderson L, Chang T, Tye LC, Rajanayagam K. Condom use in 

heterosexual sex: a review of research, 1985–1994. In: Catalan J, 

Sherr L, Hedge B (editors). The impact of AIDS: psychological and 

social aspects of HIV Infection. p. 1-26. The Netherlands: Harwood 

Academic Publishers.

6 O’Leary A. A woman’s risk for HIV from a primary partner: 

balancing risk and intimacy. Annu Rev Sex Res. 2000; 11:191 234. 

7 Paavonen J, Westrom L, Eschenbach. Pelvic Inflammatory 

Disease. In: Holmes KK, Sparling PF, Stamm WE, Piot P, 

Wasserheit JN, Corey L, Cohen, MS, Watts DH, (editors). 

Sex Transm Dis. 4th ed. New York: McGraw-Hill; 2008:1017-

1050. 

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

adult. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit 

JN, Corey L, et al, (editors). Sex Transm Dis. 4th ed. New York: 

McGraw-Hill; 2008:627-45.

9 Westrom L, Joesoef R, Reynolds G, Hagdu A, Thompson SE. 

Pelvic inflammatory disease and fertility: a cohort study of 1,844 

women with laparoscopically verified disease and 657 control 

women with normal laparoscopy. Sex Transm Dis. 1992;9:185-92.

10 Stamm WE. Chlamydia trachomatis infections in the adult. In: 

Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, 

Corey L, et al, (editors). Sex Transm Dis. 4th ed. New York: 

McGraw-Hill; 2008:575-93.

11 Marrazzo JM, Handsfield HH, Sparling PF. Neisseria gonorrhoeae

In: Mandell GL, Bennett JE, Dolin R (editors). Principles and 

practice of Infectious Diseases, 7th ed. Philadelphia, PA: Churchill 

Livingstone; 2010: 2753-2770.

12 Hillis SD, Joesoef R, Marchbanks PA, Wasserheit JN, Cates 

W Jr, Westrom L. Delayed care of pelvic inflammatory disease 

as a risk factor for impaired fertility. Am J Obstet Gynecol. 

1993;168:1503-9.

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

KK, Stamm WE. Prevention of pelvic inflammatory disease 

by screening for cervical chlamydial infection. N Engl J Med. 

1996;34(21):1362-6.

14 Oakeschott, P, Kerry S, Aghaizu A, Atherton H, Hay S, et 

al. Randomised controlled trial of screening for Chlamydia

trachomatis to prevent pelvic inflammatory disease: the POPI 

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

15 Centers for Disease Control and Prevention. Prevention of genital 

HPV infection and sequelae: report of an external consultants’ 

meeting. Atlanta: U.S. Department of Health and Human 

Services; 1999.

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

Semin Perinatol. 2007;31(1):19-25.

17 Centers for Disease Control and Prevention. Guidelines for 

prevention and control of congenital syphilis. MMWR Morb 

Mortal Wkly Rep. 1988;37(No. SS-1).

18 Farley TA, Cohen DA, Elkins W. Asymptomatic sexually 

transmitted diseases: the case for screening. preventive medicine. 

2003;36:502-9. 

19 Centers for Disease Control and Prevention. Recommendations for 

the prevention and management of Chlamydia trachomatis infections. 

1993 Aug 6;42(RR-12):1-39. 

20 Centers for Disease Control and Prevention. Congenital syphilis 

— United States, 2003–2008. MMWR Morb Mortal Wkly Rep. 

2010;59:413-17.

21 Bohm MK, Newman L, Satterwhite CL, et al. Pelvic 

inflammatory disease among privately insured women, United 

States, 2001–2005. Sex Transm Dis 2010;37:131–136.

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

Trends in pelvic inflammatory disease hospital discharges and 

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

2005;32(12)778-84.

23 Whiteman MK, Kuklina E, Jamieson DJ, et al. Inpatient 

hospitalization for gynecologic disorders in the United States. Am 

J Obstet Gynecol 2010;202:541 e1–6.

24 Hoover KW, Tao G, Kent CK. Trends in the diagnosis and 

treatment of ectopic pregnancy in the United States. Obstet 

Gynecol. 2010;3(115):495-502.
STD Surveillance 2012 Special Focus Profiles: STDs in Women and Infants 55

Figure A.

Rate per 100,000

population

Guam 924 

Puerto Rico 264 

Virgin Islands 1054 

<=400

400.1-600

>600

(n= 5)

(n= 21)

(n= 28)

VT 408

NH 322

MA 480

RI 569

CT 516

NJ 448

DE 681

MD 642

DC 1359

894

1056

678 819

604 607

571

747

650

405

741 654

530

584 557

878

357

686

467

1095

644

534

499 566

829

681

790

562

658

645

482

576

853

682

693

746

367

599

505

362

582

536

Figure B. 

Rate per 100,000

population

Guam 58.6 

Puerto Rico 8.1 

Virgin Islands 163.7 

<=19.0

19.1-100.0

>100.0

(n= 7)

(n= 25)

(n= 22)

VT 17.0

NH 9.1

MA 31.7

RI 42.7

CT 62.8

NJ 84.0

DE 106.1

MD 95.7

DC 308.8

209.7

110.8

86.8 162.7

68.9 53.4

98.3

158.0

43.6

8.0

150.1 125.0

75.7

92.6 104.9

217.4

35.4

143.0

62.3

250.3

137.3

11.7

84.5 72.8

81.5

99.9

163.4

61.3

164.4

138.6

27.0

128.1

183.8

108.5

143.8

132.6

9.4

90.6

36.0

46.6

91.8

6.8

Figure B. Gonorrhea — Women — Rates by State, United States and Outlying Areas, 2012

Figure A. Chlamydia — Women — Rates by State, United States and Outlying Areas, 2012

NOTE: The total chlamydial infection rate among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 639.0 per 

100,000 female population.

NOTE: The total gonorrhea infection rate among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 107.5 per 

100,000 female population.
56 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2012

Figure C. 

Rate per 100,000

population

Guam 1.3 

Puerto Rico 1.0 

Virgin Islands 0.0 

<=0.2

0.21-4.0

>4.0

(n= 13)

(n= 40)

(n= 1)

VT 0.0

NH 0.0

MA 0.4

RI 0.2

CT 0.5

NJ 0.4

DE 0.4

MD 1.5

DC 1.8

1.5

0.3

0.5 3.3

0.6 0.1

1.4

1.3

0.3

0.3

1.1 0.7

0.5

0.1 0.6

5.4

0.3

0.6

0.3

2.2

0.4

0.0

0.1 0.3

0.9

0.4

0.7

0.0

1.4

0.3

0.3

0.5

1.4

0.2

0.9

2.1

0.0

0.5

0.3

0.2

0.4

0.0

Figure D.

Rate per 100,000

live births

Guam 0.0 

Puerto Rico 2.2 

Virgin Islands 0.0 

<=1.0

1.1-10.0

>10.0

(n= 26)

(n= 20)

(n= 8)

VT 0.0

NH 0.0

MA 1.3

RI 0.0

CT 0.0

NJ 0.9

DE 8.7

MD 16.0

DC 0.0

6.4

8.8

15.1 27.6

6.5 0.0

16.7

9.9

0.0

0.0

15.8 0.0

0.0

0.0 3.5

49.3

0.0

6.0

1.4

0.0

1.3

0.0

3.7 2.7

3.4

3.2

0.8

0.0

11.0

0.0

2.1

4.1

9.9

0.0

1.2

19.4

0.0

1.0

0.0

0.0

1.4

0.0

Figure D. Congenital Syphilis — Infants — Rates by Year of Birth and State, United States and 

Outlying Areas, 2012

Figure C. Primary and Secondary Syphilis — Women — Rates by State, United States and Outlying 

Areas, 2012

NOTE: The total rate of primary and secondary syphilis among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 

0.9 per 100,000 females.

NOTE: The total rate of congenital syphilis for infants by year of birth for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 

7.7 per 100,000 live births.
STD Surveillance 2012 Special Focus Profiles: STDs in Women and Infants 57

Figure F.

 0

 40

 80

120

160

200

Year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Visits (in thousands)

Figure E. 

 0

 15

 30

 45

 60

 75

Year

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Hospitalizations (in thousands)

Acute, Unspecied

Chronic

Figure F. Pelvic Inflammatory Disease — Initial Visits to Physicians’ Offices by Women Aged 15 – 44 

Years, United States, 2003 – 2012 

Figure E. Pelvic Inflammatory Disease — Hospitalizations of Women Aged 15 – 44 Years, United 

States, 2001 – 2010

NOTE: The relative standard errors for acute and unspecified pelvic inflammatory disease (PID) cases ranges from 8%–18%. The relative standard error for 

chronic PID cases ranges from 12%–28%. Data only available through 2010.

SOURCE: 2010 National Hospital Discharge Survey. Atlanta: Centers for Disease Control and Prevention. Available from: http://www.cdc.gov/nchs/nhds.

htm.

NOTE: The relative standard errors for these estimates are 21.6%–30%. See Other Data Sources in the Appendix and Table 45.

SOURCE: IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966 – 2012.
58 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2012

Figure G. 

 0

 10

 20

 30

 40

 50

Year

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Hospitalizations (in thousands)

Figure G. Ectopic Pregnancy—Hospitalizations of Women Aged 15 – 44 Years, United States, 2001 – 

2010

NOTE: The relative standard errors for these estimates are 10% – 23%. Data only available through 2010.

Source: 2010 National Hospital Discharge Survey. Atlanta: Centers for Disease Control and Prevention. Available from http://www.cdc.gov/nchs/

htm.
STD Surveillance 2012 Special Focus Profiles: STDs in Adolescents and Young Adults 59

STDs in Adolescents and Young Adults

Public Health Impact

Prevalence estimates suggest that young people aged 

15–24 years acquire half of all new STDs1 and that 1 

in 4 sexually active adolescent females have an STD, 

such as chlamydia or human papillomavirus (HPV).2 

Compared with older adults, sexually active adolescents 

aged 15–19 years and young adults aged 20–24 years 

are at higher risk of acquiring STDs for a combination 

of behavioral, biological, and cultural reasons. For 

some STDs, such as chlamydia, adolescent females 

may have increased susceptibility to infection because 

of increased cervical ectopy. The higher prevalence of 

STDs among adolescents also may reflect multiple 

barriers to accessing quality STD prevention services, 

including lack of health insurance or ability to pay, lack 

of transportation, discomfort with facilities and services 

designed for adults, and concerns about confidentiality. 

Traditionally, intervention efforts have targeted 

individual-level factors associated with STD risk which 

do not address higher-level factors (e.g., peer norms and 

media influences) that may also influence behaviors.3

Interventions for at-risk adolescents and young adults 

that address underlying aspects of the social and cultural 

conditions that affect sexual risk-taking behaviors 

are needed, as are strategies designed to improve the 

underlying social conditions themselves.4,5

Observations

Chlamydia

In 2012, 1,002,692 cases of chlamydial infection 

were reported among persons under 25 years of age, 

representing 70% of all reported chlamydia cases. 

Rates of reported chlamydial infection are highest 

among persons aged 15–19 years and 20–24 years 

(Figure 5). From 2008–2011, rates increased steadily 

among those aged 15–19 years (1,947.7 to 2,120.8 

cases per 100,000 population) and then decreased 

5.6% during 2011–2012 (2,120.8 to 2,001.7 cases per 

100,000 population) (Table 10). Among those aged 

20–24 years, rates increased 18.1% during 2008–2011 

(2,075.9 to 2,450.8 cases per 100,000) and increased 

slightly (2.1%) during 2011–2012 (2,450.8 to 2,501.5 

cases per 100,000) (Table 10).

15- to 19-Year-Old Women—In 2012, the rate 

among women aged 15–19 years was 3,291.5 cases per 

100,000 females, a 5.6% decrease from the 2011 rate 

of 3,485.2 cases per 100,000 females (Figure 5, Table 

10). This is the first time that chlamydia rates among 

15–19 year old females have decreased since 2000.

20- to 24-Year-Old Women—In 2012, women aged 

20–24 years had the highest rate of chlamydia (3,695.5 

cases per 100,000 females) compared with any other 

age and sex group (Figure 5). Chlamydia rates for 

women in this age group increased slightly (1.8%) 

during 2011–2012 (Figure 5, Table 10).

15- to 19-Year-Old Men—Chlamydia rates for men 

aged 15–19 years decreased 5.1% from 816.3 cases 

per 100,000 males in 2011 to 774.8 cases per 100,000 

males in 2012 (Figure 5, Table 10). This is the first 

time that chlamydia rates among 15–19 year old males 

have decreased.

20- to 24-Year-Old Men—In 2012, as in previous 

years, men aged 20–24 years had the highest rate of 

chlamydia among men (1,350.4 cases per 100,000 

males). Chlamydia rates for men in this age group 

increased 3.3% during 2011–2012 (Figure 5, Table 10).

Gonorrhea

During 2011–2012, gonorrhea rates decreased 7.5% 

for persons aged 15–19 years and increased 3.1% for 

persons aged 20–24 years. 

15- to 19-Year-Old Women—In 2012, women aged 

15–19 years had the second highest rate of gonorrhea 

(521.2 cases per 100,000 females) compared with any 

other age or sex group (Figure 16, Table 21). During 

2011–2012, the gonorrhea rate for women in this age 

group decreased 8.2%. 

20- to 24-Year-Old Women—In 2012, women aged 

20–24 years had the highest rate of gonorrhea (578.5 

cases per 100,000 females) compared with any other 

age or sex group (Figure 16, Table 21). During 2011–

2012, the gonorrhea rate for women in this age group 

increased 1.6%.

15- to 19-Year-Old Men—In 2012, the gonorrhea 

rate among men aged 15–19 years was 239.0 cases per 

100,000 males (Figure 16, Table 21). During 2011–

2012, the gonorrhea rate for men in this age group 

decreased 5.4%.
60 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2012

20- to 24-Year-Old Men—In 2012, as in previous 

years, men aged 20–24 years had the highest rate of 

gonorrhea (462.8 cases per 100,000 males) compared 

with other males (Figure 16, Table 21). During 2011–

2012, the gonorrhea rate for men in this age group 

increased 5.5%.

Primary and Secondary Syphilis 

Syphilis rates among women aged 15–19 years 

increased annually during 2004–2009, from 1.5 

cases per 100,000 females to 3.3 cases in 2009, but 

decreased from 2.9 cases in 2010 to 2.3 cases in 2012. 

Rates among women aged 20–24 years remained 

stable during 2004–2006 (2.9–3.0 cases per 100,000 

population), then increased during 2007–2009 (from 

3.5 to 5.5 cases), before declining during 2010 and 

2011 (to 4.5 and 3.7 cases, respectively); rates rose 

during 2012 (to 3.9 cases). Rates in women have been 

highest each year among those aged 20–24 years with 

3.9 cases per 100,000 females in 2012 (Figures 35 and 

36, Table 35). 

Rates among men aged 15–19 years are much lower 

than the rates among men in older age groups (Figures 

35 and 37, Table 35). Rates in this group increased 

during 2002–2009 (from 1.3 cases per 100,000 

males to 6.0 cases in 2009), decreased to 5.5 cases in 

2010 and 2011, and increased to 5.8 cases in 2012. 

However, rates among men aged 20–24 years have 

increased each consecutive year since 2002, from 5.2 

cases per 100,000 males to 25.3 cases in 2012. Not 

only have men aged 20–24 years seen large increases 

in rates, they also have had the highest rate of P&S 

syphilis among men of any age group since 2008 

(Table 35). These changes reflect a shift in the age 

distribution of P&S syphilis; rates were highest among 

men aged 35–39 years during 2002–2006. 

Positivity in Selected Populations

During the mid-1990s to 2011, chlamydia and 

gonorrhea positivity among young women screened in 

clinics and juvenile correctional facilities participating 

in infertility prevention activities were reported to 

CDC to monitor chlamydia prevalence. As the national 

infertility prevention program expanded, these data 

became difficult to interpret as trends were influenced 

by changes in screening coverage, screening criteria, 

and test technologies, as well as demographic changes 

in patients attending clinics reporting data to CDC. 

Variables available at the national level limited the 

ability to address these issues. Positivity data continue 

to be useful locally to inform clinic-based screening 

recommendations and to identify at-risk populations 

in need of prevention interventions, but are no longer 

collected to monitor national trends in chlamydia and 

gonorrhea.

National Job Training Program 

The NJTP is an educational program for 

socioeconomically disadvantaged youth aged 16–24 

years and is administered at more than 100 sites 

throughout the country. The NJTP screens participants 

for chlamydia and gonorrhea within two days of entry 

to the program. All of NJTP’s chlamydia screening 

tests and the majority of gonorrhea screening tests are 

conducted by a single national contract laboratory*, 

which provides these data to CDC. To increase the 

stability of the estimates, chlamydia or gonorrhea 

prevalence data are presented when valid test results 

for 100 or more students per year are available for the 

population subgroup and state.

Among women entering the program in 47 states, the 

District of Columbia, and Puerto Rico, the median 

state-specific chlamydia prevalence in 2012 was 

11.0% (range: 5.5% to 19.4%) (Figure H). Among 

men entering the program in 47 states, the District of 

Columbia, and Puerto Rico, the median state-specific 

chlamydia prevalence was 7.0% (range: 0.6% to 

13.5%) (Figure I).

Among women entering the program in 45 states, 

the District of Columbia, and Puerto Rico, the 

median state-specific gonorrhea prevalence in 2012 

was 1.3% (range: 0.0% to 4.8%) (Figure J). Among 

men entering the program in 41 states, the District of 

Columbia, and Puerto Rico, the median state-specific 

gonorrhea prevalence was 0.7% (range: 0.0% to 2.8%) 

(Figure K).

* Laboratory data are provided by the Center for Disease Detection, LLC San Antonio, Texas.
STD Surveillance 2012 Special Focus Profiles: STDs in Adolescents and Young Adults 61

1 Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, 

Ocfemia MC, Su J, Xu F, Weinstock H. Sexually transmitted 

infections among US women and men: prevalence and incidence 

estimates, 2008. Sex Transm Dis. 2013 Mar;40(3):187-93.

2 Forhan SE, Gottlieb SL, Sternberg MR, Xu F, Datta SD, 

McQuillan GM, Berman SM, Markowitz LE. Prevalence of 

sexually transmitted infections among female adolescents aged 14 

to 19 in the United States. Pediatrics. 2009 Dec;124(6):1505-12 

doi: 10.1542/peds.2009-0674. Epub 2009 Nov 23.

3 DiClemente RJ, Salazar LF, Crosby RA. A review of STD/HIV 

preventive interventions for adolescents: sustaining effects using an 

ecological approach. J. Pediatr. Psychol. 2007;32 (8): 888-906. 

4 Sieving RE, Bernat DH, Resnick MD, Oliphant J, Pettingell S, 

Plowman S, et al. A clinic-based youth development program to 

reduce sexual risk behaviors among adolescent girls: prime time 

pilot study. Health Promot Pract (online). May 23, 2011.

5 Upchurch DM, Mason W, Kusunoki Y, Kriechbaum MJ. Social 

and behavioral determinants of self-reported STD among 

adolescents. Perspect Sex Reprod Health. 2004;36(6):276-287. 
62 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2012

Figure I. 

Prevalence, %

Puerto Rico 3.3 

Virgin Islands 

*

<10.0

>=10.0

(n= 4)

(n= 38)

(n= 11)

VT 3.5

NH

MA 6.0

RI

CT 4.5

NJ 9.1

DE 7.0

MD 7.1

DC 9.6

11.0

0.6

4.3 10.8

4.3 5.0

8.9

11.4

4.5

3.7

9.6 11.9

5.5

6.9 9.4

13.5

4.5

10.5

4.1

13.3

11.6

5.0

3.7 6.9

6.8

7.0

9.5

4.5

10.5

8.4

2.9

7.0

11.8

5.4

10.3

9.5

2.9

8.0

3.9

7.1

8.3

Figure I. Chlamydia — Prevalence Among Men Aged 16 – 24 Years Entering the National Job 

Training Program, by State of Residence, United States and Outlying Areas, 2012

* Fewer than 100 men who resided in these states/areas and entered the National Job Training Program were screened for chlamydia in 2012.

Figure H. 

Prevalence, %

Puerto Rico 10.6 

Virgin Islands 

*

<10.0

10.0-14.9

>=15.0

(n= 4)

(n= 20)

(n= 20)

(n= 9)

VT 8.7

NH

MA 7.6

RI 12.7

CT 7.5

NJ 9.7

DE 10.6

MD 14.9

DC 9.9

17.4

9.2

10.2 19.4

6.2 8.4

14.9

15.4

9.8

8.9

13.9 15.0

5.5

13.9 10.8

16.0

7.7

13.1

5.8

15.9

12.3

7.2

5.7 11.1

14.0

12.1

11.8

13.0

11.9

13.2

6.3

9.4

15.8

16.2

15.5

8.5

11.6

7.9

8.5

11.0

Figure H. Chlamydia—Prevalence Among Women Aged 16 – 24 Years Entering the National Job 

Training Program, by State of Residence, United States and Outlying Areas, 2012

* Fewer than 100 women who resided in these states/areas and entered the National Job Training Program were screened for chlamydia in 2012.
STD Surveillance 2012 Special Focus Profiles: STDs in Adolescents and Young Adults 63

Figure J.

Prevalence, %

Puerto Rico 0.3 

Virgin Islands 

*

<2.0

>=2.0

(n= 6)

(n= 32)

(n= 15)

VT 0.9

NH

MA 0.6

RI 2.9

CT 1.3

NJ 1.0

DE 1.1

MD 1.7

DC 3.3

4.8

0.8

0.0 4.6

0.3 0.0

1.8

3.8

2.9

1.9 1.2

0.8

1.8 1.7

3.5

0.2

2.9

0.0

2.9

0.9

0.3

1.0 0.5

2.2

1.7

1.4

0.0

4.1

2.8

0.0

1.4

0.5

3.4

2.4

0.0

2.2

1.0

0.8

Figure K. 

Prevalence, %

Puerto Rico 0.0 

Virgin Islands 

*

<2.0

>=2.0

(n= 12)

(n= 39)

(n= 2)

VT 0.0

NH

MA 0.0

RI

CT 0.7

NJ 1.6

DE

MD 1.3

DC 2.4

1.2

0.6

0.0 1.3

0.4 0.0

1.2

1.2

0.6 1.8

0.5

1.1

2.8

0.7

0.9

1.0

1.2

1.0

0.7

0.4 0.3

0.7

1.1

1.5

0.6

0.0

1.3

0.0

0.0

1.2

0.7

0.4

0.1

0.0

Figure K. Gonorrhea — Prevalence Among Men Aged 16 – 24 Years Entering the National Job 

Training Program, by State of Residence, United States and Outlying Areas, 2012

Figure J. Gonorrhea — Prevalence Among Women Aged 16 – 24 Years Entering the National Job 

Training Program, by State of Residence, United States and Outlying Areas, 2012

* Fewer than 100 women who resided in these states/areas and entered the National Job Training Program were screened for gonorrhea in 2012.

NOTE: Many training centers use local laboratories to test female students for gonorrhea; these results are not available to CDC. For this map, gonorrhea 

test results for students at centers that submitted specimens to the national contract laboratory were included if the numbers of gonorrhea tests submitted was greater than the 90% of the number of chlamydia tests submitted.

* Fewer than 100 men who resided in these states/areas and entered the National Job Training Program were screened for gonorrhea in 2012.

NOTE: Many training centers use local laboratories to test male students for gonorrhea; these results are not available to CDC. For this map, gonorrhea test 

results for students at centers that submitted specimens to the national contract laboratory were included if the number of gonorrhea tests submitted was 

greater than 90% of the number of chlamydia tests submitted.
64 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2012
STD Surveillance 2012 Special Focus Profiles: STDs in Racial and Ethnic Minorities 65

STDs in Racial and Ethnic Minorities

Public Health Impact

Surveillance data show higher rates of reported STDs 

among some racial or ethnic minority groups when 

compared with rates among whites. Race and ethnicity 

in the United States are population characteristics that 

also correlate with other fundamental determinants of 

health status.1,2

Social and economic conditions, such as high rates 

of poverty, income inequality, unemployment, low 

educational attainment and geographic isolation can 

make it more difficult for individuals to protect their 

sexual health.3 People who struggle financially are often 

experiencing life circumstances that increase their risk 

for STDs.4 Those who cannot afford basic necessities 

may have trouble accessing and affording quality sexual 

health services.5 As an example, in 2010, the poverty 

rates, unemployment rates, and high school drop-out 

rates for blacks, American Indians/Alaska Natives, and 

Hispanics were considerably higher than for whites, 

differences commensurate with observed disparities in 

STD burden.6–9 Many people of Hispanic ethnicity 

face additional barriers arising from immigration 

or undocumented citizenship status.10 Even when 

health care is available, fear and distrust of health 

care institutions can negatively affect the health careseeking experience for many racial/ethnic minorities 

when there is social discrimination, provider bias, or 

the perception that these may exist.11,12

In communities where STD prevalence is higher, 

individuals may have a more difficult time reducing 

their risk for infection. With each sexual encounter, 

they face a greater chance of encountering an infected 

partner than those in lower prevalence settings.13 

Acknowledging the inequity in STD rates by race or 

ethnicity is one of the first steps in empowering affected 

communities to organize and focus on this problem. 

STD Reporting Practices

Surveillance data are based on cases of STDs reported 

to state and local health departments (see Interpreting 

STD Surveillance Data in the Appendix). In many 

state and local health jurisdictions, reporting from 

public sources (e.g., STD clinics) is thought to 

be more complete than reporting from private 

sources. Because minority populations may use 

public clinics more than whites, differences in rates 

between minorities and whites may be increased by 

this reporting bias.14 However, prevalence data from 

population-based surveys, such as NHANES and the 

National Longitudinal Study of Adolescent Health, 

confirm the existence of marked STD disparities in 

some minority populations.15,16

Method of Classifying Race & Hispanic 

Ethnicity

Interpretation of racial and ethnic disparities among 

persons with STDs is influenced by data collection 

methods, and by the categories by which these data are 

displayed. For the first time, data on race and Hispanic 

ethnicity are displayed in this report in compliance 

with the 1997 Office of Management and Budget 

(OMB) standards.17 While 48 jurisdictions (47 states 

and the District of Columbia) collect and report data 

in formats compliant with these standards as of 2012, 

some jurisdictions only recently adopted this standard 

and used previous standards to report their case data to 

CDC in past years. The completeness of data available 

in current OMB standards continues to improve. 

However, historical trend and rate data by race and 

Hispanic ethnicity displayed in figures and interpreted 

in this report for 2008–2012 include only those 

jurisdictions (38 states plus the District of Columbia) 

reporting in the current standard consistently for 

2008 through 2012. Please refer to Interpreting STD 

Surveillance Data in the Appendix for a complete 

listing of these jurisdictions. 

Completeness of Race/Ethnicity Data

Many cases are reported with race and/or ethnicity 

missing. Rate data presented in this report are not 

adjusted for missing race or ethnicity.

Chlamydia—In 2012, 25.8% of chlamydia case 

reports were missing race or ethnicity data, ranging by 

state from 0.0% to 57.0% (Table A1).

Gonorrhea—In 2012, 19.2% of gonorrhea case 

reports were missing information on race or ethnicity, 

ranging by state from 0.0% to 43.3% (Table A1).

Syphilis—In 2012, 2.6% of P&S syphilis case reports 

were missing information on race or ethnicity, ranging 

from 0.0% to 21.9% among states with 10 or more 

cases of P&S syphilis (Table A1).
66 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2012

Observations

Chlamydia

Among the 39 jurisdictions (38 states and the District 

of Columbia) that submitted data on race and Hispanic 

ethnicity from 2008–2012 according to the revised 

OMB standards, chlamydia case rates increased during 

2008–2012 among all racial and ethnic groups (Figure 

6). During 2008–2012, chlamydia rates increased by 

3.7% among blacks, 26.7% among American Indians/

Alaska Natives, 7.6% among Hispanics, 5.1% among 

Asians, 32.4% among Native Hawaiians/Other Pacific 

Islanders, and 38.5% among whites. 

In 2012, 48 jurisdictions (47 states and the District 

of Columbia) submitted data on race and Hispanic 

ethnicity in 2012 according to the revised OMB 

standards. The following data pertain to those 

jurisdictions:

Blacks—In 2012, the overall rate among blacks in 

the United States was 1,229.4 cases per 100,000 

population (Table 11B). The rate of chlamydia among 

black women was over six times the rate among white 

women (1,613.6 and 260.5 per 100,000 females, 

respectively) (Table 11B and Figure L). The chlamydia 

rate among black men was over eight times the rate 

among white men (809.2 and 95.9 cases per 100,000 

males, respectively).

Chlamydia rates were highest for blacks aged 15–19 

and 20–24 years in 2012 (Table 11B). The chlamydia 

rate among black females aged 15–19 years was 7,719.1 

cases per 100,000 females, which was over five times 

the rate among white females in the same age group 

(1,458.3 per 100,000 females). The rate among black 

women aged 20–24 years was 4.4 times the rate among 

white women in the same age group (Table 11B).

Similar racial disparities in reported chlamydia rates 

exist among men. Among males aged 15–19 years, the 

rate among blacks was 9.9 times the rate among whites 

(Table 11B). The chlamydia rate among black men 

aged 20–24 years was six times the rate among white 

men of the same age group (3,556.0 and 590.6 cases 

per 100,000 males, respectively).

American Indians/Alaska Natives— In 2012, the 

chlamydia rate among American Indians/Alaska 

Natives was 728.2 cases per 100,000 population (Table 

11B). Overall, the rate of chlamydia among American 

Indians/Alaska Natives in the United States was 4.1 

times the rate among whites.

Native Hawaiians/Other Pacific Islanders— In 

2012, the chlamydia rate among Native Hawaiians/

Other Pacific Islanders was 590.4 cases per 100,000 

population (Table 11B). The overall rate among Native 

Hawaiians/Other Pacific Islanders was 3.3 times the 

rate among whites and 5.2 times the rate among 

Asians.

Asians— In 2012, the chlamydia rate among Asians 

was 112.9 cases per 100,000 population (Table 11B). 

The overall rate among whites is 1.6 times the rate 

among Asians. 

Hispanics— In 2012, the chlamydia rate among 

Hispanics was 380.3 cases per 100,000 population 

(Table 11B) which is over two times the rate among 

whites.

Gonorrhea

During 2008–2012, among the 39 jurisdictions (38 

states and the District of Columbia) that submitted 

data in the new race and ethnic categories for all five 

years during that period, gonorrhea rates increased 

61.8% among American Indians/Alaska Natives (81.6 

to 132.0), 33.5% among Native Hawaiians/Other 

Pacific Islanders (70.0 to 93.4), 22.9% among whites 

(27.1 to 33.3), 18.9% among Hispanics (52.3 to 

62.2), and 14.5% among Asians (15.0 to 17.2) (Figure 

19). The gonorrhea rate decreased 15.5% among 

blacks (542.7 to 458.7) 

In 2012, 48 jurisdictions (47 states and the District of 

Columbia) submitted data in the new race and ethnic 

categories according to the revised OMB standards. 

The following data pertain to those jurisdictions:

Blacks—In 2012, 63% of reported gonorrhea cases 

with known race/ethnicity occurred among blacks 

(excluding cases with missing information on race or 

ethnicity, and cases whose reported race or ethnicity 

was other) (Table 22A). The rate of gonorrhea 

among blacks in 2012 was 462.0 cases per 100,000 

population, which was 14.9 times the rate among 

whites (31.0 per 100,000) (Table 22B). This disparity 

has decreased slightly in recent years (Figure M). This 

disparity was larger for black men (16.2 times) than for 

black women (13.8 times) (Figure N, Table 22B). 

As in previous years, the disparity in gonorrhea rates 

for blacks in 2012 was larger in the Midwest and 

Northeast than in the West or the South (Figure O).
STD Surveillance 2012 Special Focus Profiles: STDs in Racial and Ethnic Minorities 67

Considering all racial/ethnic and age categories, 

gonorrhea rates were highest for blacks aged 20–24 

and 15–19 years in 2012 (Table 22B). Black women 

aged 20–24 had a gonorrhea rate of 2,172.6 cases per 

100,000 women. This rate was was 11.1 times the rate 

among white women in the same age group (194.9 

per 100,000). Black women aged 15–19 years had a 

gonorrhea rate of 2,032.2 cases per 100,000 women, 

which was 15.1 times the rate among white women in 

the same age group (134.5).

Black men aged 20–24 years had a gonorrhea rate of 

1,903.7 cases per 100,000 men, which was 16.4 times 

the rate among white men in the same age group 

(115.9 per 100,000). Black men aged 15–19 years had 

a gonorrhea rate of 1,012.3 cases per 100,000 men, 

which was 26.2 times the rate among white men in the 

same age group (38.7 per 100,000).

American Indians/Alaska Natives—In 2012, the 

gonorrhea rate among American Indians/Alaska 

Natives was 124.9 cases per 100,000 population, 

which was 4.0 times the rate among whites (Table 

22B). The disparity between gonorrhea rates for 

American Indians/Alaska Natives and whites was 

larger for American Indian/Alaska Native women (4.8 

times) than for American Indian/Alaska Native men 

(3.1 times) (Figure N, Table 22 B). The disparity in 

gonorrhea rates for American Indians/Alaska Natives 

in 2012 was larger in the Midwest than in the West, 

Northeast, and South (Figure O).

Native Hawaiians/Other Pacific Islanders—In 2012, 

the gonorrhea rate among Native Hawaiians/Other 

Pacific Islanders was 87.8 cases per 100,00 population, 

which was 2.8 times the rate among whites (Table 

22B). The disparity between gonorrhea rates for Native 

Hawaiians/Other Pacific Islanders and whites was 

the same for Native Hawaiian/Other Pacific Islander 

women and Native Hawaiian/Other Pacific Islander 

men (2.8 times) (Figure N, Table 22B). The disparity 

in gonorrhea rates for Native Hawaiian/Other Pacific 

Islanders in 2012 was lower in the West than in the 

Midwest, Northeast, and South (Figure O).

Asians—In 2012, the gonorrhea rate among Asians 

was 16.9 cases per 100,000 population, which was 

lower than (0.5 times) the rate among whites (Table 

22B). This difference is larger for Asian women than 

for Asian men (Figure N, Table 22B). In 2012, rates 

among Asians were lower than rates among whites in 

all four regions of the United States (Figure O).

Hispanics—In 2012, the gonorrhea rate among 

Hispanics was 60.4 cases per 100,000 population, 

which was 1.9 times the rate among whites (Table 

22B). This disparity was larger for Hispanic men (2.2 

times) than for Hispanic women (1.8 times) (Figure 

N, Table 22B). The disparity in gonorrhea rates for 

Hispanics was highest in the Northeast and lowest in 

the West and Midwest (Figure O).

Primary and Secondary Syphilis

The syphilis epidemic in the late 1980s occurred 

primarily among men who have sex with women only 

(MSW), women, and minority populations.18,19 While 

the rate of P&S syphilis declined among all racial and 

ethnic groups during the 1990s, rates again began 

increasing in the early 2000s among men who have sex 

with men (MSM) in their 30s and 40s of varied racial 

and ethnic groups.19 Among the 39 jurisdictions (38 

states and the District of Columbia) that submitted 

data on race and Hispanic ethnicity from 2008–2012 

according to the revised OMB standards, rates increased 

among non-Hispanic whites, Hispanics, Asians, 

American Indians/Alaska Natives, Native Hawaiian or 

Other Pacific Islanders, and Multirace individuals, and 

decreased slightly among non-Hispanic blacks (Figure 

38).

In 2012, 48 jurisdictions (47 states and the District 

of Columbia) submitted data on race and Hispanic 

ethnicity in 2012 according to the revised OMB 

standards. The following data pertain to those 

jurisdictions:

Blacks — In 2012, 39.7% of all cases reported to 

CDC were among blacks. The overall 2012 rate for 

blacks was 6.1 times the rate for whites. In 2012, the 

rate of P&S syphilis among black men was 5.7 times 

the rate among white men; the rate among black 

women was 16 times the rate among white women 

(Table 36B).

In 2012, rates among both men and women aged 20–

24 years remained highest among blacks (96.7 cases 

and 19.1 cases per 100,000 population, respectively). 

The 2012 rate among black men aged 15–19 years was 

14 times the rate for white men and 4 times the rate 

for Hispanic men of the same age, and 2012 rates for 

black women aged 15–19 years were 23 times and 8 

times the rate for white and Hispanic women of the 

same ages, respectively (Table 36B). 
68 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2012

1 Hogben M, Leichliter JS. Social determinants and sexually 

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

Suppl):S13-8.

2 Cunningham PJ, Cornelius LJ. Access to ambulatory care for 

American Indians and Alaska Natives; the relative importance of 

personal and community resources. Soc Sci Med. 1995:40(3):393-

407.

3 Gonzalez JS, Hendriksen ES, Collins EM, Duran RE, Safren SA. 

Latinos and HIV/AIDS: examining factors related to disparity and 

identifying opportunities for psychosocial intervention research. 

AIDS Behav. 2009:13:582-602.

4 Laumann EO, Youm Y. Racial/ethinic group differences in the 

prevalence of sexually transmitted diseases in the United States: a 

network explanation. Sex Transm Dis. 1999;26(5):250-61. 

5 Institute of Medicine. The Hidden Epidemic: Confronting 

Sexually Transmitted Diseases. Washington, DC: National 

Academy Press; 1997. 

6 DeNavas-Walt, Carmen, Bernadette D. Proctor, and Jessica C. 

Smith, U.S. Census Bureau, Current Population Reports, P60-238, 

Income, Poverty, and Health Insurance Coverage in the United States: 

2010, U.S. Government Printing Office, Washington, DC, 2011.

7 U.S. Department of Labor U.S. Bureau of Labor Statistics. Labor 

Force Characteristics by Race and Ethnicity, 2010. August 2011.

Report 1032.

8 U.S. Department of Commerce, Census Bureau. Current 

Population Survey (CPS), October 1967-October 2010.

9 Austin, Algernon. Different Race, Different Recession: American 

Indian Unemployment in 2010. [Accessed 10/4/2013]. Available 

at www.epi.org/publication/ib289.

10 Pérez-Escamilla R. Health care access among latinos: implications 

for social and health care reform. J Hispanic High Educ. 

American Indians/Alaska Natives — In 2012, 0.4% 

of all cases reported to CDC were among American 

Indians/Alaska Natives. The 2012 rate of P&S syphilis 

for American Indians/Alaska Natives was 2.9 cases per 

100,000 population, slightly higher than the rate for 

whites (Table 36B).

Native Hawaiians or Other Pacific Islanders — 

In 2012, 0.3% of all cases reported to CDC were 

among Native Hawaiians or Other Pacific Islanders. 

The 2012 rate of P&S syphilis for Native Hawaiians 

or Other Pacific Islanders was 8.4 cases per 100,000 

population, which is 3.1 times the rate for whites 

(Table 36B).

Asians — In 2012, 1.9% of all cases reported to CDC 

were among Asians. The 2012 rate of P&S syphilis for 

Asians was 2.0 cases per 100,000 population, which 

was 0.7 times the rate for whites (Table 36B).

Hispanics— In 2012, 19.5% of all cases reported to 

CDC were among Hispanics (an increase from 16.7% 

of all cases in 2011). The 2012 rate of P&S syphilis for 

Hispanics was 5.7 cases per 100,000 population, which 

was 2.3 times the rate for whites (Table 36B).

Congenital Syphilis

Race/ethnicity for cases of congenital syphilis is based 

on the mother’s race/ethnicity. In 2012, the rate of 

congenital syphilis was 29.6 cases per 100,000 live 

births among blacks and 7.9 cases per 100,000 live 

births among Hispanics. These rates were 14.1 and 3.8 

times, respectively, the rate among whites (2.1 cases per 

100,000 live births) (Table 43, Figure S). 

2010:9(1):43-60.

11 Berk ML, Schur CL. The effect of fear on access to care 

among undocumented latino immigrants. J Immigr Health. 

2001;3(3):151-156. 

12 Wiehe SE, Rosenman MB, Wang J, Katz BP, Fortenberry D. 

Chlamydia screening among young women: individual-and 

provider-level differences in testing. Pediatrics. 2011;127(2):d336-

44.

13 Hogben M, Leichliter JS. Social determinants and sexually 

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

Suppl):S13-8. 

14 Miller WC. Epidemiology of chlamydial infection: are we losing 

ground? Sex Transm Infect. 2008;84:82-6. 

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

McQuillan G, et al. Gonorrhea and chlamydia in the United 

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

Intern Med. 2007;147(2):89-96.

16 Miller WC, Ford CA, Morris M, Handcock MS, Schmitz JL, 

Hobbs MM, et al. Prevalence of chlamydial and gonococcal 

infections among young adults in the United States. JAMA. 

2004;291(18):2229-36.

17 Office of Management and Budget. Provisional guidance on the 

implementation of the 1997 standards for federal data on race 

and ethnicity. 1999. [Accessed July 29, 2013]. Available at: http://

www.whitehouse.gov/omb/fedreg_1997standards/ 

18 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.

19 Peterman TA, Heffelfinger JD, Swint EB, Groseclose SL. 

The changing epidemiology of syphilis. Sex Transm Dis. 

2005;32(Suppl 10):S4-10.
STD Surveillance 2012 Special Focus Profiles: STDs in Racial and Ethnic Minorities 69

Figure M. 

1:2

1:1

2:1

4:1

8:1

16:1

32:1

Year

2008 2009 2010 2011 2012

Rate Ratio†

‡

‡

AI/AN

Asians

Blacks

Hispanics

NHOPI

Figure L. 

Men Rate (per 100,000 population) Women

2250 1800 1350 900 450 0 0 Race/Ethnicity 450 900 1350 1800 2250

317.1 AI/AN* 1126.4

61.7 Asians 158.7

809.2 Blacks 1613.6

192.2 Hispanics 574.7

261.7 NHOPI* 924.9

95.9 Whites 260.5

47.5 Multirace 131.4

262.6 Total 643.3

Figure M. Gonorrhea — Rate Ratios* by Race/Ethnicity, United States, 2008 – 2012

Figure L. Chlamydia — Rates by Race/Ethnicity and Sex, 2012

* AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiian and Other Pacific Islanders.

NOTE: Includes 47 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats in 2012 (see 

Appendix “Interpreting STD Surveillance Data”).

* Rate ratios are calculated as the gonorrhea rate per 100,000 population for a given racial or ethnic minority population divided by the gonorrhea rate per 

100,000 population for non-Hispanic whites. Any population with a lower rate of gonorrhea than the non-Hispanic white population will have a rate ratio 

of less than 1:1.

† Y-axis is log scale.

‡ AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiian and Other Pacific Islanders.

NOTE: Includes 38 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats during 

2008–2012 (see Appendix “Interpreting STD Surveillance Data”).
70 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2012

Figure N.

Men Rate (per 100,000 population) Women

750 600 450 300 150 0 0 Race/Ethnicity 150 300 450 600 750

88.1 AI/AN* 160.5

20.2 Asians 13.7

467.7 Blacks 456.3

62.1 Hispanics 58.5

82.0 NHOPI* 93.4

28.8 Whites 33.1

21.8 Multirace 27.7

105.8 Total 108.7

Figure N. Gonorrhea — Rates by Race/Ethnicity and Sex, United States, 2012

* AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiian and Other Pacific Islanders.

NOTE: Includes 47 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats in 2012 (see 

Appendix “Interpreting STD Surveillance Data”).

Figure O.

Rate Ratio†

‡ ‡

West

Midwest

Northeast

South

1:4

1:2

1:1

2:1

4:1

8:1

16:1

32:1

AI/AN Asians Blacks Hispanics NHOPI

Figure O. Gonorrhea — Rate Ratios by Race/Ethnicity and Region, United States, 2012

* Rate ratios are calculated as the gonorrhea rate per 100,000 population for a given racial or ethnic minority population divided by the gonorrhea rate per 

100,000 population for non-Hispanic whites. Any population with a lower rate of gonorrhea than the non-Hispanic white population will have a rate ratio 

of less than 1:1.

† Y-axis is log scale.

‡ AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiian and Other Pacific Islanders.

NOTE: Includes 47 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats in 2012 (see 

Appendix “Interpreting STD Surveillance Data”).
STD Surveillance 2012 Special Focus Profiles: STDs in Racial and Ethnic Minorities 71

Figure P.

Men Rate (per 100,000 population) Women

30 24 18 12 6 0 Race/Ethnicity 0 6 12 18 24 30

5.3 AI/AN* 0.7

4.0 Asians 0.1

28.9 Blacks 4.9

10.4 Hispanics 0.8

14.9 NHOPI* 1.6

5.1 Whites 0.3

3.8 Multirace 0.2

9.3 Total 0.9

Figure P. Primary and Secondary Syphilis — Rates by Race/Ethnicity and Sex, United States, 2012

* AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiian and Other Pacific Islanders.

NOTE: Includes 47 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats in 2012 (see 

Appendix “Interpreting STD Surveillance Data”).

Figure Q.

 0

 4

 8

 12

 16

 20

Year

2008 2009 2010 2011 2012

Rate (per 100,000 population)

AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

Figure Q. Primary and Secondary Syphilis — Rates Among Females Aged 15 – 19 Years by Race/

Ethnicity, United States, 2008 – 2012

* AI/AN= American Indians/Alaska Natives; NHOPI= Native Hawaiian and Other Pacific Islanders. 

NOTE: Includes 38 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats during 2008–

2012 (see Appendix “Interpreting STD Surveillance Data”).
72 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2012

Figure R. 

 0

 10

 20

 30

 40

 50

Year

2008 2009 2010 2011 2012

Rate (per 100,000 population)

AI/AN*

Asians

Blacks

Hispanics

NHOPI*

Whites

Multirace

Figure R. Primary and Secondary Syphilis — Rates Among Males Aged 15 – 19 Years by Race/

Ethnicity, United States, 2008 – 2012

* AI/AN= American Indians/Alaska Natives; NHOPI= Native Hawaiian and Other Pacific Islanders. 

NOTE: Includes 38 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats during 

2008–2012 (see Appendix “Interpreting STD Surveillance Data”).

Figure S. 

 0

 10

 20

 30

 40

 50

Year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Rate (per 100,000 live births) AI/AN*

Asians/Pacic Islanders

Blacks

Hispanics

Whites

Figure S. Congenital Syphilis — Infants — Rates by Year of Birth and Mother’s Race/Ethnicity, 

United States, 2003 – 2012

* AI/AN= American Indians/Alaska Natives.

NOTE: National Center for Health Statistics bridged race categories are presented to allow the display of data across several years. Cases missing maternal 

race/ethnicity information were excluded (< 1% of cases). 
STD Surveillance 2012 Special Focus Profiles: STDs in Men Who Have Sex with Men 73

STDs in Men Who Have Sex with Men

Public Health Impact

Compared to women and men who have sex with 

women only, MSM are at increased risk for STDs.1–4

Because STDs and the behaviors associated with 

acquiring them increase the likelihood of acquiring 

and transmitting HIV infection,5 STDs among MSM 

may be associated with an increase in HIV diagnoses.6

Although a number of individual-level risk behaviors 

(e.g., higher numbers of lifetime sex partners, higher 

rates of partner change and partner acquisition rates, 

and unprotected sex) significantly contribute to the 

ongoing disparities in the sexual health of MSM, other 

interpersonal and societal-level factors have also been 

associated with higher rates of sexually transmitted 

infections, including HIV among MSM.7

 MSM who 

have lower economic status are particularly vulnerable 

to poorer health outcomes, especially if they belong 

to racial and ethnic minority populations.8,9 For 

example, studies show that for black MSM, factors

such as emotional and social support can drive sexual 

risk-taking and, in addition, broader societal factors 

such as power, privilege, and position in society also 

play a significant role.10 Similarly, for Hispanic men, 

the relationship between individual experiences of 

oppression (e.g., social discrimination and financial 

hardship) and risk for sexually transmitted infections 

in the United States has been documented.11

With the exception of reported syphilis cases, most 

nationally notifiable STD surveillance data do not 

include information on sexual behaviors; therefore, 

trends in STDs among MSM in the United States are 

based on findings from sentinel surveillance systems. 

Furthermore, testing strategies are often suboptimal 

for detecting STDs in MSM. Testing for gonorrhea 

and chlamydia in MSM largely focuses on detecting 

urethral infections, which are more likely to be 

symptomatic than pharyngeal or rectal infections.12

Data from enhanced surveillance projects are presented 

in this section to provide information on STDs in 

MSM.

STD Surveillance Network (SSuN)—

Monitoring Trends in Prevalence of 

STDs Among MSM Who Visit STD 

Clinics, 2012

In 2005, SSuN was established to improve the 

capacity of national, state, and local STD programs 

to detect, monitor, and respond rapidly to trends 

in STDs through enhanced collection, reporting, 

analysis, visualization, and interpretation of 

disease information.13

 SSuN currently includes 12 

collaborating local and state health departments. 

In 2012, a total of 42 STD clinics at these 12 sites 

collected enhanced behavioral and demographic 

information on patients who presented for care to 

these clinics.14

 For data reported in this section, 

MSM were defined as men who either reported 

having a male sex partner or who self-reported as 

gay/homosexual or bisexual. MSW were defined as 

men who reported having sex with women only or 

who did not report the sex of their sex partner, but 

reported that they considered themselves straight/

heterosexual. More detailed information about SSuN 

methodology can be found in the STD Surveillance 

Network section of the Appendix, Interpreting STD 

Surveillance Data.

Gonorrhea and Chlamydial Infection

In 2012, the proportion of MSM who tested positive 

for gonorrhea and chlamydia at STD clinics varied 

by SSuN site (Figure T). A larger proportion of 

MSM who visited SSuN STD clinics tested positive 

for gonorrhea than tested positive for chlamydia in 

all cities except Seattle, Birmingham, and Hartford/

New Haven (where the proportion for chlamydia was 

higher). 

Across the participating sites, about the same number 

of MSM were tested for gonorrhea (22,007) and 

chlamydia (21,767). The median site-specific gonorrhea 

prevalence was 16.4% (range by site: 9.84%–30.4%). 

The median site-specific chlamydia prevalence was 

12.0% (range by site: 6.4%–22.2%). For this report, a 

person who tested positive for gonorrhea or chlamydia 

more than one time in a year was counted only once for 

each infection.
74 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2012

Co-infection of P&S Syphilis and HIV

In 2012, the proportion of MSM who presented to 

SSuN clinics with P&S syphilis infection who also 

were infected with HIV ranged from 18.5% in Los 

Angeles to 66.7% in Birmingham (Figure U). The 

median site-specific proportion co-infected with HIV 

was 44.8%. P&S syphilis was identified by provider 

diagnosis and HIV was identified by laboratory 

report, self-report, or provider diagnosis.

HIV status and STDs

When comparing the prevalence of STDs by HIV 

status in MSM visiting SSuN STD clinics, the 

prevalence was lower among HIV-negative MSM 

status than among HIV-positive MSM (Figure V). The 

prevalence of P&S syphilis was 2.5% among HIVnegative MSM and 9.8% among HIV-positive MSM. 

Urethral gonorrhea positivity was 10.1% in MSM who 

were HIV-negative and 15.0% in HIV-positive MSM. 

Pharyngeal gonorrhea positivity was 7.4% in MSM 

who were HIV-negative and 10.0% in HIV-positive 

MSM; rectal gonorrhea positivity was 8.9% in MSM 

who were HIV-negative and 16.4% in HIV-positive 

MSM. Urethral chlamydia was 7.1% in MSM who 

were HIV-negative and 7.6% in HIV-positive MSM; 

rectal chlamydia positivity was 11.4% in MSM who 

were HIV-negative and 22.2% in HIV-positive MSM. 

Nationally Notifiable Syphilis 

Surveillance Data

Primary and secondary syphilis among MSM has 

been increasing at least since 2000. 3, 15

 In 33 areas 

reporting sex of partner data for P&S syphilis cases 

among MSM increased 15% during 2011 – 2012, 

a larger increase in previous years. In 2012, MSM 

accounted for 75% of all P&S syphilis cases in 49 

states and the District of Columbia that provided 

information about sex of sex partners. MSM 

accounted for more cases than MSW or women 

in all racial and ethnic groups (Figure 40). More 

information about syphilis can be found in the 

Syphilis section of the National Profile.

Gonococcal Isolate Surveillance 

Project

GISP is a national sentinel surveillance system 

designed to monitor trends in antimicrobial 

susceptibilities of N. gonorrhoeae strains in the United 

States.16 GISP has demonstrated that gonococcal 

isolates from MSM are more likely to exhibit 

antimicrobial resistance than isolates from MSW.4

Overall, the proportion of isolates from MSM in 

selected STD clinics from GISP sentinel sites has 

increased steadily, from 4.6% in 1990 to 33.1% 

in 2012 (Figure W). The reason for this increase is 

unclear, but might reflect changes in the epidemiology 

of gonorrhea or in health care seeking behavior of men 

infected with gonorrhea. The proportion of isolates 

from MSM varies geographically, with the largest 

proportion reported from the West Coast (Figure X).

More information on GISP can be found in the 

Gonorrhea section of the National Profile.
1 Brewer TH, Schillinger J, Lewis FM, Blank S, Pathela P, 

Jordahl L, et al. Infectious syphilis among adolescent and 

young adult men: implications for human immunodeficiency 

virus transmission and public health interventions. Sex Transm 

Dis. 2011 May;38(5):367-71.

2 Centers for Disease Control and Prevention. Trends in 

HIV/AIDS diagnoses among men who have sex with men ------

33 States, 2000--2006. MMWR Morb Mortal Wkly Rep. 

2008; 57:681--686.

3 Su JR, Beltrami JF, Zaidi AA, Weinstock HS. Primary and

secondary syphilis among black and Hispanic men who have 

sex with men: case report data from 27 States. Ann Intern 

Med. 2011 Aug 2;155(3):145-51.

4 Kirkcaldy RD, Zaidi A, Hook EW 3rd, Holmes KK, Soge O, 

del Rio C, et al. Neisseria gonorrhoeae antimicrobial resistance 

among men who have sex with men and men who have sex 

exclusively with women: The Gonococcal Isolate Surveillance 

Project, 2005--2010. Ann Intern Med 2013;158(5 Pt 1):321--

8.

5 Fleming DT, Wasserheit JN. From epidemiologic synergy to

public health policy and practice: the contribution of other

sexually transmitted diseases to sexual transmission of HIV

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

6 Hall HI, Song R, Rhodes P, Prejean J, An Q, Lee LM, et al, 

for the HIV Incidence Surveillance Group. Estimation of HIV 

incidence in the United States. JAMA. 2008;6;300(5):520-9.

7 Koblin BA, Husnik MJ, Marla JB, Colfax GC, Huang Y, 

Madison ME, et al. Buchbinder, SC. Risk factors for HIV 

infection among men who have sex with men. AIDS. 

2006;20(5):731-739.

8 Alvy LM , McKirnan D, Du Bois SN , Jones K, Ritchie N, 

Fingerhut D. Health Care Disparities and Behavioral Health 

Among Men Who Have Sex with Men. Journal of Gay & 

Lesbian Social Services. 2011;23(4): 507-522.

9.McKirnan DJ, Du Bois SN, Alvy LM, Jones K. Health Care 

Access and Health Behaviors Among Men Who Have Sex 

With Men: The Cost of Health Disparities. Health Educ 

Behav. 2013 Feb;40(1):32-41.

10 Mays VM, Cochran SD, Zamudio A. HIV prevention 

research: are we meeting the needs of African American men 

who have sex with men? J Black Psychol. 2004;30:78.

11 Díaz RM, Ayala G, Bein E. Sexual risk as an outcome of 

social oppression: data from a probability sample of Latino gay 

men in three U.S. cities. Cultur Divers Ethnic Minor Psychol.

2004;10(3):255-267.

12 Mahle KC, Helms DJ, Golden MR, Asbel LE, Cherneskie T,

Gratzer B, et al. Missed gonorrhea infections by anatomic site

among asymptomatic men who have sex with men (MSM)

attending U.S. STD clinics, 2002--2006. In: Program and

abstracts of the 2008 National STD Prevention Conference; 

2008 March 10-13; Chicago, IL. Abstract No. A1d.

13 Rietmeijer K, Donnelly J, Bernstein K, Bissette J, Martins S,

Pathela P, et al. Here comes the SSuN------early experiences with 

the STD Surveillance Network. Pub Health Rep. 

2009;124(Suppl 2):72-77.

14 Centers for Disease Control and Prevention. Sexually 

Transmitted Disease Surveillance 2011. Atlanta: U.S. 

Department of Health and Human Services; 2012.

15 Heffelfinger JD, Swint EB, Berman SM, Weinstock HS. 

Trends in primary and secondary syphilis among men who 

have sex with men in the United States. Am J Public Health. 

2007 Jun;97(6):1076-83.

16 Schwarcz S, Zenilman J, Schnell D, Knapp JS, Hook EW

III, Thompson S, et al. National surveillance of antimicrobial

resistance in Neisseria gonorrhoeae. JAMA. 1990;264(11):1413-

7

STD Surveillance 2012 Special Focus Profiles: STDs in Men Who Have Sex with Men 75
76 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2012

Figure T.

Percentage

Gonorrhea

Chlamydia

 0

 7

 14

 21

 28

 35

San

Francisco

Los

Angeles

Seattle  

Denver

Chicago New

Orleans

Birmingham  

Richmond

Baltimore  

Philadelphia

New York

City

Hartford/

New Haven

Figure T. Gonorrhea and Chlamydia—Proportion of MSM* Attending STD Clinics Testing Positive 

for Gonorrhea and Chlamydia, STD Surveillance Network (SSuN), 2012

* Among men who have sex with men who were tested for gonorrhea and/or chlamydia

Figure U.

Percentage

 0

 20

 40

 60

 80

100

San

Francisco

Los

Angeles Seattle

Denver New 

Orleans

Birmingham

Chicago

Baltimore  

Philadelphia

New York

City

Figure U. Primary and Secondary Syphilis and HIV — Proportion of MSM* Attending STD Clinics 

with Primary and Secondary Syphilis Who are Co-infected with HIV, STD Surveillance 

Network (SSuN), 2012

* MSM = men who have sex with men.

NOTE: Includes sites that reported data on at least 25 MSM with primary and secondary syphilis in 2012.
STD Surveillance 2012 Special Focus Profiles: STDs in Racial and Ethnic Minorities 77

Figure V.

Percentage

‡ ‡

HIVHIV+

 0

 4

 8

 12

 16

 20

P&S 

syphilis

GC 

urethral

GC 

pharyngeal

GC 

rectal

CT 

urethral

CT 

rectal

Figure V. Proportion of MSM* Attending STD Clinics with Primary and Secondary Syphilis, 

Gonorrhea or Chlamydia by HIV Status†

, STD Surveillance Network (SSuN), 2012

* MSM = men who have sex with men.

† Excludes all persons for whom there was no laboratory documentation or self-report of HIV status.

‡ GC urethral and CT urethral include results from both urethral and urine specimens.

Figure W.

 0

 7

 14

 21

 28

 35

Year

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

Percentage

Figure W. Percentage of Urethral Neisseria gonorrhoeae Isolates Obtained from MSM* Attending 

STD Clinics, Gonococcal Isolate Surveillance Project (GISP), 1990 – 2012

* MSM = men who have sex with men.
78 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2012

0

10

20

30

40

50

60

70

80

90

100

New York

City

Los Seattle Denver Chicago Birmingham Richmond Baltimore Philadelphia 

Angeles 

San 

Francisco 

Figure X. 

Year

0%

50%

100%

'09 '10 '11 '12

% of Isolates

from MSM*

 BHM

 PHX

 LAX

 ORA

 SDG

 SFO DEN

 MIA

 ATL

 HON

 TRP

 CHI

 NOR

 BAL

 PON

 MIN

 KCY LVG

 ALB

 NYC

 GRB

 CLE

 COL

 OKC

 POR

 PHI

 DAL

 RIC

 SEA

Figure X. Percentage of Urethral Neisseria gonorrhoeae Isolates Obtained from MSM* Attending 

STD Clinics, by Site, Gonococcal Isolate Surveillance Project (GISP), 2009 – 2012

* MSM = men who have sex with men.

NOTE: Participating sites include ALB = Albuquerque, NM; ATL = Atlanta, GA; BAL = Baltimore, MD; BHM = Birmingham, AL; CHI = Chicago, IL; CLE = Cleveland, OH; COL= Columbus, OH; DAL = Dallas, TX; DEN = Denver, CO; GRB = Greensboro, NC; HON = Honolulu, HI; KCY = Kansas City, MO; LAX = Los Angeles, 

CA; LVG = Las Vegas, NV; MIA = Miami, FL; MIN = Minneapolis, MN; NOR = New Orleans, LA; NYC = New York City, NY; OKC = Oklahoma City, OK; ORA = 

Orange County, CA; PHI = Philadelphia, PA; PHX = Phoenix, AZ; PON = Pontiac, MI; POR = Portland, OR; RIC = Richmond, VA; SDG = San Diego, CA; SEA = 

Seattle, WA; SFO = San Francisco, CA; and TRP = Tripler Army Medical Center, HI.
TABLES
TABLES
STD Surveillance 2012 National Summary Tables 79

Table 1. Cases of Sexually Transmitted Diseases Reported by State Health Departments and Rates 

per 100,000 Population, United States, 1941–2012

Syphilis

Year*

All Stages†

Primary and 

Secondary Early Latent

Late and Late 

Latent‡ Congenital Chlamydia Gonorrhea Chancroid

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

1941 485,560 368.2 68,231 51.7 109,018 82.6 202,984 153.9 17,600 651.1 NR — 193,468 146.7 3,384 2.5

1942 479,601 363.4 75,312 57.0 116,245 88.0 202,064 153.1 16,918 566.0 NR — 212,403 160.9 5,477 4.1

1943 575,593 447.0 82,204 63.8 149,390 116.0 251,958 195.7 16,164 520.7 NR — 275,070 213.6 8,354 6.4

1944 467,755 367.9 78,443 61.6 123,038 96.7 202,848 159.6 13,578 462.0 NR — 300,676 236.5 7,878 6.1

1945 359,114 282.3 77,007 60.5 101,719 79.9 142,187 111.8 12,339 431.7 NR — 287,181 225.8 5,515 4.3

1946 363,647 271.7 94,957 70.9 107,924 80.6 125,248 93.6 12,106 354.9 NR — 368,020 275.0 7,091 5.2

1947 355,592 252.3 93,545 66.4 104,124 73.9 122,089 86.6 12,200 319.6 NR — 380,666 270.0 9,515 6.7

1948 314,313 218.2 68,174 47.3 90,598 62.9 123,312 85.6 13,931 383.0 NR — 345,501 239.8 7,661 5.3

1949 256,463 175.3 41,942 28.7 75,045 51.3 116,397 79.5 13,952 382.4 NR — 317,950 217.3 6,707 4.6

1950 217,558 146.0 23,939 16.7 59,256 39.7 113,569 70.2 13,377 368.3 NR — 286,746 192.5 4,977 3.3

1951 174,924 116.1 14,485 9.6 43,316 28.7 98,311 65.2 11,094 290.4 NR — 254,470 168.9 4,233 2.8

1952 167,762 110.2 10,449 6.9 36,454 24.0 105,238 69.1 8,553 218.8 NR — 244,957 160.8 3,738 2.5

1953 148,573 95.9 8,637 5.6 28,295 18.3 98,870 63.8 7,675 193.9 NR — 238,340 153.9 3,338 2.2

1954 130,687 82.9 7,147 4.5 23,861 15.1 89,123 56.5 6,676 164.0 NR — 242,050 153.5 3,003 1.9

1955 122,392 76.2 6,454 4.0 20,054 12.5 86,526 53.8 5,354 130.7 NR — 236,197 147.0 2,649 1.7

1956 130,201 78.7 6,392 3.9 19,783 12.0 95,097 57.5 5,491 130.4 NR — 224,346 135.7 2,135 1.3

1957 123,758 73.5 6,576 3.9 17,796 10.6 91,309 54.2 5,288 123.0 NR — 214,496 127.4 1,637 1.0

1958 113,884 66.4 7,176 4.2 16,556 9.7 83,027 48.4 4,866 114.6 NR — 232,386 135.6 1,595 0.9

1959 120,824 69.2 9,799 5.6 17,025 9.8 86,740 49.7 5,130 119.7 NR — 240,254 137.6 1,537 0.9

1960 122,538 68.8 16,145 9.1 18,017 10.1 81,798 45.9 4,416 103.7 NR — 258,933 145.4 1,680 0.9

1961 124,658 68.8 19,851 11.0 19,486 10.8 79,304 43.8 4,163 97.5 NR — 264,158 145.8 1,438 0.8

1962 126,245 68.7 21,067 11.5 19,585 10.7 79,533 43.3 4,070 97.7 NR — 263,714 143.6 1,344 0.7

1963 124,137 66.5 22,251 11.9 18,235 9.8 78,076 41.8 4,031 98.4 NR — 278,289 149.0 1,220 0.7

1964 114,325 60.4 22,969 12.1 17,781 9.4 68,629 36.3 3,516 87.3 NR — 300,666 158.9 1,247 0.7

1965 112,842 58.9 23,338 12.2 17,458 9.1 67,317 35.1 3,564 94.8 NR — 324,925 169.5 982 0.5

1966 105,159 54.2 21,414 11.0 15,950 8.2 63,541 32.7 3,170 87.9 NR — 351,738 181.2 838 0.4

1967 102,581 52.2 21,053 10.7 15,554 7.9 61,975 31.5 2,894 82.2 NR — 404,836 205.9 784 0.4

1968 96,271 48.4 19,019 9.6 15,150 7.6 58,564 29.4 2,381 68.0 NR — 464,543 233.4 845 0.4

1969 92,162 45.7 19,130 9.5 15,402 7.6 54,587 27.1 2,074 57.6 NR — 534,872 265.4 1,104 0.5

1970 91,382 44.8 21,982 10.8 16,311 8.0 50,348 24.7 1,953 52.3 NR — 600,072 294.2 1,416 0.7

1971 95,997 46.4 23,783 11.5 19,417 9.4 49,993 24.2 2,052 57.7 NR — 670,268 324.1 1,320 0.6

1972 91,149 43.6 24,429 11.7 20,784 9.9 43,456 20.8 1,758 54.0 NR — 767,215 366.6 1,414 0.7

1973 87,469 41.4 24,825 11.7 23,584 11.2 37,054 17.5 1,527 48.7 NR — 842,621 398.7 1,165 0.6

1974 83,771 39.3 25,385 11.9 25,124 11.8 31,854 14.9 1,138 36.0 NR — 906,121 424.7 945 0.4

1975 80,356 37.3 25,561 11.9 26,569 12.3 27,096 12.6 916 29.1 NR — 999,937 464.1 700 0.3

1976 71,761 33.0 23,731 10.9 25,363 11.7 21,905 10.1 626 19.8 NR — 1,001,994 460.6 628 0.3

1977 64,621 29.4 20,399 9.3 21,329 9.7 22,313 10.2 463 13.9 NR — 1,002,219 456.0 455 0.2

1978 64,875 29.2 21,656 9.8 19,628 8.8 23,038 10.4 434 13.0 NR — 1,013,436 456.3 521 0.2

1979 67,049 29.9 24,874 11.1 20,459 9.1 21,301 9.5 332 9.5 NR — 1,004,058 447.1 840 0.4

1980 68,832 30.3 27,204 12.0 20,297 8.9 20,979 9.2 277 7.7 NR — 1,004,029 442.1 788 0.3

1981 72,799 31.7 31,266 13.6 21,033 9.2 20,168 8.8 287 7.9 NR — 990,864 431.8 850 0.4

1982 75,579 32.6 33,613 14.5 21,894 9.5 19,799 8.5 259 7.0 NR — 960,633 414.7 1,392 0.6

1983 74,637 31.9 32,698 14.0 23,738 10.2 17,896 7.7 239 6.6 NR — 900,435 385.1 847 0.4

1984 69,872 29.6 28,607 12.1 23,131 9.8 17,829 7.6 305 8.3 7,594 6.5 878,556 372.5 665 0.3

1985 67,563 28.4 27,131 11.4 21,689 9.1 18,414 7.7 329 8.7 25,848 17.4 911,419 383.0 2,067 0.9

1986 67,779 28.2 27,667 11.5 21,656 9.0 18,046 7.5 410 10.9 58,001 35.2 892,229 371.5 3,045 1.3

1987 87,286 36.0 35,585 14.7 28,233 11.7 22,988 9.5 480 12.6 91,913 50.8 787,532 325.0 4,986 2.1

1988 104,546 42.8 40,474 16.6 35,968 14.7 27,363 11.2 741 19.0 157,854 87.1 738,160 301.9 4,891 2.0

1989 115,089 46.6 45,826 18.6 45,394 18.4 22,032 8.9 1,837 45.5 200,904 102.5 733,294 297.1 4,697 1.9
80 National Summary Tables STD Surveillance 2012

Table 1. Cases of Sexually Transmitted Diseases Reported by State Health Departments and Rates 

per 100,000 Population, United States, 1941–2012 (continued)

Syphilis

Year*

All Stages†

Primary and 

Secondary Early Latent

Late and Late 

Latent‡ Congenital Chlamydia Gonorrhea Chancroid

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

1990 135,590 54.3 50,578 20.3 55,397 22.2 25,750 10.3 3,865 92.9 323,663 160.2 690,042 276.4 4,212 1.7

1991 128,719 50.9 42,950 17.0 53,855 21.3 27,490 10.9 4,424 107.6 381,228 179.7 621,918 245.8 3,476 1.4

1992 114,730 44.7 34,009 13.3 49,929 19.5 26,725 10.4 4,067 100.0 409,694 182.3 502,858 196.0 1,906 0.7

1993 102,612 39.5 26,527 10.2 41,919 16.1 30,746 11.8 3,420 85.5 405,332 178.0 444,649 171.1 1,292 0.5

1994 82,713 31.4 20,641 7.8 32,017 12.2 27,603 10.5 2,452 62.0 451,785 192.5 419,602 163.9 782 0.3

1995 69,359 26.0 16,543 6.2 26,657 10.0 24,296 9.1 1,863 47.8 478,577 187.8 392,651 147.5 607 0.2

1996 53,240 19.8 11,405 4.2 20,187 7.5 20,366 7.6 1,282 32.9 492,631 190.6 328,169 121.8 386 0.1

1997 46,716 17.1 8,556 3.1 16,631 6.1 20,447 7.5 1,082 27.9 537,904 205.5 327,665 120.2 246 0.1

1998 38,289 13.9 7,007 2.5 12,696 4.6 17,743 6.4 843 21.4 614,250 231.8 356,492 129.2 189 0.1

1999 35,386 12.7 6,617 2.4 11,534 4.1 16,655 6.0 580 14.6 662,647 247.2 360,813 129.3 110 0.0

2000 31,618 11.2 5,979 2.1 9,465 3.4 15,594 5.5 580 14.3 709,452 251.4 363,136 128.7 78 0.0

2001 32,286 11.3 6,103 2.1 8,701 3.0 16,976 5.9 506 12.6 783,242 274.5 361,705 126.8 38 0.0

2002 32,919 11.4 6,862 2.4 8,429 2.9 17,168 6.0 460 11.4 834,555 289.4 351,852 122.0 48 0.0

2003 34,289 11.8 7,177 2.5 8,361 2.9 18,319 6.3 432 10.6 877,478 301.7 335,104 115.2 54 0.0

2004 33,423 11.4 7,980 2.7 7,768 2.6 17,300 5.9 375 9.1 929,462 316.5 330,132 112.4 30 0.0

2005 33,288 11.2 8,724 2.9 8,176 2.8 16,049 5.4 339 8.2 976,445 329.4 339,593 114.6 17 0.0

2006 36,958 12.3 9,756 3.3 9,186 3.1 17,644 5.9 372 8.7 1,030,911 344.3 358,366 119.7 19 0.0

2007 40,925 13.6 11,466 3.8 10,768 3.6 18,256 6.1 435 10.1 1,108,374 367.5 355,991 118.0 23 0.0

2008 46,292 15.2 13,500 4.4 12,401 4.1 19,945 6.6 446 10.5 1,210,523 398.1 336,742 110.7 25 0.0

2009 44,832 14.6 13,997 4.6 13,066 4.3 17,338 5.6 431 10.4 1,244,180 405.3 301,174 98.1 28 0.0

2010 45,844 14.8 13,774 4.5 13,604 4.4 18,079 5.9 387 9.4 1,307,893 423.6 309,341 100.2 24 0.0

2011 46,040 14.8 13,970 4.5 13,136 4.2 18,576 6.0 358 8.7 1,412,791 453.4 321,849 103.3 8 0.0

2012 49,903 16.0 15,667 5.0 14,503 4.7 19,411 6.2 322 7.8 1,422,976 456.7 334,826 107.5 15 0.0

* For 1941-1946, data were reported for the federal fiscal year ending June 30 of the year indicated. From 1947 to the present, data were reported for the calendar 

year ending December 31. For 1941-1958, data for Alaska and Hawaii were not included. † Includes stage of syphilis not stated.

‡ Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other than 

neurosyphilis.

§ Rates include all cases of congenitally acquired syphilis per 100,000 live births. As of 1995, cases of congenital syphilis are obtained in hardcopy and electronic 

format on the basis of case reporting form CDC 73.126.

NR = No report.

NOTE: Adjustments to the number of cases reported from state health departments were made for hardcopy forms and for electronic data submissions through 

May 29, 2013 (see Appendix). The number of cases and the rates shown here supersede those published in previous reports. For more information regarding 

reporting, see Appendix, Interpreting STD Surveillance Data. Cases and rates shown in this table exclude the outlying areas of Guam, Puerto Rico, and Virgin Islands.
STD Surveillance 2012 Chlamydia Tables 81

Table 2. Chlamydia—Reported Cases and Rates by State, Ranked by Rates, United States, 2012

Rank* State Cases Rate per 100,000 Population

1 Mississippi 23,054 774.0

2 Alaska 5,462 755.8

3 Alabama 30,621 637.6

4 Louisiana 27,353 597.9

5 South Carolina 27,149 580.2

6 New Mexico 11,898 571.4

7 Arkansas 16,611 565.4

8 Georgia 52,418 534.0

9 Illinois 67,701 526.1

10 North Carolina 50,596 524.0

11 New York 100,546 516.5

12 Tennessee 32,525 507.9

13 Texas 127,036 494.8

14 Delaware 4,438 489.2

15 Michigan 47,566 481.6

16 South Dakota 3,924 476.2

17 Arizona 30,444 469.6

18 Missouri 27,835 463.1

19 Hawaii 6,340 461.2

20 Ohio 53,141 460.3

U.S. TOTAL† 1,422,976 456.7

21 Maryland 26,534 455.3

22 Indiana 29,505 452.7

23 California 167,695 444.9

24 Oklahoma 16,843 444.2

25 Virginia 34,963 431.8

26 Pennsylvania 54,993 431.6

27 North Dakota 2,908 425.2

28 Colorado 21,631 422.7

29 Wisconsin 23,726 415.4

30 Rhode Island 4,313 410.3

31 Nevada 11,137 408.9

32 Florida 77,644 407.4

33 Kentucky 17,273 395.3

34 Kansas 11,135 387.8

35 Montana 3,827 383.4

36 Iowa 11,377 371.5

37 Wyoming 2,102 370.0

38 Nebraska 6,748 366.2

39 Connecticut 13,065 364.9

40 Washington 24,596 360.1

41 Massachusetts 23,550 357.5

42 Oregon 13,454 347.5

43 Minnesota 18,056 337.8

44 New Jersey 27,271 309.2

45 Idaho 4,550 287.1

46 Vermont 1,724 275.2

47 Utah 7,615 270.3

48 West Virginia 4,790 258.2

49 Maine 3,413 257.0

50 New Hampshire 3,072 233.0

* States were ranked by rate; then by case count, then in alphabetical order, with rates shown rounded to the nearest tenth.

† Total includes cases reported by the District of Columbia with 6,808 cases and a rate of 1,101.6, but excludes outlying areas (Guam with 1,031 cases and rate of 

646.0, Puerto Rico with 6,227 cases and rate of 168.0, and Virgin Islands with 802 cases and rate of 758.1).
82 Chlamydia Tables STD Surveillance 2012

Table 3. Chlamydia—Reported Cases and Rates by State/Area and Region in Alphabetical Order, 

United States and Outlying Areas, 2008–2012

Cases Rates per 100,000 Population

State/Area 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Alabama 24,760 25,929 27,041 29,626 30,621 531.1 550.7 565.7 616.9 637.6

Alaska 4,861 5,166 6,019 5,739 5,462 708.3 739.6 847.5 794.1 755.8

Arizona 24,769 26,002 26,861 29,251 30,444 381.1 394.2 420.2 451.2 469.6

Arkansas 14,136 14,354 15,424 16,052 16,611 495.1 496.8 529.0 546.4 565.4

California 148,798 146,796 150,443 166,773 167,695 404.8 397.2 403.8 442.5 444.9

Colorado 19,180 19,998 19,447 21,811 21,631 388.3 398.0 386.7 426.3 422.7

Connecticut 12,519 12,127 12,649 13,649 13,065 357.6 344.7 353.9 381.2 364.9

Delaware 3,868 4,718 4,464 4,508 4,438 443.0 533.0 497.1 496.9 489.2

District of Columbia 6,924 6,549 5,589 6,585 6,808 1,169.9 1,092.1 928.8 1,065.5 1,101.6

Florida 71,017 72,931 74,744 76,033 77,644 387.5 393.4 397.5 399.0 407.4

Georgia 42,629 39,828 45,147 54,403 52,418 440.1 405.2 466.0 554.3 534.0

Hawaii 5,982 6,026 6,015 6,001 6,340 464.4 465.3 442.2 436.5 461.2

Idaho 4,194 3,842 4,208 4,699 4,550 275.2 248.5 268.4 296.5 287.1

Illinois 59,169 60,542 60,672 64,939 67,701 458.6 468.9 472.9 504.6 526.1

Indiana 22,154 21,732 22,825 27,801 29,505 347.4 338.3 352.0 426.6 452.7

Iowa 9,372 9,406 10,542 10,705 11,377 312.1 312.7 346.1 349.6 371.5

Kansas 9,208 10,510 9,601 10,598 11,135 328.6 372.9 336.5 369.1 387.8

Kentucky 12,163 13,293 16,376 16,629 17,273 284.9 308.1 377.4 380.6 395.3

Louisiana 22,659 27,628 29,151 31,614 27,353 513.7 615.0 643.0 691.0 597.9

Maine 2,608 2,431 2,586 3,094 3,413 198.1 184.4 194.7 232.9 257.0

Maryland 24,669 23,747 26,192 27,212 26,534 437.9 416.7 453.7 466.9 455.3

Massachusetts 17,503 19,315 21,080 22,764 23,550 269.4 292.9 321.9 345.6 357.5

Michigan 44,923 45,714 49,478 49,568 47,566 449.1 458.5 500.6 501.9 481.6

Minnesota 14,351 14,197 15,294 16,902 18,056 274.9 269.6 288.4 316.2 337.8

Mississippi 21,253 23,589 21,417 21,216 23,054 723.2 799.1 721.8 712.3 774.0

Missouri 24,817 25,868 26,049 27,887 27,835 419.8 432.0 435.0 464.0 463.1

Montana 3,101 2,988 3,082 3,406 3,827 320.5 306.5 311.5 341.2 383.4

Nebraska 5,573 5,443 5,114 6,780 6,748 312.5 303.0 280.0 368.0 366.2

Nevada 9,670 10,045 9,666 10,507 11,137 371.9 380.0 357.9 385.8 408.9

New Hampshire 2,109 2,102 2,462 3,010 3,072 160.3 158.7 187.0 228.3 233.0

New Jersey 22,405 23,974 26,142 26,209 27,271 258.0 275.3 297.3 297.1 309.2

New Mexico 9,262 9,493 11,706 11,374 11,898 466.8 472.4 568.5 546.2 571.4

New York 88,359 92,069 99,920 102,763 100,546 453.3 471.1 515.6 527.9 516.5

North Carolina 37,516 41,045 42,048 54,819 50,596 406.8 437.5 441.0 567.7 524.0

North Dakota 1,921 1,957 2,404 2,445 2,908 299.5 302.5 357.4 357.5 425.2

Ohio 47,117 48,239 51,150 52,653 53,141 410.2 417.9 443.4 456.1 460.3

Oklahoma 14,803 15,023 14,302 14,596 16,843 406.4 407.5 381.2 385.0 444.2

Oregon 10,744 11,497 12,352 13,643 13,454 283.5 300.5 322.4 352.4 347.5

Pennsylvania 42,233 43,068 47,518 52,884 54,993 339.3 341.7 374.1 415.0 431.6

Rhode Island 3,317 3,615 3,480 4,146 4,313 315.7 343.2 330.6 394.4 410.3

South Carolina 26,323 26,654 26,525 28,932 27,149 587.6 584.4 573.5 618.3 580.2

South Dakota 2,956 3,015 3,192 3,409 3,924 367.6 371.1 392.1 413.7 476.2

Tennessee 28,038 29,711 28,327 31,105 32,525 451.1 471.9 446.4 485.8 507.9

Texas 100,870 105,910 119,872 124,882 127,036 414.6 427.4 476.7 486.4 494.8

Utah 6,021 6,145 6,690 7,086 7,615 220.0 220.7 242.1 251.5 270.3

Vermont 1,190 1,186 1,257 1,483 1,724 191.5 190.7 200.9 236.7 275.2

Virginia 31,218 30,903 30,797 36,314 34,963 401.8 392.0 384.9 448.5 431.8

Washington 21,402 21,387 21,348 23,280 24,596 326.8 320.9 317.5 340.8 360.1

West Virginia 3,316 3,604 3,876 4,295 4,790 182.8 198.0 209.2 231.5 258.2

Wisconsin 20,996 20,906 23,236 24,619 23,726 373.1 369.7 408.6 431.0 415.4

Wyoming 1,577 1,963 2,113 2,092 2,102 296.1 360.7 374.9 368.2 370.0

U.S. TOTAL 1,210,523 1,244,180 1,307,893 1,412,791 1,422,976 398.1 405.3 423.6 453.4 456.7

Northeast 192,243 199,887 217,094 230,002 231,947 350.0 361.6 392.5 414.3 417.8

Midwest 262,557 267,529 279,557 298,306 303,622 394.5 400.3 417.7 444.2 452.1

South 486,162 505,416 531,292 578,821 576,656 435.2 446.0 463.8 498.8 496.9

West 269,561 271,348 279,950 305,662 310,751 380.4 379.1 389.1 419.5 426.5

Guam 687 620 899 1,071 1,031 390.4 347.5 563.9 671.1 646.0

Puerto Rico 6,874 7,302 5,960 5,634 6,227 173.8 184.1 160.0 152.0 168.0

Virgin Islands 587 488 609 820 802 534.4 444.4 573.1 775.2 758.1

OUTLYING AREAS 8,148 8,410 7,468 7,525 8,060 192.2 197.6 187.1 189.4 202.9

TOTAL 1,218,671 1,252,590 1,315,361 1,420,316 1,431,036 395.3 402.4 420.6 450.1 453.5
STD Surveillance 2012 Chlamydia Tables 83

Table 4. Chlamydia—Women—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2008–2012

Cases Rates per 100,000 Population

State/Area 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Alabama 18,744 19,413 20,030 21,217 22,099 779.8 799.8 814.4 857.9 893.5

Alaska 3,253 3,364 3,960 3,801 3,670 989.7 1,000.5 1,162.6 1,093.7 1,056.0

Arizona 18,358 19,097 19,529 21,196 22,087 566.0 580.6 607.2 650.5 677.8

Arkansas 10,643 10,689 11,303 11,921 12,247 730.6 725.2 761.5 797.3 819.1

California 104,201 101,716 102,645 114,657 114,396 567.3 551.1 547.8 605.3 603.9

Colorado 13,825 14,765 14,188 15,751 15,476 564.7 592.1 565.6 617.8 607.0

Connecticut 9,239 8,937 9,223 9,824 9,464 515.0 496.3 502.8 535.1 515.5

Delaware 2,789 3,573 3,296 3,191 3,181 620.1 784.5 711.9 682.9 680.7

District of Columbia 4,438 4,153 3,782 4,357 4,426 1,422.7 1,311.8 1,191.2 1,337.4 1,358.6

Florida 52,206 52,747 53,318 54,262 55,628 560.0 560.3 554.7 557.3 571.4

Georgia 31,515 29,074 32,863 39,829 37,456 640.4 582.2 662.8 794.6 747.3

Hawaii 4,422 4,399 4,340 4,314 4,452 692.4 686.5 639.1 629.8 649.9

Idaho 3,048 2,768 3,014 3,345 3,206 402.5 359.5 385.3 422.7 405.1

Illinois 43,112 44,560 44,598 46,728 48,575 659.0 680.2 682.1 712.9 741.0

Indiana 16,513 16,150 16,344 20,065 21,633 510.6 495.6 496.2 606.2 653.6

Iowa 6,882 6,785 7,612 7,647 8,194 452.9 445.7 494.9 495.0 530.4

Kansas 7,401 8,209 7,449 8,158 8,440 524.8 578.5 518.1 564.4 583.9

Kentucky 8,622 9,621 11,859 11,990 12,366 395.3 438.0 538.0 540.2 557.2

Louisiana 17,260 20,719 20,564 23,390 20,507 760.4 898.1 888.6 1,001.1 877.7

Maine 1,847 1,705 1,814 2,149 2,420 274.0 252.7 267.4 316.9 356.9

Maryland 19,337 18,782 19,827 20,004 19,295 665.4 639.8 664.9 665.1 641.5

Massachusetts 12,646 13,786 14,753 15,744 16,319 378.1 406.8 436.4 463.3 480.3

Michigan 33,719 33,860 36,431 36,367 34,510 663.8 668.3 723.5 723.0 686.1

Minnesota 10,266 10,204 10,965 11,827 12,568 391.8 385.7 410.4 439.7 467.2

Mississippi 16,323 17,829 15,958 15,697 16,771 1,077.6 1,172.2 1,045.7 1,024.6 1,094.7

Missouri 18,116 18,825 18,867 20,097 19,745 599.1 614.9 617.5 655.4 643.9

Montana 2,227 2,134 2,194 2,390 2,655 461.1 438.2 445.3 480.9 534.2

Nebraska 4,123 3,884 3,561 4,783 4,628 458.5 429.2 387.0 515.7 499.0

Nevada 7,131 7,112 6,897 7,215 7,628 559.0 548.3 515.9 534.9 565.6

New Hampshire 1,548 1,542 1,808 2,184 2,150 232.2 229.6 271.0 327.3 322.2

New Jersey 18,001 18,757 20,128 19,886 20,231 406.3 422.5 446.1 439.9 447.5

New Mexico 6,986 6,987 8,718 8,309 8,724 694.4 688.3 836.9 789.7 829.2

New York 61,280 63,882 68,693 70,466 68,337 611.1 636.1 686.9 702.3 681.1

North Carolina 30,693 33,002 33,836 42,992 39,140 652.3 688.9 691.9 868.1 790.3

North Dakota 1,291 1,297 1,577 1,603 1,898 404.0 403.0 474.0 474.7 562.1

Ohio 35,021 36,724 38,636 38,914 38,879 595.4 621.5 654.4 658.9 658.3

Oklahoma 11,117 11,101 10,297 10,349 12,341 603.0 595.2 543.6 540.8 644.9

Oregon 7,433 8,136 8,565 9,489 9,425 389.7 421.9 442.6 485.3 482.0

Pennsylvania 30,509 30,335 33,175 36,463 37,569 477.6 469.1 509.4 558.5 575.5

Rhode Island 2,400 2,603 2,478 2,984 3,091 442.7 480.5 455.4 549.5 569.2

South Carolina 20,492 21,124 20,842 22,278 20,497 891.5 902.7 877.5 927.2 853.1

South Dakota 2,185 2,214 2,300 2,491 2,801 541.7 544.7 565.4 606.2 681.7

Tennessee 20,479 21,655 20,559 22,200 22,732 642.8 671.1 632.1 676.3 692.5

Texas 79,002 82,551 92,847 95,326 96,405 648.4 665.5 732.6 737.1 745.5

Utah 3,982 4,019 4,473 4,821 5,149 293.8 290.5 325.2 343.9 367.3

Vermont 896 889 910 1,106 1,296 284.0 281.6 286.6 348.3 408.1

Virginia 23,172 22,390 22,348 26,283 24,670 586.3 558.7 548.4 637.9 598.7

Washington 15,581 15,741 15,634 16,641 17,271 475.1 472.0 463.3 486.5 504.9

West Virginia 2,490 2,684 2,832 3,092 3,405 269.0 289.3 301.5 328.8 362.1

Wisconsin 15,229 15,038 16,657 17,402 16,727 538.1 528.4 581.5 605.1 581.7

Wyoming 1,011 1,187 1,305 1,357 1,492 385.2 444.2 472.5 487.4 535.9

U.S. TOTAL 893,004 912,718 949,802 1,018,552 1,018,272 579.4 586.7 605.1 643.4 643.3

Northeast 138,366 142,436 152,982 160,806 160,877 490.9 502.6 537.8 563.8 564.0

Midwest 193,858 197,750 204,997 216,082 218,598 574.2 583.1 602.9 633.7 641.1

South 369,322 381,107 396,361 428,378 423,166 649.8 661.6 678.5 724.2 715.4

West 191,458 191,425 195,462 213,286 215,631 541.5 536.2 541.5 583.9 590.3

Guam 574 512 664 783 726 664.1 583.9 846.8 996.9 924.3

Puerto Rico 5,834 6,336 4,878 4,528 5,102 283.7 307.0 251.4 234.3 264.0

Virgin Islands 448 435 427 591 592 775.2 752.2 757.7 1,051.7 1,053.5

OUTLYING AREAS 6,856 7,283 5,969 5,902 6,420 311.5 329.6 287.6 285.5 310.6

TOTAL 899,860 920,001 955,771 1,024,454 1,024,692 575.6 583.1 601.0 638.8 639.0

NOTE: Cases reported with unknown sex are not included in this table.
84 Chlamydia Tables STD Surveillance 2012

Table 5. Chlamydia—Men—Reported Cases and Rates by State/Area and Region in Alphabetical 

Order, United States and Outlying Areas, 2008–2012

Cases Rates per 100,000 Population

State/Area 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Alabama 6,007 6,508 6,877 7,648 8,295 266.0 285.2 296.4 328.3 356.1

Alaska 1,608 1,802 2,058 1,938 1,792 449.7 497.5 556.8 516.5 477.6

Arizona 6,401 6,904 7,331 8,052 8,354 196.5 208.8 230.8 249.8 259.1

Arkansas 3,491 3,664 4,112 4,125 4,360 249.6 258.8 287.2 285.9 302.2

California 44,060 44,592 47,239 51,554 52,983 239.6 241.0 255.1 275.0 282.6

Colorado 5,319 5,228 5,259 6,057 6,155 213.5 206.6 208.6 235.9 239.8

Connecticut 3,264 3,190 3,426 3,825 3,524 191.2 185.7 196.9 219.2 202.0

Delaware 1,079 1,145 1,168 1,317 1,257 254.9 266.5 268.5 299.4 285.8

District of Columbia 2,438 2,390 1,789 2,225 2,345 871.1 844.3 629.4 761.4 802.5

Florida 18,593 20,069 21,362 21,685 22,009 206.5 220.0 232.5 232.6 236.1

Georgia 10,690 10,513 11,965 13,978 14,521 224.3 217.4 253.0 291.0 302.3

Hawaii 1,560 1,626 1,675 1,687 1,888 240.2 248.5 245.9 244.6 273.7

Idaho 1,133 1,051 1,183 1,347 1,344 147.8 135.5 150.6 169.7 169.3

Illinois 16,052 15,964 15,957 18,083 18,977 252.4 251.0 253.6 286.4 300.5

Indiana 5,572 5,502 6,451 7,681 7,850 177.3 173.9 202.2 239.5 244.8

Iowa 2,490 2,621 2,930 3,058 3,183 167.9 176.4 194.3 201.5 209.8

Kansas 1,807 2,301 2,152 2,440 2,695 129.8 164.4 152.0 171.1 189.0

Kentucky 3,508 3,647 4,488 4,577 4,851 168.0 172.2 210.2 212.9 225.6

Louisiana 5,226 6,841 6,658 7,568 6,846 244.1 313.1 300.0 338.1 305.8

Maine 761 726 768 944 990 118.5 112.8 118.1 145.2 152.3

Maryland 5,307 4,885 6,336 7,197 7,193 194.6 176.7 227.0 255.2 255.0

Massachusetts 4,839 5,490 6,302 7,000 7,193 153.5 171.3 199.0 219.5 225.5

Michigan 11,007 11,675 12,926 13,095 12,962 223.5 238.1 266.6 270.2 267.5

Minnesota 4,085 3,993 4,329 5,075 5,430 157.1 152.4 164.5 191.2 204.5

Mississippi 4,930 5,760 5,459 5,519 6,281 346.2 402.5 378.8 381.5 434.2

Missouri 6,701 7,043 7,182 7,790 8,090 232.0 240.7 244.8 264.6 274.8

Montana 865 851 888 1,016 1,172 178.5 174.4 178.8 202.7 233.8

Nebraska 1,441 1,549 1,548 1,987 2,093 163.0 173.7 170.8 217.1 228.7

Nevada 2,539 2,931 2,768 3,290 3,508 191.7 217.7 203.0 239.3 255.2

New Hampshire 561 560 654 826 922 86.4 85.8 100.7 126.9 141.7

New Jersey 4,390 5,200 5,874 6,231 6,958 103.3 121.8 137.3 144.9 161.8

New Mexico 2,272 2,500 2,986 3,054 3,170 232.2 251.3 293.5 296.5 307.7

New York 27,056 28,171 31,224 32,126 32,147 285.9 296.6 333.0 340.6 340.8

North Carolina 6,656 7,798 8,030 11,585 11,354 147.4 169.9 172.9 246.3 241.4

North Dakota 629 654 822 841 1,010 195.4 201.2 241.9 242.9 291.7

Ohio 10,847 10,978 12,320 13,731 14,262 193.6 194.9 218.7 243.5 252.9

Oklahoma 3,606 3,879 3,997 3,851 4,498 200.5 212.9 215.2 205.1 239.5

Oregon 3,311 3,361 3,786 4,154 4,028 175.9 177.2 199.7 216.7 210.2

Pennsylvania 11,722 12,700 14,297 16,364 17,388 193.4 206.9 231.0 263.3 279.8

Rhode Island 915 1,012 1,002 1,162 1,222 179.9 197.9 197.1 228.6 240.4

South Carolina 5,723 5,418 5,653 6,585 6,588 262.4 243.9 251.2 289.2 289.4

South Dakota 767 788 883 914 1,123 191.3 194.1 216.8 221.2 271.8

Tennessee 7,559 8,055 7,748 8,905 9,754 249.5 262.4 250.5 285.3 312.5

Texas 21,812 23,302 26,966 29,533 30,532 179.6 188.3 216.2 231.8 239.6

Utah 2,039 2,126 2,215 2,265 2,466 147.6 151.8 159.5 160.0 174.2

Vermont 294 297 347 377 428 96.2 97.1 112.6 122.1 138.6

Virginia 7,985 8,442 8,397 9,929 10,247 209.2 217.9 213.9 249.7 257.7

Washington 5,767 5,645 5,711 6,639 7,325 176.4 169.6 170.5 194.7 214.8

West Virginia 825 920 1,044 1,203 1,385 92.8 103.1 114.3 131.5 151.4

Wisconsin 5,707 5,740 6,573 7,203 6,999 204.0 204.3 232.9 254.0 246.8

Wyoming 563 776 808 734 610 208.4 280.1 281.1 253.3 210.5

U.S. TOTAL 313,779 328,783 353,923 389,970 402,557 209.3 217.1 233.2 254.4 262.6

Northeast 53,802 57,346 63,894 68,855 70,772 201.2 212.8 237.8 255.0 262.1

Midwest 67,105 68,808 74,073 81,898 84,674 204.6 209.0 225.0 247.7 256.1

South 115,435 123,236 132,049 147,430 152,316 210.3 221.2 235.2 259.1 267.7

West 77,437 79,393 83,907 91,787 94,795 218.1 221.3 234.1 252.6 260.9

Guam 113 108 235 288 305 126.2 119.0 290.1 355.3 376.3

Puerto Rico 1,034 957 1,076 1,106 1,125 54.5 50.3 60.3 62.3 63.4

Virgin Islands 139 53 182 229 210 267.1 102.0 364.7 461.8 423.5

OUTLYING AREAS 1,286 1,118 1,493 1,623 1,640 63.1 54.6 77.9 85.2 86.1

TOTAL 315,065 329,901 355,416 391,593 404,197 207.3 214.9 231.2 252.3 260.4

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2012 Chlamydia Tables 85

Table 6. Chlamydia—Reported Cases and Rates in Selected Metropolitan Statistical Areas (MSAs)* 

in Alphabetical Order, United States, 2008–2012

Cases Rates per 100,000 Population

MSAs 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Atlanta-Sandy Springs-Marietta, GA 20,722 20,292 22,144 27,308 26,401 385.4 370.6 420.3 509.6 492.6

Austin-Round Rock, TX 8,413 8,456 8,511 9,360 9,810 509.1 495.9 495.9 524.8 550.0

Baltimore-Towson, MD 13,537 12,883 13,988 14,399 13,578 507.6 478.8 516.1 527.6 497.5

Birmingham-Hoover, AL 6,690 6,120 6,126 6,834 6,868 598.6 541.1 543.1 603.6 606.6

Boston-Cambridge-Quincy, MA-NH 11,854 13,285 14,291 15,703 16,339 262.1 289.5 313.9 342.0 355.9

Buffalo-Cheektowaga-Tonawanda, NY 5,561 5,769 5,938 5,965 6,010 494.6 513.3 522.9 526.0 530.0

Charlotte-Gastonia-Concord, NC-SC 7,046 8,869 7,458 11,452 9,790 414.0 508.1 424.2 637.8 545.3

Chicago-Naperville-Joliet, IL-IN-WI 45,803 46,505 45,726 49,590 51,329 478.6 485.4 483.3 521.7 540.0

Cincinnati-Middletown, OH-KY-IN 10,016 8,872 9,805 10,059 10,256 464.8 408.5 460.3 470.5 479.7

Cleveland-Elyria-Mentor, OH 8,731 10,439 11,608 12,348 12,339 418.1 499.2 558.8 597.0 596.6

Columbus, OH 8,314 9,015 9,545 8,953 8,847 468.9 500.3 519.7 481.7 476.0

Dallas-Fort Worth-Arlington, TX 26,090 27,142 29,314 31,871 31,553 414.1 421.0 460.1 488.3 483.5

Denver-Aurora, CO 10,996 11,803 14,320 12,710 12,764 438.7 462.5 563.0 488.9 491.0

Detroit-Warren-Livonia, MI 24,987 25,347 27,751 26,237 24,229 564.7 575.6 645.9 612.2 565.3

Hartford-West Hartford-East Hartford, CT 4,781 4,467 4,616 4,837 4,562 401.6 373.5 380.7 398.7 376.0

Houston-Baytown-Sugar Land, TX 21,100 21,032 27,522 26,543 26,869 368.4 358.4 462.8 436.1 441.4

Indianapolis, IN 8,814 7,716 8,274 10,559 12,175 513.8 442.5 471.1 593.7 684.5

Jacksonville, FL 7,318 6,745 7,093 7,264 6,813 557.3 507.9 527.1 534.0 500.9

Kansas City, MO-KS 9,559 9,892 9,443 10,133 10,232 477.5 478.4 464.0 493.6 498.5

Las Vegas-Paradise, NV 7,753 8,177 7,614 8,337 8,587 415.5 429.7 390.2 423.2 435.9

Los Angeles-Long Beach-Santa Ana, CA 55,276 54,892 56,033 58,552 60,231 429.4 426.4 436.8 452.3 465.3

Louisville, KY-IN 4,953 5,294 6,344 6,691 6,886 397.9 420.6 494.2 516.7 531.8

Memphis, TN-MS-AR 11,896 13,368 12,463 11,685 12,719 925.2 1,024.4 947.0 881.5 959.5

Miami-Fort Lauderdale-Miami Beach, FL 18,128 19,101 19,095 19,561 20,933 334.8 344.3 343.1 345.0 369.2

Milwaukee-Waukesha-West Allis, WI 1,441 10,588 11,512 11,712 10,929 93.0 678.9 739.9 749.7 699.6

Minneapolis-St. Paul-Bloomington, MN-WI 10,093 9,925 10,870 12,027 12,013 312.5 303.5 331.4 362.4 362.0

Nashville-Davidson-Murfreesboro, TN 5,574 5,816 5,705 6,713 6,835 359.4 367.6 358.8 415.1 422.7

New Orleans-Metairie-Kenner, LA 5,109 6,701 6,947 7,998 7,010 450.5 563.1 594.9 671.5 588.5

New York-Newark-Edison, NY-NJ-PA 80,306 83,904 90,704 93,295 90,855 422.5 440.0 480.0 490.6 477.8

Oklahoma City, OK 5,650 5,475 4,704 5,087 5,640 468.4 446.1 375.4 398.0 441.3

Orlando, FL 8,287 9,199 9,491 9,545 9,928 403.3 441.7 444.7 439.6 457.2

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 28,749 30,449 33,050 34,799 35,513 492.4 510.2 554.0 580.7 592.6

Phoenix-Mesa-Scottsdale, AZ 14,314 15,615 16,519 17,746 20,358 334.3 357.8 394.0 416.3 477.5

Pittsburgh, PA 6,920 6,597 7,096 8,436 8,994 294.3 280.1 301.2 357.5 381.1

Portland-Vancouver-Beaverton, OR-WA 6,499 7,215 7,415 8,509 7,797 294.4 321.8 333.1 376.1 344.6

Providence-New Bedford-Fall River, RI-MA 4,551 4,865 4,759 5,559 5,941 285.0 303.9 297.3 347.4 371.3

Richmond, VA 6,783 6,681 7,065 7,845 7,384 553.4 539.6 561.5 618.0 581.7

Riverside-San Bernardino-Ontario, CA 13,557 16,934 12,263 20,749 20,994 329.4 408.7 290.3 482.0 487.7

Rochester, NY 5,294 5,767 6,575 5,842 5,827 511.9 556.9 623.6 553.6 552.2

Sacramento-Arden-Arcade-Roseville, CA 8,395 6,320 8,084 10,866 9,852 397.9 297.1 376.2 499.3 452.7

Salt Lake City, UT 3,562 3,424 3,717 3,821 4,104 319.3 302.9 330.6 333.4 358.1

San Antonio, TX 9,734 11,555 12,430 13,066 13,023 479.2 557.6 580.2 595.3 593.3

San Diego-Carlsbad-San Marcos, CA 14,373 14,169 15,341 15,346 16,524 478.9 464.0 495.6 488.7 526.2

San Francisco-Oakland-Fremont, CA 17,555 16,642 17,686 18,745 17,171 410.7 385.4 407.9 426.9 391.0

San Jose-Sunnyvale-Santa Clara, CA 5,796 5,537 5,691 5,965 4,676 318.6 301.0 309.8 319.8 250.7

Seattle-Tacoma-Bellevue, WA 11,532 11,533 11,510 12,329 12,965 344.8 338.4 334.6 352.3 370.4

St. Louis, MO-IL 14,092 14,546 14,691 15,556 14,905 500.3 514.2 522.3 552.1 529.0

Tampa-St. Petersburg-Clearwater, FL 11,230 11,835 12,158 12,595 12,274 410.8 430.8 436.8 445.9 434.5

Virginia Beach-Norfolk-Newport News, VA-NC 11,867 11,954 11,388 13,669 12,411 715.6 713.9 681.2 813.7 738.8

Washington-Arlington-Alexandria, DC-VA-MD-WV 20,943 20,116 19,870 22,660 23,727 390.9 367.3 356.0 397.3 416.0

U.S. MSAs TOTAL 690,544 718,843 752,263 807,431 807,770 420.4 432.5 453.3 480.9 481.1

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.

NOTE: 2008 Milwaukee County STD morbidity data were misclassified, resulting in incomplete case counts for MSA-Milwaukee-Waukesha-West Allis,WI.
86 Chlamydia Tables STD Surveillance 2012

Table 7. Chlamydia—Women—Reported Cases and Rates in Selected Metropolitan Statistical 

Areas (MSAs)* in Alphabetical Order, United States, 2008–2012

Cases Rates per 100,000 Population

MSAs 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Atlanta-Sandy Springs-Marietta, GA 14,898 14,208 15,508 19,457 18,241 547.7 512.7 573.3 708.3 664.0

Austin-Round Rock, TX 5,933 6,020 6,212 6,644 6,909 735.3 721.0 725.5 746.6 776.4

Baltimore-Towson, MD 10,774 10,187 10,744 10,668 9,933 779.9 730.8 764.4 754.3 702.3

Birmingham-Hoover, AL 4,948 4,530 4,525 4,834 4,866 855.2 774.5 775.0 824.1 829.5

Boston-Cambridge-Quincy, MA-NH 8,458 9,369 9,937 10,747 11,234 364.3 398.0 422.9 454.1 474.6

Buffalo-Cheektowaga-Tonawanda, NY 4,076 4,254 4,386 4,370 4,317 700.2 731.7 746.5 745.7 736.6

Charlotte-Gastonia-Concord, NC-SC 5,469 6,747 5,764 8,535 7,278 631.5 758.0 637.6 923.8 787.7

Chicago-Naperville-Joliet, IL-IN-WI 33,220 34,202 33,360 35,360 36,701 684.4 702.6 689.5 728.0 755.6

Cincinnati-Middletown, OH-KY-IN 8,031 7,243 7,749 7,774 7,766 728.5 652.1 711.8 711.9 711.1

Cleveland-Elyria-Mentor, OH 6,487 7,755 8,556 9,065 8,877 598.6 714.7 793.1 844.7 827.2

Columbus, OH 6,027 6,619 6,886 6,203 6,210 671.6 725.2 736.5 655.8 656.5

Dallas-Fort Worth-Arlington, TX 20,125 21,235 22,876 24,111 23,892 642.8 662.9 708.2 729.3 722.7

Denver-Aurora, CO 7,824 8,617 10,458 9,143 9,117 627.4 677.3 817.7 700.4 698.4

Detroit-Warren-Livonia, MI 18,826 18,870 20,530 19,161 17,460 831.9 836.7 927.2 867.8 790.8

Hartford-West Hartford-East Hartford, CT 3,474 3,250 3,324 3,470 3,301 569.4 530.6 534.2 557.6 530.5

Houston-Baytown-Sugar Land, TX 17,287 16,737 21,925 20,985 20,910 605.0 572.0 733.4 686.1 683.7

Indianapolis, IN 6,352 5,430 5,632 7,190 8,473 727.9 611.8 626.2 789.5 930.4

Jacksonville, FL 5,392 4,874 5,191 5,213 4,812 803.3 716.5 752.4 746.9 689.4

Kansas City, MO-KS 7,115 7,278 6,852 7,351 7,360 698.4 691.8 659.5 702.0 702.8

Las Vegas-Paradise, NV 5,842 5,874 5,537 5,777 5,942 637.5 628.5 571.4 590.2 607.0

Los Angeles-Long Beach-Santa Ana, CA 38,100 36,965 37,486 38,802 39,470 588.0 571.1 576.7 592.0 602.2

Louisville, KY-IN 3,504 3,821 4,646 4,867 5,023 548.5 593.3 707.4 734.4 758.0

Memphis, TN-MS-AR 9,199 10,170 9,529 8,743 9,345 1,377.8 1,501.5 1,392.6 1,268.0 1,355.3

Miami-Fort Lauderdale-Miami Beach, FL 13,144 13,788 13,566 13,815 14,692 472.2 485.5 472.5 473.5 503.6

Milwaukee-Waukesha-West Allis, WI 1,116 7,747 8,376 8,397 7,760 140.9 970.2 1,048.2 1,047.4 967.9

Minneapolis-St. Paul-Bloomington, MN-WI 7,037 7,028 7,710 8,275 8,233 433.7 427.0 464.2 492.9 490.4

Nashville-Davidson-Murfreesboro, TN 3,916 4,136 4,027 4,741 4,696 497.1 514.1 495.7 573.4 567.9

New Orleans-Metairie-Kenner, LA 3,722 4,875 5,065 5,956 5,241 630.1 789.5 845.0 973.7 856.8

New York-Newark-Edison, NY-NJ-PA 56,829 59,274 63,280 64,705 62,227 579.7 603.3 645.9 657.4 632.2

Oklahoma City, OK 4,119 3,912 3,292 3,518 3,951 673.4 627.6 517.9 543.3 610.2

Orlando, FL 6,160 6,740 6,777 6,993 7,373 594.1 640.8 621.9 631.1 665.4

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 20,708 21,297 22,863 23,928 24,166 686.9 690.9 740.7 772.0 779.7

Phoenix-Mesa-Scottsdale, AZ 10,725 11,405 11,892 12,696 14,396 506.4 529.1 564.3 592.8 672.1

Pittsburgh, PA 5,092 4,884 5,146 5,963 6,325 417.7 400.3 422.5 489.5 519.2

Portland-Vancouver-Beaverton, OR-WA 4,468 5,069 5,091 5,824 5,359 403.7 450.0 451.8 508.8 468.2

Providence-New Bedford-Fall River, RI-MA 3,327 3,503 3,433 4,022 4,256 403.6 425.1 415.1 486.9 515.2

Richmond, VA 4,981 4,843 5,282 5,710 5,201 790.6 760.1 812.9 871.3 793.6

Riverside-San Bernardino-Ontario, CA 10,009 12,305 8,810 15,241 15,296 486.8 595.5 414.8 704.9 707.4

Rochester, NY 3,594 3,859 4,448 3,935 3,891 679.0 728.8 820.8 725.7 717.6

Sacramento-Arden-Arcade-Roseville, CA 5,997 4,589 5,754 7,874 7,122 559.6 425.7 525.2 709.9 642.1

Salt Lake City, UT 2,254 2,173 2,434 2,558 2,719 411.0 389.2 436.0 449.6 477.9

San Antonio, TX 7,206 8,566 8,972 9,286 9,436 695.8 811.6 823.1 832.0 845.4

San Diego-Carlsbad-San Marcos, CA 10,257 10,050 10,538 10,395 11,102 688.0 660.5 683.6 664.9 710.2

San Francisco-Oakland-Fremont, CA 11,514 10,618 10,940 11,733 10,391 536.0 489.6 497.8 527.7 467.3

San Jose-Sunnyvale-Santa Clara, CA 4,218 3,989 3,951 4,187 3,260 475.3 443.2 431.6 450.7 350.9

Seattle-Tacoma-Bellevue, WA 7,975 8,062 8,000 8,259 8,460 477.1 473.1 463.0 470.9 482.4

St. Louis, MO-IL 10,166 10,481 10,489 11,108 10,393 699.4 718.4 723.2 764.7 715.5

Tampa-St. Petersburg-Clearwater, FL 8,099 8,323 8,527 8,913 8,738 577.2 590.9 593.9 612.5 600.5

Virginia Beach-Norfolk-Newport News, VA-NC 8,789 8,503 8,098 9,786 8,763 1,037.4 992.8 950.5 1,143.1 1,023.6

Washington-Arlington-Alexandria, DC-VA-MD-WV 14,967 14,429 14,146 15,811 16,247 545.7 516.1 493.6 540.8 555.7

U.S. MSAs TOTAL 501,750 518,703 538,520 572,099 567,131 601.7 614.9 635.2 667.6 661.8

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.

NOTE: 2008 Milwaukee County STD morbidity data were misclassified, resulting in incomplete case counts for MSA-Milwaukee-Waukesha-West Allis,WI.

Cases reported with unknown sex are not included in this table.
STD Surveillance 2012 Chlamydia Tables 87

Table 8. Chlamydia—Men—Reported Cases and Rates in Selected Metropolitan Statistical Areas 

(MSAs )* in Alphabetical Order, United States, 2008–2012

Cases Rates per 100,000 Population

MSAs 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Atlanta-Sandy Springs-Marietta, GA 5,585 5,923 6,471 7,549 7,906 210.3 219.0 252.4 289.0 302.7

Austin-Round Rock, TX 2,472 2,430 2,290 2,710 2,890 292.3 279.3 266.2 303.2 323.4

Baltimore-Towson, MD 2,754 2,665 3,231 3,723 3,608 214.2 205.5 247.6 283.2 274.4

Birmingham-Hoover, AL 1,740 1,588 1,545 1,852 1,985 322.8 290.7 283.9 339.4 363.8

Boston-Cambridge-Quincy, MA-NH 3,383 3,891 4,334 4,946 5,086 153.7 174.1 196.7 222.4 228.7

Buffalo-Cheektowaga-Tonawanda, NY 1,485 1,515 1,552 1,595 1,693 273.9 279.3 283.2 291.1 309.0

Charlotte-Gastonia-Concord, NC-SC 1,549 2,102 1,684 2,877 2,493 185.3 245.7 197.2 330.1 286.0

Chicago-Naperville-Joliet, IL-IN-WI 12,578 12,273 12,250 14,110 14,518 266.7 260.4 265.0 303.6 312.4

Cincinnati-Middletown, OH-KY-IN 1,963 1,565 2,022 2,283 2,488 186.5 147.5 194.1 218.3 237.9

Cleveland-Elyria-Mentor, OH 2,216 2,579 3,016 3,283 3,462 220.6 256.3 302.1 329.9 347.9

Columbus, OH 2,275 2,319 2,627 2,747 2,637 259.8 260.8 291.4 301.0 289.0

Dallas-Fort Worth-Arlington, TX 5,962 5,903 6,432 7,757 7,651 188.1 182.0 204.7 240.9 237.6

Denver-Aurora, CO 3,161 3,184 3,862 3,564 3,647 250.9 248.8 305.4 275.4 281.8

Detroit-Warren-Livonia, MI 5,996 6,329 7,134 7,011 6,718 277.3 294.6 342.6 337.4 323.3

Hartford-West Hartford-East Hartford, CT 1,303 1,217 1,292 1,367 1,245 224.5 208.6 219.0 231.3 210.7

Houston-Baytown-Sugar Land, TX 3,776 4,259 5,560 5,556 5,954 131.5 144.8 188.0 183.5 196.6

Indianapolis, IN 2,451 2,275 2,636 3,345 3,689 290.8 265.7 307.6 385.4 425.1

Jacksonville, FL 1,912 1,868 1,893 2,047 2,001 297.8 288.3 288.7 309.1 302.1

Kansas City, MO-KS 2,444 2,614 2,591 2,782 2,872 248.5 257.4 260.1 276.7 285.6

Las Vegas-Paradise, NV 1,911 2,301 2,076 2,558 2,644 201.3 237.7 211.4 258.1 266.8

Los Angeles-Long Beach-Santa Ana, CA 16,886 17,728 18,343 19,577 20,633 264.1 276.9 289.9 306.3 322.9

Louisville, KY-IN 1,436 1,460 1,686 1,794 1,833 237.0 237.6 269.0 283.8 290.0

Memphis, TN-MS-AR 2,697 3,197 2,928 2,942 3,374 436.4 509.4 463.4 462.5 530.4

Miami-Fort Lauderdale-Miami Beach, FL 4,934 5,304 5,523 5,721 6,238 187.5 195.9 205.0 207.8 226.6

Milwaukee-Waukesha-West Allis, WI 321 2,767 3,134 3,312 3,169 42.4 363.5 414.1 435.5 416.7

Minneapolis-St. Paul-Bloomington, MN-WI 3,056 2,897 3,160 3,752 3,775 190.1 178.4 195.2 228.8 230.2

Nashville-Davidson-Murfreesboro, TN 1,658 1,680 1,670 1,972 2,101 217.3 216.0 214.8 249.5 265.8

New Orleans-Metairie-Kenner, LA 1,349 1,804 1,687 2,017 1,769 248.3 315.1 296.8 348.1 305.3

New York-Newark-Edison, NY-NJ-PA 23,441 24,602 27,324 28,367 28,518 254.7 266.1 300.3 309.2 310.9

Oklahoma City, OK 1,473 1,536 1,410 1,457 1,688 247.8 254.3 228.4 231.1 267.7

Orlando, FL 2,117 2,452 2,705 2,539 2,555 208.0 237.9 258.9 238.8 240.3

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 8,040 9,129 10,146 10,817 11,314 284.7 316.4 352.4 373.9 391.1

Phoenix-Mesa-Scottsdale, AZ 3,586 4,210 4,626 5,047 5,960 165.7 190.6 221.8 237.9 280.9

Pittsburgh, PA 1,828 1,712 1,947 2,471 2,668 161.4 150.8 171.1 216.5 233.7

Portland-Vancouver-Beaverton, OR-WA 2,029 2,146 2,323 2,685 2,437 184.3 192.4 211.4 240.2 218.0

Providence-New Bedford-Fall River, RI-MA 1,222 1,360 1,325 1,536 1,683 158.2 175.1 171.2 198.4 217.4

Richmond, VA 1,793 1,817 1,759 2,089 2,171 301.0 302.3 289.1 340.2 353.6

Riverside-San Bernardino-Ontario, CA 3,548 4,622 3,437 5,412 5,683 172.2 222.5 163.6 252.6 265.2

Rochester, NY 1,700 1,908 2,127 1,907 1,936 336.8 377.0 415.1 371.7 377.4

Sacramento-Arden-Arcade-Roseville, CA 2,346 1,682 2,287 2,960 2,712 226.0 160.3 217.1 277.4 254.2

Salt Lake City, UT 1,308 1,251 1,283 1,263 1,385 230.6 218.7 226.7 218.9 240.1

San Antonio, TX 2,527 2,986 3,458 3,780 3,587 253.8 293.7 328.6 350.4 332.5

San Diego-Carlsbad-San Marcos, CA 4,078 4,097 4,785 4,925 5,418 270.0 267.4 308.0 312.3 343.6

San Francisco-Oakland-Fremont, CA 5,968 5,909 6,645 6,948 6,739 280.7 274.9 310.8 320.5 310.9

San Jose-Sunnyvale-Santa Clara, CA 1,558 1,513 1,649 1,667 1,353 167.2 161.0 179.0 178.0 144.5

Seattle-Tacoma-Bellevue, WA 3,538 3,471 3,509 4,070 4,505 211.4 203.7 205.0 233.1 258.0

St. Louis, MO-IL 3,925 4,065 4,200 4,444 4,494 287.9 296.7 308.3 325.6 329.3

Tampa-St. Petersburg-Clearwater, FL 3,050 3,441 3,601 3,657 3,532 229.2 257.0 267.2 267.0 257.9

Virginia Beach-Norfolk-Newport News, VA-NC 3,064 3,422 3,284 3,864 3,640 377.8 418.3 400.6 469.1 441.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 5,897 5,623 5,680 6,823 7,418 225.5 209.8 209.1 245.4 266.8

U.S. MSAs TOTAL 187,289 198,591 212,139 233,477 239,475 231.6 242.6 261.3 284.0 291.3

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.

NOTE: 2008 Milwaukee County STD morbidity data were misclassified, resulting in incomplete case counts for MSA-Milwaukee-Waukesha-West Allis,WI.

Cases reported with unknown sex are not included in this table.
88 Chlamydia Tables STD Surveillance 2012

Table 9. Chlamydia—Reported Cases and Rates in Counties and Independent Cities* Ranked by 

Number of Reported Cases, United States, 2012

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percentage

1 Los Angeles County, CA 51,589 521.7 3

2 Cook County, IL 37,946 727.3 6

3 Harris County, TX 21,933 524.6 7

4 Philadelphia County, PA 20,803 1,353.9 9

5 Kings County, NY 19,224 759.0 10

6 Maricopa County, AZ 19,044 490.8 11

7 Wayne County, MI 17,532 972.9 13

8 Bronx County, NY 17,023 1,222.9 14

9 San Diego County, CA 16,524 526.2 15

10 Dallas County, TX 16,223 671.5 16

11 Queens County, NY 12,777 568.4 17

12 San Bernardino County, CA 11,781 570.4 18

13 New York County, NY 11,777 735.2 19

14 Bexar County, TX 11,586 659.7 20

15 Cuyahoga County, OH 10,221 804.6 20

16 Marion County, IN 10,109 1,109.3 21

17 Milwaukee County, WI 10,064 1,056.6 22

18 Shelby County, TN 9,905 1,059.3 22

19 Miami-Dade County, FL 9,612 376.2 23

20 Riverside County, CA 9,213 411.4 24

21 Orange County, CA 8,642 282.8 24

22 Tarrant County, TX 8,620 466.0 25

23 Clark County, NV 8,587 435.9 26

24 Sacramento County, CA 8,153 567.7 26

25 Baltimore (City), MD 7,714 1,245.2 27

26 Broward County, FL 7,383 414.7 27

27 Hillsborough County, FL 7,098 559.9 28

28 Franklin County, OH 7,063 599.2 28

29 Fulton County, GA 6,868 723.3 29

30 Washington, D.C. 6,808 1,101.6 29

31 Travis County, TX 6,782 637.9 30

32 King County, WA 6,772 343.8 30

33 Hamilton County, OH 6,576 821.6 31

34 Alameda County, CA 6,562 428.9 31

35 Allegheny County, PA 6,444 525.2 31

36 Orange County, FL 6,361 544.1 32

37 Mecklenburg County, NC 6,286 665.6 32

38 Suffolk County, MA 6,084 832.4 33

39 Prince George's County, MD 6,037 692.9 33

40 Fresno County, CA 6,025 639.0 34

41 Kern County, CA 5,935 696.8 34

42 Hennepin County, MN 5,829 498.9 34

43 Jackson County, MO 5,521 816.3 35

44 Jefferson County, AL 5,509 836.1 35

45 Denver County, CO 5,467 881.8 36

46 St. Louis County, MO 5,379 538.6 36

47 Duval County, FL 5,331 612.3 36

48 Essex County, NJ 5,237 667.0 37

49 DeKalb County, GA 5,191 741.7 37

50 Honolulu County, HI 5,096 528.8 37

51 Erie County, NY 5,088 554.2 38

52 Jefferson County, KY 5,072 679.1 38

53 El Paso County, TX 5,014 610.9 39

54 Monroe County, NY 5,000 670.6 39

55 San Francisco County, CA 4,883 600.7 39

56 Pima County, AZ 4,761 481.1 40

57 Wake County, NC 4,659 501.1 40

58 Santa Clara County, CA 4,442 245.5 40

59 Pierce County, WA 4,313 533.9 41

60 Orleans County, LA 4,292 1,189.8 41

61 Oklahoma County, OK 4,106 560.6 41

62 St. Louis (City), MO 4,081 1,283.1 41

63 Bernalillo County, NM 4,077 607.6 42

64 New Haven County, CT 4,003 464.9 42

65 Hartford County, CT 4,001 447.2 42

66 Bell County, TX 3,997 1,268.1 43

67 Guilford County, NC 3,948 797.1 43

68 Palm Beach County, FL 3,938 294.9 43

69 Salt Lake County, UT 3,923 374.0 43

70 Pinellas County, FL 3,813 415.6 44

* Accounting for 44% of reported chlamydia cases.

† Counties and independent cities were ranked in descending order by number of cases reported then by rate in 2012.
STD Surveillance 2012 Chlamydia Tables 89

Table 10. Chlamydia—Reported Cases and Rates per 100,000 Population by Age Group and 

Sex, United States, 2008–2012

Age

Group

Cases Rates*

Total Male Female Unknown Sex Total Male Female

0–4 1,109 409 696 4 5.3 3.8 6.8

2008

5–9 240 52 185 3 1.2 0.5 1.9

10–14 14,297 1,441 12,816 40 71.3 14.0 130.9

15–19 419,026 76,741 340,975 1,310 1,947.7 695.9 3,251.4

20–24 437,163 113,948 322,054 1,161 2,075.9 1,050.7 3,153.2

25–29 188,033 60,629 126,901 503 881.4 554.1 1,221.0

30–34 74,737 26,740 47,757 240 381.4 268.5 495.5

35–39 36,537 14,908 21,510 119 174.0 141.1 206.3

40–44 17,991 8,525 9,398 68 83.7 79.3 87.3

45–54 14,271 7,386 6,832 53 32.2 33.8 30.3

55–64 3,064 1,634 1,424 6 9.1 10.1 8.2

65+ 887 427 453 7 2.3 2.6 2.0

Unknown Age 3,168 939 2,003 226

TOTAL 1,210,523 313,779 893,004 3,740 398.1 209.3 579.4

0–4 1,022 339 676 7 4.8 3.1 6.5

2009

5–9 187 33 154 0 0.9 0.3 1.5

10–14 13,899 1,405 12,447 47 69.6 13.7 127.6

15–19 429,173 80,725 347,597 851 1,992.6 730.5 3,314.7

20–24 454,760 120,975 332,946 839 2,111.3 1,090.5 3,187.3

25–29 190,481 62,437 127,708 336 878.7 561.7 1,209.1

30–34 77,606 28,344 49,103 159 390.2 280.4 502.0

35–39 36,286 14,859 21,354 73 176.7 143.5 209.7

40–44 18,263 8,750 9,467 46 87.0 83.3 90.3

45–54 15,033 7,818 7,183 32 33.7 35.6 31.8

55–64 3,365 1,787 1,573 5 9.7 10.6 8.7

65+ 946 472 471 3 2.4 2.8 2.1

Unknown Age 3,159 839 2,039 281

TOTAL 1,244,180 328,783 912,718 2,679 405.3 217.1 586.7

0–4 964 327 619 18 4.8 3.2 6.3

2010

5–9 188 26 158 4 0.9 0.3 1.6

10–14 14,531 1,590 12,860 81 70.3 15.0 127.4

15–19 441,342 85,570 354,252 1,520 2,002.4 757.0 3,299.5

20–24 488,996 131,686 355,994 1,316 2,265.3 1,195.6 3,367.4

25–29 197,525 66,470 130,561 494 936.1 625.0 1,247.4

30–34 83,408 31,230 51,925 253 417.8 312.4 521.0

35–39 38,384 15,861 22,421 102 190.2 157.9 221.2

40–44 19,614 9,594 9,931 89 93.9 92.3 94.6

45–54 16,106 8,635 7,423 48 35.8 39.0 32.5

55–64 3,523 1,834 1,674 15 9.7 10.4 8.9

65+ 954 464 481 9 2.4 2.7 2.1

Unknown Age 2,358 636 1,503 219

TOTAL 1,307,893 353,923 949,802 4,168 423.6 233.2 605.1

0–4 747 284 458 5 3.7 2.8 4.6

2011

5–9 143 24 118 1 0.7 0.2 1.2

10–14 15,405 1,743 13,588 74 74.4 16.5 134.3

15–19 459,029 90,764 366,818 1,447 2,120.8 816.3 3,485.2

20–24 542,947 147,948 393,534 1,465 2,450.8 1,307.8 3,630.0

25–29 214,534 73,357 140,628 549 1,008.2 681.7 1,337.0

30–34 91,787 34,971 56,562 254 447.5 340.1 553.0

35–39 40,734 16,911 23,711 112 207.9 173.2 241.1

40–44 21,654 10,460 11,120 74 102.9 100.0 105.2

45–54 18,136 9,910 8,182 44 40.6 45.0 36.0

55–64 4,210 2,300 1,903 7 11.1 12.5 9.7

65+ 1,064 569 486 9 2.6 3.2 2.1

Unknown Age 2,401 729 1,444 228

TOTAL 1,412,791 389,970 1,018,552 4,269 453.4 254.4 643.4

0–4 774 272 495 7 3.8 2.6 5.0

2012

5–9 151 17 134 0 0.7 0.2 1.3

10–14 14,355 1,655 12,673 27 69.3 15.6 125.3

15–19 433,239 86,150 346,430 659 2,001.7 774.8 3,291.5

20–24 554,173 152,772 400,629 772 2,501.5 1,350.4 3,695.5

25–29 224,014 77,666 146,037 311 1,052.7 721.7 1,388.4

30–34 97,736 38,011 59,594 131 476.5 369.7 582.7

35–39 43,660 18,274 25,313 73 222.8 187.2 257.4

40–44 23,882 11,596 12,245 41 113.5 110.8 115.8

45–54 20,321 11,332 8,961 28 45.4 51.5 39.5

55–64 4,950 2,783 2,161 6 13.0 15.2 11.0

65+ 1,134 602 525 7 2.7 3.4 2.2

Unknown Age 4,587 1,427 3,075 85

TOTAL 1,422,976 402,557 1,018,272 2,147 456.7 262.6 643.3

* No population data are available for unknown sex and age; therefore, rates are not calculated.

NOTE: This table should be used only for age comparisons. Cases in the 0–4 age group may include cases due to perinatal transmission.
90 Chlamydia Tables STD Surveillance 2012

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

United States*, 2012

Age

Group

American Indians/ 

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 7 3 4 6 4 2 171 72 99

5–9 1 0 1 1 0 1 49 4 45

10–14 162 13 149 54 5 49 5,502 738 4,759

15–19 4,493 792 3,696 2,558 361 2,191 142,812 34,129 108,564

20–24 5,793 1,232 4,556 5,473 1,247 4,216 161,101 50,036 110,974

25–29 2,684 648 2,033 3,106 847 2,252 59,342 22,964 36,337

30–34 1,218 347 871 1,646 554 1,090 24,657 11,126 13,519

35–39 539 121 418 897 329 566 10,158 5,146 5,004

40–44 276 89 187 534 236 297 5,155 2,935 2,216

45–54 187 43 144 453 211 242 4,242 2,660 1,582

55–64 35 12 23 123 54 69 1,010 609 401

65+ 6 3 3 28 15 13 164 106 58

Unknown Age 8 3 4 32 10 21 945 314 628

TOTAL 15,409 3,306 12,089 14,911 3,873 11,009 415,308 130,839 284,186

Age

Group

Native Hawaiians/ 

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 2 1 1 146 49 97 1 1 0

5–9 0 0 0 12 1 11 2 0 2

10–14 15 1 14 2,076 130 1,946 73 4 69

15–19 726 103 622 92,549 13,558 78,939 1,828 286 1,542

20–24 1,175 248 927 137,204 35,035 102,091 1,861 478 1,383

25–29 576 163 413 53,703 18,379 35,297 655 258 397

30–34 245 78 167 21,386 8,403 12,971 224 98 126

35–39 94 29 65 8,992 3,850 5,136 88 42 46

40–44 33 11 22 5,212 2,619 2,591 62 40 22

45–54 20 11 9 4,750 3,045 1,704 42 35 7

55–64 3 2 1 1,165 819 346 12 8 4

65+ 2 1 1 226 167 59 0 0 0

Unknown Age 6 0 6 559 153 403 1 1 0

TOTAL 2,897 648 2,248 327,980 86,208 241,591 4,849 1,251 3,598

Age

Group

Hispanics Other/Unknown

Total† Male Female Total† Male Female

0–4 91 29 60 278 86 187

5–9 27 2 25 43 7 36

10–14 1,587 186 1,400 3,176 344 2,812

15–19 50,694 9,275 41,389 97,387 18,438 78,527

20–24 70,044 17,616 52,379 123,626 32,629 90,486

25–29 31,919 9,966 21,934 50,886 16,493 34,199

30–34 14,810 4,849 9,955 23,693 8,522 15,088

35–39 6,989 2,402 4,582 11,167 4,323 6,798

40–44 3,229 1,277 1,950 6,467 2,959 3,478

45–54 2,250 1,014 1,234 5,503 2,826 2,655

55–64 402 188 213 1,428 758 666

65+ 72 36 36 461 201 254

Unknown Age 480 121 356 2,370 752 1,550

TOTAL 182,594 46,961 135,513 326,485 88,338 236,736

* Includes 47 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2012.

† Total includes unknown sex.

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 3-5 for total and sex-specific 

cases and rates. 

Cases in the 0-4 age group may include cases due to perinatal transmission.
STD Surveillance 2012 Chlamydia Tables 91

Table 11B. Chlamydia—Rates per 100,000 Population by Race/Ethnicity, Age Group, and Sex, 

United States*, 2012

Age

Group

American Indians/ 

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 4.4 3.7 5.0 0.8 1.0 0.5 6.9 5.7 8.1

5–9 0.6 0.0 1.3 0.1 0.0 0.2 2.0 0.3 3.7

10–14 96.7 15.3 180.8 6.8 1.3 12.4 211.4 55.8 372.1

15–19 2,509.8 863.2 4,235.1 313.0 86.3 548.9 4,977.7 2,333.5 7,719.1

20–24 3,310.1 1,381.1 5,309.5 558.0 250.1 874.5 5,706.2 3,556.0 7,836.3

25–29 1,753.7 846.1 2,658.7 285.0 161.0 399.5 2,459.0 1,962.9 2,922.4

30–34 858.0 491.8 1,220.0 148.7 107.4 184.3 1,061.5 1,004.8 1,112.1

35–39 407.4 185.3 623.9 77.9 60.7 93.0 464.8 497.9 434.4

40–44 199.6 131.0 265.8 50.0 47.1 52.3 225.9 271.4 184.6

45–54 62.3 29.8 92.5 24.7 24.8 24.7 89.5 118.8 63.2

55–64 15.4 11.1 19.3 8.6 8.5 8.7 28.4 37.4 20.8

65+ 3.4 3.8 3.0 2.1 2.6 1.7 5.4 8.8 3.2

Unknown Age

TOTAL 728.2 317.1 1,126.4 112.9 61.7 158.7 1,229.4 809.2 1,613.6

Age

Group

Native Hawaiians/ 

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 5.3 5.2 5.4 1.6 1.0 2.1 0.1 0.2 0.0

5–9 0.0 0.0 0.0 0.1 0.0 0.2 0.3 0.0 0.6

10–14 40.6 5.2 78.4 19.8 2.4 38.1 11.3 1.2 21.7

15–19 1,841.9 512.5 3,219.8 830.1 236.4 1,458.3 326.2 101.7 552.2

20–24 2,528.1 1,027.1 4,151.0 1,175.4 590.6 1,778.4 418.9 222.4 603.2

25–29 1,283.5 709.2 1,886.3 473.1 320.2 629.0 185.5 153.9 214.1

30–34 605.0 376.3 844.7 195.2 152.0 239.0 72.9 67.5 77.7

35–39 266.9 161.4 376.6 85.0 72.3 97.7 34.3 34.6 34.0

40–44 98.4 65.2 132.0 42.8 42.8 42.7 26.3 35.7 17.7

45–54 31.7 34.9 28.4 16.8 21.7 12.0 9.7 17.0 3.1

55–64 7.0 9.5 4.6 4.5 6.4 2.6 4.0 5.5 2.5

65+ 6.2 6.8 5.7 0.7 1.2 0.3 0.0 0.0 0.0

Unknown Age

TOTAL 590.4 261.7 924.9 179.6 95.9 260.5 90.2 47.5 131.4

Age

Group

Hispanics

Total† Male Female

0–4 1.9 1.2 2.5

5–9 0.6 0.1 1.1

10–14 36.7 8.4 66.1

15–19 1,191.0 421.4 2,013.6

20–24 1,699.0 805.1 2,707.7

25–29 795.4 467.0 1,167.6

30–34 380.4 238.2 535.9

35–39 192.6 129.1 259.2

40–44 98.3 75.9 121.8

45–54 43.0 38.4 47.7

55–64 12.8 12.4 13.1

65+ 2.7 3.1 2.4

Unknown Age

TOTAL 380.3 192.2 574.7

* Includes 47 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2012.

† Total includes unknown sex.

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 3-5 for total and sex-specific 

cases and rates. 

Cases in the 0-4 age group may include cases due to perinatal transmission. 

No population data exist for unknown sex, unknown age, or unknown race; therefore no rates are calculated.
92 Chlamydia Tables STD Surveillance 2012

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

States, 2008–2012

Age Cases Rate per 100,000 Population

2008

15 25,468 1,244.1

16 47,865 2,294.3

17 73,080 3,449.3

18 96,581 4,481.6

19 97,981 4,710.6

20 87,892 4,283.4

21 74,816 3,677.0

22 63,397 3,096.3

23 52,641 2,557.1

24 43,308 2,143.1

25 35,773 1,741.9

2009

15 25,118 1,246.0

16 47,662 2,316.9

17 72,782 3,466.4

18 98,822 4,626.6

19 103,213 4,738.9

20 92,398 4,384.4

21 78,650 3,775.1

22 64,631 3,122.6

23 53,362 2,558.1

24 43,905 2,091.4

25 35,465 1,720.0

2010

15 25,432 1,231.1

16 48,233 2,296.7

17 73,089 3,428.0

18 100,399 4,573.2

19 107,099 4,774.3

20 99,175 4,485.9

21 84,674 3,973.3

22 69,755 3,342.6

23 56,264 2,734.2

24 46,126 2,212.0

25 37,155 1,768.4

2011

15 25,792 1,272.2

16 48,942 2,368.5

17 75,143 3,569.5

18 104,501 4,902.9

19 112,440 5,122.9

20 107,958 4,804.7

21 95,195 4,236.2

22 77,799 3,605.2

23 62,339 2,953.3

24 50,243 2,417.5

25 40,711 1,943.9

2012

15 24,453 1,206.2

16 45,041 2,179.7

17 69,465 3,299.8

18 99,459 4,666.3

19 108,012 4,921.1

20 104,425 4,647.5

21 96,456 4,292.3

22 81,292 3,767.1

23 65,473 3,101.7

24 52,983 2,549.4

25 41,911 2,001.2

NOTE: This table should be used only for age comparisons. Cases with unknown sex are not included in this table.
STD Surveillance 2012 Gonorrhea Tables 93

Table 13. Gonorrhea—Reported Cases and Rates by State, Ranked by Rates, United States, 2012

Rank* State Cases Rate per 100,000 Population

1 Mississippi 6,875 230.8

2 Louisiana 8,873 194.0

3 Alabama 9,270 193.0

4 South Carolina 7,638 163.2

5 Georgia 15,326 156.1

6 North Carolina 14,318 148.3

7 Arkansas 4,307 146.6

8 Ohio 16,493 142.9

9 Tennessee 9,098 142.1

10 Illinois 18,149 141.0

11 Missouri 7,889 131.2

12 Michigan 12,584 127.4

13 Texas 32,473 126.5

14 Pennsylvania 15,390 120.8

15 Oklahoma 4,441 117.1

16 New York 22,571 116.0

17 Indiana 7,338 112.6

U.S. TOTAL† 334,826 107.5

18 Florida 19,462 102.1

19 Alaska 726 100.5

20 Delaware 899 99.1

21 Kentucky 4,283 98.0

22 Maryland 5,686 97.6

23 New Mexico 1,883 90.4

24 Arizona 5,809 89.6

25 California 33,579 89.1

26 South Dakota 707 85.8

27 Virginia 6,885 85.0

28 New Jersey 7,486 84.9

29 Nevada 2,264 83.1

30 Wisconsin 4,704 82.4

31 Kansas 2,228 77.6

32 Nebraska 1,429 77.6

33 Iowa 2,006 65.5

34 Connecticut 2,133 59.6

35 Hawaii 815 59.3

36 Minnesota 3,082 57.7

37 Colorado 2,822 55.2

38 North Dakota 335 49.0

39 Rhode Island 507 48.2

40 Washington 3,238 47.4

41 West Virginia 831 44.8

42 Massachusetts 2,628 39.9

43 Oregon 1,464 37.8

44 Maine 456 34.3

45 Utah 479 17.0

46 Vermont 99 15.8

47 New Hampshire 147 11.2

48 Montana 108 10.8

49 Idaho 167 10.5

50 Wyoming 44 7.7

* States were ranked by rate, then case count, then in alphabetical order, with rates shown rounded to the nearest tenth.

† Total includes cases reported by the District of Columbia with 2,402 cases and a rate of 388.7, but excludes outlying areas (Guam with 92 cases and rate of 57.6, 

Puerto Rico with 345 cases and rate of 9.3, and Virgin Islands with 136 cases and rate of 128.6).
94 Gonorrhea Tables STD Surveillance 2012

Table 14. Gonorrhea—Reported Cases and Rates by State/Area and Region in Alphabetical Order, 

United States and Outlying Areas, 2008–2012

Cases Rates per 100,000 Population

State/Area 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Alabama 9,740 7,498 7,933 9,132 9,270 208.9 159.2 166.0 190.1 193.0

Alaska 578 990 1,273 984 726 84.2 141.7 179.2 136.2 100.5

Arizona 3,449 3,250 3,249 4,564 5,809 53.1 49.3 50.8 70.4 89.6

Arkansas 4,514 4,460 4,769 4,687 4,307 158.1 154.4 163.6 159.5 146.6

California 25,787 23,228 26,441 27,516 33,579 70.2 62.8 71.0 73.0 89.1

Colorado 3,757 2,823 2,787 2,363 2,822 76.1 56.2 55.4 46.2 55.2

Connecticut 2,801 2,558 2,569 2,449 2,133 80.0 72.7 71.9 68.4 59.6

Delaware 1,045 971 1,010 827 899 119.7 109.7 112.5 91.2 99.1

District of Columbia 2,656 2,561 2,104 2,569 2,402 448.8 427.1 349.7 415.7 388.7

Florida 23,326 20,878 20,163 19,689 19,462 127.3 112.6 107.2 103.3 102.1

Georgia 16,272 13,687 15,852 16,428 15,326 168.0 139.2 163.6 167.4 156.1

Hawaii 610 631 759 685 815 47.4 48.7 55.8 49.8 59.3

Idaho 187 110 147 162 167 12.3 7.1 9.4 10.2 10.5

Illinois 20,674 19,962 15,777 17,037 18,149 160.2 154.6 123.0 132.4 141.0

Indiana 8,769 6,835 6,496 6,569 7,338 137.5 106.4 100.2 100.8 112.6

Iowa 1,700 1,658 1,803 1,920 2,006 56.6 55.1 59.2 62.7 65.5

Kansas 2,274 2,505 2,084 2,209 2,228 81.2 88.9 73.0 76.9 77.6

Kentucky 4,548 3,827 4,345 4,521 4,283 106.5 88.7 100.1 103.5 98.0

Louisiana 9,455 8,996 8,912 9,169 8,873 214.4 200.3 196.6 200.4 194.0

Maine 96 143 162 272 456 7.3 10.8 12.2 20.5 34.3

Maryland 6,666 6,395 7,413 6,458 5,686 118.3 112.2 128.4 110.8 97.6

Massachusetts 2,129 1,976 2,483 2,353 2,628 32.8 30.0 37.9 35.7 39.9

Michigan 17,064 14,704 13,627 12,901 12,584 170.6 147.5 137.9 130.6 127.4

Minnesota 3,037 2,303 2,119 2,284 3,082 58.2 43.7 40.0 42.7 57.7

Mississippi 7,494 7,241 6,195 5,814 6,875 255.0 245.3 208.8 195.2 230.8

Missouri 8,014 6,488 7,159 7,802 7,889 135.6 108.4 119.5 129.8 131.2

Montana 122 80 102 85 108 12.6 8.2 10.3 8.5 10.8

Nebraska 1,460 1,376 1,187 1,352 1,429 81.9 76.6 65.0 73.4 77.6

Nevada 2,172 1,726 1,728 2,000 2,264 83.5 65.3 64.0 73.4 83.1

New Hampshire 100 113 151 130 147 7.6 8.5 11.5 9.9 11.2

New Jersey 5,298 4,762 5,872 7,348 7,486 61.0 54.7 66.8 83.3 84.9

New Mexico 1,403 1,082 1,229 1,839 1,883 70.7 53.8 59.7 88.3 90.4

New York 17,108 17,004 18,320 20,706 22,571 87.8 87.0 94.5 106.4 116.0

North Carolina 15,972 13,870 14,111 17,454 14,318 173.2 147.9 148.0 180.8 148.3

North Dakota 143 151 204 251 335 22.3 23.3 30.3 36.7 49.0

Ohio 16,803 15,988 16,496 16,726 16,493 146.3 138.5 143.0 144.9 142.9

Oklahoma 5,185 4,673 4,369 4,215 4,441 142.4 126.7 116.5 111.2 117.1

Oregon 1,225 1,113 1,076 1,489 1,464 32.3 29.1 28.1 38.5 37.8

Pennsylvania 11,071 10,138 12,883 13,770 15,390 88.9 80.4 101.4 108.1 120.8

Rhode Island 307 322 291 360 507 29.2 30.6 27.6 34.2 48.2

South Carolina 9,442 8,318 7,970 8,350 7,638 210.8 182.4 172.3 178.4 163.2

South Dakota 375 344 468 602 707 46.6 42.3 57.5 73.1 85.8

Tennessee 8,780 7,926 7,121 7,667 9,098 141.3 125.9 112.2 119.7 142.1

Texas 32,199 29,295 31,788 30,930 32,473 132.4 118.2 126.4 120.5 126.5

Utah 477 341 310 277 479 17.4 12.2 11.2 9.8 17.0

Vermont 37 50 58 48 99 6.0 8.0 9.3 7.7 15.8

Virginia 10,337 7,789 7,402 6,518 6,885 133.1 98.8 92.5 80.5 85.0

Washington 3,127 2,285 2,864 2,737 3,238 47.7 34.3 42.6 40.1 47.4

West Virginia 746 475 579 796 831 41.1 26.1 31.2 42.9 44.8

Wisconsin 6,087 5,201 5,091 4,789 4,704 108.2 92.0 89.5 83.8 82.4

Wyoming 124 74 40 46 44 23.3 13.6 7.1 8.1 7.7

U.S. TOTAL 336,742 301,174 309,341 321,849 334,826 110.7 98.1 100.2 103.3 107.5

Northeast 38,947 37,066 42,789 47,436 51,417 70.9 67.0 77.4 85.4 92.6

Midwest 86,400 77,515 72,511 74,442 76,944 129.8 116.0 108.3 110.8 114.6

South 168,377 148,860 152,036 155,224 153,067 150.7 131.4 132.7 133.8 131.9

West 43,018 37,733 42,005 44,747 53,398 60.7 52.7 58.4 61.4 73.3

Guam 109 59 97 96 92 61.9 33.1 60.8 60.2 57.6

Puerto Rico 273 230 312 341 345 6.9 5.8 8.4 9.2 9.3

Virgin Islands 120 115 151 139 136 109.2 104.7 142.1 131.4 128.6

OUTLYING AREAS 502 404 560 576 573 11.8 9.5 14.0 14.5 14.4

TOTAL 337,244 301,578 309,901 322,425 335,399 109.4 96.9 99.1 102.2 106.3
STD Surveillance 2012 Gonorrhea Tables 95

Table 15. Gonorrhea—Women—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2008–2012

Cases Rates per 100,000 Population

State/Area 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Alabama 5,582 4,240 4,432 5,103 5,187 232.2 174.7 180.2 206.3 209.7

Alaska 321 516 698 515 385 97.7 153.5 204.9 148.2 110.8

Arizona 1,577 1,475 1,553 2,212 2,827 48.6 44.8 48.3 67.9 86.8

Arkansas 2,520 2,562 2,729 2,687 2,432 173.0 173.8 183.9 179.7 162.7

California 11,625 9,430 10,546 10,811 13,045 63.3 51.1 56.3 57.1 68.9

Colorado 1,978 1,502 1,514 1,285 1,362 80.8 60.2 60.4 50.4 53.4

Connecticut 1,686 1,491 1,449 1,378 1,153 94.0 82.8 79.0 75.1 62.8

Delaware 606 564 621 471 496 134.7 123.8 134.1 100.8 106.1

District of Columbia 1,259 1,233 1,073 1,209 1,006 403.6 389.5 338.0 371.1 308.8

Florida 12,279 10,745 10,240 9,999 9,570 131.7 114.1 106.5 102.7 98.3

Georgia 8,687 7,253 8,297 8,589 7,921 176.5 145.2 167.3 171.4 158.0

Hawaii 298 264 314 273 299 46.7 41.2 46.2 39.9 43.6

Idaho 90 51 68 79 63 11.9 6.6 8.7 10.0 8.0

Illinois 11,342 11,248 8,924 9,500 9,837 173.4 171.7 136.5 144.9 150.1

Indiana 5,056 3,985 3,598 3,690 4,139 156.3 122.3 109.2 111.5 125.0

Iowa 1,024 1,049 1,179 1,217 1,170 67.4 68.9 76.7 78.8 75.7

Kansas 1,459 1,541 1,235 1,360 1,339 103.5 108.6 85.9 94.1 92.6

Kentucky 2,511 2,132 2,487 2,596 2,328 115.1 97.1 112.8 117.0 104.9

Louisiana 5,177 5,125 4,824 5,263 5,080 228.1 222.2 208.5 225.3 217.4

Maine 43 62 75 122 240 6.4 9.2 11.1 18.0 35.4

Maryland 3,604 3,457 4,028 3,461 2,878 124.0 117.8 135.1 115.1 95.7

Massachusetts 1,100 976 1,004 1,083 1,076 32.9 28.8 29.7 31.9 31.7

Michigan 10,047 8,536 7,971 7,599 7,194 197.8 168.5 158.3 151.1 143.0

Minnesota 1,657 1,270 1,248 1,294 1,676 63.2 48.0 46.7 48.1 62.3

Mississippi 4,357 4,335 3,602 3,344 3,834 287.6 285.0 236.0 218.3 250.3

Missouri 4,542 3,585 3,951 4,195 4,209 150.2 117.1 129.3 136.8 137.3

Montana 92 46 56 51 58 19.0 9.4 11.4 10.3 11.7

Nebraska 891 821 675 823 784 99.1 90.7 73.4 88.7 84.5

Nevada 1,012 826 830 879 982 79.3 63.7 62.1 65.2 72.8

New Hampshire 49 54 59 59 61 7.3 8.0 8.8 8.8 9.1

New Jersey 2,813 2,435 3,115 3,916 3,798 63.5 54.8 69.0 86.6 84.0

New Mexico 783 570 610 925 857 77.8 56.2 58.6 87.9 81.5

New York 8,349 7,927 8,718 9,716 10,021 83.3 78.9 87.2 96.8 99.9

North Carolina 8,876 7,868 8,314 10,076 8,093 188.6 164.2 170.0 203.4 163.4

North Dakota 93 88 140 149 207 29.1 27.3 42.1 44.1 61.3

Ohio 9,784 9,766 10,034 10,009 9,706 166.3 165.3 169.9 169.5 164.4

Oklahoma 2,964 2,809 2,493 2,395 2,652 160.8 150.6 131.6 125.1 138.6

Oregon 553 505 477 602 528 29.0 26.2 24.7 30.8 27.0

Pennsylvania 6,210 5,650 7,268 7,687 8,360 97.2 87.4 111.6 117.7 128.1

Rhode Island 135 146 121 167 232 24.9 27.0 22.2 30.8 42.7

South Carolina 5,704 5,004 4,905 4,981 4,416 248.2 213.8 206.5 207.3 183.8

South Dakota 247 190 290 399 446 61.2 46.7 71.3 97.1 108.5

Tennessee 4,801 4,365 3,884 4,112 4,721 150.7 135.3 119.4 125.3 143.8

Texas 17,029 16,071 17,246 16,476 17,151 139.8 129.6 136.1 127.4 132.6

Utah 137 70 75 66 132 10.1 5.1 5.5 4.7 9.4

Vermont 19 29 24 24 54 6.0 9.2 7.6 7.6 17.0

Virginia 5,847 4,314 4,146 3,693 3,734 147.9 107.6 101.7 89.6 90.6

Washington 1,522 949 1,044 1,066 1,230 46.4 28.5 30.9 31.2 36.0

West Virginia 425 281 326 467 438 45.9 30.3 34.7 49.7 46.6

Wisconsin 3,744 3,113 3,164 2,907 2,640 132.3 109.4 110.5 101.1 91.8

Wyoming 71 44 19 25 19 27.0 16.5 6.9 9.0 6.8

U.S. TOTAL 182,577 162,568 165,693 171,005 172,066 118.5 104.5 105.6 108.0 108.7

Northeast 20,404 18,770 21,833 24,152 24,995 72.4 66.2 76.7 84.7 87.6

Midwest 49,886 45,192 42,409 43,142 43,347 147.7 133.3 124.7 126.5 127.1

South 92,228 82,358 83,647 84,922 81,937 162.3 143.0 143.2 143.6 138.5

West 20,059 16,248 17,804 18,789 21,787 56.7 45.5 49.3 51.4 59.6

Guam 58 32 45 44 46 67.1 36.5 57.4 56.0 58.6

Puerto Rico 128 126 141 140 157 6.2 6.1 7.3 7.2 8.1

Virgin Islands 86 90 96 94 92 148.8 155.6 170.3 167.3 163.7

OUTLYING AREAS 272 248 282 278 295 12.4 11.2 13.6 13.4 14.3

TOTAL 182,849 162,816 165,975 171,283 172,361 117.0 103.2 104.4 106.8 107.5

NOTE: Cases reported with unknown sex are not included in this table.
96 Gonorrhea Tables STD Surveillance 2012

Table 16. Gonorrhea—Men—Reported Cases and Rates by State/Area and Region in Alphabetical 

Order, United States and Outlying Areas, 2008–2012

Cases Rates per 100,000 Population

State/Area 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Alabama 4,151 3,250 3,430 3,825 4,034 183.8 142.4 147.8 164.2 173.2

Alaska 257 474 575 469 341 71.9 130.9 155.6 125.0 90.9

Arizona 1,869 1,775 1,696 2,350 2,981 57.4 53.7 53.4 72.9 92.5

Arkansas 1,993 1,898 2,038 1,996 1,873 142.5 134.1 142.4 138.3 129.8

California 14,025 13,705 15,773 16,598 20,431 76.3 74.1 85.2 88.5 109.0

Colorado 1,777 1,319 1,273 1,078 1,460 71.3 52.1 50.5 42.0 56.9

Connecticut 1,113 1,067 1,120 1,071 978 65.2 62.1 64.4 61.4 56.1

Delaware 439 407 389 356 403 103.7 94.7 89.4 80.9 91.6

District of Columbia 1,383 1,328 1,028 1,360 1,386 494.1 469.2 361.7 465.4 474.3

Florida 10,995 10,099 9,906 9,675 9,892 122.1 110.7 107.8 103.8 106.1

Georgia 7,465 6,368 7,421 7,684 7,301 156.7 131.7 156.9 160.0 152.0

Hawaii 312 367 445 412 516 48.0 56.1 65.3 59.7 74.8

Idaho 97 58 78 83 104 12.7 7.5 9.9 10.5 13.1

Illinois 9,331 8,710 6,824 7,513 8,283 146.7 137.0 108.5 119.0 131.2

Indiana 3,693 2,831 2,884 2,867 3,188 117.5 89.5 90.4 89.4 99.4

Iowa 676 609 624 703 836 45.6 41.0 41.4 46.3 55.1

Kansas 815 964 849 849 889 58.6 68.9 60.0 59.5 62.4

Kentucky 2,030 1,690 1,854 1,913 1,948 97.2 79.8 86.8 89.0 90.6

Louisiana 4,233 3,849 3,540 3,739 3,793 197.7 176.1 159.5 167.0 169.5

Maine 53 81 86 150 216 8.3 12.6 13.2 23.1 33.2

Maryland 3,054 2,922 3,377 2,992 2,806 112.0 105.7 121.0 106.1 99.5

Massachusetts 1,026 996 1,479 1,269 1,551 32.5 31.1 46.7 39.8 48.6

Michigan 6,876 6,004 5,634 5,281 5,372 139.6 122.5 116.2 109.0 110.9

Minnesota 1,380 1,033 871 990 1,395 53.1 39.4 33.1 37.3 52.5

Mississippi 3,135 2,906 2,593 2,470 3,039 220.2 203.1 179.9 170.8 210.1

Missouri 3,472 2,903 3,208 3,607 3,680 120.2 99.2 109.4 122.5 125.0

Montana 29 34 46 34 50 6.0 7.0 9.3 6.8 10.0

Nebraska 568 553 512 528 641 64.2 62.0 56.5 57.7 70.0

Nevada 1,160 900 898 1,121 1,280 87.6 66.9 65.9 81.6 93.1

New Hampshire 51 59 92 71 86 7.9 9.0 14.2 10.9 13.2

New Jersey 2,483 2,326 2,727 3,400 3,673 58.4 54.5 63.7 79.1 85.4

New Mexico 619 512 619 914 1,025 63.3 51.5 60.8 88.7 99.5

New York 8,751 9,072 9,601 10,977 12,529 92.5 95.5 102.4 116.4 132.8

North Carolina 7,023 5,902 5,712 7,300 6,180 155.5 128.6 123.0 155.2 131.4

North Dakota 50 62 64 101 127 15.5 19.1 18.8 29.2 36.7

Ohio 6,693 6,068 6,421 6,717 6,787 119.4 107.7 114.0 119.1 120.4

Oklahoma 2,212 1,857 1,873 1,708 1,789 123.0 101.9 100.9 91.0 95.3

Oregon 672 608 599 887 936 35.7 32.0 31.6 46.3 48.8

Pennsylvania 4,860 4,484 5,615 6,078 7,025 80.2 73.0 90.7 97.8 113.0

Rhode Island 172 176 170 193 275 33.8 34.4 33.4 38.0 54.1

South Carolina 3,712 3,289 3,056 3,351 3,196 170.2 148.1 135.8 147.2 140.4

South Dakota 128 153 177 202 259 31.9 37.7 43.4 48.9 62.7

Tennessee 3,979 3,560 3,235 3,555 4,368 131.4 116.0 104.6 113.9 140.0

Texas 15,150 13,215 14,524 14,448 15,286 124.8 106.8 116.5 113.4 120.0

Utah 340 271 235 211 347 24.6 19.3 16.9 14.9 24.5

Vermont 18 21 33 24 45 5.9 6.9 10.7 7.8 14.6

Virginia 4,477 3,465 3,248 2,814 3,145 117.3 89.4 82.7 70.8 79.1

Washington 1,600 1,334 1,818 1,671 2,008 48.9 40.1 54.3 49.0 58.9

West Virginia 321 194 253 329 393 36.1 21.7 27.7 36.0 42.9

Wisconsin 2,332 2,061 1,926 1,880 2,064 83.4 73.4 68.2 66.3 72.8

Wyoming 53 30 21 21 25 19.6 10.8 7.3 7.2 8.6

U.S. TOTAL 153,103 137,819 142,470 149,835 162,235 102.1 91.0 93.9 97.7 105.8

Northeast 18,527 18,282 20,923 23,233 26,378 69.3 67.9 77.9 86.1 97.7

Midwest 36,014 31,951 29,994 31,238 33,521 109.8 97.0 91.1 94.5 101.4

South 75,752 66,199 67,477 69,515 70,832 138.0 118.8 120.2 122.2 124.5

West 22,810 21,387 24,076 25,849 31,504 64.3 59.6 67.2 71.1 86.7

Guam 51 27 52 52 46 56.9 29.8 64.2 64.2 56.8

Puerto Rico 145 104 171 201 188 7.6 5.5 9.6 11.3 10.6

Virgin Islands 34 25 55 45 44 65.3 48.1 110.2 90.7 88.7

OUTLYING AREAS 230 156 278 298 278 11.3 7.6 14.5 15.6 14.6

TOTAL 153,333 137,975 142,748 150,133 162,513 100.9 89.9 92.9 96.7 104.7

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2012 Gonorrhea Tables 97

Table 17. Gonorrhea—Reported Cases and Rates in Selected Metropolitan Statistical Areas 

(MSAs)* in Alphabetical Order, United States, 2008–2012

MSAs

Cases Rates per 100,000 Population

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Atlanta-Sandy Springs-Marietta, GA 8,084 7,466 8,337 8,567 8,287 150.4 136.4 158.2 159.9 154.6

Austin-Round Rock, TX 2,388 1,973 1,932 2,009 2,204 144.5 115.7 112.6 112.6 123.6

Baltimore-Towson, MD 4,146 3,869 4,369 3,634 2,974 155.4 143.8 161.2 133.2 109.0

Birmingham-Hoover, AL 2,891 1,970 2,363 2,550 2,340 258.7 174.2 209.5 225.2 206.7

Boston-Cambridge-Quincy, MA-NH 1,464 1,352 1,881 1,671 1,995 32.4 29.5 41.3 36.4 43.5

Buffalo-Cheektowaga-Tonawanda, NY 1,898 1,574 1,227 1,543 2,172 168.8 140.1 108.1 136.1 191.5

Charlotte-Gastonia-Concord, NC-SC 3,249 3,165 2,424 3,328 2,743 190.9 181.3 137.9 185.4 152.8

Chicago-Naperville-Joliet, IL-IN-WI 16,181 15,864 12,380 13,188 14,304 169.1 165.6 130.9 138.8 150.5

Cincinnati-Middletown, OH-KY-IN 3,926 3,219 3,379 3,516 3,228 182.2 148.2 158.6 164.4 151.0

Cleveland-Elyria-Mentor, OH 2,770 3,089 3,608 3,930 4,203 132.6 147.7 173.7 190.0 203.2

Columbus, OH 3,853 3,192 3,351 3,022 2,849 217.3 177.2 182.5 162.6 153.3

Dallas-Fort Worth-Arlington, TX 9,197 7,930 8,766 8,732 7,835 146.0 123.0 137.6 133.8 120.0

Denver-Aurora, CO 2,625 1,995 2,344 1,662 2,055 104.7 78.2 92.2 63.9 79.1

Detroit-Warren-Livonia, MI 10,850 9,366 9,160 8,924 8,062 245.2 212.7 213.2 208.2 188.1

Hartford-West Hartford-East Hartford, CT 1,029 961 1,126 1,036 744 86.4 80.4 92.9 85.4 61.3

Houston-Baytown-Sugar Land, TX 7,290 6,232 7,652 6,864 7,590 127.3 106.2 128.7 112.8 124.7

Indianapolis, IN 4,194 2,975 2,969 2,962 3,542 244.5 170.6 169.1 166.5 199.1

Jacksonville, FL 2,979 2,015 2,128 2,040 1,948 226.8 151.7 158.1 150.0 143.2

Kansas City, MO-KS 3,268 3,192 3,213 2,920 2,929 163.2 154.4 157.9 142.3 142.7

Las Vegas-Paradise, NV 1,918 1,553 1,604 1,740 1,968 102.8 81.6 82.2 88.3 99.9

Los Angeles-Long Beach-Santa Ana, CA 9,832 9,774 11,156 11,105 13,102 76.4 75.9 87.0 85.8 101.2

Louisville, KY-IN 2,300 2,125 2,272 2,462 2,073 184.8 168.8 177.0 190.1 160.1

Memphis, TN-MS-AR 4,475 4,536 4,086 3,849 4,495 348.1 347.6 310.5 290.4 339.1

Miami-Fort Lauderdale-Miami Beach, FL 5,471 5,239 5,506 5,352 5,291 101.0 94.4 98.9 94.4 93.3

Milwaukee-Waukesha-West Allis, WI 446 3,588 3,425 3,349 3,277 28.8 230.0 220.1 214.4 209.8

Minneapolis-St. Paul-Bloomington, MN-WI 2,345 1,800 1,665 1,880 2,526 72.6 55.0 50.8 56.7 76.1

Nashville-Davidson-Murfreesboro, TN 1,541 1,225 1,292 1,654 1,852 99.4 77.4 81.3 102.3 114.5

New Orleans-Metairie-Kenner, LA 2,045 2,082 1,991 2,069 2,166 180.3 175.0 170.5 173.7 181.9

New York-Newark-Edison, NY-NJ-PA 15,116 15,254 17,507 20,855 20,921 79.5 80.0 92.6 109.7 110.0

Oklahoma City, OK 2,403 2,066 1,700 1,845 1,947 199.2 168.3 135.7 144.4 152.3

Orlando, FL 2,704 2,663 2,495 2,277 2,328 131.6 127.9 116.9 104.9 107.2

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 7,724 7,407 9,694 10,123 11,026 132.3 124.1 162.5 168.9 184.0

Phoenix-Mesa-Scottsdale, AZ 2,211 2,317 2,335 3,340 4,526 51.6 53.1 55.7 78.3 106.2

Pittsburgh, PA 2,569 1,866 2,069 2,473 3,048 109.3 79.2 87.8 104.8 129.2

Portland-Vancouver-Beaverton, OR-WA 1,033 826 926 1,318 1,183 46.8 36.8 41.6 58.3 52.3

Providence-New Bedford-Fall River, RI-MA 455 427 382 475 643 28.5 26.7 23.9 29.7 40.2

Richmond, VA 2,698 1,900 1,742 1,441 1,699 220.1 153.5 138.4 113.5 133.8

Riverside-San Bernardino-Ontario, CA 2,199 1,921 1,924 2,330 3,031 53.4 46.4 45.5 54.1 70.4

Rochester, NY 1,345 1,465 1,319 1,066 1,153 130.1 141.5 125.1 101.0 109.3

Sacramento-Arden-Arcade-Roseville, CA 1,771 1,124 1,676 1,913 2,324 83.9 52.8 78.0 87.9 106.8

Salt Lake City, UT 346 244 204 199 345 31.0 21.6 18.1 17.4 30.1

San Antonio, TX 3,113 3,697 3,729 3,731 3,672 153.2 178.4 174.0 170.0 167.3

San Diego-Carlsbad-San Marcos, CA 2,066 1,829 2,021 2,173 2,620 68.8 59.9 65.3 69.2 83.4

San Francisco-Oakland-Fremont, CA 5,065 4,375 4,867 5,009 5,263 118.5 101.3 112.3 114.1 119.9

San Jose-Sunnyvale-Santa Clara, CA 712 563 586 680 1,020 39.1 30.6 31.9 36.5 54.7

Seattle-Tacoma-Bellevue, WA 2,182 1,700 2,189 1,971 2,323 65.2 49.9 63.6 56.3 66.4

St. Louis, MO-IL 5,003 3,620 4,137 5,017 4,811 177.6 128.0 147.1 178.1 170.8

Tampa-St. Petersburg-Clearwater, FL 3,852 3,818 3,516 3,655 3,422 140.9 139.0 126.3 129.4 121.1

Virginia Beach-Norfolk-Newport News, VA-NC 4,935 3,647 3,429 2,810 2,625 297.6 217.8 205.1 167.3 156.3

Washington-Arlington-Alexandria, DC-VA-MD-WV 5,557 5,321 5,234 5,477 5,360 103.7 97.2 93.8 96.0 94.0

U.S. MSAs TOTAL 197,714 181,371 189,287 195,736 204,044 120.4 109.1 114.1 116.6 121.5

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.

NOTE: 2008 Milwaukee County STD morbidity data were misclassified, resulting in incomplete case counts for MSA-Milwaukee-Waukesha-West Allis,WI.
98 Gonorrhea Tables STD Surveillance 2012

Table 18. Gonorrhea—Women—Reported Cases and Rates in Selected Metropolitan Statistical 

Areas (MSAs)* in Alphabetical Order, United States, 2008–2012

Cases Rates per 100,000 Population

MSAs 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Atlanta-Sandy Springs-Marietta, GA 3,967 3,633 3,954 4,136 3,901 145.8 131.1 146.2 150.6 142.0

Austin-Round Rock, TX 1,177 980 910 935 993 145.9 117.4 106.3 105.1 111.6

Baltimore-Towson, MD 2,302 2,181 2,397 1,941 1,527 166.6 156.5 170.5 137.2 108.0

Birmingham-Hoover, AL 1,655 1,056 1,323 1,417 1,280 286.0 180.6 226.6 241.6 218.2

Boston-Cambridge-Quincy, MA-NH 720 624 708 730 738 31.0 26.5 30.1 30.8 31.2

Buffalo-Cheektowaga-Tonawanda, NY 1,059 878 669 828 1,173 181.9 151.0 113.9 141.3 200.1

Charlotte-Gastonia-Concord, NC-SC 1,697 1,750 1,334 1,776 1,499 196.0 196.6 147.6 192.2 162.2

Chicago-Naperville-Joliet, IL-IN-WI 8,594 8,712 6,741 7,015 7,464 177.1 179.0 139.3 144.4 153.7

Cincinnati-Middletown, OH-KY-IN 2,696 2,181 2,330 2,264 2,052 244.5 196.4 214.0 207.3 187.9

Cleveland-Elyria-Mentor, OH 1,469 1,808 2,082 2,371 2,426 135.5 166.6 193.0 220.9 226.1

Columbus, OH 2,062 1,873 1,917 1,552 1,509 229.8 205.2 205.0 164.1 159.5

Dallas-Fort Worth-Arlington, TX 4,953 4,556 4,788 4,645 4,157 158.2 142.2 148.2 140.5 125.7

Denver-Aurora, CO 1,345 1,035 1,261 885 965 107.9 81.4 98.6 67.8 73.9

Detroit-Warren-Livonia, MI 6,226 5,204 5,217 5,114 4,406 275.1 230.8 235.6 231.6 199.6

Hartford-West Hartford-East Hartford, CT 609 551 633 596 422 99.8 90.0 101.7 95.8 67.8

Houston-Baytown-Sugar Land, TX 3,749 3,302 4,174 3,805 4,044 131.2 112.8 139.6 124.4 132.2

Indianapolis, IN 2,290 1,603 1,545 1,572 1,842 262.4 180.6 171.8 172.6 202.3

Jacksonville, FL 1,587 1,048 1,152 1,121 983 236.4 154.1 167.0 160.6 140.8

Kansas City, MO-KS 1,888 1,821 1,810 1,596 1,590 185.3 173.1 174.2 152.4 151.8

Las Vegas-Paradise, NV 880 746 779 742 847 96.0 79.8 80.4 75.8 86.5

Los Angeles-Long Beach-Santa Ana, CA 4,214 3,641 3,947 3,944 4,359 65.0 56.2 60.7 60.2 66.5

Louisville, KY-IN 1,228 1,133 1,263 1,413 1,115 192.2 175.9 192.3 213.2 168.2

Memphis, TN-MS-AR 2,472 2,537 2,285 2,191 2,415 370.2 374.6 333.9 317.8 350.2

Miami-Fort Lauderdale-Miami Beach, FL 2,661 2,439 2,480 2,361 2,198 95.6 85.9 86.4 80.9 75.3

Milwaukee-Waukesha-West Allis, WI 300 2,098 2,070 1,980 1,814 37.9 262.8 259.0 247.0 226.3

Minneapolis-St. Paul-Bloomington, MN-WI 1,210 928 950 1,028 1,318 74.6 56.4 57.2 61.2 78.5

Nashville-Davidson-Murfreesboro, TN 783 625 597 759 831 99.4 77.7 73.5 91.8 100.5

New Orleans-Metairie-Kenner, LA 984 1,098 1,014 1,110 1,165 166.6 177.8 169.2 181.5 190.5

New York-Newark-Edison, NY-NJ-PA 7,089 6,886 8,124 9,670 8,918 72.3 70.1 82.9 98.2 90.6

Oklahoma City, OK 1,294 1,188 962 1,034 1,081 211.5 190.6 151.3 159.7 166.9

Orlando, FL 1,424 1,364 1,171 1,090 1,087 137.3 129.7 107.5 98.4 98.1

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 4,098 3,811 5,125 5,361 5,581 135.9 123.6 166.0 173.0 180.1

Phoenix-Mesa-Scottsdale, AZ 988 1,022 1,071 1,568 2,118 46.7 47.4 50.8 73.2 98.9

Pittsburgh, PA 1,524 1,161 1,274 1,501 1,857 125.0 95.2 104.6 123.2 152.4

Portland-Vancouver-Beaverton, OR-WA 420 322 371 482 393 38.0 28.6 32.9 42.1 34.3

Providence-New Bedford-Fall River, RI-MA 209 196 159 232 294 25.4 23.8 19.2 28.1 35.6

Richmond, VA 1,436 1,010 994 808 927 227.9 158.5 153.0 123.3 141.5

Riverside-San Bernardino-Ontario, CA 1,237 1,024 976 1,196 1,562 60.2 49.6 46.0 55.3 72.2

Rochester, NY 744 744 714 525 560 140.6 140.5 131.8 96.8 103.3

Sacramento-Arden-Arcade-Roseville, CA 917 557 907 990 1,212 85.6 51.7 82.8 89.3 109.3

Salt Lake City, UT 88 37 41 42 88 16.0 6.6 7.3 7.4 15.5

San Antonio, TX 1,557 1,921 1,886 1,835 1,865 150.3 182.0 173.0 164.4 167.1

San Diego-Carlsbad-San Marcos, CA 803 620 535 609 847 53.9 40.7 34.7 39.0 54.2

San Francisco-Oakland-Fremont, CA 1,863 1,421 1,710 1,531 1,493 86.7 65.5 77.8 68.9 67.1

San Jose-Sunnyvale-Santa Clara, CA 312 248 249 243 372 35.2 27.6 27.2 26.2 40.0

Seattle-Tacoma-Bellevue, WA 965 604 686 649 732 57.7 35.4 39.7 37.0 41.7

St. Louis, MO-IL 2,756 1,908 2,188 2,701 2,468 189.6 130.8 150.9 186.0 169.9

Tampa-St. Petersburg-Clearwater, FL 2,006 1,907 1,834 1,887 1,701 143.0 135.4 127.7 129.7 116.9

Virginia Beach-Norfolk-Newport News, VA-NC 2,875 2,008 1,858 1,559 1,399 339.3 234.4 218.1 182.1 163.4

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,711 2,637 2,673 2,695 2,348 98.8 94.3 93.3 92.2 80.3

U.S. MSAs TOTAL 102,093 92,637 95,838 98,035 97,936 122.4 109.8 113.0 114.4 114.3

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.

NOTE: 2008 Milwaukee County STD morbidity data were misclassified, resulting in incomplete case counts for MSA-Milwaukee-Waukesha-West Allis,WI.

Cases reported with unknown sex are not included in this table.
STD Surveillance 2012 Gonorrhea Tables 99

Table 19. Gonorrhea—Men—Reported Cases and Rates in Selected Metropolitan Statistical Areas 

(MSAs)* in Alphabetical Order, United States, 2008–2012

 Cases Rates per 100,000 Population

MSAs 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Atlanta-Sandy Springs-Marietta, GA 4,054 3,786 4,306 4,338 4,323 152.6 140.0 167.9 166.1 165.5

Austin-Round Rock, TX 1,208 991 1,022 1,073 1,196 142.8 113.9 118.8 120.1 133.8

Baltimore-Towson, MD 1,841 1,675 1,968 1,690 1,447 143.2 129.2 150.8 128.5 110.1

Birmingham-Hoover, AL 1,235 913 1,024 1,094 1,057 229.1 167.2 188.2 200.5 193.7

Boston-Cambridge-Quincy, MA-NH 742 726 1,173 940 1,257 33.7 32.5 53.2 42.3 56.5

Buffalo-Cheektowaga-Tonawanda, NY 839 696 558 715 999 154.7 128.3 101.8 130.5 182.3

Charlotte-Gastonia-Concord, NC-SC 1,542 1,405 1,083 1,542 1,237 184.5 164.3 126.8 176.9 141.9

Chicago-Naperville-Joliet, IL-IN-WI 7,586 7,141 5,610 6,150 6,819 160.9 151.5 121.4 132.3 146.7

Cincinnati-Middletown, OH-KY-IN 1,224 1,019 1,043 1,251 1,176 116.3 96.0 100.1 119.6 112.4

Cleveland-Elyria-Mentor, OH 1,295 1,254 1,517 1,559 1,777 128.9 124.6 151.9 156.7 178.6

Columbus, OH 1,788 1,289 1,431 1,470 1,340 204.2 145.0 158.7 161.1 146.8

Dallas-Fort Worth-Arlington, TX 4,243 3,374 3,975 4,086 3,675 133.9 104.0 126.5 126.9 114.1

Denver-Aurora, CO 1,278 958 1,083 777 1,090 101.5 74.8 85.6 60.0 84.2

Detroit-Warren-Livonia, MI 4,502 4,005 3,924 3,794 3,642 208.2 186.4 188.5 182.6 175.3

Hartford-West Hartford-East Hartford, CT 418 410 493 440 322 72.0 70.3 83.5 74.5 54.5

Houston-Baytown-Sugar Land, TX 3,525 2,926 3,465 3,056 3,546 122.8 99.5 117.2 100.9 117.1

Indianapolis, IN 1,902 1,369 1,421 1,383 1,691 225.7 159.9 165.8 159.4 194.8

Jacksonville, FL 1,392 966 973 919 965 216.8 149.1 148.4 138.8 145.7

Kansas City, MO-KS 1,380 1,371 1,403 1,324 1,339 140.3 135.0 140.8 131.7 133.2

Las Vegas-Paradise, NV 1,038 807 825 998 1,119 109.3 83.3 84.0 100.7 112.9

Los Angeles-Long Beach-Santa Ana, CA 5,543 6,081 7,156 7,124 8,712 86.7 95.0 113.1 111.5 136.3

Louisville, KY-IN 1,070 990 1,007 1,043 954 176.6 161.1 160.7 165.0 150.9

Memphis, TN-MS-AR 2,003 1,998 1,800 1,658 2,080 324.1 318.4 284.9 260.7 327.0

Miami-Fort Lauderdale-Miami Beach, FL 2,801 2,799 3,024 2,987 3,093 106.4 103.4 112.3 108.5 112.4

Milwaukee-Waukesha-West Allis, WI 145 1,470 1,354 1,368 1,463 19.1 193.1 178.9 179.9 192.4

Minneapolis-St. Paul-Bloomington, MN-WI 1,135 872 715 852 1,205 70.6 53.7 44.2 52.0 73.5

Nashville-Davidson-Murfreesboro, TN 758 600 694 895 1,013 99.4 77.1 89.3 113.2 128.2

New Orleans-Metairie-Kenner, LA 1,050 976 919 953 1,001 193.2 170.5 161.7 164.5 172.8

New York-Newark-Edison, NY-NJ-PA 8,017 8,363 9,358 11,149 11,974 87.1 90.5 102.8 121.5 130.5

Oklahoma City, OK 1,103 876 736 775 866 185.5 145.0 119.2 122.9 137.3

Orlando, FL 1,277 1,297 1,320 1,186 1,241 125.5 125.8 126.4 111.5 116.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 3,626 3,593 4,565 4,756 5,439 128.4 124.5 158.6 164.4 188.0

Phoenix-Mesa-Scottsdale, AZ 1,222 1,295 1,264 1,770 2,407 56.5 58.6 60.6 83.4 113.5

Pittsburgh, PA 1,045 704 795 971 1,191 92.3 62.0 69.8 85.1 104.3

Portland-Vancouver-Beaverton, OR-WA 611 504 555 836 790 55.5 45.2 50.5 74.8 70.7

Providence-New Bedford-Fall River, RI-MA 246 231 223 243 349 31.9 29.7 28.8 31.4 45.1

Richmond, VA 1,261 886 745 628 770 211.7 147.4 122.4 102.3 125.4

Riverside-San Bernardino-Ontario, CA 961 895 944 1,126 1,467 46.7 43.1 44.9 52.5 68.5

Rochester, NY 601 721 605 541 593 119.1 142.5 118.1 105.4 115.6

Sacramento-Arden-Arcade-Roseville, CA 835 558 756 917 1,104 80.4 53.2 71.8 85.9 103.5

Salt Lake City, UT 258 207 163 157 257 45.5 36.2 28.8 27.2 44.5

San Antonio, TX 1,556 1,775 1,843 1,896 1,807 156.3 174.6 175.1 175.8 167.5

San Diego-Carlsbad-San Marcos, CA 1,254 1,206 1,482 1,552 1,766 83.0 78.7 95.4 98.4 112.0

San Francisco-Oakland-Fremont, CA 3,179 2,933 3,127 3,454 3,746 149.5 136.5 146.3 159.4 172.8

San Jose-Sunnyvale-Santa Clara, CA 398 314 333 430 626 42.7 33.4 36.1 45.9 66.8

Seattle-Tacoma-Bellevue, WA 1,216 1,094 1,501 1,322 1,591 72.7 64.2 87.7 75.7 91.1

St. Louis, MO-IL 2,247 1,712 1,949 2,316 2,340 164.8 125.0 143.1 169.7 171.4

Tampa-St. Petersburg-Clearwater, FL 1,822 1,887 1,678 1,761 1,721 136.9 141.0 124.5 128.6 125.7

Virginia Beach-Norfolk-Newport News, VA-NC 2,058 1,633 1,569 1,249 1,224 253.7 199.6 191.4 151.6 148.6

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,823 2,681 2,554 2,779 2,999 107.9 100.0 94.0 100.0 107.9

U.S. MSAs TOTAL 95,153 88,232 93,031 97,293 105,806 117.7 107.8 114.6 118.4 128.7

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.

NOTE: 2008 Milwaukee County STD morbidity data were misclassified, resulting in incomplete case counts for MSA-Milwaukee-Waukesha-West Allis,WI.

Cases reported with unknown sex are not included in this table.
100 Gonorrhea Tables STD Surveillance 2012

Table 20. Gonorrhea—Reported Cases and Rates in Counties and Independent Cities* Ranked by 

Number of Reported Cases, United States, 2012

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percentage

1 Cook County, IL 12,042 230.8 3

2 Los Angeles County, CA 11,933 120.7 7

3 Philadelphia County, PA 7,293 474.7 9

4 Wayne County, MI 6,609 366.7 11

5 Harris County, TX 6,462 154.6 13

6 Kings County, NY 4,551 179.7 14

7 Dallas County, TX 4,442 183.9 15

8 Maricopa County, AZ 4,325 111.5 17

9 New York County, NY 3,835 239.4 18

10 Cuyahoga County, OH 3,708 291.9 19

11 Shelby County, TN 3,665 391.9 20

12 Bronx County, NY 3,620 260.1 21

13 Bexar County, TX 3,374 192.1 22

14 Marion County, IN 3,311 363.3 23

15 Milwaukee County, WI 3,141 329.8 24

16 Fulton County, GA 3,132 329.8 25

17 San Diego County, CA 2,620 83.4 26

18 Franklin County, OH 2,594 220.1 27

19 San Francisco County, CA 2,482 305.4 27

20 Washington, D.C. 2,402 388.7 28

21 Miami-Dade County, FL 2,401 94.0 29

22 Allegheny County, PA 2,392 194.9 29

23 Hamilton County, OH 2,367 295.7 30

24 Queens County, NY 2,341 104.1 31

25 Tarrant County, TX 2,206 119.3 32

26 Jefferson County, AL 2,196 333.3 32

27 Broward County, FL 2,158 121.2 33

28 Hillsborough County, FL 2,151 169.7 33

29 Sacramento County, CA 2,101 146.3 34

30 Jackson County, MO 2,050 303.1 35

31 Clark County, NV 1,968 99.9 35

32 Essex County, NJ 1,946 247.9 36

33 Baltimore (City), MD 1,944 313.8 36

34 St. Louis County, MO 1,923 192.6 37

35 DeKalb County, GA 1,868 266.9 38

36 San Bernardino County, CA 1,858 90.0 38

37 Mecklenburg County, NC 1,848 195.7 39

38 Erie County, NY 1,781 194.0 39

39 Jefferson County, KY 1,777 237.9 40

40 St. Louis (City), MO 1,763 554.3 40

41 Duval County, FL 1,728 198.5 41

42 Travis County, TX 1,677 157.7 41

43 Orange County, FL 1,649 141.0 42

44 Oklahoma County, OK 1,617 220.8 42

45 Hennepin County, MN 1,545 132.2 43

46 Alameda County, CA 1,537 100.5 43

47 King County, WA 1,506 76.5 44

48 Fresno County, CA 1,483 157.3 44

49 Guilford County, NC 1,473 297.4 45

50 Prince George's County, MD 1,465 168.2 45

51 Orleans County, LA 1,431 396.7 45

52 Hinds County, MS 1,361 548.4 46

53 Wake County, NC 1,340 144.1 46

54 Mobile County, AL 1,332 322.8 47

55 Davidson County, TN 1,310 206.1 47

56 Montgomery County, AL 1,296 558.5 47

57 Genesee County, MI 1,280 303.3 48

58 Kern County, CA 1,242 145.8 48

59 Camden County, NJ 1,204 234.6 48

60 Lucas County, OH 1,187 269.8 49

61 Riverside County, CA 1,173 52.4 49

62 Cumberland County, NC 1,170 360.1 50

63 Orange County, CA 1,169 38.3 50

64 Montgomery County, OH 1,132 210.6 50

65 Bell County, TX 1,123 356.3 51

66 Pulaski County, AR 1,104 285.8 51

67 Monroe County, NY 1,103 147.9 51

68 Tulsa County, OK 1,096 179.5 52

69 Caddo County, LA 1,093 425.2 52

70 Denver County, CO 1,093 176.3 52

* Accounting for 52% of reported gonorrhea cases.

† Counties and independent cities were ranked in descending order by number of cases reported then by rate in 2012.
STD Surveillance 2012 Gonorrhea Tables 101

Table 21. Gonorrhea—Reported Cases and Rates per 100,000 Population by Age Group and 

Sex, United States, 2008–2012

Age

Group

Cases Rates*

Total Male Female Unknown Sex Total Male Female

0–4 310 119 190 1 1.5 1.1 1.9

2008

5–9 142 36 105 1 0.7 0.4 1.1

10–14 3,660 596 3,059 5 18.3 5.8 31.2

15–19 97,069 30,468 66,326 275 451.2 276.3 632.5

20–24 108,747 46,796 61,647 304 516.4 431.5 603.6

25–29 56,654 28,928 27,563 163 265.6 264.4 265.2

30–34 27,561 16,077 11,387 97 140.6 161.4 118.1

35–39 16,378 10,552 5,773 53 78.0 99.8 55.4

40–44 11,020 7,809 3,170 41 51.2 72.7 29.5

45–54 11,123 8,612 2,481 30 25.1 39.4 11.0

55–64 2,622 2,186 423 13 7.8 13.5 2.4

65+ 655 545 103 7 1.7 3.3 0.5

Unknown Age 801 379 350 72

TOTAL 336,742 153,103 182,577 1,062 110.7 102.1 118.5

0–4 226 83 141 2 1.1 0.8 1.4

2009

5–9 90 13 77 0 0.4 0.1 0.8

10–14 2,983 507 2,471 5 14.9 5.0 25.3

15–19 86,996 27,444 59,353 199 403.9 248.3 566.0

20–24 100,645 43,986 56,436 223 467.3 396.5 540.3

25–29 49,855 26,016 23,719 120 230.0 234.1 224.6

30–34 24,607 14,364 10,178 65 123.7 142.1 104.1

35–39 13,971 8,997 4,928 46 68.0 86.9 48.4

40–44 8,975 6,504 2,446 25 42.8 61.9 23.3

45–54 9,294 7,311 1,954 29 20.8 33.3 8.6

55–64 2,212 1,848 363 1 6.4 11.0 2.0

65+ 554 446 108 0 1.4 2.7 0.5

Unknown Age 766 300 394 72

TOTAL 301,174 137,819 162,568 787 98.1 91.0 104.5

0–4 247 70 167 10 1.2 0.7 1.7

2010

5–9 64 10 53 1 0.3 0.1 0.5

10–14 3,016 486 2,498 32 14.6 4.6 24.7

15–19 88,250 28,002 59,867 381 400.4 247.7 557.6

20–24 105,619 46,708 58,574 337 489.3 424.1 554.1

25–29 50,890 26,818 23,907 165 241.2 252.2 228.4

30–34 25,401 14,809 10,510 82 127.2 148.1 105.5

35–39 13,769 8,812 4,907 50 68.2 87.8 48.4

40–44 9,262 6,745 2,495 22 44.3 64.9 23.8

45–54 9,555 7,490 2,043 22 21.2 33.8 8.9

55–64 2,194 1,852 338 4 6.0 10.5 1.8

65+ 520 411 105 4 1.3 2.4 0.5

Unknown Age 554 257 229 68

TOTAL 309,341 142,470 165,693 1,178 100.2 93.9 105.6

0–4 182 43 136 3 0.9 0.4 1.4

2011

5–9 82 15 66 1 0.4 0.1 0.7

10–14 3,223 548 2,648 27 15.6 5.2 26.2

15–19 88,139 28,102 59,747 290 407.2 252.7 567.7

20–24 111,730 49,633 61,756 341 504.3 438.7 569.6

25–29 53,245 28,288 24,821 136 250.2 262.9 236.0

30–34 27,157 16,044 11,044 69 132.4 156.0 108.0

35–39 14,109 8,972 5,096 41 72.0 91.9 51.8

40–44 9,686 6,955 2,708 23 46.1 66.5 25.6

45–54 10,473 8,222 2,222 29 23.4 37.3 9.8

55–64 2,747 2,270 471 6 7.2 12.4 2.4

65+ 587 485 99 3 1.4 2.7 0.4

Unknown Age 489 258 191 40

TOTAL 321,849 149,835 171,005 1,009 103.3 97.7 108.0

0–4 198 72 122 4 1.0 0.7 1.2

2012

5–9 68 16 52 0 0.3 0.2 0.5

10–14 3,136 573 2,559 4 15.1 5.4 25.3

15–19 81,548 26,578 54,852 118 376.8 239.0 521.2

20–24 115,224 52,351 62,711 162 520.1 462.8 578.5

25–29 58,441 31,631 26,722 88 274.6 293.9 254.1

30–34 31,420 18,936 12,436 48 153.2 184.2 121.6

35–39 16,193 10,493 5,670 30 82.6 107.5 57.7

40–44 10,965 7,858 3,089 18 52.1 75.1 29.2

45–54 12,383 9,773 2,594 16 27.7 44.4 11.4

55–64 3,230 2,642 586 2 8.5 14.4 3.0

65+ 644 537 105 2 1.6 3.0 0.4

Unknown Age 1,376 775 568 33

TOTAL 334,826 162,235 172,066 525 107.5 105.8 108.7

*No population data are available for unknown sex and age; therefore, rates are not calculated.

NOTE: This table should be used only for age comparisons. Cases in the 0–4 age group may include cases due to perinatal transmission.
102 Gonorrhea Tables STD Surveillance 2012

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

2012

Age

Group

American Indians/ 

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 2 0 2 0 0 0 78 30 48

5–9 0 0 0 0 0 0 25 7 18

10–14 27 2 25 7 2 5 1,620 303 1,317

15–19 581 143 438 298 92 205 43,422 14,806 28,581

20–24 925 319 605 638 339 298 57,589 26,786 30,767

25–29 533 190 343 469 274 193 25,486 14,299 11,169

30–34 291 131 160 328 200 125 12,472 7,962 4,502

35–39 135 61 74 182 126 55 6,030 4,105 1,921

40–44 61 29 32 145 116 28 3,568 2,666 898

45–54 68 36 32 118 89 29 4,070 3,302 765

55–64 13 6 7 33 24 9 1,067 923 143

65+ 5 1 4 8 6 2 149 133 16

Unknown Age 2 1 1 6 2 3 502 288 213

TOTAL 2,643 919 1,723 2,232 1,270 952 156,078 75,610 80,358

Age

Group

Native Hawaiians/ 

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 0 0 0 37 14 23 2 1 1

5–9 0 0 0 5 1 4 0 0 0

10–14 3 0 3 272 29 243 21 1 20

15–19 82 28 54 9,505 2,217 7,282 386 77 309

20–24 149 63 86 18,074 6,878 11,188 451 197 254

25–29 92 50 42 11,463 5,444 6,010 230 130 100

30–34 62 30 31 6,383 3,514 2,863 99 61 38

35–39 13 9 4 3,511 2,145 1,362 53 38 15

40–44 13 11 2 2,779 1,930 848 41 30 11

45–54 12 9 3 3,399 2,747 652 39 32 7

55–64 0 0 0 900 756 144 10 7 3

65+ 1 1 0 163 146 17 0 0 0

Unknown Age 4 2 2 119 63 55 0 0 0

TOTAL 431 203 227 56,610 25,884 30,691 1,332 574 758

Age

Group

Hispanics Other/Unknown

Total† Male Female Total† Male Female

0–4 16 5 11 46 18 24

5–9 14 2 12 16 3 13

10–14 197 41 156 653 127 522

15–19 5,947 2,148 3,795 14,613 4,760 9,785

20–24 9,920 4,918 4,995 18,431 8,210 10,119

25–29 5,724 3,315 2,403 9,207 4,682 4,475

30–34 3,296 2,042 1,251 5,448 2,988 2,438

35–39 1,640 1,067 571 2,995 1,816 1,162

40–44 1,076 780 293 2,129 1,403 717

45–54 852 650 202 2,460 1,846 602

55–64 162 120 42 736 569 166

65+ 38 33 5 209 164 43

Unknown Age 101 53 47 591 339 224

TOTAL 28,983 15,174 13,783 57,534 26,925 30,290

* Includes 47 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2012.

† Total includes unknown sex.

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 21 for age-specific cases and rates and Tables 14–16 for total and sexspecific cases and rates. 

Cases in the 0–4 age group may include cases due to perinatal transmission.
STD Surveillance 2012 Gonorrhea Tables 103

Table 22B. Gonorrhea—Rates per 100,000 Population by Race/Ethnicity, Age Group, and Sex, 

United States*, 2012

Age

Group

American Indians/ 

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 1.2 0.0 2.5 0.0 0.0 0.0 3.1 2.4 3.9

5–9 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.6 1.5

10–14 16.1 2.4 30.3 0.9 0.5 1.3 62.3 22.9 103.0

15–19 324.6 155.9 501.9 36.5 22.0 51.4 1,513.5 1,012.3 2,032.2

20–24 528.5 357.6 705.1 65.0 68.0 61.8 2,039.8 1,903.7 2,172.6

25–29 348.2 248.1 448.6 43.0 52.1 34.2 1,056.1 1,222.3 898.3

30–34 205.0 185.7 224.1 29.6 38.8 21.1 536.9 719.1 370.3

35–39 102.0 93.4 110.4 15.8 23.3 9.0 275.9 397.2 166.8

40–44 44.1 42.7 45.5 13.6 23.2 4.9 156.3 246.5 74.8

45–54 22.7 24.9 20.6 6.4 10.5 3.0 85.8 147.4 30.6

55–64 5.7 5.5 5.9 2.3 3.8 1.1 30.0 56.6 7.4

65+ 2.8 1.3 4.1 0.6 1.1 0.3 4.9 11.0 0.9

Unknown Age

TOTAL 124.9 88.1 160.5 16.9 20.2 13.7 462.0 467.7 456.3

Age

Group

Native Hawaiians/ 

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 0.0 0.0 0.0 0.4 0.3 0.5 0.2 0.2 0.2

5–9 0.0 0.0 0.0 0.1 0.0 0.1 0.0 0.0 0.0

10–14 8.1 0.0 16.8 2.6 0.5 4.8 3.3 0.3 6.3

15–19 208.0 139.3 279.5 85.3 38.7 134.5 68.9 27.4 110.7

20–24 320.6 260.9 385.1 154.8 115.9 194.9 101.5 91.6 110.8

25–29 205.0 217.6 191.8 101.0 94.9 107.1 65.1 77.5 53.9

30–34 153.1 144.7 156.8 58.3 63.6 52.8 32.2 42.0 23.4

35–39 36.9 50.1 23.2 33.2 40.3 25.9 20.7 31.3 11.1

40–44 38.8 65.2 12.0 22.8 31.6 14.0 17.4 26.8 8.9

45–54 19.0 28.6 9.5 12.0 19.6 4.6 9.0 15.5 3.1

55–64 0.0 0.0 0.0 3.4 5.9 1.1 3.3 4.8 1.9

65+ 3.1 6.8 0.0 0.5 1.1 0.1 0.0 0.0 0.0

Unknown Age

TOTAL 87.8 82.0 93.4 31.0 28.8 33.1 24.8 21.8 27.7

Age

Group

Hispanics

Total† Male Female

0–4 0.3 0.2 0.5

5–9 0.3 0.1 0.5

10–14 4.6 1.9 7.4

15–19 139.7 97.6 184.6

20–24 240.6 224.8 258.2

25–29 142.6 155.3 127.9

30–34 84.7 100.3 67.3

35–39 45.2 57.3 32.3

40–44 32.8 46.3 18.3

45–54 16.3 24.6 7.8

55–64 5.2 7.9 2.6

65+ 1.4 2.9 0.3

Unknown Age

TOTAL 60.4 62.1 58.5

* Includes 47 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2012.

† Total includes unknown sex.

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 21 for age-specific cases and rates and Tables 14–16 for total and sexspecific cases and rates. 

Cases in the 0–4 age group may include cases due to perinatal transmission. 

No population data exist for unknown sex, unknown age, or unknown race; therefore no rates are calculated.
104 Gonorrhea Tables STD Surveillance 2012

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

States, 2008–2012

Age Cases Rate per 100,000 Population

2008

15 5,379 262.8

16 9,518 456.2

17 14,078 664.5

18 18,572 861.8

19 18,779 902.8

20 16,611 809.5

21 14,169 696.4

22 12,058 588.9

23 10,316 501.1

24 8,493 420.3

25 7,346 357.7

2009

15 4,458 221.1

16 8,150 396.2

17 12,226 582.3

18 16,770 785.1

19 17,749 814.9

20 15,433 732.3

21 13,321 639.4

22 10,933 528.2

23 9,151 438.7

24 7,598 361.9

25 6,429 311.8

2010

15 4,502 217.9

16 8,286 394.6

17 12,397 581.4

18 16,743 762.6

19 17,939 799.7

20 16,320 738.2

21 14,015 657.6

22 11,087 531.3

23 9,329 453.4

24 7,823 375.1

25 6,546 311.6

2011

15 4,466 220.3

16 8,128 393.4

17 12,308 584.7

18 16,973 796.3

19 17,872 814.3

20 16,865 750.6

21 14,559 647.9

22 12,202 565.4

23 9,861 467.2

24 8,269 397.9

25 6,804 324.9

2012

15 4,241 209.2

16 7,316 354.1

17 11,006 522.8

18 15,580 731.0

19 16,709 761.3

20 15,849 705.4

21 15,029 668.8

22 12,800 593.2

23 10,449 495.0

24 8,584 413.0

25 7,343 350.6

NOTE: This table should be used only for age comparisons. Cases with unknown sex are not included in this table.
STD Surveillance 2012 Syphilis Tables 105

Table 24. All Stages of Syphilis*—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2008–2012

Cases Rates per 100,000 Population

State/Area 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Alabama 1,187 1,138 781 758 705 25.5 24.2 16.3 15.8 14.7

Alaska 9 4 15 11 34 1.3 0.6 2.1 1.5 4.7

Arizona 1,394 1,084 905 907 787 21.4 16.4 14.2 14.0 12.1

Arkansas 508 552 534 464 468 17.8 19.1 18.3 15.8 15.9

California 6,911 6,033 6,115 6,782 8,015 18.8 16.3 16.4 18.0 21.3

Colorado 352 269 342 367 503 7.1 5.4 6.8 7.2 9.8

Connecticut 173 179 234 189 121 4.9 5.1 6.5 5.3 3.4

Delaware 60 87 44 124 106 6.9 9.8 4.9 13.7 11.7

District of Columbia 370 431 495 552 589 62.5 71.9 82.3 89.3 95.3

Florida 4,585 3,860 4,070 4,143 4,483 25.0 20.8 21.6 21.7 23.5

Georgia 2,833 2,717 2,347 1,895 2,432 29.2 27.6 24.2 19.3 24.8

Hawaii 68 88 73 32 43 5.3 6.8 5.4 2.3 3.1

Idaho 26 31 20 42 53 1.7 2.0 1.3 2.6 3.3

Illinois 1,565 1,915 2,236 2,426 2,423 12.1 14.8 17.4 18.9 18.8

Indiana 351 324 412 468 531 5.5 5.0 6.4 7.2 8.1

Iowa 75 65 68 70 143 2.5 2.2 2.2 2.3 4.7

Kansas 125 151 110 76 129 4.5 5.4 3.9 2.6 4.5

Kentucky 218 239 311 335 390 5.1 5.5 7.2 7.7 8.9

Louisiana 2,024 1,964 2,484 2,043 1,779 45.9 43.7 54.8 44.7 38.9

Maine 27 15 41 24 22 2.1 1.1 3.1 1.8 1.7

Maryland 1,088 993 1,015 1,278 1,243 19.3 17.4 17.6 21.9 21.3

Massachusetts 479 473 639 770 806 7.4 7.2 9.8 11.7 12.2

Michigan 546 636 683 764 786 5.5 6.4 6.9 7.7 8.0

Minnesota 266 217 350 367 335 5.1 4.1 6.6 6.9 6.3

Mississippi 745 745 823 748 456 25.4 25.2 27.7 25.1 15.3

Missouri 542 514 512 414 426 9.2 8.6 8.5 6.9 7.1

Montana 10 5 5 9 3 1.0 0.5 0.5 0.9 0.3

Nebraska 36 45 33 36 35 2.0 2.5 1.8 2.0 1.9

Nevada 325 306 412 430 445 12.5 11.6 15.3 15.8 16.3

New Hampshire 41 37 43 33 64 3.1 2.8 3.3 2.5 4.9

New Jersey 1,009 890 947 971 883 11.6 10.2 10.8 11.0 10.0

New Mexico 189 208 151 212 234 9.5 10.3 7.3 10.2 11.2

New York 5,515 4,623 4,860 4,786 5,312 28.3 23.7 25.1 24.6 27.3

North Carolina 999 1,524 1,233 1,255 1,036 10.8 16.2 12.9 13.0 10.7

North Dakota 4 8 6 5 14 0.6 1.2 0.9 0.7 2.0

Ohio 763 795 1,076 954 1,138 6.6 6.9 9.3 8.3 9.9

Oklahoma 257 296 272 270 256 7.1 8.0 7.3 7.1 6.8

Oregon 97 132 173 252 424 2.6 3.5 4.5 6.5 11.0

Pennsylvania 902 1,028 1,007 1,125 1,349 7.2 8.2 7.9 8.8 10.6

Rhode Island 55 64 79 84 93 5.2 6.1 7.5 8.0 8.8

South Carolina 412 507 580 639 623 9.2 11.1 12.5 13.7 13.3

South Dakota 6 10 12 14 29 0.7 1.2 1.5 1.7 3.5

Tennessee 1,284 1,317 1,193 1,025 1,067 20.7 20.9 18.8 16.0 16.7

Texas 6,336 6,975 6,413 6,161 7,057 26.0 28.1 25.5 24.0 27.5

Utah 40 55 133 64 101 1.5 2.0 4.8 2.3 3.6

Vermont 18 1 4 10 12 2.9 0.2 0.6 1.6 1.9

Virginia 789 755 800 726 906 10.2 9.6 10.0 9.0 11.2

Washington 438 322 535 712 709 6.7 4.8 8.0 10.4 10.4

West Virginia 44 32 26 9 24 2.4 1.8 1.4 0.5 1.3

Wisconsin 187 166 186 203 269 3.3 2.9 3.3 3.6 4.7

Wyoming 9 7 6 6 12 1.7 1.3 1.1 1.1 2.1

U.S. TOTAL 46,292 44,832 45,844 46,040 49,903 15.2 14.6 14.8 14.8 16.0

Northeast 8,219 7,310 7,854 7,992 8,662 15.0 13.2 14.2 14.4 15.6

Midwest 4,466 4,846 5,684 5,797 6,258 6.7 7.3 8.5 8.6 9.3

South 23,739 24,132 23,421 22,425 23,620 21.2 21.3 20.4 19.3 20.4

West 9,868 8,544 8,885 9,826 11,363 13.9 11.9 12.3 13.5 15.6

Guam 45 12 11 26 27 25.6 6.7 6.9 16.3 16.9

Puerto Rico 797 725 723 671 704 20.2 18.3 19.4 18.1 19.0

Virgin Islands 1 2 4 7 2 0.9 1.8 3.8 6.6 1.9

OUTLYING AREAS 843 739 738 704 733 19.9 17.4 18.5 17.7 18.5

TOTAL 47,135 45,571 46,582 46,744 50,636 15.3 14.6 14.9 14.8 16.0

* See Syphilis Morbidity Reporting in the Appendix for definition.
106 Syphilis Tables STD Surveillance 2012

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

Areas (MSAs)†

 in Alphabetical Order, United States, 2008–2012

MSAs

Cases Rates per 100,000 Population

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Atlanta-Sandy Springs-Marietta, GA 2,243 2,187 1,916 1,549 1,820 41.7 39.9 36.4 28.9 34.0

Austin-Round Rock, TX 344 352 362 425 478 20.8 20.6 21.1 23.8 26.8

Baltimore-Towson, MD 685 567 531 710 726 25.7 21.1 19.6 26.0 26.6

Birmingham-Hoover, AL 504 412 234 276 226 45.1 36.4 20.7 24.4 20.0

Boston-Cambridge-Quincy, MA-NH 383 411 544 607 570 8.5 9.0 11.9 13.2 12.4

Buffalo-Cheektowaga-Tonawanda, NY 20 40 43 48 70 1.8 3.6 3.8 4.2 6.2

Charlotte-Gastonia-Concord, NC-SC 224 345 287 347 274 13.2 19.8 16.3 19.3 15.3

Chicago-Naperville-Joliet, IL-IN-WI 1,452 1,797 2,085 2,266 2,268 15.2 18.8 22.0 23.8 23.9

Cincinnati-Middletown, OH-KY-IN 105 227 484 436 527 4.9 10.5 22.7 20.4 24.6

Cleveland-Elyria-Mentor, OH 127 170 182 151 140 6.1 8.1 8.8 7.3 6.8

Columbus, OH 311 252 245 236 314 17.5 14.0 13.3 12.7 16.9

Dallas-Fort Worth-Arlington, TX 1,780 2,148 1,955 1,813 2,138 28.3 33.3 30.7 27.8 32.8

Denver-Aurora, CO 269 223 293 319 434 10.7 8.7 11.5 12.3 16.7

Detroit-Warren-Livonia, MI 304 412 459 522 607 6.9 9.4 10.7 12.2 14.2

Hartford-West Hartford-East Hartford, CT 71 67 85 55 21 6.0 5.6 7.0 4.5 1.7

Houston-Baytown-Sugar Land, TX 2,088 2,038 1,891 1,872 2,251 36.5 34.7 31.8 30.8 37.0

Indianapolis, IN 189 156 233 267 333 11.0 8.9 13.3 15.0 18.7

Jacksonville, FL 308 235 228 188 177 23.5 17.7 16.9 13.8 13.0

Kansas City, MO-KS 237 220 145 141 166 11.8 10.6 7.1 6.9 8.1

Las Vegas-Paradise, NV 299 273 389 402 403 16.0 14.3 19.9 20.4 20.5

Los Angeles-Long Beach-Santa Ana, CA 3,572 3,278 3,003 3,247 3,540 27.7 25.5 23.4 25.1 27.3

Louisville, KY-IN 91 123 197 187 205 7.3 9.8 15.3 14.4 15.8

Memphis, TN-MS-AR 748 777 758 586 590 58.2 59.5 57.6 44.2 44.5

Miami-Fort Lauderdale-Miami Beach, FL 2,408 1,969 2,259 2,315 2,591 44.5 35.5 40.6 40.8 45.7

Milwaukee-Waukesha-West Allis, WI 138 117 121 117 159 8.9 7.5 7.8 7.5 10.2

Minneapolis-St. Paul-Bloomington, MN-WI 223 182 309 326 313 6.9 5.6 9.4 9.8 9.4

Nashville-Davidson-Murfreesboro, TN 277 302 258 226 267 17.9 19.1 16.2 14.0 16.5

New Orleans-Metairie-Kenner, LA 491 462 684 663 539 43.3 38.8 58.6 55.7 45.3

New York-Newark-Edison, NY-NJ-PA 6,097 5,087 5,335 5,255 5,606 32.1 26.7 28.2 27.6 29.5

Oklahoma City, OK 161 210 148 114 148 13.3 17.1 11.8 8.9 11.6

Orlando, FL 460 408 391 485 499 22.4 19.6 18.3 22.3 23.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 812 959 930 1,029 1,119 13.9 16.1 15.6 17.2 18.7

Phoenix-Mesa-Scottsdale, AZ 857 682 645 676 624 20.0 15.6 15.4 15.9 14.6

Pittsburgh, PA 98 70 72 92 128 4.2 3.0 3.1 3.9 5.4

Portland-Vancouver-Beaverton, OR-WA 64 114 153 220 410 2.9 5.1 6.9 9.7 18.1

Providence-New Bedford-Fall River, RI-MA 71 76 95 111 125 4.4 4.7 5.9 6.9 7.8

Richmond, VA 226 207 213 157 197 18.4 16.7 16.9 12.4 15.5

Riverside-San Bernardino-Ontario, CA 452 416 428 527 775 11.0 10.0 10.1 12.2 18.0

Rochester, NY 51 52 66 59 91 4.9 5.0 6.3 5.6 8.6

Sacramento-Arden-Arcade-Roseville, CA 243 212 183 258 249 11.5 10.0 8.5 11.9 11.4

Salt Lake City, UT 35 40 95 48 74 3.1 3.5 8.5 4.2 6.5

San Antonio, TX 598 739 730 736 983 29.4 35.7 34.1 33.5 44.8

San Diego-Carlsbad-San Marcos, CA 828 495 607 609 717 27.6 16.2 19.6 19.4 22.8

San Francisco-Oakland-Fremont, CA 1,044 932 1,150 1,271 1,595 24.4 21.6 26.5 28.9 36.3

San Jose-Sunnyvale-Santa Clara, CA 156 141 183 159 233 8.6 7.7 10.0 8.5 12.5

Seattle-Tacoma-Bellevue, WA 359 256 439 589 559 10.7 7.5 12.8 16.8 16.0

St. Louis, MO-IL 322 294 403 271 281 11.4 10.4 14.3 9.6 10.0

Tampa-St. Petersburg-Clearwater, FL 680 631 503 516 582 24.9 23.0 18.1 18.3 20.6

Virginia Beach-Norfolk-Newport News, VA-NC 248 236 236 212 296 15.0 14.1 14.1 12.6 17.6

Washington-Arlington-Alexandria, DC-VA-MD-WV 956 1,004 1,191 1,315 1,372 17.8 18.3 21.3 23.1 24.1

U.S. MSAs TOTAL 34,709 33,003 34,376 35,006 38,810 21.1 19.9 20.7 20.8 23.1

* See Syphilis Morbidity Reporting in the Appendix for definition.

† MSAs were selected on the basis of the largest population in the 2000 U.S. Census.
STD Surveillance 2012 Syphilis Tables 107

Table 26. Primary and Secondary Syphilis—Reported Cases and Rates by State, Ranked by Rates, 

United States, 2012

Rank* State Cases Rate per 100,000 Population

1 Georgia 937 9.5

2 California 2,953 7.8

3 Louisiana 339 7.4

4 Maryland 431 7.4

5 Florida 1,369 7.2

6 Texas 1,627 6.3

7 New York 1,224 6.3

8 Illinois 804 6.2

9 Arkansas 173 5.9

10 Oregon 212 5.5

11 Mississippi 150 5.0

U.S. TOTAL† 15,667 5.0

12 New Mexico 101 4.9

13 South Carolina 225 4.8

14 Massachusetts 316 4.8

15 Alabama 216 4.5

16 Washington 302 4.4

17 Delaware 38 4.2

18 Rhode Island 44 4.2

19 Tennessee 266 4.2

20 Nevada 113 4.1

21 Colorado 208 4.1

22 Pennsylvania 494 3.9

23 Ohio 425 3.7

24 North Carolina 347 3.6

25 Virginia 285 3.5

26 Indiana 224 3.4

27 Kentucky 150 3.4

28 Arizona 202 3.1

29 Michigan 295 3.0

30 New Hampshire 36 2.7

31 Missouri 157 2.6

32 New Jersey 229 2.6

33 Iowa 70 2.3

34 Minnesota 118 2.2

35 Oklahoma 83 2.2

36 South Dakota 18 2.2

37 Hawaii 23 1.7

38 Idaho 26 1.6

39 Wisconsin 91 1.6

40 Connecticut 55 1.5

41 Alaska 11 1.5

42 Utah 42 1.5

43 Maine 17 1.3

44 Vermont 6 1.0

45 Kansas 24 0.8

46 Wyoming 4 0.7

47 North Dakota 4 0.6

48 Nebraska 8 0.4

49 West Virginia 8 0.4

50 Montana 2 0.2

* States were ranked by rate, then case count, then in alphabetical order, with rates shown rounded to the nearest tenth.

† Total includes cases reported by the District of Columbia with 165 cases and a rate of 26.7, but excludes outlying areas (Guam with 6 cases and rate of 3.8, Puerto 

Rico with 306 cases and rate of 8.3, and Virgin Islands with 0 cases and rate of 0.0).
108 Syphilis Tables STD Surveillance 2012

Table 27. Primary and Secondary Syphilis—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2008–2012

State/Area

Cases Rates per 100,000 Population

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Alabama 449 417 260 228 216 9.6 8.9 5.4 4.7 4.5

Alaska 1 0 3 5 11 0.1 0.0 0.4 0.7 1.5

Arizona 317 231 230 274 202 4.9 3.5 3.6 4.2 3.1

Arkansas 206 275 205 182 173 7.2 9.5 7.0 6.2 5.9

California 2,204 1,900 2,065 2,443 2,953 6.0 5.1 5.5 6.5 7.8

Colorado 128 105 138 133 208 2.6 2.1 2.7 2.6 4.1

Connecticut 34 65 98 65 55 1.0 1.8 2.7 1.8 1.5

Delaware 16 27 9 27 38 1.8 3.1 1.0 3.0 4.2

District of Columbia 146 163 134 165 165 24.7 27.2 22.3 26.7 26.7

Florida 1,044 1,041 1,184 1,257 1,369 5.7 5.6 6.3 6.6 7.2

Georgia 914 953 795 678 937 9.4 9.7 8.2 6.9 9.5

Hawaii 29 33 35 14 23 2.3 2.5 2.6 1.0 1.7

Idaho 7 3 6 13 26 0.5 0.2 0.4 0.8 1.6

Illinois 554 750 908 881 804 4.3 5.8 7.1 6.8 6.2

Indiana 140 158 175 173 224 2.2 2.5 2.7 2.7 3.4

Iowa 16 23 19 20 70 0.5 0.8 0.6 0.7 2.3

Kansas 30 32 19 24 24 1.1 1.1 0.7 0.8 0.8

Kentucky 93 92 139 129 150 2.2 2.1 3.2 3.0 3.4

Louisiana 707 741 546 447 339 16.0 16.5 12.0 9.8 7.4

Maine 10 4 32 12 17 0.8 0.3 2.4 0.9 1.3

Maryland 378 314 328 452 431 6.7 5.5 5.7 7.8 7.4

Massachusetts 216 238 285 266 316 3.3 3.6 4.4 4.0 4.8

Michigan 210 230 235 286 295 2.1 2.3 2.4 2.9 3.0

Minnesota 116 71 149 139 118 2.2 1.3 2.8 2.6 2.2

Mississippi 184 237 228 191 150 6.3 8.0 7.7 6.4 5.0

Missouri 224 173 152 136 157 3.8 2.9 2.5 2.3 2.6

Montana 7 4 3 7 2 0.7 0.4 0.3 0.7 0.2

Nebraska 15 5 12 10 8 0.8 0.3 0.7 0.5 0.4

Nevada 77 91 130 136 113 3.0 3.4 4.8 5.0 4.1

New Hampshire 20 14 22 18 36 1.5 1.1 1.7 1.4 2.7

New Jersey 226 212 244 232 229 2.6 2.4 2.8 2.6 2.6

New Mexico 44 61 53 71 101 2.2 3.0 2.6 3.4 4.9

New York 1,217 1,182 1,098 1,083 1,224 6.2 6.0 5.7 5.6 6.3

North Carolina 287 579 396 431 347 3.1 6.2 4.2 4.5 3.6

North Dakota 0 4 3 1 4 0.0 0.6 0.4 0.1 0.6

Ohio 351 360 528 440 425 3.1 3.1 4.6 3.8 3.7

Oklahoma 86 97 92 84 83 2.4 2.6 2.5 2.2 2.2

Oregon 26 57 71 97 212 0.7 1.5 1.9 2.5 5.5

Pennsylvania 272 341 369 373 494 2.2 2.7 2.9 2.9 3.9

Rhode Island 18 20 41 46 44 1.7 1.9 3.9 4.4 4.2

South Carolina 98 123 155 221 225 2.2 2.7 3.4 4.7 4.8

South Dakota 1 0 4 0 18 0.1 0.0 0.5 0.0 2.2

Tennessee 413 403 277 278 266 6.6 6.4 4.4 4.3 4.2

Texas 1,405 1,644 1,230 1,169 1,627 5.8 6.6 4.9 4.6 6.3

Utah 25 31 65 14 42 0.9 1.1 2.4 0.5 1.5

Vermont 11 0 4 9 6 1.8 0.0 0.6 1.4 1.0

Virginia 266 299 279 213 285 3.4 3.8 3.5 2.6 3.5

Washington 181 139 266 328 302 2.8 2.1 4.0 4.8 4.4

West Virginia 13 8 6 4 8 0.7 0.4 0.3 0.2 0.4

Wisconsin 65 44 49 65 91 1.2 0.8 0.9 1.1 1.6

Wyoming 3 3 0 0 4 0.6 0.6 0.0 0.0 0.7

U.S. TOTAL 13,500 13,997 13,774 13,970 15,667 4.4 4.6 4.5 4.5 5.0

Northeast 2,024 2,076 2,193 2,104 2,421 3.7 3.8 4.0 3.8 4.4

Midwest 1,722 1,850 2,253 2,175 2,238 2.6 2.8 3.4 3.2 3.3

South 6,705 7,413 6,263 6,156 6,809 6.0 6.5 5.5 5.3 5.9

West 3,049 2,658 3,065 3,535 4,199 4.3 3.7 4.3 4.9 5.8

Guam 6 2 1 5 6 3.4 1.1 0.6 3.1 3.8

Puerto Rico 167 227 228 254 306 4.2 5.7 6.1 6.9 8.3

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 173 229 229 259 312 4.1 5.4 5.7 6.5 7.9

TOTAL 13,673 14,226 14,003 14,229 15,979 4.4 4.6 4.5 4.5 5.1
STD Surveillance 2012 Syphilis Tables 109

Table 28. Primary and Secondary Syphilis—Women—Reported Cases and Rates by State/Area and 

Region in Alphabetical Order, United States and Outlying Areas, 2008–2012

Cases Rates per 100,000 Population

State/Area 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Alabama 171 137 75 54 38 7.1 5.6 3.0 2.2 1.5

Alaska 0 0 0 1 1 0.0 0.0 0.0 0.3 0.3

Arizona 56 22 20 15 16 1.7 0.7 0.6 0.5 0.5

Arkansas 81 104 82 76 49 5.6 7.1 5.5 5.1 3.3

California 110 79 74 103 116 0.6 0.4 0.4 0.5 0.6

Colorado 3 6 2 4 3 0.1 0.2 0.1 0.2 0.1

Connecticut 0 1 5 5 9 0.0 0.1 0.3 0.3 0.5

Delaware 6 11 1 1 2 1.3 2.4 0.2 0.2 0.4

District of Columbia 7 10 2 7 6 2.2 3.2 0.6 2.1 1.8

Florida 193 147 147 134 134 2.1 1.6 1.5 1.4 1.4

Georgia 96 101 82 58 66 2.0 2.0 1.7 1.2 1.3

Hawaii 7 6 7 0 2 1.1 0.9 1.0 0.0 0.3

Idaho 1 0 0 1 2 0.1 0.0 0.0 0.1 0.3

Illinois 38 55 108 81 73 0.6 0.8 1.7 1.2 1.1

Indiana 16 13 20 13 22 0.5 0.4 0.6 0.4 0.7

Iowa 3 6 3 5 7 0.2 0.4 0.2 0.3 0.5

Kansas 5 9 1 0 2 0.4 0.6 0.1 0.0 0.1

Kentucky 14 4 8 19 13 0.6 0.2 0.4 0.9 0.6

Louisiana 307 349 251 179 127 13.5 15.1 10.8 7.7 5.4

Maine 0 0 0 0 2 0.0 0.0 0.0 0.0 0.3

Maryland 77 42 26 49 45 2.6 1.4 0.9 1.6 1.5

Massachusetts 6 5 16 23 15 0.2 0.1 0.5 0.7 0.4

Michigan 60 40 23 26 30 1.2 0.8 0.5 0.5 0.6

Minnesota 5 0 9 5 7 0.2 0.0 0.3 0.2 0.3

Mississippi 66 73 69 45 34 4.4 4.8 4.5 2.9 2.2

Missouri 29 15 3 6 12 1.0 0.5 0.1 0.2 0.4

Montana 1 0 0 1 0 0.2 0.0 0.0 0.2 0.0

Nebraska 3 0 3 1 1 0.3 0.0 0.3 0.1 0.1

Nevada 14 7 7 7 4 1.1 0.5 0.5 0.5 0.3

New Hampshire 0 0 1 1 0 0.0 0.0 0.1 0.1 0.0

New Jersey 21 26 16 13 19 0.5 0.6 0.4 0.3 0.4

New Mexico 6 6 3 2 9 0.6 0.6 0.3 0.2 0.9

New York 52 55 47 37 45 0.5 0.5 0.5 0.4 0.4

North Carolina 44 108 55 31 37 0.9 2.3 1.1 0.6 0.7

North Dakota 0 1 1 0 0 0.0 0.3 0.3 0.0 0.0

Ohio 63 63 132 107 85 1.1 1.1 2.2 1.8 1.4

Oklahoma 25 24 16 12 6 1.4 1.3 0.8 0.6 0.3

Oregon 2 1 1 0 6 0.1 0.1 0.1 0.0 0.3

Pennsylvania 21 42 36 34 34 0.3 0.6 0.6 0.5 0.5

Rhode Island 0 1 2 3 1 0.0 0.2 0.4 0.6 0.2

South Carolina 12 10 9 24 34 0.5 0.4 0.4 1.0 1.4

South Dakota 1 0 0 0 1 0.2 0.0 0.0 0.0 0.2

Tennessee 119 122 49 34 31 3.7 3.8 1.5 1.0 0.9

Texas 450 490 333 255 269 3.7 4.0 2.6 2.0 2.1

Utah 1 0 2 0 0 0.1 0.0 0.1 0.0 0.0

Vermont 0 0 2 0 0 0.0 0.0 0.6 0.0 0.0

Virginia 25 22 20 18 21 0.6 0.5 0.5 0.4 0.5

Washington 5 6 5 6 9 0.2 0.2 0.1 0.2 0.3

West Virginia 4 2 0 0 2 0.4 0.2 0.0 0.0 0.2

Wisconsin 14 10 6 5 11 0.5 0.4 0.2 0.2 0.4

Wyoming 2 1 0 0 0 0.8 0.4 0.0 0.0 0.0

U.S. TOTAL 2,242 2,232 1,780 1,501 1,458 1.5 1.4 1.1 0.9 0.9

Northeast 100 130 125 116 125 0.4 0.5 0.4 0.4 0.4

Midwest 237 212 309 249 251 0.7 0.6 0.9 0.7 0.7

South 1,697 1,756 1,225 996 914 3.0 3.0 2.1 1.7 1.5

West 208 134 121 140 168 0.6 0.4 0.3 0.4 0.5

Guam 1 1 1 2 1 1.2 1.1 1.3 2.5 1.3

Puerto Rico 29 23 18 17 20 1.4 1.1 0.9 0.9 1.0

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 30 24 19 19 21 1.4 1.1 0.9 0.9 1.0

TOTAL 2,272 2,256 1,799 1,520 1,479 1.5 1.4 1.1 0.9 0.9

NOTE: Cases reported with unknown sex are not included in this table.
110 Syphilis Tables STD Surveillance 2012

Table 29. Primary and Secondary Syphilis—Men—Reported Cases and Rates by State/Area and 

Region in Alphabetical Order, United States and Outlying Areas, 2008–2012

Cases Rates per 100,000 Population

State/Area 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Alabama 278 280 185 174 178 12.3 12.3 8.0 7.5 7.6

Alaska 1 0 3 4 10 0.3 0.0 0.8 1.1 2.7

Arizona 261 208 210 257 186 8.0 6.3 6.6 8.0 5.8

Arkansas 125 171 123 106 124 8.9 12.1 8.6 7.3 8.6

California 2,092 1,821 1,990 2,327 2,823 11.4 9.8 10.7 12.4 15.1

Colorado 125 99 136 129 205 5.0 3.9 5.4 5.0 8.0

Connecticut 34 64 93 60 46 2.0 3.7 5.3 3.4 2.6

Delaware 10 16 8 26 36 2.4 3.7 1.8 5.9 8.2

District of Columbia 139 153 132 158 159 49.7 54.1 46.4 54.1 54.4

Florida 850 894 1,037 1,123 1,235 9.4 9.8 11.3 12.0 13.2

Georgia 818 852 713 620 870 17.2 17.6 15.1 12.9 18.1

Hawaii 22 27 28 14 21 3.4 4.1 4.1 2.0 3.0

Idaho 6 3 6 12 24 0.8 0.4 0.8 1.5 3.0

Illinois 516 695 800 800 731 8.1 10.9 12.7 12.7 11.6

Indiana 124 145 155 160 202 3.9 4.6 4.9 5.0 6.3

Iowa 13 17 16 15 63 0.9 1.1 1.1 1.0 4.2

Kansas 25 23 18 24 22 1.8 1.6 1.3 1.7 1.5

Kentucky 79 88 131 110 137 3.8 4.2 6.1 5.1 6.4

Louisiana 400 392 284 268 212 18.7 17.9 12.8 12.0 9.5

Maine 10 4 32 12 15 1.6 0.6 4.9 1.8 2.3

Maryland 301 272 302 403 386 11.0 9.8 10.8 14.3 13.7

Massachusetts 210 233 269 243 301 6.7 7.3 8.5 7.6 9.4

Michigan 150 190 212 260 265 3.0 3.9 4.4 5.4 5.5

Minnesota 111 71 140 134 111 4.3 2.7 5.3 5.0 4.2

Mississippi 118 164 159 146 116 8.3 11.5 11.0 10.1 8.0

Missouri 195 158 149 130 145 6.8 5.4 5.1 4.4 4.9

Montana 6 4 3 6 2 1.2 0.8 0.6 1.2 0.4

Nebraska 12 5 9 9 7 1.4 0.6 1.0 1.0 0.8

Nevada 63 84 123 129 109 4.8 6.2 9.0 9.4 7.9

New Hampshire 20 14 21 17 36 3.1 2.1 3.2 2.6 5.5

New Jersey 205 186 228 219 210 4.8 4.4 5.3 5.1 4.9

New Mexico 38 55 50 69 92 3.9 5.5 4.9 6.7 8.9

New York 1,165 1,127 1,051 1,045 1,175 12.3 11.9 11.2 11.1 12.5

North Carolina 243 471 341 400 310 5.4 10.3 7.3 8.5 6.6

North Dakota 0 3 2 1 4 0.0 0.9 0.6 0.3 1.2

Ohio 288 297 396 333 340 5.1 5.3 7.0 5.9 6.0

Oklahoma 61 73 76 72 77 3.4 4.0 4.1 3.8 4.1

Oregon 24 56 70 97 206 1.3 3.0 3.7 5.1 10.7

Pennsylvania 251 299 333 339 460 4.1 4.9 5.4 5.5 7.4

Rhode Island 18 19 39 43 43 3.5 3.7 7.7 8.5 8.5

South Carolina 86 113 146 197 191 3.9 5.1 6.5 8.7 8.4

South Dakota 0 0 4 0 17 0.0 0.0 1.0 0.0 4.1

Tennessee 294 281 228 244 235 9.7 9.2 7.4 7.8 7.5

Texas 955 1,154 896 914 1,358 7.9 9.3 7.2 7.2 10.7

Utah 24 31 63 14 42 1.7 2.2 4.5 1.0 3.0

Vermont 11 0 2 9 6 3.6 0.0 0.6 2.9 1.9

Virginia 241 277 259 195 264 6.3 7.1 6.6 4.9 6.6

Washington 176 133 261 322 293 5.4 4.0 7.8 9.4 8.6

West Virginia 9 6 6 4 6 1.0 0.7 0.7 0.4 0.7

Wisconsin 51 34 43 60 80 1.8 1.2 1.5 2.1 2.8

Wyoming 1 2 0 0 4 0.4 0.7 0.0 0.0 1.4

U.S. TOTAL 11,255 11,764 11,981 12,453 14,190 7.5 7.8 7.9 8.1 9.3

Northeast 1,924 1,946 2,068 1,987 2,292 7.2 7.2 7.7 7.4 8.5

Midwest 1,485 1,638 1,944 1,926 1,987 4.5 5.0 5.9 5.8 6.0

South 5,007 5,657 5,026 5,160 5,894 9.1 10.2 9.0 9.1 10.4

West 2,839 2,523 2,943 3,380 4,017 8.0 7.0 8.2 9.3 11.1

Guam 5 1 0 3 5 5.6 1.1 0.0 3.7 6.2

Puerto Rico 138 204 210 237 286 7.3 10.7 11.8 13.4 16.1

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 143 205 210 240 291 7.0 10.0 11.0 12.6 15.3

TOTAL 11,398 11,969 12,191 12,693 14,481 7.5 7.8 7.9 8.2 9.3

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2012 Syphilis Tables 111

Table 30. Primary and Secondary Syphilis—Reported Cases and Rates in Selected Metropolitan 

Statistical Areas (MSAs)* in Alphabetical Order, United States, 2008–2012

Cases Rates per 100,000 Population

MSAs 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Atlanta-Sandy Springs-Marietta, GA 765 809 651 581 745 14.2 14.8 12.4 10.8 13.9

Austin-Round Rock, TX 107 99 107 114 154 6.5 5.8 6.2 6.4 8.6

Baltimore-Towson, MD 270 204 212 308 307 10.1 7.6 7.8 11.3 11.2

Birmingham-Hoover, AL 188 145 82 89 73 16.8 12.8 7.3 7.9 6.4

Boston-Cambridge-Quincy, MA-NH 173 203 240 191 204 3.8 4.4 5.3 4.2 4.4

Buffalo-Cheektowaga-Tonawanda, NY 3 10 11 14 27 0.3 0.9 1.0 1.2 2.4

Charlotte-Gastonia-Concord, NC-SC 58 138 106 145 105 3.4 7.9 6.0 8.1 5.8

Chicago-Naperville-Joliet, IL-IN-WI 535 732 881 853 759 5.6 7.6 9.3 9.0 8.0

Cincinnati-Middletown, OH-KY-IN 62 124 272 228 166 2.9 5.7 12.8 10.7 7.8

Cleveland-Elyria-Mentor, OH 64 71 82 55 44 3.1 3.4 3.9 2.7 2.1

Columbus, OH 135 115 120 122 159 7.6 6.4 6.5 6.6 8.6

Dallas-Fort Worth-Arlington, TX 328 502 342 317 391 5.2 7.8 5.4 4.9 6.0

Denver-Aurora, CO 103 92 120 116 183 4.1 3.6 4.7 4.5 7.0

Detroit-Warren-Livonia, MI 100 151 146 203 235 2.3 3.4 3.4 4.7 5.5

Hartford-West Hartford-East Hartford, CT 8 25 32 15 9 0.7 2.1 2.6 1.2 0.7

Houston-Baytown-Sugar Land, TX 456 432 330 322 537 8.0 7.4 5.5 5.3 8.8

Indianapolis, IN 80 81 108 91 150 4.7 4.6 6.1 5.1 8.4

Jacksonville, FL 67 57 49 47 44 5.1 4.3 3.6 3.5 3.2

Kansas City, MO-KS 102 80 43 57 65 5.1 3.9 2.1 2.8 3.2

Las Vegas-Paradise, NV 72 86 125 126 97 3.9 4.5 6.4 6.4 4.9

Los Angeles-Long Beach-Santa Ana, CA 920 858 766 876 1,049 7.1 6.7 6.0 6.8 8.1

Louisville, KY-IN 36 57 105 92 84 2.9 4.5 8.2 7.1 6.5

Memphis, TN-MS-AR 234 189 165 120 110 18.2 14.5 12.5 9.1 8.3

Miami-Fort Lauderdale-Miami Beach, FL 509 518 652 630 705 9.4 9.3 11.7 11.1 12.4

Milwaukee-Waukesha-West Allis, WI 45 28 29 35 43 2.9 1.8 1.9 2.2 2.8

Minneapolis-St. Paul-Bloomington, MN-WI 105 67 140 127 116 3.3 2.0 4.3 3.8 3.5

Nashville-Davidson-Murfreesboro, TN 85 92 73 84 88 5.5 5.8 4.6 5.2 5.4

New Orleans-Metairie-Kenner, LA 170 138 92 101 66 15.0 11.6 7.9 8.5 5.5

New York-Newark-Edison, NY-NJ-PA 1,353 1,301 1,219 1,162 1,293 7.1 6.8 6.5 6.1 6.8

Oklahoma City, OK 61 70 55 39 54 5.1 5.7 4.4 3.1 4.2

Orlando, FL 126 109 103 174 168 6.1 5.2 4.8 8.0 7.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 214 289 307 302 369 3.7 4.8 5.1 5.0 6.2

Phoenix-Mesa-Scottsdale, AZ 211 169 161 213 162 4.9 3.9 3.8 5.0 3.8

Pittsburgh, PA 38 29 36 49 61 1.6 1.2 1.5 2.1 2.6

Portland-Vancouver-Beaverton, OR-WA 21 53 66 90 209 1.0 2.4 3.0 4.0 9.2

Providence-New Bedford-Fall River, RI-MA 25 28 47 55 58 1.6 1.7 2.9 3.4 3.6

Richmond, VA 92 97 89 52 66 7.5 7.8 7.1 4.1 5.2

Riverside-San Bernardino-Ontario, CA 157 115 157 182 166 3.8 2.8 3.7 4.2 3.9

Rochester, NY 9 11 16 19 16 0.9 1.1 1.5 1.8 1.5

Sacramento-Arden-Arcade-Roseville, CA 102 73 57 131 151 4.8 3.4 2.7 6.0 6.9

Salt Lake City, UT 23 28 54 9 34 2.1 2.5 4.8 0.8 3.0

San Antonio, TX 195 216 183 188 329 9.6 10.4 8.5 8.6 15.0

San Diego-Carlsbad-San Marcos, CA 345 190 274 293 331 11.5 6.2 8.9 9.3 10.5

San Francisco-Oakland-Fremont, CA 478 438 543 626 744 11.2 10.1 12.5 14.3 16.9

San Jose-Sunnyvale-Santa Clara, CA 42 59 91 68 105 2.3 3.2 5.0 3.6 5.6

Seattle-Tacoma-Bellevue, WA 153 115 236 276 248 4.6 3.4 6.9 7.9 7.1

St. Louis, MO-IL 121 83 118 92 95 4.3 2.9 4.2 3.3 3.4

Tampa-St. Petersburg-Clearwater, FL 191 180 183 199 230 7.0 6.6 6.6 7.0 8.1

Virginia Beach-Norfolk-Newport News, VA-NC 98 102 92 64 106 5.9 6.1 5.5 3.8 6.3

Washington-Arlington-Alexandria, DC-VA-MD-WV 297 324 311 360 358 5.5 5.9 5.6 6.3 6.3

U.S. MSAs TOTAL 10,132 10,182 10,479 10,702 12,068 6.2 6.1 6.3 6.4 7.2

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.
112 Syphilis Tables STD Surveillance 2012

Table 31. Primary and Secondary Syphilis—Women—Reported Cases and Rates in Selected 

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2008–2012

MSAs

Cases Rates per 100,000 Population

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Atlanta-Sandy Springs-Marietta, GA 51 59 44 40 33 1.9 2.1 1.6 1.5 1.2

Austin-Round Rock, TX 16 14 18 12 8 2.0 1.7 2.1 1.3 0.9

Baltimore-Towson, MD 70 33 19 39 39 5.1 2.4 1.4 2.8 2.8

Birmingham-Hoover, AL 77 44 21 10 7 13.3 7.5 3.6 1.7 1.2

Boston-Cambridge-Quincy, MA-NH 4 3 12 14 5 0.2 0.1 0.5 0.6 0.2

Buffalo-Cheektowaga-Tonawanda, NY 0 0 0 2 1 0.0 0.0 0.0 0.3 0.2

Charlotte-Gastonia-Concord, NC-SC 9 14 6 14 11 1.0 1.6 0.7 1.5 1.2

Chicago-Naperville-Joliet, IL-IN-WI 40 46 107 77 77 0.8 0.9 2.2 1.6 1.6

Cincinnati-Middletown, OH-KY-IN 14 26 107 99 63 1.3 2.3 9.8 9.1 5.8

Cleveland-Elyria-Mentor, OH 13 14 6 3 5 1.2 1.3 0.6 0.3 0.5

Columbus, OH 19 15 11 10 14 2.1 1.6 1.2 1.1 1.5

Dallas-Fort Worth-Arlington, TX 116 153 103 63 56 3.7 4.8 3.2 1.9 1.7

Denver-Aurora, CO 1 3 0 1 3 0.1 0.2 0.0 0.1 0.2

Detroit-Warren-Livonia, MI 27 26 9 20 27 1.2 1.2 0.4 0.9 1.2

Hartford-West Hartford-East Hartford, CT 0 0 3 2 3 0.0 0.0 0.5 0.3 0.5

Houston-Baytown-Sugar Land, TX 114 113 77 69 97 4.0 3.9 2.6 2.3 3.2

Indianapolis, IN 8 6 12 5 10 0.9 0.7 1.3 0.5 1.1

Jacksonville, FL 16 11 11 11 4 2.4 1.6 1.6 1.6 0.6

Kansas City, MO-KS 20 8 1 4 1 2.0 0.8 0.1 0.4 0.1

Las Vegas-Paradise, NV 11 7 6 4 2 1.2 0.7 0.6 0.4 0.2

Los Angeles-Long Beach-Santa Ana, CA 31 22 17 16 26 0.5 0.3 0.3 0.2 0.4

Louisville, KY-IN 3 1 4 7 9 0.5 0.2 0.6 1.1 1.4

Memphis, TN-MS-AR 71 67 33 22 22 10.6 9.9 4.8 3.2 3.2

Miami-Fort Lauderdale-Miami Beach, FL 74 54 55 47 63 2.7 1.9 1.9 1.6 2.2

Milwaukee-Waukesha-West Allis, WI 11 9 5 5 5 1.4 1.1 0.6 0.6 0.6

Minneapolis-St. Paul-Bloomington, MN-WI 5 0 5 5 7 0.3 0.0 0.3 0.3 0.4

Nashville-Davidson-Murfreesboro, TN 14 23 10 3 1 1.8 2.9 1.2 0.4 0.1

New Orleans-Metairie-Kenner, LA 53 36 30 17 9 9.0 5.8 5.0 2.8 1.5

New York-Newark-Edison, NY-NJ-PA 60 69 52 37 53 0.6 0.7 0.5 0.4 0.5

Oklahoma City, OK 16 16 12 6 1 2.6 2.6 1.9 0.9 0.2

Orlando, FL 21 19 7 10 15 2.0 1.8 0.6 0.9 1.4

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 17 37 33 28 30 0.6 1.2 1.1 0.9 1.0

Phoenix-Mesa-Scottsdale, AZ 24 8 12 9 14 1.1 0.4 0.6 0.4 0.7

Pittsburgh, PA 6 4 2 4 5 0.5 0.3 0.2 0.3 0.4

Portland-Vancouver-Beaverton, OR-WA 0 0 2 0 9 0.0 0.0 0.2 0.0 0.8

Providence-New Bedford-Fall River, RI-MA 0 1 3 3 1 0.0 0.1 0.4 0.4 0.1

Richmond, VA 6 3 6 10 10 1.0 0.5 0.9 1.5 1.5

Riverside-San Bernardino-Ontario, CA 5 5 1 8 3 0.2 0.2 0.0 0.4 0.1

Rochester, NY 0 1 3 0 1 0.0 0.2 0.6 0.0 0.2

Sacramento-Arden-Arcade-Roseville, CA 18 16 12 7 5 1.7 1.5 1.1 0.6 0.5

Salt Lake City, UT 1 0 0 0 0 0.2 0.0 0.0 0.0 0.0

San Antonio, TX 58 42 28 39 59 5.6 4.0 2.6 3.5 5.3

San Diego-Carlsbad-San Marcos, CA 12 6 3 13 12 0.8 0.4 0.2 0.8 0.8

San Francisco-Oakland-Fremont, CA 12 9 20 27 28 0.6 0.4 0.9 1.2 1.3

San Jose-Sunnyvale-Santa Clara, CA 3 5 3 4 3 0.3 0.6 0.3 0.4 0.3

Seattle-Tacoma-Bellevue, WA 2 4 2 3 6 0.1 0.2 0.1 0.2 0.3

St. Louis, MO-IL 16 9 3 3 9 1.1 0.6 0.2 0.2 0.6

Tampa-St. Petersburg-Clearwater, FL 54 29 33 26 29 3.8 2.1 2.3 1.8 2.0

Virginia Beach-Norfolk-Newport News, VA-NC 12 11 3 7 5 1.4 1.3 0.4 0.8 0.6

Washington-Arlington-Alexandria, DC-VA-MD-WV 15 19 13 16 15 0.5 0.7 0.5 0.5 0.5

U.S. MSAs TOTAL 1,246 1,120 985 881 921 1.5 1.3 1.2 1.0 1.1

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2012 Syphilis Tables 113

Table 32. Primary and Secondary Syphilis—Men—Reported Cases and Rates in Selected 

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2008–2012

MSAs

Cases Rates per 100,000 Population

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Atlanta-Sandy Springs-Marietta, GA 714 750 607 541 712 26.9 27.7 23.7 20.7 27.3

Austin-Round Rock, TX 91 85 89 102 146 10.8 9.8 10.3 11.4 16.3

Baltimore-Towson, MD 200 171 193 269 268 15.6 13.2 14.8 20.5 20.4

Birmingham-Hoover, AL 111 101 61 79 66 20.6 18.5 11.2 14.5 12.1

Boston-Cambridge-Quincy, MA-NH 169 200 228 177 199 7.7 8.9 10.4 8.0 8.9

Buffalo-Cheektowaga-Tonawanda, NY 3 10 11 12 26 0.6 1.8 2.0 2.2 4.7

Charlotte-Gastonia-Concord, NC-SC 49 124 100 131 94 5.9 14.5 11.7 15.0 10.8

Chicago-Naperville-Joliet, IL-IN-WI 495 686 774 776 682 10.5 14.6 16.7 16.7 14.7

Cincinnati-Middletown, OH-KY-IN 48 98 165 129 103 4.6 9.2 15.8 12.3 9.8

Cleveland-Elyria-Mentor, OH 51 57 76 52 39 5.1 5.7 7.6 5.2 3.9

Columbus, OH 116 100 109 112 145 13.2 11.2 12.1 12.3 15.9

Dallas-Fort Worth-Arlington, TX 212 349 239 254 335 6.7 10.8 7.6 7.9 10.4

Denver-Aurora, CO 102 89 120 115 180 8.1 7.0 9.5 8.9 13.9

Detroit-Warren-Livonia, MI 73 125 137 183 208 3.4 5.8 6.6 8.8 10.0

Hartford-West Hartford-East Hartford, CT 8 25 29 13 6 1.4 4.3 4.9 2.2 1.0

Houston-Baytown-Sugar Land, TX 342 319 253 253 440 11.9 10.8 8.6 8.4 14.5

Indianapolis, IN 72 75 96 86 140 8.5 8.8 11.2 9.9 16.1

Jacksonville, FL 51 46 38 36 40 7.9 7.1 5.8 5.4 6.0

Kansas City, MO-KS 82 72 42 53 64 8.3 7.1 4.2 5.3 6.4

Las Vegas-Paradise, NV 61 79 119 122 95 6.4 8.2 12.1 12.3 9.6

Los Angeles-Long Beach-Santa Ana, CA 889 836 749 858 1,019 13.9 13.1 11.8 13.4 15.9

Louisville, KY-IN 33 56 101 85 75 5.4 9.1 16.1 13.4 11.9

Memphis, TN-MS-AR 163 122 132 98 88 26.4 19.4 20.9 15.4 13.8

Miami-Fort Lauderdale-Miami Beach, FL 435 464 597 583 642 16.5 17.1 22.2 21.2 23.3

Milwaukee-Waukesha-West Allis, WI 34 19 24 30 38 4.5 2.5 3.2 3.9 5.0

Minneapolis-St. Paul-Bloomington, MN-WI 100 67 135 122 109 6.2 4.1 8.3 7.4 6.6

Nashville-Davidson-Murfreesboro, TN 71 69 63 81 87 9.3 8.9 8.1 10.2 11.0

New Orleans-Metairie-Kenner, LA 117 102 55 84 57 21.5 17.8 9.7 14.5 9.8

New York-Newark-Edison, NY-NJ-PA 1,293 1,232 1,167 1,124 1,236 14.0 13.3 12.8 12.3 13.5

Oklahoma City, OK 45 54 43 33 53 7.6 8.9 7.0 5.2 8.4

Orlando, FL 105 90 96 164 153 10.3 8.7 9.2 15.4 14.4

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 197 252 274 274 339 7.0 8.7 9.5 9.5 11.7

Phoenix-Mesa-Scottsdale, AZ 187 161 149 202 148 8.6 7.3 7.1 9.5 7.0

Pittsburgh, PA 32 25 34 45 56 2.8 2.2 3.0 3.9 4.9

Portland-Vancouver-Beaverton, OR-WA 21 53 64 90 200 1.9 4.8 5.8 8.0 17.9

Providence-New Bedford-Fall River, RI-MA 25 27 44 52 57 3.2 3.5 5.7 6.7 7.4

Richmond, VA 86 94 83 42 56 14.4 15.6 13.6 6.8 9.1

Riverside-San Bernardino-Ontario, CA 150 110 156 171 163 7.3 5.3 7.4 8.0 7.6

Rochester, NY 9 10 13 19 15 1.8 2.0 2.5 3.7 2.9

Sacramento-Arden-Arcade-Roseville, CA 84 57 45 122 144 8.1 5.4 4.3 11.4 13.5

Salt Lake City, UT 22 28 54 9 34 3.9 4.9 9.5 1.6 5.9

San Antonio, TX 137 174 155 149 270 13.8 17.1 14.7 13.8 25.0

San Diego-Carlsbad-San Marcos, CA 333 184 271 279 318 22.1 12.0 17.4 17.7 20.2

San Francisco-Oakland-Fremont, CA 466 429 523 596 713 21.9 20.0 24.5 27.5 32.9

San Jose-Sunnyvale-Santa Clara, CA 39 54 88 64 102 4.2 5.7 9.5 6.8 10.9

Seattle-Tacoma-Bellevue, WA 151 111 234 273 242 9.0 6.5 13.7 15.6 13.9

St. Louis, MO-IL 105 74 115 89 86 7.7 5.4 8.4 6.5 6.3

Tampa-St. Petersburg-Clearwater, FL 137 151 150 173 201 10.3 11.3 11.1 12.6 14.7

Virginia Beach-Norfolk-Newport News, VA-NC 86 91 89 57 101 10.6 11.1 10.9 6.9 12.3

Washington-Arlington-Alexandria, DC-VA-MD-WV 282 305 298 344 343 10.8 11.4 11.0 12.4 12.3

U.S. MSAs TOTAL 8,884 9,062 9,487 9,807 11,133 11.0 11.1 11.7 11.9 13.5

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.

NOTE: Cases reported with unknown sex are not included in this table.
114 Syphilis Tables STD Surveillance 2012

Table 33. Primary and Secondary Syphilis—Reported Cases and Rates in Counties and 

Independent Cities* Ranked by Number of Reported Cases, United States, 2012

Rank† County/Independent City Cases Rate per 100,000 Population Cumulative Percentage

1 Los Angeles County, CA 943 9.5 6

2 Cook County, IL 679 13.0 10

3 San Francisco County, CA 496 61.0 13

4 Harris County, TX 489 11.7 16

5 Fulton County, GA 394 41.5 19

6 New York County, NY 378 23.6 21

7 Miami-Dade County, FL 346 13.5 23

8 San Diego County, CA 331 10.5 25

9 Bexar County, TX 321 18.3 27

10 Broward County, FL 281 15.8 29

11 Philadelphia County, PA 269 17.5 31

12 Kings County, NY 267 10.5 33

13 Baltimore (City), MD 251 40.5 34

14 King County, WA 213 10.8 36

15 Dallas County, TX 189 7.8 37

16 Bronx County, NY 178 12.8 38

17 Wayne County, MI 171 9.5 39

18 DeKalb County, GA 167 23.9 40

19 Washington, D.C. 165 26.7 41

20 Tarrant County, TX 163 8.8 42

21 Queens County, NY 161 7.2 43

22 Maricopa County, AZ 159 4.1 44

23 Hillsborough County, FL 155 12.2 45

24 Franklin County, OH 151 12.8 46

25 Travis County, TX 137 12.9 47

26 Orange County, FL 137 11.7 48

27 Alameda County, CA 136 8.9 49

28 Sacramento County, CA 135 9.4 50

29 Multnomah County, OR 134 17.9 51

30 Hamilton County, OH 134 16.7 51

31 Marion County, IN 129 14.2 52

32 Denver County, CO 122 19.7 53

33 Riverside County, CA 113 5.0 54

34 Orange County, CA 106 3.5 54

35 Santa Clara County, CA 104 5.7 55

36 Caddo County, LA 101 39.3 56

37 Suffolk County, MA 98 13.4 56

38 Shelby County, TN 97 10.4 57

39 Clark County, NV 97 4.9 58

40 Mecklenburg County, NC 88 9.3 58

41 Prince George's County, MD 83 9.5 59

42 Palm Beach County, FL 78 5.8 59

43 Hennepin County, MN 76 6.5 60

44 San Joaquin County, CA 75 10.8 60

45 Richland County, SC 74 19.0 61

46 Kern County, CA 73 8.6 61

47 Jefferson County, KY 72 9.6 62

48 Davidson County, TN 71 11.2 62

49 Hampden County, MA 63 13.6 62

50 Jefferson County, AL 62 9.4 63

51 Bernalillo County, NM 62 9.2 63

52 Hinds County, MS 61 24.6 64

53 Pinellas County, FL 61 6.6 64

54 Contra Costa County, CA 61 5.7 64

55 Pulaski County, AR 57 14.8 65

56 Wake County, NC 56 6.0 65

57 Hudson County, NJ 55 8.6 65

58 Cobb County, GA 55 7.9 66

59 Allegheny County, PA 55 4.5 66

60 San Bernardino County, CA 53 2.6 66

61 East Baton Rouge County, LA 52 11.8 67

62 Jackson County, MO 52 7.7 67

63 Clayton County, GA 49 18.7 67

64 Orleans County, LA 49 13.6 68

65 Essex County, NJ 49 6.2 68

66 Fresno County, CA 49 5.2 68

67 Westchester County, NY 48 5.0 69

68 Middlesex County, MA 48 3.2 69

69 Escambia County, FL 47 15.7 69

70 St. Louis (City), MO 47 14.8 70

* Accounting for 70% of reported primary and secondary syphilis cases.

† Counties and independent cities were ranked in descending order by number of cases reported then by rate in 2012.
STD Surveillance 2012 Syphilis Tables 115

Table 34. Primary and Secondary Syphilis—Reported Cases and Rates* Among Men and Women 

and Male-To-Female Rate Ratios in the Counties and Independent Cities Ranked in the 

Top 30 for Cases in 2012, United States, 2011–2012

Male Female Male-to-Female

2011 2012 2011 2012 Rate Ratio

County/Independent City† Cases Rates Cases Rates Cases Rates Cases Rates 2011 2012

Maricopa County, AZ 198 10.3 147 7.7 8 0.4 12 0.6 25.8 12.8

Alameda County, CA 121 16.1 126 16.8 12 1.5 9 1.2 10.7 14.0

Los Angeles County, CA 795 16.3 918 18.8 15 0.3 23 0.5 54.3 37.6

Sacramento County, CA 112 15.9 128 18.2 5 0.7 5 0.7 22.7 26.0

San Diego County, CA 279 17.7 318 20.2 13 0.8 12 0.8 22.1 25.3

San Francisco County, CA 378 91.5 483 116.9 7 1.8 11 2.8 50.8 41.8

Washington, D.C. 158 54.1 159 54.4 7 2.1 6 1.8 25.8 30.2

Broward County, FL 214 24.8 255 29.5 21 2.3 26 2.8 10.8 10.5

Hillsborough County, FL 104 16.8 136 21.9 20 3.1 19 2.9 5.4 7.6

Miami-Dade County, FL 311 25.0 325 26.2 19 1.4 21 1.6 17.9 16.4

Orange County, FL 124 21.5 126 21.9 9 1.5 11 1.9 14.3 11.5

DeKalb County, GA 93 27.7 163 48.5 5 1.4 4 1.1 19.8 44.1

Fulton County, GA 333 71.7 376 81.0 29 6.0 18 3.7 12.0 21.9

Cook County, IL 705 27.9 615 24.3 68 2.5 64 2.4 11.2 10.1

Baltimore (City), MD 200 68.5 221 75.7 33 10.1 30 9.2 6.8 8.2

Wayne County, MI 125 14.4 148 17.1 15 1.6 23 2.5 9.0 6.8

Bronx County, NY 145 22.1 170 25.9 8 1.1 7 1.0 20.1 25.9

Kings County, NY 262 21.9 257 21.5 6 0.4 10 0.7 54.8 30.7

New York County, NY 346 45.9 373 49.4 7 0.8 4 0.5 57.4 98.8

Queens County, NY 104 9.5 152 13.9 2 0.2 7 0.6 47.5 23.2

Franklin County, OH 106 18.5 139 24.2 9 1.5 12 2.0 12.3 12.1

Hamilton County, OH 109 28.4 77 20.0 85 20.4 57 13.7 1.4 1.5

Multnomah County, OR 71 19.2 131 35.4 0 0.0 3 0.8 39.4 44.3

Philadelphia County, PA 185 25.5 247 34.1 22 2.7 22 2.7 9.4 12.6

Bexar County, TX 145 16.8 265 30.8 39 4.4 56 6.3 3.8 4.9

Dallas County, TX 151 12.6 168 14.0 28 2.3 21 1.7 5.5 8.2

Harris County, TX 218 10.5 405 19.4 55 2.6 84 4.0 4.0 4.9

Tarrant County, TX 94 10.4 135 14.9 30 3.2 28 3.0 3.3 5.0

Travis County, TX 91 17.0 130 24.2 9 1.7 7 1.3 10.0 18.6

King County, WA 232 23.6 208 21.2 2 0.2 5 0.5 118.0 42.4

* Cases per 100,000 population.

† Counties and independent cities are in alphabetical order by state.
116 Syphilis Tables STD Surveillance 2012

Table 35. Primary and Secondary Syphilis—Reported Cases and Rates per 100,000 

Population by Age Group and Sex, United States, 2008–2012

Age

Group

Cases Rates*

Total Male Female Unknown Sex Total Male Female

2008

0–4 1 0 1 0 0.0 0.0 0.0

5–9 2 0 2 0 0.0 0.0 0.0

10–14 27 8 19 0 0.1 0.1 0.2

15–19 903 585 318 0 4.2 5.3 3.0

20–24 2,397 1,877 520 0 11.4 17.3 5.1

25–29 2,256 1,851 404 1 10.6 16.9 3.9

30–34 1,733 1,489 244 0 8.8 15.0 2.5

35–39 1,809 1,568 241 0 8.6 14.8 2.3

40–44 1,776 1,573 202 1 8.3 14.6 1.9

45–54 2,027 1,790 236 1 4.6 8.2 1.0

55–64 458 412 46 0 1.4 2.5 0.3

65+ 105 97 8 0 0.3 0.6 0.0

Unknown Age 6 5 1 0

TOTAL 13,500 11,255 2,242 3 4.4 7.5 1.5

2009

0–4 1 0 1 0 0.0 0.0 0.0

5–9 1 0 1 0 0.0 0.0 0.0

10–14 19 4 15 0 0.1 0.0 0.2

15–19 1,005 661 344 0 4.7 6.0 3.3

20–24 2,812 2,242 570 0 13.1 20.2 5.5

25–29 2,405 2,027 377 1 11.1 18.2 3.6

30–34 1,857 1,571 286 0 9.3 15.5 2.9

35–39 1,612 1,409 203 0 7.8 13.6 2.0

40–44 1,643 1,476 167 0 7.8 14.1 1.6

45–54 2,033 1,815 218 0 4.6 8.3 1.0

55–64 517 475 42 0 1.5 2.8 0.2

65+ 90 83 7 0 0.2 0.5 0.0

Unknown Age 2 1 1 0

TOTAL 13,997 11,764 2,232 1 4.6 7.8 1.4

2010

0–4 1 0 1 0 0.0 0.0 0.0

5–9 0 0 0 0 0.0 0.0 0.0

10–14 18 7 11 0 0.1 0.1 0.1

15–19 932 617 313 2 4.2 5.5 2.9

20–24 2,907 2,429 474 4 13.5 22.1 4.5

25–29 2,455 2,131 322 2 11.6 20.0 3.1

30–34 1,794 1,597 197 0 9.0 16.0 2.0

35–39 1,454 1,313 140 1 7.2 13.1 1.4

40–44 1,553 1,448 104 1 7.4 13.9 1.0

45–54 2,056 1,877 176 3 4.6 8.5 0.8

55–64 493 457 36 0 1.4 2.6 0.2

65+ 107 102 5 0 0.3 0.6 0.0

Unknown Age 4 3 1 0

TOTAL 13,774 11,981 1,780 13 4.5 7.9 1.1

2011

0–4 9 5 4 0 0.0 0.0 0.0

5–9 1 1 0 0 0.0 0.0 0.0

10–14 15 6 9 0 0.1 0.1 0.1

15–19 864 606 258 0 4.0 5.5 2.5

20–24 2,987 2,582 403 2 13.5 22.8 3.7

25–29 2,546 2,277 268 1 12.0 21.2 2.5

30–34 1,846 1,657 187 2 9.0 16.1 1.8

35–39 1,382 1,265 115 2 7.1 13.0 1.2

40–44 1,503 1,408 91 4 7.1 13.5 0.9

45–54 2,123 1,999 120 4 4.7 9.1 0.5

55–64 554 510 43 1 1.5 2.8 0.2

65+ 138 135 3 0 0.3 0.8 0.0

Unknown Age 2 2 0 0

TOTAL 13,970 12,453 1,501 16 4.5 8.1 0.9

2012

0–4 1 1 0 0 0.0 0.0 0.0

5–9 0 0 0 0 0.0 0.0 0.0

10–14 9 5 4 0 0.0 0.0 0.0

15–19 880 640 238 2 4.1 5.8 2.3

20–24 3,280 2,859 418 3 14.8 25.3 3.9

25–29 2,911 2,641 266 4 13.7 24.5 2.5

30–34 2,209 2,023 182 4 10.8 19.7 1.8

35–39 1,563 1,443 120 0 8.0 14.8 1.2

40–44 1,618 1,544 70 4 7.7 14.8 0.7

45–54 2,439 2,310 128 1 5.5 10.5 0.6

55–64 614 586 27 1 1.6 3.2 0.1

65+ 123 121 2 0 0.3 0.7 0.0

Unknown Age 20 17 3 0

TOTAL 15,667 14,190 1,458 19 5.0 9.3 0.9

* No population data are available for unknown sex and age; therefore, rates are not calculated.

NOTE: This table should be used only for age comparisons. Cases in the 0–4 and 5–9 age groups may include cases due to congenital 

transmission.
STD Surveillance 2012 Syphilis Tables 117

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118 Syphilis Tables STD Surveillance 2012

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

Sex, United States*, 2012

Age

Group

American Indians/ 

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 0 0 0 0 0 0 1 1 0

5–9 0 0 0 0 0 0 0 0 0

10–14 0 0 0 0 0 0 5 3 2

15–19 4 4 0 10 7 3 502 342 160

20–24 19 16 3 46 42 4 1,631 1,361 270

25–29 10 8 2 56 54 1 1,200 1,043 157

30–34 9 9 0 33 32 1 758 654 103

35–39 7 6 1 42 41 1 419 357 62

40–44 3 3 0 31 31 0 370 332 38

45–54 9 8 1 33 33 0 501 444 57

55–64 1 1 0 10 10 0 134 116 18

65+ 0 0 0 1 1 0 24 22 2

Unknown Age 0 0 0 0 0 0 7 5 2

TOTAL 62 55 7 262 251 10 5,552 4,680 871

Age

Group

Native Hawaiians/ 

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 0 0 0 0 0 0 0 0 0

5–9 0 0 0 0 0 0 0 0 0

10–14 0 0 0 3 2 1 0 0 0

15–19 2 1 1 128 99 29 2 1 1

20–24 7 5 2 603 542 61 23 22 1

25–29 8 8 0 668 618 50 18 18 0

30–34 6 6 0 639 599 40 18 17 1

35–39 2 2 0 541 515 26 14 12 2

40–44 3 3 0 673 654 19 9 9 0

45–54 9 8 1 1,207 1,169 37 21 20 1

55–64 2 2 0 345 340 4 1 1 0

65+ 2 2 0 63 63 0 0 0 0

Unknown Age 0 0 0 4 4 0 0 0 0

TOTAL 41 37 4 4,874 4,605 267 106 100 6

Age

Group

Hispanics Other/Unknown

Total† Male Female Total† Male Female

0–4 0 0 0 0 0 0

5–9 0 0 0 0 0 0

10–14 0 0 0 0 0 0

15–19 145 116 28 11 6 4

20–24 573 531 40 54 46 8

25–29 533 495 37 69 67 1

30–34 436 411 24 51 47 3

35–39 307 290 17 37 34 3

40–44 306 295 10 47 43 2

45–54 355 337 18 76 73 3

55–64 55 52 3 17 17 0

65+ 15 15 0 8 8 0

Unknown Age 8 8 0 1 0 1

TOTAL 2,733 2,550 177 371 341 25

* Includes 47 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2012.

† Total includes unknown sex.

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 35 for age-specific cases and rates and Tables 27–29 for total and sexspecific cases and rates. 

Cases in the 0–4 and 5–9 age groups may include cases due to congenital transmission.
STD Surveillance 2012 Syphilis Tables 119

Table 36B. Primary and Secondary Syphilis—Rates per 100,000 Population by Race/Ethnicity, Age 

Group, and Sex, United States*, 2012

Age

Group

American Indians/ 

Alaska Natives Asians Blacks, Non-Hispanic

Total† Male Female Total† Male Female Total† Male Female

0–4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0

5–9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

10–14 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.2 0.2

15–19 2.2 4.4 0.0 1.2 1.7 0.8 17.5 23.4 11.4

20–24 10.9 17.9 3.5 4.7 8.4 0.8 57.8 96.7 19.1

25–29 6.5 10.4 2.6 5.1 10.3 0.2 49.7 89.2 12.6

30–34 6.3 12.8 0.0 3.0 6.2 0.2 32.6 59.1 8.5

35–39 5.3 9.2 1.5 3.6 7.6 0.2 19.2 34.5 5.4

40–44 2.2 4.4 0.0 2.9 6.2 0.0 16.2 30.7 3.2

45–54 3.0 5.5 0.6 1.8 3.9 0.0 10.6 19.8 2.3

55–64 0.4 0.9 0.0 0.7 1.6 0.0 3.8 7.1 0.9

65+ 0.0 0.0 0.0 0.1 0.2 0.0 0.8 1.8 0.1

Unknown Age

TOTAL 2.9 5.3 0.7 2.0 4.0 0.1 16.4 28.9 4.9

Age

Group

Native Hawaiians/ 

Other Pacific Islanders Whites, Non-Hispanic Multirace

Total† Male Female Total† Male Female Total† Male Female

0–4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

5–9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

10–14 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

15–19 5.1 5.0 5.2 1.1 1.7 0.5 0.4 0.4 0.4

20–24 15.1 20.7 9.0 5.2 9.1 1.1 5.2 10.2 0.4

25–29 17.8 34.8 0.0 5.9 10.8 0.9 5.1 10.7 0.0

30–34 14.8 28.9 0.0 5.8 10.8 0.7 5.9 11.7 0.6

35–39 5.7 11.1 0.0 5.1 9.7 0.5 5.5 9.9 1.5

40–44 8.9 17.8 0.0 5.5 10.7 0.3 3.8 8.0 0.0

45–54 14.2 25.4 3.2 4.3 8.3 0.3 4.9 9.7 0.4

55–64 4.7 9.5 0.0 1.3 2.7 0.0 0.3 0.7 0.0

65+ 6.2 13.5 0.0 0.2 0.5 0.0 0.0 0.0 0.0

Unknown Age

TOTAL 8.4 14.9 1.6 2.7 5.1 0.3 2.0 3.8 0.2

Age

Group

Hispanics

Total† Male Female

0–4 0.0 0.0 0.0

5–9 0.0 0.0 0.0

10–14 0.0 0.0 0.0

15–19 3.4 5.3 1.4

20–24 13.9 24.3 2.1

25–29 13.3 23.2 2.0

30–34 11.2 20.2 1.3

35–39 8.5 15.6 1.0

40–44 9.3 17.5 0.6

45–54 6.8 12.8 0.7

55–64 1.8 3.4 0.2

65+ 0.6 1.3 0.0

Unknown Age

TOTAL 5.7 10.4 0.8

* Includes 47 states and the District of Columbia reporting race/ethnicity data in the Office of Management and Budget compliant formats in 2012.

† Total includes unknown sex.

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 35 for age-specific cases and rates and Tables 27–29 for total and sexspecific cases and rates. 

Cases in the 0–4 and 5–9 age groups may include cases due to congenital transmission. 

No population data exist for unknown sex, unknown age, or unknown race; therefore no rates are calculated.
120 Syphilis Tables STD Surveillance 2012

Table 37. Early Latent Syphilis—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2008–2012

Cases Rates per 100,000 Population

State/Area 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Alabama 440 419 277 268 237 9.4 8.9 5.8 5.6 4.9

Alaska 2 0 5 3 8 0.3 0.0 0.7 0.4 1.1

Arizona 258 196 166 187 147 4.0 3.0 2.6 2.9 2.3

Arkansas 144 172 202 167 152 5.0 6.0 6.9 5.7 5.2

California 1,648 1,621 1,788 2,030 2,519 4.5 4.4 4.8 5.4 6.7

Colorado 91 63 129 154 194 1.8 1.3 2.6 3.0 3.8

Connecticut 28 40 51 57 52 0.8 1.1 1.4 1.6 1.5

Delaware 23 23 14 49 38 2.6 2.6 1.6 5.4 4.2

District of Columbia 77 158 239 222 244 13.0 26.3 39.7 35.9 39.5

Florida 1,252 1,254 1,294 1,212 1,384 6.8 6.8 6.9 6.4 7.3

Georgia 563 768 636 436 639 5.8 7.8 6.6 4.4 6.5

Hawaii 9 15 15 5 9 0.7 1.2 1.1 0.4 0.7

Idaho 6 3 4 11 21 0.4 0.2 0.3 0.7 1.3

Illinois 271 344 502 581 690 2.1 2.7 3.9 4.5 5.4

Indiana 83 55 103 95 148 1.3 0.9 1.6 1.5 2.3

Iowa 11 9 4 11 15 0.4 0.3 0.1 0.4 0.5

Kansas 54 58 63 34 54 1.9 2.1 2.2 1.2 1.9

Kentucky 47 64 88 109 139 1.1 1.5 2.0 2.5 3.2

Louisiana 809 799 742 488 343 18.3 17.8 16.4 10.7 7.5

Maine 10 10 6 8 2 0.8 0.8 0.5 0.6 0.2

Maryland 313 261 279 332 361 5.6 4.6 4.8 5.7 6.2

Massachusetts 149 135 195 233 231 2.3 2.0 3.0 3.5 3.5

Michigan 99 155 121 132 150 1.0 1.6 1.2 1.3 1.5

Minnesota 47 46 73 121 96 0.9 0.9 1.4 2.3 1.8

Mississippi 232 312 386 313 253 7.9 10.6 13.0 10.5 8.5

Missouri 145 146 133 124 135 2.5 2.4 2.2 2.1 2.2

Montana 1 0 2 1 0 0.1 0.0 0.2 0.1 0.0

Nebraska 0 6 1 3 8 0.0 0.3 0.1 0.2 0.4

Nevada 168 137 178 166 214 6.5 5.2 6.6 6.1 7.9

New Hampshire 4 6 5 5 9 0.3 0.5 0.4 0.4 0.7

New Jersey 415 401 386 452 410 4.8 4.6 4.4 5.1 4.6

New Mexico 45 40 41 56 68 2.3 2.0 2.0 2.7 3.3

New York 1,372 1,266 1,358 1,254 1,413 7.0 6.5 7.0 6.4 7.3

North Carolina 221 357 328 333 244 2.4 3.8 3.4 3.4 2.5

North Dakota 2 0 0 1 0 0.3 0.0 0.0 0.1 0.0

Ohio 224 221 189 160 171 2.0 1.9 1.6 1.4 1.5

Oklahoma 117 172 149 145 146 3.2 4.7 4.0 3.8 3.9

Oregon 18 29 33 63 94 0.5 0.8 0.9 1.6 2.4

Pennsylvania 309 361 355 412 484 2.5 2.9 2.8 3.2 3.8

Rhode Island 7 14 20 20 24 0.7 1.3 1.9 1.9 2.3

South Carolina 192 284 344 345 336 4.3 6.2 7.4 7.4 7.2

South Dakota 3 2 0 0 3 0.4 0.2 0.0 0.0 0.4

Tennessee 312 333 363 256 255 5.0 5.3 5.7 4.0 4.0

Texas 1,733 1,932 1,874 1,581 1,767 7.1 7.8 7.5 6.2 6.9

Utah 10 7 20 8 8 0.4 0.3 0.7 0.3 0.3

Vermont 6 1 0 1 6 1.0 0.2 0.0 0.2 1.0

Virginia 238 233 275 289 303 3.1 3.0 3.4 3.6 3.7

Washington 98 64 109 146 181 1.5 1.0 1.6 2.1 2.7

West Virginia 16 8 4 0 10 0.9 0.4 0.2 0.0 0.5

Wisconsin 78 66 52 57 86 1.4 1.2 0.9 1.0 1.5

Wyoming 1 0 3 0 2 0.2 0.0 0.5 0.0 0.4

U.S. TOTAL 12,401 13,066 13,604 13,136 14,503 4.1 4.3 4.4 4.2 4.7

Northeast 2,300 2,234 2,376 2,442 2,631 4.2 4.0 4.3 4.4 4.7

Midwest 1,017 1,108 1,241 1,319 1,556 1.5 1.7 1.9 2.0 2.3

South 6,729 7,549 7,494 6,545 6,851 6.0 6.7 6.5 5.6 5.9

West 2,355 2,175 2,493 2,830 3,465 3.3 3.0 3.5 3.9 4.8

Guam 2 1 0 4 1 1.1 0.6 0.0 2.5 0.6

Puerto Rico 241 164 191 211 222 6.1 4.1 5.1 5.7 6.0

Virgin Islands 0 0 3 0 0 0.0 0.0 2.8 0.0 0.0

OUTLYING AREAS 243 165 194 215 223 5.7 3.9 4.9 5.4 5.6

TOTAL 12,644 13,231 13,798 13,351 14,726 4.1 4.3 4.4 4.2 4.7
STD Surveillance 2012 Syphilis Tables 121

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

Areas (MSAs)* in Alphabetical Order, United States, 2008–2012

Cases Rates per 100,000 Population

MSAs 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Atlanta-Sandy Springs-Marietta, GA 402 613 529 352 491 7.5 11.2 10.0 6.6 9.2

Austin-Round Rock, TX 109 135 137 137 170 6.6 7.9 8.0 7.7 9.5

Baltimore-Towson, MD 214 153 148 198 206 8.0 5.7 5.5 7.3 7.5

Birmingham-Hoover, AL 199 150 67 90 74 17.8 13.3 5.9 7.9 6.5

Boston-Cambridge-Quincy, MA-NH 124 116 161 176 158 2.7 2.5 3.5 3.8 3.4

Buffalo-Cheektowaga-Tonawanda, NY 10 3 0 7 11 0.9 0.3 0.0 0.6 1.0

Charlotte-Gastonia-Concord, NC-SC 62 78 90 95 60 3.6 4.5 5.1 5.3 3.3

Chicago-Naperville-Joliet, IL-IN-WI 251 324 476 531 630 2.6 3.4 5.0 5.6 6.6

Cincinnati-Middletown, OH-KY-IN 23 42 88 67 78 1.1 1.9 4.1 3.1 3.6

Cleveland-Elyria-Mentor, OH 48 70 20 25 13 2.3 3.3 1.0 1.2 0.6

Columbus, OH 89 64 42 36 49 5.0 3.6 2.3 1.9 2.6

Dallas-Fort Worth-Arlington, TX 496 592 647 500 604 7.9 9.2 10.2 7.7 9.3

Denver-Aurora, CO 68 57 109 139 177 2.7 2.2 4.3 5.3 6.8

Detroit-Warren-Livonia, MI 45 88 76 82 113 1.0 2.0 1.8 1.9 2.6

Hartford-West Hartford-East Hartford, CT 10 13 18 18 9 0.8 1.1 1.5 1.5 0.7

Houston-Baytown-Sugar Land, TX 555 421 370 351 421 9.7 7.2 6.2 5.8 6.9

Indianapolis, IN 56 27 70 65 102 3.3 1.5 4.0 3.7 5.7

Jacksonville, FL 86 82 91 50 57 6.5 6.2 6.8 3.7 4.2

Kansas City, MO-KS 79 64 59 40 61 3.9 3.1 2.9 1.9 3.0

Las Vegas-Paradise, NV 166 135 174 162 207 8.9 7.1 8.9 8.2 10.5

Los Angeles-Long Beach-Santa Ana, CA 910 1,070 991 1,132 1,393 7.1 8.3 7.7 8.7 10.8

Louisville, KY-IN 20 17 46 43 72 1.6 1.4 3.6 3.3 5.6

Memphis, TN-MS-AR 199 259 256 180 188 15.5 19.8 19.5 13.6 14.2

Miami-Fort Lauderdale-Miami Beach, FL 563 644 749 682 831 10.4 11.6 13.5 12.0 14.7

Milwaukee-Waukesha-West Allis, WI 60 46 35 33 57 3.9 2.9 2.2 2.1 3.6

Minneapolis-St. Paul-Bloomington, MN-WI 43 45 68 112 91 1.3 1.4 2.1 3.4 2.7

Nashville-Davidson-Murfreesboro, TN 54 64 70 37 50 3.5 4.0 4.4 2.3 3.1

New Orleans-Metairie-Kenner, LA 239 243 193 108 88 21.1 20.4 16.5 9.1 7.4

New York-Newark-Edison, NY-NJ-PA 1,628 1,530 1,595 1,556 1,654 8.6 8.0 8.4 8.2 8.7

Oklahoma City, OK 72 123 76 65 79 6.0 10.0 6.1 5.1 6.2

Orlando, FL 148 132 138 142 136 7.2 6.3 6.5 6.5 6.3

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 305 362 348 398 408 5.2 6.1 5.8 6.6 6.8

Phoenix-Mesa-Scottsdale, AZ 160 131 126 153 120 3.7 3.0 3.0 3.6 2.8

Pittsburgh, PA 43 25 27 30 46 1.8 1.1 1.1 1.3 1.9

Portland-Vancouver-Beaverton, OR-WA 11 22 33 58 101 0.5 1.0 1.5 2.6 4.5

Providence-New Bedford-Fall River, RI-MA 13 16 26 26 35 0.8 1.0 1.6 1.6 2.2

Richmond, VA 81 59 77 69 78 6.6 4.8 6.1 5.4 6.1

Riverside-San Bernardino-Ontario, CA 89 88 86 144 138 2.2 2.1 2.0 3.3 3.2

Rochester, NY 5 6 7 9 6 0.5 0.6 0.7 0.9 0.6

Sacramento-Arden-Arcade-Roseville, CA 39 38 43 51 38 1.8 1.8 2.0 2.3 1.7

Salt Lake City, UT 10 4 12 7 7 0.9 0.4 1.1 0.6 0.6

San Antonio, TX 203 290 305 252 269 10.0 14.0 14.2 11.5 12.3

San Diego-Carlsbad-San Marcos, CA 179 80 177 162 236 6.0 2.6 5.7 5.2 7.5

San Francisco-Oakland-Fremont, CA 281 253 373 396 528 6.6 5.9 8.6 9.0 12.0

San Jose-Sunnyvale-Santa Clara, CA 25 22 29 35 44 1.4 1.2 1.6 1.9 2.4

Seattle-Tacoma-Bellevue, WA 91 56 91 134 142 2.7 1.6 2.6 3.8 4.1

St. Louis, MO-IL 70 90 106 84 89 2.5 3.2 3.8 3.0 3.2

Tampa-St. Petersburg-Clearwater, FL 275 225 117 139 176 10.1 8.2 4.2 4.9 6.2

Virginia Beach-Norfolk-Newport News, VA-NC 69 78 84 108 90 4.2 4.7 5.0 6.4 5.4

Washington-Arlington-Alexandria, DC-VA-MD-WV 224 306 441 402 497 4.2 5.6 7.9 7.0 8.7

U.S. MSAs TOTAL 9,201 9,551 10,097 9,868 11,378 5.6 5.7 6.1 5.9 6.8

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.
122 Syphilis Tables STD Surveillance 2012

Table 39. Late and Late Latent Syphilis*—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2008–2012

Cases Rates per 100,000 Population

State/Area 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Alabama 286 289 235 252 248 6.1 6.1 4.9 5.2 5.2

Alaska 6 4 7 3 14 0.9 0.6 1.0 0.4 1.9

Arizona 789 629 493 431 424 12.1 9.5 7.7 6.6 6.5

Arkansas 149 95 116 100 132 5.2 3.3 4.0 3.4 4.5

California 2,995 2,449 2,223 2,269 2,509 8.1 6.6 6.0 6.0 6.7

Colorado 133 101 75 80 101 2.7 2.0 1.5 1.6 2.0

Connecticut 109 72 83 67 14 3.1 2.0 2.3 1.9 0.4

Delaware 20 36 19 48 29 2.3 4.1 2.1 5.3 3.2

District of Columbia 147 110 121 164 180 24.8 18.3 20.1 26.5 29.1

Florida 2,272 1,547 1,572 1,641 1,693 12.4 8.3 8.4 8.6 8.9

Georgia 1,345 982 898 771 842 13.9 10.0 9.3 7.9 8.6

Hawaii 30 39 23 13 11 2.3 3.0 1.7 0.9 0.8

Idaho 13 24 9 18 6 0.9 1.6 0.6 1.1 0.4

Illinois 720 805 799 946 902 5.6 6.2 6.2 7.4 7.0

Indiana 128 110 134 200 159 2.0 1.7 2.1 3.1 2.4

Iowa 48 33 45 39 58 1.6 1.1 1.5 1.3 1.9

Kansas 41 58 28 18 51 1.5 2.1 1.0 0.6 1.8

Kentucky 77 81 84 95 99 1.8 1.9 1.9 2.2 2.3

Louisiana 485 413 1,163 1,090 1,065 11.0 9.2 25.7 23.8 23.3

Maine 7 1 3 4 3 0.5 0.1 0.2 0.3 0.2

Maryland 374 387 386 470 439 6.6 6.8 6.7 8.1 7.5

Massachusetts 114 100 158 271 258 1.8 1.5 2.4 4.1 3.9

Michigan 227 246 322 338 334 2.3 2.5 3.3 3.4 3.4

Minnesota 102 99 128 107 120 2.0 1.9 2.4 2.0 2.2

Mississippi 320 188 200 238 53 10.9 6.4 6.7 8.0 1.8

Missouri 171 189 225 153 133 2.9 3.2 3.8 2.5 2.2

Montana 2 1 0 1 1 0.2 0.1 0.0 0.1 0.1

Nebraska 21 34 20 23 18 1.2 1.9 1.1 1.2 1.0

Nevada 71 75 99 125 117 2.7 2.8 3.7 4.6 4.3

New Hampshire 17 17 16 10 19 1.3 1.3 1.2 0.8 1.4

New Jersey 364 270 314 282 243 4.2 3.1 3.6 3.2 2.8

New Mexico 96 107 57 85 64 4.8 5.3 2.8 4.1 3.1

New York 2,903 2,160 2,387 2,436 2,667 14.9 11.1 12.3 12.5 13.7

North Carolina 480 578 499 485 444 5.2 6.2 5.2 5.0 4.6

North Dakota 2 3 3 3 10 0.3 0.5 0.4 0.4 1.5

Ohio 185 206 349 341 526 1.6 1.8 3.0 3.0 4.6

Oklahoma 51 25 31 39 27 1.4 0.7 0.8 1.0 0.7

Oregon 53 46 69 92 117 1.4 1.2 1.8 2.4 3.0

Pennsylvania 313 321 280 335 365 2.5 2.5 2.2 2.6 2.9

Rhode Island 30 29 18 18 25 2.9 2.8 1.7 1.7 2.4

South Carolina 120 100 80 73 56 2.7 2.2 1.7 1.6 1.2

South Dakota 2 8 8 14 8 0.2 1.0 1.0 1.7 1.0

Tennessee 548 568 542 483 545 8.8 9.0 8.5 7.5 8.5

Texas 3,071 3,271 3,204 3,312 3,585 12.6 13.2 12.7 12.9 14.0

Utah 5 17 47 42 51 0.2 0.6 1.7 1.5 1.8

Vermont 1 0 0 0 0 0.2 0.0 0.0 0.0 0.0

Virginia 281 221 245 224 317 3.6 2.8 3.1 2.8 3.9

Washington 159 118 159 236 226 2.4 1.8 2.4 3.5 3.3

West Virginia 14 16 16 5 6 0.8 0.9 0.9 0.3 0.3

Wisconsin 43 56 84 80 91 0.8 1.0 1.5 1.4 1.6

Wyoming 5 4 3 6 6 0.9 0.7 0.5 1.1 1.1

U.S. TOTAL 19,945 17,338 18,079 18,576 19,411 6.6 5.6 5.9 6.0 6.2

Northeast 3,858 2,970 3,259 3,423 3,594 7.0 5.4 5.9 6.2 6.5

Midwest 1,690 1,847 2,145 2,262 2,410 2.5 2.8 3.2 3.4 3.6

South 10,040 8,907 9,411 9,490 9,760 9.0 7.9 8.2 8.2 8.4

West 4,357 3,614 3,264 3,401 3,647 6.1 5.0 4.5 4.7 5.0

Guam 37 9 10 17 20 21.0 5.0 6.3 10.7 12.5

Puerto Rico 381 328 302 204 175 9.6 8.3 8.1 5.5 4.7

Virgin Islands 1 2 1 7 2 0.9 1.8 0.9 6.6 1.9

OUTLYING AREAS 419 339 313 228 197 9.9 8.0 7.8 5.7 5.0

TOTAL 20,364 17,677 18,392 18,804 19,608 6.6 5.7 5.9 6.0 6.2

* Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other than 

neurosyphilis.
STD Surveillance 2012 Syphilis Tables 123

Table 40. Late and Late Latent Syphilis*—Reported Cases and Rates in Selected Metropolitan 

Statistical Areas (MSAs)†

 in Alphabetical Order, United States, 2008–2012

Cases Rates per 100,000 Population

MSAs 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Atlanta-Sandy Springs-Marietta, GA 1,068 756 723 611 573 19.9 13.8 13.7 11.4 10.7

Austin-Round Rock, TX 127 116 118 168 154 7.7 6.8 6.9 9.4 8.6

Baltimore-Towson, MD 186 193 162 196 203 7.0 7.2 6.0 7.2 7.4

Birmingham-Hoover, AL 110 112 84 95 79 9.8 9.9 7.4 8.4 7.0

Boston-Cambridge-Quincy, MA-NH 86 92 142 240 207 1.9 2.0 3.1 5.2 4.5

Buffalo-Cheektowaga-Tonawanda, NY 7 27 32 27 32 0.6 2.4 2.8 2.4 2.8

Charlotte-Gastonia-Concord, NC-SC 100 127 91 106 108 5.9 7.3 5.2 5.9 6.0

Chicago-Naperville-Joliet, IL-IN-WI 650 727 703 866 853 6.8 7.6 7.4 9.1 9.0

Cincinnati-Middletown, OH-KY-IN 20 58 117 131 275 0.9 2.7 5.5 6.1 12.9

Cleveland-Elyria-Mentor, OH 15 29 79 70 82 0.7 1.4 3.8 3.4 4.0

Columbus, OH 84 71 82 76 99 4.7 3.9 4.5 4.1 5.3

Dallas-Fort Worth-Arlington, TX 934 1,020 941 979 1,130 14.8 15.8 14.8 15.0 17.3

Denver-Aurora, CO 98 74 64 64 74 3.9 2.9 2.5 2.5 2.8

Detroit-Warren-Livonia, MI 154 171 232 229 252 3.5 3.9 5.4 5.3 5.9

Hartford-West Hartford-East Hartford, CT 51 29 34 22 3 4.3 2.4 2.8 1.8 0.2

Houston-Baytown-Sugar Land, TX 1,024 1,139 1,149 1,168 1,268 17.9 19.4 19.3 19.2 20.8

Indianapolis, IN 53 48 55 111 81 3.1 2.8 3.1 6.2 4.6

Jacksonville, FL 153 95 87 89 73 11.7 7.2 6.5 6.5 5.4

Kansas City, MO-KS 55 70 43 44 40 2.7 3.4 2.1 2.1 1.9

Las Vegas-Paradise, NV 52 49 85 111 98 2.8 2.6 4.4 5.6 5.0

Los Angeles-Long Beach-Santa Ana, CA 1,722 1,332 1,238 1,222 1,091 13.4 10.3 9.7 9.4 8.4

Louisville, KY-IN 34 48 46 50 49 2.7 3.8 3.6 3.9 3.8

Memphis, TN-MS-AR 306 316 326 278 291 23.8 24.2 24.8 21.0 22.0

Miami-Fort Lauderdale-Miami Beach, FL 1,326 797 853 984 1,032 24.5 14.4 15.3 17.4 18.2

Milwaukee-Waukesha-West Allis, WI 32 43 57 49 59 2.1 2.8 3.7 3.1 3.8

Minneapolis-St. Paul-Bloomington, MN-WI 75 70 101 87 105 2.3 2.1 3.1 2.6 3.2

Nashville-Davidson-Murfreesboro, TN 138 145 115 105 129 8.9 9.2 7.2 6.5 8.0

New Orleans-Metairie-Kenner, LA 75 78 391 453 380 6.6 6.6 33.5 38.0 31.9

New York-Newark-Edison, NY-NJ-PA 3,089 2,237 2,502 2,522 2,651 16.3 11.7 13.2 13.3 13.9

Oklahoma City, OK 26 16 17 10 15 2.2 1.3 1.4 0.8 1.2

Orlando, FL 184 165 149 166 192 9.0 7.9 7.0 7.6 8.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 287 304 271 325 338 4.9 5.1 4.5 5.4 5.6

Phoenix-Mesa-Scottsdale, AZ 468 368 345 299 332 10.9 8.4 8.2 7.0 7.8

Pittsburgh, PA 17 16 9 13 21 0.7 0.7 0.4 0.6 0.9

Portland-Vancouver-Beaverton, OR-WA 32 39 54 72 99 1.4 1.7 2.4 3.2 4.4

Providence-New Bedford-Fall River, RI-MA 33 31 22 30 32 2.1 1.9 1.4 1.9 2.0

Richmond, VA 53 50 47 36 52 4.3 4.0 3.7 2.8 4.1

Riverside-San Bernardino-Ontario, CA 202 210 185 201 465 4.9 5.1 4.4 4.7 10.8

Rochester, NY 37 34 43 31 69 3.6 3.3 4.1 2.9 6.5

Sacramento-Arden-Arcade-Roseville, CA 100 94 81 69 59 4.7 4.4 3.8 3.2 2.7

Salt Lake City, UT 2 8 29 32 33 0.2 0.7 2.6 2.8 2.9

San Antonio, TX 190 221 232 286 366 9.4 10.7 10.8 13.0 16.7

San Diego-Carlsbad-San Marcos, CA 292 211 148 154 144 9.7 6.9 4.8 4.9 4.6

San Francisco-Oakland-Fremont, CA 277 239 230 244 321 6.5 5.5 5.3 5.6 7.3

San Jose-Sunnyvale-Santa Clara, CA 84 58 62 54 84 4.6 3.2 3.4 2.9 4.5

Seattle-Tacoma-Bellevue, WA 115 84 112 177 169 3.4 2.5 3.3 5.1 4.8

St. Louis, MO-IL 129 120 177 94 96 4.6 4.2 6.3 3.3 3.4

Tampa-St. Petersburg-Clearwater, FL 212 223 195 175 171 7.8 8.1 7.0 6.2 6.1

Virginia Beach-Norfolk-Newport News, VA-NC 80 55 59 40 100 4.8 3.3 3.5 2.4 6.0

Washington-Arlington-Alexandria, DC-VA-MD-WV 425 362 425 536 515 7.9 6.6 7.6 9.4 9.0

U.S. MSAs TOTAL 15,069 12,977 13,544 14,197 15,144 9.2 7.8 8.2 8.5 9.0

* Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other than 

neurosyphilis.

† MSAs were selected on the basis of the largest population in the 2000 U.S. Census.
124 Syphilis Tables STD Surveillance 2012

Table 41. Congenital Syphilis—Reported Cases and Rates in Infants by Year of Birth, by State, 

Ranked by Rates, United States, 2012

Rank* State† Cases Rate per 100,000 Live Births

1 Louisiana 32 49.3

2 Arkansas 11 27.6

3 Texas 78 19.4

4 Florida 37 16.7

5 Maryland 12 16.0

6 Illinois 27 15.8

7 Arizona 14 15.1

8 Ohio 16 11.0

9 Georgia 14 9.9

10 South Carolina 6 9.9

HEALTHY PEOPLE 2020 TARGET 9.1

11 Alaska 1 8.8

12 Delaware 1 8.7

U.S. TOTAL‡ 322 7.8

13 California 34 6.5

14 Alabama 4 6.4

15 Michigan 7 6.0

16 Pennsylvania 6 4.1

17 Nebraska 1 3.7

18 Kentucky 2 3.5

19 New Mexico 1 3.4

20 New York 8 3.2

21 Nevada 1 2.7

22 Oregon 1 2.1

23 Minnesota 1 1.4

24 Wisconsin 1 1.4

25 Massachusetts 1 1.3

26 Missouri 1 1.3

27 Tennessee 1 1.2

28 Virginia 1 1.0

29 New Jersey 1 0.9

30 North Carolina 1 0.8

Colorado 0 0.0

Connecticut 0 0.0

Hawaii 0 0.0

Idaho 0 0.0

Indiana 0 0.0

Iowa 0 0.0

Kansas 0 0.0

Maine 0 0.0

Mississippi 0 0.0

Montana 0 0.0

New Hampshire 0 0.0

North Dakota 0 0.0

Oklahoma 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

Wyoming 0 0.0

* States were ranked by rate; then by case count, then in alphabetical order, with rates shown rounded to the nearest tenth.

† Mother’s state of residence was used to assign case.

‡ Total includes cases reported by the District of Columbia, with 0 cases, but excludes outlying areas (Guam with 0 cases, Puerto Rico with 1 case and rate of 

2.2, and Virgin Islands with 0 cases).
STD Surveillance 2012 Syphilis Tables 125

Table 42. Congenital Syphilis—Reported Cases and Rates in Infants by Year of Birth, by State/Area 

and Region in Alphabetical Order, United States and Outlying Areas, 2008–2012

Cases Rates per 100,000 Live Births

State/Area* 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Alabama 12 13 9 10 4 18.6 20.8 14.4 16.0 6.4

Alaska 0 0 0 0 1 0.0 0.0 0.0 0.0 8.8

Arizona 30 28 16 15 14 30.2 30.2 17.2 16.2 15.1

Arkansas 9 10 11 15 11 22.1 25.1 27.6 37.7 27.6

California 64 63 39 40 34 11.6 12.0 7.4 7.6 6.5

Colorado 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Connecticut 2 2 2 0 0 5.0 5.1 5.1 0.0 0.0

Delaware 1 1 2 0 1 8.3 8.7 17.3 0.0 8.7

District of Columbia 0 0 1 1 0 0.0 0.0 11.1 11.1 0.0

Florida 17 18 20 33 37 7.3 8.1 9.0 14.9 16.7

Georgia 11 14 18 10 14 7.5 9.9 12.7 7.1 9.9

Hawaii 0 1 0 0 0 0.0 5.3 0.0 0.0 0.0

Idaho 0 1 1 0 0 0.0 4.2 4.2 0.0 0.0

Illinois 20 16 27 18 27 11.3 9.3 15.8 10.5 15.8

Indiana 0 1 0 0 0 0.0 1.2 0.0 0.0 0.0

Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kansas 0 3 0 0 0 0.0 7.2 0.0 0.0 0.0

Kentucky 1 2 0 2 2 1.7 3.5 0.0 3.5 3.5

Louisiana 23 11 33 18 32 35.2 16.9 50.8 27.7 49.3

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 23 31 22 24 12 29.8 41.3 29.3 32.0 16.0

Massachusetts 0 0 1 0 1 0.0 0.0 1.3 0.0 1.3

Michigan 10 5 5 8 7 8.3 4.3 4.3 6.8 6.0

Minnesota 1 1 0 0 1 1.4 1.4 0.0 0.0 1.4

Mississippi 9 8 9 6 0 20.0 18.6 21.0 14.0 0.0

Missouri 2 6 2 1 1 2.5 7.6 2.5 1.3 1.3

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 0 0 0 0 1 0.0 0.0 0.0 0.0 3.7

Nevada 9 3 5 3 1 22.8 8.0 13.3 8.0 2.7

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 4 7 3 5 1 3.5 6.3 2.7 4.5 0.9

New Mexico 4 0 0 0 1 13.3 0.0 0.0 0.0 3.4

New York 23 15 17 13 8 9.2 6.0 6.9 5.2 3.2

North Carolina 11 10 10 6 1 8.4 7.9 7.9 4.7 0.8

North Dakota 0 1 0 0 0 0.0 11.1 0.0 0.0 0.0

Ohio 3 8 10 13 16 2.0 5.5 6.9 9.0 11.0

Oklahoma 3 2 0 2 0 5.5 3.7 0.0 3.7 0.0

Oregon 0 0 0 0 1 0.0 0.0 0.0 0.0 2.1

Pennsylvania 8 5 3 5 6 5.4 3.4 2.0 3.4 4.1

Rhode Island 0 1 0 0 0 0.0 8.7 0.0 0.0 0.0

South Carolina 2 0 1 0 6 3.2 0.0 1.6 0.0 9.9

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 11 13 11 8 1 12.9 15.8 13.4 9.7 1.2

Texas 127 128 105 99 78 31.3 31.8 26.1 24.6 19.4

Utah 0 0 1 0 0 0.0 0.0 1.9 0.0 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 4 2 1 0 1 3.7 1.9 1.0 0.0 1.0

Washington 0 1 1 2 0 0.0 1.1 1.1 2.2 0.0

West Virginia 1 0 0 0 0 4.7 0.0 0.0 0.0 0.0

Wisconsin 1 0 1 1 1 1.4 0.0 1.4 1.4 1.4

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 446 431 387 358 322 10.5 10.4 9.4 8.7 7.8

Northeast 37 30 26 23 16 5.5 4.5 3.9 3.5 2.4

Midwest 37 41 45 41 54 4.2 4.7 5.2 4.7 6.2

South 265 263 253 234 200 16.4 16.7 16.0 14.8 12.7

West 107 97 63 60 52 10.1 9.5 6.2 5.9 5.1

Guam 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Puerto Rico 8 6 2 2 1 17.5 13.4 4.5 4.5 2.2

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 8 6 2 2 1 15.7 12.0 4.0 4.0 2.0

TOTAL 454 437 389 360 323 10.6 10.5 9.3 8.6 7.7

* Mother’s state of residence was used to assign case.
126 Syphilis Tables STD Surveillance 2012

Table 43. Congenital Syphilis—Reported Cases and Rates per 100,000 Live Births in Infants by 

Year of Birth and Race/Ethnicity of Mother, United States, 2008–2012

Year of Birth

Whites, Non-Hispanic Blacks, Non-Hispanic Hispanics

Cases Rate Cases Rate Cases Rate

2008 67 2.9 226 35.9 135 13.0

2009 65 2.9 216 35.1 128 12.8

2010 63 2.8 216 35.1 91 9.1

2011 50 2.2 211 34.3 73 7.3

2012 47 2.1 182 29.6 79 7.9

Year of Birth

Asians/Pacific Islanders American Indians/Alaska Natives Multirace

Cases Rate Cases Rate Cases Rate

2008 7 2.9 6 13.8 0 NA

2009 11 4.6 5 11.8 0 NA

2010 9 3.7 1 2.4 2 NA

2011 14 5.8 2 4.7 0 NA

2012 6 2.5 2 4.7 0 NA

Year of Birth

Other Unknown Total

Cases Rate Cases Rate Cases Rate

2008 1 NA 4 NA 446 10.5

2009 2 NA 4 NA 431 10.4

2010 1 NA 4 NA 387 9.4

2011 3 NA 5 NA 358 8.7

2012 2 NA 4 NA 322 7.8

NA = Not applicable.
STD Surveillance 2012 Chancroid Tables 127

Table 44. Chancroid—Reported Cases and Rates by State/Area in Alphabetical Order, United 

States and Outlying Areas, 2008–2012

Cases Rates per 100,000 Population

State/Area 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Alabama 0 0 1 0 1 0.0 0.0 0.0 0.0 0.0

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 0 0 0 1 0 0.0 0.0 0.0 0.0 0.0

Arkansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

California 2 1 5 1 7 0.0 0.0 0.0 0.0 0.0

Colorado 2 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Connecticut 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Delaware 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

District of Columbia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Florida 0 1 1 0 0 0.0 0.0 0.0 0.0 0.0

Georgia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Hawaii 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Idaho 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Illinois 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Indiana 0 1 0 0 1 0.0 0.0 0.0 0.0 0.0

Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kentucky 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Louisiana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 0 0 0 0 1 0.0 0.0 0.0 0.0 0.0

Massachusetts 4 3 1 2 1 0.1 0.0 0.0 0.0 0.0

Michigan 0 0 0 1 2 0.0 0.0 0.0 0.0 0.0

Minnesota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Mississippi 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Missouri 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nevada 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Mexico 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New York 2 0 0 0 0 0.0 0.0 0.0 0.0 0.0

North Carolina 4 6 1 0 1 0.0 0.1 0.0 0.0 0.0

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Oklahoma 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Oregon 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Pennsylvania 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Rhode Island 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

South Carolina 1 1 1 2 0 0.0 0.0 0.0 0.0 0.0

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 0 0 1 0 0 0.0 0.0 0.0 0.0 0.0

Texas 8 8 12 1 0 0.0 0.0 0.0 0.0 0.0

Utah 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 0 1 0 0 1 0.0 0.0 0.0 0.0 0.0

Washington 1 0 1 0 0 0.0 0.0 0.0 0.0 0.0

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wisconsin 0 6 0 0 0 0.0 0.1 0.0 0.0 0.0

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 25 28 24 8 15 0.0 0.0 0.0 0.0 0.0

Guam 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Puerto Rico 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

TOTAL 25 28 24 8 15 0.0 0.0 0.0 0.0 0.0
128 Selected STDs STD Surveillance 2012

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

Disease and Therapeutic Index, United States, 1966–2012

Year Genital Herpes Genital Warts

Vaginal 

Trichomoniasis* Other Vaginitis*

Pelvic Inflammatory 

Disease†

1966 19,000 56,000 579,000 1,155,000 NA

1967 15,000 72,000 515,000 1,277,000 NA

1968 16,000 87,000 463,000 1,460,000 NA

1969 15,000 61,000 421,000 1,390,000 NA

1970 17,000 119,000 529,000 1,500,000 NA

1971 49,000 128,000 484,000 1,281,000 NA

1972 26,000 165,000 574,000 1,810,000 NA

1973 51,000 198,000 466,000 1,858,000 NA

1974 75,000 202,000 427,000 1,907,000 NA

1975 36,000 181,000 500,000 1,919,000 NA

1976 57,000 217,000 473,000 1,690,000 NA

1977 116,000 221,000 324,000 1,713,000 NA

1978 76,000 269,000 329,000 2,149,000 NA

1979 83,000 200,000 363,000 1,662,000 NA

1980 57,000 218,000 358,000 1,670,000 423,000

1981 133,000 191,000 369,000 1,742,000 283,000

1982 134,000 256,000 268,000 1,859,000 374,000

1983 106,000 203,000 424,000 1,932,000 424,000

1984 157,000 224,000 381,000 2,450,000 381,000

1985 124,000 263,000 291,000 2,728,000 425,000

1986 136,000 275,000 338,000 3,118,000 457,000

1987 102,000 351,000 293,000 3,087,000 403,000

1988 163,000 290,000 191,000 3,583,000 431,000

1989 148,000 220,000 165,000 3,374,000 413,000

1990 172,000 275,000 213,000 4,474,000 358,000

1991 235,000 282,000 198,000 3,822,000 377,000

1992 139,000 218,000 182,000 3,428,000 335,000

1993 172,000 167,000 207,000 3,755,000 407,000

1994 142,000 239,000 199,000 4,123,000 332,000

1995 160,000 253,000 141,000 3,927,000 262,000

1996 208,000 191,000 245,000 3,472,000 286,000

1997 176,000 145,000 176,000 3,100,000 260,000

1998 188,000 211,000 164,000 3,200,000 233,000

1999 224,000 240,000 171,000 3,077,000 250,000

2000 179,000 220,000 222,000 3,470,000 254,000

2001 157,000 233,000 210,000 3,365,000 244,000

2002 216,000 266,000 150,000 3,315,000 197,000

2003 203,000 264,000 179,000 3,516,000 123,000

2004 269,000 316,000 221,000 3,602,000 132,000

2005 266,000 357,000 165,000 4,071,000 176,000

2006 371,000 422,000 200,000 3,891,000 106,000

2007 317,000 312,000 205,000 3,723,000 146,000

2008 292,000 385,000 204,000 3,571,000 104,000

2009 306,000 357,000 216,000 3,063,000 100,000

2010 232,000 376,000 149,000 3,192,000 113,000

2011 227,000 453,000 168,000 3,102,000 90,000

2012 228,000 353,000 219,000 3,452,000 106,000

 *Women only.

† Women aged 15-44 years only.

NA = Not available.

NOTE: Standard errors for estimates under 100,000 are not available. The relative standard errors for estimates 100,000-300,000 are from 20% to 30%; 

300,000-600,000 are from 16% to 20%; 600,000-1,000,000 are from 13% to 16%; and 1,000,000-5,000,000 are from 9% to 13%.

SOURCE: National Disease and Therapeutic Index (IMS Health). See Other Data Sources in the Appendix for more information.
APPENDIX
APPENDIX
STD Surveillance 2012 Appendix: Interpreting STD Surveillance Data 129

Interpreting STD Surveillance Data

Sexually Transmitted Disease Surveillance 2012 presents 

surveillance information derived from the official 

statistics for the reported occurrence of nationally 

notifiable sexually transmitted diseases (STDs) in the 

United States, test positivity and prevalence data from 

numerous prevalence monitoring initiatives, sentinel 

surveillance, and national health care services surveys.

Nationally Notifiable STD Surveillance

Nationally notifiable STD surveillance data are 

collected and compiled from reports sent by the 

STD control programs and health departments 

in all 50 states, the District of Columbia, selected 

cities, U.S. dependencies and possessions, and 

independent nations in free association with the 

United States to the Division of STD Prevention, 

National Center for HIV/AIDS, Viral Hepatitis, 

STD, and TB Prevention, Centers for Disease 

Control and Prevention (CDC). Included among the 

dependencies, possessions, and independent nations 

are Guam, Puerto Rico, and the Virgin Islands. These 

entities are identified as “outlying areas” of the United 

States in selected figures and tables.

Reporting Formats

STD morbidity data presented in this report are 

compiled from a combination of data reported on 

standardized hard copy reporting forms and electronic 

data received through the National Electronic 

Telecommunications System for Surveillance (NETSS).

Summary Report Forms

The following hard copy forms were used to report 

national STD morbidity data:

1. FORM CDC 73.998: Monthly Surveillance Report 

of Early Syphilis. This monthly hard copy reporting 

form was used during 1984–2002 to report 

summary data for primary and secondary syphilis 

and early latent syphilis by county and state.

2. FORM CDC 73.688: Sexually Transmitted 

Disease Morbidity Report. This quarterly hard copy 

reporting form was used during 1963–2002 to 

report summary data for all stages of syphilis, 

congenital syphilis, gonorrhea, chancroid, 

chlamydia, and other STDs by sex and source of 

report (private versus public) for all 50 states, the 

District of Columbia, 64 selected cities (including 

San Juan, Puerto Rico), and outlying areas of the 

United States. 

Note: Chlamydial infection became a nationally 

notifiable condition in 1996, and the form was 

modified to support reporting of chlamydia that 

year. Congenital syphilis was dropped from this 

aggregate form in 1995 and replaced by the casespecific CDC 73.126 form described later in this 

section.

3. FORM CDC 73.2638: Report of Civilian Cases 

of Primary & Secondary Syphilis, Gonorrhea, and 

Chlamydia by Reporting Source, Sex, Race/Ethnicity, 

and Age Group. This annual hard copy form was 

used during 1981–2002 to report summary data 

for P&S syphilis, gonorrhea, and chlamydia by age, 

race, sex, and source (public versus private) for all 

50 states, seven large cities (Baltimore, Chicago, 

New York City, Los Angeles, Philadelphia, San 

Francisco, and the District of Columbia), and 

outlying areas of the United States. 

Note: Chlamydial infection became a nationally 

notifiable condition in 1996, and the form was 

modified to support reporting of chlamydia that 

year.

4. FORM CDC 73.126: Congenital Syphilis (CS) 

Case Investigation and Reporting. This casespecific hard copy form was first used in 1983 

and continued to be used through 2012 to report 

detailed case-specific data for congenital syphilis in 

some areas.

National Electronic 

Telecommunications System for 

Surveillance

Notifiable STD data reported electronically through 

NETSS make up the nationally notifiable disease 

information published in CDC’s Morbidity and 

Mortality Weekly Report. 

As of December 31, 2003, all 50 states and the District 

of Columbia had converted from summary hard copy 

reporting to electronic submission of line-listed (i.e., 
130 Appendix: Interpreting STD Surveillance Data STD Surveillance 2012

case-specific) STD data through NETSS (43 reporting 

areas submit congenital syphilis surveillance data 

through NETSS). Puerto Rico converted to electronic 

reporting in 2006 for all STDs excluding congenital 

syphilis. Guam and the Virgin Islands continue to 

report STD data through summary hard copy forms.

Surveillance data and updates sent to CDC through 

NETSS and on hard copy forms through May 29, 

2013, are included in this report. Data received after 

this date will appear in subsequent STD surveillance 

reports. The data presented in the figures and tables in 

this report supersede those in all earlier publications.

Population Denominators and Rate 

Calculations

2000–2012 Rates and Population

CDC’s National Center for Health Statistics (NCHS) 

released bridged-race population counts for the 

2000–2011 U.S. resident populations that are based 

on counts from the 2000 U.S. Census. These estimates 

resulted from bridging the 31 race categories used 

in the 2000 census, as specified in the 1997 Office 

of Management and Budget (OMB) standards, to 

the five race/ethnicity groups specified in the 1977 

OMB standards. This report uses the first published 

population estimate for a given year. The latest 

available year for bridged-race population estimates 

at the time this report was written was 2011. Thus 

2011 population estimates were used to calculate 

2011 and 2012 rates. Once published, the 2012 

population estimates will be used to calculate rates in 

the upcoming 2013 STD Surveillance Report. 

Population estimates for Guam, Puerto Rico, and the 

Virgin Islands were obtained from the U.S. Census 

Bureau Web site at http://www.census.gov/ipc/www/

idb/tables.html. The 2010–2011 rates for outlying areas 

were calculated by using the 2011 population estimates.

Because of the use of the updated population data, 

rates for 2000–2011 may be different from those 

presented in previous STD surveillance reports.

1990–1999 Rates and Population

The population counts for 1990 through 1999 

incorporated the bridged single-race estimates of 

the April 1, 2000, U.S. resident population. These 

files were prepared by the U.S. Census Bureau with 

support from the National Cancer Institute.

1981–1989 Rates and Population

Rates were calculated by using U.S. Census Bureau 

population estimates for 1981 through 1989.1,2

1941–1980 Rates and Population

Rates for 1941 through 1980 were based on 

population estimates from the U.S. Census Bureau 

and are currently maintained by CDC’s Division of 

STD Prevention.

1941–2012 Congenital Syphilis Rates and 

Live Births

The congenital syphilis data in Table 1 of this report 

represent the number of congenital syphilis cases per 

100,000 live births for all years during 1941–2012. 

Previous publications presented congenital syphilis 

rates per 100,000 population during 1941–1994 

and rates for cases diagnosed at younger than 1 year 

of age per 100,000 live births during 1995–2005. 

To allow for trends in congenital syphilis rates to 

be compared for the period 1941 through 2012, 

live births now are used as the denominator for 

congenital syphilis, and case counts are no longer 

limited to those diagnosed within the first year of life. 

Congenital syphilis morbidity is assigned by year of 

birth. Rates of congenital syphilis for 1963 through 

1988 were calculated by using published live birth 

data.3

 Congenital syphilis rates for 1989 through 

2006 were calculated by using live birth data based 

on information coded by the states and provided to 

the NCHS through the Vital Statistics Cooperative 

Program. Rates for 2007 through 2012 were 

calculated by using live birth data for 2009.

Reporting Practices

Although most state and local STD programs 

generally adhere to the national notifiable STD case 

definitions collaboratively developed by the Council 

of State and Territorial Epidemiologists and CDC, 

differences in policies and systems for collecting 

surveillance data may exist. Thus, comparisons of case 

numbers and rates between jurisdictions should be 

interpreted with caution. 

However, because case definitions and surveillance 

activities within a given area remain relatively stable 

over time, trends should be minimally affected by these 

differences. 
STD Surveillance 2012 Appendix: Interpreting STD Surveillance Data 131

Reporting of Surveillance Data by 

Metropolitan Statistical Area

Sexually Transmitted Disease Surveillance 2012

continues the presentation of STD incidence data 

and rates for the 50 metropolitan statistical areas 

(MSAs) with the largest populations according to 

2000 census data. STD surveillance reports published 

before 2005 presented data by selected cities; these 

data were derived from county data, which were used 

to estimate city-specific disease rates. Because county 

data were used to estimate city-specific morbidity and 

because current STD project areas’ reporting practices 

do not support direct identification of city-specific 

morbidity reports, MSAs were chosen as a geographic 

unit smaller than a state or territory for presentation 

of STD morbidity data.

MSAs are defined by the OMB to provide nationally 

consistent definitions for collecting, tabulating, and 

publishing federal statistics for a set of geographic 

areas.4

 An MSA is associated with at least one 

urbanized area that has a population of at least 

50,000. The MSA comprises the central county or 

counties containing the central county, plus adjacent, 

outlying counties that have a high degree of social 

and economic integration with the central county as 

measured through commuting. 

The title of an MSA includes the name of the 

principal city with the largest 2000 census 

population. If there are multiple principal cities, the 

names of the second largest and third largest principal 

cities appear in the title in order of descending 

population size.

The MSA concept has been used as a statistical 

representation of the social and economic links 

between urban cores and outlying, integrated areas. 

However, MSAs do not equate to an urban-rural 

classification; all counties included in MSAs and 

many other counties contain both urban and rural 

territory and populations. STD programs that treat 

all parts of an MSA as if they were as urban as the 

densely settled core ignore the rural conditions that 

may exist in some parts of the area. In short, MSAs 

are not intended to be a general purpose geographic 

framework for nonstatistical activities or for use in 

program funding formulas.

For more information on the MSA definitions used in 

this report, go to: http://www.census.gov/population/

estimates/metro-city/03mfips.txt.

Reporting of Data for Race/Ethnicity

In April 2008, the NETSS record layout was updated 

to conform to the OMB’s current government-wide 

standard for race/ethnicity data.5 The OMB standards 

were first issued in 1997. Beginning with this 

publication, Sexually Transmitted Disease Surveillance 

2012, the race/ethnicity data are presented according 

to the current standard categories: American Indian 

or Alaska Native, Asian, Black or African American, 

Hispanic or Latino, Native Hawaiian or Other Pacific 

Islander, White and multirace. As of reporting year 

2012, there are 47 states (Alabama, Arizona, Arkansas, 

California, Colorado, Connecticut, Delaware, Florida, 

Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, 

Kansas, Kentucky, Louisiana, Maine, Massachusetts, 

Michigan, Minnesota, Mississippi, Missouri, Montana, 

Nebraska, Nevada, New Hampshire, New Jersey, 

New Mexico, North Carolina, North Dakota, Ohio, 

Oklahoma, Oregon, Pennsylvania, Rhode Island, 

South Carolina, South Dakota, Tennessee, Texas, 

Utah, Vermont, Virginia, Washington, West Virginia, 

Wisconsin, Wyoming) and the District of Columbia 

compliant with the current OMB race/ethnicity 

standards. In figures where trends are shown for 2008-

2012, the data are presented for 38 states (Alabama, 

Arizona, Arkansas, California, Colorado, Connecticut, 

Delaware, Florida, Georgia, Hawaii, Illinois, 

Missouri, Indiana, Iowa, Kansas, Kentucky, Maine, 

Massachusetts, Michigan, Minnesota, Mississippi, 

Nebraska, Nevada, New Hampshire, New Mexico, 

North Dakota, Ohio, Oklahoma, Rhode Island, South 

Carolina, South Dakota, Tennessee, Texas, Vermont, 

Virginia, Washington, West Virginia, Wyoming) and 

the District of Columbia since these areas consistently 

reported race/ethnicity data according to the current 

standard categories for the five consecutive years. 

Management of Unknown, Missing, 

or Invalid Data for Age Group, Race/

Ethnicity, and Sex

The percentage of unknown, missing, or invalid data 

for age group, race/ethnicity, and sex varies from year 

to year, state to state, and by disease for reported STDs 

(Table A1).

Prior to the publication of Sexually Transmitted Disease 

Surveillance 2010, when the percentage of unknown, 

missing, or invalid values for age group, race/ethnicity, 

and sex exceeded 50% for any state, the state’s 

incidence and population data were excluded from the 
132 Appendix: Interpreting STD Surveillance Data STD Surveillance 2012

tables that presented data stratified by one or more of 

these variables. For the states for which 50% or more 

of their data were valid for age group, race/ethnicity, 

and sex, the values for unknown, missing, or invalid 

data were redistributed on the basis of the state’s 

distribution of known age group, race/ethnicity, and 

sex data. Beginning with the publication of Sexually 

Transmitted Disease Surveillance 2010, redistribution 

methodology is not applied to any of the data. The 

counts presented in this report are summations of all 

valid data reported in reporting year 2012.

As a result, rate data that are stratified by one or more of 

these variables reflect rates based on reported data only.

Classification of STD Morbidity 

Reporting Sources

Before 1996, states classified the source of case reports 

as either private source (including private physicians, 

hospitals, and institutions) or public source (primarily 

STD clinics). As states began reporting morbidity data 

electronically in 1996, the classification categories 

for source of case reports expanded to include the 

following data sources: STD clinics, HIV counseling 

and testing sites, drug treatment clinics, family 

planning clinics, prenatal/obstetrics clinics, tuberculosis 

clinics, private physicians/health maintenance 

organizations, hospitals (inpatient), emergency rooms, 

correctional facilities, laboratories, blood banks, the 

National Job Training Program (NJTP), school-based 

clinics, mental health providers, the military, the 

Indian Health Service, and other unspecified sources.

Analysis of the data reported electronically after 1996 

confirmed that the new STD clinic source of report 

data corresponded to the earlier public source category. 

Therefore, source of case report data during 1984–

2012 are presented as STD clinic or non-STD clinic 

only (Table A2).

Chlamydia Case Reporting

Trends in chlamydia case reporting from many state 

and local jurisdictions are likely reflective of changes 

in diagnostic, screening, and reporting practices than 

of actual trends in disease incidence. In particular, 

morbidity trends are likely to be influenced by 

changes in test technology as laboratories expand 

their use of more sensitive tests (e.g., nucleic acid 

amplification tests). 

Syphilis Morbidity Reporting 

The category of “total syphilis” or “all stages of syphilis” 

includes primary, secondary, latent (including early 

latent, late latent, and latent syphilis of unknown 

duration), neurosyphilis, late (including late syphilis 

with clinical manifestations other than neurosyphilis), 

and congenital syphilis.

In 1996, the syphilis stage “late syphilis with clinical 

manifestations other than neurosyphilis (late benign 

and cardiovascular syphilis)” was added to the syphilis 

case definition (see STD Surveillance Case Definitions 

in the Appendix). Although neurosyphilis can occur 

at almost any stage of syphilis, during 1996–2005, it 

was classified and reported as one of several mutually 

exclusive stages of syphilis. Beginning in 2005, 

neurosyphilis was no longer classified or reported as a 

distinct stage of syphilis. 

Congenital Syphilis Morbidity 

Reporting

In 1988, the surveillance case definition for congenital 

syphilis was changed. This case definition has greater 

sensitivity than the former definition.6 In addition, 

many state and local STD programs have greatly 

enhanced active case finding for congenital syphilis 

since 1988. For these reasons, as well as because 

of increasing morbidity, the number of reported 

cases increased dramatically during 1989–1991. 

All reporting areas had implemented the new case 

definition for reporting congenital syphilis by 

January 1, 1992.

In addition to changing the case definition for 

congenital syphilis, CDC introduced a new data 

collection form (CDC 73.126) in 1990 (revised 

April 2010). Since 1995, the data collected on this 

form have been used for reporting congenital syphilis 

cases and associated rates. This form is used to collect 

individual case information, which allows more 

thorough analysis of case characteristics. For the 

purpose of analyzing race/ethnicity, cases are classified 

by the race/ethnicity of the mother. Congenital syphilis 

cases were reported by state and city of residence of the 

mother during 1995–2012.

Congenital syphilis reporting may be delayed as a 

result of case investigation and validation. Cases 

for previous years are added to CDC’s surveillance 

databases throughout the year. Congenital syphilis data 
STD Surveillance 2012 Appendix: Interpreting STD Surveillance Data 133

reported after publication of the current annual STD 

surveillance report will appear in subsequent reports 

and are assigned by the case patient’s year of birth.

Chlamydia and Gonorrhea Positivity 

and Prevalence Monitoring

Chlamydia and gonorrhea prevalence was calculated 

for men and women entering the NJTP. To increase 

the stability of the estimates, chlamydia or gonorrhea 

prevalence data are presented when valid test results 

for 100 or more students per year are available for 

the population subgroup and state. The majority of 

NJTP’s chlamydia screening tests are conducted by 

a single national contract laboratory, which provides 

these data to CDC. Gonorrhea screening tests for 

male and female students in many training centers 

are conducted by local laboratories; these data are 

not available to CDC. Test results for students 

at centers that submit specimens to the national 

contract laboratory are included only if the number of 

gonorrhea tests submitted is greater than 90% of the 

number of chlamydia tests submitted from the same 

center for the same period. Prevalence data for statespecific figures were published with permission from 

the NJTP.

During the mid-1990s to 2011, chlamydia and 

gonorrhea positivity among women screened in 

correctional facilities, family planning clinics, and 

prenatal care clinics participating in infertility 

prevention activities were reported to CDC to 

monitor chlamydia and gonorrhea prevalence. As the 

national infertility prevention program expanded, 

these data became difficult to interpret as trends were 

influenced by changes in screening coverage, screening 

criteria, and test technologies, as well as demographic 

changes in patients attending clinics reporting data to 

CDC. These issues could not be addressed with the 

limited variables that were collected at the national 

level. Positivity data continue to be useful locally to 

inform clinic-based screening recommendations and 

to identify at-risk populations in need of prevention 

interventions, but are no longer collected to monitor 

national trends in chlamydia and gonorrhea.

STD Surveillance Network (SSuN)

In 2005, CDC established the STD Surveillance 

Network (SSuN) as a dynamic network comprised 

of local enhanced STD surveillance systems that 

follow common protocols. The purpose of SSuN is 

to improve the capacity of national, state, and local 

STD programs to detect, monitor, and respond rapidly 

to trends in STDs through enhanced collection, 

reporting, analysis, visualization, and interpretation of 

disease information.

Twelve collaborating local or state health departments 

participated in SSuN in 2012: Alabama Department 

of Public Health, Baltimore City Health Department, 

Chicago Department of Public Health, Colorado 

Department of Public Health and Environment, 

Connecticut Department of Public Health, County 

of Los Angeles Department of Public Health (in 

collaboration with California State Department of 

Public Health), Louisiana Office of Public Health, 

New York City Department of Health and Mental 

Hygiene, Philadelphia Department of Public Health, 

San Francisco Department of Public Health, Virginia 

Department of Health, and Washington State 

Department of Health.

The SSuN data contained in this report include 

demographic, behavioral, clinical, and laboratory 

information collected from all patients at 42 STD 

clinics within the jurisdictions of SSuN health 

departments. These clinics are located in San Francisco, 

CA (San Francisco City Clinic); Los Angeles, CA (12 

STD clinics in Los Angeles County); Seattle, WA 

(Seattle-King County Clinic); Denver, CO (Denver 

Metro Health Clinic); Chicago, IL (7 public STD 

clinics in Cook County); New Orleans, LA (Delgado 

Personal Health Center); Birmingham, AL (Jefferson 

County STD Clinic); Richmond, VA (Richmond City, 

Henrico County and Chesterfield County Clinics); 

Baltimore, MD (Druid STD Clinic and Eastern STD 

Clinic); Philadelphia, PA (Philadelphia STD Clinics 1 

and 5); New York City, NY (9 public STD clinics in 5 

boroughs); Hartford, CT (Hartford STD Clinic); and 

New Haven, CT (New Haven STD Clinic).

Men who have sex with men (MSM) were defined 

as men who either reported having sex with another 

man ever before STD testing (asked at all SSuN sites) 

or who did not report sex with men but reported that 

they considered themselves gay/homosexual or bisexual 

(asked at 10 of the 12 sites). Men who have sex with 

women (MSW) were defined as men who reported 

having sex with women only before STD testing or who 

did not report the sex of their sex partner, but reported 

that they considered themselves straight/heterosexual 

(asked at 10 of the 12 sites). 
134 Appendix: Interpreting STD Surveillance Data STD Surveillance 2012

Gonococcal Isolate Surveillance 

Project

Data on antimicrobial susceptibility in Neisseria 

gonorrhoeae were collected through the Gonococcal 

Isolate Surveillance Project (GISP), a sentinel system 

of selected STD clinics located at 25–30 GISP sentinel 

sites and 4–5 regional laboratories in the United States. 

For more details on findings from GISP, go to: http://

www.cdc.gov/std/GISP.

For 2012, the antimicrobial agents tested by GISP 

were ceftriaxone, cefixime, cefpodoxime, azithromycin, 

spectinomycin, ciprofloxacin, penicillin, and tetracycline. 

The antimicrobial susceptibility criteria used in GISP for 

2012 are as follows: 

•	 Ceftriaxone, minimum inhibitory concentration 

(MIC) ≥0.5 μg/ml (decreased susceptibility).*

•	 Cefixime, MIC ≥0.5 μg/ml (decreased 

susceptibility).*

•	 Cefpodoxime, MIC ≥1.0 μg/ml (decreased 

susceptibility).*

•	 Azithromycin, MIC ≥2.0 μg/ml (decreased 

susceptibility).*

•	 Spectinomycin, MIC ≥128.0 μg/ml (resistance).

•	 Ciprofloxacin, MIC 0.125–0.5 μg/ml 

(intermediate resistance).

•	 Ciprofloxacin, MIC ≥1.0 μg/ml (resistance).

•	 Penicillin, MIC ≥2.0 μg/ml (resistance).

•	 Tetracycline, MIC ≥2.0 μg/ml (resistance).

The majority of these criteria are also recommended 

by the Clinical and Laboratory Standards Institute 

(CLSI).7

Other Surveillance Data Sources

National Health and Nutrition 

Examination Survey

The National Health and Nutrition Examination 

Survey (NHANES) is a series of cross-sectional 

surveys designed to provide national statistics on the 

health and nutritional status of the general household 

population in the United States. Data are collected 

through household interviews, standardized physical 

examinations, and the collection of biological samples 

in special mobile examination centers. In 1999, 

NHANES became a continuous survey with data 

released every 2 years. The sampling plan of the survey 

is a stratified, multistage, probability cluster design that 

selects a sample representative of the U.S. civilian, noninstitutionalized population. For more information, 

see: http://www.cdc.gov/nchs/nhanes.htm.

National Disease and Therapeutic Index

The information on the number of initial visits 

to private physicians’ offices for STDs was based 

on analysis of data from the National Disease and 

Therapeutic Index (NDTI) (machine-readable files or 

summary statistics for 1966 through 2012). NDTI 

is a probability sample survey of private physicians’ 

clinical management practices. For more information 

on this database, contact IMS Health, e-mail: 

ServiceCenter@us.imshealth.com; Telephone: (800) 

523-5334.

National Hospital Discharge Survey

The information on patients hospitalized for pelvic 

inflammatory disease (PID) or ectopic pregnancy was 

based on analysis of data from the National Hospital 

Discharge Survey (NHDS) (machine-readable files for 

1980 through 2010. NHDS, which is conducted by 

NCHS, is an ongoing, nationwide sample survey of 

medical records of patients discharged from acute care 

hospitals in the United States. For more information, 

see: http://www.cdc.gov/nchs/nhds.htm. The 

estimates generated by using NHDS data are based 

on statistical surveys and therefore have sampling 

variability associated with the estimates.

Healthy People 2020 Objectives

For three decades, Healthy People has provided 

a comprehensive set of national 10-year health 

promotion and disease prevention objectives aimed at 

improving the health of all Americans.8

 It is grounded 

in the principle that establishing objectives and 

providing benchmarks to track and monitor progress 

over time can motivate, guide, and focus action.

Healthy People 2020 (HP2020) continues in the 

tradition of its ambitious, yet achievable, 10-year 

agenda for improving the Nation’s health. HP2020 

is the result of a multiyear process that reflects input 

from a diverse group of individuals and organizations. 

* The Clinical Laboratory Standards Institute criteria for decreased susceptibility and resistance to ceftriaxone, cefixime, cefpodoxime, and 

azithromycin and for susceptibility to azithromycin have not been established for N. gonorrhoeae.
STD Surveillance 2012 Appendix: Interpreting STD Surveillance Data 135

HP2020 is organized into 42 topic areas, with more 

than 1,200 measures designed drive action that will 

support its four overarching goals:

•	 Attain high-quality, longer lives free of 

preventable disease, disability, injury, and 

premature death.

•	 Achieve health equity, eliminate disparities, and 

improve the health of all groups.

•	 Create social and physical environments that 

promote good health for all.

•	 Promote quality of life, healthy development, 

and healthy behaviors across all life stages.

The topic area, Sexually Transmitted Diseases, contains 

objectives and measures related to STDs. Baselines, 

HP2020 targets, and annual progress toward the 

targets are reported in Table A3. The year 2020 

targets for the diseases addressed in this report are as 

follows: P&S syphilis (males), 6.8 cases per 100,000 

population; P&S syphilis (females), 1.4 cases per 

100,000 population congenital syphilis, 9.1 cases per 

100,000 live births; gonorrhea (females aged 15–44 

years), 257.0 cases per 100,000 population and 

gonorrhea (males aged 15–44 years), 198.0 cases per 

100,000 population. 

The majority of the STD-related HP2020 targets were 

set using a standard percentage improvement with a 

standard default of a “10 percent improvement over 

the baseline.”

Government Performance and Results 

Act of 1993

The Government Performance and Results Act 

(GPRA) of 1993 was enacted by Congress to increase 

confidence in the capability of the federal government 

to increase the effectiveness and accountability of 

federal programs, to improve service delivery, to 

provide federal agencies a uniform tool for internal 

management, and to help Congress make decisions. 

GPRA requires each agency to have a performance 

plan with long-term outcomes and annual, measurable 

performance goals and to report on these plans 

annually, comparing results with annual goals. There 

are two GPRA goals for STD: reducing PID and 

eliminating congenital syphilis. Each of these goals has 

specific measures of progress, which are outlined in 

Table A4.

1 U.S. Census Bureau. United States population estimates by age, 

sex and race: 1980–1988. In: Current population reports [Series 

P-25, No. 1045]. Washington, DC: U.S. Government Printing 

Office; 1990. 

2 U.S. Census Bureau. United States population estimates by age, 

sex and race: 1989. In: Current population reports [Series P-25, 

No. 1057]. Washington, DC: U.S. Government Printing Office; 

1990.

3 Centers for Disease Control and Prevention. Vital statistics of 

the United States 1988. vol.1 - natality. Hyattsville (MD): U.S. 

Department of Health and Human Services; 1990.

4 Office of Management and Budget. Standards for defining 

metropolitan and micropolitan statistical areas. Federal Register. 

2000;65(249):82228-38.

5 Office of Management and Budget. Revisions to the Standards 

for Classification of Federal Data on Race and Ethnicity. Federal 

Register Notice. October 30, 1997.

6 Kaufman RE, Jones OG, Blount JH, Wiesner PJ. Questionnaire 

survey of reported early congenital syphilis: problems in diagnosis, 

prevention, and treatment. Sex Transm Dis. 1977;4:135-9.

7 Clinical and Laboratory Standards Institute. Performance 

standards for antimicrobial susceptibility testing; twentieth 

informational supplement. M100-S23, 33(1). Wayne (PA): 

Clinical and Laboratory Standards Institute; 2013.

8 U.S. Department of Health and Human Services. Healthy People 

2020 Web site. [Accessed on 10/18/2013] http://healthypeople.

gov/2020/default.aspx.
136 Appendix: Percentage Unknown STD Surveillance 2012

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

Variables by State and by Nationally Notifiable STD, 2012

State

Primary and Secondary Syphilis Gonorrhea Chlamydia

Percentage 

Unknown 

Race/

Ethnicity

Percentage 

Unknown 

Age

Percentage 

Unknown 

Sex

Percentage 

Unknown 

Sex Partner

Percentage 

Unknown 

Race/

Ethnicity

Percentage 

Unknown 

Age

Percentage 

Unknown 

Sex

Percentage 

Unknown 

Race/

Ethnicity

Percentage 

Unknown 

Age

Percentage 

Unknown 

Sex

Alabama 0.0 0.0 0.0 32.9 28.8 0.1 0.5 32.9 0.1 0.7

Alaska 0.0 0.0 0.0 100.0 0.3 0.0 0.0 1.0 0.0 0.0

Arizona 0.5 0.0 0.0 99.0 15.0 0.0 0.0 19.9 0.0 0.0

Arkansas 1.2 0.0 0.0 12.1 9.6 0.1 0.0 12.9 0.1 0.0

California 3.6 0.1 0.5 8.1 26.1 0.5 0.3 33.7 0.4 0.2

Colorado 5.8 0.0 0.0 3.4 13.9 0.0 0.0 28.1 0.0 0.0

Connecticut 0.0 1.8 0.0 12.7 34.5 0.1 0.1 53.4 0.3 0.6

Delaware 0.0 0.0 0.0 89.5 2.8 0.0 0.0 3.2 0.0 0.0

District of Columbia 1.2 0.0 0.0 18.2 34.2 0.1 0.4 36.4 0.1 0.5

Florida 0.4 0.0 0.0 6.1 7.7 0.0 0.0 21.4 0.0 0.0

Georgia 3.0 0.0 0.1 45.8 28.6 0.1 0.7 37.7 0.1 0.8

Hawaii 0.0 0.0 0.0 13.0 43.3 0.1 0.0 51.2 0.1 0.0

Idaho 0.0 0.0 0.0 23.1 30.5 0.6 0.0 32.0 0.2 0.0

Illinois 1.9 0.0 0.0 20.0 17.5 0.0 0.2 23.1 0.0 0.2

Indiana 1.8 0.0 0.0 2.7 11.1 0.0 0.1 14.7 0.0 0.1

Iowa 8.6 0.0 0.0 4.3 8.7 0.0 0.0 13.2 0.0 0.0

Kansas 0.0 0.0 0.0 4.2 14.9 0.0 0.0 33.9 0.0 0.0

Kentucky 0.0 0.0 0.0 2.7 20.6 0.5 0.2 28.4 0.6 0.3

Louisiana 0.0 0.0 0.0 13.6 10.6 0.0 0.0 12.3 0.0 0.0

Maine 5.9 0.0 0.0 5.9 12.1 0.2 0.0 25.1 0.4 0.1

Maryland 0.2 0.0 0.0 6.0 19.5 0.4 0.0 28.7 0.3 0.2

Massachusetts 6.3 0.0 0.0 21.2 23.1 0.0 0.0 33.6 0.1 0.2

Michigan 0.7 0.7 0.0 8.5 29.4 0.1 0.1 31.7 0.1 0.2

Minnesota 7.6 0.0 0.0 10.2 20.1 0.0 0.4 24.9 0.0 0.3

Mississippi 4.0 0.7 0.0 4.0 17.2 0.0 0.0 21.5 0.0 0.0

Missouri 1.3 0.0 0.0 2.5 7.4 0.0 0.0 12.0 0.0 0.0

Montana* 0.0 0.0 0.0 50.0 4.6 0.0 0.0 6.6 0.0 0.0

Nebraska* 25.0 0.0 0.0 87.5 22.8 0.1 0.3 33.5 0.1 0.4

Nevada 3.5 0.0 0.0 1.8 26.7 0.0 0.1 31.2 0.0 0.0

New Hampshire 0.0 0.0 0.0 2.8 10.2 0.0 0.0 10.2 0.0 0.0

New Jersey 3.5 5.2 0.0 14.0 38.8 12.9 0.2 57.0 11.1 0.3

New Mexico 12.9 0.0 0.0 3.0 32.2 0.0 0.1 30.7 0.0 0.0

New York 4.2 0.0 0.3 21.2 31.5 0.1 0.1 40.1 0.1 0.1

North Carolina 0.0 0.0 0.0 4.9 13.1 0.0 0.3 17.0 0.0 0.2

North Dakota* 25.0 0.0 0.0 0.0 17.0 0.3 0.3 22.4 0.0 0.0

Ohio 0.2 0.0 0.0 7.8 20.6 0.2 0.0 26.5 0.1 0.0

Oklahoma 0.0 0.0 0.0 4.8 8.5 0.0 0.0 11.9 0.0 0.0

Oregon 4.7 0.0 0.0 28.3 8.3 0.0 0.0 20.6 0.0 0.0

Pennsylvania 4.0 0.0 0.0 13.8 26.9 0.0 0.0 34.1 0.0 0.1

Rhode Island 0.0 0.0 0.0 2.3 8.9 0.0 0.0 17.8 0.0 0.0

South Carolina 0.0 0.0 0.0 2.7 32.3 0.1 0.3 36.7 0.1 0.2

South Dakota 0.0 0.0 0.0 11.1 3.1 0.0 0.3 17.9 0.0 0.0

Tennessee 1.9 0.0 0.0 1.9 2.4 0.0 0.1 2.9 0.0 0.1

Texas 0.1 0.1 0.0 2.9 6.5 0.1 0.1 9.2 0.1 0.1

Utah 0.0 0.0 0.0 11.9 0.0 0.0 0.0 0.0 0.0 0.0

Vermont* 0.0 0.0 0.0 0.0 2.0 0.0 0.0 1.6 0.0 0.0

Virginia 0.0 0.0 0.0 4.9 17.5 0.0 0.1 28.2 0.1 0.1

Washington 21.9 0.0 0.0 6.0 16.5 0.1 0.0 21.6 0.1 0.0

West Virginia* 0.0 0.0 0.0 0.0 6.6 0.0 0.0 7.3 0.0 0.0

Wisconsin 8.8 0.0 0.0 59.3 21.2 0.0 0.0 22.3 0.0 0.0

Wyoming* 0.0 0.0 0.0 0.0 9.1 0.0 0.0 16.1 0.0 0.0

U.S. TOTAL 2.6 0.1 0.1 13.7 19.2 0.4 0.2 25.8 0.3 0.2

* Percentages for primary and secondary syphilis are based on less than 10 cases.

NOTE: Unknown includes unknown, missing, or invalid data values.
STD Surveillance 2012 Appendix: STD Reporting Source 137

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2012

Disease

Non-STD Clinic STD Clinic Total

Male Female Total* Male Female Total* Male† Female† Total‡

Chlamydia 279,690 840,146 1,121,526 76,126 62,748 138,979 402,557 1,018,272 1,422,976

Gonorrhea 108,491 135,498 244,386 35,150 16,035 51,221 162,235 172,066 334,826

Primary Syphilis 2,596 185 2,785 1,261 68 1,329 4,076 280 4,360

Secondary Syphilis 7,042 831 7,887 2,386 264 2,651 10,114 1,178 11,307

Early Latent Syphilis 8,697 1,478 10,184 2,835 567 3,405 12,327 2,164 14,503

Late and Late Latent Syphilis§ 10,121 4,694 14,833 2,170 746 2,917 13,458 5,929 19,411

Chancroid 5 7 12 1 0 1 7 8 15

* Total includes unknown sex.

† Total includes unknown reporting source.

‡ Total includes unknown sex and reporting source.

§ Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other than 

neurosyphilis.
138 Appendix: Healthy People 2020 STD Surveillance 2012

Table A3. Healthy People 2020 (HP 2020) Sexually Transmitted Diseases Objectives 

HP2020 Objectives Baseline 

Year Baseline 2010 2011 2012 HP 2020 

Target

1 Reduce the proportion of adolescents and young adults with 

Chlamydia trachomatis infections

a. Among females aged 15 to 24 years attending family planning 

clinics 2008 7.4% 8.0% 8.3%

IPP no 

longer 

collected

6.7%

b. Among females aged 24 years and under enrolled in a National 

Job Training Program 2008 12.8% 11.4% 10.4% 11.0% 11.5%

c. Among males aged 24 years and under enrolled in a National Job 

Training Program 2008 7.0% 7.2% 8.0% 7.0% 6.3%

2

Increase the proportion of sexually active females aged 24 

years and under enrolled in Medicaid plans who are screened 

for genital Chlamydia infections during the measurement year

a. Females aged 16 to 20 years 2008 52.7% 54.6% 54.9% 53.5% 70.9%

b. Females aged 21 to 24 years 2008 59.4% 62.3% 63.4% 63.6% 80.0%

3

Increase the proportion of sexually active females aged 24 

years and under enrolled in commercial health insurance plans 

who are screened for genital Chlamydia infections during the 

measurement year

a. Females aged 16 to 20 years 2008 40.1% 40.8% 41.5% 41.1% 61.3%

b. Females aged 21 to 24 years 2008 43.5% 45.7% 48.4% 49.2% 74.6%

4 Reduce the proportion of females aged 15 to 44 who have ever 

required treatment for pelvic inflammatory disease (PID) 2006-2008 4.0% 4.2%* N/A N/A 3.6%

5 Reduce gonorrhea rates (cases per 100,000 population)

a. Females aged 15 to 44 years 2008 284.0 256.9 264.2 264.7 257.0

b. Males aged 15 to 44 years 2008 219.4 208.1 216.6 232.1 198.0

6 Reduce sustained domestic transmission of primary and 

secondary syphilis (cases per 100,000 population)

a. Among females 2008 1.5 1.1 1.0 0.9 1.4

b. Among males 2008 7.5 7.9 8.2 9.3 6.8

7 Reduce congenital syphilis 2008 10.1 8.7 8.5 7.8 9.1

8 Reduce the proportion of females with human papillomavirus 

(HPV) Infection (DEVELOPMENTAL)

a. Females with types 6 and 11 2003-2006 3.2 2.0** N/A N/A N/A

b. Females with types 16 and 18 2003-2006 6.2 6.1** N/A N/A N/A

c. Females with other types 2003-2006 40.3 38.3** N/A N/A N/A

9 Reduce the proportion of young adults with genital herpes 

infection due to herpes simplex type 2 2005-2008 10.5% 8.8%*** N/A N/A N/A

HP2020 

Objectives Data Source

1 a STD Surveillance System (STDSS), NCHHSTP, CDC

1b, 1c National Job Training Program, STD Surveillance System (STDSS), NCHHSTP, CDC

2a, 2b Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)

3a, 3b Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)

4 2006-2010 National Survey of Family Growth (NSFG), NCHS, CDC

5a, 5b STD Surveillance System (STDSS), NCHHSTP, CDC

6a, 6b STD Surveillance System (STDSS), NCHHSTP, CDC

7 STD Surveillance System (STDSS), NCHHSTP, CDC

8a, 8b NHANES, CDC, NCHS and the National Health Interview Survey (NHIS), CDC

8c NHANES, CDC, NCHS

9 NHANES, CDC, NCHS

* 2006–2010

** 2007–2010

*** 2009–2010 data among 20–29 years old
STD Surveillance 2012 Appendix: GPRA Goals 139

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

Measures, and Target

GPRA Goals

Actual Target

2010 2011 2012 2013

Goal 1: Reduction in PID (as measured by initial visits to physicians 

in women 15–44 years of age) 113,000 90,000 106,000 99,667

a. Proportion of high-risk women aged 16-20 infected with chlamydia* 13.3† 13.1† 12.4† 12.3

b. Proportion of high-risk women aged 21-24 infected with chlamydia* 8.4† 9.1† 8.9† 7.8

c. Rate of gonorrhea/100,000 population in women aged 16-20 658.8 663 618.5 708.4

d. Rate of gonorrhea/100,000 population in women aged 21-24 505.4 536.9 545.3 528.8

e. Black: white ratio of gonorrhea in women 16-24 13.9 13.6 12.4 12.9

f. Proportion of sexually active females 16-20 enrolled in Medicaid 

who are screened for chlamydia infections 54.6 54.9 N/A 59.8

g. Proportion of sexually active females 21-24 enrolled in Medicaid 

who are screened for chlamydia infections 62.3 63.4 N/A 70.1

h. Proportion of sexually active females 16-20 enrolled in commercial 

health insurance plans who are screened for chlamydia infections 40.8 41.5 N/A 48.0

i. Proportion of sexually active females 21-24 enrolled in commercial 

health insurance plans who are screened for chlamydia infections 45.7 48.4 N/A 55.5

Goal 2: Elimination of Congenital Syphilis

a. Incidence of P&S syphilis/100,000 population in women aged 15-44 2.5 2.1 2.1 3.0

b. Incidence of congenital syphilis/100,000 live births 9.4 8.7 7.8 10.0

c. Proportion of pregnant women that are screened for syphilis at least 

one month before delivery 84.8 83.0 N/A 81.3

GPRA Goals Data Source

1 National Disease and Therapeutic Index (IMS Health)

1a, 1b National Job Training Program

1c, 1d, 1e STD Surveillance System (STDSS), NCHHSTP, CDC

1f, 1g, 1h, 1i Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)

2a, 2b STD Surveillance System (STDSS), NCHHSTP, CDC

2c Marketscan. Thomson Reuters (Healthcare) Inc.

* Median state-specific chlamydia prevalence/positivity among states with >100 females in this age group entering the National Job Training Program. † In FY 2013 CDC improved the calculation of these data to increase the stability of estimate over time. Data for 2010 and later years reflect this improved 

calculation method.

GPRA= Government Performance and Results Act; PID= pelvic inflammatory disease; P&S= primary and secondary.
140 Appendix: STD Surveillance Case Definitions STD Surveillance 2012

STD Surveillance Case Definitions

PART 1. CASE DEFINITIONS1 FOR NATIONALLY NOTIFIABLE 

INFECTIOUS DISEASES

Chancroid (Revised 9/96)

Clinical description

A sexually transmitted disease characterized by painful genital ulceration and inflammatory inguinal 

adenopathy. The disease is caused by infection with Haemophilus ducreyi.

Laboratory criteria for diagnosis

•	 Isolation of H. ducreyi from a clinical specimen

Case classification

Probable: a clinically compatible case with both a) no evidence of Treponema pallidum infection by darkfield 

microscopic examination of ulcer exudate or by a serologic test for syphilis performed ≥7 days after onset of 

ulcers and b) either a clinical presentation of the ulcer(s) not typical of disease caused by herpes simplex virus 

(HSV) or a culture negative for HSV.

Confirmed: a clinically compatible case that is laboratory confirmed

Chlamydia trachomatis, Infection (Revised 6/09)

Clinical description

Infection with Chlamydia trachomatis may result in urethritis, epididymitis, cervicitis, acute salpingitis, or 

other syndromes when sexually transmitted; however, the infection is often asymptomatic in women. Perinatal 

infections may result in inclusion conjunctivitis and pneumonia in newborns. Other syndromes caused by C. 

trachomatis include lymphogranuloma venereum (see Lymphogranuloma Venereum) and trachoma.

Laboratory criteria for diagnosis

•	 Isolation of C. trachomatis by culture or

•	 Demonstration of C. trachomatis in a clinical specimen by detection of antigen or nucleic acid

Case classification

Confirmed: a case that is laboratory confirmed

Gonorrhea (Revised 9/96)

Clinical description

A sexually transmitted infection commonly manifested by urethritis, cervicitis, or salpingitis. Infection may be 

asymptomatic.

1 Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance, 1997. MMWR 

Morb Mortal Wkly Rep. 1997;46(No. RR-10).
STD Surveillance 2012 Appendix: STD Surveillance Case Definitions 141

Laboratory criteria for diagnosis

•	 Isolation of typical gram-negative, oxidase-positive diplococci (presumptive Neisseria gonorrhoeae) from a 

clinical specimen, or

•	 Demonstration of N. gonorrhoeae in a clinical specimen by detection of antigen or nucleic acid, or

•	 Observation of gram-negative intracellular diplococci in a urethral smear obtained from a male

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, DFA-TP, 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
142 Appendix: STD Surveillance Case Definitions STD Surveillance 2012

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.

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
STD Surveillance 2012 Appendix: STD Surveillance Case Definitions 143

Neurosyphilis

Note

Since neurosyphilis can occur at almost any stage of syphilis, , it was classified and reported, between 1996 

and 2005, as one of several mutually exclusive stages of syphilis. In 2005, the Division of STD Prevention 

requested that STD control programs discontinue classifying and reporting neurosyphilis as a distinct stage of 

syphilis. Since 2005, if the patient has confirmed or probably neurosyphilis, the case should be reported as the 

appropriate state of syphilis and neurological manifestations should be noted.

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 of the following:

•	 Elevated CSF protein or leukocyte count in the absence of other known causes of these abnormalities

•	 Clinical symptoms or signs consistent with neurosyphilis without other known causes for these clinical 

abnormalities

Confirmed: syphilis of any stage that meets the laboratory criteria for neurosyphilis

Syphilis, late, with clinical manifestations other than Neurosyphilis (late benign syphilis 

and cardiovascular syphilis)

Clinical description

Clinical manifestations of late syphilis other than neurosyphilis may include inflammatory lesions of the 

cardiovascular system, skin, and bone. Rarely, other structures (e.g., the upper and lower respiratory tracts, 

mouth, eye, abdominal organs, reproductive organs, lymph nodes, and skeletal muscle) may be involved. Late 

syphilis usually becomes clinically manifest only after a period of 15–30 years of untreated infection.

Laboratory criteria for diagnosis

•	 Demonstration of T. pallidum in late lesions by fluorescent antibody or special stains (although organisms 

are rarely visualized in late lesions)

Case classification

Probable: characteristic abnormalities or lesions of the cardiovascular system, skin, bone, or other structures 

with a reactive treponemal test, in the absence of other known causes of these abnormalities, and without CSF 

abnormalities and clinical symptoms or signs consistent with neurosyphilis

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Analysis of CSF for evidence of neurosyphilis is necessary in the evaluation of late syphilis with clinical 

manifestations.

Syphilitic Stillbirth

Clinical description

A fetal death that occurs after a 20-week gestation or in which the fetus weighs >500 g and the mother had 

untreated or inadequately* treated syphilis at delivery
144 Appendix: STD Surveillance Case Definitions STD Surveillance 2012

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 2012 Appendix: STD Surveillance Case Definitions 145

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.

1 Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance, 1997. MMWR 

Morb Mortal Wkly Rep. 1997;46(No. RR-10).
146 Appendix: STD Surveillance Case Definitions STD Surveillance 2012

Granuloma Inguinale

Clinical description

A slowly progressive ulcerative disease of the skin and lymphatics of the genital and perianal area caused by 

infection with Calymmatobacterium granulomatis. A clinically compatible case would have one or more painless 

or minimally painful granulomatous lesions in the anogenital area.

Laboratory criteria for diagnosis

•	 Demonstration of intracytoplasmic Donovan bodies in Wright or Giemsa-stained smears or biopsies of 

granulation tissue

Case classification

Confirmed: a clinically compatible case that is laboratory confirmed

Lymphogranuloma Venereum

Clinical description

Infection with L1, L2, or, L3 serovars of Chlamydia trachomatis may result in a disease characterized by genital lesions, 

suppurative regional lymphadenopathy, or hemorrhagic proctitis. The infection is usually sexually transmitted.

Laboratory criteria for diagnosis

•	 Isolation of C. trachomatis, serotype L1, L2, or L3 from clinical specimen, or

•	 Demonstration by immunofluorescence of inclusion bodies in leukocytes of an inguinal lymph node 

(bubo) aspirate, or

•	 Positive microimmunofluorescent serologic test for a lymphogranuloma venereum strain of C. trachomatis

Case classification

Probable: a clinically compatible case with one or more tender fluctuant inguinal lymph nodes or characteristic 

proctogenital lesions with supportive laboratory findings of a single C. trachomatis complement fixation titer of >64

Confirmed: a clinically compatible case that is laboratory confirmed

Mucopurulent Cervicitis (Revised 9/96)

Clinical description

Cervical inflammation that is not the result of infection with Neisseria gonorrhoeae or Trichomonas vaginalis. 

Cervical inflammation is defined by the presence of one of the following criteria:

•	 Mucopurulent secretion (from the endocervix) that is yellow or green when viewed on a white, cottontipped swab (positive swab test)

•	 Induced endocervical bleeding (bleeding when the first swab is placed in the endocervix)

Laboratory criteria for diagnosis

•	 No evidence of N. gonorrhoeae by culture, Gram stain, or antigen or nucleic acid detection, and no 

evidence of T. vaginalis on wet mount

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 
STD Surveillance 2012 Appendix: STD Surveillance Case Definitions 147

chlamydia are excluded, a clinically compatible illness should be classified as MPC. An illness in a female that 

meets the case definition of MPC and C. trachomatis infection should be classified as chlamydia.

Nongonococcal Urethritis (Revised 9/96)

Clinical description

Urethral inflammation that is not the result of infection with Neisseria gonorrhoeae. Urethral inflammation may 

be diagnosed by the presence of one of the following criteria:

•	 A visible abnormal urethral discharge, or

•	 A positive leukocyte esterase test from a male aged <60 years who does not have a history of kidney 

disease or bladder infection, prostate enlargement, urogenital anatomic anomaly, or recent urinary tract 

instrumentation, or

•	 Microscopic evidence of urethritis (≥5 white blood cells per high-power field) on a Gram stain of a 

urethral smear

Laboratory criteria for diagnosis

•	 No evidence of N. gonorrhoeae infection by culture, Gram stain, or antigen or nucleic acid detection

Case classification

Confirmed: a clinically compatible case in a male in whom gonorrhea is not found, either by culture, Gram 

stain, or antigen or nucleic acid detection

Comment

Nongonococcal urethritis (NGU) is a clinical diagnosis of exclusion. The syndrome may result from infection 

with any of several agents (see Chlamydia trachomatis, Genital Infection). If gonorrhea and chlamydia are 

excluded, a clinically compatible illness should be classified as NGU. An illness in a male that meets the case 

definition of NGU and C. trachomatis infection should be classified as chlamydia.

Pelvic Inflammatory Disease (Revised 9/96)

Clinical case definition

A clinical syndrome resulting from the ascending spread of microorganisms from the vagina and endocervix to 

the endometrium, fallopian tubes, and/or contiguous structures. In a female who has lower abdominal pain and 

who has not been diagnosed as having an established cause other than pelvic inflammatory disease (PID) (e.g., 

ectopic pregnancy, acute appendicitis, and functional pain), all the following clinical criteria must be present:

•	 Lower abdominal tenderness, and

•	 Tenderness with motion of the cervix, and

•	 Adnexal tenderness

In addition to the preceding criteria, at least one of the following findings must also be present:

•	 Meets the surveillance case definition of C. trachomatis infection or gonorrhea

•	 Temperature >100.4 F (>38.0 C)

•	 Leukocytosis >10,000 white blood cells/mm3

•	 Purulent material in the peritoneal cavity obtained by culdocentesis or laparoscopy

•	 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.
148 Appendix: Contributors STD Surveillance 2012

Contributors

We gratefully acknowledge the contributions of state STD project directors, STD program managers, state 

and territorial epidemiologists, and laboratory directors. The persons listed were in the positions shown as of 

September 3, 2013.

State/City/Outlying Area STD Project Directors STD Program Managers State Epidemiologists Laboratory Directors

Alabama Anthony Merriweather Anthony Merriweather Mary McIntyre Sharon Massingale

Alaska Ward Hurlburt Donna Cecere Joe McLaughlin Bernard Jilly

Arizona Brenda Flattum Roxanne Ereth Kenneth Komatsu Victor Waddell

Arkansas Kellye McCarthy Brandi Roberts Dirk Haselow Glen Baker

California Heidi Bauer Romni Neiman Gilberto Chavez Paul Kimsey

Los Angeles Christine Wigen Vacant Gilberto Chavez Nicole Green (Acting)

San Francisco Susan Philip Wendy Wolf Gilberto Chavez Mark Pandori

Colorado Melanie Mattson Rebecca Jordan Lisa Miller (Acting) Laura Gillim-Ross

Connecticut Heidi Jenkins Vacant Matthew Cartter John Fontana

Delaware Catherine Mosley Catherine Mosley Marjorie Shannon Christina Pleasanton

District of Columbia Michael Kharfen Michael Kharfen John Davies-Cole Alpha Diallo (Acting)

Florida Adrian Cooksey Adrian Cooksey Carina Blackmore Susanne R. Crowe (Acting)

Georgia Michelle Allen Michelle Allen Cherie Drenzek Elizabeth Franko

Hawaii Peter Whiticar Gerald “Luke” Hasty, Jr. Sarah Park A. Christian Whelen

Idaho Aimee Shipman Vacant Christine Hahn Christopher Ball

Illinois Rich Zimmerman Rich Zimmerman Craig Conover Tom Johnson

Chicago Nanette Benbow Vacant Craig Conover Susan Gerber

Indiana Andrea Allen Andrea Allen Pamela Pontones Judith Lovchik

Iowa Randy Mayer George Walton Patricia Quinlisk Christopher Atchison

Kansas Jennifer VandeVelde Jennifer VandeVelde Charles Hunt Leo Henning

Kentucky Vacant Chang Lee Kraig Humbaugh Paul Bachner

Louisiana DeAnn Gruber Jeff Hitt Raoult Ratard Stephen Martin

Maine James Markiewicz Sarah Bly Stephen Sears Kenneth Pote

Maryland Barbara Conrad Barbara Conrad David Blythe Robert Myers

Baltimore Patrick Chaulk Patrick Chaulk David Blythe Jack DeBoy

Massachusetts Vacant David Goudreau Alfred DeMaria Michael Pentella

Michigan Amna Osman Karen Krzanowski Corrine Miller Sandip Shah

Minnesota Marcie Babcock Marcie Babcock Ruth Lynfield Joanne Bartkus

Mississippi Nicholas Mosca David Peyton Thomas Dobbs Daphne Ware

Missouri Ingrid Denney Ken Palermo George Turabelidze Bill Whitmar

Montana Laurie Kops Laurie Kops Carol Ballew Ron Paul

Nebraska Jeri Weberg-Bryce Jeri Weberg-Bryce Thomas Safranek Steve Hinrichs

Nevada Sandra Noffsinger Jon Basilio Ishan Azzam L. Dee Brown

New Hampshire Donna M. Mombourquette Lindsay Pierce Christine Adamski Christine Bean

New Jersey Vacant Patricia Mason Christina Tan Onesia Bishop

New Mexico Daniel Burke Vacant Michael Landen (Acting) David Mills

New York Alison Muse Vacant Debra Blog Jill Taylor (Acting)

New York City Susan Blank Vacant Debra Blog Jennifer Rakeman

North Carolina Jacquelyn Clymore Pete Moore Megan Davies Scott Zimmerman

North Dakota Kirby Kruger Lindsey VanderBusch Tracy Miller Myra Kosse

Ohio Jamie Blair Jen Keagy Mary DiOrio Rosemarie Gearhart

Oklahoma Jan Fox Kristen Eberly Kristy Bradley S. Terrance Dunn

Oregon Veda Latin Doug Harger Katrina Hedberg Michael Skeels

Pennsylvania Beth Butler Faith Blough Maria Moll (Acting) Julia Kiehlbauch

Philadelphia Melinda Salmon Melinda Salmon Maria Moll (Acting) Kerry Buchs

Rhode Island Vacant Jaime Comella Utpala Bandy Ewa King

South Carolina Vacant Janice Tapp Linda Bell Shahiedy Shahied

South Dakota Amanda Gill Amanda Gill Lon Kightlinger Michael Smith

Tennessee Brad Beasely Tim Jones James Gibson

Texas Feipe Rocha Vacant Linda Gaul Grace Kubin

Utah Emily Holmes Lynn Meinor Allyn Nakashima Robyn Atkinson-Dunn

Vermont Daniel Daltry Vacant Patsy Kelso Mary Celotti

Virginia Theresa Henry Tammie Woodson David Trump Thomas York

Washington Mark Aubin Mark Aubin Wayne Turnberg Romesh Gautom

West Virginia Susan Hall Ken Gould Loretta Haddy Sharon Lee Cibrik

Wisconsin Diane Christen Anthony Wade Jeffrey Davis Charles Brokopp

Wyoming Tai Wright Tracy Murphy Richard Harris

American Samoa Elizabeth Ponausuia Vacant Sharmain Mageo Utoofili Mago

Federated States of Micronesia Vita Skilling Vacant Vita Skilling

Government of the Marshall Islands Justina Langidrik Vacant Paul Lalita

Northern Marianas (CNMI) Joseph Villagomz Vacant James Hosfschneider Joseph Villagomez

Guam Josie O’Mallan Vacant Josephine O’Mallan Josie O’Mallan

Puerto Rico Greduvel Duran-Guzman Trinidad Garcia-Vargas Haydée García Díaz Myriam Garcia-Negron (Acting)

Republic of Palau Victor Yano Johana Ngiruchelbad Julie Erb-Alvarez Francis Permeteet

Virgin Islands Gritell Martinez Vacant Thomas Morris Joseph Mark