Sexually

Transmitted

Disease

Surveillance

2009

Division of STD Prevention

November 2010

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 2009

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, regional Infertility Prevention Projects, and public 

health laboratories. We also acknowledge the contributions of staff within the Division of STD Prevention, the 

Statistics and Data Management Branch, and the Epidemiology and Surveillance Branch of CDC’s National Center 

for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
STD Surveillance 2009 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 2009. Atlanta: U.S. 

Department of Health and Human Services; 2010.

Web Site

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

Printed copies can be ordered from http://wwwn.cdc.gov/pubs/dstdp.aspx. 

Selected STD Surveillance and Prevention References and Web Sites

STD Surveillance Reports 1993–2009

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

STD Data on Wonder

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

STD Data Management & Information Technology

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

STD Fact Sheets

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

STD Treatment Guidelines

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

STD Program Evaluation Guidelines

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

STD Program Operation Guidelines

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

Recommendations for Public Health Surveillance of Syphilis in the United States

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

Behavioral Surveillance

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

National Survey of Family Growth

Mosher WE, Chandra A, Jones J. Sexual behavior and selected health measures: men and women 15–44 years of 

age, United States, 2002. Adv Data. 2005;362:1-56. Available from:

http://www.cdc.gov/nchs/products/data/ad/ad362.pdf.

STD Surveillance 2009 v

Foreword

“STDs are hidden epidemics of enormous health and 

economic consequence in the United States. They are 

hidden because many Americans are reluctant to address 

sexual health issues in an open way and because of 

the biologic and social characteristics of these diseases. 

All Americans have an interest in STD prevention 

because all communities are impacted by STDs and all 

individuals directly or indirectly pay for the costs of these 

diseases. 

STDs are public health problems that lack easy solutions 

because they are rooted in human behavior and 

fundamental societal problems. Indeed, there are many 

obstacles to effective prevention efforts. The first hurdle 

will be to confront the reluctance of American society 

to openly confront issues surrounding sexuality and 

STDs. Despite the barriers, there are existing individualand community-based interventions that are effective 

and can be implemented immediately. That is why a 

multifaceted approach is necessary to both the individual 

and community levels.

To successfully prevent STDs, many stakeholders 

need to redefine their mission, refocus their efforts, 

modify how they deliver services, and accept new 

responsibilities. In this process, strong leadership, 

innovative thinking, partnerships, and adequate 

resources will be required. The additional investment 

required to effectively prevent STDs may be 

considerable, but it is negligible when compared with 

the likely return on the investment. 

The process of preventing STDs must be a collaborative 

one. No one agency, organization, or sector can 

effectively do it alone; all members of the community 

must do their part. A successful national initiative to 

confront and prevent STDs requires widespread public 

awareness and participation and bold national leadership 

from the highest levels.”1

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

hidden epidemic: confronting sexually transmitted diseases. 

Washington (DC): National Academy Press; 1997. p. 43.
vi STD Surveillance 2009

Preface

Sexually Transmitted Disease Surveillance 2009 presents 

statistics and trends for sexually transmitted diseases 

(STDs) in the United States through 2009. This annual 

publication is intended as a reference document for 

policy makers, program managers, health planners, 

researchers, and others who are concerned with the 

public health implications of these diseases. The figures 

and tables in this edition supersede those in earlier 

publications of these data.

The surveillance information in this report is based 

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

reporting from state and local STD programs; 

(2) projects that monitor STD prevalence in various 

settings, including regional Infertility Prevention 

Projects, the National Job Training Program, the Indian 

Health Service, the STD Surveillance Network, and the 

Gonococcal Isolate Surveillance Project; and 

(3) national surveys implemented by federal and private 

organizations.

The STD surveillance systems operated by state and 

local STD control programs, which provide the case 

report data for chlamydia, gonorrhea, syphilis, and 

chancroid, are the data sources of many of the figures 

and most of the statistical tables in this publication. 

These systems are an integral part of program 

management at all levels of STD prevention and control 

in the United States. Because of incomplete diagnosis 

and reporting, the number of STD cases reported to 

the Centers for Disease Control and Prevention 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.

Sexually Transmitted Disease Surveillance 2009 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 subgroups and 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 

2010 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 2009 vii

Guide to Acronyms

Add Health National Longitudinal Study of Adolescent Health

CDC Centers for Disease Control and Prevention

CSF cerebrospinal fluid

DSTDP Division of STD Prevention

GISP Gonococcal Isolate Surveillance Project 

GPRA Government Performance and Results Act 

HEDIS Healthcare Effectiveness Data and Information Set

HHS U.S. Department of Health and Human Services

HMOs health maintenance organizations

HIV human immunodeficiency virus

HP2010 Healthy People 2010 

HPV human papillomavirus

HSV herpes simplex virus

IPP Infertility Prevention Project

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

NETSS National Electronic Telecommunications System for Surveillance

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 2009 ix

Contents

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

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

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

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

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

Figures in the Special Focus Profiles..............................................................................................................xiii

Tables in the National Profile ........................................................................................................................ xv

Census Regions of the United States............................................................................................................. xix

National Overview of Sexually Transmitted Diseases (STDs), 2009.................................................................1

National Profile ........................................................................................................................................5

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

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

Syphilis..................................................................................................................................................33

Other Sexually Transmitted Diseases......................................................................................................45

Special Focus Profiles...........................................................................................................................53

STDs in Women and Infants.................................................................................................................55

STDs in Adolescents and Young Adults.................................................................................................63

STDs in Racial and Ethnic Minorities...................................................................................................69

STDs in Men Who Have Sex with Men ................................................................................................77

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

Tables

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

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

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

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

Chancroid ...........................................................................................................................................133

Selected STDs .....................................................................................................................................134

Appendix

Interpreting STD Surveillance Data.....................................................................................................135

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

Selected Variables by State and by Nationally Notifiable STD, 2009 .............................. 143

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2009 .................. 144

Table A3. Healthy People 2010 (HP2010) Sexually Transmitted Diseases Objective Status.............. 145

Table A4. Government Performance and Results Act (GPRA)

Sexually Transmitted Diseases Goals and Measures......................................................... 146

STD Surveillance Case Definitions......................................................................................................147

Contributors........................................................................................................................................156
x STD Surveillance 2009

Figures in the National Profile

Chlamydia

Figure 1. Chlamydia—Rates by Sex, United States, 1990–2009...................................................... 10

Figure 2. Chlamydia—Rates by Region, United States, 2000–2009................................................ 10

Figure 3. Chlamydia—Rates by State, United States and Outlying Areas, 2009 .............................. 11

Figure 4. Chlamydia—Rates by County, United States, 2009 ......................................................... 11

Figure 5. Chlamydia—Rates by Age and Sex, United States, 2009 .................................................. 12

Figure 6. Chlamydia—Rates by Race/Ethnicity, United States, 2000–2009 .................................... 12

Figure 7. Chlamydia—Cases by Reporting Source and Sex, United States, 2000–2009................... 13

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

United States, 2009.......................................................................................................... 13

Figure 9. Chlamydia—Prevalence by Age Group and Race/Ethnicity, National Health and

Nutrition Examination Survey, 1999–2002...................................................................... 14

Figure 10. Chlamydia—Median State-specific Positivity Rates Among Women Aged 15–24 

Years Tested in Family Planning Clinics, Infertility Prevention Project, 

United States, 1997–2009................................................................................................ 14

Figure 11. Chlamydia—Positivity Among Women Aged 15–24 Years Tested in 

Family Planning Clinics, by State, Infertility Prevention Project, 

United States and Outlying Areas, 2009........................................................................... 15

Figure 12. Chlamydia—Trends in Positivity Rates Among Women Aged 15–24 Years Tested in

Family Planning Clinics, by U.S. Department of Health and Human Services (HHS)

Region, Infertility Prevention Project, 2005–2009 ........................................................... 15

Figure 13. Chlamydia—Percentage of Nucleic Acid Amplification Tests Used Among Women

Aged 15–24 Years Tested in Family Planning Clinics, by U.S. Department of Health

and Human Services (HHS) Region, Infertility Prevention Project, 2005–2009............... 16

Gonorrhea

Figure 14. Gonorrhea—Rates, United States, 1941–2009................................................................. 22

Figure 15. Gonorrhea—Rates by Sex, United States, 1990–2009...................................................... 22

Figure 16. Gonorrhea—Rates by Region, United States, 2000–2009 ................................................ 23

Figure 17. Gonorrhea—Rates by State, United States and Outlying Areas, 2009 .............................. 23

Figure 18. Gonorrhea—Rates by County, United States, 2009 ......................................................... 24

Figure 19. Gonorrhea—Rates by Age and Sex, United States, 2009 .................................................. 24

Figure 20. Gonorrhea—Rates by Age Among Women Aged 15–44 Years, 

United States, 2000–2009................................................................................................ 25

Figure 21. Gonorrhea—Rates by Age Among Men Aged 15–44 Years, 

United States, 2000–2009................................................................................................ 25

Figure 22. Gonorrhea—Rates by Race/Ethnicity, United States, 2000–2009 .................................... 26

Figure 23. Gonorrhea—Cases by Reporting Source and Sex, United States, 2000–2009................... 26

Figure 24. Gonorrhea—Percentage of Reported Cases by Sex and Selected Reporting 

Sources, United States, 2009 ............................................................................................ 27

Figure 25. Gonorrhea—Positivity Among Women Aged 15–24 Years Tested in Family

Planning Clinics, by State, Infertility Prevention Project, United States and

Outlying Areas, 2009 ....................................................................................................... 27
STD Surveillance 2009 xi

Figure 26. Gonococcal Isolate Surveillance Project (GISP)—Location of Participating 

Sentinel Sites and Regional Laboratories, United States, 2009.......................................... 28

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

Inhibitory Concentrations (MICs) to Ceftriaxone Among GISP 

Isolates, 2005–2009 ......................................................................................................... 28

Figure 28. Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum 

Inhibitory Concentrations (MICs) to Cefixime Among GISP Isolates, 

2005–2006 and 2009....................................................................................................... 29

Figure 29. Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum 

Inhibitory Concentrations (MICs) to Azithromycin Among GISP 

Isolates, 2005–2009 ......................................................................................................... 29

Figure 30. Gonococcal Isolate Surveillance Project (GISP)—Percentage of Neisseria gonorrhoeae

Isolates with Resistance or Intermediate Resistance to Ciprofloxacin, 1990–2009 ............ 30

Figure 31. Gonococcal Isolate Surveillance Project (GISP)—Penicillin, Tetracycline, and

Ciprofloxacin Resistance Among GISP Isolates, 2009 ...................................................... 30

Figure 32. Gonococcal Isolate Surveillance Project (GISP)—Drugs Used to Treat Gonorrhea

Among GISP Participants, 1988–2009 ............................................................................ 31

Syphilis

Figure 33. Syphilis—Reported Cases by Stage of Infection, United States, 1941–2009..................... 37

Figure 34. Primary and Secondary Syphilis—Rates by Sex and Male-to-Female Rate Ratios,

United States, 1990–2009................................................................................................ 37

Figure 35. Primary and Secondary Syphilis—Rates by Region, United States, 2000–2009................ 38

Figure 36. Primary and Secondary Syphilis—Rates by State, United States and 

Outlying Areas, 2009 ....................................................................................................... 38

Figure 37. Primary and Secondary Syphilis—Rates by County, United States, 2009 ......................... 39

Figure 38. Primary and Secondary Syphilis—Rates by Age and Sex, United States, 2009.................. 39

Figure 39. Primary and Secondary Syphilis—Rates by Age Among Women Aged 15–44 

Years, United States, 2000–2009 ...................................................................................... 40

Figure 40. Primary and Secondary Syphilis—Rates by Age Among Men Aged 15–44 Years,

United States, 2000–2009................................................................................................ 40

Figure 41. Primary and Secondary Syphilis—Rates by Race/Ethnicity, 

United States, 2000–2009................................................................................................ 41

Figure 42. Primary and Secondary Syphilis—Reported Cases by Stage, Sex, and 

Sexual Behavior, United States, 2009................................................................................ 41

Figure 43. Primary and Secondary Syphilis—Reported Cases by Sex, Sexual Behavior, and

Race/Ethnicity, United States, 2009 ................................................................................. 42

Figure 44. Primary and Secondary Syphilis—Reported Cases by Reporting Source and Sex,

United States, 2000–2009................................................................................................ 42

Figure 45. Primary and Secondary Syphilis—Percentage of Reported Cases by Sex, 

Sexual Behavior, and Selected Reporting Sources, 2009.................................................... 43

Figure 46. Congenital Syphilis—Reported Cases Among Infants by Year of Birth and Rates of 

Primary and Secondary Syphilis Among Women, United States, 2000–2009 ................... 43
xii STD Surveillance 2009

Other Sexually Transmitted Diseases

Figure 47. Chancroid—Reported Cases, United States, 1981–2009.................................................. 47

Figure 48. Human Papillomavirus—Prevalence of High-risk and Low-risk Types Among

Females Aged 14–59 Years, National Health and Nutrition Examination Survey,

2003–2004....................................................................................................................... 47

Figure 49. Genital Warts—Initial Visits to Physicians’ Offices, United States, 1966–2009 ............... 48

Figure 50. Genital Warts—Prevalence Among Sexually Transmitted Disease (STD) Clinic

Patients by Sex, Sex of Partners, and Site, STD Surveillance Network, 2009 .................... 48

Figure 51. Genital Herpes—Initial Visits to Physicians’ Offices, United States, 1966–2009 ............. 49

Figure 52. Herpes Simplex Virus Type 2—Seroprevalence in Non-Hispanic Whites and 

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

Survey, 1976–1980, 1988–1994, 1999–2004, 2005–2008............................................... 50

Figure 53. Trichomoniasis and Other Vaginal Infections—Women—Initial Visits to

Physicians’ Offices, United States, 1966–2009 ................................................................. 51
STD Surveillance 2009 xiii

Figures in the Special Focus Profiles

STDs in Women and Infants

Figure A. Chlamydia—Women—Rates by State, United States and Outlying Areas, 2009.............. 58

Figure B. Chlamydia—Positivity Among Women Aged 15–24 Years Tested in Prenatal Clinics,

by State, Infertility Prevention Project, United States and Outlying Areas, 2009 .............. 58

Figure C. Gonorrhea—Women—Rates by State, United States and Outlying Areas, 2009 .............. 59

Figure D. Gonorrhea—Positivity Among Women Aged 15–24 Years Tested in Prenatal Clinics,

by State, Infertility Prevention Project, United States and Outlying Areas, 2009 .............. 59

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

Outlying Areas, 2009 ....................................................................................................... 60

Figure F. Congenital Syphilis—Infants—Rates by Year of Birth and State, 

United States and Outlying Areas, 2009........................................................................... 60

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

United States, 1998–2007................................................................................................ 61

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

15–44 Years, United States, 2000–2009 ........................................................................... 61

Figure I. Ectopic Pregnancy—Hospitalizations of Women Aged 15–44 Years, 

United States, 1998–2007................................................................................................ 62

STDs in Adolescents and Young Adults

Figure J. Chlamydia—Trends in Positivity Among Women Aged 15–19 Years Tested in Family

Planning Clinics, by U.S. Department of Health and Human Services (HHS)

Region, Infertility Prevention Project, 2005–2009 ........................................................... 65

Figure K. Chlamydia—Prevalence Among Women Aged 16–24 Years 

Entering the National Job Training Program, by State of Residence, 

United States and Outlying Areas, 2009........................................................................... 65

Figure L. Chlamydia—Prevalence Among Men Aged 16–24 Years 

Entering the National Job Training Program, by State of Residence, 

United States and Outlying Areas, 2009........................................................................... 66

Figure M. Gonorrhea—Prevalence Among Women Aged 16–24 Years 

Entering the National Job Training Program, by State of Residence, 

United States and Outlying Areas, 2009........................................................................... 66

Figure N. Gonorrhea—Prevalence Among Men Aged 16–24 Years 

Entering the National Job Training Program, by State of Residence, 

United States and Outlying Areas, 2009........................................................................... 67

STDs in Racial and Ethnic Minorities

Figure O. Chlamydia—Rates by Race/Ethnicity and Sex, United States, 2009................................. 72

Figure P. Gonorrhea—Rate Ratios by Race/Ethnicity, United States, 2000–2009........................... 72

Figure Q. Gonorrhea—Rates by Race/Ethnicity and Sex, United States, 2009 ................................. 73

Figure R. Gonorrhea—Rate Ratios by Race/Ethnicity and Region, United States, 2009.................. 73

Figure S. Primary and Secondary Syphilis—Rates by Race/Ethnicity and Sex, 

United States, 2009.......................................................................................................... 74

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

Race/Ethnicity, United States, 2000–2009 ....................................................................... 74
xiv STD Surveillance 2009

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

Race/Ethnicity, United States, 2000–2009 ....................................................................... 75

Figure V. Congenital Syphilis—Infants—Rates by Year of Birth and 

Mother’s Race/Ethnicity, United States, 2000–2009......................................................... 75

STDs in Men Who Have Sex with Men

Figure W. Gonorrhea and Chlamydia—Proportion of MSM Testing Positive for 

Gonorrhea and Chlamydia, by Site, STD Surveillance Network, 2009 ............................ 79

Figure X. Primary and Secondary Syphilis and HIV—Proportion of MSM with Primary 

and Secondary Syphilis Who Are Co-infected with HIV, by Site, 

STD Surveillance Network, 2009..................................................................................... 79

Figure Y. Gonococcal Isolate Surveillance Project (GISP)—Percentage of Urethral 

Neisseria gonorrhoeae Isolates Obtained From MSM Attending

STD Clinics, 1990–2009................................................................................................. 80

Figure Z. Gonococcal Isolate Surveillance Project (GISP)—Percentage of Urethral 

Neisseria gonorrhoeae Isolates Obtained from MSM Attending

STD Clinics, by Site, 2006–2009..................................................................................... 80

STDs in Persons Entering Corrections Facilities

Figure AA. Chlamydia—Positivity by Age and Sex, Juvenile Corrections Facilities, 2009................... 83

Figure BB. Chlamydia—Positivity by Age Group and Sex, Adult Corrections Facilities, 2009 ........... 83

Figure CC. Gonorrhea—Positivity by Age and Sex, Juvenile Corrections Facilities, 2009 ................... 84

Figure DD. Gonorrhea—Positivity by Age Group and Sex, Adult Corrections Facilities, 2009 ........... 84
STD Surveillance 2009 xv

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, 1941–2009......................................... 85

Chlamydia

Table 2. Chlamydia—Reported Cases and Rates by State, Ranked by Rates, 

United States, 2009.......................................................................................................... 87

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

Alphabetical Order, United States and Outlying Areas, 2005–2009 ................................. 88

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

in Alphabetical Order, United States and Outlying Areas, 2005–2009 ............................. 89

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

Alphabetical Order, United States and Outlying Areas, 2005–2009 ................................. 90

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

Areas (MSAs) in Alphabetical Order, United States, 2005–2009 ...................................... 91

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2005–2009 ...................... 92

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2005–2009 ...................... 93

Table 9. Chlamydia—Counties and Independent Cities Ranked by Number of 

Reported Cases, United States, 2009 ................................................................................ 94

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

and Sex, United States, 2005–2009.................................................................................. 95

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

United States, 2005–2009................................................................................................ 96

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

and Sex, United States, 2005–2009.................................................................................. 97

Gonorrhea

Table 12. Gonorrhea—Reported Cases and Rates by State, Ranked by Rates, 

United States, 2009.......................................................................................................... 98

Table 13. Gonorrhea—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2005–2009 ................................. 99

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

Alphabetical Order, United States and Outlying Areas, 2005–2009 ............................... 100

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

Alphabetical Order, United States and Outlying Areas, 2005–2009 ............................... 101

Table 16. Gonorrhea—Reported Cases and Rates in Selected Metropolitan Statistical 

Areas (MSAs) in Alphabetical Order, United States, 2005–2009 .................................... 102

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2005–2009 .................... 103

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2005–2009 .................... 104
xvi STD Surveillance 2009

Table 19. Gonorrhea—Counties and Independent Cities Ranked by Number of 

Reported Cases, United States, 2009 .............................................................................. 105

Table 20. Gonorrhea—Reported Cases and Rates per 100,000 Population by Age Group 

and Sex, United States, 2005–2009................................................................................ 106

Table 21A. Gonorrhea—Reported Cases by Race/Ethnicity, Age Group, and Sex, 

United States, 2005–2009.............................................................................................. 108

Table 21B. Gonorrhea—Rates per 100,000 Population by Race/Ethnicity, Age Group, 

and Sex, United States, 2005–2009................................................................................ 109

Syphilis

Table 22. All Stages of Syphilis—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2005–2009 ............................... 110

Table 23. All Stages of Syphilis—Reported Cases and Rates in Selected Metropolitan 

Statistical Areas (MSAs) in Alphabetical Order, United States, 2005–2009 .................... 111

Table 24. Primary and Secondary Syphilis—Reported Cases and Rates by State, 

Ranked by Rates, United States, 2009 ........................................................................... 112

Table 25. Primary and Secondary Syphilis—Reported Cases and Rates by State/Area and 

Region in Alphabetical Order, United States and Outlying Areas, 2005–2009 ............... 113

Table 26. Primary and Secondary Syphilis—Women—Reported Cases and Rates by 

State/Area and Region in Alphabetical Order, United States and 

Outlying Areas, 2005–2009 ........................................................................................... 114

Table 27. Primary and Secondary Syphilis—Men—Reported Cases and Rates by 

State/Area and Region in Alphabetical Order, United States and 

Outlying Areas, 2005–2009 ........................................................................................... 115

Table 28. Primary and Secondary Syphilis—Reported Cases and Rates in Selected 

Metropolitan Statistical Areas (MSAs) in Alphabetical Order, United 

States, 2005–2009.......................................................................................................... 116

Table 29. Primary and Secondary Syphilis—Women—Reported Cases and Rates in 

Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2005–2009.............................................................................................. 117

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

Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2005–2009.............................................................................................. 118

Table 31. Primary and Secondary Syphilis—Counties and Independent Cities Ranked by 

Number of Reported Cases, United States, 2009............................................................ 119

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

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

Cities Ranked in the Top 30 for Cases in 2009, United States, 2008–2009 .................... 121

Table 33. Primary and Secondary Syphilis—Reported Cases and Rates per 100,000 

Population by Age Group and Sex, United States, 2005–2009 ....................................... 122

Table 34A. Primary and Secondary Syphilis—Reported Cases by Race/Ethnicity, 

Age Group, and Sex, United States, 2005–2009............................................................. 124

Table 34B. Primary and Secondary Syphilis—Rates per 100,000 Population by 

Race/Ethnicity, Age Group, and Sex, United States, 2005–2009 .................................... 125
STD Surveillance 2009 xvii

Table 35. Early Latent Syphilis—Reported Cases and Rates by State/Area and Region 

in Alphabetical Order, United States and Outlying Areas, 2005–2009 ........................... 126

Table 36. Early Latent Syphilis—Reported Cases and Rates in Selected Metropolitan 

Statistical Areas (MSAs) in Alphabetical Order, United States, 2005–2009 .................... 127

Table 37. Late and Late Latent Syphilis—Reported Cases and Rates by State/Area and 

Region in Alphabetical Order, United States and Outlying Areas, 2005–2009 ............... 128

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2005–2009 .................... 129

Table 39. Congenital Syphilis—Reported Cases and Rates in Infants by Year of Birth, by State, 

Ranked by Rates, United States, 2009 ............................................................................ 130

Table 40. 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, 2005–2009 ........................................................................................... 131

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

Race/Ethnicity of Mother, United States, 2005–2009 .................................................... 132

Chancroid

Table 42. Chancroid—Reported Cases and Rates by State/Area in Alphabetical Order, 

United States and Outlying Areas, 2005–2009............................................................... 133

Selected STDs

Table 43. Selected STDs and Complications—Initial Visits To Physicians’ Offices, 

National Disease and Therapeutic Index, United States, 1966–2009 .............................. 134

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, 2009 .............................. 143

Table A2. Reported Cases of STDs by Reporting Source and Sex: United States, 2009 .................. 144

Table A3. Healthy People 2010 (HP2010) Sexually Transmitted Diseases Objective Status.............. 145

Table A4. Government Performance and Results Act Sexually Transmitted 

Diseases Goals and Measures.......................................................................................... 146

STD Surveillance 2009 xix

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 2009 Overview 1

National Overview of Sexually 

Transmitted Diseases (STDs), 2009

Organized collaboration among interested, committed 

public and private organizations and communities is the 

key to reducing sexually transmitted diseases (STDs) and 

their related health burdens. As noted in the Institute 

of Medicine report, The Hidden Epidemic: Confronting 

Sexually Transmitted Diseases,1 surveillance is a key 

component of our efforts to prevent and control these 

diseases.

This overview summarizes national surveillance data 

for 2009 on the three notifiable diseases for which 

there are federally funded control programs: chlamydia, 

gonorrhea, and syphilis. Several observations for 2009 

are worthy of note.

Chlamydia

In 2009, a total of 1,244,180 cases of sexually 

transmitted Chlamydia trachomatis infection were 

reported to the Centers for Disease Control and 

Prevention (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 409.2 cases per 

100,000 population, an increase of 2.8% compared with 

the rate in 2008. Rates of reported chlamydial infections 

among women have been increasing annually since the 

late 1980s, when public programs for screening and 

treatment of women were first established to avert pelvic 

inflammatory disease (PID) and related complications. 

The continued increase in chlamydia case reports in 

2009 most likely represents a continued increase in 

screening for this infection, expanded use of more 

sensitive tests, and more complete national reporting, 

but it also may reflect a true increase in morbidity.

In 2009, the overall rate of chlamydial infection in the 

United States among women (592.2 cases per 100,000 

females) was almost three times the rate among men 

(219.3 cases per 100,000 males), reflecting the large 

number of women screened for this disease (Tables 4 

and 5). However, with the increased availability of urine 

testing, men are increasingly being tested for chlamydial 

infection. During 2005–2009, the chlamydia rate in 

men increased 37.6%, compared with a 20.3% increase 

in women during this period. Rates also varied among 

different racial and ethnic minority populations. For 

example, in 2009, the chlamydia rate in black men was 

nearly 12 times higher than that in white men; the rate 

in black women was nearly 8 times higher than that in 

white women.

Data from multiple sources on the prevalence of 

chlamydial infection in defined populations have 

been useful in monitoring disease burden and guiding 

chlamydia screening programs.

In 2009, the median state-specific chlamydia test 

positivity was 7.5% (range: 3.5% to 15.5%) among 

women aged 15–24 years who were screened at selected 

family planning clinics in all 50 states, the District of 

Columbia, Puerto Rico, and the Virgin Islands (Figures 

10 and 11).

At selected prenatal clinics in 18 states, Puerto Rico, and 

the Virgin Islands, the median state-specific chlamydia 

positivity was 7.7% (range: 3.6% to 20.4%) (Figure B).

The prevalence of infection was greater among 

economically disadvantaged women aged 16–24 years 

who entered the National Job Training Program (NJTP) 

in 2009 in 43 states, the District of Columbia, and 

Puerto Rico. The median state-specific prevalence was 

11.3% (range: 4.2% to 19.0%) (Figure K). Among men 

entering the program in 2009 in 48 states, the District 

of Columbia, and Puerto Rico, the median state-specific 

chlamydia prevalence was 7.0% (range: 2.4% to 11.7%) 

(Figure L).

Among females entering juvenile corrections facilities, 

the median facility-specific chlamydia positivity was 

14.4% (range: 1.8% to 35.7%). Among males entering 

juvenile corrections facilities, the median facility-specific 

chlamydia positivity was 6.0% (range: 0.0% to 19.4%).
2 Overview STD Surveillance 2009

Gonorrhea

Following a 74% decline in the rate of reported 

gonorrhea during 1975–1996, overall gonorrhea rates 

plateaued for 10 years and then decreased during 

the past 3 years. In 2009, a total of 301,174 cases 

of gonorrhea were reported in the United States, 

which corresponds to a rate of 99.1 cases per 100,000 

population. The 2009 rate is a 10.5% decrease from 

the rate of 110.7 cases per 100,000 population in 2008 

(Figure 14, Table 1). 

In 2009, as in previous years, the South had the highest 

gonorrhea rate among the four regions of the country 

(Table 13). Rates in the South and Midwest remained 

higher than rates in the Northeast and West. Rates in all 

regions of the country have decreased for the last 2 years 

(Figure 16).

During 1996–2009, gonorrhea rates in men and 

women were similar, but slightly higher in women in 

more recent years (Figure 15). In 2009, the gonorrhea 

rate in women was 105.5 cases per 100,000 population 

compared with a rate of 90.8 in men (Figure 15). As 

with chlamydia, gonorrhea rates in women were highest 

among those aged 15–24 years. In men, they were 

highest among those aged 20–24 years (Figure 19). In 

2009, the gonorrhea rate in black men was 26 times 

higher than that in white men; the rate in black women 

was 17 times higher than that in white women.

As with chlamydia, data on gonorrhea prevalence in 

defined populations were available from several sources 

in 2009. These data showed a continuing high burden 

of disease in some adolescents and young adults 

in parts of the United States.

In 2009, the median state-specific gonorrhea test 

positivity among women aged 15–24 years screened in 

selected family planning clinics in 46 states, the District 

of Columbia, Puerto Rico, and the Virgin Islands was 

1.0% (range: 0.0% to 3.4%) (Figure 25). In 2009, the 

median state-specific gonorrhea test positivity among 

women aged 15–24 years screened in selected prenatal 

clinics in 18 states, Puerto Rico, and the Virgin Islands 

was 1.2% (range: 0.0% to 5.5%) (Figure D).

For women aged 16–24 years entering the NJTP in 41 

states, the District of Columbia, and Puerto Rico in 

2009, the median state-specific gonorrhea prevalence 

was 1.6% (range: 0.0% to 5.0%) (Figure M). Among 

men entering the program in 33 states, the District of 

Columbia, and Puerto Rico, the median state-specific 

gonorrhea prevalence was 0.6% (range: 0.0% to 3.4%) 

(Figure N).

Among females entering juvenile corrections facilities, 

the median facility-specific gonorrhea positivity was 

2.9% (range: 0.0% to 13.4%); the median facilityspecific gonorrhea positivity for males entering juvenile 

corrections facilities was 0.7% (range: 0.0% to 6.5%).

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 2006.2

 The overall rate of P&S syphilis in the 

United States declined 89.7% during 1990–2000, but 

has increased each year since 2001, mostly in men, but 

also in women during 2004–2008. The overall rate in 

women declined slightly in 2009.

In 2009, a total of 13,997 cases of P&S syphilis were 

reported to CDC. This case count is the highest number 

of cases reported since 1995 and corresponds to a rate of 

4.6 cases per 100,000 population, a 5% increase from 

2008. Since 2005, the rate of P&S syphilis has increased 

59%. 

After 14 years of decline, the number of reported cases of 

congenital syphilis reached a historic low of 339 cases in 

2005. The number of cases has since increased, with 427 

cases reported in 2009, a 26% increase since 2005.

Although wide disparities exist in the rates of STDs 

among racial and ethnic groups, these disparities have 

decreased for syphilis over the past 10 years. In 2009, 

the P&S syphilis rate among blacks was 9 times the 

rate among whites (Table 34B), which is substantially 

lower than the disparity observed in 1999, when the rate 

among blacks was 24 times higher than the rate among 

whites.
STD Surveillance 2009 Overview 3

However, during 2005–2009, syphilis rates increased 

167% among black men aged 15–19 years (Table 34B) 

and 212% among those aged 20–24 years. This increase 

is the largest observed in any age, sex, or racial/ethnic 

group. The 2009 rate among men aged 15–19 years 

was 26 times higher for blacks than for whites. Among 

black women aged 15–24 years, rates doubled during 

2005–2009. In 2009, rates were 29 times higher for 

black women aged 15–19 years than for white women 

of the same age.

Although efforts to eliminate syphilis have focused on 

racial and ethnic minority populations, the syphilis 

rates among all men who have sex with men (MSM) 

have increased since 2001. Rates also have increased 

recently among black women and among black men 

who have sex with women (MSW). These findings 

highlight the importance of continually reassessing and 

refining surveillance, prevention, and control strategies 

to eliminate syphilis.

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

hidden epidemic: confronting sexually transmitted diseases. 

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

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. 

NATIONAL PROFILE
NATIONAL PROFILE
STD Surveillance 2009 National Profile 5

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 2009 National Profile: Chlamydia 7

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. Among young adults (aged 18–26 

years) who participated in the nationally representative 

National Longitudinal Study of Adolescent Health (Add 

Health) during 2001–2002, chlamydia prevalence was 

4.2%.1

Chlamydial infections in women, which are usually 

asymptomatic, can result in PID, which is a major 

cause of infertility, ectopic pregnancy, and chronic 

pelvic pain. Data from a randomized controlled trial 

of chlamydia screening in a managed care setting 

suggested that screening programs can lead to as much 

as a 60% reduction in the incidence of PID.2

 As with 

other inflammatory STDs, chlamydial infection can 

facilitate the transmission of human immunodeficiency 

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

infected with chlamydia can pass the infection to their 

infants during delivery, potentially resulting in neonatal 

ophthalmia and pneumonia. Because of the large 

burden of disease and risks associated with infection, 

CDC recommends that all sexually active women 

younger than age 26 years receive an annual chlamydia 

screening.4

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. However, 

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. 

Chlamydia screening and reporting are likely to continue 

to expand in response to the Healthcare Effectiveness 

Data and Information Set (HEDIS) annual measure, 

which assesses chlamydia screening coverage of sexually 

active young women who receive medical care through 

commercial or Medicaid managed care organizations.5 

The annual chlamydia screening rate increased from 

25.3% in 2000 to 41.6% in 2007 among sexually 

active females aged 16–25 years (or aged 16–26 years 

during 2000–2002) who were enrolled in commercial 

or Medicaid health plans in the United States during 

2000–2007.6 In 2008, women aged 16–20 years in 

commercial plans had a chlamydia screening coverage 

rate of 40.1%, while those in Medicaid had a rate of 

52.7%.7

To better monitor trends in disease burden in defined 

populations during the expansion of chlamydia 

screening activities, data on chlamydia positivity and 

prevalence among people screened in a variety of settings 

are used. In most instances, test positivity serves as a 

reasonable approximation of prevalence.8

Chlamydia—United States

In 2009, a total of 1,244,180 chlamydial infections 

were reported to CDC in 50 states and the District of 

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

rate of 409.2 cases per 100,000 population, which is 

an increase of 2.8% compared with the rate of 398.1 

in 2008. During 1990–2009, the rate of reported 

chlamydial infection increased from 160.2 to 409.2 cases 

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

Chlamydia by Region

During 2000–2009, chlamydia rates increased in all 

regions (Figure 2). In 2009, rates were highest in the 

South (452.4 per 100,000 population), followed by 

the Midwest (401.9) and the West (383.0) (Table 3). 

Rates have consistently remained lowest in the 

Northeast (363.9). 

Chlamydia by State

In 2009, chlamydia rates per 100,000 population by 

state ranged from 159.7 cases in New Hampshire to 

802.7 cases in Mississippi (Figure 3, Table 2). 
8 National Profile: Chlamydia STD Surveillance 2009

Chlamydia by Metropolitan 

Statistical Area 

In 2009, the chlamydia rate per 100,000 population 

in the 50 most populous metropolitan statistical areas 

(MSAs) increased (Table 6). Among women, the 2009 

rate of 629.3 cases was a 3.3% increase over the 2008 

rate of 609.0 cases (Table 7). The 2009 rate among men 

(248.3) increased 6.1% from the 2008 rate (234.1) 

(Table 8). In 2009, 58.4% of chlamydia cases were 

reported by these MSAs. 

Chlamydia by County

Counties in the United States with the highest 

chlamydia case rates per 100,000 population were 

located primarily in the Southeast and West, including 

Alaska (Figure 4). In 2009, a total of 710 (22.6%) 

of 3,141 counties had rates higher than 400.0 cases 

per 100,000 population. Fifty-four counties and 

independent cities reported 40% of all chlamydia cases 

in 2009 (Table 9). 

Chlamydia by Sex

In 2009, the overall rate of reported chlamydial infection 

among women in all 50 states and the District of 

Columbia (592.2 cases per 100,000 females) was almost 

three times higher than the rate among men (219.3 cases 

per 100,000 males), 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 

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 2005–2009, the chlamydial infection rate 

among men increased 37.6% (from 159.4 to 219.3 cases 

per 100,000 males) compared with a 20.3% increase 

among women during the same period (from 492.2 to 

592.2 cases per 100,000 females).

Chlamydia by Age

Among women, the highest age-specific rates of reported 

chlamydia in 2009 were among those aged 15–19 years 

(3,329.3 cases per 100,000 females) and 20–24 years 

(3,273.9 cases per 100,000 females) (Figure 5, Table 10). 

Age-specific rates among men, although substantially 

lower than the rates among women, were highest in 

those aged 20–24 years (1,120.6 cases per 100,000 

males) (Figure 5, Table 10). 

Chlamydia by Race/Ethnicity

In 2009, chlamydia rates were highest among black 

men and women (Figure 6, Table 11B). The rate of 

chlamydia in blacks was more than eight times higher 

than that in whites (1,559.1 and 178.8 cases per 

100,000 population, respectively). During 2005–2009, 

rates among blacks increased 26.3% (from 1,234.2 to 

1,559.1). Among whites, rates increased 17.9% (from 

151.7 to 178.8). The rates among American Indians/

Alaska Natives (776.5) and Hispanics (504.2) were 4.3 

and 2.8 times higher, respectively, than that of whites. 

Chlamydia by Reporting Source

Most chlamydia cases reported in 2009 were from 

venues outside of STD clinics (Table A2). Over time, 

the proportion of cases reported from non-STD clinic 

sites has continued to increase (Figure 7). In 2009, 

among women, only 11.5% of chlamydia cases were 

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

among women were reported from private physicians/

health maintenance organizations (HMOs) (39.7%). In 

contrast, among men, 33.1% of chlamydia cases were 

reported from an STD clinic in 2009 and 26.9% 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, noninstitutionalized population 

aged 14–39 years that provides an important measure 

of chlamydia disease burden. During 1999–2002, the 

overall prevalence of chlamydial infection was 2.2% 

and was similar in males and females (2.0% and 2.5%, 
STD Surveillance 2009 National Profile: Chlamydia 9

respectively).9 Prevalence was higher among nonHispanic blacks than non-Hispanic whites in all age 

groups (Figure 9).

Prevalence Monitoring

Chlamydia screening and prevalence monitoring 

activities were initiated in Region X of the U.S. 

Department of Health and Human Services (HHS) 

in 1988 as a CDC-supported demonstration project. 

In 1993, chlamydia screening services for women were 

expanded to three additional HHS regions (III, VII, and 

VIII) and in 1995, to the remaining HHS regions (I, 

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

chlamydia screening supplements local- and state-funded 

screening programs. Screening criteria and practices vary 

by region and state. See Definitions of HHS Regions in 

the Appendix for details. 

In 2009, the median state-specific chlamydia test 

positivity among women aged 15–24 years who were 

tested during visits to selected family planning clinics 

in all 50 states, the District of Columbia, Puerto 

Rico, and the Virgin Islands was 7.5% (range: 3.5% 

to 15.5%) (Figures 10 and 11). Since 1997, median 

chlamydia positivity has increased steadily. This increase 

is likely because of increasing use of more sensitive test 

technology. See Chlamydia and Gonorrhea Prevalence 

Monitoring in the Appendix for details.

Chlamydia test positivity among women aged 15–24 

years screened in family planning clinics fluctuated in 

all 10 HHS regions during 2005–2009 (Figure 12). 

Positivity has remained fairly stable in six regions (I, II, 

III, IV, V, and X). In the remaining four regions (VI, 

VII, VIII, and IX), positivity increased slightly during 

2005–2009. 

The positivity trend data in Figure 12 are not adjusted 

for changes in laboratory test methods and associated 

increases in test sensitivity. Using more sensitive tests 

has been shown to affect positivity.10 Use of NAATs in 

family planning clinics to screen women aged 15–24 

years for chlamydia is increasingly widespread (Figure 

13). In four HHS regions (I, V, VII, and VIII), NAATs 

were used nearly exclusively during 2005–2009. In four 

other regions (III, IV, VI, and IX), NAATs usage was 

97% or higher in 2009. The remaining two regions used 

NAATs more than 80% of the time in 2008.

Chlamydia Among Special Populations

More information on chlamydia screening programs 

for women of reproductive age and chlamydia among 

adolescents, minority populations, and people in 

corrections facilities is presented in the Special Focus 

Profiles.

Chlamydia Summary

Both prevalence and the number of reported cases of 

C. trachomatis infections remain high among most age 

groups, racial/ethnic groups, geographic areas, and both 

sexes. The reported number of chlamydia cases is higher 

among women, especially those of younger age (15–19 

and 20–24 years), but this finding could be a reflection 

of screening recommendations. Racial differences also 

persist; rates among blacks continue to be substantially 

higher than rates among other racial/ethnic groups.

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

MM, et al. Prevalence of chlamydial and gonococcal infections among 

young adults in the United States. JAMA. 2004;291(18):2229-36.

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

Stamm WE. Prevention of pelvic inflammatory disease by screening 

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

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, 2006. MMWR Recomm Rep. 

2006;55(No.RR-11):1-94.

5 National Committee for Quality Assurance. HEDIS 2009: technical 

specifications. Washington (DC): National Committee for Quality 

Assurance; 2008. p.81-3.

6 Centers for Disease Control and Prevention. Chlamydia screening 

among sexually active young female enrollees of health plans — 

United States, 2000–2007. MMWR Morb Mortal Wkly Rep. 

2009;58(14):362-5.

7 National Committee for Quality Assurance. The state of healthcare 

quality 2009. Washington (DC): National Committee for Quality 

Assurance; 2009. p.37-38.

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

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

9 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.

10 Dicker LW, Mosure DJ, Levine WC, Black CM, Berman SM. 

Impact of switching laboratory tests on reported trends in Chlamydia 

trachomatis infections. Am J Epidemiol. 2000;151(4):430-5.
10 National Profile: Chlamydia STD Surveillance 2009

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

Total

Women

Men

Figure 1. Chlamydia—Rates by Sex, United States, 1990–2009

Rate (per 100,000 population)

NOTE: As of January 2000, all 50 states and the District of Columbia had regulations that required chlamydia cases to be reported.

0

100

200

300

400

500

600

Year

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

South

Northeast

Midwest

West

Figure 2. Chlamydia—Rates by Region, United States, 2000–2009

Rate (per 100,000 population)

0

100

200

300

400

500

Year
STD Surveillance 2009 National Profile: Chlamydia 11

Guam

352

Figure 3. Chlamydia—Rates by State, United States and Outlying Areas, 2009

NOTE: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 406.3 per 100,000 population. 

For more information on chlamydia reporting, see Chlamydia Morbidity Reporting in the Appendix.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 191

 160

 297

 344

 346

 276

 540

 422

1,107

<300.0 (n = 10)

Rate per 100,000 

population

300.1–400.0 (n = 21)

>400.0 (n = 23)

327

303

399

386

309

753

Puerto Rico

185

Virgin

Islands

444

305 185

472

346

595

435

252

225

478

369

375

305

272

372

803

556

411

398

445

398

420

457

341

478

438

413

626

503

469

311

405 199

400

468

313

375

Figure 4. Chlamydia—Rates by County, United States, 2009

<300.0 (n = 2,052)

Rate per 100,000

population

300.1–400.0 (n = 379)

>400.0 (n = 710)
12 National Profile: Chlamydia STD Surveillance 2009

3,800 3,040 2,280 1,520 760 0 0 760 1,520 2,280 3,040 3,800

10–14

15–19

20–24

25–29

30–34

35–39

40–44

45–54

55–64

65+

Total

13.8

735.5

1,120.6

573.3

286.0

141.3

81.9

36.0

219.8

2.9

11.0

127.9

3,329.3

3,273.9

1,234.0

511.7

205.8

88.4

32.0

593.4

2.1

9.1

Men Rate (per 100,000 population) Women

Age

Figure 5. Chlamydia—Rates by Age and Sex, United States, 2009

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Whites

Hispanics

Blacks

Asians/Pacic Islanders

American Indians/Alaska Natives

Figure 6. Chlamydia—Rates by Race/Ethnicity, United States, 2000–2009

Rate (per 100,000 population)

0

500

1000

1500

2000

Year
STD Surveillance 2009 National Profile: Chlamydia 13

0

100

200

300

400

500

600

700

800

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

STD Clinic, Women

STD Clinic, Men

Non-STD Clinic, Women

Non-STD* Clinic, Men

Figure 7. Chlamydia—Cases by Reporting Source and Sex, United States, 2000–2009

Cases (in thousands)

* STD = sexually transmitted disease.

Year

STD* Clinic

Private Physician/HMO*

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

Sources, United States, 2009

* HMO = health maintenance organization; STD = sexually transmitted disease; HD = health department.

NOTE: These categories represent 75.2% of cases with a known reporting source. Of all cases, 9.5% had a missing or unknown reporting source.

Other HD* Clinic

Family Planning Clinic

Emergency Room

Percentage

Men Women

0

5

10

15

20

25

30

35

40
14 National Profile: Chlamydia STD Surveillance 2009

0

2

4

6

8

10

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Figure 10. Chlamydia—Median State-specific Positivity Rates Among Women Aged 15–24 

Years Tested in Family Planning Clinics, Infertility Prevention Project, United 

States, 1997–2009

Median State-Specic Positivity Rate

NOTE: As of 1997, all 10 U.S. Department of Health and Human Services (HHS) regions, which represent all 50 states, the District of Columbia, and 

outlying areas, reported chlamydia positivity data. See De nition of HHS Regions in the Appendix for de nitions.

Year

Non-Hispanic Blacks

Non-Hispanic Whites

Figure 9. Chlamydia—Prevalence by Age Group and Race/Ethnicity, National Health and 

Nutrition Examination Survey, 1999–2002

NOTE: Error bars indicate 95% condence intervals.

SOURCE: 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.

Mexican-Americans

0

4

8

12

16

14–19 20–29 30–39

Prevalence, %

Age
STD Surveillance 2009 National Profile: Chlamydia 15

NOTE: See Denition of HHS Regions in the Appendix for denitions.

Figure 12. Chlamydia—Trends in Positivity Rates Among Women Aged 15–24 Years Tested in 

Family Planning Clinics, by U.S. Department of Health and Human Services (HHS) 

Region, Infertility Prevention Project, 2005–2009

Region I

Region II

Region III

Region IV

Region V

Region VI Region VII

Region VIII

Region IX

Region X

IV

VII IX

I II

X

III

VI

V

VIII

4.7

05

4.7

06

4.8

07

5.2

08

5.1

09

5.7

05

5.6

06

5.9

07

6.2

08

6.5

09

5.8

05

5.4

06

5.5

07

6.3

08

6.4

09

8.8

05

9.0

06

9.6

07

9.6

08

9.4

09

7.7

05

7.6

06

7.6

07

7.6

08

7.9

09

7.4

05

7.9

06

8.8

07

10.2

08

11.0

09

5.8

05

6.5

06

6.5

07

6.8

08

7.6

09

6.3

05

7.2

06

7.3

07

7.8

08

7.6

09

6.4

05

6.8

06

7.3

07

7.5

08

8.3

09

5.6

05

5.7

06

5.8

07

6.0

08

6.0

09

6.3

5.4

6.9

8.1

6.2

5.9

Puerto Rico

10.0

Virgin

Islands

15.5

Guam

396

6.3 4.7

5.3

6.4

11.1

12.3

6.6

11.1

14.4

8.1

7.5

6.7

6.5

8.9

13.7

10.8

10.8

8.6

7.8

7.2

8.2

6.7

8.8

6.0

8.7

7.0

13.1

10.7

7.8

5.4

7.7 4.4

9.7

6.8

7.2

Figure 11. Chlamydia—Positivity Among Women Aged 15–24 Years Tested in Family 

Planning Clinics, by State, Infertility Prevention Project, United States and 

Outlying Areas, 2009

NOTE: Includes states and outlying areas that reported chlamydia positivity data on at least 500 women aged 15–24 years who were

screened during 2009.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

3.5

3.7

6.0

7.5

6.3

8.3

9.2

6.1

8.6

<5.0 (n = 4)

Positivity, %

5.0–9.9 (n = 38)

>10.0 (n = 11)

8.9
16 National Profile: Chlamydia STD Surveillance 2009

Figure 13. Chlamydia—Percentage of Nucleic Acid Amplification Tests Used Among Women 

Aged 15–24 Years Tested in Family Planning Clinics, by U.S. Department of Health

and Human Services (HHS) Region, Infertility Prevention Project, 2005–2009

NOTE: See Denition of HHS Regions in the Appendix for denitions.

Region I

Percentage

Region II

Percentage

Region III

Percentage

Region IV

Percentage

Region V

Percentage

Region VI

Percentage

Region VII

Percentage

Region VIII

Percentage

Region IX

Percentage

Region X

Percentage

0

20

40

60

80

100

05 06 07 08 09 0

20

40

60

80

100

05 06 07 08 09 0

20

40

60

80

100

05 06 07 08 09 0

20

40

60

80

100

05 06 07 08 09

0

20

40

60

80

100

05 06 07 08 09 0

20

40

60

80

100

05 06 07 08 09 0

20

40

60

80

100

05 06 07 08 09 0

20

40

60

80

100

05 06 07 08 09

0

20

40

60

80

100

05 06 07 08 09 0

20

40

60

80

100

05 06 07 08 09
STD Surveillance 2009 National Profile: Gonorrhea 17

Gonorrhea

Background

Gonorrhea is the second most commonly reported 

notifiable disease in the United States. Infections due 

to Neisseria gonorrhoeae, like those resulting from C. 

trachomatis, are a major cause of PID in the United 

States. PID can lead to serious outcomes in women, 

such as tubal infertility, ectopic pregnancy, and chronic 

pelvic pain. In addition, epidemiologic and biologic 

studies provide strong evidence that gonococcal 

infections facilitate the transmission of HIV infection.1

During 1975–1997, the national gonorrhea rate 

declined 74% after implementation of the national 

gonorrhea control program in the mid-1970s (Figure 

14). During 1996–2006, the rate fluctuated at about 

115 cases per 100,000 population. During 2006–2009, 

it decreased from 119.7 cases per 100,000 population to 

99.1 cases (Table 1). 

During 2006–2009, decreases in gonorrhea rates were 

seen in all racial/ethnic groups, in all age groups, and in 

both males and females (Figure 15). During 2008–2009, 

rate decreases were seen in 84% (42/50) of states. 

In 2007, increases in quinolone-resistant N. gonorrhoeae

(QRNG) led to changes in national guidelines that 

now limit the recommended treatment of gonorrhea 

to a single class of drug, the cephalosporins.2

 The 

combination of persistently high gonorrhea morbidity in 

some populations, along with increases in resistance and 

decreased treatment options, has reinforced the need to 

better understand the epidemiology of gonorrhea.

Although gonorrhea case reporting is useful for 

monitoring disease trends, true increases or decreases 

in the burden of the disease may be masked by changes 

in screening practices (e.g., concomitant testing for 

chlamydia and broader use of urine-based testing), 

changes in reporting practices, and the use of diagnostic 

tests with different test performance.3

For most states, 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. 

As with other STDs, reporting of gonorrhea cases to 

CDC is incomplete.4

 For these reasons, supplemental 

data on gonorrhea prevalence in persons screened in a 

variety of settings are useful in assessing the burden of 

the disease in selected populations.

Gonorrhea—United States

In 2009, a total of 301,174 cases of gonorrhea were 

reported in the United States, a rate of 99.1 cases per 

100,000 population (Figure 14, Table 1). This is a rate 

decrease of 10.5% since 2008. 

Gonorrhea by Region

In 2009, as in previous years, the South had the highest 

gonorrhea rate (133.2 cases per 100,000 population) 

among the four regions of the country, and rates in the 

South and Midwest remained higher than rates in the 

Northeast and West. Rates in all regions have decreased 

during the past 2 years (Figure 16, Table 13).

Gonorrhea by State

In 2009, gonorrhea rates per 100,000 population by 

state ranged from 7.2 in Idaho to 246.4 in Mississippi 

(Figure 17, Table 12). During 2008–2009, 84% (42/50) 

of states reported a decrease in gonorrhea rates.

Gonorrhea by Metropolitan 

Statistical Area 

The overall gonorrhea rate in the 50 most populous 

MSAs was 110.4 cases per 100,000 population in 

2009. This is a decrease from the rate of 120.4 cases 

per 100,000 population in 2008. In 2009, 60.2% of 

gonorrhea cases were reported by these MSAs (Table 

16). Similar to previous years, the total gonorrhea rate 

among females in these MSAs in 2009 (111.1) remained 

similar to that in males (109.1) (Tables 17 and 18).
18 National Profile: Gonorrhea STD Surveillance 2009

Gonorrhea by County

In 2009, a total of 1,405 counties (44.7%) in the 

United States had a rate less than or equal to 19 cases per 

100,000 population. Rates ranged from 19.0 to 100.0 

in 1,129 counties (35.9%) and more than 100.0 in 607 

counties (19.3%). Most counties with more than 100 

cases per 100,000 population were located in the South 

(Figure 18). 

In 2009, 50% of reported gonorrhea cases occurred in 

just 63 counties or independent cities (Table 19).

Gonorrhea by Sex

Before 1996, gonorrhea rates among men were higher 

than rates among women. Since that time, rates have 

been similar among women and men, but during the 

past 3 years, an increasing trend shows slightly lower 

rates among men (Figure 15). In 2009, the gonorrhea 

rate was 105.5 cases per 100,000 population among 

women and 91.9 among men (Tables 14 and 15).

Gonorrhea by Age

In 2009, gonorrhea rates continued to be highest 

among adolescents and young adults. In 2009, women 

aged 15–19 and 20–24 years had the highest rates of 

gonorrhea (568.8 and 555.3, respectively). Among men, 

the rate was highest among those aged 20–24 years 

(407.5) (Figure 19, Table 20). 

During 2005–2009, gonorrhea rates decreased in 

all age groups (Table 20). The largest decreases were 

among those aged 40–44 years (33.4%), 65 years or 

older (33.3%), and 35–39 years (29.8%). The smallest 

decreases were among those aged 20–24 years (5.2%) 

and 15–19 years (6.1%). 

These decreases were reported for both males and 

females. In males, the largest decreases were among 

those aged 65 years or older (34.1%) and 40–44 years 

(33.6%). The smallest decreases were among those aged 

15–19 years (2.9%) and 20–24 years (6.2%). In females, 

the largest decreases were among those aged 40–44 

years (33.2%) and 10–14 years (29.1%). The smallest 

decreases were among those aged 20–24 years (4.3%) 

and 15–19 years (7.6%).

Gonorrhea by Race/Ethnicity

In 2009, gonorrhea rates remained highest among blacks 

(556.4 cases per 100,000 population) (Figure 22, Table 

21B). Similar to recent years, the rate among blacks was 

20.5 times higher than the rate among whites (27.2). 

Gonorrhea rates were 4.2 times higher among American 

Indians/Alaska Natives (113.3) and 2.2 times higher 

among Hispanics (58.6) than among whites in 2009. 

Rates among whites were 1.5 times higher than those 

among Asians/Pacific Islanders (18.1) in 2009 (Figure 

22, Table 21B).

During 2005–2009, gonorrhea rates decreased in all 

racial/ethnic groups (22.5% in non-Hispanic whites, 

10.2% in blacks, 19.1% in Hispanics, 28.2% in Asians/

Pacific Islanders, and 13.8% in American Indians/Alaska 

Natives) (Figure 22, Table 21B). More information on 

gonorrhea rates among minority populations can be 

found in the Special Focus Profiles.

Gonorrhea by Region and Sex

During 2005–2009, gonorrhea rates among women 

decreased in the West, Northeast, and Midwest and 

remained essentially unchanged in the South (39.2% 

decrease in the West, 13.7% in the Northeast, and 

12.7% in the Midwest; 0.6% increase in the South) 

(Table 14). During 2005–2009, rates among men 

decreased in all regions of the United States (29.1% in 

the West, 20.2% in the Midwest, 13.2% in the South, 

and 4.7% in the Northeast) (Table 15).

Gonorrhea by Race/Ethnicity and Sex

During 2005–2009, overall gonorrhea rates decreased 

among men in all racial/ethnic groups (31.8% in Asians/

Pacific Islanders, 22.1% in whites, 16.5% in Hispanics, 

15.6% in blacks, and 15.1% in American Indians/

Alaska Natives) (Table 21B). 

During 2005–2009, overall gonorrhea rates decreased 

among women in all racial/ethnic groups (24.8% in 

Asians/Pacific Islanders, 22.6% in whites, 21.3% in 

Hispanics, 13.2% in American Indians/Alaska Natives, 

and 4.6% in blacks) (Table 21 B). 
STD Surveillance 2009 National Profile: Gonorrhea 19

In 2009, black women aged 15–19 years had the 

highest gonorrhea rate of any group (2,613.8 per 

100,000 population). Black women and black men aged 

20–24 years had similar rates (2,548.7 and 2,168.9, 

respectively).

Gonorrhea by Reporting Source

In 2009, 22.6% of gonorrhea cases were reported by 

STD clinics (Table A2). This is a decrease from 2005, 

when 28.1% of gonorrhea cases were reported by STD 

clinics. In 2009, a higher proportion of male gonorrhea 

cases than female cases (31.8% and 14.9%, respectively) 

were reported from STD clinics (Figure 23, Table A2). 

Among males, 35.0% of cases with known reporting 

source came from STD clinics. 

Other common reporting sources for males were private 

physicians/HMOs (22.8%), other health department 

clinics (7.5%), family planning clinics (2.9%), and 

emergency rooms (5.0%) (Figure 24). Among females, 

the most common reporting source was private 

physicians/HMOs (30.9%), followed by STD clinics 

(16.7%), family planning clinics (9.1%), other health 

department clinics (8.1%), and emergency rooms 

(5.8%).

Prevalence Monitoring

Positivity data from gonorrhea tests are primarily 

available from family planning clinics. Screening 

criteria and practices vary by state and over time.

In 2009, the median state-specific gonorrhea test 

positivity among women aged 15–24 years screened in 

selected family planning clinics in 46 states, the District 

of Columbia, Puerto Rico, and the Virgin Islands was 

1.0% (range: 0.0% to 3.4%) (Figure 25). 

Gonococcal Isolate Surveillance 

Project 

Antimicrobial resistance remains an important 

consideration in the treatment of gonorrhea.3,5–12 In 

1986, the Gonococcal Isolate Surveillance Project 

(GISP), a national sentinel surveillance system, 

was established to monitor trends in antimicrobial 

susceptibilities of strains of N. gonorrhoeae in the United 

States. Data are collected from selected STD clinics 

at 25–30 GISP sentinel sites and from 4–5 regional 

laboratories (Figure 26).12 

With the renewed availability of cefixime, susceptibility 

testing for this oral cephalosporin antibiotic was restarted 

in 2009. Susceptibility testing for an additional oral 

cephalosporin, cefpodoxime, was started in 2009. 

Information on the GISP antimicrobial susceptibility 

criteria used can be found in the Gonococcal 

Isolate Surveillance Project section of the Appendix, 

Interpreting STD Surveillance Data. 

Susceptibility to Ceftriaxone

Susceptibility testing for ceftriaxone began in 1987. 

Figure 27 shows the distribution of minimum inhibitory 

concentrations (MICs) to ceftriaxone among GISP 

isolates during 2005–2009. An increase was reported 

in the proportion of isolates with MICs of 0.06 μg/ml, 

from 0.5% in 2006 to 2.4% in 2009. No increases were 

observed at higher MIC values. 

The GISP has reported four isolates with decreased 

susceptibility to ceftriaxone, and all four had MICs 

of 0.5 μg/ml. The locations and years of these isolates 

were San Diego, 1987; Cincinnati, 1992 and 1993; 

and Philadelphia, 1997. No isolates with decreased 

susceptibility to ceftriaxone were seen in 2009.

Susceptibility to Cefixime

Susceptibility testing for cefixime began in 1992, was 

discontinued in 2007, and was restarted in 2009. Figure 

28 displays the distribution of MICs to cefixime among 

GISP isolates in 2005, 2006, and 2009. An increase was 

reported in the proportion of isolates with MICs greater 

than or equal to 0.06 μg/ml, from 3.4% in 2005 to 

8.3% in 2009. 

Since 2000, the GISP has reported 11 isolates with 

decreased susceptibility to cefixime, and all had MICs of 

0.5 μg/ml. Four isolates with decreased susceptibility to 

cefixime (MIC = 0.5 μg/ml) were reported in 2009 from 

Chicago, Honolulu, Los Angeles, and Portland. 
20 National Profile: Gonorrhea STD Surveillance 2009

Susceptibility to Cefpodoxime

GISP began monitoring cefpodoxime susceptibility in 

2009. Of 5,630 GISP isolates tested for cefpodoxime 

susceptibility in 2009, 58.1% had MICs to cefpodoxime 

less than or equal to 0.015 μg/ml, 39.8% had MICs of 

0.03–0.125 μg/ml, and 1.3% had MICs of 0.250–0.5 

μg/ml. There were 46 (0.8%) isolates with decreased 

susceptibility to cefpodoxime (MICs of 1.0–2.0 μg/ml). 

Susceptibility to Azithromycin

GISP began monitoring azithromycin susceptibility 

in 1992. Figure 29 shows the distribution of MICs to 

azithromycin among GISP isolates during 2005–2009. 

The proportion of GISP isolates with MICs of 0.5 μg/

ml and 1.0 μg/ml to azithromycin increased during 

2005–2008 and decreased in 2009. In 2009, five isolates 

had MICs of 8.0 μg/ml, and two isolates had MICs of 

16.0 μg/ml.

Susceptibility to Spectinomycin

All isolates were susceptible to spectinomycin in 

2009. GISP has reported five spectinomycin-resistant 

isolates—from St. Louis in 1988, Honolulu in 1989, 

San Francisco in 1989, Long Beach in 1990, and West 

Palm Beach in 1994.

Susceptibility to Ciprofloxacin

Resistance to ciprofloxacin (a fluoroquinolone in the 

quinolone family of antimicrobials) was first identified 

at GISP sites in 1991. However, since 1999, QRNG 

prevalence has steadily increased, first in Hawaii and the 

Pacific Islands, then in the Western states, then among 

MSM,6,8,9 and eventually among all populations in all 

regions of the United States.2 

In 2009, a total of 542 (9.6%) of 5,630 GISP isolates 

collected were identified as QRNG (Figure 30). The 

proportion of GISP isolates identified as QRNG 

declined in 2008 and 2009 after peaking at 14.8% 

in 2007. 

Quinolone-resistant Neisseria gonorrhoeae 

by Sexual Behavior

The prevalence of QRNG in isolates from men who 

have sex with men (MSM) decreased from 33.6% in 

2008 to 20.1% in 2009. During the same period, the 

prevalence of QRNG in isolates from men who have sex 

with women only (MSW) also decreased from 8.2% in 

2008 to 6.0% in 2009.

Other Antimicrobial Susceptibility Testing

Overall in 2009, 23.5% of isolates collected from 

GISP sites were resistant to penicillin, tetracycline, 

ciprofloxacin, or some combination of those antibiotics 

(Figure 31). 

Antimicrobial Treatments Given for 

Gonorrhea

The antimicrobial agents given to GISP patients 

for gonorrhea therapy are shown in Figure 32. The 

proportion of GISP patients treated with cephalosporins 

increased from 95.1% in 2008 to 96.2% in 2009. 

Among patients treated with cephalosporins, the 

proportion treated with ceftriaxone 250 mg increased 

from 15.7% in 2008 to 21.6% in 2009; the proportion 

treated with ceftriaxone 125 mg decreased from 59.5% 

in 2008 to 53.7% in 2009. The proportion treated 

with cefixime increased from 5.1% in 2008 to 13.2% 

in 2009. 

Conversely, the proportion of GISP patients being 

treated with fluoroquinolones (ciprofloxacin, ofloxacin, 

or levofloxacin) declined from 2.2% in 2008 to 0.5% 

in 2009. Treatment with azithromycin 2 g increased 

slightly, from 1.2% in 2008 to 1.7% in 2009.

More information about 2009 GISP data can be found 

at http://www.cdc.gov/std/GISP.
STD Surveillance 2009 National Profile: Gonorrhea 21

1 Fleming DT, Wasserheit JN. From epidemiological synergy 

to public health policy and practice: the contribution of other 

sexually transmitted diseases to sexual transmission of HIV 

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

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

sexually transmitted diseases treatment guidelines, 2006: 

fluoroquinolones no longer recommended for treatment of 

gonococcal infections. MMWR Morb Mortal Wkly Rep. 

2007;56:332-6.

3 Centers for Disease Control and Prevention. Gonorrhea 

— United States, 1998. MMWR Morb Mortal Wkly Rep. 

2000;49:538-42.

4 American Social Health Association. Sexually transmitted diseases 

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

Kaiser Family Foundation; 1998.

5 Centers for Disease Control and Prevention. Fluoroquinoloneresistance in Neisseria gonorrhoeae, Hawaii, 1999, and decreased 

susceptibility to azithromycin in N. gonorrhoeae, Missouri, 1999. 

MMWR Morb Mortal Wkly Rep. 2000;49:833-7.

6 Centers for Disease Control and Prevention. Sexually transmitted 

disease surveillance 2007 supplement: Gonococcal Isolate 

Surveillance Project (GISP) annual report 2007. Atlanta (GA): 

U.S. Department of Health and Human Services; 2007.

7 Centers for Disease Control and Prevention. Increases in 

fluoroquinolone-resistant Neisseria gonorrhoeae — Hawaii 

and California, 2001. MMWR Morb Mortal Wkly Rep. 

2002;51:1041-4.

8 Centers for Disease Control and Prevention. Increases in 

fluoroquinolone-resistant Neisseria gonorrhoeae among men 

who have sex with men — United States, 2003, and revised 

recommendations for gonorrhea treatment, 2004. MMWR

Morb Mortal Wkly Rep. 2004;53:335-8.

9 Centers for Disease Control and Prevention. Sexually 

transmitted diseases treatment guidelines, 2006. MMWR 

Recomm Rep. 2006;55(No.RR-11).

10 Wang SA, Lee MV, Iverson CJ, Ohye RG, Whiticar PM, 

Hale JA, et al. Multi-drug resistant Neisseria gonorrhoeae with 

decreased susceptibility to cefixime, Hawaii, 2001. Clin Infect 

Dis. 2003;37:849-52.

11 Wang SA, Harvey AB, Conner SM, Zaidi AA, Knapp JS, 

Whittington WL, et al. Antimicrobial resistance for Neisseria 

gonorrhoeae in the United States, 1988 to 2003: the spread of 

fluoroquinolone resistance. Ann Intern Med. 2007;147:81-9.

12 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.

Gonorrhea Among Special Populations

More information about gonorrhea in racial and ethnic 

minority populations, 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 fluctuated at about 115 

cases per 100,000 population for 10 years during 1996–

2006 and then decreased during 2006–2009. High rates 

persist in some geographic areas, adolescents and young 

adults, and some racial/ethnic groups.

The GISP continues to monitor for the emergence of 

decreased susceptibility and resistance to cephalosporins 

and for decreased susceptibility to azithromycin.
22 National Profile: Gonorrhea STD Surveillance 2009

Figure 14. Gonorrhea—Rates, United States, 1941–2009

Rate (per 100,000 population)

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

0

100

200

300

400

500

Year

1990 1994 1996 1998 2000 2002 2004 2006 2008

Total

Women

Men

Figure 15. Gonorrhea—Rates by Sex, United States, 1990–2009

Rate (per 100,000 population)

0

100

200

300

400

1992

Year
STD Surveillance 2009 National Profile: Gonorrhea 23

34.9

29.4

63.2

66.4

8.3

144.3

Puerto Rico

5.8

Virgin

Islands

104.7

Guam

33.5

23.5 10.9

87.2

81.4

185.7

120.4

7.2

12.5

54.5

13.9

42.8

77.2

44.1

92.4

246.4 160.8

141.3

113.9

150.4

100.3

139.2

147.0

107.2

127.5

109.8

128.3

204.0

156.2

154.7

89.6

57.2 26.2

50.0

55.2

89.4

Figure 17. Gonorrhea—Rates by State, United States and Outlying Areas, 2009

NOTE: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 97.8 per 100,000 population.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 8.0

 8.6

 30.4

 30.6

 73.1

 54.8

111.2

113.5

432.7

<19.0 (n = 8)

Rate per 100,000 

population

19.1–100.0 (n = 24)

>100.0 (n = 22)

49.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

South

Northeast

Midwest

West

Figure 16. Gonorrhea—Rates by Region, United States, 2000–2009

Rate (per 100,000 population)

0

50

100

150

200

250

300

Year
24 National Profile: Gonorrhea STD Surveillance 2009

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

10–14

15–19

20–24

25–29

30–34

35–39

40–44

45–54

55–64

65+

Total

5.0

250.0

407.5

238.9

145.0

85.6

60.8

33.6

92.2

2.7

11.4

25.3

568.8

555.3

229.4

106.2

47.6

22.9

8.7

105.7

0.5

2.1

Men Rate (per 100,000 population) Women

Age

Figure 19. Gonorrhea—Rates by Age and Sex, United States, 2009

Figure 18. Gonorrhea—Rates by County, United States, 2009

<19.0 (n = 1,405)

Rate per 100,000

population

19.1–100.0 (n = 1,129)

>100.0 (n = 607)
STD Surveillance 2009 National Profile: Gonorrhea 25

0

150

300

450

600

750

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Figure 21. Gonorrhea—Rates by Age Among Men Aged 15–44 Years, United States, 

2000–2009

Rate (per 100,000 population)

Year

35–39

40–44

30–34

25–29

20–24

15–19

Age Group

0

200

400

600

800

1,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

35–39

40–44

30–34

25–29

20–24

15–19

Figure 20. Gonorrhea—Rates by Age Among Women Aged 15–44 Years, United States, 

2000–2009

Rate (per 100,000 population)

Year

Age Group
26 National Profile: Gonorrhea STD Surveillance 2009

0

100

200

300

400

500

600

700

800

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Whites

Hispanics

Blacks

Asians/Pacic Islanders

American Indians/Alaska Natives

Figure 22. Gonorrhea—Rates by Race/Ethnicity, United States, 2000–2009

Rate (per 100,000 population)

Year

0

40

80

120

160

200

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

STD Clinic, Women

STD Clinic, Men

Non-STD Clinic, Women

Non-STD* Clinic, Men

Figure 23. Gonorrhea—Cases by Reporting Source and Sex, United States, 2000–2009

Cases (in thousands)

Year

* STD = sexually transmitted disease.
STD Surveillance 2009 National Profile: Gonorrhea 27

STD* Clinic

Private Physician/HMO*

Figure 24. Gonorrhea—Percentage of Reported Cases by Sex and Selected Reporting 

Sources, United States, 2009

* HMO = health maintenance organization; STD = sexually transmitted disease; HD = health department.

NOTE: These categories represent 71.9% of cases with known reporting source. Of all cases, 10.3% had a missing or unknown reporting source.

Other HD* Clinic

Family Planning Clinic

Emergency Room

Percentage

Men Women

0

5

10

15

20

25

30

35

1.0

3.4

1.1

0.2

Puerto Rico

0.1

Virgin

Islands

2.0

0.0

0.5

0.8

2.0

2.0

0.1

0.3

1.6

0.2

0.8

0.4 0.3

0.3

0.1

2.7

2.4

1.8

2.0

1.2

1.2

1.0

1.8

1.4

1.1

0.6

1.0

0.8

2.1

1.9

1.4

0.5

0.4 0.2

0.4

0.5

1.0

Figure 25. Gonorrhea—Positivity Among Women Aged 15–24 Years Tested in Family 

Planning Clinics, by State, Infertility Prevention Project, United States and 

Outlying Areas, 2009

* States/areas not meeting minimum inclusion criteria.

NOTE: Includes states and outlying areas that reported positivity data on at least 500 women aged 15–24 years who were screened during 2009.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

0.2

0.3

0.6

1.2

1.3

2.5

* (n = 4)

Positivity(%)

<1.0 (n = 24)

1.0–1.9 (n = 16)

0.5 >2.0 (n = 9)
28 National Profile: Gonorrhea STD Surveillance 2009

Figure 26. Gonococcal Isolate Surveillance Project (GISP)—Location of Participating Sentinel 

Sites and Regional Laboratories, United States, 2009

 Birmingham Phoenix

 Los Angeles

 Orange Co.

 San Diego

 San Francisco Denver

 Miami

 Atlanta

 Honolulu

 Tripler AMC

 Chicago

 New Orleans

 Baltimore

 Detroit Minneapolis

 Kansas City

 Las Vegas

 Albuquerque

 New York City

 Greensboro

 Cincinnati

 Cleveland

 Oklahoma City

 Portland

 Philadelphia

 Dallas

 Richmond

 Seattle

Sentinel Sites

Sites and Regional Labs

0

20

40

60

80

100

<0.008 0.015 0.03 0.06 0.125 0.25

2006

2005

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

Inhibitory Concentrations (MICs) to Ceftriaxone Among GISP Isolates, 2005–2009

Percentage

2007

2009

2008

MICs (μg/ml)
STD Surveillance 2009 National Profile: Gonorrhea 29

0

20

40

60

80

100

<0.015 0.03 0.06 0.125 0.25 0.5

Figure 28. Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum Inhibitory 

Concentrations (MICs) to Cefixime Among GISP Isolates, 2005–2006 and 2009

Percentage

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

MICs (μg/ml)

2006

2005

2009

0

10

20

30

40

<0.03 0.06 0.125 0.25 0.5 1 2 4 8 16

2006

2005

Figure 29. Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum 

Inhibitory Concentrations (MICs) to Azithromycin Among GISP Isolates, 

2005–2009

Percentage

2007

2009

2008

MICs (μg/ml)
30 National Profile: Gonorrhea STD Surveillance 2009

0

5

10

15

20

20092008200720062005200420032002200120001999199819971996199519941993199219911990

Intermediate Resistance

Resistance

Figure 30. Gonococcal Isolate Surveillance Project (GISP)—Percentage of Neisseria 

gonorrhoeae Isolates with Resistance or Intermediate Resistance to

Ciprofloxacin, 1990–2009

Percentage

NOTE: Resistant isolates have ciprooxacin minimum inhibitory concentrations (MICs) >1 μg/ml. Isolates with intermediate resistance have ciprooxacin 

MICs of 0.125–0.5 μg/ml. Susceptibility to ciprooxacin was rst measured in GISP in 1990.

Year

PenR/QRNG

PenR

TetR/QRNG

PenR/TetR

QRNG

PenR/TetR/QRNG

TetR

Susceptible

Figure 31. Gonococcal Isolate Surveillance Project (GISP)—Penicillin, Tetracycline, and 

Ciprofloxacin Resistance Among GISP Isolates, 2009

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. 

76.5%

7.9%

5.5% 2.1%

2.2%

1.1%

3.8%

0.9%
STD Surveillance 2009 National Profile: Gonorrhea 31

0

20

40

60

80

100

1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

Figure 32. Gonococcal Isolate Surveillance Project (GISP)—Drugs Used to Treat Gonorrhea 

Among GISP Participants, 1988–2009

NOTE: For 2009, “Other” includes no therapy (1.5%), azithromycin 2 g (1.7%), and other less frequently used drugs.

Ceftriaxone 125 mg Spectinomycin

Ceftriaxone 250 mg

Cexime

Penicillins

Ciprooxacin

Tetracyclines

Ooxacin

Other

Percentage

Year

Other Cephalosporins

STD Surveillance 2009 National Profile: Syphilis 33

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 33). The 

low rate of infectious syphilis and the concentration 

of the majority of syphilis cases in a small number 

of geographic areas in the United States led to the 

development of CDC’s National Plan to Eliminate 

Syphilis, which was announced by Surgeon General 

David Satcher, MD, PhD, 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. Overall increases in rates 

were observed primarily among men (increasing from 

3.0 cases per 100,000 population in 2001 to 7.8 cases in 

2009). After persistent declines during 1992–2003, the 

rate among women increased from 0.8 cases in 2004 to 

1.4 cases in 2009.

Syphilis remains a major health problem in the South 

and in urban areas in other regions of the country. 

Increases in cases among MSM (including men having 

sex with both men and women) have occurred and have 

been characterized by high rates of HIV co-infection and 

high-risk sexual behaviors.3–7 The estimated proportion 

of P&S syphilis cases attributable to MSM increased 

from 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. In 2009, 

62% of P&S syphilis cases in 44 states and the District 

of Columbia that provided information about sex of sex 

partners were among MSM. Of reported male cases with 

P&S syphilis, sex of sex partner information in 2009 was 

available for 80%.

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

Late, Late Latent, and Congenital)

During 2008–2009, the number of cases of early latent 

syphilis reported to CDC increased 5.4% (from 12,401 

to 13,066 cases), while the number of cases of late and 

late latent syphilis decreased 13.1% (from 19,945 to 

17,338 cases) (Tables 1, 35, and 37). The total number 

of cases of syphilis (P&S, early latent, late, late latent, 

and congenital) reported to CDC decreased 3.2% (from 

46,291 to 44,828 cases) during 2008–2009 (Table 1).

P&S Syphilis—United States

P&S syphilis cases reported to CDC increased from 

13,500 in 2008 to 13,997 in 2009, an increase of 3.7%. 

The rate of P&S syphilis in the United States in 2009 

(4.6 cases per 100,000 population) was 4.5% higher 

than the rate in 2008 (4.4 cases) (Figure 33, Table 1).

P&S Syphilis by Region

The South accounted for 53.0% of the P&S syphilis 

cases in 2009 and 49.7% in 2008. During 2008–2009, 

rates increased 10.0% in the South (from 6.0 to 6.6 

cases per 100,000 population), 2.7% in the Northeast 

(from 3.7 to 3.8 cases), and 7.7% in the Midwest (from 

2.6 to 2.8 cases). Rates decreased in the West by 11.6% 

(from 4.3 to 3.8 cases) (Figure 35, Table 25).

P&S Syphilis by State

In 2009, the 13 states with the highest rates of P&S 

syphilis accounted for 75% of all U.S. cases of P&S 

syphilis. The rate of P&S syphilis in these 13 states 

exceeded the national rate of 4.6 cases per 100,000 

population. Of these states, 10 were in the South 

(Figure 36, Table 24). 
34 National Profile: Syphilis STD Surveillance 2009

P&S Syphilis by Metropolitan 

Statistical Area 

The rate of P&S syphilis in 2009 for the 50 most 

populous MSAs (6.2 cases per 100,000 population) 

exceeded the overall rate for the United States (4.6 cases) 

(Table 28). The rate increased in 25 of these 50 MSAs 

(50%) during 2008–2009. 

P&S Syphilis by County

In 2009, a total of 2,194 of the 3,141 counties (69.9%) 

in the United States reported no cases of P&S syphilis, 

compared with 2,180 counties (69.3%) in 2008 (Figure 

37). In 2009, half of the total number of P&S syphilis 

cases was reported from 29 counties and two cities 

(Table 31).

P&S Syphilis by Sex

The rate of P&S syphilis increased 4.0% among men 

(from 7.5 to 7.8 cases per 100,000 men) during 2008–

2009 (Figure 34, Table 27). During this same period, 

the rate decreased 6.7% among women (from 1.5 to 1.4 

cases per 100,000 women) (Figure 34, Table 26).

P&S Syphilis by Age

In 2009, the rate of P&S syphilis was highest among 

persons aged 20–24 years and 25–29 years (13.4 and 

11.3 cases per 100,000 population, respectively) (Figure 

38, Table 33).

During 2008–2009, rates for men increased the most in 

those aged 15–19 years and 20–24 years (Figures 38–40, 

Table 33). Rates for men are now highest in those aged 

20–24 years, and the rates decrease with age. These 

data indicate a considerable shift since 2000, when the 

highest rates were in men aged 25–34 years. In women, 

rates increased the most among those aged 15–19 years 

and 30–34 years (Figures 38–40, Table 33), but have 

remained highest in those aged 20–24 years.

P&S Syphilis by Race/Ethnicity

During 2008–2009, the rate of P&S syphilis increased 

in all racial and ethnic groups except non-Hispanic 

whites and Hispanics (Figure 41, Table 34B). The rate 

increased 11.6% among non-Hispanic blacks (from 

17.2 to 19.2 cases per 100,000 population), 6.7% 

among Asians/Pacific Islanders (from 1.5 to 1.6 cases), 

and 4.3% among American Indians/Alaska Natives 

(from 2.3 to 2.4 cases). The rate decreased 4.5% among 

non-Hispanic whites (from 2.2 to 2.1 cases) and 2.2% 

among Hispanics (from 4.6 to 4.5 cases) (Table 34B).

P&S Syphilis by Sex and Sex Behavior

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

steadily since 1996, when it was 1.2, reflecting higher 

rates in men than women (Figure 34). This increase is 

consistent with an increase in P&S syphilis rates among 

MSM. In 2008, this ratio decreased to 5.0, but in 2009, 

it increased to 5.6.

In 2005, CDC began collecting information on the sex 

partners of patients with P&S syphilis. In 2009, this 

information was available for 80% of male cases.

In 2009, among men who have sex with women only 

(MSW) with P&S syphilis, 39.4% had primary syphilis, 

and 60.6% had secondary syphilis. Among women 

with P&S syphilis, 15.9% had primary syphilis, and 

84.1% had secondary syphilis. Among MSM, 23.9% 

had primary syphilis, and 76.1% had secondary syphilis 

(Figure 42).

Among women with P&S syphilis, 19.0% were white, 

72.9% were black, 6.5% were Hispanic, and 1.5% were 

of other races/ethnicities. Among MSW, 16.1% were 

white, 68.4% were black, 13.4% were Hispanic, and 

2.1% were of other races/ethnicities. Among MSM, 

37.7% were white, 39.6% were black, 19.1% were 

Hispanic, and 3.6% were of other races/ethnicities 

(Figure 43).

P&S Syphilis by Race/Ethnicity and Sex

During 2008–2009, the P&S syphilis rate decreased 

2.5% (from 4.0 to 3.9 cases per 100,000 population) 

among non-Hispanic white males and 20% (from 0.5 to 

0.4 cases) among non-Hispanic white females.
STD Surveillance 2009 National Profile: Syphilis 35

The rate increased 12.2% among non-Hispanic black 

males (from 27.9 to 31.3 cases) and 7.9% among nonHispanic black females (from 7.6 to 8.2 cases). The rate 

increased 1.3% among Hispanic males (from 8.0 to 

8.1 cases) and decreased 33% among Hispanic females 

(from 0.9 to 0.6 cases). 

The rate remained unchanged for Asian/Pacific Islander 

males (3.0 cases) but increased among Asian/Pacific 

Islander females (from 0.1 to 0.2 cases). The rate 

increased among American Indian/Alaska Native males 

(from 3.1 to 3.9 cases) and decreased among American 

Indian/Alaska Native females (from 1.4 to 0.9 cases) 

(Table 34B).

P&S Syphilis by Race/Ethnicity, Age, 

and Sex 

In 2009, the rate of P&S syphilis among non-Hispanic 

blacks was highest among women aged 20–24 years 

(29.6 cases, an 18.9% increase from 24.9 cases in 2008) 

and among men aged 20–24 years (94.2 cases, a 27.0% 

increase from 74.2 cases in 2008) and 25–29 years (79.2 

cases). For non-Hispanic whites, the rate was highest 

among women aged 20–24 years (1.3 cases) and among 

men 40–44 years (9.9 cases).

For Hispanics, the rate was highest among women aged 

20–24 years (2.0 cases) and among men aged 20–24 

years (18.9 cases). For Asians/Pacific Islanders, the rate 

was highest among women aged 35–39 years (0.6 cases) 

and among men aged 30–34 years (6.8 cases). For 

American Indians/Alaska Natives, the rate was highest 

among women aged 25–29 years (3.1 cases) and among 

men aged 35–39 years (11.4 cases) (Table 34B).

P&S Syphilis by Reporting Source

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

from sources other than STD clinics; this figure 

increased to 39.2% in 1998. During 1998–2009, the 

proportion of cases reported from sources other than 

STD clinics increased from 39.2% to 64.9% (Figure 

44, Table A2). During 2001–2009, the number of cases 

among males reported from non-STD clinic sources 

increased sharply, while the number reported from STD 

clinics increased only slightly (Figure 44).

During 2009, patients with P&S syphilis usually sought 

care from private physicians or STD clinics. More cases 

of syphilis among MSM were reported from private 

physicians (34.8%) than STD clinics (33.0%) (Figure 

45). More cases among women and MSW were reported 

from STD clinics than from private physicians.

Congenital Syphilis—United States

Overall, the rate of congenital syphilis decreased during 

2008–2009 (from 10.4 to 10.0 cases per 100,000 live 

births); a 17% rate increase occured during 2006–2007 

(Table 40). In 2009, a total of 427.0 cases were reported, 

an increase from 339.0 in 2005. The increase in the 

rate of congenital syphilis since 2005 (when the rate 

reached a low point of 8.2 cases per 100,000 live births) 

might be associated with the increase in the rate of P&S 

syphilis among women that has occurred since 2004 

(Figure 46).10

In 2009, a total of 33 states and 1 outlying area had 1 or 

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

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, MSM have accounted for an increasing 

number of syphilis cases in the United States.9 According 

to information reported in 44 states and the District 

of Columbia, 62% of P&S syphilis cases are among 

MSM. Although the majority of U.S. syphilis cases have 

occurred among MSM, syphilis among MSW is an 

emerging problem.11
36 National Profile: Syphilis STD Surveillance 2009

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 Centers for Disease Control and Prevention. Congenital syphilis 

— United States, 2003–2008. MMWR Morb Mortal Wkly Rep. 

2010;59:413-7.

11 Centers for Disease Control and Prevention. Primary and 

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

MMWR Morb Mortal Wkly Rep. 2009;58:463-7.
STD Surveillance 2009 National Profile: Syphilis 37

Total Syphilis

Early Latent

Primary and Secondary

Figure 33. Syphilis—Reported Cases by Stage of Infection, United States, 1941–2009

Cases (in thousands)

0

100

200

300

400

500

600

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

Year

Male-to-Female Rate Ratio

Total Rate

Female Rate

Male Rate

Figure 34. Primary and Secondary Syphilis—Rates by Sex and Male-to-Female Rate Ratios, 

United States, 1990–2009

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

Year

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

0

5

10

15

20

25

1:1

2:1

4:1

8:1

16:1
38 National Profile: Syphilis STD Surveillance 2009

Guam

1.1

Figure 36. Primary and Secondary Syphilis—Rates by State, United States and Outlying 

Areas, 2009

NOTE: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 4.6 per 

100,000 population.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 0.0

 1.1

 3.7

 1.9

 1.9

 2.4

 3.1

 5.6

27.5

<0.2 (n = 5)

Rate per 100,000 

population

0.21–2.2 (n = 19)

>2.2 (n = 30)

2.1

1.5

5.2

3.5

0.4

0.0

Puerto Rico

5.7

Virgin

Islands

0.0

0.6 0.3

6.1

2.7

2.7

6.8

0.2

1.1

3.1

0.6

0.0

0.3

1.4

0.8

8.1

8.9

9.8

5.7

6.3

3.8

3.1

2.3

2.5

6.5

2.9

2.7

16.8

9.6

5.8

2.2

2.1 0.4

3.6

2.6

0.8

1.1

South

Northeast

Midwest

West

Figure 35. Primary and Secondary Syphilis—Rates by Region, United States, 2000–2009

Rate (per 100,000 population)

0

2

4

6

8

10

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Year
STD Surveillance 2009 National Profile: Syphilis 39

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

10–14

15–19

20–24

25–29

30–34

35–39

40–44

45–54

55–64

65+

Total

0.0

6.0

20.7

18.5

15.8

13.3

13.7

8.3

7.8

0.5

2.9

0.2

3.3

5.6

3.6

3.0

1.9

1.6

1.0

1.4

0.0

0.2

Men Rate (per 100,000 population) Women

Age

Figure 38. Primary and Secondary Syphilis—Rates by Age and Sex, United States, 2009

Figure 37. Primary and Secondary Syphilis—Rates by County, United States, 2009

<0.2 (n = 2,196)

Rate per 100,000

population

0.21–2.2 (n = 353)

>2.2 (n = 592)

NOTE: In 2009, a total of 2,194 (69.9%) of 3,141 counties in the United States reported no cases of primary and secondary syphilis.
40 National Profile: Syphilis STD Surveillance 2009

0

1

2

3

4

5

6

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

35–39

40–44

30–34

25–29

20–24

15–19

Figure 39. Primary and Secondary Syphilis—Rates by Age Among Women Aged 15–44 Years, 

United States, 2000–2009

Rate (per 100,000 population)

Year

Age Group

0

5

10

15

20

25

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

35–39

40–44

30–34

25–29

20–24

15–19

Figure 40. Primary and Secondary Syphilis—Rates by Age Among Men Aged 15–44 Years, 

United States, 2000–2009

Rate (per 100,000 population)

Year

Age Group
STD Surveillance 2009 National Profile: Syphilis 41

Secondary

Primary

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

Behavior, United States, 2009

Cases

* Of the reported male cases of primary and secondary syphilis, 20% were missing sex of sex partner information. †

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

0

1,000

2,000

3,000

4,000

5,000

6,000

MSW† Women MSM†

Whites

Hispanics

Blacks

Asians/Pacic Islanders

American Indians/Alaska Natives

Figure 41. Primary and Secondary Syphilis—Rates by Race/Ethnicity, United States, 

2000–2009

Rate (per 100,000 population)

0

5

10

15

20

25

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Year
42 National Profile: Syphilis STD Surveillance 2009

Blacks

Whites

Figure 43. Primary and Secondary Syphilis—Reported Cases* by Sex, Sexual Behavior, and 

Race/Ethnicity,† United States, 2009

Cases

* Of the reported male cases of primary and secondary syphilis, 20% were missing sex of sex partner information; 1.7% of reported male cases with sex 

of sex partner data were missing race/ethnicity data. †

 No imputation was done for race/ethnicity. ‡

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

Other

Hispanics

0

500

1,000

1,500

2,000

2,500

3,000

MSW‡ Women MSM‡

0

1

2

3

4

5

6

7

8

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

STD Clinic, Women

STD Clinic, Men

Non-STD Clinic, Women

Non-STD* Clinic , Men

Figure 44. Primary and Secondary Syphilis—Reported Cases by Reporting Source and Sex, 

United States, 2000–2009

Cases (in thousands)

* STD = sexually transmitted disease.

Year
STD Surveillance 2009 National Profile: Syphilis 43

HIV Counseling and Testing Site

Correctional Facility

Figure 45. Primary and Secondary Syphilis—Percentage of Reported Cases* by Sex, Sexual 

Behavior, and Selected Reporting Sources, 2009

Percentage

* Of the reported male cases of primary and secondary syphilis, 20% were missing sex of sex partner information, and 1.7% of reported male cases with 

sex of sex partner data were missing source of information data. †

 HMO = health maintenance organization; STD = sexually transmitted disease; MSW = men who have sex with women only; MSM = men who have sex 

with men.

STD† Clinic

Private Physician/HMO†

0

10

20

30

40

50

MSW† Women MSM†

P&S Rate

CS Cases

Figure 46. Congenital Syphilis—Reported Cases Among Infants by Year of Birth and Rates of 

Primary and Secondary Syphilis Among Women, United States, 2000–2009

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

* CS = congenital syphilis; P&S = primary and secondary syphilis.

0.0

0.2

0.4

0.6

0.8

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

0

1

2

3

4

Year

STD Surveillance 2009 National Profile: Other Sexually Transmitted Diseases 45

Other Sexually Transmitted Diseases 

Chancroid

Since 1987, reported cases of chancroid had declined 

steadily until 2001. Since then, the number of cases 

reported has fluctuated (Figure 47, Table 1). In 2009, 

a total of 28 cases of chancroid were reported in the 

United States. Only nine states reported one or more 

cases of chancroid in 2009 (Table 42). 

Although the overall decline in reported chancroid cases 

most likely reflects a decline in the incidence of this 

disease, these data should be interpreted with caution 

because Haemophilus ducreyi, the causative organism 

of chancroid, is difficult to culture, and as a result, this 

condition may be substantially underdiagnosed.1,2

Human Papillomavirus 

Persistent infection with high-risk human papillomavirus 

(HPV) can lead to development of anogenital cancers 

(e.g., cervical cancer). In June 2006, a quadrivalent HPV 

vaccine was licensed for use in the United States. The 

vaccine provides protection against HPV types 6, 11, 16, 

and 18. Types 6 and 11 are associated with genital warts, 

while types 16 and 18 are high-risk oncogenic types 

associated with anogenital cancers. In October 2009, a 

bivalent HPV vaccine that provides protection against 

types 16 and 18 also was licensed.

Sentinel surveillance for cervical infection with high-risk 

HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 

59, or 68 was conducted in 26 STD, family planning, 

and primary care clinics in 6 locations (Boston, 

Baltimore, New Orleans, Denver, Seattle, and Los 

Angeles) as part of an effort to estimate national burden 

of disease and guide prevention efforts, such as vaccine 

programs, in the United States. Testing was performed 

by using a commercially available test for high-risk 

HPV DNA (Hybrid Capture 2, Digene, Gaithersburg, 

Maryland). 

Results during 2003–2005 document an overall highrisk HPV prevalence of 23%. Prevalence was 27% in 

STD clinics, 26% in family planning clinics, and 15% 

in primary care clinics. Prevalence by age group was 35% 

in those aged 14–19 years, 29% in those aged 20–29 

years, 13% in those aged 30–39 years, 11% in those aged 

40–49 years, and 6.3% in those aged 50–65 years.3

National population-based data also were obtained from 

NHANES to examine the prevalence of both highrisk HPV and low-risk HPV—including types 6 and 

11, which are responsible for about 90% of anogenital 

warts—in the civilian, noninstitutionalized female 

population during 2003–2004 (Figure 48). The overall 

HPV prevalence of high- and low-risk types was 26.8% 

(95% confidence interval [CI]: 23.3–30.9) among U.S. 

females aged 14–59 years. HPV vaccine-preventable 

types 6 or 11 (low-risk types) or 16 or 18 (high-risk 

types) were detected in 3.4% of female participants: 

HPV-6 in 1.3% (95% CI: 0.8–2.3), HPV-11 in 0.1% 

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

0.9–2.6), and HPV-18 in 0.8% (95% CI: 0.4–1.5).4

Data from the National Disease and Therapeutic Index 

(NDTI) suggest that incidence of genital warts (Figure 

49), as measured by initial visits to physicians’ offices, 

may be increasing. 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.5

For data reported in Figure 50, enhanced behavioral and 

demographic information on patients who presented 

for care in 2009 at the 42 clinics participating in the 

STD Surveillance Network (SSuN) was used. Genital 

warts were identified by provider 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 selfreport 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.
46 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2009

The prevalence of genital warts in 2009 is presented 

separately for MSM, MSW, and women by SSuN 

site. With few exceptions, prevalence was lowest in 

women for most sites and ranged from 1.0% to 4.0%. 

Prevalence was higher or similar among MSM compared 

with MSW in Seattle, Denver, New Orleans, Baltimore, 

and Philadelphia. Prevalence at these sites ranged from 

3.6% to 8.0% for MSM and from 2.3% to 8.6% 

for MSW. Prevalence was higher in MSW compared 

with MSM in the remaining areas (San Francisco, Los 

Angeles, Chicago, and Richmond), ranging from 4.6% 

to 7.0% for MSW and 1.5% to 5.9% for MSM.

Pelvic Inflammatory Disease 

For data on PID, 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 in physicians’ offices for these 

conditions from the NDTI (Figure 51, Table 43).

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% (95% CI: 19.1–23.1) in 1988–1994 to 

17.0% (95% CI: 15.8–18.3) in 1999–2004 and 16.2% 

(95% CI: 14.6–17.9) in 2005–2008. These data, along 

with data from NHANES survey years 1976–1980, 

indicate that blacks had higher seroprevalence than 

whites for each survey period and age group (Figure 52). 

During 2005–2008, the percentage of NHANES survey 

participants aged 20–49 years who reported a diagnosis 

of genital herpes was 18.9%.

Although HSV-2 seroprevalence is decreasing, most 

persons with HSV-2 have not received a diagnosis. 

An increase in the number of visits for genital herpes, 

as suggested by NDTI data, may indicate increased 

recognition of infection.

Trichomoniasis

Case reporting data are not available for trichomoniasis, 

and trend data for this infection are limited to estimates 

of initial physician office visits from NDTI (Figure 53, 

Table 43). 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).6

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(No. 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;178:1795-8.

3 Datta SD, Koutsky L, 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.

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

Patel SS, et al. Prevalence of HPV infection among females in the 

United States. JAMA. 2007;297(8):813-9.

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

among 18- to 59-year-olds in the United States, National Health 

and Nutrition Examination Survey, 1999–2004. Sex Transm Dis. 

2008;35(4):357-60.

6 Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman, S, 

Markowitz LE. The prevalence of Trichomonas vaginalis infection 

among reproductive-age women in the United States, 2001–2004. 

Clin Infect Dis. 2007;45(10):1319-26.
STD Surveillance 2009 National Profile: Other Sexually Transmitted Diseases 47

0

5

10

15

20

25

30

35

40

45

14–19 20–24 25–29 30–39 40–49 50–59

Low-risk HPV*

Figure 48. Human Papillomavirus—Prevalence of High-risk and Low-risk Types Among 

Females Aged 14–59 Years, National Health and Nutrition Examination Survey,

2003–2004

Prevalence, %

* HPV = human papillomavirus.

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

SOURCE: Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, Patel SS, et al. Prevalence of HPV infection among females in the United States. JAMA. 2007;297(8):813-9. 

Copyright ©2007 American Medical Association. All rights reserved.

High-risk HPV

Age

0

1

2

3

4

5

1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009

Figure 47. Chancroid—Reported Cases, United States, 1981–2009

Cases (in thousands)

Year
48 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2009

0

100

200

300

400

500

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

Figure 49. Genital Warts—Initial Visits to Physicians’ Offices, United States, 1966–2009

Visits (in thousands)

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 43.

SOURCE: IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966–2009. 

Year

0

2

4

6

8

10

New Richmond Baltimore Philadelphia

Orleans

Los Seattle Denver Chicago

Angeles

San 

Francisco

MSW*

MSM*

Figure 50. Genital Warts—Prevalence Among Sexually Transmitted Disease (STD) Clinic 

Patients by Sex, Sex of Partners, and Site, STD Surveillance Network, 2009

Percentage

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

NOTE: Data not available for Birmingham, New York City, and Hartford/New Haven STD clinics.

Women
STD Surveillance 2009 National Profile: Other Sexually Transmitted Diseases 49

0

50

100

150

200

250

300

350

400

Figure 51. Genital Herpes—Initial Visits to Physicians’ Offices, United States, 1966–2009

Visits (in thousands)

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 43.

SOURCE: IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966–2009. 

Year

1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008
50 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2009

0

20

40

60

80

100

All Ages* 14–19 20–29 30–39 40–49

0

20

40

60

80

100

All Ages* 14–19 20–29 30–39 40–49 

1976–1980

Figure 52. Herpes Simplex Virus Type 2—Seroprevalence in Non-Hispanic Whites and NonHispanic Blacks by Age Group, National Health and Nutrition Examination Survey,

1976–1980, 1988–1994, 1999–2004, 2005–2008

Percentage

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

NOTE: Error bars indicate 95% condence intervals.

1988–1994 1999–2004 2005–2008

Percentage

Non-Hispanic Blacks

Non-Hispanic Whites

Age

Age
STD Surveillance 2009 National Profile: Other Sexually Transmitted Diseases 51

0

900

1,800

2,700

3,600

4,500

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

Other Vaginitis

Trichomoniasis

Figure 53. Trichomoniasis and Other Vaginal Infections—Women—Initial Visits to

Physicians’ Offices, United States, 1966–2009

Visits (in thousands)

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 Data Sources in the Appendix and Table 43.

SOURCE: IMS Health, Integrated Promotional ServicesTM, IMS Health Report, 1966–2009.

Year

SPECIAL FOCUS PROFILES
SPECIAL FOCUS PROFILES
STD Surveillance 2009 Special Focus Profiles 53

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. They include women and infants, adolescents and young adults, racial and ethnic 

minorities, MSM, and persons entering corrections facilities. The figures cited in this section are located in diseasespecific sections of the National Profile, as well as throughout this section.

STD Surveillance 2009 Special Focus Profiles: STDs in Women and Infants 55

STDs in Women and Infants

Public Health Impact

Women and infants disproportionately bear the longterm consequences of STDs. 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 gonorrrhea may develop PID if they do not receive 

adequate treatment.1 Among women with PID, tubal 

scarring can cause involuntary infertility in 20% of 

women, ectopic pregnancy in 9%, and chronic pelvic 

pain in 18%.2

About 80%–90% of chlamydial infections and 50% of 

gonococcal infections in women are asymptomatic.3–5

These infections are detected primarily through 

screening. The vague symptoms associated with PID 

cause 85% of women to delay seeking medical care, 

thereby increasing the risk for infertility and ectopic 

pregnancy.6 Data from a randomized controlled trial of 

chlamydia screening in a managed care setting suggest 

that such screening programs can reduce the incidence 

of PID by as much as 60%.7

HPV infections are highly prevalent 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.8

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.9

When a woman has a syphilis infection during 

pregnancy, she can transmit the infection to the fetus 

in utero. This transmittal 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.10

Observations

Chlamydia—United States 

During 2008–2009, the rate of chlamydial infections in 

women increased from 579.4 to 592.2 cases per 100,000 

females (Figure 1, Table 4). Chlamydia rates exceeded 

gonorrhea rates among women in all states (Figures A 

and C, Tables 4 and 14).

Prevalence Monitoring Project

Prenatal Clinics—In 2009, the median state-specific 

chlamydia test positivity among women aged 15–24 

years who were screened in selected prenatal clinics in 

18 states, Puerto Rico, and the Virgin Islands was 7.7% 

(range: 3.6% to 20.4%) (Figure B). 

Family Planning Clinics—In 2009, the median statespecific chlamydia test positivity among women aged 

15–24 years who were screened during visits to selected 

family planning clinics in all 50 states, the District of 

Columbia, Puerto Rico, and the Virgin Islands was 

7.5% (range: 3.5% to 15.5%) (Figure 11).

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 
56 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2009

in cases detected through screening, gonorrhea rates 

for both women and men declined steadily throughout 

the 1980s and early 1990s and then reached a plateau 

(Figure 15). The gonorrhea rate for women (105.5 cases 

per 100,000 females) decreased in 2009 for the second 

time in 2 years (Figure 15, Table 14).

Although the gonorrhea rate in men has historically 

been higher than the rate in women, the gonorrhea rate 

among women has been slightly higher than the rate 

among men for 8 consecutive years (Figure 15, Tables 14 

and 15).

Prevalence Monitoring Project

Prenatal Clinics—In 2009, the median state-specific 

gonorrhea test positivity among women aged 15–24 

years who were screened in selected prenatal clinics in 

18 states, Puerto Rico, and the Virgin Islands was 1.2% 

(range: 0.0% to 5.5%) (Figure D).

Family Planning Clinics—In 2009, the median 

state-specific gonorrhea test positivity among women 

aged 15–24 years who were screened during visits to 

selected family planning clinics in 46 states, the District 

of Columbia, Puerto Rico, and the Virgin Islands was 

1.0% (range: 0.0% to 3.4%) (Figure 25).

Congenital Syphilis

Trends in congenital syphilis usually follow trends in 

P&S syphilis among women, with a lag of 1–2 years 

(Figure 46). 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 33). The rate of 

congenital syphilis declined by 92.4% (from a peak of 

107.3 cases to 8.2 cases per 100,000 live births) during 

1991–2005 (Table 40). However, the rate in women has 

increased since 2004, and the rate of congenital syphilis 

has likewise increased since 2005. 

The rate of P&S syphilis among women was 1.4 cases 

per 100,000 women in 2009 (Table 26), and the rate of 

congenital syphilis was 10.0 cases per 100,000 live births 

in 2009 (Table 40). The highest rates of P&S syphilis 

among women and congenital syphilis were observed in 

the South (Figures E and F, Table 40).

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.11

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. Hospitalizations for 

PID declined steadily throughout the 1980s and early 

1990s,12,13 but remained relatively constant from 2000 

through 2007, the most recent year for which data are 

available (Figure G).

The estimated number of initial visits to physicians’ 

offices for PID from NDTI generally declined during 

2000–2009 (Figure H, Table 43).

Racial disparities in diagnosed PID have been observed 

in both ambulatory and hospitalized settings. 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.13

Ectopic Pregnancy

Evidence suggests that health care practices associated 

with clinical management of ectopic pregnancy 

changed in the late 1980s and early 1990s. Before that 

time, treatment of ectopic pregnancy usually required 

admission to a hospital. Hospitalization statistics 

were therefore useful for monitoring trends in ectopic 

pregnancy. During 1997–2006, hospitalizations for 

ectopic pregnancy remained generally stable (Figure I).14

As of the publication date of this report, 2008 data were 

not available. The data that are available suggest that 

nearly half of all ectopic pregnancies are treated on an 

outpatient basis.15
STD Surveillance 2009 Special Focus Profiles: STDs in Women and Infants 57

1 Haggarty CL, Gottlieb S, Taylor BD, Low N, Xu F, Ness RB. 

Risk of sequelae after Chlamydia trachomatis genital infection in 

women. J Infect Dis. 2010;201(Supp 2):S134-55.

2 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.

3 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. Sexually transmitted 

diseases. 4th ed. New York: McGraw-Hill; 2008. p. 627-45.

4 Stamm WE. Chlamydia trachomatis infections in the adult. In: 

Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, 

Corey L, et al, editors. Sexually transmitted diseases. 4th ed. New 

York: McGraw-Hill; 2008. p. 575-93.

5 Johnson RE, Berman SM. Sexual transmission: Chlamydia 

trachomatis. In: Krämer A, Kretzschmar M, Krickeberg K, editors. 

Modern infectious disease epidemiology. New York: Springer; 

2009. p. 357-80.

6 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.

7 Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes 

KK, Stamm WE. Prevention of pelvic inflammatory disease 

by screening for cervical chlamydial infection. N Engl J Med. 

1996;34(21):1362-6.

8 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.

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

Semin Perinatol. 2007;31(1):19-25.

10 Centers for Disease Control and Prevention. Guidelines for 

prevention and control of congenital syphilis. MMWR Morb 

Mortal Wkly Rep. 1988;37(No. SS-1).

11 Centers for Disease Control and Prevention. Congenital syphilis 

— United States, 2003–2008. MMWR Morb Mortal Wkly Rep. 

2010;59:413-17.

12 Rolfs RT, Galaid EI, Zaidi AA. Pelvic inflammatory disease: trends 

in hospitalization and office visits, 1979 through 1988. Am J 

Obstet Gynecol. 1992;166:983-90.

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

Trends in pelvic inflammatory disease hospital discharges and 

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

2005;32(12)778-84.

14 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.

15 Centers for Disease Control and Prevention. Ectopic pregnancy in 

the United States, 1990–1992. MMWR Morb Mortal Wkly Rep.

1995;44:46-8.
58 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2009

480

427

554

558

442

1,024

Puerto Rico

308

Virgin

Islands

753

Guam

592

406 253

637

475

919

678

366

297

695

549

389

531

1,177 808

566

701

567

624

667

499

680

623

602

913

734

681

441

603 290

589

447

582

Figure A. Chlamydia—Women—Rates by State, United States and Outlying Areas, 2009

NOTE: The total chlamydial infection rate among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 588.5 per 

100,000 female population.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 282

 231

 412

 480

 498

 423

 794

 646

1,331

Rate per 100,000

population

689

<400.0 (n = 8)

400.1–600.0 (n = 24)

>600.0 (n = 22)

452

432

591

4.8

Puerto Rico

12.7

Virgin

Islands

16.3

Guam

7.1

8.4

12.9

13.7

13.9

6.7

7.5

7.9

6.5

3.6 8.1

20.4

10.6

6.9

5.0

4.6

6.8

Figure B. Chlamydia—Positivity Among Women Aged 15–24 Years Tested in Prenatal Clinics, 

by State, Infertility Prevention Project, United States and Outlying Areas, 2009

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

NOTE: Includes states and outlying areas that reported chlamydia positivity data on at least 100 women aged 15–24 years during 2009.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

* (n = 33)

Positivity, %

<5.0 (n = 3)

5.0–9.9 (n = 10)

>10.0 (n = 7)
STD Surveillance 2009 Special Focus Profiles: STDs in Women and Infants 59

28.9

26.5

51.3

64.8

9.5

157.0

Puerto Rico

6.1

Virgin

Islands

155.7

Guam

37.0

27.5 9.2

79.0

88.4

217.7

131.9

6.7

5.2

56.7

16.8

47.1

91.3

48.5

110.0

286.2

176.4

147.4

115.3

167.2

109.2

166.0

168.0

123.2

137.0

118.6

152.4

225.8

175.9

171.9

97.7

61.3

45.5

69.0

109.3

Figure C. Gonorrhea—Women—Rates by State, United States and Outlying Areas, 2009

NOTE: The total gonorrhea infection rate among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 104.1 per 

100,000 female population.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 9.2

 8.1

 29.2

 26.9

 83.1

 55.0

125.4

118.9

395.3

Rate per 100,000

population

<19.0 (n = 8)

19.1–100.0 (n = 22)

>100.0 (n = 24)

41.3

30.4

Puerto Rico

0.2

Virgin

Islands

1.9

Guam

396

0.5

2.4

1.3

0.0

2.1

2.2

0.8

1.3

1.3

1.2 0.7

5.5

2.0

1.6

0.2

0.0 0.7 0.4

Figure D. Gonorrhea—Positivity Among Women Aged 15–24 Years Tested in Prenatal Clinics, 

by State, Infertility Prevention Project, United States and Outlying Areas, 2009

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

NOTE: Includes states and outlying areas that reported gonorrhea positivity data on at least 100 women aged 15–24 years during 2009.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

* (n = 33)

Positivity, %

<1.0 (n = 9)

1.0–1.9 (n = 6)

>2.0 (n = 5)
60 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2009

1.2

0.0

10.8

7.5

0.0

0.0

Puerto Rico

10.3

Virgin

Islands

0.0

Guam

0.0

11.6 0.0

6.0

2.7

0.0

31.5

4.1

0.0

0.0

0.0

0.0

0.0

1.4

0.0

17.4

20.6

9.4

8.9

7.8

1.9

4.6

3.1

1.1

15.4

7.4

3.7

17.4

24.4

8.9

3.4

0.0 0.0

27.3

0.0

7.3

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

Outlying Areas, 2009

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 10.0 per 100,000 live births.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 0.0

 0.0

 0.0

 8.1

 4.8

 6.1

 8.3

40.0

 0.0

Rates per 100,000

live births

<1.0 (n = 20)

1.1–10.0 (n = 23)

>10.0 (n =11)

5.3

0.2

0.1

0.4

0.5

0.0

0.0

Puerto Rico

1.1

Virgin

Islands

0.0

Guam

1.2

0.3 0.0

0.5

0.7

0.4

4.0

0.0

0.0

0.6

0.4

0.0

0.0

0.0

0.4

4.8

5.7

2.1

1.6

2.3

0.6

1.1

0.8

0.4

3.8

0.5

1.3

15.4

7.1

0.8

0.2

0.2 0.2

0.7

0.4

0.6

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

Outlying Areas, 2009

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 1.4 per 100,000 females.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

0.0

0.0

0.1

0.2

0.1

0.6

2.4

1.4

3.2

Rate per 100,000

population

<0.2 (n = 19)

0.21–4.0 (n = 31)

>4.0 (n = 4)

0.9
STD Surveillance 2009 Special Focus Profiles: STDs in Women and Infants 61

0

60

120

180

240

300

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

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

15–44 Years, United States, 2000–2009

Visits (in thousands)

NOTE: The relative standard errors for these estimates are 21.6%–30%. See Other Data Sources in the Appendix and Table 43.

SOURCE: IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966–2009. 

Year

0

15

30

45

60

75

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Chronic

Acute, Unspecied

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

United States, 1998–2007

Hospitalizations (in thousands)

NOTE: The relative standard errors for these estimates of acute unspecied pelvic inammatory disease (PID) cases are 11.9%–17.2%. The relative

standard errors for these estimates of chronic PID cases are 11%–18%. Data only available through 2007.

SOURCE: 2007 National Hospital Discharge Survey [Internet]. Atlanta: Centers for Disease Control and Prevention. Available from: 

http://www.cdc.gov/nchs/nhds/about/nhds.htm.

Year
62 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2009

0

10

20

30

40

50

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

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

1998–2007

Hospitalizations (in thousands)

NOTE: The relative standard error for these estimates is 14.2%. Data only available through 2007.

SOURCE: 2007 National Hospital Discharge Survey [Internet]. Atlanta: Centers for Disease Control and Prevention. Available from: 

http://www.cdc.gov/nchs/nhds/about/nhds.htm. 

Year
STD Surveillance 2009 Special Focus Profiles: STDs in Adolescents and Young Adults 63

STDs in Adolescents and Young Adults

Public Health Impact

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 C. trachomatis, adolescent females 

may have a physiologically 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 insurance or other ability to 

pay, lack of transportation, discomfort with facilities 

and services designed for adults, and concerns about 

confidentiality.

Estimates suggest that even though young people 

aged 15–24 years represent only 25% of the sexually 

experienced population, they acquire nearly half of all 

new STDs.1

Observations

Chlamydia

Chlamydia rates for persons aged 15–19 years and 

20–24 years continue to increase. During 2008–2009, 

the increase was 2.4% for those aged 15–19 years and 

4.0% for those aged 20–24 years (Table 10).

15- to 19-Year-Old Women—In 2009, as in previous 

years, women aged 15–19 years had the highest rate of 

chlamydia compared with any other age or sex group 

(Figure 5, Table 10). Chlamydia rates for women in 

this age group increased 1.8%, from 3,269.5 cases per 

100,000 population in 2008 to 3,329.3 cases in 2009.

20- to 24-Year-Old Women—In 2009, as in previous 

years, women aged 20–24 years had the second 

highest rate of chlamydia (3,273.9 cases per 100,000 

population) compared with any other age or sex group. 

Chlamydia rates for women in this age group increased 

3.3% during 2008–2009.

15- to 19-Year-Old Men—Chlamydia rates for men 

aged 15–19 years increased 5.0%, from 700.3 cases per 

100,000 population in 2008 to 735.5 cases in 2009.

20- to 24-Year-Old Men—In 2009, as in previous 

years, men aged 20–24 years had the highest rate of 

chlamydia (1,120.6 cases per 100,000 population). 

Chlamydia rates for men in this age group increased 

6.0% during 2008–2009.

Gonorrhea

In 2009, gonorrhea rates for persons aged 15–19 years 

and 20–24 years decreased for the second year in a row. 

During 2008–2009, the gonorrhea rate decreased 10.3% 

for those aged 15–19 years and decreased 7.4% for those 

aged 20–24 years (Table 20).

15- to 19-Year-Old Women—In 2009, as in previous 

years, women aged 15–19 years had the highest rate 

of gonorrhea (568.8 cases per 100,000 population) 

compared with any other age or sex group (Figure 20, 

Table 20). During 2008–2009, gonorrhea rates for 

women of this age group decreased 10.5%. 

20- to 24-Year-Old Women—In 2009, as in previous 

years, women aged 20–24 years had the second highest 

rate of gonorrhea (555.3 cases per 100,000 population) 

compared with any other age or sex group. During 

2008–2009, gonorrhea rates for women in this age 

group decreased 8.5%.

15- to 19-Year-Old Men—In 2009, as in previous 

years, men aged 15–19 years had the second highest 

rate of gonorrhea (250.0 cases per 100,000 population). 

During 2008–2009, gonorrhea rates for men in this age 

group decreased 10.0% (Figure 21, Table 20).

20- to 24-Year-Old Men—In 2009, as in previous 

years, men aged 20–24 years had the highest rate of 

gonorrhea (407.5 cases per 100,000 population). 

During 2008–2009, gonorrhea rates for men in this age 

group declined 6.1%.
64 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2009

Primary and Secondary Syphilis 

Syphilis rates among women aged 15–19 years have 

increased annually since 2004, from 1.5 cases per 

100,000 population to 3.3 in 2009. Rates in women 

have been highest each year among those aged 20–24 

years, with 5.6 cases per 100,000 population in 2009 

(Figures 38 and 39, Table 33). 

Rates among men aged 15–19 years are much lower 

than the rates among men in older age groups (Figure 

38). However, rates in this group have increased since 

2002, from 1.3 cases per 100,000 population to 6.0 

cases in 2009. Men aged 20–24 years had the highest 

rate of syphilis (20.7 cases per 100,000 population) in 

2009 (Figure 38, Table 33).

Prevalence Monitoring

Chlamydia test positivity among women aged 15–19 

years screened in family planning clinics fluctuated in all 

10 HHS regions during 2005–2009 (Figure J). In 2009, 

positivity ranged from 5.8% in Region I to 13.2% in 

Region VI. Test positivity data presented in Figure J are 

not adjusted for changes in laboratory test methods and 

associated increases in test sensitivity.

National Job Training Program 

Since 1990 about 20,000 female NJTP entrants have 

been screened each year for chlamydia. Since 2004, 

about 35,000 male entrants have been screened annually. 

This educational program for socioeconomically 

disadvantaged youth aged 16–24 years is administered 

at more than 100 sites throughout the country. The data 

presented are from sites where more than 100 persons 

were screened in 2009.

Chlamydial infection is widespread geographically 

and highly prevalent among socioeconomically 

disadvantaged young women and men entering the 

NJTP.2

 Specimens from students in each state and 

outlying area were tested by a single national contract 

laboratory.* 

Among women entering the program in 43 states, the 

District of Columbia, and Puerto Rico, the median 

state-specific chlamydia prevalence was 11.3% (range: 

4.2% to 19.0%) (Figure K). 

Among men entering the program in 48 states, the 

District of Columbia, and Puerto Rico, the median 

state-specific chlamydia prevalence was 7.0% (range: 

2.4% to 11.7%) (Figure L).

The data from NJTP centers that submit gonorrhea 

specimens from female students aged 16–24 years to the 

national contract laboratory indicated a high prevalence 

of gonococcal infection in this population. Among 

women entering the program in 41 states, the District 

of Columbia, and Puerto Rico, the median state-specific 

gonorrhea prevalence in 2009 was 1.6% (range: 0.0% 

to 5.0%) (Figure M). Among men entering the program 

in 33 states, the District of Columbia, and Puerto Rico, 

the median state-specific gonorrhea prevalence was 0.6% 

(range: 0.0% to 3.4%) (Figure N).

Juvenile Corrections Facilities

Among adolescent females entering juvenile corrections 

facilities, the median facility-specific chlamydia positivity 

was 14.4% (range: 1.8% to 35.7%); the median 

gonorrhea positivity was 2.9% (range: 0.0% to 13.4%). 

Among adolescent males entering juvenile corrections 

facilities, the median facility-specific chlamydia positivity 

was 6.0% (range: 0.0% to 19.4%); the median 

gonorrhea positivity rate was 0.7% (range: 0.0% to 

6.5%). See the STDs in Persons Entering Corrections 

Facilities section for more details.

* Laboratory data are provided by the Center for Disease Detection, 

San Antonio, Texas.

1 Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases 

among American youth: incidence and prevalence estimates, 2000. 

Perspect Sex Reprod Health. 2004:36(1):6-10.

2 Satterwhite CL, Tian LH, Braxton J, Weinstock H. Chlamydia 

prevalence among women and men entering the National Job 

Training Program: United States, 2003–2007. Sex Transm Dis. 

2010;37(2):63-7.
STD Surveillance 2009 Special Focus Profiles: STDs in Adolescents and Young Adults 65

NOTE: See Denition of HHS Regions in the Appendix for denitions.

Figure J. Chlamydia—Trends in Positivity Among Women Aged 15–19 Years Tested in Family 

Planning Clinics, by U.S. Department of Health and Human Services (HHS) 

Region, Infertility Prevention Project, 2005–2009

IV

VII IX

I II

X

III

VI

V

VIII

Region I

Region II

Region III

Region IV

Region V

Region VI Region VII

Region VIII

Region IX

Region X

5.4

05

5.5

06

5.6

07

5.8

08

5.8

09

7.3

05

7.3

06

7.6

07

8.3

08

8.9

09

7.1

05

6.5

06

6.8

07

7.9

08

8.0

09

10.7

05

11.0

06

11.7

07

11.9

08

11.8

09

9.0

05

8.9

06

9.0

07

9.3

08

9.8

09

9.2

05

10.2

06

10.7

07

12.6

08

13.2

09

6.7

05

7.5

06

7.6

07

7.9

08

9.0

09

6.6

05

7.7

06

8.1

07

8.7

08

8.5

09

7.4

05

8.3

06

9.0

07

9.3

08

9.8

09

6.5

05

6.6

06

6.8

07

7.2

08

7.0

09

6.1

4.5

7.4

10.5

11.1

10.7

11.9

9.3

4.9

Puerto Rico

8.9

Virgin

Islands

Guam

7.2 4.7

12.5

9.9

12.8

15.0

5.3

15.6

14.7

15.9

14.3

15.7

9.2

14.0

15.6

13.8

14.5

13.6

12.1

19.0

16.5

12.4

11.3

10.3

9.7

9.7

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

Training Program, by State of Residence, United States and Outlying Areas, 2009

* Fewer than 100 women who resided in these states/areas and entered the National Job Training Program were screened for chlamydia in 2009.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

4.2

 7.6

 6.7

12.3

14.9

11.8

10.8

14.8

* (n = 8)

Prevalence, %

<10.0 (n = 16)

10.0–14.9 (n = 22)

11.0 >15.0 (n = 7)
66 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2009

0.2

0.7

0.7

1.6

0.5

0.0

Puerto Rico

0.0

Virgin

Islands

Guam

396

0.5 1.2

1.1

0.7

0.0

2.5

2.3

4.3

3.0

1.6

2.4

0.7

3.2

2.0

1.8

1.1

2.7

1.5

3.4

2.6

4.0

2.0

1.1

0.0

0.0

3.2

2.0

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

Training Program, by State of Residence, United States and Outlying Areas, 2009

* Fewer than 100 women who resided in these states/areas and entered the National Job Training Program were screened for gonorrhea in 2009.

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 number of gonorrhea 

tests submitted was greater than 90% of the number of chlamydia tests submitted.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

0.0

0.9

0.0

1.6

2.7

0.6

1.6

5.0

* (n =10)

Prevalence, %

<2.0 (n = 27)

2.0–4.9 (n = 15)

1.7 >5.0 (n = 1)

2.4

2.8

3.4

3.0

4.4

7.0

Puerto Rico

4.3

Virgin

Islands

Guam

396

2.4 3.8

8.6

6.4

10.6

9.6

3.1

4.7

6.9

4.1

4.3

5.7

7.4

11.1

9.1

11.2

7.9

9.2

9.7

10.7

10.2

6.9

10.3

8.8

6.7

10.8

10.8

11.7

8.5

7.1 8.8

5.1

4.5

5.0

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

Training Program, by State of Residence, United States and Outlying Areas, 2009

* Fewer than 100 men who resided in these states/areas and entered the National Job Training Program were screened for chlamydia in 2009.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 3.4

 5.6

 4.5

 6.1

 9.7

 8.7

 10.8

8.2

* (n = 3)

Prevalence, %

<10.0 (n = 40)

10.0–14.9 (n = 10)

5.7 >15.0
STD Surveillance 2009 Special Focus Profiles: STDs in Adolescents and Young Adults 67

0.0

0.4

0.0

Puerto Rico

0.0

Virgin

Islands

Guam

396

0.1

0.8

0.6

3.4

1.4

0.2

0.0

0.3

0.0

1.1 0.8

1.6

2.1

1.2

1.9

1.1

1.3

0.3

0.9

0.5

0.8

1.9

0.3

0.6 2.0

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

Training Program, by State of Residence, United States and Outlying Areas, 2009

* Fewer than 100 men who resided in these states/areas and entered the National Job Training Program were screened for gonorrhea in 2009.

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.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

0.3

0.5

0.0

0.3

0.7

1.2

* (n = 18)

Prevalence, %

<2.0 (n = 32)

2.0–4.9 (n = 3)

STD Surveillance 2009 Special Focus Profiles: STDs in Racial and Ethnic Minorities 69

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 risk markers that correlate 

with other more fundamental determinants of health 

status, such as poverty, access to quality health care, 

health care-seeking behavior, illicit drug use, and 

living in communities with high prevalence of STDs. 

Acknowledging the disparity in STD rates by race or 

ethnicity is one of the first steps in empowering affected 

communities to organize and focus on this problem.

STD Reporting Practices

Surveillance data are based on cases of STDs reported to 

state and local health departments (see 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.1 However, prevalence 

data from population-based surveys, such as NHANES 

and Add Health, confirm the existence of marked STD 

disparities in some minority populations.2,3

Completeness of Race/Ethnicity Data

Cases for which information is unknown are 

redistributed according to the distribution of cases in 

which race or ethnicity is known to adjust for missing 

case report data. This process may exacerbate any 

reporting bias.

Chlamydia—In 2009, 26.0% of chlamydia case reports 

were missing race or ethnicity data, ranging by state 

from 0.1% to 59.5% (Table A1).

Gonorrhea—In 2009, 20.1% of gonorrhea case reports 

were missing information on race or ethnicity data, 

ranging by state from 0.0% to 41.8% (Table A1).

Syphilis—In 2009, 2.0% of syphilis case reports were 

missing information on race or ethnicity data, ranging 

from 0.0% to 19.7% among states with 10 or more 

cases of P&S syphilis (Table A1).

Observations

Chlamydia

Chlamydia rates based on reported cases increased 

during 2008–2009 among blacks, whites, and Hispanics 

(Table 11B). Among Asians/Pacific Islanders and 

American Indians/Alaska Natives, rates decreased 

slightly. During 2005–2009, chlamydia rates increased 

by 26.3% among blacks, 3.9% among American 

Indians/Alaska Natives, 13.4% among Hispanics, 0.4% 

among Asians/Pacific Islanders, and 17.9% among 

whites. 

Blacks—In 2009, about 48% of all reported chlamydia 

cases occurred among blacks (Table 11A). Overall, the 

rate of chlamydia among blacks in the United States was 

more than eight times that among whites. The rate of 

chlamydia among black women was nearly eight times 

higher than the rate among white women (2,095.5 and 

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

Table 11B). The chlamydia rate among black men was 

almost 12 times as high as the rate among white men 

(970.0 and 84.0 cases per 100,000 men, respectively).

American Indians/Alaska Natives—In 2009, the 

chlamydia rate among American Indians/Alaska Natives 

was 776.5 cases per 100,000 population, a decrease of 

1.5% from the 2008 rate of 788.3. Overall, the rate of 

chlamydia among American Indians/Alaska Natives in 

the United States was more than four times that among 

whites. 

Asians/Pacific Islanders—In 2009, the chlamydia 

rate among Asians/Pacific Islanders was 149.0 cases per 

100,000 population, a slight decrease from the 2008 rate 

of 149.3. The overall rate among Asians/Pacific Islanders 

was lower than the rate among whites.
70 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2009

Hispanics—In 2009, the chlamydia rate among 

Hispanics was 504.2 cases per 100,000 population, 

which is a small increase from the 2008 rate of 494.8 

cases and nearly three times higher than the rate among 

whites (178.8).

Gonorrhea

During 2008–2009, gonorrhea rates decreased 12.0% 

in whites, 10.6% in blacks, 9.6% in Hispanics, and 

8.1% in Asians/Pacific Islanders. The gonorrhea rate in 

American Indians/Alaska Natives increased 5.5% (Figure 

22, Table 21B).

Blacks—In 2009, about 71% of all reported cases of 

gonorrhea occurred among blacks (Table 21A). The 

rate of gonorrhea among blacks in 2009 was 556.4 

cases per 100,000 population (Table 21B), which was 

20.5 times higher than the rate among whites. This 

disparity has changed little in recent years (17.6 times 

higher in 2005 and 20.1 times higher in 2008) (Figure 

P, Table 21B). This disparity was larger for black men 

(25.8 times higher) than for black women (17.0 times 

higher) (Figure Q). 

As in 2008, the disparity in gonorrhea rates for blacks 

in 2009 was larger in the Midwest and Northeast (28.4 

and 26.7 times higher, respectively) than in the South 

or the West (16.2 and 13.9 times higher, respectively) 

(Figure R).

Considering all racial, ethnic, and age categories, 

gonorrhea rates were highest for blacks aged 15–19 

and 20–24 years in 2009. Black women aged 15–19 

years had a gonorrhea rate of 2,613.8 cases per 100,000 

women. This rate was 16.7 times higher than the rate 

among white women in the same age group (156.7). 

Black men aged 15–19 years had a gonorrhea rate of 

1,316.4 cases per 100,000 men, which was 38.3 times 

higher than the rate among white men in the same age 

group (34.4). Among men and women aged 20–24 

years, the gonorrhea rate among blacks was 17.8 times 

higher than the rate among whites (2,356.7 and 132.2, 

respectively) (Table 21B).

American Indians/Alaska Natives—In 2009, the 

gonorrhea rate among American Indians/Alaska Natives 

was 113.3 cases per 100,000 population, which was 4.2 

times higher than the rate among whites. This disparity 

was similar to that in recent years (3.7 times higher in 

2005) (Figure P, Table 21B). The disparity between 

gonorrhea rates for American Indians/Alaska Natives 

and whites was larger for American Indian/Alaska Native 

women (4.5 times higher) than for American Indian/

Alaska Native men (3.6 times higher) (Figure Q). 

In 2009, the disparity in gonorrhea rates for American 

Indians/Alaska Natives was slightly larger in the West 

and Midwest (4.7 times higher in both regions) than 

in the Northeast or South (3.5 and 3.0 times higher, 

respectively) (Figure R).

Asians/Pacific Islanders—In 2009, the gonorrhea 

rate among Asians/Pacific Islanders was 18.1 cases per 

100,000 population, which was lower than the rate 

among whites (Figure P, Table 21B). This difference is 

larger for Asian/Pacific Islander women than for Asian/

Pacific Islander men (Figure Q). In 2009, rates among 

Asians/Pacific Islanders were again lower than rates 

among whites in all four regions of the United States 

(Figure R).

Hispanics—In 2009, the gonorrhea rate among 

Hispanics was 58.6 cases per 100,000 population, which 

was higher than the rate among whites. This disparity 

was similar to that in recent years (Figure P, Table 21B) 

and was higher for Hispanic men than for Hispanic 

women. The disparity in gonorrhea rates for Hispanics 

was larger in the Northeast (4.1 times higher) than in 

the South (2.2 times higher), the Midwest (1.9 times 

higher), or the West (1.7 times higher) (Figure R).

Primary and Secondary Syphilis

The syphilis epidemic in the late 1980s occurred 

primarily among men who have sex with women only 

(MSW) and minority populations.4,5 During the 1990s, 

the rate of P&S syphilis declined among all racial and 

ethnic groups (Figure 33). During 2005–2009, the rate 

increased among all racial and ethnic groups except 

American Indians/Alaska Natives (Table 34B).

Blacks—During 2008–2009, the rate of P&S syphilis 

among blacks increased 11.6% (from 17.2 to 19.2 cases 

per 100,000 population). In 2009, 52.4% of all cases 

reported to CDC were among blacks and 30.4% of all 

cases were among whites (Table 34A). 
STD Surveillance 2009 Special Focus Profiles: STDs in Racial and Ethnic Minorities 71

Compared with whites, the overall 2009 rate for blacks 

was 9.1 times higher, while the 2008 rate was 7.8 times 

higher (Table 34B). In 2009, the rate of P&S syphilis 

among black men was 8 times higher than the rate 

among white men; the rate among black women was 

more than 20 times higher than the rate among white 

women (Figure S).

In some age groups, particularly black men and women 

aged 15–19 years and 20–24 years, disparities have 

increased markedly in recent years as rates of disease 

have increased (Figures T and U). During 2005–2009, 

rates among men aged 15–19 years increased the most 

among black men (167%) (Table 34B). During the 

same period, rates among black men aged 20–24 years 

increased 212% (from 30.2 to 94.2 cases per 100,000 

population); this increase was the highest reported 

regardless of age, sex, or race/ethnicity. The 2009 rate 

among men aged 15–19 years was 26 times higher for 

blacks than for whites. 

Among black women aged 15–24 years, rates increased 

more than twofold during 2005–2009. In 2009, rates 

were 29 times higher for black women aged 15–19 years 

than for white women of the same age.

Recent trends in syphilis rates in young black men are 

of particular concern given data indicating high HIV 

incidence in this population.6

American Indians/Alaska Natives—During 2008–

2009, the rate of P&S syphilis among American 

Indians/Alaska Natives increased 4.3% (from 2.3 to 2.4 

cases per 100,000 population). In 2009, 0.4% of all 

cases reported to CDC were among American Indians/

Alaska Natives (Table 34A). Compared with whites, the 

2009 rate of P&S syphilis for American Indians/Alaska 

Natives was 1.1 times higher (Table 34B).

Asians/Pacific Islanders—During 2008–2009, the rate 

of P&S syphilis among Asians/Pacific Islanders increased 

6.7% (from 1.5 to 1.6 cases per 100,000 population). In 

2009, 1.6% of all cases reported to CDC were among 

Asians/Pacific Islanders (Table 34A). Compared with 

whites, the 2009 rate of P&S syphilis for Asians/Pacific 

Islanders was 0.8 times higher (Table 34B).

Hispanics—During 2008–2009, the rate of P&S 

syphilis among Hispanics decreased 2.2% (from 4.6 to 

4.5 cases per 100,000 population). In 2009, 15.1% of 

all cases reported to CDC were among Hispanics (Table 

34A). Compared with whites, the 2009 rate of P&S 

syphilis for Hispanics was 2.1 times higher (Table 34B).

Congenital Syphilis

In 2009, the rate of congenital syphilis (which is based 

on the mother’s race/ethnicity) was 34.9 cases per 

100,000 live births among blacks and 12.0 cases per 

100,000 live births among Hispanics. These rates are 

12.9 and 4.4 times higher, respectively, than the rate 

among whites (2.7 cases per 100,000 live births) 

(Figure V, Table 41).

1 Miller WC. Epidemiology of chlamydial infection: are we losing 

ground? Sex Transm Infect. 2008;84:82-6. 

2 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.

3 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.

4 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.

5 Peterman TA, Heffelfinger JD, Swint EB, Groseclose SL. 

The changing epidemiology of syphilis. Sex Transm Dis. 

2005;32(Suppl 10):S4-10.

6 Centers for Disease Control and Prevention. Subpopulation 

estimates from the HIV incidence surveillance system — United 

States, 2006. MMWR Morb Mortal Wkly Rep. 2008;57:985-9.
72 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2009

2,500 2,000 1,500 1,000 500 0 0 500 1,000 1,500 2,000 2,500

AI/AN*

A/PI*

Blacks

* AI/AN = American Indians/Alaska Natives; A/PI = Asians/Pacic Islanders.

Hispanics

Whites

Total

72.0

970.0

237.7

84.0

219.3

323.8

221.9

2,095.5

788.8

270.2

592.2

1,214.9

Men Rate (per 100,000 population) Women

Race/

Ethnicity

Figure O. Chlamydia—Rates by Race/Ethnicity and Sex, United States, 2009

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Hispanics

Blacks

Asians/Pacic Islanders

American Indians/Alaska Natives

Figure P. Gonorrhea—Rate Ratios* by Race/Ethnicity, United States, 2000–2009

Rate Ratio†

* Rate ratios are calculated as the gonorrhea rate per 100,000 population for a given racial or ethnic minority population divided by the gonorrhea rate

per 100,000 population for non-Hispanic whites. Any population with a lower rate of gonorrhea than the non-Hispanic white population will have a 

rate ratio of less than 1:1.

†

 Y-axis is log scale.

1:2

1:1

2:1

4:1

8:1

16:1

32:1

Year
STD Surveillance 2009 Special Focus Profiles: STDs in Racial and Ethnic Minorities 73

Midwest

West

Figure R. Gonorrhea—Rate Ratios* by Race/Ethnicity and Region, United States, 2009

Rate Ratio†

* Rate ratios are calculated as the gonorrhea rate per 100,000 population for a given racial or ethnic minority population divided by the gonorrhea rate

per 100,000 population for non-Hispanic whites. Any population with a lower rate of gonorrhea than the non-Hispanic white population will have a 

rate ratio of less than 1:1.

†

 Y-axis is log scale.

‡

 A/PI = Asians/Pacic Islanders; AI/AN = American Indians/Alaska Natives.

South

Northeast

1:4

1:2

1:1

2:1

4:1

8:1

16:1

32:1

AI/AN‡ A/PI‡ Blacks Hispanics

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

AI/AN*

A/PI*

Blacks

* AI/AN = American Indians/Alaska Natives; A/PI = Asians/Pacic Islanders.

Hispanics

Whites

Total

17.6

555.2

54.5

21.5

91.9

78.2

18.5

557.5

63.0

32.8

105.5

147.3

Men Rate (per 100,000 population) Women

Race/

Ethnicity

Figure Q. Gonorrhea—Rates by Race/Ethnicity and Sex, United States, 2009
74 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2009

35 28 21 14 7 0 0 7 14 21 28 35

* AI/AN = American Indians/Alaska Natives; A/PI = Asians/Paci	c Islanders.

3.0

31.3

8.1

3.9

7.8

3.9

0.2

8.2

0.6

0.4

1.4

0.9

Men Rate (per 100,000 population) Women

Figure S. Primary and Secondary Syphilis—Rates by Race/Ethnicity and Sex, United States, 2009

AI/AN*

A/PI*

Blacks

Hispanics

Whites

Total

Race/

Ethnicity

0

5

10

15

20

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Whites

Hispanics

Blacks

Asians/Pacic Islanders

American Indians/Alaska Natives

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

Race/Ethnicity, United States, 2000–2009

Rate (per 100,000 population)

Year
STD Surveillance 2009 Special Focus Profiles: STDs in Racial and Ethnic Minorities 75

0

5

10

15

20

25

30

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Whites

Hispanics

Blacks

Asians/Pacic Islanders

American Indians/Alaska Natives

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

Race/Ethnicity, United States, 2000–2009

Rate (per 100,000 population)

Year

0

10

20

30

40

50

60

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Whites

Hispanics

Blacks

Asians/Pacic Islanders

American Indians/Alaska Natives

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

United States, 2000–2009

Rate (per 100,000 live births)

NOTE: Less than 1% of cases had missing maternal race/ethnicity information and were excluded.

Year

STD Surveillance 2009 Special Focus Profiles: STDs in Men Who Have Sex with Men 77

STDs in Men Who Have Sex with Men

Public Health Impact

Notifiable disease surveillance data on syphilis and data 

from GISP suggest that some STDs in MSM, including 

men who have sex with both women and men, are 

increasing.1–4 Because STDs and the behaviors associated 

with acquiring them increase the likelihood of acquiring 

and transmitting HIV infection,5

 the rise in STDs 

among MSM may be associated with an increase in HIV 

diagnoses among MSM.6

With the exception of reported syphilis cases, most 

nationally notifiable STD surveillance data do not 

include information on sexual behaviors; therefore, 

data on national trends in STDs among MSM in the 

United States are not currently available. Furthermore, 

testing strategies are often suboptimal for detecting 

STDs in MSM. Testing for gonorrhea and chlamydia 

in MSM largely focuses on detecting urethral 

infections, which are more likely to be symptomatic 

than pharyngeal or rectal infections.7 Data from 

enhanced surveillance projects are presented in this 

section to provide information on STDs in MSM.

STD Surveillance Network—Monitoring 

Trends in Prevalence of STDs Among 

MSM Who Visit STD Clinics, 2009

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.8

 SSuN 

currently includes 12 collaborating local and state 

health departments. In 2009, 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. During 1999–2008, similar 

enhanced surveillance data were collected in eight STD 

clinics, including three community-based gay men’s 

health clinics, through the MSM Prevalence Monitoring 

Project.9

For data reported in this section, MSM were defined as 

men who either reported having sex with another man 

in the 3 months before STD testing or who self-reported 

as gay/homosexual or bisexual. MSW were defined 

as men who reported having sex with women only 

within the 3 months before STD testing 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 2009, the proportion of MSM who tested positive for 

gonorrhea and chlamydia at SSuN STD clinics varied 

by city (Figure W). A larger proportion of MSM who 

visited SSuN STD clinics tested positive for gonorrhea 

than tested positive for chlamydia in all cities except 

New Orleans (where the proportions were equal) and 

Birmingham (where the proportion for chlamydia was 

higher). 

Across the participating sites, about the same number of 

MSM were tested for gonorrhea (17,007) and chlamydia 

(16,615). The median site-specific gonorrhea prevalence 

was 14.9% (range by site: 6.5%–27.9%). The median 

site-specific chlamydia prevalence was 11.2% (range by 

site: 4.5%–18.5%). For this report, a person who tested 

positive for gonorrhea or chlamydia more than one time 

was counted only once.

Co-infection with P&S Syphilis 

and HIV

In 2009, the proportion of MSM who presented to 

SSuN clinics with P&S syphilis infection who also were 

infected with HIV ranged from 30% in Birmingham to 

74% in Baltimore (Figure X). The median site-specific 

proportion was 44.4%. P&S syphilis was identified by 

provider diagnosis and HIV was identified by laboratory 

report, self-report, or provider diagnosis.
78 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2009

Nationally Notifiable Syphilis 

Surveillance Data

P&S syphilis increased in the United States during 

2005–2009, with a 59.3% increase in the number of 

P&S syphilis cases among men and a 66.7% increase 

among women (Tables 26 and 27). In 2009, the rate 

of reported P&S syphilis among men (7.8 cases per 

100,000 males) was 5.6 times higher than the rate 

among women (1.4 cases per 100,000 females) (Tables 

26 and 27). Higher rates were observed in men than in 

women for all racial and ethnic groups.

In 2009, MSM accounted for 62% of all P&S syphilis 

cases in the United States. MSM accounted for more 

cases than MSW or women in all racial and ethnic 

groups (Figure 43). 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 

strains of N. gonorrhoeae in the United States.4,10 GISP 

also reports the percentage of N. gonorrhoeae isolates 

obtained from MSM. Overall, the proportion of isolates 

from MSM in selected STD clinics from GISP sentinel 

sites has increased steadily, from 4.6% in 1990 to 25.3% 

in 2009 (Figure Y). The proportion of isolates from 

MSM varies geographically, with the largest proportion 

reported from the West Coast (Figure Z).

More information on GISP can be found in the 

Gonorrhea section of the National Profile.

1 Fox KK, del Rio C, Holmes KK, Hook EW 3rd, Judson FN, 

Knapp JS, et al. Gonorrhea in the HIV era: a reversal in trends 

among men who have sex with men. Am J Public Health. 

2001;91:959-64.

2 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.

3 Helms DJ, Weinstock HS, Asbel LE, Ciesielski C, Cherneskie T, 

Furness BW, et al. Increases in syphilis among men who have sex 

with men attending STD clinics, 2000–2005. In: Program and 

abstracts of the 17th Biennial Meeting of the ISSTDR; 2007 Jul 

29-Aug 1; Seattle, WA. Abstract No. P-608.

4 Centers for Disease Control and Prevention. Sexually transmitted 

disease surveillance 2007 supplement: Gonococcal Isolate 

Surveillance Project (GISP) annual report 2007. Atlanta: U.S. 

Department of Health and Human Services; 2009.

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 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.

8 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. Public Health Reports. 

2009;124(Suppl 2):72–77.

9 Centers for Disease Control and Prevention. Sexually transmitted 

disease surveillance 2008. Atlanta: U.S. Department of Health and 

Human Services; 2009.

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(11):1413-7.
STD Surveillance 2009 Special Focus Profiles: STDs in Men Who Have Sex with Men 79

0

5

10

15

20

25

30

New York

City

New Birmingham Richmond Baltimore Philadelphia

Orleans

Los Seattle Denver Chicago

Angeles

San 

Francisco

Chlamydia

Gonorrhea

Figure W. Gonorrhea and Chlamydia—Proportion of MSM* Testing Positive for Gonorrhea 

and Chlamydia, by Site, STD* Surveillance Network, 2009

Percentage

* MSM = men who have sex with men; STD = sexually transmitted disease.

NOTE: Data not available for Hartford/New Haven STD clinics.

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. Primary and Secondary Syphilis and HIV—Proportion of MSM* with Primary and 

Secondary Syphilis Who Are Co-infected with HIV, by Site, STD* Surveillance 

Network, 2009

Percentage

* MSM = men who have sex with men; STD = sexually transmitted disease.

NOTE: Data not available for New Orleans and Hartford/New Haven STD clinics.
80 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2009

0

5

10

15

20

25

30

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

Figure Y. Gonococcal Isolate Surveillance Project (GISP)—Percentage of Urethral Neisseria 

gonorrhoeae Isolates Obtained from MSM* Attending STD* Clinics, 1990–2009

Percentage

* MSM = men who have sex with men; STD = sexually transmitted disease.

Year

Figure Z. Gonococcal Isolate Surveillance Project (GISP)—Percentage of Urethral 

Neisseria gonorrhoeae Isolates Obtained from MSM* Attending STD* 

Clinics, by Site, 2006–2009

* MSM = men who have sex with men; STD = sexually transmitted disease.

NOTE: Not all sites participated in GISP for the last 4 years. Participating sites include ALB = Albuquerque, NM; ATL = Atlanta, GA; BAL = Baltimore, MD; 

BHM = Birmingham, AL; CHI = Chicago, IL; CIN = Cincinnati, OH; CLE = Cleveland, OH; DAL = Dallas, TX; DEN = Denver, CO; DTR = Detroit, MI; GRB = 

Greensboro, NC; HON = Honolulu, HI; KCY = Kansas City, MO; LAX = Los Angeles, CA; LVG = Las Vegas, NV; MIA = Miami, FL; MIN = Minneapolis, MN; NOR 

= New Orleans, LA; NYC = New York City, NY; OKC = Oklahoma City, OK; ORA = Orange County, CA; PHI = Philadelphia, PA; PHX = Phoenix, AZ; POR = 

Portland, OR; RIC = Richmond, VA; SDG = San Diego, CA; SEA = Seattle, WA; SFO = San Francisco, CA; and TRP = Tripler Army Medical Center, HI (does not 

provide sexual risk behavior data).

0

50

100

06 07 08 09

% of Isolates 

from MSM

 BHM

 PHX

 LAX

 ORA

 SDG

 SFO DEN

 MIA

 ATL

 HON TRP

 CHI

 NOR

 BAL

 DTR

 MIN

 LVG KCY

 ALB

 NYC

 GRB

 CIN

 CLE

 OKC

 POR

 PHI

 DAL

 RIC

 SEA

Year
STD Surveillance 2009 Special Focus Profiles: STDs in Persons Entering Corrections Facilities 81

STDs in Persons Entering Corrections 

Facilities

Public Health Impact

Multiple studies and surveillance projects have 

demonstrated a high prevalence of STDs in persons 

entering jails and juvenile corrections facilities.1–4

Prevalence rates for chlamydia and gonorrhea in these 

settings are consistently among the highest observed 

in any venue.4

 Screening for chlamydia, gonorrhea, 

and syphilis at intake offers an opportunity to 

identify infections, prevent complications, and reduce 

transmission in the general community. 

For example, data from one study in a location with 

high syphilis incidence suggested that screening and 

treatment of female inmates for syphilis may reduce 

syphilis in the general community.5

 In some locations, 

a substantial proportion of all early syphilis cases are 

reported from corrections facilities.6

Description of Population 

In 2009, STD screening data from corrections 

facilities were reported in 37 states and Puerto Rico for 

chlamydia, 36 states and Puerto Rico for gonorrhea, 

and 19 states for syphilis. Line-listed (i.e., case-specific) 

data for chlamydia and gonorrhea are provided to 

CDC through the Infertility Prevention Project (IPP). 

Aggregate syphilis data are reported to CDC by local 

and state STD prevention programs.The figures and 

tables presented in this section represent 50,968 

chlamydia tests of women, 129,548 chlamydia tests of 

men, 42,124 gonorrhea tests of women, and 114,984 

gonorrhea tests of men.

Chlamydia 

Overall, chlamydia positivity was higher in women than 

in men for all age groups. 

Males in Juvenile Corrections Facilities—Among 

males aged 12–18 years entering 123 juvenile corrections 

facilities, the overall chlamydia positivity was 6.6% 

(Figure AA). Chlamydia positivity increased from 1.2% 

for adolescent males aged 12 years to 10.1% for those 

aged 18 years. 

Females in Juvenile Corrections Facilities—Among 

females aged 12–18 years entering 83 juvenile 

corrections facilities, the overall chlamydia positivity was 

14.8% (Figure AA). Positivity increased from 4.7% for 

females aged 12 years to 16.2% for those aged 16 years 

and remained high for women aged 17–18 years. 

Men in Adult Corrections Facilities—Among men 

entering 59 adult corrections facilities in 2009, positivity 

in men younger than aged 20 years (10.8%) was higher 

than the overall prevalence observed in adolescent 

males entering juvenile facilities (6.6%) (Figure BB). 

Chlamydia positivity decreased with age, from 10.8% 

for those younger than aged 20 years to 1.8% for those 

older than 34 years. Overall positivity among adult men 

entering corrections facilities in 2009 was 6.6%. 

Women in Adult Corrections Facilities—Among 

women entering 31 adult corrections facilities in 2009, 

positivity was 7.2% (Figure BB). Chlamydia positivity 

decreased with age, from 16.6% for those younger than 

aged 20 years to 2.3% for those older than aged 34 years. 

Overall chlamydia positivity in women entering adult 

corrections facilities (7.2%) was substantially lower than 

that in adolescent females entering juvenile corrections 

facilities (14.8%). However, chlamydia positivity among 

women younger than aged 20 years entering adult 

corrections facilities was higher than that among women 

entering juvenile corrections facilities.

Gonorrhea

Overall, gonorrhea positivity in women was uniformly 

higher than in men for all age groups.
82 Special Focus Profiles: STDs in Persons Entering Corrections Facilities STD Surveillance 2009

Males in Juvenile Corrections Facilities—The overall 

gonorrhea positivity for adolescent males entering 118 

juvenile corrections facilities in 2009 was 1.0% (Figure 

CC). Positivity increased with age, from 0.1% for those 

aged 12 years to 1.4% for those aged 18 years.

Females in Juvenile Corrections Facilities—The 

overall gonorrhea positivity for adolescent females 

entering 71 juvenile corrections facilities in 2009 was 

3.9% (Figure CC). Positivity increased with age, from 

1.8% for those aged 12 years to 4.4% for those aged 16 

years and remained high for women aged 17–18 years.

Men in Adult Corrections Facilities—The overall 

gonorrhea positivity for men entering 57 adult 

corrections facilities in 2009 was 1.2% (Figure DD). 

Positivity was highest in men younger than aged 20 years 

(2.2%) and declined with age to 0.4% in men older 

than aged 34 years. Men younger than aged 20 years 

entering adult facilities had higher gonorrhea positivity 

than males entering juvenile corrections facilities.

Women in Adult Corrections Facilities—Among 

women entering 29 adult corrections facilities in 2009, 

overall gonorrhea positivity was 1.6% (Figure DD). 

Positivity decreased with age, from 3.1% among those 

younger than aged 20 years to 0.7% among those older 

than aged 34 years. Women younger than aged 20 years 

entering adult facilities had lower gonorrhea positivity 

than females entering juvenile corrections facilities.

Syphilis

In 2008, reports of P&S syphilis from correctional 

facilities accounted for 7% of P&S syphilis among 

men who have sex with women only (MSW), 5% 

among women, and 1% among men who have sex with 

men (MSM). In 2009, reports of P&S syphilis from 

correctional facilities accounted for 5% of P&S syphilis 

among MSW, 4% among women, and 1% among 

MSM (Figure 45).

1 Heimberger TS, Chang HG, Birkhead GS, DiFerdinando GD, 

Greenberg AJ, Gunn R, et al. High prevalence of syphilis detected 

through a jail screening program. A potential public health 

measure to address the syphilis epidemic. Arch Intern Med. 

1993;153:1799-804.

2 Kahn RH, Mosure DJ, Blank S, Kent CK, Chow JM, Boudov 

MR, et al. Chlamydia trachomatis and Neisseria gonorrhoeae

prevalence and coinfection in adolescents entering selected 

US juvenile detention centers, 1997–2002. Sex Transm Dis. 

2005;29:255-59.

3 Joesoef MR, Weinstock HS, Kent CK, Chow JM, Boudov MR, 

Parvez FM, et al. Sex and age correlates of chlamydia prevalence 

in adolescents and adults entering correctional facilities, 2005: 

implications for screening policy. Sex Transm Dis. 2009;36(Suppl 

2):S67-71.

4 Satterwhite CL, Joesoef MR, Datta SD, Weinstock H. Estimates 

of Chlamydia trachomatis infections among men: United States. 

Sex Transm Dis. 2008;35(Suppl 11):S3-7.

5 Blank S, McDonnell DD, Rubin SR, Neal JJ, Brome MW, 

Masterson MB, et al. New approaches to syphilis control. Finding 

opportunities for syphilis treatment and congenital syphilis 

prevention in a women’s correctional setting. Sex Transm Dis. 

1997;24:218-26.

6 Kahn R, Voigt R, Swint E, Weinstock H. Early syphilis in the 

United States identified in corrections facilities, 1999–2002. Sex 

Transm Dis. 2004;29:271-76.
STD Surveillance 2009 Special Focus Profiles: STDs in Persons Entering Corrections Facilities 83

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

12

13

14

NOTE: Positivity percentage is presented from facilities reporting more than 100 test results.

15

16

17

18

Total

1.9

3.5

5.7

7.6

8.2

10.1

6.6

1.2 4.7

11.2

13.5

15.4

16.2

14.9

13.6

14.8

Men Positivity Women

Age

Figure AA. Chlamydia—Positivity by Age and Sex, Juvenile Corrections Facilities, 2009

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

<20

20–24

25–29

NOTE: Positivity percentage is presented from facilities reporting more than100 test results.

30–34

>35

Total

10.0

5.1

3.6

1.8

6.6

10.8

10.5

6.4

5.3

2.3

7.2

16.6

Men Positivity Women

Age

Figure BB. Chlamydia—Positivity by Age Group and Sex, Adult Corrections Facilities, 2009
84 Special Focus Profiles: STDs in Persons Entering Corrections Facilities STD Surveillance 2009

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

12

13

14

NOTE: Positivity percentage is presented from facilities reporting more than 100 test results.

15

16

17

18

Total

0.4

0.4

0.7

1.2

1.2

1.4

1.0

0.1 1.8

3.2

3.7

4.0

4.4

3.4

3.7

3.9

Men Positivity Women

Age

Figure CC. Gonorrhea—Positivity by Age and Sex, Juvenile Corrections Facilities, 2009

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

<20

20–24

25–29

NOTE: Positivity percentage is presented from facilities reporting more than 100 test results.

30–34

>35

Total

1.7

0.8

0.8

0.4

1.2

2.2

2.0

1.7

1.3

0.7

1.6

3.1

Men Positivity Women

Age

Figure DD. Gonorrhea—Positivity by Age Group and Sex, Adult Corrections Facilities, 2009
TABLES
TABLES
STD Surveillance 2009 National Summary Tables 85

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

per 100,000 Population, United States, 1941–2009

Year*

Syphilis

All Stages Chlamydia Gonorrhea Chancroid

Primary and 

Secondary Early Latent

Late and Late 

Latent† Congenital

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 130,697 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

1990 135,590 54.3 50,578 20.3 55,397 22.2 25,750 10.3 3,865 92.9 323,663 160.2 690,042 276.4 4,212 1.7

1991 128,719 50.9 42,950 17.0 53,855 21.3 27,490 10.9 4,424 107.6 381,228 179.7 621,918 245.8 3,476 1.4

1992 114,730 44.7 34,009 13.3 49,929 19.5 26,725 10.4 4,067 100.0 409,694 182.3 502,858 196.0 1,906 0.7

1993 102,612 39.5 26,527 10.2 41,919 16.1 30,746 11.8 3,420 85.5 405,332 178.0 444,649 171.1 1,292 0.5

1994 82,713 31.4 20,641 7.8 32,017 12.2 27,603 10.5 2,452 62.0 451,785 192.5 419,602 163.9 782 0.3

1995 69,359 26.0 16,543 6.2 26,657 10.0 24,296 9.1 1,863 47.8 478,577 187.8 392,651 147.5 607 0.2

1996 53,240 19.8 11,405 4.2 20,187 7.5 20,366 7.6 1,282 32.9 492,631 190.6 328,169 121.8 386 0.1

1997 46,716 17.1 8,556 3.1 16,631 6.1 20,447 7.5 1,082 27.9 537,904 205.5 327,665 120.2 246 0.1

1998 38,289 13.9 7,007 2.5 12,696 4.6 17,743 6.4 843 21.4 614,250 231.8 356,492 129.2 189 0.1

1999 35,385 12.7 6,617 2.4 11,534 4.1 16,655 6.0 579 14.6 662,647 247.2 360,813 129.3 110 0.0
86 National Summary Tables STD Surveillance 2009

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

per 100,000 Population, United States, 1941–2009 (continued)

Year*

Syphilis

All Stages Chlamydia Gonorrhea Chancroid

Primary and 

Secondary Early Latent

Late and Late 

Latent† Congenital

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate‡ Cases Rate Cases Rate Cases Rate

2000 31,618 11.2 5,979 2.1 9,465 3.4 15,594 5.5 580 14.3 709,452 251.4 363,136 128.7 78 0.0

2001 32,284 11.3 6,103 2.1 8,701 3.0 16,976 5.9 504 12.5 783,242 274.5 361,705 126.8 38 0.0

2002 32,919 11.4 6,862 2.4 8,429 2.9 17,168 6.0 460 11.4 834,555 289.4 351,852 122.0 48 0.0

2003 34,289 11.8 7,177 2.5 8,361 2.9 18,319 6.3 432 10.6 877,478 301.7 335,104 115.2 54 0.0

2004 33,423 11.4 7,980 2.7 7,768 2.6 17,300 5.9 375 9.1 929,462 316.5 330,132 112.4 30 0.0

2005 33,288 11.2 8,724 2.9 8,176 2.8 16,049 5.4 339 8.2 976,445 329.4 339,593 114.6 17 0.0

2006 36,958 12.3 9,756 3.3 9,186 3.1 17,644 5.9 372 8.7 1,030,911 344.3 358,366 119.7 19 0.0

2007 40,925 13.6 11,466 3.8 10,768 3.6 18,256 6.1 435 10.2 1,108,374 367.5 355,991 118.0 23 0.0

2008 46,291 15.2 13,500 4.4 12,401 4.1 19,945 6.6 445 10.4 1,210,523 398.1 336,742 110.7 25 0.0

2009 44,828 14.7 13,997 4.6 13,066 4.3 17,338 5.7 427 10.0 1,244,180 409.2 301,174 99.1 28 0.0

* For 1941–1946, data were reported for the federal fiscal year ending June 30 of the year indicated. From 1947 to present, data were reported for the calendar year 

ending December 31. For 1941–1958, data for Alaska and Hawaii were not included.

† Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other than 

neurosyphilis.

‡ Rates include all cases of congenitally acquired syphilis per 100,000 live births. As of 1995, cases of congenital syphilis are obtained in hard copy 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 hard copy forms and for electronic data submissions through 

June 9, 2010 (see Appendix). The number of cases and the rates shown here supersede those published in previous reports. For more information regarding 

reporting, see Interpreting STD Surveillance Data in the Appendix. Cases and rates shown in this table exclude the outlying areas of Guam, Puerto Rico, and Virgin 

Islands.
STD Surveillance 2009 Chlamydia Tables 87

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

2009

Rank* State Cases Rates per 100,000 Population

1 Mississippi 23,589 802.7

2 Alaska 5,166 752.7

3 Louisiana 27,628 626.4

4 South Carolina 26,654 595.0

5 Alabama 25,929 556.2

6 Delaware 4,718 540.4

7 Arkansas 14,354 502.7

8 New Mexico 9,493 478.4

9 Tennessee 29,711 478.1

10 New York 92,069 472.4

11 Illinois 60,542 469.3

12 Hawaii 6,026 467.8

13 Michigan 45,714 457.0

14 North Carolina 41,045 445.1

15 Missouri 25,868 437.6

16 Texas 105,910 435.4

17 Maryland 23,747 421.5

18 Ohio 48,239 420.0

19 Oklahoma 15,023 412.5

20 Georgia 39,828 411.2

U.S. TOTAL† 1,244,180 409.2

21 Colorado 19,998 404.9

22 Arizona 26,002 400.0

23 California 146,796 399.4

24 Florida 72,931 397.9

25 Virginia 30,903 397.8

26 Nevada 10,045 386.3

27 Kansas 10,510 375.1

28 South Dakota 3,015 374.9

29 Wisconsin 20,906 371.5

30 Wyoming 1,963 368.5

31 Connecticut 12,127 346.4

32 Pennsylvania 43,068 346.0

33 Rhode Island 3,615 344.0

34 Indiana 21,732 340.8

35 Washington 21,387 326.6

36 Iowa 9,406 313.3

37 Kentucky 13,293 311.4

38 Montana 2,988 308.9

39 Nebraska 5,443 305.2

40 North Dakota 1,957 305.1

41 Oregon 11,497 303.3

42 Massachusetts 19,315 297.2

43 New Jersey 23,974 276.1

44 Minnesota 14,197 272.0

45 Idaho 3,842 252.1

46 Utah 6,145 224.6

47 West Virginia 3,604 198.6

48 Vermont 1,186 190.9

49 Maine 2,431 184.7

50 New Hampshire 2,102 159.7

* States were ranked in descending order by rate, number of cases, and alphabetically.

† Total includes cases reported by the District of Columbia with 6,549 cases and a rate of 1,106.6 but excludes outlying areas (Guam with 620 cases and 

rate of 352.3, Puerto Rico with 7,302 cases and rate of 184.7, and Virgin Islands with 488 cases and rate of 444.3).
88 Chlamydia Tables STD Surveillance 2009

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

United States and Outlying Areas, 2005–2009

State/Area

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Alabama 17,109 22,915 25,153 24,760 25,929 375.4 498.3 543.5 531.1 556.2

Alaska 4,355 4,525 4,911 4,861 5,166 656.2 675.3 718.5 708.3 752.7

Arizona 21,264 24,090 24,866 24,769 26,002 358.0 390.7 392.3 381.1 400.0

Arkansas 8,507 8,259 9,954 14,136 14,354 306.1 293.8 351.1 495.1 502.7

California 130,716 135,827 141,928 148,798 146,796 361.8 372.6 388.3 404.8 399.4

Colorado 15,432 16,313 17,186 19,180 19,998 330.8 343.2 353.5 388.3 404.9

Connecticut 11,039 10,946 11,454 12,519 12,127 314.5 312.3 327.0 357.6 346.4

Delaware 3,392 3,615 3,479 3,868 4,718 402.1 423.6 402.3 443.0 540.4

District of Columbia 3,678 3,368 6,029 6,924 6,549 668.1 579.2 1,024.8 1,169.9 1,106.6

Florida 43,372 48,955 57,575 71,017 72,931 243.8 270.6 315.5 387.5 397.9

Georgia 33,562 38,972 42,913 42,629 39,828 369.9 416.2 449.6 440.1 411.2

Hawaii 5,489 5,548 5,659 5,982 6,026 430.4 431.6 440.9 464.4 467.8

Idaho 2,799 3,345 3,722 4,194 3,842 195.9 228.1 248.2 275.2 252.1

Illinois 50,559 53,586 55,470 59,169 60,542 396.1 417.6 431.6 458.6 469.3

Indiana 20,063 19,859 20,712 22,154 21,732 319.9 314.5 326.4 347.4 340.8

Iowa 7,390 8,390 8,643 9,372 9,406 249.1 281.3 289.3 312.1 313.3

Kansas 7,419 7,829 8,180 9,208 10,510 270.3 283.2 294.7 328.6 375.1

Kentucky 8,351 8,940 8,798 12,163 13,293 200.1 212.5 207.4 284.9 311.4

Louisiana 17,227 17,885 19,362 22,659 27,628 380.8 417.1 451.0 513.7 626.4

Maine 2,254 2,306 2,541 2,608 2,431 170.6 174.5 192.9 198.1 184.7

Maryland 18,291 21,859 23,150 24,669 23,747 326.6 389.2 412.0 437.9 421.5

Massachusetts 14,411 15,394 16,145 17,503 19,315 225.2 239.1 250.3 269.4 297.2

Michigan 38,730 36,753 37,353 44,923 45,714 382.7 364.0 370.9 449.1 457.0

Minnesota 12,189 12,935 13,413 14,351 14,197 237.5 250.3 258.1 274.9 272.0

Mississippi 21,268 19,002 21,686 21,253 23,589 728.1 652.9 743.0 723.2 802.7

Missouri 22,371 22,982 23,308 24,817 25,868 385.7 393.3 396.5 419.8 437.6

Montana 2,400 2,650 2,748 3,101 2,988 256.5 280.5 286.9 320.5 308.9

Nebraska 5,098 5,428 5,132 5,573 5,443 289.9 307.0 289.2 312.5 305.2

Nevada 7,321 8,398 9,514 9,670 10,045 303.2 336.5 370.9 371.9 386.3

New Hampshire 1,842 1,997 2,055 2,109 2,102 140.6 151.9 156.2 160.3 159.7

New Jersey 19,152 20,194 21,536 22,405 23,974 219.7 231.5 247.9 258.0 276.1

New Mexico 8,456 9,829 9,460 9,262 9,493 438.5 502.9 480.2 466.8 478.4

New York 63,966 68,720 80,717 88,359 92,069 332.2 355.9 418.3 453.3 472.4

North Carolina 31,183 33,615 30,611 37,516 41,045 359.1 379.6 337.8 406.8 445.1

North Dakota 1,667 1,820 1,789 1,921 1,957 261.8 286.2 279.7 299.5 305.1

Ohio 43,806 40,106 47,434 47,117 48,239 382.1 349.4 413.7 410.2 420.0

Oklahoma 13,407 12,992 12,529 14,803 15,023 377.9 363.0 346.4 406.4 412.5

Oregon 9,018 9,577 9,849 10,744 11,497 247.7 258.8 262.8 283.5 303.3

Pennsylvania 37,261 39,487 42,469 42,233 43,068 299.8 317.4 341.6 339.3 346.0

Rhode Island 3,269 3,142 3,177 3,317 3,615 303.8 294.3 300.3 315.7 344.0

South Carolina 18,296 22,351 26,431 26,323 26,654 430.0 517.2 599.7 587.6 595.0

South Dakota 2,701 2,633 2,620 2,956 3,015 348.1 336.7 329.1 367.6 374.9

Tennessee 23,084 25,320 26,866 28,038 29,711 387.1 419.3 436.4 451.1 478.1

Texas 71,860 75,543 85,786 100,870 105,910 314.3 321.4 358.9 414.6 435.4

Utah 4,602 5,092 5,721 6,021 6,145 186.3 199.7 216.3 220.0 224.6

Vermont 957 1,191 1,057 1,190 1,186 153.6 190.9 170.1 191.5 190.9

Virginia 22,668 24,087 24,579 31,218 30,903 299.5 315.2 318.7 401.8 397.8

Washington 18,616 17,819 18,784 21,402 21,387 296.1 278.6 290.4 326.8 326.6

West Virginia 2,944 2,910 3,168 3,316 3,604 162.0 160.0 174.8 182.8 198.6

Wisconsin 20,461 20,190 19,555 20,996 20,906 369.6 363.4 349.1 373.1 371.5

Wyoming 1,173 1,422 1,197 1,577 1,963 230.3 276.1 228.9 296.1 368.5

U.S. TOTAL 976,445 1,030,911 1,108,374 1,210,523 1,244,180 329.4 344.3 367.5 398.1 409.2

Northeast 154,151 163,377 181,151 192,243 199,887 282.1 298.5 331.3 350.0 363.9

Midwest 232,454 232,511 243,609 262,557 267,529 352.4 351.1 366.9 394.5 401.9

South 358,199 390,588 428,069 486,162 505,416 333.2 358.1 387.6 435.2 452.4

West 231,641 244,435 255,545 269,561 271,348 339.2 352.4 364.6 380.4 383.0

Guam 807 832 822 687 620 478.7 486.5 473.7 390.4 352.3

Puerto Rico 3,714 5,102 7,909 6,874 7,302 94.9 129.9 200.6 173.8 184.7

Virgin Islands 235 203 348 587 488 216.2 186.9 316.9 534.4 444.3

OUTLYING AREAS 4,756 6,137 9,079 8,148 8,410 113.5 145.8 214.8 192.2 198.4

TOTAL 981,201 1,037,048 1,117,453 1,218,671 1,252,590 326.4 341.6 365.4 395.3 406.3
STD Surveillance 2009 Chlamydia Tables 89

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

Alphabetical Order, United States and Outlying Areas, 2005–2009

State/Area

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Alabama 14,532 17,915 19,186 18,744 19,413 619.4 756.0 804.2 779.8 807.6

Alaska 2,908 3,067 3,295 3,253 3,364 907.4 947.7 1,002.6 989.7 1,023.5

Arizona 16,201 18,485 18,794 18,358 19,097 546.2 600.1 593.7 566.0 588.8

Arkansas 6,823 6,604 7,893 10,643 10,689 481.8 460.8 546.0 730.6 733.8

California 93,646 97,170 101,175 104,201 101,716 517.8 532.9 553.6 567.3 553.7

Colorado 11,219 12,037 12,707 13,825 14,765 485.8 510.0 527.1 564.7 603.0

Connecticut 8,383 8,205 8,577 9,239 8,937 464.4 456.2 477.7 515.0 498.2

Delaware 2,493 2,625 2,554 2,789 3,573 576.8 597.6 573.3 620.1 794.4

District of Columbia 2,976 2,510 3,970 4,438 4,153 1,028.4 812.7 1,279.9 1,422.7 1,331.3

Florida 34,850 38,536 42,173 52,206 52,747 384.4 418.6 454.3 560.0 565.8

Georgia 26,317 30,546 31,827 31,515 29,074 574.0 642.7 656.1 640.4 590.8

Hawaii 4,093 4,161 4,228 4,422 4,399 640.1 648.0 663.1 692.4 688.8

Idaho 2,162 2,435 2,660 3,048 2,768 303.6 334.4 357.1 402.5 365.5

Illinois 37,672 39,705 41,733 43,112 44,560 580.3 609.5 640.2 659.0 681.2

Indiana 15,263 14,907 15,576 16,513 16,150 479.4 465.4 483.9 510.6 499.3

Iowa 5,400 6,157 6,310 6,882 6,785 358.7 407.9 416.9 452.9 446.5

Kansas 6,054 6,286 6,629 7,401 8,209 438.4 451.4 473.6 524.8 582.1

Kentucky 6,041 6,336 6,184 8,622 9,621 284.5 295.4 285.9 395.3 441.1

Louisiana 13,395 14,290 15,334 17,260 20,719 576.4 649.0 694.6 760.4 912.7

Maine 1,644 1,672 1,831 1,847 1,705 243.2 247.6 271.5 274.0 252.9

Maryland 14,653 17,339 18,230 19,337 18,782 507.5 598.1 628.7 665.4 646.3

Massachusetts 10,587 11,175 11,671 12,646 13,786 321.0 336.6 351.2 378.1 412.2

Michigan 30,079 27,915 28,341 33,719 33,860 584.6 544.6 554.4 663.8 666.6

Minnesota 8,820 9,243 9,681 10,266 10,204 341.3 355.7 371.0 391.8 389.4

Mississippi 16,684 14,853 16,718 16,323 17,829 1,110.4 989.4 1,110.8 1,077.6 1,177.0

Missouri 16,580 16,938 17,080 18,116 18,825 559.3 566.9 567.9 599.1 622.6

Montana 1,776 1,932 2,024 2,227 2,134 378.9 409.3 423.2 461.1 441.9

Nebraska 3,713 3,956 3,755 4,123 3,884 417.6 443.7 419.5 458.5 432.0

Nevada 5,362 6,185 7,044 7,131 7,112 452.3 504.2 559.7 559.0 557.6

New Hampshire 1,343 1,484 1,533 1,548 1,542 202.2 222.7 230.0 232.2 231.3

New Jersey 15,826 16,560 17,355 18,001 18,757 354.1 371.1 391.1 406.3 423.3

New Mexico 6,333 7,456 7,044 6,986 6,987 646.2 753.3 705.7 694.4 694.5

New York 45,391 48,568 56,590 61,280 63,882 457.2 488.1 569.5 611.1 637.0

North Carolina 25,702 27,301 25,110 30,693 33,002 582.6 604.6 541.9 652.3 701.4

North Dakota 1,091 1,231 1,194 1,291 1,297 342.1 389.0 374.7 404.0 405.9

Ohio 33,312 30,483 36,143 35,021 36,724 566.9 518.4 615.1 595.4 624.3

Oklahoma 10,608 9,678 9,130 11,117 11,101 591.1 533.3 499.0 603.0 602.2

Oregon 6,194 6,585 6,890 7,433 8,136 338.4 353.8 365.5 389.7 426.6

Pennsylvania 27,131 28,503 30,511 30,509 30,335 424.0 445.8 477.9 477.6 474.9

Rhode Island 2,396 2,175 2,282 2,400 2,603 430.7 394.5 418.0 442.7 480.2

South Carolina 15,694 19,055 20,793 20,492 21,124 719.6 859.3 919.8 891.5 919.0

South Dakota 1,924 1,923 1,894 2,185 2,214 492.9 491.4 474.2 541.7 548.9

Tennessee 16,453 18,352 19,604 20,479 21,655 540.8 594.3 622.2 642.8 679.7

Texas 58,668 60,327 67,966 79,002 82,551 511.4 511.5 567.4 648.4 677.6

Utah 3,081 3,457 3,926 3,982 4,019 250.6 272.7 299.8 293.8 296.6

Vermont 725 897 812 896 889 229.3 283.1 257.4 284.0 281.7

Virginia 16,805 17,682 18,136 23,172 22,390 437.2 455.0 461.8 586.3 566.5

Washington 13,471 13,021 13,793 15,581 15,741 427.8 406.1 425.0 475.1 480.0

West Virginia 2,272 2,208 2,423 2,490 2,684 244.9 238.0 262.0 269.0 289.9

Wisconsin 14,751 14,606 14,438 15,229 15,038 527.9 522.5 512.4 538.1 531.3

Wyoming 874 1,051 913 1,011 1,187 346.0 413.8 354.2 385.2 452.2

U.S. TOTAL 740,371 775,788 825,660 893,004 912,718 492.2 510.8 539.8 579.4 592.2

Northeast 113,426 119,239 131,162 138,366 142,436 403.5 423.8 467.1 490.9 505.4

Midwest 174,659 173,350 182,774 193,858 197,750 521.0 515.8 542.6 574.2 585.7

South 284,966 306,157 327,231 369,322 381,107 521.5 551.6 582.3 649.8 670.6

West 167,320 177,042 184,493 191,458 191,425 490.2 511.0 527.2 541.5 541.5

Guam 667 692 669 574 512 807.0 824.7 785.4 664.1 592.3

Puerto Rico 3,366 4,091 6,781 5,834 6,336 165.6 200.3 330.8 283.7 308.1

Virgin Islands 189 144 267 448 435 332.5 253.6 462.5 775.2 752.7

OUTLYING AREAS 4,222 4,927 7,717 6,856 7,283 194.4 225.7 351.9 311.5 330.9

TOTAL 744,593 780,715 833,377 899,860 920,001 488.0 506.7 537.1 575.6 588.5

NOTE: Cases reported with unknown sex are not included in this table.
90 Chlamydia Tables STD Surveillance 2009

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

Order, United States and Outlying Areas, 2005–2009

State/Area

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Alabama 2,507 4,985 5,955 6,007 6,508 113.4 223.6 265.6 266.0 288.2

Alaska 1,447 1,458 1,616 1,608 1,802 421.6 420.9 455.4 449.7 503.9

Arizona 5,058 5,588 6,055 6,401 6,904 170.1 181.1 190.8 196.5 212.0

Arkansas 1,684 1,655 2,060 3,491 3,664 123.6 120.1 148.3 249.6 262.0

California 36,449 38,003 40,213 44,060 44,592 202.0 208.5 220.0 239.6 242.5

Colorado 4,213 4,276 4,479 5,319 5,228 178.8 178.7 182.8 213.5 209.9

Connecticut 2,656 2,741 2,877 3,264 3,190 155.8 160.7 168.5 191.2 186.8

Delaware 899 990 925 1,079 1,145 218.6 239.0 220.6 254.9 270.5

District of Columbia 681 819 2,034 2,438 2,390 260.8 300.4 731.4 871.1 853.9

Florida 8,522 10,410 15,376 18,593 20,069 97.7 117.2 171.4 206.5 222.9

Georgia 6,793 8,089 10,808 10,690 10,513 151.4 175.4 230.3 224.3 220.6

Hawaii 1,396 1,384 1,431 1,560 1,626 219.6 215.1 221.6 240.2 250.3

Idaho 616 895 1,030 1,133 1,051 85.9 121.2 136.5 147.8 137.1

Illinois 12,886 13,881 13,736 16,052 15,964 205.5 219.7 216.9 252.4 251.0

Indiana 4,703 4,849 5,032 5,572 5,502 152.3 155.9 160.9 177.3 175.1

Iowa 1,990 2,233 2,333 2,490 2,621 136.2 151.6 158.2 167.9 176.8

Kansas 1,365 1,543 1,551 1,807 2,301 100.1 112.5 112.7 129.8 165.3

Kentucky 2,285 2,580 2,605 3,508 3,647 111.5 125.2 125.3 168.0 174.7

Louisiana 3,583 3,372 3,758 5,226 6,841 162.9 161.7 180.2 244.1 319.6

Maine 606 634 708 761 726 93.9 98.1 110.1 118.5 113.0

Maryland 3,627 4,439 4,907 5,307 4,885 133.7 163.4 180.5 194.6 179.1

Massachusetts 3,809 4,193 4,457 4,839 5,490 122.8 134.5 142.6 153.5 174.1

Michigan 8,525 8,724 8,845 11,007 11,675 171.3 175.5 178.3 223.5 237.1

Minnesota 3,369 3,692 3,732 4,085 3,993 132.2 143.7 144.2 157.1 153.6

Mississippi 4,584 4,149 4,968 4,930 5,760 323.1 294.4 351.4 346.2 404.5

Missouri 5,791 6,044 6,228 6,701 7,043 204.2 211.7 216.9 232.0 243.9

Montana 619 709 716 865 851 132.6 150.0 149.3 178.5 175.7

Nebraska 1,378 1,401 1,363 1,441 1,549 158.4 159.8 155.0 163.0 175.2

Nevada 1,955 2,211 2,460 2,539 2,931 159.0 174.2 188.3 191.7 221.3

New Hampshire 499 513 522 561 560 77.3 79.1 80.4 86.4 86.3

New Jersey 3,323 3,606 4,169 4,390 5,200 78.2 84.6 98.1 103.3 122.3

New Mexico 2,121 2,368 2,415 2,272 2,500 223.6 245.4 248.5 232.2 255.5

New York 18,547 20,148 24,045 27,056 28,171 198.9 215.4 256.9 285.9 297.7

North Carolina 5,481 6,314 5,493 6,656 7,798 128.3 145.4 124.1 147.4 172.6

North Dakota 574 588 594 629 654 180.6 184.1 185.0 195.4 203.1

Ohio 9,139 9,039 10,852 10,847 10,978 163.6 161.5 194.1 193.6 195.9

Oklahoma 2,799 3,314 3,399 3,606 3,879 159.6 187.8 190.2 200.5 215.6

Oregon 2,824 2,992 2,959 3,311 3,361 155.9 162.6 158.9 175.9 178.5

Pennsylvania 10,128 10,981 11,934 11,722 12,700 168.0 181.6 197.3 193.4 209.6

Rhode Island 868 962 892 915 1,012 167.0 186.4 174.3 179.9 198.9

South Carolina 2,572 3,272 5,549 5,723 5,418 124.0 155.5 258.4 262.4 248.4

South Dakota 774 709 725 767 788 200.7 181.5 182.7 191.3 196.6

Tennessee 6,619 6,968 7,262 7,559 8,055 226.6 236.1 241.6 249.5 265.9

Texas 13,138 15,178 17,687 21,812 23,302 115.4 129.6 148.3 179.6 191.9

Utah 1,521 1,635 1,795 2,039 2,126 122.6 127.5 134.4 147.6 153.9

Vermont 232 294 245 294 297 75.6 95.8 80.1 96.2 97.1

Virginia 5,823 6,384 6,433 7,985 8,442 156.4 169.9 170.0 209.2 221.2

Washington 5,145 4,798 4,991 5,767 5,645 163.9 150.4 154.9 176.4 172.6

West Virginia 671 698 744 825 920 75.5 78.4 83.9 92.8 103.5

Wisconsin 5,688 5,551 5,090 5,707 5,740 207.5 201.1 182.8 204.0 205.2

Wyoming 299 371 284 563 776 116.5 142.1 107.2 208.4 287.2

U.S. TOTAL 232,781 252,630 280,337 313,779 328,783 159.4 171.3 188.6 209.3 219.3

Northeast 40,668 44,072 49,849 53,802 57,346 153.3 165.6 187.4 201.2 214.5

Midwest 56,182 58,254 60,081 67,105 68,808 173.2 178.6 183.7 204.6 209.8

South 72,268 83,616 99,963 115,435 123,236 136.7 156.0 184.3 210.3 224.5

West 63,663 66,688 70,444 77,437 79,393 186.4 192.1 200.7 218.1 223.6

Guam 140 140 153 113 108 162.9 160.7 173.1 126.2 120.6

Puerto Rico 348 1,007 1,125 1,034 957 18.5 53.4 59.4 54.5 50.4

Virgin Islands 46 55 81 139 53 88.7 106.1 155.5 267.1 101.8

OUTLYING AREAS 534 1,202 1,359 1,286 1,118 26.5 59.3 66.8 63.1 54.8

TOTAL 233,315 253,832 281,696 315,065 329,901 157.6 169.7 186.9 207.3 217.1

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2009 Chlamydia Tables 91

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

(MSAs)* in Alphabetical Order, United States, 2005–2009

MSAs

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Atlanta-Sandy Springs-Marietta, GA 16,748 20,979 21,609 20,722 20,292 340.6 408.3 409.3 385.4 377.4

Austin-Round Rock, TX 5,103 7,325 6,814 8,413 8,456 351.3 484.0 426.4 509.1 511.7

Baltimore-Towson, MD 11,071 11,617 13,053 13,537 12,883 416.9 437.0 489.2 507.6 483.0

Birmingham-Hoover, AL 4,720 5,338 6,913 6,690 6,120 433.0 485.3 623.8 598.6 547.6

Boston-Cambridge-Quincy, MA-NH 9,368 9,918 10,697 11,854 13,285 212.3 222.6 238.6 262.1 293.7

Buffalo-Cheektowaga-Tonawanda, NY 5,013 4,992 5,078 5,561 5,769 436.8 438.8 450.1 494.6 513.1

Charlotte-Gastonia-Concord, NC-SC 5,830 5,076 4,216 7,046 8,869 383.2 320.7 255.3 414.0 521.2

Chicago-Naperville-Joliet, IL-IN-WI 38,966 41,521 41,403 45,803 46,505 412.6 436.8 434.7 478.6 486.0

Cincinnati-Middletown, OH-KY-IN 8,516 8,616 10,080 10,016 8,872 411.3 409.5 472.4 464.8 411.7

Cleveland-Elyria-Mentor, OH 8,181 7,462 9,351 8,731 10,439 384.7 353.0 446.0 418.1 499.9

Columbus, OH 5,902 5,843 7,157 8,314 9,015 345.4 338.6 408.0 468.9 508.4

Dallas-Fort Worth-Arlington, TX 18,005 17,035 22,292 26,090 27,142 309.4 283.7 362.8 414.1 430.8

Denver-Aurora, CO 8,534 7,934 9,539 10,996 11,803 361.6 329.4 387.0 438.7 470.9

Detroit-Warren-Livonia, MI 20,497 17,201 17,934 24,987 25,347 456.7 384.9 401.4 564.7 572.8

Hartford-West Hartford-East Hartford, CT 3,815 3,799 4,300 4,781 4,467 321.1 319.6 361.6 401.6 375.2

Houston-Baytown-Sugar Land, TX 13,476 14,641 17,196 21,100 21,032 255.2 264.3 305.5 368.4 367.2

Indianapolis, IN 8,226 7,780 8,173 8,814 7,716 501.4 467.0 482.2 513.8 449.8

Jacksonville, FL 5,246 5,582 6,501 7,318 6,745 420.2 436.8 499.8 557.3 513.6

Kansas City, MO-KS 7,900 7,825 8,358 9,559 9,892 405.6 397.7 421.0 477.5 494.1

Las Vegas-Paradise, NV 5,623 6,592 7,333 7,753 8,177 328.7 370.8 399.3 415.5 438.3

Los Angeles-Long Beach-Santa Ana, CA 50,703 50,913 52,352 55,276 54,892 392.3 393.1 406.6 429.4 426.4

Louisville, KY-IN 3,143 3,319 3,493 4,953 5,294 260.1 271.6 283.1 397.9 425.3

Memphis, TN-MS-AR 9,457 10,224 11,349 11,896 13,368 750.0 802.1 886.3 925.2 1,039.7

Miami-Fort Lauderdale-Miami Beach, FL 10,403 12,142 13,761 18,128 19,101 191.9 222.2 254.2 334.8 352.8

Milwaukee-Waukesha-West Allis, WI 10,368 10,498 10,150 1,441 10,588 685.3 695.2 657.2 93.0 683.4

Minneapolis-St. Paul-Bloomington, MN-WI 8,513 9,271 9,514 10,093 9,925 270.9 292.0 296.6 312.5 307.3

Nashville-Davidson-Murfreesboro, TN 4,538 4,910 4,972 5,574 5,816 319.0 337.4 326.8 359.4 375.0

New Orleans-Metairie-Kenner, LA 4,761 3,401 4,573 5,109 6,701 360.9 331.9 443.8 450.5 590.9

New York-Newark-Edison, NY-NJ-PA 58,134 62,334 74,071 80,306 83,904 310.1 331.2 393.7 422.5 441.4

Oklahoma City, OK 4,798 4,627 4,646 5,650 5,475 414.8 394.7 389.4 468.4 453.9

Orlando, FL 5,862 6,579 6,825 8,287 9,199 303.2 331.5 335.8 403.3 447.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 24,913 27,417 28,116 28,749 30,449 427.8 470.5 482.4 492.4 521.5

Phoenix-Mesa-Scottsdale, AZ 11,984 15,278 15,245 14,314 15,615 310.1 378.2 364.8 334.3 364.7

Pittsburgh, PA 5,880 5,789 6,616 6,920 6,597 246.4 244.2 280.8 294.3 280.6

Portland-Vancouver-Beaverton, OR-WA 5,636 5,654 5,970 6,499 7,215 268.9 264.5 274.5 294.4 326.8

Providence-New Bedford-Fall River, RI-MA 4,316 4,197 4,297 4,551 4,865 266.0 260.2 268.4 285.0 304.7

Richmond, VA 4,710 5,044 5,294 6,783 6,681 400.6 422.4 436.4 553.4 545.1

Riverside-San Bernardino-Ontario, CA 12,179 12,472 14,316 13,557 16,934 311.5 309.8 350.8 329.4 411.4

Rochester, NY 3,850 4,168 4,833 5,294 5,767 370.5 402.5 469.0 511.9 557.7

Sacramento-Arden-Arcade-Roseville, CA 8,175 9,094 8,770 8,395 6,320 400.3 439.9 419.4 397.9 299.5

Salt Lake City, UT 2,642 2,910 3,395 3,562 3,424 255.4 272.5 308.6 319.3 306.9

San Antonio, TX 8,049 8,338 8,727 9,734 11,555 425.9 429.3 438.4 479.2 568.8

San Diego-Carlsbad-San Marcos, CA 11,520 11,980 12,693 14,373 14,169 392.7 407.3 426.7 478.9 472.1

San Francisco-Oakland-Fremont, CA 13,988 15,565 16,710 17,555 16,642 336.8 372.4 397.5 410.7 389.3

San Jose-Sunnyvale-Santa Clara, CA 5,374 5,898 5,892 5,796 5,537 306.2 330.0 326.7 318.6 304.4

Seattle-Tacoma-Bellevue, WA 10,588 9,778 10,397 11,532 11,533 330.5 299.6 314.2 344.8 344.8

St. Louis, MO-IL 13,328 13,509 13,710 14,092 14,546 479.7 483.1 489.0 500.3 516.4

Tampa-St. Petersburg-Clearwater, FL 6,315 7,475 9,501 11,230 11,835 238.5 277.1 348.8 410.8 432.9

Virginia Beach-Norfolk-Newport News, VA-NC 8,414 9,139 9,383 11,867 11,954 510.8 554.1 565.7 715.6 720.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 12,827 15,456 18,069 20,943 20,116 246.0 292.2 340.5 390.9 375.4

U.S. MSAs TOTAL 563,318 592,216 643,582 698,755 727,082 353.2 367.1 395.5 425.4 442.6

* 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.
92 Chlamydia Tables STD Surveillance 2009

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

Areas (MSAs)* in Alphabetical Order, United States, 2005–2009

MSAs

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Atlanta-Sandy Springs-Marietta, GA 12,995 16,165 15,553 14,898 14,208 524.8 622.2 582.4 547.7 522.3

Austin-Round Rock, TX 3,720 5,170 4,753 5,933 6,020 522.7 699.1 609.2 735.3 746.1

Baltimore-Towson, MD 8,927 9,344 10,416 10,774 10,187 649.4 677.9 753.5 779.9 737.4

Birmingham-Hoover, AL 3,709 4,277 5,165 4,948 4,530 657.7 751.3 900.4 855.2 782.9

Boston-Cambridge-Quincy, MA-NH 6,663 7,140 7,721 8,458 9,369 293.8 311.7 335.2 364.3 403.5

Buffalo-Cheektowaga-Tonawanda, NY 3,849 3,762 3,818 4,076 4,254 646.3 637.8 653.5 700.2 730.8

Charlotte-Gastonia-Concord, NC-SC 4,878 4,189 3,430 5,469 6,747 631.9 520.7 407.4 631.5 779.1

Chicago-Naperville-Joliet, IL-IN-WI 28,860 30,600 31,134 33,220 34,202 600.4 633.8 644.2 684.4 704.6

Cincinnati-Middletown, OH-KY-IN 6,580 6,871 8,082 8,031 7,243 621.4 638.2 740.4 728.5 657.0

Cleveland-Elyria-Mentor, OH 6,066 5,458 7,023 6,487 7,755 548.7 497.2 645.2 598.6 715.6

Columbus, OH 4,445 4,549 5,428 6,027 6,619 513.4 520.7 611.1 671.6 737.6

Dallas-Fort Worth-Arlington, TX 14,641 13,466 17,251 20,125 21,235 504.7 450.4 564.5 642.8 678.2

Denver-Aurora, CO 6,122 5,827 7,020 7,824 8,617 521.7 485.8 572.1 627.4 691.0

Detroit-Warren-Livonia, MI 16,172 13,096 13,580 18,826 18,870 703.4 572.9 594.5 831.9 833.9

Hartford-West Hartford-East Hartford, CT 2,842 2,786 3,122 3,474 3,250 464.3 456.5 511.7 569.4 532.7

Houston-Baytown-Sugar Land, TX 11,539 12,178 14,170 17,287 16,737 437.0 439.8 504.4 605.0 585.7

Indianapolis, IN 5,949 5,596 5,808 6,352 5,430 712.5 660.3 673.8 727.9 622.3

Jacksonville, FL 4,021 4,273 4,627 5,392 4,874 630.6 654.9 695.7 803.3 726.1

Kansas City, MO-KS 5,930 5,791 6,231 7,115 7,278 598.8 578.2 616.2 698.4 714.4

Las Vegas-Paradise, NV 4,319 5,014 5,620 5,842 5,874 513.8 573.3 623.0 637.5 641.0

Los Angeles-Long Beach-Santa Ana, CA 36,044 35,826 36,520 38,100 36,965 552.9 549.2 563.3 588.0 570.5

Louisville, KY-IN 2,232 2,344 2,482 3,504 3,821 360.6 374.3 392.6 548.5 598.1

Memphis, TN-MS-AR 7,150 7,935 8,846 9,199 10,170 1,098.1 1,202.2 1,332.7 1,377.8 1,523.2

Miami-Fort Lauderdale-Miami Beach, FL 8,492 9,553 9,985 13,144 13,788 304.2 340.1 359.0 472.2 495.4

Milwaukee-Waukesha-West Allis, WI 7,558 7,761 7,653 1,116 7,747 973.0 1,004.8 968.8 140.9 978.3

Minneapolis-St. Paul-Bloomington, MN-WI 6,022 6,462 6,727 7,037 7,028 380.0 404.3 417.2 433.7 433.1

Nashville-Davidson-Murfreesboro, TN 3,122 3,413 3,445 3,916 4,136 433.4 462.7 446.5 497.1 525.0

New Orleans-Metairie-Kenner, LA 3,563 2,673 3,503 3,722 4,875 519.8 503.2 653.5 630.1 825.3

New York-Newark-Edison, NY-NJ-PA 42,214 45,007 52,815 56,829 59,274 435.0 462.7 543.6 579.7 604.6

Oklahoma City, OK 3,744 3,394 3,262 4,119 3,912 638.7 570.1 539.5 673.4 639.5

Orlando, FL 4,667 5,326 5,203 6,160 6,740 477.4 531.7 507.6 594.1 650.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 18,236 19,813 20,132 20,708 21,297 605.3 658.0 668.7 686.9 706.5

Phoenix-Mesa-Scottsdale, AZ 9,338 11,859 11,675 10,725 11,405 487.7 592.7 564.2 506.4 538.5

Pittsburgh, PA 4,398 4,267 4,870 5,092 4,884 354.2 346.5 398.4 417.7 400.7

Portland-Vancouver-Beaverton, OR-WA 3,816 3,769 4,109 4,468 5,069 363.1 351.7 376.7 403.7 458.0

Providence-New Bedford-Fall River, RI-MA 3,225 2,967 3,116 3,327 3,503 384.3 355.8 376.8 403.6 425.0

Richmond, VA 3,425 3,617 3,778 4,981 4,843 566.7 590.0 605.1 790.6 768.7

Riverside-San Bernardino-Ontario, CA 9,257 9,426 10,773 10,009 12,305 474.3 468.5 528.4 486.8 598.5

Rochester, NY 2,670 2,890 3,337 3,594 3,859 501.5 544.7 632.2 679.0 729.1

Sacramento-Arden-Arcade-Roseville, CA 5,890 6,614 6,310 5,997 4,589 567.4 629.1 594.0 559.6 428.2

Salt Lake City, UT 1,709 1,941 2,299 2,254 2,173 334.4 368.8 425.3 411.0 396.3

San Antonio, TX 6,105 6,232 6,567 7,206 8,566 633.1 628.0 646.8 695.8 827.1

San Diego-Carlsbad-San Marcos, CA 8,210 8,620 9,187 10,257 10,050 565.1 590.4 620.4 688.0 674.1

San Francisco-Oakland-Fremont, CA 9,217 10,418 11,118 11,514 10,618 439.6 495.3 525.7 536.0 494.3

San Jose-Sunnyvale-Santa Clara, CA 3,752 4,128 4,232 4,218 3,989 435.6 472.4 480.4 475.3 449.5

Seattle-Tacoma-Bellevue, WA 7,411 6,915 7,412 7,975 8,062 462.5 423.6 447.2 477.1 482.3

St. Louis, MO-IL 9,804 9,952 10,012 10,166 10,481 683.2 689.2 691.6 699.4 721.1

Tampa-St. Petersburg-Clearwater, FL 5,184 5,936 6,841 8,099 8,323 380.8 428.6 489.4 577.2 593.1

Virginia Beach-Norfolk-Newport News, VA-NC 6,016 6,651 6,884 8,789 8,503 720.5 789.6 811.7 1,037.4 1,003.6

Washington-Arlington-Alexandria, DC-VA-MD-WV 10,086 11,722 13,194 14,967 14,429 378.3 432.7 485.5 545.7 526.1

U.S. MSAs TOTAL 420,153 438,711 472,138 507,910 524,772 518.0 535.1 571.2 609.0 629.3

* 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.
STD Surveillance 2009 Chlamydia Tables 93

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

(MSAs)* in Alphabetical Order, United States, 2005–2009

MSAs

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Atlanta-Sandy Springs-Marietta, GA 3,463 4,574 5,896 5,585 5,923 141.8 180.1 226.0 210.3 223.0

Austin-Round Rock, TX 1,357 2,147 2,053 2,472 2,430 183.2 277.4 251.0 292.3 287.3

Baltimore-Towson, MD 2,139 2,250 2,624 2,754 2,665 167.0 175.8 204.1 214.2 207.3

Birmingham-Hoover, AL 1,005 1,058 1,745 1,740 1,588 191.0 199.4 326.4 322.8 294.6

Boston-Cambridge-Quincy, MA-NH 2,697 2,762 2,966 3,383 3,891 125.8 127.6 136.1 153.7 176.8

Buffalo-Cheektowaga-Tonawanda, NY 1,164 1,229 1,260 1,485 1,515 210.8 224.4 231.7 273.9 279.4

Charlotte-Gastonia-Concord, NC-SC 951 887 786 1,549 2,102 126.9 113.9 97.1 185.3 251.5

Chicago-Naperville-Joliet, IL-IN-WI 10,075 10,905 10,259 12,578 12,273 217.3 233.1 218.7 266.7 260.3

Cincinnati-Middletown, OH-KY-IN 1,746 1,691 1,935 1,963 1,565 172.6 164.6 185.7 186.5 148.7

Cleveland-Elyria-Mentor, OH 1,986 1,953 2,285 2,216 2,579 194.6 192.2 226.7 220.6 256.7

Columbus, OH 1,377 1,272 1,706 2,275 2,319 163.4 149.3 197.0 259.8 264.8

Dallas-Fort Worth-Arlington, TX 3,346 3,558 4,987 5,962 5,903 114.6 118.0 161.5 188.1 186.3

Denver-Aurora, CO 2,412 2,107 2,519 3,161 3,184 203.3 174.2 203.5 250.9 252.8

Detroit-Warren-Livonia, MI 4,256 4,027 4,220 5,996 6,329 194.4 184.5 193.3 277.3 292.7

Hartford-West Hartford-East Hartford, CT 973 1,013 1,178 1,303 1,217 168.9 175.1 203.5 224.5 209.7

Houston-Baytown-Sugar Land, TX 1,930 2,449 2,963 3,776 4,259 73.1 88.4 105.1 131.5 148.4

Indianapolis, IN 2,242 2,167 2,340 2,451 2,275 278.3 264.7 280.9 290.8 269.9

Jacksonville, FL 1,225 1,309 1,873 1,912 1,868 200.6 209.3 294.6 297.8 291.0

Kansas City, MO-KS 1,970 2,034 2,127 2,444 2,614 205.8 210.6 218.3 248.5 265.8

Las Vegas-Paradise, NV 1,301 1,576 1,704 1,911 2,301 149.6 174.5 182.4 201.3 242.4

Los Angeles-Long Beach-Santa Ana, CA 14,585 14,921 15,639 16,886 17,728 227.7 232.2 244.7 264.1 277.3

Louisville, KY-IN 909 961 1,011 1,436 1,460 154.2 161.3 168.1 237.0 241.0

Memphis, TN-MS-AR 2,307 2,289 2,503 2,697 3,197 378.3 372.4 405.8 436.4 517.3

Miami-Fort Lauderdale-Miami Beach, FL 1,911 2,588 3,771 4,934 5,304 72.6 97.5 143.3 187.5 201.6

Milwaukee-Waukesha-West Allis, WI 2,804 2,720 2,473 321 2,767 380.9 368.8 327.8 42.4 365.3

Minneapolis-St. Paul-Bloomington, MN-WI 2,491 2,809 2,787 3,056 2,897 159.9 178.2 174.6 190.1 180.3

Nashville-Davidson-Murfreesboro, TN 1,415 1,497 1,527 1,658 1,680 201.5 208.6 203.7 217.3 220.2

New Orleans-Metairie-Kenner, LA 1,100 676 985 1,349 1,804 173.5 137.0 199.3 248.3 332.0

New York-Newark-Edison, NY-NJ-PA 15,890 17,301 21,165 23,441 24,602 175.7 190.3 232.6 254.7 267.3

Oklahoma City, OK 1,054 1,233 1,384 1,473 1,536 184.7 213.7 235.2 247.8 258.4

Orlando, FL 1,195 1,252 1,620 2,117 2,452 125.0 127.3 160.8 208.0 240.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 6,677 7,600 7,972 8,040 9,129 237.6 269.9 283.0 284.7 323.3

Phoenix-Mesa-Scottsdale, AZ 2,646 3,410 3,569 3,586 4,210 135.7 167.3 169.1 165.7 194.5

Pittsburgh, PA 1,482 1,522 1,745 1,828 1,712 129.5 133.6 154.0 161.4 151.2

Portland-Vancouver-Beaverton, OR-WA 1,820 1,885 1,861 2,029 2,146 174.2 176.9 171.6 184.3 195.0

Providence-New Bedford-Fall River, RI-MA 1,085 1,223 1,178 1,222 1,360 138.5 157.0 152.2 158.2 176.1

Richmond, VA 1,281 1,423 1,514 1,793 1,817 224.2 244.9 257.2 301.0 305.1

Riverside-San Bernardino-Ontario, CA 2,913 3,029 3,532 3,548 4,622 148.8 150.4 172.9 172.2 224.4

Rochester, NY 1,180 1,278 1,496 1,700 1,908 232.9 253.1 297.6 336.8 378.0

Sacramento-Arden-Arcade-Roseville, CA 2,220 2,431 2,387 2,346 1,682 221.1 239.3 232.0 226.0 162.0

Salt Lake City, UT 933 969 1,096 1,308 1,251 178.2 179.0 195.9 230.6 220.5

San Antonio, TX 1,942 2,104 2,160 2,527 2,986 209.8 221.5 221.5 253.8 299.9

San Diego-Carlsbad-San Marcos, CA 3,022 3,134 3,457 4,078 4,097 204.1 211.6 231.4 270.0 271.3

San Francisco-Oakland-Fremont, CA 4,686 5,058 5,465 5,968 5,909 227.9 243.6 261.6 280.7 277.9

San Jose-Sunnyvale-Santa Clara, CA 1,575 1,723 1,633 1,558 1,513 176.2 188.7 177.0 167.2 162.4

Seattle-Tacoma-Bellevue, WA 3,177 2,863 2,985 3,538 3,471 198.5 175.5 180.7 211.4 207.4

St. Louis, MO-IL 3,524 3,557 3,698 3,925 4,065 262.3 263.0 272.7 287.9 298.2

Tampa-St. Petersburg-Clearwater, FL 1,131 1,535 2,652 3,050 3,441 87.9 116.9 200.0 229.2 258.6

Virginia Beach-Norfolk-Newport News, VA-NC 2,375 2,481 2,494 3,064 3,422 292.4 307.4 307.7 377.8 421.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,706 3,637 4,849 5,897 5,623 106.2 140.9 187.3 225.5 215.0

U.S. MSAs TOTAL 141,491 152,049 170,076 189,336 200,758 180.5 191.7 212.4 234.1 248.3

*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.
94 Chlamydia Tables STD Surveillance 2009

Table 9. Chlamydia—Counties and Independent Cities* Ranked by Number of Reported Cases, 

United States, 2009

Rank† County/Independent City Cases Rates per 100,000 Population Cumulative Percentage

1 Los Angeles County, CA 46,977 476.3 3

2 Cook County, IL 35,531 671.1 6

3 Wayne County, MI 18,778 963.0 8

4 Kings County, NY 18,693 731.2 9

5 Philadelphia County, PA 18,104 1,250.8 11

6 Bronx County, NY 17,174 1,233.9 12

7 Harris County, TX 16,751 420.4 13

8 Maricopa County, AZ 14,665 370.8 15

9 Dallas County, TX 14,333 594.0 16

10 San Diego County, CA 14,169 472.1 17

11 Shelby County, TN 10,827 1,193.9 18

12 Queens County, NY 10,757 469.1 19

13 Bexar County, TX 10,639 655.6 19

14 New York County, NY 10,520 643.5 20

15 Milwaukee County, WI 9,917 1,040.3 21

16 Cuyahoga County, OH 8,902 693.3 22

17 San Bernardino County, CA 8,654 429.4 22

18 Miami-Dade County, FL 8,318 346.8 23

19 Riverside County, CA 8,280 394.2 24

20 Clark County, NV 8,177 438.3 24

21 Orange County, CA 7,915 262.9 25

22 Tarrant County, TX 7,834 447.6 26

23 Baltimore (City), MD 7,822 1,228.1 26

24 Franklin County, OH 7,730 684.6 27

25 Broward County, FL 6,949 396.8 28

26 Alameda County, CA 6,778 459.7 28

27 Marion County, IN 6,630 753.1 29

28 Hillsborough County, FL 6,611 559.9 29

29 Washington, D.C. 6,549 1,106.6 30

30 Orange County, FL 6,016 560.8 30

31 Travis County, TX 5,981 599.0 31

32 King County, WA 5,908 315.0 31

33 Fulton County, GA 5,876 579.0 32

34 Mecklenburg County, NC 5,822 653.8 32

35 Suffolk County, MA 5,703 778.4 32

36 Denver County, CO 5,670 947.0 33

37 Hamilton County, OH 5,606 658.4 33

38 Duval County, FL 5,539 650.9 34

39 Jackson County, MO 5,493 821.8 34

40 Fresno County, CA 5,416 595.7 35

41 Santa Clara County, CA 5,392 305.6 35

42 Jefferson County, AL 5,284 801.2 36

43 St. Louis County, MO 5,264 530.7 36

44 Prince George’s County, MD 5,224 636.4 36

45 Monroe County, NY 5,118 698.5 37

46 Essex County, NJ 5,014 650.6 37

47 Erie County, NY 4,990 548.4 38

48 Kern County, CA 4,987 623.0 38

49 Sacramento County, CA 4,924 353.2 38

50 Allegheny County, PA 4,916 404.6 39

51 Honolulu County, HI 4,740 523.7 39

52 Hennepin County, MN 4,737 415.2 40

53 St. Louis (City), MO 4,390 1,238.8 40

54 Oklahoma County, OK 4,231 598.8 40

* Accounting for 40% of reported chlamydia cases.

† Counties and independent cities were ranked in descending order by the number of cases reported in 2009.
STD Surveillance 2009 Chlamydia Tables 95

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

Group and Sex, United States, 2005–2009

Age 

Group

Cases Rates

Total Male Female Total Male Female

10–14 14,124 1,200 12,924 67.7 11.2 127.0

2005

15–19 336,036 53,734 282,302 1,597.2 498.0 2,754.5

20–24 360,574 86,931 273,643 1,713.9 800.7 2,687.8

25–29 148,059 44,712 103,347 737.9 435.4 1,054.8

30–34 60,065 21,102 38,964 299.2 207.8 392.6

35–39 28,509 11,700 16,809 135.7 110.8 161.0

40–44 14,397 6,940 7,458 63.0 61.0 64.9

45–54 10,105 5,203 4,902 23.8 24.9 22.7

55–64 2,191 1,169 1,021 7.2 8.0 6.5

65+ 885 402 483 2.4 2.6 2.3

TOTAL 976,445 233,553 742,892 329.4 160.0 493.9

10–14 13,601 1,238 12,364 65.9 11.7 122.8

2006

15–19 352,212 58,820 293,392 1,651.7 537.9 2,824.0

20–24 377,798 93,035 284,763 1,789.6 852.7 2,791.5

25–29 161,178 49,369 111,809 778.3 466.4 1,104.3

30–34 63,810 22,558 41,252 323.8 226.0 424.1

35–39 30,947 12,763 18,184 146.1 119.8 172.6

40–44 15,329 7,410 7,919 68.2 66.2 70.2

45–54 11,351 5,818 5,533 26.2 27.3 25.2

55–64 2,411 1,334 1,077 7.6 8.8 6.6

65+ 894 424 469 2.4 2.7 2.2

TOTAL 1,030,911 253,236 777,675 344.3 171.7 512.0

10–14 13,629 1,251 12,378 67.1 12.0 124.8

2007

15–19 379,416 67,247 312,169 1,766.9 611.0 2,982.5

20–24 402,597 101,782 300,815 1,914.2 937.8 2,955.1

25–29 174,826 54,889 119,938 830.2 509.4 1,166.5

30–34 69,417 24,633 44,785 355.4 248.7 465.2

35–39 33,654 13,838 19,816 158.9 129.9 188.3

40–44 16,617 7,992 8,625 75.6 72.9 78.3

45–54 13,141 6,881 6,261 30.0 31.9 28.1

55–64 2,842 1,531 1,311 8.7 9.7 7.7

65+ 812 417 395 2.1 2.6 1.8

TOTAL 1,108,374 280,931 827,443 367.5 189.0 540.9

10–14 14,333 1,450 12,883 71.5 14.1 131.6

2008

15–19 420,101 77,226 342,875 1,952.7 700.3 3,269.5

20–24 438,311 114,615 323,696 2,081.3 1,056.8 3,169.3

25–29 188,535 60,985 127,550 883.7 557.4 1,227.3

30–34 74,939 26,911 48,027 382.4 270.2 498.3

35–39 36,637 15,004 21,633 174.5 142.0 207.5

40–44 18,041 8,585 9,457 83.9 79.9 87.9

45–54 14,311 7,437 6,874 32.3 34.0 30.5

55–64 3,073 1,642 1,430 9.1 10.1 8.2

65+ 889 432 458 2.3 2.6 2.0

TOTAL 1,210,523 314,752 895,771 398.1 209.9 581.2

10–14 13,934 1,414 12,520 69.5 13.8 127.9

2009

15–19 430,255 81,110 349,145 1,999.9 735.5 3,329.3

20–24 455,918 121,536 334,382 2,165.0 1,120.6 3,273.9

25–29 190,970 62,721 128,249 895.2 573.3 1,234.0

30–34 77,806 28,481 49,325 397.0 286.0 511.7

35–39 36,380 14,930 21,450 173.3 141.3 205.8

40–44 18,311 8,796 9,514 85.1 81.9 88.4

45–54 15,072 7,856 7,216 34.0 36.0 32.0

55–64 3,374 1,795 1,579 10.0 11.0 9.1

65+ 948 475 474 2.4 2.9 2.1

TOTAL 1,244,180 329,490 914,690 409.2 219.8 593.4

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the distribution 

of cases for which age was known. Differences between total cases from this table and others in the report are due to different reporting 

formats. The 0- to 9-year age group is not shown because some of these cases may not be due to sexual transmission; however, they are 

included in the totals.
96 Chlamydia Tables STD Surveillance 2009

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

2005–2009

Age 

Group

Whites, 

Non-Hispanic

Blacks, 

Non-Hispanic Hispanics

Asians/Pacific 

Islanders

American Indians/

Alaska Natives

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

2005

10–14 2,986 126 2,860 7,355 723 6,631 2,069 183 1,886 112 14 98 332 24 309

15–19 93,876 9,636 84,240 153,777 30,214 123,563 52,224 8,526 43,698 3,761 646 3,115 5,964 882 5,082

20–24 114,066 24,303 89,763 142,156 39,355 102,801 64,259 14,772 49,487 6,315 1,416 4,899 6,148 1,295 4,853

25–29 40,477 11,580 28,897 57,704 19,824 37,879 31,795 8,528 23,267 3,107 896 2,211 2,829 715 2,114

30–34 14,600 4,739 9,861 23,142 9,740 13,402 14,349 4,132 10,217 1,849 638 1,211 1,177 270 906

35–39 7,143 3,024 4,119 10,768 5,300 5,468 6,539 2,001 4,538 1,057 337 720 625 181 444

40–44 3,986 2,045 1,941 5,662 3,148 2,515 2,656 908 1,748 559 213 346 345 92 254

45–54 2,875 1,639 1,236 4,032 2,338 1,693 1,674 575 1,100 443 158 286 240 82 158

55–64 657 408 250 791 467 324 334 123 211 148 47 101 50 21 30

65+ 253 123 130 345 168 177 141 53 87 35 18 17 15 4 12

TOTAL 281,268 57,709 223,559 406,423 111,513 294,910 176,271 39,885 136,386 17,408 4,388 13,020 17,762 3,571 14,191

2006

10–14 2,732 84 2,648 8,187 891 7,296 2,088 233 1,856 98 3 95 309 18 290

15–19 97,442 10,379 87,063 180,893 36,692 144,201 58,312 9,483 48,829 3,387 413 2,974 6,259 1,016 5,243

20–24 120,835 26,260 94,575 164,045 45,448 118,597 71,991 16,675 55,316 5,836 1,129 4,707 6,646 1,309 5,337

25–29 46,643 13,506 33,137 67,691 23,107 44,584 36,568 9,968 26,600 3,206 826 2,381 3,103 708 2,395

30–34 16,327 5,518 10,809 26,296 11,044 15,253 16,281 4,596 11,685 1,876 523 1,354 1,421 329 1,092

35–39 8,102 3,265 4,837 12,686 6,367 6,319 7,570 2,319 5,251 998 292 706 709 171 538

40–44 4,253 2,131 2,122 6,436 3,639 2,797 3,211 1,157 2,054 633 197 437 413 106 307

45–54 3,296 1,792 1,504 5,049 2,901 2,148 1,938 695 1,242 486 190 296 271 82 189

55–64 796 474 322 943 588 355 392 157 234 133 47 86 64 16 48

65+ 285 147 139 337 177 161 176 56 119 26 14 12 28 6 22

TOTAL 301,064 63,675 237,389 473,235 131,077 342,159 198,783 45,432 153,351 16,701 3,640 13,061 19,267 3,773 15,493

2007

10–14 2,586 96 2,490 8,301 894 7,407 2,139 214 1,925 125 7 119 249 17 232

15–19 102,471 11,768 90,703 199,686 42,634 157,052 60,919 10,273 50,647 3,919 555 3,364 5,801 909 4,893

20–24 127,025 27,910 99,114 181,659 52,169 129,490 73,166 17,063 56,103 6,127 1,232 4,895 6,212 1,281 4,930

25–29 50,642 14,958 35,684 75,660 26,692 48,967 37,779 10,367 27,412 3,661 941 2,720 2,992 651 2,342

30–34 17,687 5,926 11,761 29,957 12,456 17,501 16,772 4,754 12,018 1,948 579 1,368 1,299 319 979

35–39 9,118 3,531 5,587 14,181 7,024 7,158 7,721 2,438 5,283 1,144 369 775 638 152 486

40–44 4,626 2,243 2,383 7,190 3,983 3,207 3,366 1,214 2,152 649 254 395 371 108 263

45–54 3,916 2,225 1,691 5,955 3,440 2,515 2,183 800 1,383 510 192 317 249 71 178

55–64 924 574 350 1,196 688 508 430 138 292 181 76 105 30 8 22

65+ 279 171 108 318 157 162 145 56 89 31 14 17 12 5 7

TOTAL 319,675 69,524 250,151 524,817 150,384 374,433 204,855 47,389 157,467 18,310 4,223 14,087 17,872 3,525 14,348

2008

10–14 2,686 143 2,543 8,714 1,020 7,694 2,380 235 2,144 94 8 86 215 14 201

15–19 110,221 13,270 96,951 223,088 49,101 173,987 68,593 12,020 56,573 4,187 544 3,643 6,397 1,003 5,394

20–24 135,198 30,684 104,514 199,298 58,689 140,609 80,714 19,741 60,973 6,888 1,469 5,419 6,912 1,443 5,468

25–29 54,253 16,559 37,694 81,611 29,326 52,286 40,786 11,731 29,056 4,073 1,076 2,997 3,434 790 2,643

30–34 19,540 6,668 12,872 31,778 13,256 18,522 18,211 5,355 12,855 2,191 666 1,525 1,436 344 1,093

35–39 9,742 3,833 5,910 15,044 7,438 7,607 8,912 2,765 6,147 1,306 433 873 708 169 539

40–44 5,016 2,464 2,552 7,619 4,128 3,491 3,923 1,418 2,505 633 240 394 392 124 268

45–54 4,245 2,362 1,883 6,374 3,655 2,718 2,427 915 1,513 614 249 365 328 83 245

55–64 1,007 606 401 1,277 743 534 457 175 282 210 68 142 51 11 40

65+ 303 181 122 331 155 175 161 54 108 53 22 31 20 9 11

TOTAL 342,555 76,880 265,675 575,822 167,755 408,067 226,793 54,487 172,306 20,274 4,780 15,493 19,917 3,997 15,920

2009

10–14 2,479 124 2,355 8,553 1,003 7,550 2,340 242 2,098 91 8 83 235 21 214

15–19 112,894 14,452 98,442 229,139 51,652 177,487 70,229 12,231 57,998 4,132 542 3,590 6,127 971 5,156

20–24 140,776 32,450 108,326 209,146 62,987 146,159 82,236 20,465 61,771 6,975 1,531 5,443 7,044 1,527 5,517

25–29 55,639 17,291 38,348 82,144 30,062 52,082 41,275 12,080 29,195 4,041 1,065 2,976 3,306 744 2,562

30–34 20,922 7,333 13,588 32,936 13,867 19,069 18,465 5,624 12,841 2,062 572 1,490 1,442 371 1,070

35–39 9,543 3,836 5,707 15,082 7,402 7,679 8,869 2,761 6,109 1,266 421 845 708 158 550

40–44 5,058 2,429 2,629 7,648 4,289 3,360 4,098 1,526 2,572 739 263 476 367 102 264

45–54 4,689 2,719 1,970 6,394 3,582 2,812 2,701 1,032 1,670 658 251 407 287 91 196

55–64 1,136 709 427 1,401 773 628 524 188 337 186 68 118 61 20 42

65+ 321 190 131 371 175 196 158 60 98 62 33 29 16 7 9

TOTAL 353,798 81,619 272,179 593,428 175,990 417,438 231,090 56,271 174,819 20,221 4,760 15,461 19,618 4,024 15,594

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 3–5 for total and sex-specific 

cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were specified. For 

the following years, the states listed did not report age or race/ethnicity for most cases, and their case data and population denominators were excluded: 2005 

(Colorado, the District of Columbia, Georgia, Hawaii, New Jersey); 2006 (Colorado, Hawaii); 2007 (Colorado, Hawaii); 2008 (Colorado, Hawaii); 2009 (Colorado, Hawaii). 

Differences between total cases from this table and others in the report are due to different reporting formats and the exclusions listed above. The 0- to 9-year age 

group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals.
STD Surveillance 2009 Chlamydia Tables 97

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

United States, 2005–2009

Age 

Group

Whites, 

Non-Hispanic

Blacks, 

Non-Hispanic Hispanics

Asians/Pacific 

Islanders

American Indians/

Alaska Natives

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

10–14 25.6 2.1 50.5 251.4 48.7 460.9 57.2 9.9 106.8 14.8 3.6 26.7 157.4 22.1 295.9

2005

15–19 766.1 153.2 1,412.8 5,348.8 2,073.2 8,716.3 1,613.2 511.2 2,784.1 492.4 164.2 840.9 2,665.3 775.9 4,617.5

20–24 938.3 391.5 1,508.7 5,324.4 2,927.8 7,754.4 1,854.2 782.9 3,134.6 727.6 321.8 1,144.8 2,920.5 1,215.3 4,669.1

25–29 364.1 206.5 524.5 2,432.2 1,722.3 3,101.1 855.5 414.0 1,404.5 307.6 180.5 430.5 1,635.7 817.9 2,472.6

30–34 130.1 83.9 176.8 1,028.3 911.8 1,133.5 409.4 219.0 631.4 159.6 112.7 204.4 738.5 340.3 1,135.0

35–39 57.1 48.1 66.2 467.7 487.3 450.1 208.5 119.9 309.5 100.7 65.9 133.7 390.9 229.4 548.5

40–44 27.4 28.2 26.7 229.3 272.4 191.5 95.5 62.6 131.2 58.6 46.1 70.2 193.8 106.0 276.6

45–54 10.0 11.5 8.5 93.1 116.9 72.8 42.2 28.7 55.9 27.5 20.9 33.4 75.5 54.2 94.9

55–64 3.0 3.8 2.2 30.1 39.8 22.3 15.1 11.7 18.2 14.4 10.0 18.2 24.8 21.2 28.1

65+ 0.9 1.0 0.8 12.6 16.0 10.5 6.6 5.9 7.1 3.6 4.4 3.0 8.8 4.8 11.8

TOTAL 151.7 63.4 236.7 1,234.3 709.9 1,712.6 444.5 194.9 710.5 148.4 77.0 215.9 747.0 305.3 1,174.6

10–14 22.5 1.4 44.9 255.3 54.7 462.2 54.2 11.8 98.6 11.7 0.7 23.2 149.4 17.6 284.7

2006

15–19 748.9 155.4 1,374.9 5,483.0 2,195.4 8,858.2 1,646.6 519.5 2,845.8 402.3 95.2 729.3 2,748.8 879.6 4,672.9

20–24 940.2 398.9 1,508.7 5,435.0 2,980.0 7,942.6 1,964.5 838.3 3,301.5 627.9 238.5 1,032.1 3,066.6 1,187.9 5,008.6

25–29 385.5 221.9 550.9 2,425.6 1,705.6 3,105.1 900.9 440.4 1,481.2 288.6 151.1 421.5 1,696.7 767.3 2,642.2

30–34 142.2 95.6 189.4 1,046.0 926.6 1,153.6 424.6 220.7 666.9 146.1 83.3 206.2 889.7 411.4 1,368.0

35–39 61.0 49.0 73.1 482.4 514.6 453.7 219.1 125.8 325.9 82.5 49.5 113.9 434.9 211.8 653.6

40–44 28.5 28.6 28.4 231.8 280.4 189.1 105.0 72.1 141.3 58.7 37.5 78.8 232.5 121.8 338.0

45–54 10.7 11.7 9.7 101.4 126.3 80.1 43.9 31.1 57.0 26.8 22.3 30.8 81.9 52.3 108.8

55–64 3.3 4.1 2.6 30.3 42.5 20.6 15.8 13.2 18.1 11.2 8.6 13.5 29.7 15.5 42.6

65+ 1.0 1.2 0.8 10.9 14.8 8.4 7.5 5.6 8.8 2.4 3.0 2.0 14.9 7.4 20.7

TOTAL 152.8 65.9 236.6 1,261.3 733.3 1,741.8 459.2 203.0 733.6 127.2 57.0 193.6 790.1 314.5 1,250.8

10–14 21.8 1.6 43.1 266.0 56.4 482.4 55.2 10.8 101.7 14.8 1.5 28.5 125.3 17.1 236.6

2007

15–19 789.6 176.7 1,435.6 5,953.3 2,509.0 9,490.0 1,664.0 544.9 2,852.4 461.4 126.7 817.8 2,547.7 789.2 4,346.9

20–24 988.8 423.8 1,583.1 5,987.0 3,400.4 8,632.6 2,030.1 882.8 3,356.8 681.1 268.5 1,111.3 2,843.3 1,153.4 4,592.0

25–29 409.8 240.4 581.4 2,640.6 1,905.9 3,343.1 928.1 457.4 1,519.3 334.4 174.1 490.9 1,579.4 680.4 2,495.6

30–34 156.7 104.4 209.6 1,198.3 1,049.4 1,332.9 430.7 223.9 678.4 155.0 94.5 212.8 809.4 397.4 1,222.6

35–39 69.6 53.7 85.7 537.5 565.5 512.7 216.9 128.2 318.6 90.7 60.0 120.0 390.0 187.6 589.3

40–44 32.1 31.2 33.0 263.7 312.6 220.8 107.5 73.8 145.0 59.2 47.7 70.2 214.6 127.7 297.5

45–54 12.6 14.5 10.8 117.2 146.7 91.9 47.0 33.9 60.6 27.4 21.9 32.4 73.7 43.8 100.7

55–64 3.7 4.8 2.8 36.8 47.6 28.2 16.3 10.9 21.4 14.5 13.2 15.6 13.1 7.4 18.2

65+ 0.9 1.3 0.6 10.1 12.9 8.3 5.9 5.4 6.3 2.7 2.8 2.7 6.0 6.1 5.8

TOTAL 162.0 71.8 248.9 1,384.7 832.6 1,887.3 461.0 206.4 733.3 137.1 65.0 205.4 725.7 291.0 1,146.4

10–14 23.0 2.4 44.7 286.2 65.9 513.6 61.1 11.8 112.7 11.1 2.0 20.4 110.6 14.3 209.9

2008

15–19 855.7 200.7 1,546.1 6,586.2 2,858.9 10,420.1 1,822.9 620.9 3,096.7 490.8 123.7 881.0 2,837.4 880.7 4,833.1

20–24 1,050.8 465.2 1,667.0 6,481.4 3,779.0 9,239.2 2,256.2 1,039.6 3,632.2 775.5 323.3 1,248.9 3,144.4 1,292.0 5,059.1

25–29 430.5 260.2 604.3 2,780.3 2,026.4 3,513.4 1,010.2 524.0 1,615.3 378.9 201.6 553.8 1,730.0 787.9 2,692.9

30–34 172.7 117.2 228.8 1,262.4 1,105.4 1,405.3 462.0 247.8 722.0 179.8 111.9 244.6 883.4 422.0 1,346.4

35–39 76.0 59.6 92.6 572.1 600.4 546.8 244.5 141.8 362.8 101.3 68.6 132.5 433.3 208.1 655.8

40–44 36.1 35.4 36.7 284.6 329.8 245.0 122.3 83.7 165.5 57.0 44.4 69.0 233.6 151.1 312.4

45–54 13.6 15.3 12.0 123.1 153.0 97.4 49.8 36.8 63.4 32.1 27.5 36.3 95.6 50.8 136.5

55–64 4.0 4.9 3.1 37.7 49.3 28.4 16.4 13.0 19.6 15.9 11.2 20.0 21.5 9.4 32.4

65+ 1.0 1.4 0.7 10.2 12.4 8.8 6.2 4.8 7.2 4.4 4.3 4.5 9.4 9.4 9.3

TOTAL 173.2 79.2 263.8 1,512.8 924.7 2,048.5 494.8 230.2 777.5 149.3 72.4 222.3 788.3 321.5 1,240.3

10–14 21.2 2.1 41.4 280.9 64.9 504.0 60.1 12.1 110.3 10.7 1.9 19.7 120.8 21.0 223.8

2009

15–19 876.5 218.6 1,569.9 6,764.9 3,007.5 10,629.7 1,866.4 631.8 3,174.7 484.3 123.3 868.0 2,717.5 852.8 4,619.3

20–24 1,094.2 491.9 1,727.8 6,801.7 4,055.7 9,603.9 2,298.7 1,077.8 3,679.7 785.3 337.1 1,254.5 3,204.8 1,367.0 5,104.4

25–29 441.5 271.7 614.8 2,798.5 2,077.3 3,499.7 1,022.3 539.6 1,623.0 375.9 199.6 549.9 1,665.8 741.6 2,610.5

30–34 184.9 128.9 241.5 1,308.4 1,156.3 1,446.9 468.5 260.3 721.2 169.2 96.0 239.0 886.8 456.0 1,319.2

35–39 74.5 59.6 89.5 573.5 597.6 552.0 243.4 141.6 360.5 98.2 66.7 128.2 433.3 194.8 669.1

40–44 36.4 34.9 37.8 285.7 342.6 235.8 127.8 90.1 170.0 66.5 48.8 83.4 218.3 124.5 307.8

45–54 15.1 17.6 12.6 123.5 150.0 100.8 55.5 41.5 70.0 34.4 27.7 40.5 83.7 55.6 109.3

55–64 4.5 5.7 3.3 41.4 51.3 33.4 18.8 14.0 23.3 14.1 11.2 16.5 25.9 17.5 33.4

65+ 1.0 1.4 0.7 11.4 14.0 9.8 6.1 5.4 6.6 5.1 6.3 4.2 7.8 8.0 7.6

TOTAL 178.8 84.0 270.2 1,559.1 970.0 2,095.5 504.2 237.7 788.8 149.0 72.0 221.9 776.5 323.8 1,214.9

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 10 for age-specific cases and rates and Tables 3–5 for total and sex-specific 

cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were specified. For 

the following years, the states listed did not report age or race/ethnicity for most cases, and their case data and population denominators were excluded: 2005 

(Colorado, the District of Columbia, Georgia, Hawaii, New Jersey); 2006 (Colorado, Hawaii); 2007 (Colorado, Hawaii); 2008 (Colorado, Hawaii); 2009 (Colorado, Hawaii). 

Differences between total rates from this table and others in the report are due to different reporting formats and the exclusions listed above. The 0- to 9-year age 

group is not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals.
98 Gonorrhea Tables STD Surveillance 2009

Table 12. Gonorrhea—Reported Cases and Rates by State, Ranked by Rates, United States, 2009

Rank* State Cases Rates per 100,000 Population

1 Mississippi 7,241 246.4

2 Louisiana 8,996 204.0

3 South Carolina 8,318 185.7

4 Alabama 7,498 160.8

5 Arkansas 4,460 156.2

6 Illinois 19,962 154.7

7 North Carolina 13,870 150.4

8 Michigan 14,704 147.0

9 Alaska 990 144.3

10 Georgia 13,687 141.3

11 Ohio 15,988 139.2

12 Oklahoma 4,673 128.3

13 Tennessee 7,926 127.5

14 Texas 29,295 120.4

15 Florida 20,878 113.9

16 Maryland 6,395 113.5

17 Delaware 971 111.2

18 Missouri 6,488 109.8

19 Indiana 6,835 107.2

20 Virginia 7,789 100.3

U.S. TOTAL† 301,174 99.1

21 Wisconsin 5,201 92.4

22 Kentucky 3,827 89.6

23 Kansas 2,505 89.4

24 New York 17,004 87.2

25 Pennsylvania 10,138 81.4

26 Nebraska 1,376 77.2

27 Connecticut 2,558 73.1

28 Nevada 1,726 66.4

29 California 23,228 63.2

30 Colorado 2,823 57.2

31 Iowa 1,658 55.2

32 New Jersey 4,762 54.8

33 New Mexico 1,082 54.5

34 Arizona 3,250 50.0

35 Hawaii 631 49.0

36 Minnesota 2,303 44.1

37 South Dakota 344 42.8

38 Washington 2,285 34.9

39 Rhode Island 322 30.6

40 Massachusetts 1,976 30.4

41 Oregon 1,113 29.4

42 West Virginia 475 26.2

43 North Dakota 151 23.5

YEAR 2010 TARGET 19.0

44 Wyoming 74 13.9

45 Utah 341 12.5

46 Maine 143 10.9

47 New Hampshire 113 8.6

48 Montana 80 8.3

49 Vermont 50 8.0

50 Idaho 110 7.2

* States were ranked in descending order by rate, number of cases, and alphabetically.

† Total includes cases reported by the District of Columbia, with 2,561 cases and a rate of 432.7, but excludes outlying areas (Guam with 59 cases and rate of 33.5, 

Puerto Rico with 230 cases and rate of 5.8, and Virgin Islands with 115 cases and rate of 104.7).
STD Surveillance 2009 Gonorrhea Tables 99

Table 13. Gonorrhea—Reported Cases and Rates by State/Area and Region in Alphabetical 

Order, United States and Outlying Areas, 2005–2009

State/Area

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Alabama 9,406 10,665 10,885 9,740 7,498 206.4 231.9 235.2 208.9 160.8

Alaska 600 630 579 578 990 90.4 94.0 84.7 84.2 144.3

Arizona 4,951 5,949 5,062 3,449 3,250 83.4 96.5 79.9 53.1 50.0

Arkansas 4,476 4,306 4,168 4,514 4,460 161.1 153.2 147.0 158.1 156.2

California 34,338 33,740 31,294 25,787 23,228 95.0 92.5 85.6 70.2 63.2

Colorado 3,224 3,695 3,376 3,757 2,823 69.1 77.7 69.4 76.1 57.2

Connecticut 2,750 2,610 2,327 2,801 2,558 78.3 74.5 66.4 80.0 73.1

Delaware 913 1,485 1,293 1,045 971 108.2 174.0 149.5 119.7 111.2

District of Columbia 2,146 1,887 2,373 2,656 2,561 389.8 324.5 403.4 448.8 432.7

Florida 20,225 23,976 23,327 23,326 20,878 113.7 132.5 127.8 127.3 113.9

Georgia 15,860 19,669 17,835 16,272 13,687 174.8 210.1 186.9 168.0 141.3

Hawaii 1,024 885 659 610 631 80.3 68.8 51.3 47.4 49.0

Idaho 119 206 269 187 110 8.3 14.0 17.9 12.3 7.2

Illinois 20,019 20,186 20,813 20,674 19,962 156.8 157.3 161.9 160.2 154.7

Indiana 8,094 8,732 8,790 8,769 6,835 129.1 138.3 138.5 137.5 107.2

Iowa 1,606 1,966 1,928 1,700 1,658 54.1 65.9 64.5 56.6 55.2

Kansas 2,605 2,210 2,282 2,274 2,505 94.9 80.0 82.2 81.2 89.4

Kentucky 2,935 3,277 3,449 4,548 3,827 70.3 77.9 81.3 106.5 89.6

Louisiana 9,572 10,883 11,137 9,455 8,996 211.6 253.8 259.4 214.4 204.0

Maine 142 137 118 96 143 10.7 10.4 9.0 7.3 10.9

Maryland 7,035 7,328 6,768 6,666 6,395 125.6 130.5 120.5 118.3 113.5

Massachusetts 2,537 2,429 2,695 2,129 1,976 39.6 37.7 41.8 32.8 30.4

Michigan 17,684 15,677 15,482 17,064 14,704 174.7 155.3 153.7 170.6 147.0

Minnesota 3,482 3,303 3,459 3,037 2,303 67.8 63.9 66.5 58.2 44.1

Mississippi 7,171 7,511 8,314 7,494 7,241 245.5 258.1 284.8 255.0 246.4

Missouri 9,455 10,204 9,876 8,014 6,488 163.0 174.6 168.0 135.6 109.8

Montana 158 194 122 122 80 16.9 20.5 12.7 12.6 8.3

Nebraska 1,158 1,433 1,434 1,460 1,376 65.8 81.0 80.8 81.9 77.2

Nevada 2,880 2,791 2,357 2,172 1,726 119.3 111.8 91.9 83.5 66.4

New Hampshire 177 180 138 100 113 13.5 13.7 10.5 7.6 8.6

New Jersey 5,722 5,492 6,076 5,298 4,762 65.6 62.9 70.0 61.0 54.8

New Mexico 1,552 1,733 1,796 1,403 1,082 80.5 88.7 91.2 70.7 54.5

New York 17,717 17,459 17,697 17,108 17,004 92.0 90.4 91.7 87.8 87.2

North Carolina 15,072 17,312 16,666 15,972 13,870 173.6 195.5 183.9 173.2 150.4

North Dakota 128 153 116 143 151 20.1 24.1 18.1 22.3 23.5

Ohio 20,985 19,190 21,066 16,803 15,988 183.1 167.2 183.7 146.3 139.2

Oklahoma 5,228 4,951 4,827 5,185 4,673 147.4 138.3 133.4 142.4 128.3

Oregon 1,562 1,461 1,236 1,225 1,113 42.9 39.5 33.0 32.3 29.4

Pennsylvania 11,222 11,466 12,706 11,071 10,138 90.3 92.2 102.2 88.9 81.4

Rhode Island 438 508 402 307 322 40.7 47.6 38.0 29.2 30.6

South Carolina 8,561 10,320 10,326 9,442 8,318 201.2 238.8 234.3 210.8 185.7

South Dakota 351 367 261 375 344 45.2 46.9 32.8 46.6 42.8

Tennessee 8,605 9,694 9,564 8,780 7,926 144.3 160.5 155.3 141.3 127.5

Texas 26,110 30,449 32,073 32,199 29,295 114.2 129.5 134.2 132.4 120.4

Utah 727 888 821 477 341 29.4 34.8 31.0 17.4 12.5

Vermont 60 72 64 37 50 9.6 11.5 10.3 6.0 8.0

Virginia 8,346 6,476 6,269 10,337 7,789 110.3 84.7 81.3 133.1 100.3

Washington 3,739 4,231 3,653 3,127 2,285 59.5 66.2 56.5 47.7 34.9

West Virginia 770 953 930 746 475 42.4 52.4 51.3 41.1 26.2

Wisconsin 5,869 6,927 6,752 6,087 5,201 106.0 124.7 120.5 108.2 92.4

Wyoming 87 120 81 124 74 17.1 23.3 15.5 23.3 13.9

U.S. TOTAL 339,593 358,366 355,991 336,742 301,174 114.6 119.7 118.0 110.7 99.1

Northeast 40,765 40,353 42,223 38,947 37,066 74.6 73.7 77.2 70.9 67.5

Midwest 91,436 90,348 92,259 86,400 77,515 138.6 136.4 139.0 129.8 116.5

South 152,431 171,142 170,204 168,377 148,860 141.8 156.9 154.1 150.7 133.2

West 54,961 56,523 51,305 43,018 37,733 80.5 81.5 73.2 60.7 53.3

Guam 106 98 141 109 59 62.9 57.3 81.2 61.9 33.5

Puerto Rico 328 302 323 273 230 8.4 7.7 8.2 6.9 5.8

Virgin Islands 30 34 69 120 115 27.6 31.3 62.8 109.2 104.7

OUTLYING AREAS 464 434 533 502 404 11.1 10.3 12.6 11.8 9.5

TOTAL 340,057 358,800 356,524 337,244 301,578 113.1 118.2 116.6 109.4 97.8
100 Gonorrhea Tables STD Surveillance 2009

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

Alphabetical Order, United States and Outlying Areas, 2005–2009

State/Area

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Alabama 4,494 5,983 6,095 5,582 4,240 191.5 252.5 255.5 232.2 176.4

Alaska 349 356 326 321 516 108.9 110.0 99.2 97.7 157.0

Arizona 2,338 2,847 2,342 1,577 1,475 78.8 92.4 74.0 48.6 45.5

Arkansas 2,252 2,182 2,275 2,520 2,562 159.0 152.3 157.4 173.0 175.9

California 15,827 15,688 14,533 11,625 9,430 87.5 86.0 79.5 63.3 51.3

Colorado 1,619 1,879 1,807 1,978 1,502 70.1 79.6 75.0 80.8 61.3

Connecticut 1,590 1,478 1,372 1,686 1,491 88.1 82.2 76.4 94.0 83.1

Delaware 515 829 699 606 564 119.2 188.7 156.9 134.7 125.4

District of Columbia 1,029 808 1,077 1,259 1,233 355.6 261.6 347.2 403.6 395.3

Florida 10,204 12,427 11,793 12,279 10,745 112.6 135.0 127.0 131.7 115.3

Georgia 7,819 10,002 9,334 8,687 7,253 170.5 210.4 192.4 176.5 147.4

Hawaii 619 476 295 298 264 96.8 74.1 46.3 46.7 41.3

Idaho 57 113 152 90 51 8.0 15.5 20.4 11.9 6.7

Illinois 10,998 10,926 11,312 11,342 11,248 169.4 167.7 173.5 173.4 171.9

Indiana 4,453 4,806 4,884 5,056 3,985 139.9 150.0 151.7 156.3 123.2

Iowa 885 1,179 1,121 1,024 1,049 58.8 78.1 74.1 67.4 69.0

Kansas 1,645 1,327 1,401 1,459 1,541 119.1 95.3 100.1 103.5 109.3

Kentucky 1,530 1,709 1,887 2,511 2,132 72.1 79.7 87.2 115.1 97.7

Louisiana 4,761 5,605 5,822 5,177 5,125 204.9 254.5 263.7 228.1 225.8

Maine 61 54 45 43 62 9.0 8.0 6.7 6.4 9.2

Maryland 3,620 3,850 3,529 3,604 3,457 125.4 132.8 121.7 124.0 118.9

Massachusetts 1,320 1,214 1,282 1,100 976 40.0 36.6 38.6 32.9 29.2

Michigan 10,161 8,900 8,984 10,047 8,536 197.5 173.6 175.7 197.8 168.0

Minnesota 1,909 1,814 1,930 1,657 1,270 73.9 69.8 74.0 63.2 48.5

Mississippi 4,234 4,400 4,901 4,357 4,335 281.8 293.1 325.6 287.6 286.2

Missouri 5,334 5,752 5,481 4,542 3,585 179.9 192.5 182.3 150.2 118.6

Montana 102 123 75 92 46 21.8 26.1 15.7 19.0 9.5

Nebraska 688 865 847 891 821 77.4 97.0 94.6 99.1 91.3

Nevada 1,343 1,257 1,066 1,012 826 113.3 102.5 84.7 79.3 64.8

New Hampshire 97 97 63 49 54 14.6 14.6 9.5 7.3 8.1

New Jersey 3,077 2,829 3,059 2,813 2,435 68.9 63.4 68.9 63.5 55.0

New Mexico 884 1,003 974 783 570 90.2 101.3 97.6 77.8 56.7

New York 9,031 8,479 8,324 8,349 7,927 91.0 85.2 83.8 83.3 79.0

North Carolina 7,545 8,718 8,941 8,876 7,868 171.0 193.1 193.0 188.6 167.2

North Dakota 76 86 66 93 88 23.8 27.2 20.7 29.1 27.5

Ohio 11,592 10,508 11,771 9,784 9,766 197.3 178.7 200.3 166.3 166.0

Oklahoma 3,018 2,780 2,606 2,964 2,809 168.2 153.2 142.4 160.8 152.4

Oregon 661 609 564 553 505 36.1 32.7 29.9 29.0 26.5

Pennsylvania 6,271 6,219 6,945 6,210 5,650 98.0 97.3 108.8 97.2 88.4

Rhode Island 227 273 169 135 146 40.8 49.5 31.0 24.9 26.9

South Carolina 4,601 5,406 5,640 5,704 5,004 211.0 243.8 249.5 248.2 217.7

South Dakota 196 215 153 247 190 50.2 54.9 38.3 61.2 47.1

Tennessee 4,395 5,104 5,247 4,801 4,365 144.5 165.3 166.5 150.7 137.0

Texas 13,827 15,619 16,192 17,029 16,071 120.5 132.4 135.2 139.8 131.9

Utah 319 369 345 137 70 25.9 29.1 26.3 10.1 5.2

Vermont 26 39 30 19 29 8.2 12.3 9.5 6.0 9.2

Virginia 4,402 3,287 3,369 5,847 4,314 114.5 84.6 85.8 147.9 109.2

Washington 1,622 1,938 1,858 1,522 949 51.5 60.4 57.2 46.4 28.9

West Virginia 427 488 504 425 281 46.0 52.6 54.5 45.9 30.4

Wisconsin 3,433 4,047 4,066 3,744 3,113 122.9 144.8 144.3 132.3 110.0

Wyoming 54 71 41 71 44 21.4 28.0 15.9 27.0 16.8

U.S. TOTAL 177,537 187,033 187,594 182,577 162,568 118.0 123.1 122.6 118.5 105.5

Northeast 21,700 20,682 21,289 20,404 18,770 77.2 73.5 75.8 72.4 66.6

Midwest 51,370 50,425 52,016 49,886 45,192 153.2 150.0 154.4 147.7 133.8

South 78,673 89,197 89,911 92,228 82,358 144.0 160.7 160.0 162.3 144.9

West 25,794 26,729 24,378 20,059 16,248 75.6 77.2 69.7 56.7 46.0

Guam 71 49 66 58 32 85.9 58.4 77.5 67.1 37.0

Puerto Rico 194 152 165 128 126 9.5 7.4 8.0 6.2 6.1

Virgin Islands 18 23 51 86 90 31.7 40.5 88.3 148.8 155.7

OUTLYING AREAS 283 224 282 272 248 13.0 10.3 12.9 12.4 11.3

TOTAL 177,820 187,257 187,876 182,849 162,816 116.5 121.5 121.1 117.0 104.1

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2009 Gonorrhea Tables 101

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

Order, United States and Outlying Areas, 2005–2009

State/Area

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Alabama 4,892 4,678 4,786 4,151 3,250 221.2 209.8 213.5 183.8 143.9

Alaska 251 274 253 257 474 73.1 79.1 71.3 71.9 132.5

Arizona 2,610 3,097 2,718 1,869 1,775 87.8 100.4 85.7 57.4 54.5

Arkansas 2,223 2,122 1,890 1,993 1,898 163.1 154.0 136.0 142.5 135.7

California 18,348 17,856 16,632 14,025 13,705 101.7 98.0 91.0 76.3 74.5

Colorado 1,605 1,816 1,569 1,777 1,319 68.1 75.9 64.0 71.3 52.9

Connecticut 1,160 1,132 955 1,113 1,067 68.0 66.3 55.9 65.2 62.5

Delaware 398 656 594 439 407 96.8 158.4 141.7 103.7 96.1

District of Columbia 1,113 1,072 1,284 1,383 1,328 426.2 393.2 461.7 494.1 474.5

Florida 10,021 11,546 11,527 10,995 10,099 114.9 130.0 128.5 122.1 112.1

Georgia 7,885 9,510 8,401 7,465 6,368 175.7 206.2 179.0 156.7 133.6

Hawaii 405 409 364 312 367 63.7 63.6 56.4 48.0 56.5

Idaho 60 92 112 97 58 8.4 12.5 14.8 12.7 7.6

Illinois 9,020 9,260 9,501 9,331 8,710 143.8 146.6 150.0 146.7 137.0

Indiana 3,616 3,895 3,880 3,693 2,831 117.1 125.2 124.1 117.5 90.1

Iowa 721 787 807 676 609 49.4 53.4 54.7 45.6 41.1

Kansas 960 883 881 815 964 70.4 64.4 64.0 58.6 69.3

Kentucky 1,399 1,561 1,559 2,030 1,690 68.2 75.7 75.0 97.2 80.9

Louisiana 4,744 5,186 5,201 4,233 3,849 215.7 248.6 249.4 197.7 179.8

Maine 81 83 73 53 81 12.5 12.8 11.4 8.3 12.6

Maryland 3,410 3,461 3,238 3,054 2,922 125.7 127.4 119.1 112.0 107.1

Massachusetts 1,216 1,212 1,412 1,026 996 39.2 38.9 45.2 32.5 31.6

Michigan 7,468 6,738 6,447 6,876 6,004 150.1 135.6 130.0 139.6 121.9

Minnesota 1,573 1,489 1,529 1,380 1,033 61.7 58.0 59.1 53.1 39.7

Mississippi 2,937 3,111 3,413 3,135 2,906 207.0 220.7 241.4 220.2 204.1

Missouri 4,121 4,452 4,395 3,472 2,903 145.3 156.0 153.1 120.2 100.5

Montana 56 71 47 29 34 12.0 15.0 9.8 6.0 7.0

Nebraska 467 552 583 568 553 53.7 63.0 66.3 64.2 62.5

Nevada 1,535 1,533 1,291 1,160 900 124.9 120.8 98.8 87.6 67.9

New Hampshire 80 83 75 51 59 12.4 12.8 11.6 7.9 9.1

New Jersey 2,645 2,657 3,014 2,483 2,326 62.3 62.3 70.9 58.4 54.7

New Mexico 668 730 822 619 512 70.4 75.7 84.6 63.3 52.3

New York 8,680 8,976 9,363 8,751 9,072 93.1 95.9 100.0 92.5 95.9

North Carolina 7,527 8,594 7,725 7,023 5,902 176.2 198.0 174.5 155.5 130.7

North Dakota 52 67 50 50 62 16.4 21.0 15.6 15.5 19.3

Ohio 9,035 8,493 9,164 6,693 6,068 161.7 151.7 163.9 119.4 108.3

Oklahoma 2,210 2,171 2,221 2,212 1,857 126.0 123.0 124.3 123.0 103.2

Oregon 901 852 672 672 608 49.8 46.3 36.1 35.7 32.3

Pennsylvania 4,950 5,247 5,758 4,860 4,484 82.1 86.8 95.2 80.2 74.0

Rhode Island 211 235 232 172 176 40.6 45.5 45.3 33.8 34.6

South Carolina 3,925 4,899 4,665 3,712 3,289 189.2 232.9 217.3 170.2 150.8

South Dakota 155 152 107 128 153 40.2 38.9 27.0 31.9 38.2

Tennessee 4,209 4,590 4,317 3,979 3,560 144.1 155.5 143.6 131.4 117.5

Texas 12,269 14,812 15,819 15,150 13,215 107.7 126.4 132.6 124.8 108.8

Utah 408 519 476 340 271 32.9 40.5 35.6 24.6 19.6

Vermont 34 33 34 18 21 11.1 10.7 11.1 5.9 6.9

Virginia 3,939 3,187 2,895 4,477 3,465 105.8 84.8 76.5 117.3 90.8

Washington 2,117 2,293 1,795 1,600 1,334 67.4 71.9 55.7 48.9 40.8

West Virginia 343 465 426 321 194 38.6 52.2 48.0 36.1 21.8

Wisconsin 2,431 2,870 2,673 2,332 2,061 88.7 104.0 96.0 83.4 73.7

Wyoming 33 49 40 53 30 12.9 18.8 15.1 19.6 11.1

U.S. TOTAL 161,117 170,508 167,685 153,103 137,819 110.4 115.6 112.8 102.1 91.9

Northeast 19,057 19,658 20,916 18,527 18,282 71.8 73.9 78.6 69.3 68.4

Midwest 39,619 39,638 40,017 36,014 31,951 122.1 121.5 122.4 109.8 97.4

South 73,444 81,621 79,961 75,752 66,199 138.9 152.3 147.4 138.0 120.6

West 28,997 29,591 26,791 22,810 21,387 84.9 85.3 76.3 64.3 60.2

Guam 35 49 75 51 27 40.7 56.2 84.9 56.9 30.1

Puerto Rico 134 150 158 145 104 7.1 8.0 8.3 7.6 5.5

Virgin Islands 12 11 18 34 25 23.1 21.2 34.6 65.3 48.0

OUTLYING AREAS 181 210 251 230 156 9.0 10.4 12.3 11.3 7.7

TOTAL 161,298 170,718 167,936 153,333 137,975 109.0 114.2 111.4 100.9 90.8

NOTE: Cases reported with unknown sex are not included in this table.
102 Gonorrhea Tables STD Surveillance 2009

Table 16. Gonorrhea—Reported Cases and Rates in Selected Metropolitan Statistical Areas 

(MSAs)* in Alphabetical Order, United States, 2005–2009

MSAs

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Atlanta-Sandy Springs-Marietta, GA 7,838 10,223 9,060 8,084 7,466 159.4 199.0 171.6 150.4 138.9

Austin-Round Rock, TX 1,706 2,446 2,075 2,388 1,973 117.5 161.6 129.8 144.5 119.4

Baltimore-Towson, MD 4,779 4,653 4,156 4,146 3,869 180.0 175.0 155.8 155.4 145.1

Birmingham-Hoover, AL 2,381 2,444 3,129 2,891 1,970 218.4 222.2 282.3 258.7 176.3

Boston-Cambridge-Quincy, MA-NH 1,684 1,542 1,770 1,464 1,352 38.2 34.6 39.5 32.4 29.9

Buffalo-Cheektowaga-Tonawanda, NY 1,926 2,068 2,289 1,898 1,574 167.8 181.8 202.9 168.8 140.0

Charlotte-Gastonia-Concord, NC-SC 3,330 3,388 2,388 3,249 3,165 218.9 214.0 144.6 190.9 186.0

Chicago-Naperville-Joliet, IL-IN-WI 14,857 15,127 14,979 16,181 15,864 157.3 159.1 157.3 169.1 165.8

Cincinnati-Middletown, OH-KY-IN 3,927 3,862 4,583 3,926 3,219 189.7 183.5 214.8 182.2 149.4

Cleveland-Elyria-Mentor, OH 4,641 4,663 4,286 2,770 3,089 218.3 220.6 204.4 132.6 147.9

Columbus, OH 3,445 3,303 4,136 3,853 3,192 201.6 191.4 235.8 217.3 180.0

Dallas-Fort Worth-Arlington, TX 8,416 8,365 10,064 9,197 7,930 144.6 139.3 163.8 146.0 125.9

Denver-Aurora, CO 2,147 2,253 2,238 2,625 1,995 91.0 93.5 90.8 104.7 79.6

Detroit-Warren-Livonia, MI 10,766 8,535 8,554 10,850 9,366 239.9 191.0 191.5 245.2 211.7

Hartford-West Hartford-East Hartford, CT 993 988 920 1,029 961 83.6 83.1 77.4 86.4 80.7

Houston-Baytown-Sugar Land, TX 5,213 7,318 7,757 7,290 6,232 98.7 132.1 137.8 127.3 108.8

Indianapolis, IN 4,142 4,410 4,543 4,194 2,975 252.5 264.7 268.0 244.5 173.4

Jacksonville, FL 2,578 2,954 3,113 2,979 2,015 206.5 231.1 239.3 226.8 153.4

Kansas City, MO-KS 3,769 3,822 3,683 3,268 3,192 193.5 194.3 185.5 163.2 159.4

Las Vegas-Paradise, NV 2,487 2,478 2,112 1,918 1,553 145.4 139.4 115.0 102.8 83.2

Los Angeles-Long Beach-Santa Ana, CA 12,697 12,210 11,059 9,832 9,774 98.2 94.3 85.9 76.4 75.9

Louisville, KY-IN 1,551 1,749 1,908 2,300 2,125 128.3 143.1 154.7 184.8 170.7

Memphis, TN-MS-AR 3,782 4,665 4,756 4,475 4,536 299.9 366.0 371.4 348.1 352.8

Miami-Fort Lauderdale-Miami Beach, FL 4,497 5,356 5,152 5,471 5,239 82.9 98.0 95.2 101.0 96.8

Milwaukee-Waukesha-West Allis, WI 4,031 5,006 4,960 446 3,588 266.4 331.5 321.2 28.8 231.6

Minneapolis-St. Paul-Bloomington, MN-WI 2,920 2,780 2,834 2,345 1,800 92.9 87.6 88.3 72.6 55.7

Nashville-Davidson-Murfreesboro, TN 1,474 1,734 1,692 1,541 1,225 103.6 119.2 111.2 99.4 79.0

New Orleans-Metairie-Kenner, LA 2,609 1,962 2,713 2,045 2,082 197.7 191.5 263.3 180.3 183.6

New York-Newark-Edison, NY-NJ-PA 15,533 14,949 15,396 15,116 15,254 82.9 79.4 81.8 79.5 80.3

Oklahoma City, OK 2,548 2,315 2,373 2,403 2,066 220.3 197.5 198.9 199.2 171.3

Orlando, FL 2,848 3,393 2,743 2,704 2,663 147.3 170.9 135.0 131.6 129.6

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 7,719 8,163 8,669 7,724 7,407 132.6 140.1 148.7 132.3 126.9

Phoenix-Mesa-Scottsdale, AZ 3,133 4,260 3,333 2,211 2,317 81.1 105.5 79.7 51.6 54.1

Pittsburgh, PA 2,157 2,057 2,599 2,569 1,866 90.4 86.8 110.3 109.3 79.4

Portland-Vancouver-Beaverton, OR-WA 1,393 1,128 1,053 1,033 826 66.5 52.8 48.4 46.8 37.4

Providence-New Bedford-Fall River, RI-MA 650 693 621 455 427 40.1 43.0 38.8 28.5 26.7

Richmond, VA 2,361 1,778 2,199 2,698 1,900 200.8 148.9 181.3 220.1 155.0

Riverside-San Bernardino-Ontario, CA 3,012 2,994 3,166 2,199 1,921 77.0 74.4 77.6 53.4 46.7

Rochester, NY 1,899 1,457 1,207 1,345 1,465 182.8 140.7 117.1 130.1 141.7

Sacramento-Arden-Arcade-Roseville, CA 2,450 2,235 2,315 1,771 1,124 120.0 108.1 110.7 83.9 53.3

Salt Lake City, UT 460 623 573 346 244 44.5 58.3 52.1 31.0 21.9

San Antonio, TX 2,300 2,701 2,601 3,113 3,697 121.7 139.1 130.7 153.2 182.0

San Diego-Carlsbad-San Marcos, CA 2,695 2,767 2,385 2,066 1,829 91.9 94.1 80.2 68.8 60.9

San Francisco-Oakland-Fremont, CA 5,713 6,029 5,695 5,065 4,375 137.6 144.2 135.5 118.5 102.4

San Jose-Sunnyvale-Santa Clara, CA 1,055 1,065 893 712 563 60.1 59.6 49.5 39.1 30.9

Seattle-Tacoma-Bellevue, WA 2,704 3,079 2,572 2,182 1,700 84.4 94.3 77.7 65.2 50.8

St. Louis, MO-IL 6,391 6,547 6,483 5,003 3,620 230.0 234.1 231.2 177.6 128.5

Tampa-St. Petersburg-Clearwater, FL 2,910 3,667 3,819 3,852 3,818 109.9 135.9 140.2 140.9 139.7

Virginia Beach-Norfolk-Newport News, VA-NC 3,355 2,544 2,504 4,935 3,647 203.7 154.2 151.0 297.6 219.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 4,497 4,358 4,665 5,557 5,321 86.2 82.4 87.9 103.7 99.3

U.S. MSAs TOTAL 202,369 209,106 208,773 197,714 181,371 126.9 129.6 128.3 120.4 110.4

* 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.
STD Surveillance 2009 Gonorrhea Tables 103

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

Areas (MSAs)* in Alphabetical Order, United States, 2005–2009

MSAs

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Atlanta-Sandy Springs-Marietta, GA 3,567 5,026 4,515 3,967 3,633 144.1 193.5 169.1 145.8 133.6

Austin-Round Rock, TX 830 1,134 992 1,177 980 116.6 153.3 127.1 145.9 121.5

Baltimore-Towson, MD 2,426 2,470 2,179 2,302 2,181 176.5 179.2 157.6 166.6 157.9

Birmingham-Hoover, AL 1,133 1,511 1,761 1,655 1,056 200.9 265.4 307.0 286.0 182.5

Boston-Cambridge-Quincy, MA-NH 793 728 773 720 624 35.0 31.8 33.6 31.0 26.9

Buffalo-Cheektowaga-Tonawanda, NY 1,079 1,153 1,258 1,059 878 181.2 195.5 215.3 181.9 150.8

Charlotte-Gastonia-Concord, NC-SC 1,604 1,584 1,188 1,697 1,750 207.8 196.9 141.1 196.0 202.1

Chicago-Naperville-Joliet, IL-IN-WI 7,948 7,853 7,813 8,594 8,712 165.3 162.7 161.7 177.1 179.5

Cincinnati-Middletown, OH-KY-IN 2,274 2,465 2,884 2,696 2,181 214.8 229.0 264.2 244.5 197.8

Cleveland-Elyria-Mentor, OH 2,264 2,277 2,180 1,469 1,808 204.8 207.4 200.3 135.5 166.8

Columbus, OH 1,896 1,758 2,142 2,062 1,873 219.0 201.2 241.1 229.8 208.7

Dallas-Fort Worth-Arlington, TX 4,135 4,129 4,905 4,953 4,556 142.6 138.1 160.5 158.2 145.5

Denver-Aurora, CO 996 1,044 1,128 1,345 1,035 84.9 87.0 91.9 107.9 83.0

Detroit-Warren-Livonia, MI 6,079 4,613 4,721 6,226 5,204 264.4 201.8 206.7 275.1 230.0

Hartford-West Hartford-East Hartford, CT 520 521 522 609 551 85.0 85.4 85.6 99.8 90.3

Houston-Baytown-Sugar Land, TX 3,016 3,806 3,805 3,749 3,302 114.2 137.5 135.5 131.2 115.6

Indianapolis, IN 2,163 2,297 2,385 2,290 1,603 259.1 271.1 276.7 262.4 183.7

Jacksonville, FL 1,240 1,506 1,532 1,587 1,048 194.5 230.8 230.4 236.4 156.1

Kansas City, MO-KS 2,035 2,099 2,040 1,888 1,821 205.5 209.6 201.8 185.3 178.8

Las Vegas-Paradise, NV 1,163 1,123 954 880 746 138.4 128.4 105.8 96.0 81.4

Los Angeles-Long Beach-Santa Ana, CA 5,687 5,657 5,001 4,214 3,641 87.2 86.7 77.1 65.0 56.2

Louisville, KY-IN 740 887 1,026 1,228 1,133 119.6 141.6 162.3 192.2 177.4

Memphis, TN-MS-AR 1,990 2,548 2,789 2,472 2,537 305.6 386.0 420.2 370.2 380.0

Miami-Fort Lauderdale-Miami Beach, FL 2,317 2,708 2,444 2,661 2,439 83.0 96.4 87.9 95.6 87.6

Milwaukee-Waukesha-West Allis, WI 2,298 2,923 2,972 300 2,098 295.8 378.4 376.2 37.9 264.9

Minneapolis-St. Paul-Bloomington, MN-WI 1,548 1,486 1,500 1,210 928 97.7 93.0 93.0 74.6 57.2

Nashville-Davidson-Murfreesboro, TN 661 794 800 783 625 91.8 107.6 103.7 99.4 79.3

New Orleans-Metairie-Kenner, LA 1,287 965 1,322 984 1,098 187.8 181.7 246.6 166.6 185.9

New York-Newark-Edison, NY-NJ-PA 7,784 7,015 6,979 7,089 6,886 80.2 72.1 71.8 72.3 70.2

Oklahoma City, OK 1,486 1,275 1,202 1,294 1,188 253.5 214.2 198.8 211.5 194.2

Orlando, FL 1,286 1,688 1,377 1,424 1,364 131.6 168.5 134.3 137.3 131.5

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 4,219 4,257 4,416 4,098 3,811 140.0 141.4 146.7 135.9 126.4

Phoenix-Mesa-Scottsdale, AZ 1,456 2,014 1,497 988 1,022 76.0 100.7 72.3 46.7 48.3

Pittsburgh, PA 1,216 1,174 1,530 1,524 1,161 97.9 95.3 125.2 125.0 95.2

Portland-Vancouver-Beaverton, OR-WA 551 436 446 420 322 52.4 40.7 40.9 38.0 29.1

Providence-New Bedford-Fall River, RI-MA 365 374 282 209 196 43.5 44.9 34.1 25.4 23.8

Richmond, VA 1,256 824 1,122 1,436 1,010 207.8 134.4 179.7 227.9 160.3

Riverside-San Bernardino-Ontario, CA 1,572 1,602 1,705 1,237 1,024 80.5 79.6 83.6 60.2 49.8

Rochester, NY 1,006 748 608 744 744 188.9 141.0 115.2 140.6 140.6

Sacramento-Arden-Arcade-Roseville, CA 1,307 1,164 1,190 917 557 125.9 110.7 112.0 85.6 52.0

Salt Lake City, UT 183 246 229 88 37 35.8 46.7 42.4 16.0 6.7

San Antonio, TX 1,155 1,412 1,279 1,557 1,921 119.8 142.3 126.0 150.3 185.5

San Diego-Carlsbad-San Marcos, CA 1,108 1,158 961 803 620 76.3 79.3 64.9 53.9 41.6

San Francisco-Oakland-Fremont, CA 2,052 2,122 2,174 1,863 1,421 97.9 100.9 102.8 86.7 66.2

San Jose-Sunnyvale-Santa Clara, CA 457 488 385 312 248 53.1 55.8 43.7 35.2 27.9

Seattle-Tacoma-Bellevue, WA 1,060 1,300 1,205 965 604 66.1 79.6 72.7 57.7 36.1

St. Louis, MO-IL 3,638 3,718 3,539 2,756 1,908 253.5 257.5 244.5 189.6 131.3

Tampa-St. Petersburg-Clearwater, FL 1,542 2,064 1,973 2,006 1,907 113.3 149.0 141.1 143.0 135.9

Virginia Beach-Norfolk-Newport News, VA-NC 1,717 1,305 1,355 2,875 2,008 205.6 154.9 159.8 339.3 237.0

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,269 2,048 2,268 2,711 2,637 85.1 75.6 83.5 98.8 96.2

U.S. MSAs TOTAL 102,374 105,497 105,253 102,093 92,637 126.2 128.7 127.3 122.4 111.1

* 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.
104 Gonorrhea Tables STD Surveillance 2009

Table 18. Gonorrhea—Men—Reported Cases and Rates in Selected Metropolitan Statistical Areas 

(MSAs)* in Alphabetical Order, United States, 2005–2009

MSAs

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Atlanta-Sandy Springs-Marietta, GA 4,183 5,083 4,484 4,054 3,786 171.3 200.1 171.9 152.6 142.5

Austin-Round Rock, TX 870 1,310 1,081 1,208 991 117.4 169.2 132.2 142.8 117.2

Baltimore-Towson, MD 2,352 2,180 1,976 1,841 1,675 183.6 170.3 153.7 143.2 130.3

Birmingham-Hoover, AL 1,243 932 1,367 1,235 913 236.2 175.6 255.7 229.1 169.4

Boston-Cambridge-Quincy, MA-NH 890 812 996 742 726 41.5 37.5 45.7 33.7 33.0

Buffalo-Cheektowaga-Tonawanda, NY 847 913 1,031 839 696 153.4 166.7 189.6 154.7 128.4

Charlotte-Gastonia-Concord, NC-SC 1,726 1,804 1,199 1,542 1,405 230.4 231.7 148.1 184.5 168.1

Chicago-Naperville-Joliet, IL-IN-WI 6,900 7,267 7,161 7,586 7,141 148.8 155.4 152.6 160.9 151.4

Cincinnati-Middletown, OH-KY-IN 1,616 1,373 1,674 1,224 1,019 159.7 133.6 160.6 116.3 96.8

Cleveland-Elyria-Mentor, OH 2,329 2,366 2,091 1,295 1,254 228.2 232.8 207.4 128.9 124.8

Columbus, OH 1,531 1,537 1,985 1,788 1,289 181.6 180.4 229.2 204.2 147.2

Dallas-Fort Worth-Arlington, TX 4,276 4,230 5,123 4,243 3,374 146.5 140.3 165.9 133.9 106.5

Denver-Aurora, CO 1,151 1,209 1,110 1,278 958 97.0 100.0 89.7 101.5 76.1

Detroit-Warren-Livonia, MI 4,657 3,890 3,786 4,502 4,005 212.7 178.2 173.4 208.2 185.2

Hartford-West Hartford-East Hartford, CT 473 467 398 418 410 82.1 80.7 68.7 72.0 70.6

Houston-Baytown-Sugar Land, TX 2,194 3,504 3,930 3,525 2,926 83.1 126.4 139.4 122.8 101.9

Indianapolis, IN 1,972 2,106 2,150 1,902 1,369 244.8 257.3 258.1 225.7 162.4

Jacksonville, FL 1,338 1,448 1,581 1,392 966 219.1 231.5 248.7 216.8 150.5

Kansas City, MO-KS 1,734 1,723 1,643 1,380 1,371 181.1 178.4 168.6 140.3 139.4

Las Vegas-Paradise, NV 1,322 1,354 1,158 1,038 807 152.0 149.9 123.9 109.3 85.0

Los Angeles-Long Beach-Santa Ana, CA 6,985 6,505 6,023 5,543 6,081 109.1 101.2 94.2 86.7 95.1

Louisville, KY-IN 811 858 881 1,070 990 137.6 144.0 146.5 176.6 163.4

Memphis, TN-MS-AR 1,792 2,117 1,967 2,003 1,998 293.9 344.4 318.9 324.1 323.3

Miami-Fort Lauderdale-Miami Beach, FL 2,180 2,648 2,706 2,801 2,799 82.9 99.7 102.8 106.4 106.4

Milwaukee-Waukesha-West Allis, WI 1,731 2,080 1,975 145 1,470 235.2 282.0 261.8 19.1 194.1

Minneapolis-St. Paul-Bloomington, MN-WI 1,372 1,294 1,334 1,135 872 88.1 82.1 83.6 70.6 54.3

Nashville-Davidson-Murfreesboro, TN 813 940 892 758 600 115.8 131.0 119.0 99.4 78.6

New Orleans-Metairie-Kenner, LA 1,299 981 1,352 1,050 976 204.9 198.8 273.5 193.2 179.6

New York-Newark-Edison, NY-NJ-PA 7,744 7,929 8,406 8,017 8,363 85.6 87.2 92.4 87.1 90.9

Oklahoma City, OK 1,062 1,040 1,171 1,103 876 186.1 180.2 199.0 185.5 147.4

Orlando, FL 1,562 1,704 1,366 1,277 1,297 163.4 173.3 135.6 125.5 127.4

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 3,500 3,904 4,250 3,626 3,593 124.5 138.6 150.9 128.4 127.2

Phoenix-Mesa-Scottsdale, AZ 1,676 2,242 1,834 1,222 1,295 85.9 110.0 86.9 56.5 59.8

Pittsburgh, PA 941 883 1,069 1,045 704 82.2 77.5 94.3 92.3 62.2

Portland-Vancouver-Beaverton, OR-WA 842 692 607 611 504 80.6 64.9 56.0 55.5 45.8

Providence-New Bedford-Fall River, RI-MA 285 318 338 246 231 36.4 40.8 43.7 31.9 29.9

Richmond, VA 1,105 954 1,074 1,261 886 193.4 164.2 182.4 211.7 148.8

Riverside-San Bernardino-Ontario, CA 1,440 1,390 1,450 961 895 73.5 69.0 71.0 46.7 43.4

Rochester, NY 893 709 599 601 721 176.3 140.4 119.2 119.1 142.8

Sacramento-Arden-Arcade-Roseville, CA 1,123 1,046 1,098 835 558 111.8 103.0 106.7 80.4 53.7

Salt Lake City, UT 277 377 344 258 207 52.9 69.6 61.5 45.5 36.5

San Antonio, TX 1,145 1,289 1,322 1,556 1,775 123.7 135.7 135.5 156.3 178.3

San Diego-Carlsbad-San Marcos, CA 1,500 1,531 1,415 1,254 1,206 101.3 103.4 94.7 83.0 79.9

San Francisco-Oakland-Fremont, CA 3,644 3,882 3,493 3,179 2,933 177.2 186.9 167.2 149.5 137.9

San Jose-Sunnyvale-Santa Clara, CA 597 570 506 398 314 66.8 62.4 54.8 42.7 33.7

Seattle-Tacoma-Bellevue, WA 1,644 1,779 1,367 1,216 1,094 102.7 109.1 82.7 72.7 65.4

St. Louis, MO-IL 2,753 2,829 2,944 2,247 1,712 204.9 209.2 217.1 164.8 125.6

Tampa-St. Petersburg-Clearwater, FL 1,368 1,602 1,842 1,822 1,887 106.3 122.0 138.9 136.9 141.8

Virginia Beach-Norfolk-Newport News, VA-NC 1,636 1,237 1,148 2,058 1,633 201.4 153.3 141.6 253.7 201.3

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,220 2,291 2,385 2,823 2,681 87.1 88.8 92.1 107.9 102.5

U.S. MSAs TOTAL 99,544 103,129 103,082 95,153 88,232 127.0 130.0 128.8 117.7 109.1

* 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.
STD Surveillance 2009 Gonorrhea Tables 105

Table 19. Gonorrhea—Counties and Independent Cities* Ranked by Number of Reported Cases, 

United States, 2009

Rank† County/Independent City Cases Rates per 100,000 Population Cumulative Percentage

1 Cook County, IL 13,330 251.8 4

2 Los Angeles County, CA 9,020 91.5 7

3 Wayne County, MI 7,654 392.5 9

4 Harris County, TX 5,209 130.7 11

5 Philadelphia County, PA 4,823 333.2 13

6 Dallas County, TX 4,472 185.3 14

7 Shelby County, TN 3,827 422.0 16

8 Kings County, NY 3,510 137.3 17

9 Milwaukee County, WI 3,507 367.9 18

10 Bexar County, TX 3,458 213.1 19

11 Bronx County, NY 3,029 217.6 20

12 Franklin County, OH 2,922 258.8 21

13 Fulton County, GA 2,906 286.3 22

14 Baltimore (City), MD 2,882 452.5 23

15 Marion County, IN 2,824 320.8 24

16 Cuyahoga County, OH 2,723 212.1 25

17 Washington, D.C. 2,561 432.7 26

18 Hamilton County, OH 2,459 288.8 26

19 Tarrant County, TX 2,459 140.5 27

20 New York County, NY 2,355 144.1 28

21 Miami-Dade County, FL 2,338 97.5 29

22 Maricopa County, AZ 2,258 57.1 30

23 Jackson County, MO 2,179 326.0 30

24 Mecklenburg County, NC 2,031 228.1 31

25 Hillsborough County, FL 2,015 170.6 32

26 Broward County, FL 1,968 112.4 32

27 Orange County, FL 1,895 176.6 33

28 Jefferson County, KY 1,874 262.5 34

29 San Diego County, CA 1,829 60.9 34

30 Duval County, FL 1,825 214.5 35

31 Queens County, NY 1,808 78.8 35

32 San Francisco County, CA 1,799 222.4 36

33 Jefferson County, AL 1,790 271.4 37

34 Oklahoma County, OK 1,768 250.2 37

35 DeKalb County, GA 1,761 238.0 38

36 Alameda County, CA 1,653 112.1 38

37 Clark County, NV 1,553 83.2 39

38 Allegheny County, PA 1,535 126.3 39

39 Pinellas County, FL 1,509 165.8 40

40 Travis County, TX 1,461 146.3 40

41 Essex County, NJ 1,457 189.1 41

42 Prince George’s County, MD 1,428 174.0 41

43 Tulsa County, OK 1,419 239.7 42

44 Monroe County, NY 1,414 193.0 42

45 Erie County, NY 1,409 154.9 43

46 Pulaski County, AR 1,351 358.5 43

47 Hinds County, MS 1,344 542.7 44

48 St. Louis County, MO 1,330 134.1 44

49 Orleans County, LA 1,316 422.0 44

50 St. Louis (City), MO 1,296 365.7 45

51 Caddo County, LA 1,284 507.7 45

52 Bell County, TX 1,176 412.5 46

53 Denver County, CO 1,169 195.3 46

54 San Bernardino County, CA 1,163 57.7 46

55 Genesee County, MI 1,125 262.4 47

56 King County, WA 1,103 58.8 47

57 Norfolk (City), VA 1,091 465.8 48

58 Hennepin County, MN 1,050 92.0 48

59 Montgomery County, OH 1,049 196.2 48

60 Richland County, SC 1,043 286.5 49

61 Lucas County, OH 1,043 236.8 49

62 Guilford County, NC 1,013 214.5 49

63 Sacramento County, CA 985 70.7 50

64 Leon County, FL 977 370.0 50

65 Oakland County, MI 976 81.2 50

* Accounting for 50% of reported gonorrhea cases.

† Counties and independent cities were ranked in descending order by the number of cases reported in 2009.
106 Gonorrhea Tables STD Surveillance 2009

Table 20. Gonorrhea—Reported Cases and Rates per 100,000 Population by 

Age Group and Sex, United States, 2005–2009

Age 

Group

Cases Rates

Total Male Female Total Male Female

2005

10–14 4,278 646 3,631 20.5 6.0 35.7

15–19 90,840 27,781 63,060 431.8 257.5 615.3

20–24 106,280 47,187 59,093 505.2 434.6 580.4

25–29 57,195 30,631 26,565 285.0 298.3 271.1

30–34 30,044 18,244 11,800 149.6 179.7 118.9

35–39 19,948 13,413 6,535 95.0 127.0 62.6

40–44 14,346 10,406 3,940 62.8 91.5 34.3

45–54 12,636 10,063 2,573 29.7 48.2 11.9

55–64 2,777 2,399 378 9.1 16.4 2.4

65+ 763 631 132 2.1 4.1 0.6

TOTAL 339,593 161,557 178,036 114.6 110.7 118.4

2006

10–14 4,250 675 3,574 20.6 6.4 35.5

15–19 96,524 30,119 66,405 452.6 275.4 639.2

20–24 110,969 49,304 61,665 525.6 451.9 604.5

25–29 61,843 32,946 28,897 298.6 311.3 285.4

30–34 31,313 18,858 12,455 158.9 188.9 128.1

35–39 20,674 13,813 6,861 97.6 129.7 65.1

40–44 14,534 10,636 3,898 64.6 95.0 34.6

45–54 13,847 11,064 2,782 32.0 52.0 12.7

55–64 3,137 2,686 451 9.9 17.6 2.8

65+ 800 648 152 2.1 4.1 0.7

TOTAL 358,366 170,902 187,464 119.7 115.9 123.4

2007

10–14 3,958 623 3,335 19.5 6.0 33.6

15–19 98,579 31,270 67,309 459.1 284.1 643.1

20–24 111,788 49,101 62,687 531.5 452.4 615.8

25–29 61,364 32,296 29,068 291.4 299.7 282.7

30–34 30,294 18,114 12,180 155.1 182.9 126.5

35–39 19,094 12,724 6,370 90.2 119.4 60.5

40–44 13,184 9,704 3,480 60.0 88.5 31.6

45–54 13,346 10,690 2,656 30.4 49.5 11.9

55–64 3,179 2,692 487 9.7 17.1 2.9

65+ 710 620 89 1.9 3.9 0.4

TOTAL 355,991 168,012 187,979 118.0 113.0 122.9

2008

10–14 3,668 598 3,070 18.3 5.8 31.3

15–19 97,293 30,637 66,656 452.2 277.8 635.6

20–24 109,005 47,053 61,951 517.6 433.9 606.6

25–29 56,791 29,089 27,701 266.2 265.9 266.5

30–34 27,629 16,177 11,452 141.0 162.4 118.8

35–39 16,419 10,615 5,804 78.2 100.4 55.7

40–44 11,048 7,859 3,189 51.4 73.1 29.6

45–54 11,152 8,659 2,493 25.1 39.6 11.1

55–64 2,629 2,203 426 7.8 13.6 2.4

65+ 657 552 104 1.7 3.4 0.5

TOTAL 336,742 153,599 183,143 110.7 102.5 118.8

2009

10–14 2,991 509 2,482 14.9 5.0 25.3

15–19 87,221 27,573 59,648 405.4 250.0 568.8

20–24 100,902 44,190 56,712 479.1 407.5 555.3

25–29 49,981 26,142 23,840 234.3 238.9 229.4

30–34 24,669 14,437 10,232 125.9 145.0 106.2

35–39 14,006 9,049 4,957 66.7 85.6 47.6

40–44 8,997 6,538 2,459 41.8 60.8 22.9

45–54 9,317 7,352 1,965 21.0 33.6 8.7

55–64 2,217 1,853 364 6.6 11.4 2.1

65+ 555 447 108 1.4 2.7 0.5

TOTAL 301,174 138,187 162,987 99.1 92.2 105.7

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the 

distribution of cases for which age was known. Differences between total cases from this table and others in the report are due 

to different reporting formats. The 0- to 9-year age group is not shown because some of these cases may not be due to sexual 

transmission; however, they are included in the totals.
STD Surveillance 2009 107

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108 Gonorrhea Tables STD Surveillance 2009

Table 21A. Gonorrhea—Reported Cases by Race/Ethnicity, Age Group, and Sex, United States, 

2005–2009

Age 

Group

Whites, 

Non-Hispanic

Blacks, 

Non-Hispanic Hispanics

Asians/Pacific 

Islanders

American Indians/

Alaska Natives

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

2005

10–14 691 35 655 3,154 549 2,604 355 52 304 25 1 23 45 8 37

15–19 15,758 2,679 13,079 66,165 22,563 43,602 7,299 2,134 5,165 606 176 430 845 196 650

20–24 20,892 6,509 14,383 73,365 35,373 37,991 9,742 4,438 5,303 960 418 542 1,012 344 668

25–29 11,681 4,667 7,013 38,213 22,200 16,013 5,915 3,126 2,790 633 341 293 569 216 353

30–34 6,790 3,405 3,385 19,172 12,540 6,632 3,248 1,830 1,418 405 281 124 314 137 177

35–39 5,384 3,256 2,127 12,004 8,570 3,433 2,009 1,270 739 268 180 88 193 97 97

40–44 4,255 2,863 1,392 8,606 6,593 2,012 1,153 776 377 146 93 53 119 44 75

45–54 3,535 2,668 867 7,993 6,667 1,325 831 561 270 118 79 39 93 46 46

55–64 853 721 132 1,653 1,490 163 191 134 57 44 28 16 24 17 6

65+ 242 203 39 452 386 66 55 36 19 8 4 4 3 1 2

TOTAL 70,209 27,050 43,159 231,076 117,025 114,050 30,845 14,374 16,471 3,214 1,602 1,612 3,225 1,112 2,113

2006

10–14 596 53 543 3,227 549 2,678 367 70 297 23 1 21 36 1 34

15–19 16,038 2,612 13,426 70,992 24,675 46,317 8,055 2,451 5,603 556 125 431 877 251 626

20–24 21,590 6,684 14,906 77,200 37,200 40,000 10,340 4,739 5,601 809 335 474 1,045 356 689

25–29 12,907 5,147 7,760 41,339 23,863 17,477 6,408 3,424 2,985 558 278 280 634 238 396

30–34 6,948 3,313 3,636 20,334 13,363 6,971 3,340 1,861 1,478 365 207 157 325 114 211

35–39 5,570 3,281 2,289 12,565 9,018 3,547 2,097 1,270 827 246 154 93 193 89 103

40–44 4,231 2,800 1,432 8,798 6,831 1,967 1,241 843 398 144 102 42 117 59 59

45–54 3,952 2,875 1,077 8,744 7,427 1,317 896 619 277 125 69 56 128 74 55

55–64 1,019 836 183 1,886 1,699 187 172 116 55 32 14 18 27 19 8

65+ 269 226 44 450 370 80 65 44 21 8 3 5 8 6 2

TOTAL 73,200 27,848 45,353 245,855 125,102 120,753 33,044 15,460 17,584 2,869 1,290 1,579 3,398 1,208 2,189

2007

10–14 477 20 457 3,066 537 2,529 364 64 300 22 0 22 30 3 27

15–19 15,620 2,700 12,920 74,252 25,860 48,392 7,536 2,439 5,097 498 122 376 668 147 521

20–24 20,828 6,344 14,485 79,557 37,666 41,891 9,761 4,544 5,217 767 297 470 884 256 628

25–29 12,481 4,997 7,484 42,001 23,643 18,358 5,880 3,188 2,692 519 285 234 485 186 299

30–34 6,516 3,006 3,510 20,077 12,995 7,082 3,120 1,822 1,298 354 207 146 227 85 143

35–39 4,984 2,778 2,206 11,915 8,578 3,337 1,843 1,170 673 187 120 67 164 78 86

40–44 3,680 2,451 1,228 8,238 6,433 1,805 1,048 710 339 119 82 37 98 28 70

45–54 3,786 2,808 979 8,540 7,176 1,364 824 594 230 114 64 50 81 48 33

55–64 1,010 833 177 1,908 1,680 228 196 133 63 49 33 16 15 13 2

65+ 275 244 31 367 318 49 50 44 6 13 10 3 4 4 0

TOTAL 69,753 26,209 43,544 250,260 125,010 125,250 30,676 14,729 15,947 2,643 1,221 1,422 2,659 850 1,809

2008

10–14 448 37 411 2,847 507 2,340 312 44 268 27 4 23 33 6 27

15–19 14,141 2,484 11,657 74,285 25,450 48,835 7,651 2,410 5,240 529 130 399 681 159 522

20–24 19,542 5,774 13,768 78,084 36,182 41,902 9,637 4,454 5,183 842 349 493 906 300 606

25–29 11,213 4,326 6,887 38,706 21,221 17,486 5,814 3,086 2,727 552 279 273 509 180 329

30–34 5,692 2,575 3,117 18,355 11,619 6,736 3,016 1,725 1,291 322 169 153 243 90 154

35–39 3,967 2,165 1,802 10,258 7,093 3,165 1,834 1,149 685 211 144 67 148 65 83

40–44 2,987 1,946 1,041 6,725 5,017 1,708 1,096 751 345 134 100 34 105 45 60

45–54 3,158 2,288 870 6,933 5,642 1,290 796 562 233 162 111 51 103 55 48

55–64 804 671 133 1,588 1,372 215 168 112 56 47 29 18 22 19 3

65+ 270 224 46 317 281 35 45 32 13 14 6 7 11 9 2

TOTAL 62,306 22,518 39,788 238,410 114,496 123,915 30,412 14,339 16,073 2,849 1,327 1,522 2,764 926 1,838

2009

10–14 346 31 314 2,369 428 1,942 234 44 190 16 1 15 25 4 20

15–19 12,317 2,317 10,000 66,650 22,751 43,899 6,986 2,222 4,764 537 118 419 726 165 562

20–24 17,366 5,447 11,919 72,968 33,947 39,021 8,919 4,198 4,721 750 325 425 906 279 628

25–29 9,858 4,202 5,656 34,021 18,670 15,351 5,096 2,811 2,284 498 263 234 513 197 316

30–34 5,193 2,555 2,638 16,158 9,996 6,162 2,729 1,602 1,127 292 165 128 296 121 175

35–39 3,442 1,921 1,521 8,641 5,963 2,678 1,544 946 598 195 140 55 183 79 103

40–44 2,536 1,748 788 5,227 3,938 1,290 991 701 290 135 100 35 107 51 56

45–54 2,891 2,231 660 5,405 4,395 1,010 766 562 204 142 98 44 112 64 48

55–64 742 611 130 1,239 1,087 153 157 106 51 44 23 21 35 26 10

65+ 231 198 33 262 208 54 45 27 17 10 9 2 6 4 2

TOTAL 54,961 21,273 33,688 213,165 101,459 111,706 27,512 13,229 14,283 2,621 1,242 1,378 2,917 991 1,925

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 20 for age-specific cases and rates and Tables 13–15 for total and sexspecific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were 

specified. In 2005, Hawaii did not report age or race/ethnicity for most cases and their case data and population denominators were excluded. Differences between 

total cases from this table and others in the report are due to different reporting formats. The 0- to 9-year age group is not shown because some of these cases may 

not be due to sexual transmission; however, they are included in the totals.
STD Surveillance 2009 Gonorrhea Tables 109

Table 21B. Gonorrhea—Rates per 100,000 Population by Race/Ethnicity, Age Group, and Sex, 

United States, 2005–2009

Age 

Group

Whites, 

Non-Hispanic

Blacks, 

Non-Hispanic Hispanics

Asians/Pacific 

Islanders

American Indians/

Alaska Natives

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

10–14 5.5 0.5 10.7 95.5 32.8 160.2 9.2 2.6 16.1 3.0 0.3 5.8 20.9 7.4 34.7

2005

15–19 119.3 39.5 203.6 2,044.5 1,376.4 2,730.3 211.5 119.9 308.9 73.1 41.2 107.1 367.8 167.5 575.2

20–24 160.0 97.6 225.1 2,437.0 2,333.5 2,542.0 261.7 218.3 314.0 102.5 88.0 117.4 466.7 312.9 625.0

25–29 97.5 77.2 118.1 1,412.1 1,692.4 1,148.5 147.1 139.7 156.5 57.7 63.1 52.4 317.6 238.4 398.8

30–34 55.7 55.5 55.9 742.3 1,024.0 488.3 85.7 89.3 81.4 31.8 45.1 19.0 189.8 165.9 213.7

35–39 39.7 47.7 31.5 455.3 688.7 246.6 59.4 70.3 46.9 23.2 31.9 14.9 116.5 117.7 115.3

40–44 27.1 36.5 17.7 305.6 500.6 134.3 38.5 49.6 26.3 13.9 18.3 9.9 64.6 49.5 79.0

45–54 11.4 17.3 5.5 163.3 294.9 50.3 19.5 26.1 12.8 6.7 9.6 4.2 28.2 29.5 26.9

55–64 3.6 6.3 1.1 55.7 112.7 9.9 8.1 11.9 4.6 3.9 5.4 2.6 11.3 17.2 5.8

65+ 0.8 1.6 0.2 14.7 32.8 3.5 2.4 3.7 1.5 0.8 1.0 0.7 1.9 1.8 1.9

TOTAL 35.1 27.6 42.4 619.4 658.0 584.2 72.4 65.3 80.1 25.2 25.8 24.6 131.5 92.1 169.7

10–14 4.8 0.8 9.0 100.0 33.5 168.6 9.3 3.5 15.4 2.6 0.3 4.9 17.1 1.4 33.2

2006

15–19 121.0 38.4 208.3 2,139.5 1,467.6 2,829.6 222.3 131.3 319.2 61.8 27.0 98.7 379.0 214.1 548.9

20–24 164.6 99.4 233.2 2,540.8 2,421.0 2,663.3 275.6 232.6 326.7 82.1 66.8 97.9 473.3 317.3 634.8

25–29 104.3 82.7 126.2 1,471.2 1,748.0 1,209.6 153.9 147.5 162.1 47.5 48.1 46.9 339.5 252.5 428.2

30–34 59.2 56.1 62.4 803.0 1,111.7 524.0 85.0 87.2 82.4 27.0 31.5 22.8 199.1 139.7 258.6

35–39 41.1 48.2 33.9 474.4 722.8 253.2 59.4 67.3 50.2 19.3 24.7 14.2 115.7 108.4 123.0

40–44 27.8 36.8 18.8 314.8 522.4 132.3 39.7 51.4 26.8 12.5 18.3 7.1 64.7 66.2 63.3

45–54 12.6 18.4 6.8 174.6 321.3 48.8 19.8 27.1 12.4 6.4 7.5 5.5 38.0 45.9 30.9

55–64 4.2 7.0 1.5 60.4 122.1 10.8 6.8 9.6 4.2 2.5 2.3 2.6 12.4 18.2 7.0

65+ 0.9 1.8 0.2 14.4 30.8 4.2 2.7 4.3 1.5 0.6 0.6 0.7 4.3 7.2 2.1

TOTAL 36.5 28.3 44.4 651.2 695.1 611.3 74.6 67.4 82.2 20.4 18.9 21.9 136.9 98.9 173.7

10–14 3.9 0.3 7.8 97.6 33.6 163.6 9.2 3.1 15.5 2.4 0.0 4.9 14.7 2.7 27.1

2007

15–19 118.2 39.8 200.9 2,200.9 1,512.6 2,907.9 201.2 126.4 280.5 54.8 26.1 85.4 288.5 125.4 455.4

20–24 158.9 94.3 226.9 2,604.2 2,436.3 2,776.2 264.5 229.4 305.1 80.4 61.1 100.5 396.9 226.0 574.3

25–29 98.7 78.5 119.2 1,455.2 1,674.3 1,245.4 140.8 137.1 145.6 44.9 50.0 40.0 250.4 190.3 311.8

30–34 56.5 51.8 61.2 797.3 1,085.4 536.1 78.1 83.7 71.5 26.8 32.2 21.7 138.6 103.3 174.1

35–39 37.3 41.3 33.1 448.3 684.5 237.6 50.6 60.1 39.7 14.0 18.4 9.8 98.0 93.8 102.2

40–44 25.0 33.4 16.7 300.2 500.9 123.6 32.8 42.2 22.3 10.2 14.4 6.2 55.4 32.1 77.6

45–54 12.0 17.9 6.1 167.0 303.9 49.6 17.3 24.6 9.8 5.7 6.8 4.7 23.6 29.4 18.3

55–64 4.0 6.8 1.4 58.5 115.6 12.6 7.3 10.3 4.5 3.6 5.2 2.2 6.5 11.9 1.5

65+ 0.9 1.9 0.2 11.5 26.0 2.5 2.0 4.1 0.4 1.0 1.8 0.4 2.2 5.0 0.0

TOTAL 34.7 26.5 42.5 656.0 687.1 627.7 67.4 62.6 72.6 18.5 17.6 19.4 106.0 68.8 142.0

10–14 3.8 0.6 7.1 92.9 32.5 155.2 7.8 2.2 13.7 3.0 0.9 5.2 16.6 5.7 27.8

2008

15–19 107.8 36.9 182.6 2,179.9 1,472.5 2,907.8 198.7 121.7 280.3 58.1 27.7 90.3 296.9 137.1 460.0

20–24 148.8 85.7 215.3 2,521.9 2,311.7 2,736.9 263.1 228.9 301.8 89.4 72.4 107.1 404.1 263.3 550.1

25–29 86.9 66.4 107.9 1,308.8 1,453.9 1,167.4 140.4 134.4 147.9 48.6 49.5 47.8 250.9 175.0 328.6

30–34 49.2 44.2 54.2 723.8 960.6 507.9 74.6 77.8 70.7 25.2 27.1 23.3 146.2 107.4 185.3

35–39 30.3 32.9 27.7 387.1 567.4 226.2 49.2 57.5 39.5 15.5 21.7 9.7 88.8 78.0 99.5

40–44 21.1 27.4 14.7 249.6 397.6 119.2 33.4 43.4 22.3 11.4 17.5 5.7 61.4 53.4 69.0

45–54 9.9 14.5 5.4 133.1 234.6 46.0 16.0 22.1 9.6 7.9 11.4 4.8 29.5 32.9 26.4

55–64 3.1 5.3 1.0 46.6 90.5 11.4 5.9 8.1 3.8 3.3 4.5 2.3 9.1 16.3 2.5

65+ 0.9 1.7 0.3 9.7 22.4 1.8 1.7 2.8 0.9 1.0 1.0 1.0 5.2 9.8 1.6

TOTAL 30.9 22.7 38.8 622.3 626.5 618.4 64.8 59.1 70.8 19.7 18.8 20.5 107.4 73.1 140.6

10–14 2.9 0.5 5.4 77.3 27.5 128.7 5.9 2.2 9.8 1.8 0.3 3.4 12.5 4.3 20.9

2009

15–19 93.9 34.4 156.7 1,955.8 1,316.4 2,613.8 181.4 112.2 254.8 59.0 25.2 94.8 316.9 142.4 494.9

20–24 132.2 80.8 186.4 2,356.7 2,168.9 2,548.7 243.5 215.7 274.9 79.6 67.5 92.2 404.3 244.4 570.0

25–29 76.4 64.5 88.6 1,150.4 1,279.1 1,024.9 123.1 122.4 123.9 43.8 46.7 41.0 252.7 191.5 315.3

30–34 44.9 43.9 45.9 637.2 826.3 464.6 67.5 72.3 61.8 22.8 26.3 19.5 178.1 145.0 211.3

35–39 26.3 29.2 23.4 326.1 477.0 191.4 41.4 47.4 34.5 14.4 21.1 7.9 109.5 95.6 123.2

40–44 17.9 24.6 11.1 194.0 312.1 90.0 30.2 40.4 18.8 11.5 17.5 5.8 62.4 60.5 64.1

45–54 9.1 14.1 4.1 103.8 182.8 36.0 15.4 22.1 8.3 6.9 10.1 4.1 32.0 38.4 26.1

55–64 2.9 4.9 1.0 36.4 71.7 8.1 5.5 7.7 3.4 3.1 3.5 2.7 14.6 22.5 7.5

65+ 0.7 1.5 0.2 8.0 16.6 2.7 1.7 2.4 1.1 0.8 1.5 0.2 2.9 4.6 1.5

TOTAL 27.2 21.5 32.8 556.4 555.2 557.5 58.6 54.5 63.0 18.1 17.6 18.5 113.3 78.2 147.3

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 20 for age-specific cases and rates and Tables 13–15 for total and sexspecific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were 

specified. In 2005, Hawaii did not report age or race/ethnicity for most cases and their case data, and population denominators were excluded. Differences 

between total rates from this table and others in the report are due to different reporting formats. The 0- to 9-year age group is not shown because some of these 

cases may not be due to sexual transmission; however, they are included in the totals.
110 Syphilis Tables STD Surveillance 2009

Table 22. All Stages of Syphilis*—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2005–2009

State/Area

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Alabama 551 931 1,006 1,187 1,138 12.1 20.2 21.7 25.5 24.4

Alaska 22 25 16 9 4 3.3 3.7 2.3 1.3 0.6

Arizona 792 926 1,245 1,394 1,084 13.3 15.0 19.6 21.4 16.7

Arkansas 231 246 371 508 552 8.3 8.8 13.1 17.8 19.3

California 5,340 6,046 6,323 6,911 6,031 14.8 16.6 17.3 18.8 16.4

Colorado 144 182 157 352 269 3.1 3.8 3.2 7.1 5.4

Connecticut 166 197 148 173 179 4.7 5.6 4.2 4.9 5.1

Delaware 35 74 63 60 87 4.1 8.7 7.3 6.9 10.0

District of Columbia 365 314 416 370 431 66.3 54.0 70.7 62.5 72.8

Florida 2,888 2,945 3,918 4,585 3,863 16.2 16.3 21.5 25.0 21.1

Georgia 1,924 1,933 2,254 2,833 2,717 21.2 20.6 23.6 29.2 28.1

Hawaii 57 66 58 68 88 4.5 5.1 4.5 5.3 6.8

Idaho 54 12 14 26 31 3.8 0.8 0.9 1.7 2.0

Illinois 1,608 1,473 1,220 1,565 1,915 12.6 11.5 9.5 12.1 14.8

Indiana 288 250 216 351 324 4.6 4.0 3.4 5.5 5.1

Iowa 28 68 65 75 65 0.9 2.3 2.2 2.5 2.2

Kansas 88 87 97 125 151 3.2 3.1 3.5 4.5 5.4

Kentucky 129 188 153 218 239 3.1 4.5 3.6 5.1 5.6

Louisiana 1,239 1,390 1,808 2,024 1,964 27.4 32.4 42.1 45.9 44.5

Maine 6 22 21 27 15 0.5 1.7 1.6 2.1 1.1

Maryland 1,005 1,038 1,171 1,088 993 17.9 18.5 20.8 19.3 17.6

Massachusetts 398 378 399 479 473 6.2 5.9 6.2 7.4 7.3

Michigan 488 384 473 546 635 4.8 3.8 4.7 5.5 6.3

Minnesota 208 189 186 265 217 4.1 3.7 3.6 5.1 4.2

Mississippi 371 520 708 745 745 12.7 17.9 24.3 25.4 25.4

Missouri 372 430 484 542 514 6.4 7.4 8.2 9.2 8.7

Montana 7 2 8 10 5 0.7 0.2 0.8 1.0 0.5

Nebraska 18 34 30 36 45 1.0 1.9 1.7 2.0 2.5

Nevada 343 389 396 325 306 14.2 15.6 15.4 12.5 11.8

New Hampshire 33 35 52 41 37 2.5 2.7 4.0 3.1 2.8

New Jersey 813 799 926 1,009 890 9.3 9.2 10.7 11.6 10.3

New Mexico 183 237 180 189 208 9.5 12.1 9.1 9.5 10.5

New York 3,853 4,586 5,001 5,515 4,623 20.0 23.8 25.9 28.3 23.7

North Carolina 713 962 1,093 999 1,524 8.2 10.9 12.1 10.8 16.5

North Dakota 1 3 2 4 8 0.2 0.5 0.3 0.6 1.2

Ohio 502 491 549 763 794 4.4 4.3 4.8 6.6 6.9

Oklahoma 159 251 216 257 296 4.5 7.0 6.0 7.1 8.1

Oregon 109 99 59 97 132 3.0 2.7 1.6 2.6 3.5

Pennsylvania 712 888 844 902 1,027 5.7 7.1 6.8 7.2 8.3

Rhode Island 64 71 76 55 64 5.9 6.7 7.2 5.2 6.1

South Carolina 549 397 411 412 507 12.9 9.2 9.3 9.2 11.3

South Dakota 4 29 12 6 10 0.5 3.7 1.5 0.7 1.2

Tennessee 917 1,015 1,212 1,284 1,317 15.4 16.8 19.7 20.7 21.2

Texas 4,289 4,956 5,506 6,336 6,973 18.8 21.1 23.0 26.0 28.7

Utah 50 68 45 40 55 2.0 2.7 1.7 1.5 2.0

Vermont 1 7 11 18 1 0.2 1.1 1.8 2.9 0.2

Virginia 655 701 736 789 755 8.7 9.2 9.5 10.2 9.7

Washington 359 423 367 438 322 5.7 6.6 5.7 6.7 4.9

West Virginia 18 30 27 44 32 1.0 1.6 1.5 2.4 1.8

Wisconsin 138 170 170 187 166 2.5 3.1 3.0 3.3 2.9

Wyoming 1 1 6 9 7 0.2 0.2 1.1 1.7 1.3

U.S. TOTAL 33,288 36,958 40,925 46,291 44,828 11.2 12.3 13.6 15.2 14.7

Northeast 6,046 6,983 7,478 8,219 7,309 11.1 12.8 13.7 15.0 13.3

Midwest 3,743 3,608 3,504 4,465 4,844 5.7 5.4 5.3 6.7 7.3

South 16,038 17,891 21,069 23,739 24,133 14.9 16.4 19.1 21.2 21.6

West 7,461 8,476 8,874 9,868 8,542 10.9 12.2 12.7 13.9 12.1

Guam 19 13 37 45 12 11.3 7.6 21.3 25.6 6.8

Puerto Rico 1,223 1,068 1,269 797 724 31.3 27.2 32.2 20.2 18.3

Virgin Islands 13 5 5 1 2 12.0 4.6 4.6 0.9 1.8

OUTLYING AREAS 1,255 1,086 1,311 843 738 30.0 25.8 31.0 19.9 17.4

TOTAL 34,543 38,044 42,236 47,134 45,566 11.5 12.5 13.8 15.3 14.8

* See Syphilis Morbidity Reporting in the Appendix for definition.
STD Surveillance 2009 Syphilis Tables 111

Table 23. All Stages of Syphilis*—Reported Cases and Rates in Selected Metropolitan Statistical 

Areas (MSAs)† in Alphabetical Order, United States, 2005–2009

MSAs

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Atlanta-Sandy Springs-Marietta, GA 1,626 1,641 1,904 2,243 2,187 33.1 31.9 36.1 41.7 40.7

Austin-Round Rock, TX 193 212 234 344 352 13.3 14.0 14.6 20.8 21.3

Baltimore-Towson, MD 679 642 650 685 567 25.6 24.1 24.4 25.7 21.3

Birmingham-Hoover, AL 243 561 483 504 412 22.3 51.0 43.6 45.1 36.9

Boston-Cambridge-Quincy, MA-NH 339 329 324 383 411 7.7 7.4 7.2 8.5 9.1

Buffalo-Cheektowaga-Tonawanda, NY 14 42 28 20 40 1.2 3.7 2.5 1.8 3.6

Charlotte-Gastonia-Concord, NC-SC 235 303 301 224 345 15.4 19.1 18.2 13.2 20.3

Chicago-Naperville-Joliet, IL-IN-WI 1,541 1,386 1,116 1,452 1,797 16.3 14.6 11.7 15.2 18.8

Cincinnati-Middletown, OH-KY-IN 55 58 77 105 226 2.7 2.8 3.6 4.9 10.5

Cleveland-Elyria-Mentor, OH 52 53 83 127 170 2.4 2.5 4.0 6.1 8.1

Columbus, OH 227 229 222 311 252 13.3 13.3 12.7 17.5 14.2

Dallas-Fort Worth-Arlington, TX 1,495 1,678 1,643 1,780 2,146 25.7 27.9 26.7 28.3 34.1

Denver-Aurora, CO 111 141 120 269 223 4.7 5.9 4.9 10.7 8.9

Detroit-Warren-Livonia, MI 390 284 339 304 411 8.7 6.4 7.6 6.9 9.3

Hartford-West Hartford-East Hartford, CT 57 65 51 71 67 4.8 5.5 4.3 6.0 5.6

Houston-Baytown-Sugar Land, TX 1,188 1,570 2,048 2,088 2,038 22.5 28.3 36.4 36.5 35.6

Indianapolis, IN 134 121 95 189 156 8.2 7.3 5.6 11.0 9.1

Jacksonville, FL 151 165 198 308 235 12.1 12.9 15.2 23.5 17.9

Kansas City, MO-KS 193 228 268 237 220 9.9 11.6 13.5 11.8 11.0

Las Vegas-Paradise, NV 300 355 364 299 273 17.5 20.0 19.8 16.0 14.6

Los Angeles-Long Beach-Santa Ana, CA 3,159 3,594 3,581 3,572 3,278 24.4 27.8 27.8 27.7 25.5

Louisville, KY-IN 102 101 77 91 123 8.4 8.3 6.2 7.3 9.9

Memphis, TN-MS-AR 585 612 761 748 777 46.4 48.0 59.4 58.2 60.4

Miami-Fort Lauderdale-Miami Beach, FL 1,444 1,455 1,863 2,408 1,972 26.6 26.6 34.4 44.5 36.4

Milwaukee-Waukesha-West Allis, WI 77 100 127 138 117 5.1 6.6 8.2 8.9 7.6

Minneapolis-St. Paul-Bloomington, MN-WI 187 161 170 223 182 6.0 5.1 5.3 6.9 5.6

Nashville-Davidson-Murfreesboro, TN 189 194 240 277 302 13.3 13.3 15.8 17.9 19.5

New Orleans-Metairie-Kenner, LA 350 352 560 491 462 26.5 34.4 54.3 43.3 40.7

New York-Newark-Edison, NY-NJ-PA 4,318 4,924 5,503 6,097 5,087 23.0 26.2 29.2 32.1 26.8

Oklahoma City, OK 87 116 114 161 210 7.5 9.9 9.6 13.3 17.4

Orlando, FL 413 403 583 460 408 21.4 20.3 28.7 22.4 19.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 583 773 778 812 959 10.0 13.3 13.3 13.9 16.4

Phoenix-Mesa-Scottsdale, AZ 595 757 866 857 682 15.4 18.7 20.7 20.0 15.9

Pittsburgh, PA 112 152 122 98 70 4.7 6.4 5.2 4.2 3.0

Portland-Vancouver-Beaverton, OR-WA 94 74 51 64 114 4.5 3.5 2.3 2.9 5.2

Providence-New Bedford-Fall River, RI-MA 75 92 100 71 76 4.6 5.7 6.2 4.4 4.8

Richmond, VA 87 106 129 226 207 7.4 8.9 10.6 18.4 16.9

Riverside-San Bernardino-Ontario, CA 399 376 340 452 416 10.2 9.3 8.3 11.0 10.1

Rochester, NY 36 90 76 51 52 3.5 8.7 7.4 4.9 5.0

Sacramento-Arden-Arcade-Roseville, CA 39 136 117 243 212 1.9 6.6 5.6 11.5 10.0

Salt Lake City, UT 35 41 35 35 40 3.4 3.8 3.2 3.1 3.6

San Antonio, TX 458 473 420 598 739 24.2 24.4 21.1 29.4 36.4

San Diego-Carlsbad-San Marcos, CA 448 572 788 828 493 15.3 19.4 26.5 27.6 16.4

San Francisco-Oakland-Fremont, CA 719 741 783 1,044 932 17.3 17.7 18.6 24.4 21.8

San Jose-Sunnyvale-Santa Clara, CA 121 94 159 156 141 6.9 5.3 8.8 8.6 7.8

Seattle-Tacoma-Bellevue, WA 285 356 309 359 256 8.9 10.9 9.3 10.7 7.7

St. Louis, MO-IL 173 186 252 322 294 6.2 6.7 9.0 11.4 10.4

Tampa-St. Petersburg-Clearwater, FL 326 428 612 680 631 12.3 15.9 22.5 24.9 23.1

Virginia Beach-Norfolk-Newport News, VA-NC 246 245 232 248 236 14.9 14.9 14.0 15.0 14.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 894 928 1,163 956 1,004 17.1 17.5 21.9 17.8 18.7

U.S. MSAs TOTAL 25,859 28,695 31,459 34,709 33,000 16.2 17.8 19.3 21.1 20.1

* 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.
112 Syphilis Tables STD Surveillance 2009

Table 24. Primary and Secondary Syphilis—Reported Cases and Rates by State, 

Ranked by Rates, United States, 2009 

Rank* State Cases Rates per 100,000 Population

1 Louisiana 741 16.8

2 Georgia 953 9.8

3 Arkansas 275 9.6

4 Alabama 417 8.9

5 Mississippi 237 8.1

6 Texas 1,644 6.8

7 Tennessee 403 6.5

8 North Carolina 579 6.3

9 New York 1,182 6.1

10 Illinois 750 5.8

11 Florida 1,041 5.7

12 Maryland 314 5.6

13 California 1,900 5.2

U.S. TOTAL† 13,997 4.6

14 Virginia 299 3.8

15 Massachusetts 238 3.7

16 Arizona 231 3.6

17 Nevada 91 3.5

18 Ohio 360 3.1

19 Delaware 27 3.1

20 New Mexico 61 3.1

21 Missouri 173 2.9

22 South Carolina 123 2.7

23 Pennsylvania 341 2.7

24 Oklahoma 97 2.7

25 Hawaii 33 2.6

26 Indiana 158 2.5

27 New Jersey 212 2.4

28 Michigan 230 2.3

29 Kentucky 92 2.2

30 Colorado 105 2.1

31 Washington 139 2.1

32 Rhode Island 20 1.9

33 Connecticut 65 1.9

34 Oregon 57 1.5

35 Minnesota 71 1.4

36 Kansas 32 1.1

37 Utah 31 1.1

38 New Hampshire 14 1.1

39 Wisconsin 44 0.8

40 Iowa 23 0.8

41 North Dakota 4 0.6

42 Wyoming 3 0.6

43 West Virginia 8 0.4

44 Montana 4 0.4

45 Maine 4 0.3

46 Nebraska 5 0.3

YEAR 2010 TARGET 0.2

47 Idaho 3 0.2

Alaska 0 0.0

South Dakota 0 0.0

Vermont 0 0.0

* States were ranked in descending order by rate, number of cases, and alphabetically.

† Total includes cases reported by the District of Columbia, with 163 cases and a rate of 27.5, but excludes outlying areas (Guam with 2 cases 

and rate of 1.1, Puerto Rico with 227 cases and rate of 5.7, and Virgin Islands with 0 cases and rate of 0.0).
STD Surveillance 2009 Syphilis Tables 113

Table 25. Primary and Secondary Syphilis—Reported Cases and Rates by State/Area and Region 

in Alphabetical Order, United States and Outlying Areas, 2005–2009

State/Area

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Alabama 169 319 380 449 417 3.7 6.9 8.2 9.6 8.9

Alaska 9 11 7 1 0 1.4 1.6 1.0 0.1 0.0

Arizona 175 203 296 317 231 2.9 3.3 4.7 4.9 3.6

Arkansas 52 77 122 206 275 1.9 2.7 4.3 7.2 9.6

California 1,585 1,835 2,038 2,204 1,900 4.4 5.0 5.6 6.0 5.2

Colorado 46 69 57 128 105 1.0 1.5 1.2 2.6 2.1

Connecticut 58 64 39 34 65 1.7 1.8 1.1 1.0 1.9

Delaware 11 20 18 16 27 1.3 2.3 2.1 1.8 3.1

District of Columbia 114 116 178 146 163 20.7 19.9 30.3 24.7 27.5

Florida 724 719 913 1,044 1,041 4.1 4.0 5.0 5.7 5.7

Georgia 645 581 680 914 953 7.1 6.2 7.1 9.4 9.8

Hawaii 11 18 9 29 33 0.9 1.4 0.7 2.3 2.6

Idaho 20 3 1 7 3 1.4 0.2 0.1 0.5 0.2

Illinois 525 431 464 554 750 4.1 3.4 3.6 4.3 5.8

Indiana 62 93 54 140 158 1.0 1.5 0.9 2.2 2.5

Iowa 9 19 21 16 23 0.3 0.6 0.7 0.5 0.8

Kansas 19 27 28 30 32 0.7 1.0 1.0 1.1 1.1

Kentucky 52 73 56 93 92 1.2 1.7 1.3 2.2 2.2

Louisiana 278 342 533 707 741 6.1 8.0 12.4 16.0 16.8

Maine 1 9 9 10 4 0.1 0.7 0.7 0.8 0.3

Maryland 313 300 345 378 314 5.6 5.3 6.1 6.7 5.6

Massachusetts 125 124 155 216 238 2.0 1.9 2.4 3.3 3.7

Michigan 105 118 123 210 230 1.0 1.2 1.2 2.1 2.3

Minnesota 70 47 59 116 71 1.4 0.9 1.1 2.2 1.4

Mississippi 49 86 133 184 237 1.7 3.0 4.6 6.3 8.1

Missouri 147 168 239 224 173 2.5 2.9 4.1 3.8 2.9

Montana 7 1 8 7 4 0.7 0.1 0.8 0.7 0.4

Nebraska 4 7 4 15 5 0.2 0.4 0.2 0.8 0.3

Nevada 109 137 111 77 91 4.5 5.5 4.3 3.0 3.5

New Hampshire 16 13 30 20 14 1.2 1.0 2.3 1.5 1.1

New Jersey 133 173 227 226 212 1.5 2.0 2.6 2.6 2.4

New Mexico 56 79 46 44 61 2.9 4.0 2.3 2.2 3.1

New York 705 736 1,068 1,217 1,182 3.7 3.8 5.5 6.2 6.1

North Carolina 274 309 323 287 579 3.2 3.5 3.6 3.1 6.3

North Dakota 1 1 1 0 4 0.2 0.2 0.2 0.0 0.6

Ohio 211 184 194 351 360 1.8 1.6 1.7 3.1 3.1

Oklahoma 44 70 65 86 97 1.2 2.0 1.8 2.4 2.7

Oregon 41 29 18 26 57 1.1 0.8 0.5 0.7 1.5

Pennsylvania 199 264 263 272 341 1.6 2.1 2.1 2.2 2.7

Rhode Island 24 14 36 18 20 2.2 1.3 3.4 1.7 1.9

South Carolina 84 66 91 98 123 2.0 1.5 2.1 2.2 2.7

South Dakota 2 13 7 1 0 0.3 1.7 0.9 0.1 0.0

Tennessee 217 249 367 413 403 3.6 4.1 6.0 6.6 6.5

Texas 873 1,064 1,160 1,405 1,644 3.8 4.5 4.9 5.8 6.8

Utah 10 21 20 25 31 0.4 0.8 0.8 0.9 1.1

Vermont 1 3 10 11 0 0.2 0.5 1.6 1.8 0.0

Virginia 143 190 230 266 299 1.9 2.5 3.0 3.4 3.8

Washington 152 182 154 181 139 2.4 2.8 2.4 2.8 2.1

West Virginia 3 11 6 13 8 0.2 0.6 0.3 0.7 0.4

Wisconsin 41 68 66 65 44 0.7 1.2 1.2 1.2 0.8

Wyoming 0 0 4 3 3 0.0 0.0 0.8 0.6 0.6

U.S. TOTAL 8,724 9,756 11,466 13,500 13,997 2.9 3.3 3.8 4.4 4.6

Northeast 1,262 1,400 1,837 2,024 2,076 2.3 2.6 3.4 3.7 3.8

Midwest 1,196 1,176 1,260 1,722 1,850 1.8 1.8 1.9 2.6 2.8

South 4,045 4,592 5,600 6,705 7,413 3.8 4.2 5.1 6.0 6.6

West 2,221 2,588 2,769 3,049 2,658 3.3 3.7 4.0 4.3 3.8

Guam 2 3 8 6 2 1.2 1.8 4.6 3.4 1.1

Puerto Rico 224 150 169 167 227 5.7 3.8 4.3 4.2 5.7

Virgin Islands 1 1 0 0 0 0.9 0.9 0.0 0.0 0.0

OUTLYING AREAS 227 154 177 173 229 5.4 3.7 4.2 4.1 5.4

TOTAL 8,951 9,910 11,643 13,673 14,226 3.0 3.3 3.8 4.4 4.6
114 Syphilis Tables STD Surveillance 2009

Table 26. Primary and Secondary Syphilis—Women—Reported Cases and Rates by State/Area and 

Region in Alphabetical Order, United States and Outlying Areas, 2005–2009

State/Area

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Alabama 69 116 143 171 137 2.9 4.9 6.0 7.1 5.7

Alaska 1 2 1 0 0 0.3 0.6 0.3 0.0 0.0

Arizona 49 33 64 56 22 1.7 1.1 2.0 1.7 0.7

Arkansas 21 35 50 81 104 1.5 2.4 3.5 5.6 7.1

California 121 128 115 110 79 0.7 0.7 0.6 0.6 0.4

Colorado 2 5 2 3 6 0.1 0.2 0.1 0.1 0.2

Connecticut 2 2 2 0 1 0.1 0.1 0.1 0.0 0.1

Delaware 2 4 1 6 11 0.5 0.9 0.2 1.3 2.4

District of Columbia 11 6 5 7 10 3.8 1.9 1.6 2.2 3.2

Florida 100 98 153 193 147 1.1 1.1 1.6 2.1 1.6

Georgia 47 41 53 96 101 1.0 0.9 1.1 2.0 2.1

Hawaii 0 1 1 7 6 0.0 0.2 0.2 1.1 0.9

Idaho 6 2 1 1 0 0.8 0.3 0.1 0.1 0.0

Illinois 47 37 39 38 55 0.7 0.6 0.6 0.6 0.8

Indiana 10 10 8 16 13 0.3 0.3 0.2 0.5 0.4

Iowa 1 6 3 3 6 0.1 0.4 0.2 0.2 0.4

Kansas 2 2 6 5 9 0.1 0.1 0.4 0.4 0.6

Kentucky 3 7 9 14 4 0.1 0.3 0.4 0.6 0.2

Louisiana 112 123 209 307 349 4.8 5.6 9.5 13.5 15.4

Maine 0 2 0 0 0 0.0 0.3 0.0 0.0 0.0

Maryland 88 61 47 77 42 3.0 2.1 1.6 2.6 1.4

Massachusetts 4 7 10 6 5 0.1 0.2 0.3 0.2 0.1

Michigan 20 26 27 60 40 0.4 0.5 0.5 1.2 0.8

Minnesota 2 4 1 5 0 0.1 0.2 0.0 0.2 0.0

Mississippi 12 36 35 66 73 0.8 2.4 2.3 4.4 4.8

Missouri 12 19 27 29 15 0.4 0.6 0.9 1.0 0.5

Montana 1 0 2 1 0 0.2 0.0 0.4 0.2 0.0

Nebraska 0 1 0 3 0 0.0 0.1 0.0 0.3 0.0

Nevada 24 34 12 14 7 2.0 2.8 1.0 1.1 0.5

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 17 12 16 21 26 0.4 0.3 0.4 0.5 0.6

New Mexico 16 22 15 6 6 1.6 2.2 1.5 0.6 0.6

New York 28 29 32 52 55 0.3 0.3 0.3 0.5 0.5

North Carolina 58 67 60 44 108 1.3 1.5 1.3 0.9 2.3

North Dakota 0 0 0 0 1 0.0 0.0 0.0 0.0 0.3

Ohio 40 43 28 63 63 0.7 0.7 0.5 1.1 1.1

Oklahoma 17 19 24 25 24 0.9 1.0 1.3 1.4 1.3

Oregon 2 0 2 2 1 0.1 0.0 0.1 0.1 0.1

Pennsylvania 34 34 34 21 42 0.5 0.5 0.5 0.3 0.7

Rhode Island 6 0 2 0 1 1.1 0.0 0.4 0.0 0.2

South Carolina 17 11 10 12 10 0.8 0.5 0.4 0.5 0.4

South Dakota 0 5 2 1 0 0.0 1.3 0.5 0.2 0.0

Tennessee 64 73 113 119 122 2.1 2.4 3.6 3.7 3.8

Texas 243 261 297 450 490 2.1 2.2 2.5 3.7 4.0

Utah 1 3 0 1 0 0.1 0.2 0.0 0.1 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 19 23 16 25 22 0.5 0.6 0.4 0.6 0.6

Washington 5 4 6 5 6 0.2 0.1 0.2 0.2 0.2

West Virginia 0 1 2 4 2 0.0 0.1 0.2 0.4 0.2

Wisconsin 3 3 6 14 10 0.1 0.1 0.2 0.5 0.4

Wyoming 0 0 1 2 1 0.0 0.0 0.4 0.8 0.4

U.S. TOTAL 1,339 1,458 1,692 2,242 2,232 0.9 1.0 1.1 1.5 1.4

Northeast 91 86 96 100 130 0.3 0.3 0.3 0.4 0.5

Midwest 137 156 147 237 212 0.4 0.5 0.4 0.7 0.6

South 883 982 1,227 1,697 1,756 1.6 1.8 2.2 3.0 3.1

West 228 234 222 208 134 0.7 0.7 0.6 0.6 0.4

Guam 1 1 4 1 1 1.2 1.2 4.7 1.2 1.2

Puerto Rico 81 46 56 29 23 4.0 2.3 2.7 1.4 1.1

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 82 47 60 30 24 3.8 2.2 2.7 1.4 1.1

TOTAL 1,421 1,505 1,752 2,272 2,256 0.9 1.0 1.1 1.5 1.4

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2009 Syphilis Tables 115

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

Region in Alphabetical Order, United States and Outlying Areas, 2005–2009

State/Area

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Alabama 100 203 237 278 280 4.5 9.1 10.6 12.3 12.4

Alaska 8 9 6 1 0 2.3 2.6 1.7 0.3 0.0

Arizona 125 166 230 261 208 4.2 5.4 7.2 8.0 6.4

Arkansas 31 42 72 125 171 2.3 3.0 5.2 8.9 12.2

California 1,463 1,706 1,921 2,092 1,821 8.1 9.4 10.5 11.4 9.9

Colorado 44 64 55 125 99 1.9 2.7 2.2 5.0 4.0

Connecticut 56 62 37 34 64 3.3 3.6 2.2 2.0 3.7

Delaware 9 16 17 10 16 2.2 3.9 4.1 2.4 3.8

District of Columbia 103 110 173 139 153 39.4 40.3 62.2 49.7 54.7

Florida 624 621 760 850 894 7.2 7.0 8.5 9.4 9.9

Georgia 598 540 626 818 852 13.3 11.7 13.3 17.2 17.9

Hawaii 11 17 8 22 27 1.7 2.6 1.2 3.4 4.2

Idaho 14 1 0 6 3 2.0 0.1 0.0 0.8 0.4

Illinois 478 394 425 516 695 7.6 6.2 6.7 8.1 10.9

Indiana 52 83 46 124 145 1.7 2.7 1.5 3.9 4.6

Iowa 8 13 18 13 17 0.5 0.9 1.2 0.9 1.1

Kansas 17 25 22 25 23 1.2 1.8 1.6 1.8 1.7

Kentucky 49 66 47 79 88 2.4 3.2 2.3 3.8 4.2

Louisiana 166 219 324 400 392 7.5 10.5 15.5 18.7 18.3

Maine 1 7 9 10 4 0.2 1.1 1.4 1.6 0.6

Maryland 225 239 298 301 272 8.3 8.8 11.0 11.0 10.0

Massachusetts 121 117 145 210 233 3.9 3.8 4.6 6.7 7.4

Michigan 85 92 96 150 190 1.7 1.9 1.9 3.0 3.9

Minnesota 68 43 58 111 71 2.7 1.7 2.2 4.3 2.7

Mississippi 37 50 98 118 164 2.6 3.5 6.9 8.3 11.5

Missouri 135 149 212 195 158 4.8 5.2 7.4 6.8 5.5

Montana 6 1 6 6 4 1.3 0.2 1.3 1.2 0.8

Nebraska 4 6 4 12 5 0.5 0.7 0.5 1.4 0.6

Nevada 85 103 99 63 84 6.9 8.1 7.6 4.8 6.3

New Hampshire 16 13 30 20 14 2.5 2.0 4.6 3.1 2.2

New Jersey 116 161 211 205 186 2.7 3.8 5.0 4.8 4.4

New Mexico 40 57 31 38 55 4.2 5.9 3.2 3.9 5.6

New York 677 707 1,036 1,165 1,127 7.3 7.6 11.1 12.3 11.9

North Carolina 216 242 263 243 471 5.1 5.6 5.9 5.4 10.4

North Dakota 1 1 1 0 3 0.3 0.3 0.3 0.0 0.9

Ohio 171 141 166 288 297 3.1 2.5 3.0 5.1 5.3

Oklahoma 27 51 41 61 73 1.5 2.9 2.3 3.4 4.1

Oregon 39 29 16 24 56 2.2 1.6 0.9 1.3 3.0

Pennsylvania 165 230 229 251 299 2.7 3.8 3.8 4.1 4.9

Rhode Island 18 14 34 18 19 3.5 2.7 6.6 3.5 3.7

South Carolina 67 55 81 86 113 3.2 2.6 3.8 3.9 5.2

South Dakota 2 8 5 0 0 0.5 2.0 1.3 0.0 0.0

Tennessee 153 176 254 294 281 5.2 6.0 8.4 9.7 9.3

Texas 630 803 863 955 1,154 5.5 6.9 7.2 7.9 9.5

Utah 9 18 20 24 31 0.7 1.4 1.5 1.7 2.2

Vermont 1 3 10 11 0 0.3 1.0 3.3 3.6 0.0

Virginia 124 167 214 241 277 3.3 4.4 5.7 6.3 7.3

Washington 147 178 148 176 133 4.7 5.6 4.6 5.4 4.1

West Virginia 3 10 4 9 6 0.3 1.1 0.5 1.0 0.7

Wisconsin 38 65 60 51 34 1.4 2.4 2.2 1.8 1.2

Wyoming 0 0 3 1 2 0.0 0.0 1.1 0.4 0.7

U.S. TOTAL 7,383 8,293 9,769 11,255 11,764 5.1 5.6 6.6 7.5 7.8

Northeast 1,171 1,314 1,741 1,924 1,946 4.4 4.9 6.5 7.2 7.3

Midwest 1,059 1,020 1,113 1,485 1,638 3.3 3.1 3.4 4.5 5.0

South 3,162 3,610 4,372 5,007 5,657 6.0 6.7 8.1 9.1 10.3

West 1,991 2,349 2,543 2,839 2,523 5.8 6.8 7.2 8.0 7.1

Guam 1 2 4 5 1 1.2 2.3 4.5 5.6 1.1

Puerto Rico 143 104 113 138 204 7.6 5.5 6.0 7.3 10.8

Virgin Islands 1 1 0 0 0 1.9 1.9 0.0 0.0 0.0

OUTLYING AREAS 145 107 117 143 205 7.2 5.3 5.8 7.0 10.1

TOTAL 7,528 8,400 9,886 11,398 11,969 5.1 5.6 6.6 7.5 7.9

NOTE: Cases reported with unknown sex are not included in this table.
116 Syphilis Tables STD Surveillance 2009

Table 28. Primary and Secondary Syphilis—Reported Cases and Rates in Selected Metropolitan 

Statistical Areas (MSAs)* in Alphabetical Order, United States, 2005–2009

MSAs

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Atlanta-Sandy Springs-Marietta, GA 598 529 608 765 809 12.2 10.3 11.5 14.2 15.0

Austin-Round Rock, TX 44 84 74 107 99 3.0 5.5 4.6 6.5 6.0

Baltimore-Towson, MD 244 213 211 270 204 9.2 8.0 7.9 10.1 7.6

Birmingham-Hoover, AL 101 244 189 188 145 9.3 22.2 17.1 16.8 13.0

Boston-Cambridge-Quincy, MA-NH 106 117 131 173 203 2.4 2.6 2.9 3.8 4.5

Buffalo-Cheektowaga-Tonawanda, NY 7 18 11 3 10 0.6 1.6 1.0 0.3 0.9

Charlotte-Gastonia-Concord, NC-SC 103 121 103 58 138 6.8 7.6 6.2 3.4 8.1

Chicago-Naperville-Joliet, IL-IN-WI 510 416 427 535 732 5.4 4.4 4.5 5.6 7.6

Cincinnati-Middletown, OH-KY-IN 24 13 34 62 124 1.2 0.6 1.6 2.9 5.8

Cleveland-Elyria-Mentor, OH 22 18 29 64 71 1.0 0.9 1.4 3.1 3.4

Columbus, OH 109 107 76 135 115 6.4 6.2 4.3 7.6 6.5

Dallas-Fort Worth-Arlington, TX 305 320 265 328 502 5.2 5.3 4.3 5.2 8.0

Denver-Aurora, CO 38 56 46 103 92 1.6 2.3 1.9 4.1 3.7

Detroit-Warren-Livonia, MI 77 82 91 100 151 1.7 1.8 2.0 2.3 3.4

Hartford-West Hartford-East Hartford, CT 14 23 15 8 25 1.2 1.9 1.3 0.7 2.1

Houston-Baytown-Sugar Land, TX 279 396 501 456 432 5.3 7.1 8.9 8.0 7.5

Indianapolis, IN 35 47 26 80 81 2.1 2.8 1.5 4.7 4.7

Jacksonville, FL 50 41 44 67 57 4.0 3.2 3.4 5.1 4.3

Kansas City, MO-KS 89 112 149 102 80 4.6 5.7 7.5 5.1 4.0

Las Vegas-Paradise, NV 103 132 102 72 86 6.0 7.4 5.6 3.9 4.6

Los Angeles-Long Beach-Santa Ana, CA 806 945 1,061 920 858 6.2 7.3 8.2 7.1 6.7

Louisville, KY-IN 46 41 32 36 57 3.8 3.4 2.6 2.9 4.6

Memphis, TN-MS-AR 138 145 208 234 189 10.9 11.4 16.2 18.2 14.7

Miami-Fort Lauderdale-Miami Beach, FL 395 369 414 509 518 7.3 6.8 7.6 9.4 9.6

Milwaukee-Waukesha-West Allis, WI 22 38 53 45 28 1.5 2.5 3.4 2.9 1.8

Minneapolis-St. Paul-Bloomington, MN-WI 68 43 57 105 67 2.2 1.4 1.8 3.3 2.1

Nashville-Davidson-Murfreesboro, TN 34 40 84 85 92 2.4 2.7 5.5 5.5 5.9

New Orleans-Metairie-Kenner, LA 88 90 168 170 138 6.7 8.8 16.3 15.0 12.2

New York-Newark-Edison, NY-NJ-PA 773 811 1,208 1,353 1,301 4.1 4.3 6.4 7.1 6.8

Oklahoma City, OK 23 24 36 61 70 2.0 2.0 3.0 5.1 5.8

Orlando, FL 106 94 145 126 109 5.5 4.7 7.1 6.1 5.3

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 127 173 205 214 289 2.2 3.0 3.5 3.7 4.9

Phoenix-Mesa-Scottsdale, AZ 113 157 193 211 169 2.9 3.9 4.6 4.9 3.9

Pittsburgh, PA 69 91 60 38 29 2.9 3.8 2.5 1.6 1.2

Portland-Vancouver-Beaverton, OR-WA 39 25 11 21 53 1.9 1.2 0.5 1.0 2.4

Providence-New Bedford-Fall River, RI-MA 28 18 44 25 28 1.7 1.1 2.7 1.6 1.8

Richmond, VA 13 28 38 92 97 1.1 2.3 3.1 7.5 7.9

Riverside-San Bernardino-Ontario, CA 121 108 95 157 115 3.1 2.7 2.3 3.8 2.8

Rochester, NY 6 14 16 9 11 0.6 1.4 1.6 0.9 1.1

Sacramento-Arden-Arcade-Roseville, CA 16 32 59 102 73 0.8 1.5 2.8 4.8 3.5

Salt Lake City, UT 9 15 19 23 28 0.9 1.4 1.7 2.1 2.5

San Antonio, TX 129 136 157 195 216 6.8 7.0 7.9 9.6 10.6

San Diego-Carlsbad-San Marcos, CA 194 235 347 345 190 6.6 8.0 11.7 11.5 6.3

San Francisco-Oakland-Fremont, CA 331 363 308 478 438 8.0 8.7 7.3 11.2 10.2

San Jose-Sunnyvale-Santa Clara, CA 44 52 56 42 59 2.5 2.9 3.1 2.3 3.2

Seattle-Tacoma-Bellevue, WA 125 160 138 153 115 3.9 4.9 4.2 4.6 3.4

St. Louis, MO-IL 50 65 112 121 83 1.8 2.3 4.0 4.3 2.9

Tampa-St. Petersburg-Clearwater, FL 85 110 195 191 180 3.2 4.1 7.2 7.0 6.6

Virginia Beach-Norfolk-Newport News, VA-NC 60 84 88 98 102 3.6 5.1 5.3 5.9 6.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 233 250 377 297 324 4.5 4.7 7.1 5.5 6.0

U.S. MSAs TOTAL 7,149 7,845 9,116 10,132 10,182 4.5 4.9 5.6 6.2 6.2

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.
STD Surveillance 2009 Syphilis Tables 117

Table 29. Primary and Secondary Syphilis—Women—Reported Cases and Rates in Selected 

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2005–2009

MSAs

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Atlanta-Sandy Springs-Marietta, GA 36 33 40 51 59 1.5 1.3 1.5 1.9 2.2

Austin-Round Rock, TX 3 11 12 16 14 0.4 1.5 1.5 2.0 1.7

Baltimore-Towson, MD 84 53 40 70 33 6.1 3.8 2.9 5.1 2.4

Birmingham-Hoover, AL 35 94 80 77 44 6.2 16.5 13.9 13.3 7.6

Boston-Cambridge-Quincy, MA-NH 1 7 10 4 3 0.0 0.3 0.4 0.2 0.1

Buffalo-Cheektowaga-Tonawanda, NY 0 2 0 0 0 0.0 0.3 0.0 0.0 0.0

Charlotte-Gastonia-Concord, NC-SC 20 28 20 9 14 2.6 3.5 2.4 1.0 1.6

Chicago-Naperville-Joliet, IL-IN-WI 50 43 31 40 46 1.0 0.9 0.6 0.8 0.9

Cincinnati-Middletown, OH-KY-IN 0 5 6 14 26 0.0 0.5 0.5 1.3 2.4

Cleveland-Elyria-Mentor, OH 1 2 5 13 14 0.1 0.2 0.5 1.2 1.3

Columbus, OH 22 30 11 19 15 2.5 3.4 1.2 2.1 1.7

Dallas-Fort Worth-Arlington, TX 100 112 93 116 153 3.4 3.7 3.0 3.7 4.9

Denver-Aurora, CO 1 3 1 1 3 0.1 0.3 0.1 0.1 0.2

Detroit-Warren-Livonia, MI 17 20 22 27 26 0.7 0.9 1.0 1.2 1.1

Hartford-West Hartford-East Hartford, CT 0 1 1 0 0 0.0 0.2 0.2 0.0 0.0

Houston-Baytown-Sugar Land, TX 61 65 108 114 113 2.3 2.3 3.8 4.0 4.0

Indianapolis, IN 4 1 3 8 6 0.5 0.1 0.3 0.9 0.7

Jacksonville, FL 20 11 11 16 11 3.1 1.7 1.7 2.4 1.6

Kansas City, MO-KS 5 17 25 20 8 0.5 1.7 2.5 2.0 0.8

Las Vegas-Paradise, NV 21 32 11 11 7 2.5 3.7 1.2 1.2 0.8

Los Angeles-Long Beach-Santa Ana, CA 63 72 58 31 22 1.0 1.1 0.9 0.5 0.3

Louisville, KY-IN 3 3 2 3 1 0.5 0.5 0.3 0.5 0.2

Memphis, TN-MS-AR 50 52 87 71 67 7.7 7.9 13.1 10.6 10.0

Miami-Fort Lauderdale-Miami Beach, FL 43 40 60 74 54 1.5 1.4 2.2 2.7 1.9

Milwaukee-Waukesha-West Allis, WI 1 2 5 11 9 0.1 0.3 0.6 1.4 1.1

Minneapolis-St. Paul-Bloomington, MN-WI 3 3 1 5 0 0.2 0.2 0.1 0.3 0.0

Nashville-Davidson-Murfreesboro, TN 2 2 13 14 23 0.3 0.3 1.7 1.8 2.9

New Orleans-Metairie-Kenner, LA 23 25 51 53 36 3.4 4.7 9.5 9.0 6.1

New York-Newark-Edison, NY-NJ-PA 37 31 42 60 69 0.4 0.3 0.4 0.6 0.7

Oklahoma City, OK 9 6 13 16 16 1.5 1.0 2.2 2.6 2.6

Orlando, FL 14 14 13 21 19 1.4 1.4 1.3 2.0 1.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 13 6 14 17 37 0.4 0.2 0.5 0.6 1.2

Phoenix-Mesa-Scottsdale, AZ 23 18 29 24 8 1.2 0.9 1.4 1.1 0.4

Pittsburgh, PA 25 28 25 6 4 2.0 2.3 2.0 0.5 0.3

Portland-Vancouver-Beaverton, OR-WA 0 0 1 0 0 0.0 0.0 0.1 0.0 0.0

Providence-New Bedford-Fall River, RI-MA 7 0 2 0 1 0.8 0.0 0.2 0.0 0.1

Richmond, VA 1 1 3 6 3 0.2 0.2 0.5 1.0 0.5

Riverside-San Bernardino-Ontario, CA 12 10 4 5 5 0.6 0.5 0.2 0.2 0.2

Rochester, NY 1 0 1 0 1 0.2 0.0 0.2 0.0 0.2

Sacramento-Arden-Arcade-Roseville, CA 0 3 2 18 16 0.0 0.3 0.2 1.7 1.5

Salt Lake City, UT 1 1 0 1 0 0.2 0.2 0.0 0.2 0.0

San Antonio, TX 34 32 35 58 42 3.5 3.2 3.4 5.6 4.1

San Diego-Carlsbad-San Marcos, CA 25 12 12 12 6 1.7 0.8 0.8 0.8 0.4

San Francisco-Oakland-Fremont, CA 8 7 12 12 9 0.4 0.3 0.6 0.6 0.4

San Jose-Sunnyvale-Santa Clara, CA 2 7 4 3 5 0.2 0.8 0.5 0.3 0.6

Seattle-Tacoma-Bellevue, WA 4 2 4 2 4 0.2 0.1 0.2 0.1 0.2

St. Louis, MO-IL 5 3 9 16 9 0.3 0.2 0.6 1.1 0.6

Tampa-St. Petersburg-Clearwater, FL 8 15 52 54 29 0.6 1.1 3.7 3.8 2.1

Virginia Beach-Norfolk-Newport News, VA-NC 15 18 10 12 11 1.8 2.1 1.2 1.4 1.3

Washington-Arlington-Alexandria, DC-VA-MD-WV 13 11 12 15 19 0.5 0.4 0.4 0.5 0.7

U.S. MSAs TOTAL 926 994 1,106 1,246 1,120 1.1 1.2 1.3 1.5 1.3

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.
118 Syphilis Tables STD Surveillance 2009

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

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2005–2009

MSAs

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Atlanta-Sandy Springs-Marietta, GA 562 496 567 714 750 23.0 19.5 21.7 26.9 28.2

Austin-Round Rock, TX 41 73 62 91 85 5.5 9.4 7.6 10.8 10.1

Baltimore-Towson, MD 160 160 171 200 171 12.5 12.5 13.3 15.6 13.3

Birmingham-Hoover, AL 66 150 109 111 101 12.5 28.3 20.4 20.6 18.7

Boston-Cambridge-Quincy, MA-NH 105 110 121 169 200 4.9 5.1 5.6 7.7 9.1

Buffalo-Cheektowaga-Tonawanda, NY 7 16 11 3 10 1.3 2.9 2.0 0.6 1.8

Charlotte-Gastonia-Concord, NC-SC 83 93 83 49 124 11.1 11.9 10.3 5.9 14.8

Chicago-Naperville-Joliet, IL-IN-WI 460 373 396 495 686 9.9 8.0 8.4 10.5 14.5

Cincinnati-Middletown, OH-KY-IN 24 8 28 48 98 2.4 0.8 2.7 4.6 9.3

Cleveland-Elyria-Mentor, OH 21 16 24 51 57 2.1 1.6 2.4 5.1 5.7

Columbus, OH 87 77 65 116 100 10.3 9.0 7.5 13.2 11.4

Dallas-Fort Worth-Arlington, TX 205 208 172 212 349 7.0 6.9 5.6 6.7 11.0

Denver-Aurora, CO 37 53 45 102 89 3.1 4.4 3.6 8.1 7.1

Detroit-Warren-Livonia, MI 60 62 69 73 125 2.7 2.8 3.2 3.4 5.8

Hartford-West Hartford-East Hartford, CT 14 22 14 8 25 2.4 3.8 2.4 1.4 4.3

Houston-Baytown-Sugar Land, TX 218 331 393 342 319 8.3 11.9 13.9 11.9 11.1

Indianapolis, IN 31 46 23 72 75 3.8 5.6 2.8 8.5 8.9

Jacksonville, FL 30 30 33 51 46 4.9 4.8 5.2 7.9 7.2

Kansas City, MO-KS 84 95 124 82 72 8.8 9.8 12.7 8.3 7.3

Las Vegas-Paradise, NV 82 100 91 61 79 9.4 11.1 9.7 6.4 8.3

Los Angeles-Long Beach-Santa Ana, CA 743 873 1,002 889 836 11.6 13.6 15.7 13.9 13.1

Louisville, KY-IN 43 38 30 33 56 7.3 6.4 5.0 5.4 9.2

Memphis, TN-MS-AR 88 93 121 163 122 14.4 15.1 19.6 26.4 19.7

Miami-Fort Lauderdale-Miami Beach, FL 352 329 354 435 464 13.4 12.4 13.5 16.5 17.6

Milwaukee-Waukesha-West Allis, WI 21 36 48 34 19 2.9 4.9 6.4 4.5 2.5

Minneapolis-St. Paul-Bloomington, MN-WI 65 40 56 100 67 4.2 2.5 3.5 6.2 4.2

Nashville-Davidson-Murfreesboro, TN 32 38 71 71 69 4.6 5.3 9.5 9.3 9.0

New Orleans-Metairie-Kenner, LA 65 65 117 117 102 10.3 13.2 23.7 21.5 18.8

New York-Newark-Edison, NY-NJ-PA 736 780 1,166 1,293 1,232 8.1 8.6 12.8 14.0 13.4

Oklahoma City, OK 14 18 23 45 54 2.5 3.1 3.9 7.6 9.1

Orlando, FL 92 80 132 105 90 9.6 8.1 13.1 10.3 8.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 114 167 191 197 252 4.1 5.9 6.8 7.0 8.9

Phoenix-Mesa-Scottsdale, AZ 89 136 162 187 161 4.6 6.7 7.7 8.6 7.4

Pittsburgh, PA 44 63 35 32 25 3.8 5.5 3.1 2.8 2.2

Portland-Vancouver-Beaverton, OR-WA 39 25 10 21 53 3.7 2.3 0.9 1.9 4.8

Providence-New Bedford-Fall River, RI-MA 21 18 42 25 27 2.7 2.3 5.4 3.2 3.5

Richmond, VA 12 27 35 86 94 2.1 4.6 5.9 14.4 15.8

Riverside-San Bernardino-Ontario, CA 108 98 90 150 110 5.5 4.9 4.4 7.3 5.3

Rochester, NY 5 14 15 9 10 1.0 2.8 3.0 1.8 2.0

Sacramento-Arden-Arcade-Roseville, CA 16 29 57 84 57 1.6 2.9 5.5 8.1 5.5

Salt Lake City, UT 8 14 19 22 28 1.5 2.6 3.4 3.9 4.9

San Antonio, TX 95 104 122 137 174 10.3 10.9 12.5 13.8 17.5

San Diego-Carlsbad-San Marcos, CA 169 223 335 333 184 11.4 15.1 22.4 22.1 12.2

San Francisco-Oakland-Fremont, CA 323 355 296 466 429 15.7 17.1 14.2 21.9 20.2

San Jose-Sunnyvale-Santa Clara, CA 42 45 52 39 54 4.7 4.9 5.6 4.2 5.8

Seattle-Tacoma-Bellevue, WA 121 158 134 151 111 7.6 9.7 8.1 9.0 6.6

St. Louis, MO-IL 45 62 103 105 74 3.3 4.6 7.6 7.7 5.4

Tampa-St. Petersburg-Clearwater, FL 77 95 143 137 151 6.0 7.2 10.8 10.3 11.3

Virginia Beach-Norfolk-Newport News, VA-NC 45 66 78 86 91 5.5 8.2 9.6 10.6 11.2

Washington-Arlington-Alexandria, DC-VA-MD-WV 220 239 365 282 305 8.6 9.3 14.1 10.8 11.7

U.S. MSAs TOTAL 6,221 6,847 8,005 8,884 9,062 7.9 8.6 10.0 11.0 11.2

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.
STD Surveillance 2009 Syphilis Tables 119

Table 31. Primary and Secondary Syphilis—Counties and Independent Cities* Ranked by 

Number of Reported Cases, United States, 2009

Rank† County/Independent City Cases Rates per 100,000 Population Cumulative Percentage

1 Los Angeles County, CA 768 7.8 5

2 Cook County, IL 634 12.0 10

3 New York County, NY 439 26.9 13

4 Fulton County, GA 396 39.0 15

5 Harris County, TX 327 8.2 18

6 San Francisco County, CA 314 38.8 20

7 Miami-Dade County, FL 313 13.1 22

8 Kings County, NY 308 12.0 24

9 Dallas County, TX 294 12.2 27

10 Philadelphia County, PA 218 15.1 28

11 Bexar County, TX 212 13.1 30

12 DeKalb County, GA 207 28.0 31

13 San Diego County, CA 190 6.3 33

14 Tarrant County, TX 182 10.4 34

15 Shelby County, TN 175 19.3 35

16 Bronx County, NY 175 12.6 36

17 Broward County, FL 172 9.8 38

18 Maricopa County, AZ 165 4.2 39

19 Washington, D.C. 163 27.5 40

20 Jefferson County, TX 158 65.0 41

21 Caddo County, LA 141 55.8 42

22 Baltimore (City), MD 141 22.1 43

23 Wayne County, MI 126 6.5 44

24 Forsyth County, NC 122 35.6 45

25 Queens County, NY 119 5.2 46

26 Mecklenburg County, NC 116 13.0 46

27 Jefferson County, AL 115 17.4 47

28 Suffolk County, MA 113 15.4 48

29 Franklin County, OH 107 9.5 49

30 Hamilton County, OH 105 12.3 50

31 Hillsborough County, FL 101 8.6 50

32 King County, WA 99 5.3 51

33 Orleans County, LA 96 30.8 52

34 Riverside County, CA 91 4.3 52

35 Orange County, CA 90 3.0 53

36 Travis County, TX 88 8.8 54

37 Clark County, NV 86 4.6 54

38 Knox County, TN 80 18.6 55

39 Orange County, FL 78 7.3 55

40 Wake County, NC 72 8.3 56

41 Prince George’s County, MD 71 8.6 56

42 Marion County, IN 70 8.0 57

43 Cuyahoga County, OH 69 5.4 57

44 Alameda County, CA 69 4.7 58

45 Pulaski County, AR 68 18.0 58

46 Davidson County, TN 68 10.9 59

47 Cobb County, GA 68 9.7 59

48 Denver County, CO 67 11.2 60

49 Pinellas County, FL 67 7.4 60

50 Sacramento County, CA 67 4.8 61

51 Oklahoma County, OK 65 9.2 61

52 Hinds County, MS 60 24.2 62

53 Jackson County, MO 59 8.8 62

54 Santa Clara County, CA 59 3.3 63

55 Miller County, AR 54 124.9 63

56 Pima County, AZ 54 5.3 63

57 Bowie County, TX 53 57.4 64

58 Duval County, FL 52 6.1 64

59 Hudson County, NJ 49 8.2 64

60 Essex County, NJ 49 6.4 65

61 St. Landry County, LA 48 52.1 65

62 Hennepin County, MN 48 4.2 65
120 Syphilis Tables STD Surveillance 2009

Table 31. Primary and Secondary Syphilis—Counties and Independent Cities* Ranked by 

Number of Reported Cases, United States, 2009 (continued)

Rank† County/Independent City Cases Rates per 100,000 Population Cumulative Percentage

63 Clayton County, GA 47 17.2 66

64 Lafayette County, LA 46 22.2 66

65 Guilford County, NC 46 9.7 66

66 Montgomery County, AL 44 19.6 67

67 Richland County, SC 44 12.1 67

68 Madison County, AL 43 13.5 67

69 Gwinnett County, GA 43 5.4 68

70 Ouachita County, LA 41 27.3 68

71 Jefferson County, KY 41 5.7 68

72 Tangipahoa County, LA 40 34.2 69

73 Galveston County, TX 40 13.9 69

74 Norfolk (City), VA 39 16.7 69

75 St. Louis (City), MO 39 11.0 69

76 East Baton Rouge County, LA 39 9.1 70

77 Multnomah County, OR 38 5.3 70

78 Richmond (City), VA 37 18.3 70

79 Wayne County, NC 33 29.0 70

* Accounting for 70% of reported primary and secondary syphilis cases.

† Counties and independent cities were ranked in descending order by number of cases reported in 2009.
STD Surveillance 2009 Syphilis Tables 121

Table 32. Primary and Secondary Syphilis—Reported Cases and Rates* Among Men and Women 

and Male-to-Female Rate Ratios in the Counties and Independent Cities Ranked in the 

Top 30 for Cases in 2009, United States, 2008–2009

Male Female Male-to-Female 

2008 2009 2008 2009 Rate Ratio

County/Independent City† Cases Rates Cases Rates Cases Rates Cases Rates 2008 2009

Jefferson County, AL 107 34.3 78 25.0 76 21.9 37 10.7 1.6 2.3

Maricopa County, AZ 185 9.3 157 7.9 22 1.1 8 0.4 8.5 19.8

Los Angeles County, CA 793 16.2 747 15.3 29 0.6 21 0.4 27.0 38.3

San Diego County, CA 333 22.1 184 12.2 12 0.8 6 0.4 27.6 30.5

San Francisco County, CA 338 82.0 310 75.2 6 1.5 4 1.0 54.7 75.2

Washington, D.C. 139 49.7 153 54.7 7 2.2 10 3.2 22.6 17.1

Broward County, FL 194 22.8 154 18.1 21 2.3 18 2.0 9.9 9.1

Miami-Dade County, FL 207 17.8 280 24.1 47 3.8 33 2.7 4.7 8.9

DeKalb County, GA 166 46.1 187 51.9 16 4.2 20 5.3 11.0 9.8

Fulton County, GA 368 73.5 368 73.5 18 3.5 28 5.4 21.0 13.6

Cook County, IL 456 17.6 594 23.0 32 1.2 40 1.5 14.7 15.3

Caddo County, LA 71 59.1 66 55.0 59 44.4 75 56.5 1.3 1.0

Baltimore (City), MD 140 47.1 118 39.7 58 17.1 23 6.8 2.8 5.8

Suffolk County, MA 100 28.1 112 31.5 1 0.3 1 0.3 93.7 105.0

Wayne County, MI 62 6.6 104 11.1 24 2.4 22 2.2 2.8 5.0

Bronx County, NY 163 25.0 164 25.2 11 1.5 11 1.5 16.7 16.8

Kings County, NY 259 21.4 282 23.3 16 1.2 26 1.9 17.8 12.3

New York County, NY 482 61.6 430 55.0 9 1.1 9 1.1 56.0 50.0

Queens County, NY 118 10.6 118 10.6 4 0.3 1 0.1 35.3 106.0

Forsyth County, NC 20 12.1 85 51.5 6 3.4 37 20.8 3.6 2.5

Mecklenburg County, NC 44 10.1 106 24.2 4 0.9 10 2.2 11.2 11.0

Franklin County, OH 111 20.0 92 16.6 18 3.1 15 2.6 6.5 6.4

Hamilton County, OH 37 9.1 79 19.3 12 2.7 26 5.9 3.4 3.3

Philadelphia County, PA 142 21.0 191 28.2 8 1.0 27 3.5 21.0 8.1

Shelby County, TN 138 31.9 113 26.1 60 12.6 62 13.1 2.5 2.0

Bexar County, TX 130 16.4 172 21.7 54 6.5 40 4.8 2.5 4.5

Dallas County, TX 136 11.1 206 16.8 77 6.5 88 7.4 1.7 2.3

Harris County, TX 291 14.6 256 12.8 89 4.5 71 3.6 3.2 3.6

Jefferson County, TX 74 60.1 85 69.0 67 55.8 73 60.8 1.1 1.1

Tarrant County, TX 66 7.6 122 14.0 37 4.2 60 6.8 1.8 2.1

* Cases per 100,000 population.

† Counties and independent cities are in alphabetical order by state.
122 Syphilis Tables STD Surveillance 2009

Table 33. Primary and Secondary Syphilis—Reported Cases and Rates per 100,000 Population 

by Age Group and Sex, United States, 2005–2009

Age 

Group

Cases Rates

Total Male Female Total Male Female

2005

10–14 10 2 8 0.0 0.0 0.1

15–19 443 251 192 2.1 2.3 1.9

20–24 1,181 875 306 5.6 8.1 3.0

25–29 1,214 1,008 206 6.0 9.8 2.1

30–34 1,329 1,178 150 6.6 11.6 1.5

35–39 1,574 1,394 179 7.5 13.2 1.7

40–44 1,418 1,253 164 6.2 11.0 1.4

45–54 1,192 1,080 111 2.8 5.2 0.5

55–64 304 284 20 1.0 1.9 0.1

65+ 59 57 2 0.2 0.4 0.0

TOTAL 8,724 7,385 1,339 2.9 5.1 0.9

2006

10–14 13 2 11 0.1 0.0 0.1

15–19 565 332 233 2.7 3.0 2.2

20–24 1,382 1,083 299 6.5 9.9 2.9

25–29 1,574 1,333 241 7.6 12.6 2.4

30–34 1,221 1,058 163 6.2 10.6 1.7

35–39 1,581 1,427 154 7.5 13.4 1.5

40–44 1,516 1,363 153 6.7 12.2 1.4

45–54 1,443 1,278 165 3.3 6.0 0.8

55–64 375 340 35 1.2 2.2 0.2

65+ 81 79 2 0.2 0.5 0.0

TOTAL 9,756 8,297 1,459 3.3 5.6 1.0

2007

10–14 13 5 8 0.1 0.0 0.1

15–19 664 416 248 3.1 3.8 2.4

20–24 1,818 1,462 356 8.6 13.5 3.5

25–29 1,841 1,576 265 8.7 14.6 2.6

30–34 1,500 1,306 193 7.7 13.2 2.0

35–39 1,721 1,530 191 8.1 14.4 1.8

40–44 1,745 1,553 192 7.9 14.2 1.7

45–54 1,664 1,464 200 3.8 6.8 0.9

55–64 409 379 30 1.3 2.4 0.2

65+ 91 82 9 0.2 0.5 0.0

TOTAL 11,466 9,773 1,693 3.8 6.6 1.1

2008

10–14 27 8 19 0.1 0.1 0.2

15–19 903 585 318 4.2 5.3 3.0

20–24 2,398 1,878 520 11.4 17.3 5.1

25–29 2,257 1,853 404 10.6 16.9 3.9

30–34 1,734 1,490 244 8.8 15.0 2.5

35–39 1,810 1,569 241 8.6 14.8 2.3

40–44 1,777 1,575 202 8.3 14.7 1.9

45–54 2,028 1,792 236 4.6 8.2 1.0

55–64 458 412 46 1.4 2.5 0.3

65+ 105 97 8 0.3 0.6 0.0

TOTAL 13,500 11,258 2,242 4.4 7.5 1.5

2009

10–14 19 4 15 0.1 0.0 0.2

15–19 1,005 661 344 4.7 6.0 3.3

20–24 2,812 2,242 570 13.4 20.7 5.6

25–29 2,405 2,028 377 11.3 18.5 3.6

30–34 1,857 1,571 286 9.5 15.8 3.0

35–39 1,612 1,409 203 7.7 13.3 1.9

40–44 1,643 1,476 167 7.6 13.7 1.6

45–54 2,033 1,815 218 4.6 8.3 1.0

55–64 517 475 42 1.5 2.9 0.2

65+ 90 83 7 0.2 0.5 0.0

TOTAL 13,997 11,765 2,232 4.6 7.8 1.4

NOTE: This table should be used only for age comparisons. If age was not specified, cases were prorated according to the distribution of cases for which 

age was known. Differences between total cases from this table and others in the report are due to different reporting formats. The 0- to 9-year age group is 

not shown because some of these cases may not be due to sexual transmission; however, they are included in the totals.
STD Surveillance 2009 123

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124 Syphilis Tables STD Surveillance 2009

Table 34A. Primary and Secondary Syphilis—Reported Cases by Race/Ethnicity, Age Group, and 

Sex, United States, 2005–2009

Age 

Group

Whites, 

Non-Hispanic

Blacks, 

Non-Hispanic Hispanics

Asians/Pacific 

Islanders

American Indians/

Alaska Natives

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

2005

10–14 0 0 0 9 1 8 1 1 0 0 0 0 0 0 0

15–19 67 36 30 304 173 131 62 36 26 5 4 1 5 1 4

20–24 281 230 51 660 459 201 216 167 49 15 11 4 8 7 1

25–29 331 299 32 612 480 132 236 198 38 27 25 2 8 6 2

30–34 491 456 35 554 455 99 230 216 14 43 42 1 12 10 2

35–39 761 712 49 518 415 103 268 244 24 19 19 0 8 4 4

40–44 741 700 40 446 350 97 193 172 21 26 24 2 12 7 4

45–54 660 631 29 385 320 65 126 111 14 15 14 1 6 4 2

55–64 167 162 5 102 90 13 30 28 2 4 4 0 0 0 0

65+ 26 26 0 23 21 2 8 8 0 2 2 0 0 0 0

TOTAL 3,524 3,254 270 3,615 2,764 850 1,370 1,182 188 156 145 11 60 40 20

2006

10–14 1 0 1 11 2 9 0 0 0 0 0 0 1 0 1

15–19 71 39 33 419 246 173 74 46 28 1 1 0 0 0 0

20–24 291 247 44 853 630 223 218 187 31 12 11 1 8 7 1

25–29 431 381 50 795 641 154 304 271 34 37 35 2 7 6 1

30–34 433 395 38 497 398 99 243 223 20 34 31 3 14 11 3

35–39 720 676 44 532 447 85 282 263 18 33 32 1 14 9 5

40–44 802 756 46 443 356 87 227 213 14 30 29 1 15 10 5

45–54 766 729 38 500 394 107 143 129 14 24 22 2 9 5 4

55–64 194 186 8 139 115 24 35 33 2 2 2 0 5 4 1

65+ 34 34 0 25 23 2 17 17 0 0 0 0 5 5 0

TOTAL 3,744 3,443 301 4,215 3,253 962 1,543 1,381 162 173 163 10 80 57 24

2007

10–14 0 0 0 13 5 8 0 0 0 0 0 0 0 0 0

15–19 95 49 46 470 299 171 91 66 26 0 0 0 7 2 5

20–24 338 271 67 1,124 883 240 328 289 40 15 12 2 13 6 7

25–29 486 431 54 954 784 170 352 319 33 35 34 1 15 7 7

30–34 506 455 51 612 504 108 325 298 27 38 35 3 19 15 4

35–39 699 650 49 683 559 125 293 280 12 31 31 0 15 10 5

40–44 841 783 58 605 486 119 265 254 11 27 26 1 6 4 2

45–54 824 773 51 620 489 132 187 171 16 24 24 0 10 7 2

55–64 213 210 3 154 130 24 41 38 3 2 2 0 0 0 0

65+ 47 45 2 38 31 7 5 5 0 1 1 0 0 0 0

TOTAL 4,049 3,668 381 5,274 4,170 1,104 1,887 1,720 167 171 164 7 85 52 33

2008

10–14 2 1 1 23 7 16 2 0 2 0 0 0 0 0 0

15–19 123 72 50 645 411 235 126 98 29 7 5 2 2 0 2

20–24 453 366 87 1,543 1,161 381 357 308 49 34 34 0 11 8 3

25–29 583 500 83 1,203 926 277 412 375 37 45 41 4 15 11 3

30–34 552 499 53 772 617 155 349 317 33 49 49 0 12 8 3

35–39 688 615 73 742 607 134 345 317 28 30 27 2 5 2 3

40–44 781 718 63 684 562 122 282 267 15 24 23 1 5 4 1

45–54 996 935 61 779 624 155 225 206 19 22 22 0 5 4 1

55–64 229 219 9 185 151 33 36 34 2 7 7 0 2 1 1

65+ 62 59 3 30 25 5 11 11 0 2 2 0 0 0 0

TOTAL 4,469 3,983 486 6,607 5,093 1,514 2,146 1,931 214 220 211 9 58 40 18

2009

10–14 1 0 1 16 3 13 2 1 1 0 0 0 0 0 0

15–19 108 70 37 774 489 286 111 92 19 9 8 1 3 2 1

20–24 440 360 80 1,922 1,470 452 400 366 34 37 35 2 12 10 2

25–29 516 452 64 1,436 1,152 284 403 381 22 35 32 3 13 10 3

30–34 527 469 58 929 723 206 346 327 19 45 43 2 9 7 2

35–39 592 531 62 671 557 114 290 269 22 47 43 4 11 9 2

40–44 737 694 43 610 499 111 268 256 12 23 22 1 5 5 0

45–54 1,003 931 71 755 625 130 241 229 12 28 26 2 5 3 2

55–64 286 276 9 184 156 28 43 38 5 2 2 0 1 1 0

65+ 48 48 0 36 29 7 6 6 0 0 0 0 0 0 0

TOTAL 4,256 3,831 425 7,335 5,703 1,632 2,112 1,965 147 225 210 15 61 49 12

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 33 for age-specific cases and rates and Tables 25–27 for total and sexspecific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were 

specified. For the following years, the states listed did not report age or race/ethnicity for most cases, and their case data and population denominators were 

excluded: 2007 (Idaho) and 2009 (Nebraska, Wyoming). Differences between total cases from this table and others in the report are due to different reporting 

formats and above listed exclusions. The 0- to 9-year age group is not shown because some of these cases may not be due to sexual transmission; however, they 

are included in the totals.
STD Surveillance 2009 Syphilis Tables 125

Table 34B. Primary and Secondary Syphilis—Rates per 100,000 Population by Race/Ethnicity, Age 

Group, and Sex, United States, 2005–2009

Age 

Group

Whites, 

Non-Hispanic

Blacks, 

Non-Hispanic Hispanics

Asians/Pacific 

Islanders

American Indians/

Alaska Natives

Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

10–14 0.0 0.0 0.0 0.3 0.1 0.5 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0

2005

15–19 0.5 0.5 0.5 9.4 10.6 8.2 1.8 2.0 1.6 0.6 0.9 0.2 2.3 0.9 3.7

20–24 2.1 3.4 0.8 21.9 30.2 13.5 5.8 8.2 2.9 1.6 2.3 0.8 3.8 6.6 0.9

25–29 2.8 4.9 0.5 22.6 36.5 9.5 5.8 8.8 2.1 2.4 4.5 0.4 4.6 6.6 2.6

30–34 4.0 7.4 0.6 21.4 37.1 7.3 6.0 10.5 0.8 3.2 6.5 0.2 7.1 11.6 2.5

35–39 5.6 10.4 0.7 19.6 33.3 7.4 7.9 13.5 1.5 1.5 3.2 0.0 5.1 5.3 4.9

40–44 4.7 8.9 0.5 15.8 26.5 6.4 6.4 11.0 1.5 2.3 4.4 0.4 6.2 8.3 4.3

45–54 2.1 4.1 0.2 7.9 14.1 2.5 2.9 5.2 0.7 0.8 1.6 0.1 1.9 2.7 1.2

55–64 0.7 1.4 0.0 3.5 6.8 0.8 1.3 2.5 0.2 0.3 0.7 0.0 0.0 0.0 0.0

65+ 0.1 0.2 0.0 0.7 1.8 0.1 0.4 0.9 0.0 0.2 0.4 0.0 0.0 0.0 0.0

TOTAL 1.8 3.3 0.3 9.7 15.5 4.4 3.2 5.4 0.9 1.1 2.2 0.2 2.4 3.3 1.6

10–14 0.0 0.0 0.0 0.3 0.1 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.5 0.0 1.0

2006

15–19 0.5 0.6 0.5 12.6 14.7 10.6 2.0 2.5 1.6 0.1 0.2 0.0 0.0 0.0 0.0

20–24 2.2 3.7 0.7 28.1 41.0 14.8 5.8 9.2 1.8 1.3 2.3 0.2 3.7 6.3 1.1

25–29 3.5 6.1 0.8 28.3 46.9 10.7 7.3 11.7 1.8 3.1 6.0 0.3 3.9 6.7 1.1

30–34 3.7 6.7 0.6 19.6 33.1 7.4 6.2 10.4 1.1 2.5 4.7 0.4 8.4 13.0 3.7

35–39 5.3 9.9 0.7 20.1 35.8 6.1 8.0 14.0 1.1 2.6 5.2 0.2 8.3 10.5 6.1

40–44 5.3 9.9 0.6 15.9 27.3 5.8 7.3 13.0 1.0 2.6 5.1 0.2 8.1 10.8 5.5

45–54 2.4 4.7 0.2 10.0 17.0 4.0 3.2 5.6 0.6 1.2 2.4 0.2 2.8 3.3 2.3

55–64 0.8 1.6 0.1 4.5 8.3 1.4 1.4 2.7 0.2 0.2 0.4 0.0 2.4 4.0 0.9

65+ 0.1 0.3 0.0 0.8 1.9 0.1 0.7 1.6 0.0 0.0 0.0 0.0 2.7 6.3 0.0

TOTAL 1.9 3.5 0.3 11.2 18.1 4.9 3.5 6.0 0.8 1.2 2.4 0.1 3.2 4.7 1.9

10–14 0.0 0.0 0.0 0.4 0.3 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

2007

15–19 0.7 0.7 0.7 13.9 17.5 10.3 2.4 3.4 1.4 0.0 0.0 0.0 3.1 1.8 4.5

20–24 2.6 4.1 1.1 36.8 57.2 15.9 8.9 14.6 2.3 1.5 2.6 0.4 6.0 5.5 6.5

25–29 3.9 6.8 0.9 33.1 55.5 11.5 8.5 13.8 1.8 3.0 5.9 0.2 7.6 7.6 7.6

30–34 4.4 7.9 0.9 24.3 42.1 8.2 8.2 13.7 1.5 2.9 5.4 0.5 11.6 18.1 5.1

35–39 5.3 9.7 0.7 25.7 44.6 8.9 8.1 14.4 0.7 2.3 4.8 0.0 8.9 11.7 6.2

40–44 5.8 10.7 0.8 22.0 37.8 8.2 8.3 15.1 0.7 2.3 4.5 0.2 3.6 5.0 2.3

45–54 2.6 4.9 0.3 12.1 20.7 4.8 3.9 7.1 0.7 1.2 2.5 0.0 2.8 4.6 1.2

55–64 0.9 1.7 0.0 4.7 8.9 1.3 1.5 2.9 0.2 0.2 0.3 0.0 0.0 0.0 0.0

65+ 0.2 0.3 0.0 1.2 2.5 0.4 0.2 0.5 0.0 0.1 0.2 0.0 0.0 0.0 0.0

TOTAL 2.0 3.7 0.4 13.8 22.9 5.5 4.2 7.3 0.8 1.2 2.4 0.1 3.4 4.2 2.6

10–14 0.0 0.0 0.0 0.7 0.4 1.0 0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0

2008

15–19 0.9 1.1 0.8 18.9 23.8 14.0 3.3 4.9 1.5 0.8 1.1 0.5 0.9 0.0 1.9

20–24 3.5 5.4 1.4 49.8 74.2 24.9 9.7 15.8 2.8 3.6 7.1 0.0 5.1 7.2 2.9

25–29 4.5 7.7 1.3 40.7 63.5 18.5 9.9 16.3 2.0 3.9 7.2 0.7 7.3 11.2 3.3

30–34 4.8 8.6 0.9 30.4 51.0 11.7 8.6 14.3 1.8 3.8 7.8 0.0 7.0 10.1 3.9

35–39 5.3 9.3 1.1 28.0 48.6 9.6 9.2 15.9 1.6 2.2 4.1 0.3 3.2 2.5 3.9

40–44 5.5 10.1 0.9 25.4 44.6 8.5 8.6 15.4 1.0 2.1 4.1 0.2 3.1 5.1 1.2

45–54 3.1 5.9 0.4 15.0 26.0 5.5 4.5 8.1 0.8 1.1 2.3 0.0 1.5 2.5 0.6

55–64 0.9 1.7 0.1 5.4 10.0 1.8 1.2 2.4 0.1 0.5 1.1 0.0 0.9 0.9 0.9

65+ 0.2 0.4 0.0 0.9 2.0 0.2 0.4 0.9 0.0 0.2 0.4 0.0 0.0 0.0 0.0

TOTAL 2.2 4.0 0.5 17.2 27.9 7.6 4.6 8.0 0.9 1.5 3.0 0.1 2.3 3.1 1.4

10–14 0.0 0.0 0.0 0.5 0.2 0.9 0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0

2009

15–19 0.8 1.1 0.6 22.8 28.3 17.1 2.9 4.7 1.0 1.0 1.7 0.2 1.3 1.8 0.9

20–24 3.4 5.4 1.3 62.2 94.2 29.6 11.0 18.9 2.0 3.9 7.2 0.4 5.5 9.1 1.9

25–29 4.0 7.0 1.0 48.7 79.2 19.0 9.8 16.7 1.2 3.1 5.7 0.5 6.6 10.1 3.1

30–34 4.6 8.1 1.0 36.7 59.9 15.5 8.6 14.8 1.0 3.5 6.8 0.3 5.7 8.8 2.5

35–39 4.6 8.1 1.0 25.4 44.6 8.2 7.8 13.5 1.2 3.5 6.5 0.6 6.9 11.4 2.5

40–44 5.2 9.9 0.6 22.7 39.6 7.7 8.2 14.8 0.8 2.0 3.8 0.2 3.1 6.3 0.0

45–54 3.2 6.0 0.4 14.5 26.0 4.7 4.9 9.0 0.5 1.4 2.7 0.2 1.5 1.9 1.1

55–64 1.1 2.2 0.1 5.4 10.3 1.5 1.5 2.8 0.3 0.1 0.3 0.0 0.4 0.9 0.0

65+ 0.2 0.4 0.0 1.1 2.3 0.3 0.2 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0

TOTAL 2.1 3.9 0.4 19.2 31.3 8.2 4.5 8.1 0.6 1.6 3.0 0.2 2.4 3.9 0.9

NOTE: These tables should be used only for race/ethnicity comparisons. See Table 33 for age-specific cases and rates and Tables 25–27 for total and sexspecific cases and rates. If age or race/ethnicity was not specified, cases were prorated according to the distribution of cases for which these variables were 

specified. For the following years, the states listed did not report age or race/ethnicity for most cases, and their case data and population denominators were 

excluded: 2007 (Idaho) and 2009 (Nebraska, Wyoming). Differences between total rates from this table and others in the report are due to different reporting 

formats and above listed exclusions. The 0- to 9-year age group is not shown because some of these cases may not be due to sexual transmission; however, they 

are included in the totals.
126 Syphilis Tables STD Surveillance 2009

Table 35. Early Latent Syphilis—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2005–2009

State/Area

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Alabama 184 341 363 440 419 4.0 7.4 7.8 9.4 9.0

Alaska 8 6 3 2 0 1.2 0.9 0.4 0.3 0.0

Arizona 134 186 269 258 196 2.3 3.0 4.2 4.0 3.0

Arkansas 48 67 115 144 172 1.7 2.4 4.1 5.0 6.0

California 1,153 1,369 1,421 1,648 1,621 3.2 3.8 3.9 4.5 4.4

Colorado 27 38 35 91 63 0.6 0.8 0.7 1.8 1.3

Connecticut 19 27 20 28 40 0.5 0.8 0.6 0.8 1.1

Delaware 9 16 14 23 23 1.1 1.9 1.6 2.6 2.6

District of Columbia 103 77 84 77 158 18.7 13.2 14.3 13.0 26.7

Florida 726 760 1,155 1,252 1,254 4.1 4.2 6.3 6.8 6.8

Georgia 380 366 423 563 768 4.2 3.9 4.4 5.8 7.9

Hawaii 4 2 11 9 15 0.3 0.2 0.9 0.7 1.2

Idaho 13 3 3 6 3 0.9 0.2 0.2 0.4 0.2

Illinois 397 267 224 271 344 3.1 2.1 1.7 2.1 2.7

Indiana 42 46 39 83 55 0.7 0.7 0.6 1.3 0.9

Iowa 6 6 6 11 9 0.2 0.2 0.2 0.4 0.3

Kansas 18 18 25 54 58 0.7 0.7 0.9 1.9 2.1

Kentucky 23 36 34 47 64 0.6 0.9 0.8 1.1 1.5

Louisiana 252 481 722 809 799 5.6 11.2 16.8 18.3 18.1

Maine 2 7 5 10 10 0.2 0.5 0.4 0.8 0.8

Maryland 289 193 320 313 261 5.2 3.4 5.7 5.6 4.6

Massachusetts 105 82 116 149 135 1.6 1.3 1.8 2.3 2.1

Michigan 69 43 73 99 155 0.7 0.4 0.7 1.0 1.5

Minnesota 46 58 55 47 46 0.9 1.1 1.1 0.9 0.9

Mississippi 162 197 269 232 312 5.5 6.8 9.2 7.9 10.6

Missouri 108 93 120 145 146 1.9 1.6 2.0 2.5 2.5

Montana 0 0 0 1 0 0.0 0.0 0.0 0.1 0.0

Nebraska 2 1 3 0 6 0.1 0.1 0.2 0.0 0.3

Nevada 64 119 174 168 137 2.7 4.8 6.8 6.5 5.3

New Hampshire 0 2 13 4 6 0.0 0.2 1.0 0.3 0.5

New Jersey 289 314 343 415 401 3.3 3.6 3.9 4.8 4.6

New Mexico 53 85 66 45 40 2.7 4.3 3.4 2.3 2.0

New York 1,084 993 1,149 1,372 1,266 5.6 5.1 6.0 7.0 6.5

North Carolina 215 294 247 221 357 2.5 3.3 2.7 2.4 3.9

North Dakota 0 0 0 2 0 0.0 0.0 0.0 0.3 0.0

Ohio 136 115 135 224 221 1.2 1.0 1.2 2.0 1.9

Oklahoma 64 121 115 117 172 1.8 3.4 3.2 3.2 4.7

Oregon 16 19 6 18 29 0.4 0.5 0.2 0.5 0.8

Pennsylvania 204 286 309 309 361 1.6 2.3 2.5 2.5 2.9

Rhode Island 5 6 10 7 14 0.5 0.6 0.9 0.7 1.3

South Carolina 222 174 143 192 284 5.2 4.0 3.2 4.3 6.3

South Dakota 0 6 4 3 2 0.0 0.8 0.5 0.4 0.2

Tennessee 203 233 304 312 333 3.4 3.9 4.9 5.0 5.4

Texas 1,013 1,312 1,467 1,733 1,932 4.4 5.6 6.1 7.1 7.9

Utah 7 7 2 10 7 0.3 0.3 0.1 0.4 0.3

Vermont 0 2 1 6 1 0.0 0.3 0.2 1.0 0.2

Virginia 148 165 177 238 233 2.0 2.2 2.3 3.1 3.0

Washington 63 81 76 98 64 1.0 1.3 1.2 1.5 1.0

West Virginia 3 6 9 16 8 0.2 0.3 0.5 0.9 0.4

Wisconsin 58 60 91 78 66 1.0 1.1 1.6 1.4 1.2

Wyoming 0 0 0 1 0 0.0 0.0 0.0 0.2 0.0

U.S. TOTAL 8,176 9,186 10,768 12,401 13,066 2.8 3.1 3.6 4.1 4.3

Northeast 1,708 1,719 1,966 2,300 2,234 3.1 3.1 3.6 4.2 4.1

Midwest 882 713 775 1,017 1,108 1.3 1.1 1.2 1.5 1.7

South 4,044 4,839 5,961 6,729 7,549 3.8 4.4 5.4 6.0 6.8

West 1,542 1,915 2,066 2,355 2,175 2.3 2.8 2.9 3.3 3.1

Guam 0 3 3 2 1 0.0 1.8 1.7 1.1 0.6

Puerto Rico 432 368 408 241 164 11.0 9.4 10.3 6.1 4.1

Virgin Islands 7 0 1 0 0 6.4 0.0 0.9 0.0 0.0

OUTLYING AREAS 439 371 412 243 165 10.5 8.8 9.7 5.7 3.9

TOTAL 8,615 9,557 11,180 12,644 13,231 2.9 3.1 3.7 4.1 4.3
STD Surveillance 2009 Syphilis Tables 127

Table 36. Early Latent Syphilis—Reported Cases and Rates in Selected Metropolitan Statistical 

Areas (MSAs)* in Alphabetical Order, United States, 2005–2009

MSAs

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Atlanta-Sandy Springs-Marietta, GA 314 293 363 402 613 6.4 5.7 6.9 7.5 11.4

Austin-Round Rock, TX 59 51 66 109 135 4.1 3.4 4.1 6.6 8.2

Baltimore-Towson, MD 211 136 185 214 153 7.9 5.1 6.9 8.0 5.7

Birmingham-Hoover, AL 82 220 196 199 150 7.5 20.0 17.7 17.8 13.4

Boston-Cambridge-Quincy, MA-NH 84 65 95 124 116 1.9 1.5 2.1 2.7 2.6

Buffalo-Cheektowaga-Tonawanda, NY 3 14 6 10 3 0.3 1.2 0.5 0.9 0.3

Charlotte-Gastonia-Concord, NC-SC 71 98 63 62 78 4.7 6.2 3.8 3.6 4.6

Chicago-Naperville-Joliet, IL-IN-WI 395 269 209 251 324 4.2 2.8 2.2 2.6 3.4

Cincinnati-Middletown, OH-KY-IN 13 7 12 23 42 0.6 0.3 0.6 1.1 1.9

Cleveland-Elyria-Mentor, OH 21 11 21 48 70 1.0 0.5 1.0 2.3 3.4

Columbus, OH 41 55 47 89 64 2.4 3.2 2.7 5.0 3.6

Dallas-Fort Worth-Arlington, TX 381 532 468 496 592 6.5 8.9 7.6 7.9 9.4

Denver-Aurora, CO 22 32 30 68 57 0.9 1.3 1.2 2.7 2.3

Detroit-Warren-Livonia, MI 59 34 47 45 88 1.3 0.8 1.1 1.0 2.0

Hartford-West Hartford-East Hartford, CT 7 10 8 10 13 0.6 0.8 0.7 0.8 1.1

Houston-Baytown-Sugar Land, TX 207 291 468 555 421 3.9 5.3 8.3 9.7 7.3

Indianapolis, IN 19 18 20 56 27 1.2 1.1 1.2 3.3 1.6

Jacksonville, FL 56 56 51 86 82 4.5 4.4 3.9 6.5 6.2

Kansas City, MO-KS 51 41 70 79 64 2.6 2.1 3.5 3.9 3.2

Las Vegas-Paradise, NV 57 112 170 166 135 3.3 6.3 9.3 8.9 7.2

Los Angeles-Long Beach-Santa Ana, CA 666 851 893 910 1,070 5.2 6.6 6.9 7.1 8.3

Louisville, KY-IN 16 18 12 20 17 1.3 1.5 1.0 1.6 1.4

Memphis, TN-MS-AR 171 174 222 199 259 13.6 13.7 17.3 15.5 20.1

Miami-Fort Lauderdale-Miami Beach, FL 302 304 440 563 644 5.6 5.6 8.1 10.4 11.9

Milwaukee-Waukesha-West Allis, WI 36 46 65 60 46 2.4 3.0 4.2 3.9 3.0

Minneapolis-St. Paul-Bloomington, MN-WI 43 52 54 43 45 1.4 1.6 1.7 1.3 1.4

Nashville-Davidson-Murfreesboro, TN 29 42 56 54 64 2.0 2.9 3.7 3.5 4.1

New Orleans-Metairie-Kenner, LA 68 127 222 239 243 5.2 12.4 21.5 21.1 21.4

New York-Newark-Edison, NY-NJ-PA 1,281 1,178 1,360 1,628 1,530 6.8 6.3 7.2 8.6 8.0

Oklahoma City, OK 36 74 65 72 123 3.1 6.3 5.4 6.0 10.2

Orlando, FL 124 91 160 148 132 6.4 4.6 7.9 7.2 6.4

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 171 280 310 305 362 2.9 4.8 5.3 5.2 6.2

Phoenix-Mesa-Scottsdale, AZ 97 166 165 160 131 2.5 4.1 3.9 3.7 3.1

Pittsburgh, PA 28 43 45 43 25 1.2 1.8 1.9 1.8 1.1

Portland-Vancouver-Beaverton, OR-WA 12 9 5 11 22 0.6 0.4 0.2 0.5 1.0

Providence-New Bedford-Fall River, RI-MA 10 9 12 13 16 0.6 0.6 0.7 0.8 1.0

Richmond, VA 24 29 45 81 59 2.0 2.4 3.7 6.6 4.8

Riverside-San Bernardino-Ontario, CA 64 64 49 89 88 1.6 1.6 1.2 2.2 2.1

Rochester, NY 13 8 5 5 6 1.3 0.8 0.5 0.5 0.6

Sacramento-Arden-Arcade-Roseville, CA 11 23 16 39 38 0.5 1.1 0.8 1.8 1.8

Salt Lake City, UT 3 5 2 10 4 0.3 0.5 0.2 0.9 0.4

San Antonio, TX 144 172 115 203 290 7.6 8.9 5.8 10.0 14.3

San Diego-Carlsbad-San Marcos, CA 117 123 156 179 80 4.0 4.2 5.2 6.0 2.7

San Francisco-Oakland-Fremont, CA 220 220 200 281 253 5.3 5.3 4.8 6.6 5.9

San Jose-Sunnyvale-Santa Clara, CA 18 18 25 25 22 1.0 1.0 1.4 1.4 1.2

Seattle-Tacoma-Bellevue, WA 60 74 70 91 56 1.9 2.3 2.1 2.7 1.7

St. Louis, MO-IL 34 30 57 70 90 1.2 1.1 2.0 2.5 3.2

Tampa-St. Petersburg-Clearwater, FL 101 177 294 275 225 3.8 6.6 10.8 10.1 8.2

Virginia Beach-Norfolk-Newport News, VA-NC 78 74 54 69 78 4.7 4.5 3.3 4.2 4.7

Washington-Arlington-Alexandria, DC-VA-MD-WV 208 171 265 224 306 4.0 3.2 5.0 4.2 5.7

U.S. MSAs TOTAL 6,338 6,997 8,034 9,201 9,551 4.0 4.3 4.9 5.6 5.8

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.
128 Syphilis Tables STD Surveillance 2009

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

Alphabetical Order, United States and Outlying Areas, 2005–2009

State/Area

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Alabama 193 262 254 286 289 4.2 5.7 5.5 6.1 6.2

Alaska 5 8 6 6 4 0.8 1.2 0.9 0.9 0.6

Arizona 455 521 650 789 629 7.7 8.4 10.3 12.1 9.7

Arkansas 124 92 122 149 95 4.5 3.3 4.3 5.2 3.3

California 2,527 2,773 2,777 2,995 2,449 7.0 7.6 7.6 8.1 6.7

Colorado 70 73 63 133 101 1.5 1.5 1.3 2.7 2.0

Connecticut 88 106 87 109 72 2.5 3.0 2.5 3.1 2.1

Delaware 15 38 31 20 36 1.8 4.5 3.6 2.3 4.1

District of Columbia 148 120 153 147 110 26.9 20.6 26.0 24.8 18.6

Florida 1,422 1,445 1,830 2,272 1,547 8.0 8.0 10.0 12.4 8.4

Georgia 898 977 1,142 1,345 982 9.9 10.4 12.0 13.9 10.1

Hawaii 42 46 38 30 39 3.3 3.6 3.0 2.3 3.0

Idaho 21 6 10 13 24 1.5 0.4 0.7 0.9 1.6

Illinois 663 760 522 720 805 5.2 5.9 4.1 5.6 6.2

Indiana 182 111 121 128 110 2.9 1.8 1.9 2.0 1.7

Iowa 13 43 37 48 33 0.4 1.4 1.2 1.6 1.1

Kansas 51 41 44 41 58 1.9 1.5 1.6 1.5 2.1

Kentucky 54 78 63 77 81 1.3 1.9 1.5 1.8 1.9

Louisiana 696 551 516 485 413 15.4 12.9 12.0 11.0 9.4

Maine 3 6 7 7 1 0.2 0.5 0.5 0.5 0.1

Maryland 387 526 482 374 387 6.9 9.4 8.6 6.6 6.9

Massachusetts 168 172 128 114 100 2.6 2.7 2.0 1.8 1.5

Michigan 297 210 262 227 246 2.9 2.1 2.6 2.3 2.5

Minnesota 89 83 72 102 99 1.7 1.6 1.4 2.0 1.9

Mississippi 160 237 305 320 188 5.5 8.1 10.4 10.9 6.4

Missouri 114 166 124 171 189 2.0 2.8 2.1 2.9 3.2

Montana 0 1 0 2 1 0.0 0.1 0.0 0.2 0.1

Nebraska 12 26 23 21 34 0.7 1.5 1.3 1.2 1.9

Nevada 169 117 104 71 75 7.0 4.7 4.1 2.7 2.9

New Hampshire 17 20 9 17 17 1.3 1.5 0.7 1.3 1.3

New Jersey 375 297 345 364 270 4.3 3.4 4.0 4.2 3.1

New Mexico 68 66 62 96 107 3.5 3.4 3.1 4.8 5.4

New York 2,054 2,833 2,766 2,903 2,160 10.7 14.7 14.3 14.9 11.1

North Carolina 213 352 516 480 578 2.5 4.0 5.7 5.2 6.3

North Dakota 0 2 1 2 3 0.0 0.3 0.2 0.3 0.5

Ohio 153 192 219 185 206 1.3 1.7 1.9 1.6 1.8

Oklahoma 50 58 33 51 25 1.4 1.6 0.9 1.4 0.7

Oregon 52 51 33 53 46 1.4 1.4 0.9 1.4 1.2

Pennsylvania 308 335 264 313 321 2.5 2.7 2.1 2.5 2.6

Rhode Island 35 51 30 30 29 3.3 4.8 2.8 2.9 2.8

South Carolina 239 155 176 120 100 5.6 3.6 4.0 2.7 2.2

South Dakota 2 10 1 2 8 0.3 1.3 0.1 0.2 1.0

Tennessee 493 527 537 548 568 8.3 8.7 8.7 8.8 9.1

Texas 2,336 2,501 2,780 3,071 3,271 10.2 10.6 11.6 12.6 13.4

Utah 33 38 23 5 17 1.3 1.5 0.9 0.2 0.6

Vermont 0 2 0 1 0 0.0 0.3 0.0 0.2 0.0

Virginia 361 343 328 281 221 4.8 4.5 4.3 3.6 2.8

Washington 144 160 135 159 118 2.3 2.5 2.1 2.4 1.8

West Virginia 12 13 11 14 16 0.7 0.7 0.6 0.8 0.9

Wisconsin 37 42 12 43 56 0.7 0.8 0.2 0.8 1.0

Wyoming 1 1 2 5 4 0.2 0.2 0.4 0.9 0.8

U.S. TOTAL 16,049 17,644 18,256 19,945 17,338 5.4 5.9 6.1 6.6 5.7

Northeast 3,048 3,822 3,636 3,858 2,970 5.6 7.0 6.6 7.0 5.4

Midwest 1,613 1,686 1,438 1,690 1,847 2.4 2.5 2.2 2.5 2.8

South 7,801 8,275 9,279 10,040 8,907 7.3 7.6 8.4 9.0 8.0

West 3,587 3,861 3,903 4,357 3,614 5.3 5.6 5.6 6.1 5.1

Guam 16 7 24 37 9 9.5 4.1 13.8 21.0 5.1

Puerto Rico 554 535 682 381 328 14.2 13.6 17.3 9.6 8.3

Virgin Islands 5 4 4 1 2 4.6 3.7 3.6 0.9 1.8

OUTLYING AREAS 575 546 710 419 339 13.7 13.0 16.8 9.9 8.0

TOTAL 16,624 18,190 18,966 20,364 17,677 5.5 6.0 6.2 6.6 5.7

* Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other 

than neurosyphilis.
STD Surveillance 2009 Syphilis Tables 129

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

Statistical Areas (MSAs)† in Alphabetical Order, United States, 2005–2009

MSAs

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Atlanta-Sandy Springs-Marietta, GA 714 814 929 1,068 756 14.5 15.8 17.6 19.9 14.1

Austin-Round Rock, TX 89 74 94 127 116 6.1 4.9 5.9 7.7 7.0

Baltimore-Towson, MD 209 283 236 186 193 7.9 10.6 8.8 7.0 7.2

Birmingham-Hoover, AL 57 94 93 110 112 5.2 8.5 8.4 9.8 10.0

Boston-Cambridge-Quincy, MA-NH 149 147 98 86 92 3.4 3.3 2.2 1.9 2.0

Buffalo-Cheektowaga-Tonawanda, NY 4 7 9 7 27 0.3 0.6 0.8 0.6 2.4

Charlotte-Gastonia-Concord, NC-SC 61 83 133 100 127 4.0 5.2 8.1 5.9 7.5

Chicago-Naperville-Joliet, IL-IN-WI 611 687 469 650 727 6.5 7.2 4.9 6.8 7.6

Cincinnati-Middletown, OH-KY-IN 18 37 31 20 58 0.9 1.8 1.5 0.9 2.7

Cleveland-Elyria-Mentor, OH 9 24 33 15 29 0.4 1.1 1.6 0.7 1.4

Columbus, OH 76 67 99 84 71 4.4 3.9 5.6 4.7 4.0

Dallas-Fort Worth-Arlington, TX 792 809 881 934 1,020 13.6 13.5 14.3 14.8 16.2

Denver-Aurora, CO 51 51 43 98 74 2.2 2.1 1.7 3.9 3.0

Detroit-Warren-Livonia, MI 238 155 187 154 171 5.3 3.5 4.2 3.5 3.9

Hartford-West Hartford-East Hartford, CT 35 32 27 51 29 2.9 2.7 2.3 4.3 2.4

Houston-Baytown-Sugar Land, TX 685 856 1,032 1,024 1,139 13.0 15.5 18.3 17.9 19.9

Indianapolis, IN 80 56 49 53 48 4.9 3.4 2.9 3.1 2.8

Jacksonville, FL 41 63 102 153 95 3.3 4.9 7.8 11.7 7.2

Kansas City, MO-KS 53 75 49 55 70 2.7 3.8 2.5 2.7 3.5

Las Vegas-Paradise, NV 139 95 85 52 49 8.1 5.3 4.6 2.8 2.6

Los Angeles-Long Beach-Santa Ana, CA 1,649 1,759 1,588 1,722 1,332 12.8 13.6 12.3 13.4 10.3

Louisville, KY-IN 40 42 33 34 48 3.3 3.4 2.7 2.7 3.9

Memphis, TN-MS-AR 272 287 326 306 316 21.6 22.5 25.5 23.8 24.6

Miami-Fort Lauderdale-Miami Beach, FL 742 773 997 1,326 797 13.7 14.1 18.4 24.5 14.7

Milwaukee-Waukesha-West Allis, WI 18 16 9 32 43 1.2 1.1 0.6 2.1 2.8

Minneapolis-St. Paul-Bloomington, MN-WI 74 65 59 75 70 2.4 2.0 1.8 2.3 2.2

Nashville-Davidson-Murfreesboro, TN 126 112 100 138 145 8.9 7.7 6.6 8.9 9.4

New Orleans-Metairie-Kenner, LA 190 133 157 75 78 14.4 13.0 15.2 6.6 6.9

New York-Newark-Edison, NY-NJ-PA 2,241 2,905 2,913 3,089 2,237 12.0 15.4 15.5 16.3 11.8

Oklahoma City, OK 28 18 12 26 16 2.4 1.5 1.0 2.2 1.3

Orlando, FL 183 217 277 184 165 9.5 10.9 13.6 9.0 8.0

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 284 315 253 287 304 4.9 5.4 4.3 4.9 5.2

Phoenix-Mesa-Scottsdale, AZ 363 424 486 468 368 9.4 10.5 11.6 10.9 8.6

Pittsburgh, PA 15 18 17 17 16 0.6 0.8 0.7 0.7 0.7

Portland-Vancouver-Beaverton, OR-WA 43 40 34 32 39 2.1 1.9 1.6 1.4 1.8

Providence-New Bedford-Fall River, RI-MA 37 65 44 33 31 2.3 4.0 2.7 2.1 1.9

Richmond, VA 50 49 46 53 50 4.3 4.1 3.8 4.3 4.1

Riverside-San Bernardino-Ontario, CA 208 203 194 202 210 5.3 5.0 4.8 4.9 5.1

Rochester, NY 17 68 55 37 34 1.6 6.6 5.3 3.6 3.3

Sacramento-Arden-Arcade-Roseville, CA 8 78 40 100 94 0.4 3.8 1.9 4.7 4.5

Salt Lake City, UT 23 21 14 2 8 2.2 2.0 1.3 0.2 0.7

San Antonio, TX 178 156 142 190 221 9.4 8.0 7.1 9.4 10.9

San Diego-Carlsbad-San Marcos, CA 133 202 273 292 211 4.5 6.9 9.2 9.7 7.0

San Francisco-Oakland-Fremont, CA 165 156 263 277 239 4.0 3.7 6.3 6.5 5.6

San Jose-Sunnyvale-Santa Clara, CA 56 22 76 84 58 3.2 1.2 4.2 4.6 3.2

Seattle-Tacoma-Bellevue, WA 100 122 99 115 84 3.1 3.7 3.0 3.4 2.5

St. Louis, MO-IL 86 89 82 129 120 3.1 3.2 2.9 4.6 4.3

Tampa-St. Petersburg-Clearwater, FL 139 140 119 212 223 5.2 5.2 4.4 7.8 8.2

Virginia Beach-Norfolk-Newport News, VA-NC 105 85 89 80 55 6.4 5.2 5.4 4.8 3.3

Washington-Arlington-Alexandria, DC-VA-MD-WV 453 496 514 425 362 8.7 9.4 9.7 7.9 6.8

U.S. MSAs TOTAL 12,137 13,585 13,990 15,069 12,977 7.6 8.4 8.6 9.2 7.9

* 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.
130 Syphilis Tables STD Surveillance 2009

Table 39. Congenital Syphilis—Reported Cases and Rates in Infants by Year of Birth, by 

State, Ranked by Rates, United States, 2009

Rank* State† Cases Rates per 100,000 Live Births

1 Maryland 31 40.0

2 Texas 126 31.5

3 Arizona 28 27.3

4 Arkansas 10 24.4

5 Alabama 13 20.6

6 Mississippi 8 17.4

7 Louisiana 11 17.4

8 Tennessee 13 15.4

9 North Dakota 1 11.6

10 California 61 10.8

U.S. TOTAL‡ 427 10.0

11 Georgia 14 9.4

12 Florida 21 8.9

13 Illinois 16 8.9

14 Delaware 1 8.3

15 Rhode Island 1 8.1

16 North Carolina 10 7.8

17 Nevada 3 7.5

18 Missouri 6 7.4

19 Kansas 3 7.3

20 New Jersey 7 6.1

21 New York 15 6.0

22 Hawaii 1 5.3

23 Connecticut 2 4.8

24 Ohio 7 4.6

25 Idaho 1 4.1

26 Oklahoma 2 3.7

27 Kentucky 2 3.4

28 Michigan 4 3.1

29 Pennsylvania 4 2.7

30 Virginia 2 1.9

31 Minnesota 1 1.4

32 Washington 1 1.2

33 Indiana 1 1.1

YEAR 2010 TARGET 1.0

Alaska 0 0.0

Colorado 0 0.0

Iowa 0 0.0

Maine 0 0.0

Massachusetts 0 0.0

Montana 0 0.0

Nebraska 0 0.0

New Hampshire 0 0.0

New Mexico 0 0.0

Oregon 0 0.0

South Carolina 0 0.0

South Dakota 0 0.0

Utah 0 0.0

Vermont 0 0.0

West Virginia 0 0.0

Wisconsin 0 0.0

Wyoming 0 0.0

* States were ranked in descending order by rate, number of cases, and alphabetically. States with no cases were not ranked.

† Mother’s state of residence was used to assign case.

‡ Total includes cases reported by the District of Columbia, with 0 cases and a rate of 0.0, but excludes outlying areas (Guam with 0 cases and rate 

of 0.0, Puerto Rico with 5 cases and rate of 10.3, and Virgin Islands with 0 cases and rate of 0.0).
STD Surveillance 2009 Syphilis Tables 131

Table 40. 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, 2005–2009

State/Area*

Cases Rates per 100,000 Live Births

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Alabama 5 9 9 12 13 8.3 14.2 14.2 19.0 20.6

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 28 16 30 30 28 29.1 15.6 29.3 29.3 27.3

Arkansas 7 10 12 9 10 17.9 24.4 29.3 22.0 24.4

California 75 69 87 64 61 13.7 12.3 15.5 11.4 10.8

Colorado 1 2 2 0 0 1.5 2.8 2.8 0.0 0.0

Connecticut 1 0 2 2 2 2.4 0.0 4.8 4.8 4.8

Delaware 0 0 0 1 1 0.0 0.0 0.0 8.3 8.3

District of Columbia 0 1 1 0 0 0.0 11.7 11.7 0.0 0.0

Florida 16 21 20 17 21 7.1 8.9 8.4 7.2 8.9

Georgia 1 9 9 11 14 0.7 6.1 6.1 7.4 9.4

Hawaii 0 0 0 0 1 0.0 0.0 0.0 0.0 5.3

Idaho 0 0 0 0 1 0.0 0.0 0.0 0.0 4.1

Illinois 23 15 10 20 16 12.8 8.3 5.5 11.1 8.9

Indiana 2 0 2 0 1 2.3 0.0 2.3 0.0 1.1

Iowa 0 0 1 0 0 0.0 0.0 2.5 0.0 0.0

Kansas 0 1 0 0 3 0.0 2.4 0.0 0.0 7.3

Kentucky 0 1 0 1 2 0.0 1.7 0.0 1.7 3.4

Louisiana 13 16 37 23 11 21.3 25.2 58.4 36.3 17.4

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 16 19 24 23 31 21.3 24.5 31.0 29.7 40.0

Massachusetts 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Michigan 17 13 15 10 4 13.3 10.2 11.8 7.8 3.1

Minnesota 3 1 0 0 1 4.2 1.4 0.0 0.0 1.4

Mississippi 0 0 1 9 8 0.0 0.0 2.2 19.5 17.4

Missouri 3 3 1 2 6 3.8 3.7 1.2 2.5 7.4

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nevada 1 16 7 9 3 2.7 40.0 17.5 22.5 7.5

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 16 15 11 4 7 14.1 13.0 9.6 3.5 6.1

New Mexico 6 7 6 4 0 20.8 23.4 20.0 13.4 0.0

New York 10 24 18 23 15 4.1 9.6 7.2 9.2 6.0

North Carolina 11 7 7 11 10 8.9 5.5 5.5 8.6 7.8

North Dakota 0 0 0 0 1 0.0 0.0 0.0 0.0 11.6

Ohio 2 0 1 3 7 1.3 0.0 0.7 2.0 4.6

Oklahoma 1 2 3 3 2 1.9 3.7 5.6 5.6 3.7

Oregon 0 0 2 0 0 0.0 0.0 4.1 0.0 0.0

Pennsylvania 1 3 8 8 4 0.7 2.0 5.4 5.4 2.7

Rhode Island 0 0 0 0 1 0.0 0.0 0.0 0.0 8.1

South Carolina 4 2 1 2 0 6.9 3.2 1.6 3.2 0.0

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 4 6 4 11 13 4.9 7.1 4.7 13.0 15.4

Texas 67 79 99 127 126 17.4 19.8 24.8 31.8 31.5

Utah 0 2 0 0 0 0.0 3.7 0.0 0.0 0.0

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 3 3 1 4 2 2.9 2.8 0.9 3.7 1.9

Washington 0 0 2 0 1 0.0 0.0 2.3 0.0 1.2

West Virginia 0 0 1 1 0 0.0 0.0 4.8 4.8 0.0

Wisconsin 2 0 1 1 0 2.8 0.0 1.4 1.4 0.0

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 339 372 435 445 427 8.2 8.7 10.2 10.4 10.0

Northeast 28 42 39 37 29 4.2 6.2 5.7 5.4 4.3

Midwest 52 33 31 36 39 5.9 3.7 3.4 4.0 4.3

South 148 185 229 265 264 9.6 11.5 14.2 16.4 16.4

West 111 112 136 107 95 10.8 10.5 12.7 10.0 8.9

Guam 1 0 2 0 0 31.4 0.0 59.0 0.0 0.0

Puerto Rico 13 15 10 8 5 25.7 30.9 20.6 16.5 10.3

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 14 15 12 8 5 25.3 27.9 22.4 14.9 9.3

TOTAL 353 387 447 453 432 8.4 9.0 10.3 10.5 10.0

* Mother’s state of residence was used to assign case.
132 Syphilis Tables STD Surveillance 2009

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

Birth by Race/Ethnicity of Mother, United States, 2005–2009

Year of 

Birth Race/Ethnicity Cases Rates per 100,000 Live Births 2005

Whites, Non-Hispanic 31 1.3

Blacks, Non-Hispanic 156 26.6

Hispanics 124 12.6

Asians/Pacific Islanders 15 6.8

American Indians/Alaska Natives 5 12.2

Other 2 NA

Unknown 6 NA

TOTAL 339 8.2

2006

Whites, Non-Hispanic 39 1.7

Blacks, Non-Hispanic 151 24.3

Hispanics 151 14.5

Asians/Pacific Islanders 10 4.3

American Indians/Alaska Natives 5 11.7

Other 5 NA

Unknown 11 NA

TOTAL 372 8.7

2007

Whites, Non-Hispanic 53 2.3

Blacks, Non-Hispanic 192 30.9

Hispanics 144 13.9

Asians/Pacific Islanders 20 8.6

American Indians/Alaska Natives 8 18.7

Other 4 NA

Unknown 14 NA

TOTAL 435 10.2

2008

Whites, Non-Hispanic 67 2.9

Blacks, Non-Hispanic 225 36.2

Hispanics 135 13.0

Asians/Pacific Islanders 7 3.0

American Indians/Alaska Natives 6 14.0

Other 1 NA

Unknown 4 NA

TOTAL 445 10.4

2009

Whites, Non-Hispanic 64 2.7

Blacks, Non-Hispanic 217 34.9

Hispanics 125 12.0

Asians/Pacific Islanders 11 4.7

American Indians/Alaska Natives 5 11.7

Other 2 NA

Unknown 3 NA

TOTAL 427 10.0

NA = Not applicable.
STD Surveillance 2009 Chancroid Table 133

Table 42. Chancroid—Reported Cases and Rates by State/Area in Alphabetical Order, United 

States and Outlying Areas, 2005–2009

State/Area

Cases Rates per 100,000 Population

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

Alabama 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 1 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arkansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

California 1 0 1 2 1 0.0 0.0 0.0 0.0 0.0

Colorado 0 0 0 2 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 1 1 3 0 1 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 0 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 4 1 4 0 0 0.1 0.0 0.1 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 0 0.0 0.0 0.0 0.0 0.0

Massachusetts 1 0 1 4 3 0.0 0.0 0.0 0.1 0.0

Michigan 0 1 0 0 0 0.0 0.0 0.0 0.0 0.0

Minnesota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Mississippi 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Missouri 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Montana 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nebraska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Nevada 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 1 5 5 2 0 0.0 0.0 0.0 0.0 0.0

North Carolina 5 5 2 4 6 0.1 0.1 0.0 0.0 0.1

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 1 0 0 1 0 0.0 0.0 0.0 0.0 0.0

Oklahoma 0 0 0 0 0 0.0 0.0 0.0 0.0 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 0 0 0 1 1 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 0 0 0 0.0 0.0 0.0 0.0 0.0

Texas 1 5 5 8 8 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 0 0 0 1 0 0.0 0.0 0.0 0.0 0.0

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wisconsin 0 0 2 0 6 0.0 0.0 0.0 0.0 0.1

Wyoming 1 0 0 0 0 0.2 0.0 0.0 0.0 0.0

U.S. TOTAL 17 19 23 25 28 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 3 0 0 0 0 0.1 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 3 0 0 0 0 0.1 0.0 0.0 0.0 0.0

TOTAL 20 19 23 25 28 0.0 0.0 0.0 0.0 0.0
134 Selected STDs Table STD Surveillance 2009

Table 43. Selected STDs and Complications—Initial Visits To Physicians’ Offices, National 

Disease and Therapeutic Index, United States, 1966–2009

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

* 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 range from 20% to 

30%; 300,000–600,000 range from 16% to 20%; 600,000–1,000,000 range from 13% to 16%; and 1,000,000–5,000,000 range 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 2009 Appendix: Interpreting STD Surveillance Data 135

Interpreting STD Surveillance Data

Sexually Transmitted Disease Surveillance 2009 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 of gonococcal antimicrobial resistance, and 

national health care services surveys.

Nationally Notifiable STD Surveillance

Nationally notifiable STD surveillance data are collected 

and compiled from reports sent by the STD control 

programs and health departments in 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 case-specific hard 

copy form was first used in 1983 and continues 

to be used to report detailed case-specific data for 

congenital syphilis in some areas.
136 Appendix: Interpreting STD Surveillance Data STD Surveillance 2009

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., 

case-specific) STD data through NETSS (42 reporting 

areas submit congenital syphilis surveillance data 

through NETSS). Puerto Rico converted to electronic 

reporting in 2006. Guam and the Virgin Islands 

continue to report STD data through summary hard 

copy forms.

Jurisdictions differ in their ability to resolve differences 

in total cases derived from summary hard copy 

monthly, quarterly, and annual reports, as well as 

from electronically submitted line-listed data. Thus, 

depending on the database used, discrepancies may 

exist in the total number of cases reported in the figures 

and tables in earlier STD surveillance reports. In most 

instances, these discrepancies are less than 5% of total 

reported cases and have minimal effect on national case 

totals and rates. However, for a specific jurisdiction, the 

discrepancies may be larger.

Surveillance data and updates sent to CDC through 

NETSS and on hard copy forms through June 9, 2010, 

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

2000–2009 Rates and Population

CDC’s National Center for Health Statistics (NCHS) 

released bridged-race population counts for the 2000–

2008 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.

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 2008–2009 rates for outlying areas 

were calculated by using the 2008 population estimates.

Because of the use of the updated population data, rates 

for 2000–2008 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

For the United States, 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.

1941–2009 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 1941–2009. 

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 2009, live births are used as 

the denominator for congenital syphilis, and case counts 
STD Surveillance 2009 Appendix: Interpreting STD Surveillance Data 137

are no longer limited to those diagnosed within the 

first year of life. Congenital syphilis morbidity (i.e., case 

reports) is assigned by year of birth. Rates of congenital 

syphilis for 1963 through 1988 were calculated by using 

published live birth data.3

 Congenital syphilis rates for 

1989 through 2005 were calculated by using live birth 

data that are based on information coded by the states 

and provided to the NCHS through the Vital Statistics 

Cooperative Program. Rates for 2006 through 2009 

were calculated by using live birth data for 2006.

Reporting Practices

Although most state and local STD programs generally 

adhere to the national notifiable STD case definitions 

collaboratively developed by the Council of State and 

Territorial Epidemiologists and CDC, 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. In many state and local STD jurisdictions, 

the reporting from publicly supported institutions (e.g., 

STD clinics) has been more complete than from other 

sources (e.g., private practitioners). Thus, trends may not 

be representative of all segments of the population.

Reporting of Surveillance Data by 

Metropolitan Statistical Area

Sexually Transmitted Disease Surveillance 2009 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.

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).

When the percentage of unknown, missing, or invalid 

data for age group, race/ethnicity, and sex exceeds 50% 

for any state, the state’s incidence and population data 

are excluded from the tables that present data stratified 

by one or more of these variables. For the states for 

which 50% or more of their data are valid for age group, 
138 Appendix: Interpreting STD Surveillance Data STD Surveillance 2009

race/ethnicity, and sex, the values for unknown, missing, 

or invalid data are redistributed on the basis of the state’s 

distribution of known age group, race/ethnicity, and 

sex data.

As a result, incidence and rate data that are stratified by 

one or more of these variables may not accurately reflect 

total national incidence or rates.

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 1984–2009 

are presented as STD clinic or non-STD clinic only 

(Table A2).

Definition of HHS Regions

The 10 regions of the U.S. Department of Health 

and Human Services (HHS) include the following 

jurisdictions: Region I = Connecticut, Maine, 

Massachusetts, New Hampshire, Rhode Island, and 

Vermont; Region II = New Jersey, New York, Puerto 

Rico, and U.S. Virgin Islands; Region III = Delaware, 

District of Columbia, Maryland, Pennsylvania, Virginia, 

and West Virginia; Region IV = Alabama, Florida, 

Georgia, Kentucky, Mississippi, North Carolina, South 

Carolina, and Tennessee; Region V= Illinois, Indiana, 

Michigan, Minnesota, Ohio, and Wisconsin; Region 

VI = Arkansas, Louisiana, New Mexico, Oklahoma, 

and Texas; Region VII = Iowa, Kansas, Missouri, and 

Nebraska; Region VIII = Colorado, Montana, North 

Dakota, South Dakota, Utah, and Wyoming; Region IX 

= Arizona, California, Guam, Hawaii, and Nevada; and 

Region X = Alaska, Idaho, Oregon, and Washington.

Chlamydia Morbidity

Trends in chlamydia morbidity reporting from many 

state and local jurisdictions are more reflective of changes 

in diagnostic, screening, and reporting practices than 

of actual trends in disease incidence. In particular, 

morbidity trends are likely to be influenced by changes 

in test technology as laboratories expand their use of 

more sensitive tests (e.g., nucleic acid amplification 

tests). As more jurisdictions develop chlamydia 

prevention and control programs, including improved 

surveillance systems to monitor trends, the data should 

improve and become more representative of true trends 

in disease.

Syphilis Morbidity Reporting 

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.5 In addition, many 
STD Surveillance 2009 Appendix: Interpreting STD Surveillance Data 139

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 October 

2003). Since 1995, the data collected on this form have 

been used for reporting congenital syphilis cases and 

associated rates. This form is used to collect individual 

case information, which allows more thorough analysis 

of case characteristics. For the purpose of analyzing race/

ethnicity, cases are classified by the race/ethnicity of the 

mother. Congenital syphilis cases were reported by state 

and city of residence of the mother during 1995–2009.

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 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 Prevalence 

Monitoring

Chlamydia and gonorrhea test positivity or prevalence 

were calculated for women visiting family planning 

clinics and prenatal clinics, men and women entering 

NJTP, and men and women entering corrections 

facilities. Except for the screening data from NJTP, these 

data sources may include more than one test from the 

same person if that person was tested more than once 

during a year.

To increase the stability of the annual prevalence 

estimates from NJTP, 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. 

To ensure that the state-specific gonorrhea screening 

data presented here are representative of all students 

entering training centers, 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.

Various laboratory test methods were used for all of these 

data sources. No adjustments for laboratory test type 

and sensitivity were made to any figures that present test 

positivity or prevalence data. 

Prevalence data for region- and state-specific figures 

were published with permission from the Infertility 

Prevention Project (IPP), selected state STD prevention 

programs, and NJTP.

STD Surveillance Network

In 2005, CDC established the STD Surveillance 

Network (SSuN) as a dynamic STD surveillance 

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 

participate in SSuN: 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.
140 Appendix: Interpreting STD Surveillance Data STD Surveillance 2009

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 (SeattleKing County Clinic); Denver, CO (Denver Metro 

Health Clinic); Chicago, IL (6 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 (10 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 

in the 3 months 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 8 of the 12 sites). Men who have sex 

with women (MSW) were defined as men who reported 

having sex with women only within the 3 months before 

STD testing or who did not report the sex of their sex 

partner, but reported that they considered themselves 

straight/heterosexual (asked at 8 of the 12 sites). 

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 2009, the antimicrobial agents tested by GISP 

were ceftriaxone, cefixime, cefpodoxime, azithromycin, 

spectinomycin, ciprofloxacin, penicillin, and tetracycline. 

The antimicrobial susceptibility criteria used in GISP for 

2009 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).6

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.

* 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 2009 Appendix: Interpreting STD Surveillance Data 141

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 2009). NDTI is a probability sample 

survey of private physicians’ clinical management 

practices. For more information on this database, contact 

IMS Health, 660 W. Germantown Pike, Plymouth 

Meeting, PA 19462; Telephone: (800) 523-5333.

National Hospital Discharge Survey

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 2007). 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 

Graves EJ. 1988 summary: National Hospital Discharge 

Survey. Adv Data. 1990;185:1-11.

The estimates generated by using NHDS data are 

based on statistical surveys and therefore have sampling 

variability associated with the estimates.

Healthy People 2010 Objectives

Healthy People 2010 (HP2010) is a set of health 

objectives for the United States to achieve over the first 

decade of the new century.7 It is used by people, states, 

communities, professional organizations, and others 

to help develop programs to improve health. HP2010 

builds on initiatives pursued over the past 2 decades. 

The 1979 Surgeon General’s Report, Healthy People, and 

Healthy People 2000: National Health Promotion and 

Disease Prevention Objectives established national health 

objectives and served as the basis for the development 

of state and community plans. Like its predecessors, 

HP2010 was developed through a broad consultation 

process, built on the best scientific knowledge, and 

designed to measure programs over time.

HP2010 is organized into 28 focus areas, each with 

objectives and measures designed to drive action that 

will support two overarching goals: (1) increasing the 

quality and years of healthy life and (2) eliminating 

health disparities.

Focus area 25, Sexually Transmitted Diseases, contains 

objectives and measures related to STDs. Baselines, 

HP2010 targets, and annual progress toward the targets 

are reported in Table A3. The year 2010 targets for the 

diseases addressed in this report are as follows: P&S 

syphilis, 0.2 case per 100,000 population; congenital 

syphilis, 1.0 case per 100,000 live births; and gonorrhea, 

19.0 cases per 100,000 population. 

An additional target is to reduce the Chlamydia 

trachomatis test positivity to 3% among females aged 

15–24 years who visit family planning and STD clinics 

and among males aged 15–24 years who visit STD 

clinics.

HP2010 targets were based on a national baseline. 

For most of the objectives, one target was set for all 

population groups to reach by the year 2010, and this 

target was set as a “better than the best” measure for any 

racial or ethnic group at the baseline. 

For example, at the 1997 baseline for objective 25-2 

(gonorrhea rate per 100,000 population), Asians/

Pacific Islanders had the “best” rate of 20 cases per 

100,000 population. Using the “better than the best” 

methodology resulted in the target for that objective 

being set at 19 per 100,000 population, even though the 

overall rate for the United States in 1997 was 123 cases 

per 100,000 population.
142 Appendix: Interpreting STD Surveillance Data STD Surveillance 2009

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 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.

6 Clinical and Laboratory Standards Institute. Performance 

standards for antimicrobial susceptibility testing; twentieth 

informational supplement. M100-S20, 30(1). Wayne (PA): 

Clinical and Laboratory Standards Institute; 2010.

7 U.S. Department of Health and Human Services. Healthy People 

2010. 2nd ed. With understanding and improving health and 

objectives for improving health. 2 vols. Washington, DC: U.S. 

Government Printing Office; 2000.

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 

syphilis. Each of these goals has specific measures of 

progress, which are outlined in Table A4.
STD Surveillance 2009 Appendix: Percentage Unknown 143

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

Variables by State and by Nationally Notifiable STD, 2009

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 1.9 0.2 0.0 3.6 29.4 0.2 0.1 32.5 0.2 0.0

Alaska* 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.3 0.0 0.0

Arizona 0.0 0.0 0.4 47.6 17.9 0.0 0.0 22.2 0.0 0.0

Arkansas 0.4 0.0 0.0 18.9 7.5 0.2 0.0 9.3 0.1 0.0

California 2.8 0.1 0.0 7.3 29.2 0.3 0.4 32.0 0.3 0.3

Colorado 6.7 0.0 0.0 7.6 40.0 0.0 0.1 59.5 0.1 0.0

Connecticut 0.0 0.0 0.0 1.5 25.8 0.4 0.0 34.8 0.5 0.0

Delaware 0.0 0.0 0.0 92.6 3.0 0.0 0.0 3.7 0.0 0.0

District of Columbia 3.7 0.0 0.0 14.1 17.0 0.0 0.0 27.1 0.1 0.1

Florida 4.0 0.0 0.0 2.6 11.2 0.0 0.2 13.8 0.1 0.2

Georgia 0.4 0.0 0.0 20.9 37.0 0.5 0.5 43.9 0.6 0.6

Hawaii 3.0 0.0 0.0 6.1 39.0 0.0 0.0 51.2 0.1 0.0

Idaho* 0.0 0.0 0.0 0.0 41.8 1.8 0.9 33.2 0.1 0.6

Illinois 3.2 0.0 0.0 26.0 11.2 0.0 0.0 15.0 0.0 0.0

Indiana 5.1 0.0 0.0 3.8 14.3 0.3 0.3 18.2 0.5 0.4

Iowa 0.0 0.0 0.0 0.0 8.1 0.0 0.0 11.4 0.1 0.0

Kansas 0.0 0.0 0.0 3.1 19.8 0.1 0.0 35.2 0.1 0.0

Kentucky 0.0 0.0 0.0 6.5 25.4 0.1 0.1 31.2 0.2 0.2

Louisiana 0.5 0.0 0.0 100.0 16.9 0.3 0.2 22.2 0.3 0.2

Maine* 0.0 0.0 0.0 0.0 5.6 1.4 0.0 21.7 0.3 0.0

Maryland 2.2 0.0 0.0 9.9 25.4 0.2 0.3 34.1 0.4 0.3

Massachusetts 4.6 0.0 0.0 23.5 29.9 0.5 0.2 38.9 0.6 0.2

Michigan 1.3 0.0 0.0 10.9 34.6 0.2 1.1 39.3 0.2 0.4

Minnesota 0.0 0.0 0.0 2.8 13.2 0.0 0.0 16.8 0.0 0.0

Mississippi 0.8 0.0 0.0 4.2 17.6 0.1 0.0 21.3 0.1 0.0

Missouri 0.0 0.0 0.0 4.0 13.7 0.0 0.0 22.5 0.0 0.0

Montana* 25.0 0.0 0.0 0.0 20.0 0.0 0.0 13.7 0.2 0.1

Nebraska* 60.0 0.0 0.0 40.0 23.3 0.1 0.1 31.9 0.3 0.2

Nevada 13.2 0.0 0.0 1.1 36.3 0.1 0.0 42.5 0.1 0.0

New Hampshire 0.0 0.0 0.0 21.4 15.0 0.0 0.0 12.1 0.0 0.0

New Jersey 1.4 0.0 0.0 8.0 25.6 0.8 0.0 42.0 0.7 0.1

New Mexico 19.7 0.0 0.0 8.2 18.6 0.2 0.0 29.1 0.4 0.1

New York 0.4 0.0 0.0 14.2 32.5 0.3 0.0 43.2 0.4 0.0

North Carolina 0.3 0.0 0.0 100.0 9.0 0.3 0.7 13.7 0.2 0.6

North Dakota* 25.0 0.0 0.0 0.0 19.9 0.7 0.7 34.0 0.2 0.3

Ohio 0.3 0.0 0.0 8.6 37.2 1.6 1.0 43.3 1.5 1.1

Oklahoma 1.0 0.0 0.0 5.2 9.0 0.1 0.1 13.2 0.1 0.3

Oregon 3.5 0.0 0.0 100.0 9.0 0.0 0.0 19.5 0.0 0.0

Pennsylvania 2.3 0.0 0.0 11.4 26.7 0.1 0.0 28.0 0.1 0.1

Rhode Island 10.0 0.0 0.0 15.0 19.3 0.0 0.0 21.7 0.0 0.0

South Carolina 0.0 0.0 0.0 2.4 31.6 0.0 0.3 37.0 0.1 0.4

South Dakota* 0.0 0.0 0.0 0.0 6.7 0.3 0.3 9.7 0.2 0.4

Tennessee 0.2 0.0 0.0 1.5 2.2 0.0 0.0 2.5 0.0 0.0

Texas 0.4 0.0 0.0 2.7 4.8 0.1 0.0 6.0 0.1 0.1

Utah 0.0 0.0 0.0 19.4 3.5 0.0 0.0 1.6 0.0 0.0

Vermont* 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5.3 0.0 0.0

Virginia 0.0 0.0 0.0 5.0 17.1 0.1 0.1 29.4 0.2 0.2

Washington 19.4 0.0 0.0 3.6 20.4 0.0 0.1 22.2 0.0 0.0

West Virginia* 0.0 0.0 0.0 25.0 12.6 0.0 0.0 16.3 0.0 0.0

Wisconsin 9.1 0.0 0.0 2.3 0.1 0.4 0.5 0.1 0.4 0.6

Wyoming* 66.7 0.0 0.0 66.7 14.9 0.0 0.0 24.6 0.1 0.0

U.S. TOTAL 2.0 0.0 0.0 19.1 20.1 0.3 0.3 26.0 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.
144 Appendix: STD Reporting Source STD Surveillance 2009

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2009

Disease

Non-STD Clinic STD Clinic Total

Male Female Total* Male Female Total* Male† Female† Total‡

Chlamydia 200,168 730,657 932,687 99,005 94,668 193,833 328,783 912,718 1,244,180

Gonorrhea 81,292 120,284 202,043 43,834 24,159 68,028 137,819 162,568 301,174

Primary syphilis 1,891 187 2,078 1,309 162 1,472 3,265 355 3,621

Secondary syphilis 5,782 1,218 7,000 2,578 635 3,213 8,499 1,877 10,376

Early latent syphilis 6,553 2,187 8,742 3,052 1,055 4,107 9,773 3,291 13,066

Late and late latent syphilis§ 8,876 4,619 13,503 2,398 1,174 3,573 11,446 5,883 17,338

Chancroid 8 11 20 1 1 2 10 17 28

* 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.
STD Surveillance 2009 Appendix: Healthy People 2010 145

Table A3. Healthy People 2010 (HP 2010) Sexually Transmitted Diseases Objective Status

HP2010 Objectives

Baseline 

Year Baseline 2005 2006 2007 2008 2009

HP 2010 

Target

25–1 Reduce the proportion of adolescents and young 

adults with Chlamydia trachomatis infections

a. Females aged 15 to 24 years attending family 

planning clinics* 1997 5.0% 6.9% 7.1% 7.5% 7.8% 8.1% 3.0%

b. Females aged 15 to 24 years attending STD clinics* 1997 12.2% 15.4% 14.8% 15.3% 16.3% 16.4% 3.0%

c. Males aged 15 to 24 years attending STD clinics* 1997 15.7% 20.5% 20.8% 22.4% 23.7% 24.0% 3.0%

d. Females aged 24 years or less enrolled in National 

Job Training Program 2002 10.1% 9.2% 13.1% 13.2% 12.8% 11.3% 6.8%

25–2 Reduce the incidence of gonorrhea (new cases per 

100,000 population)

a. Reduce gonorrhea incidence per 100,000 

population 1997 123.0 114.6 119.7 118.0 111.6 99.1 19.0

b. Females aged 15 to 44 years 2002 279.0 275.0 289.0 291.0 285.0 255.0 42.0

25–3 Eliminate sustained domestic transmission of 

primary and secondary syphilis (cases per 100,000 

population)

1997 3.2 2.9 3.3 3.8 4.5 4.6 0.2

25–4 Reduce the proportion of adults aged 20 to 29 

years with genital herpes infection 1988–94 17.0% NA NA NA NA NA 14.0%

25–6 Reduce the proportion of females aged 15 to 44 

years who have ever required treatment for pelvic 

inflammatory disease (PID)

1995 8.0% NA NA NA NA NA 5.0%

25–7 Reduce the proportion of childless females 

with fertility problems who have had a sexually 

transmitted disease or who have required 

treatment for pelvic inflammatory disease (PID)

1995 27.0% NA NA NA NA NA 15.0%

25–9 Reduce congenital syphilis (cases per 100,000 live 

births) 1997 27.0 8.2 8.7 10.1 10.1 10.0 1.0

25–11 Increase the proportion of adolescents who 

abstain from sexual intercourse or use condoms if 

currently sexually active (grades 9 through 12)

a. Adolescents (grade 9) who never had sexual 

intercourse 1999 50.0% 53.0% NA 52.0% NA 54.0% 56.0%

b. Adolescents (grade 9) who had sexual intercourse 

but not in the past 3 months 1999 27.0% 27.0% NA 27.0% NA 26.0% 30.0%

c. Adolescents (grades 9 through 12) who used 

condoms at last intercourse 1999 58.0% 63.0% NA 62.0% NA 61.0% 65.0%

25–13 Increase the proportion of Tribal, state, and local 

sexually transmitted disease programs that 

routinely offer hepatitis B vaccines to all STD 

clients

1998 5.0% NA NA NA NA NA 90.0%

25–16 Increase the proportion of sexually active females 

aged 25 years and under who are screened 

annually for genital chlamydia infections

a. Females aged 25 years and under enrolled in 

commercial MCOs 2003 25% 35% 37% 38% 42% 43% 62%

b. Females aged 25 years and under enrolled in 

Medicaid MCOs 2003 41% 51% 52% 51% 55% 57% 62%

HP2010 Objective Data Source

25–1 a, b, c Regional Infertility Prevention Projects (IPP), STD Surveillance System (STDSS), NCHHSTP, CDC

25–1 d National Job Training Program, STD Surveillance System (STDSS), NCHHSTP, CDC

25–2 a, b STD Surveillance System (STDSS), NCHHSTP, CDC

25–3 STD Surveillance System (STDSS), NCHHSTP, CDC

25–4 National Health and Nutrition Examination Survey (NHANES), NCHS, CDC

25–6 National Survey of Family Growth (NSFG), NCHS, CDC

25–7 National Survey of Family Growth (NSFG), NCHS, CDC

25–9 STD Surveillance System, NCHHSTP, CDC, National Vital Statistics System- Natality (NVSS-N), NCHS, CDC

25–11 a, b, c Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC

25–13 Survey of STD Programs, National Coalition of STD Directors (NCSD); IHS

25–16 a, b Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)

* Overall chlamydia positivity.

NA = Not available; HP 2010 = Healthy People 2010; MCOs = managed care organizations.

NOTE: Healthy People 2010 developmental objectives are not addressed in this report.
146 Appendix: GPRA Goals    STD Surveillance

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

and Measures

GPRA Goals

Baseline

Actual

Performance

Long-Term 

Goal

2002 2008 2009 2010**

Goal 1: Reduction in PID (as measured by initial visits to physicians in 

women 15–44-years of age) 197,000 104,000 100,000 94,000

a. Prevalence of chlamydia in women <25 years at high-risk* 10.1% 12.8% 11.3% 12%

b. Prevalence of chlamydia in women <25 years in family planning clinics* 5.6% 7.4% 7.5% 7.9%

c. Incidence of gonorrhea/100, 000 population in women 15–44 years of age 278 285 255 288

Goal 2: Elimination of Syphilis (as measured by incidence of P&S 

Syphilis/100,000 population) 2.4 4.5 4.6 5.5

a. Incidence of P&S syphilis/100, 000 population, men 3.8 7.6 7.8 9.4

b. Incidence of P&S syphilis/100, 000 population, women 1.1 1.5 1.4 2.0

c. Incidence of congenital syphilis/100, 000 live births 10.2 10.1 10.0 16.2

d. Black:white rate ratio of P&S syphilis 8:1 8:1 9:1 9:1

GPRA Goals Data Source

1 National Disease and Therapeutic Index (IMS Health)

1–a National Job Training Program

1–b Regional Infertility Prevention Projects (IPP), STD Surveillance System (STDSS), NCHHSTP, CDC

1–c STD Surveillance System (STDSS), NCHHSTP, CDC

2 STD Surveillance System (STDSS), NCHHSTP, CDC

2–a STD Surveillance System (STDSS), NCHHSTP, CDC

2–b STD Surveillance System (STDSS), NCHHSTP, CDC

2–c STD Surveillance System (STDSS), NCHHSTP, CDC

2–d STD Surveillance System (STDSS), NCHHSTP, CDC

* Median state-specific chlamydia prevalence/positivity.

** Reflects 05/24/11 modification to Long-Term 2010 GPRA Goals since the November 2010 publication of the 2009 STD Surveillance Report.

GPRA = Government Performance and Results Act; PID = pelvic inflammatory disease; P&S = primary and secondary.
STD Surveillance 2009 Appendix: STD Surveillance Case Definitions 147

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.
148 Appendix: STD Surveillance Case Definitions STD Surveillance 2009

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
STD Surveillance 2009 Appendix: STD Surveillance Case Definitions 149

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
150 Appendix: STD Surveillance Case Definitions STD Surveillance 2009

Neurosyphilis

Note

Since neurosyphilis can occur at almost any stage of syphilis, between 1996 and 2005, it was classified and 

reported as one of several mutually exclusive stages of syphilis. In 2005, the Division of STD Prevention 

requested that STD control programs discontinue classifying and reporting neurosyphilis as a distinct stage of 

syphilis. Since 2005, if the patient has confirmed or 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.
STD Surveillance 2009 Appendix: STD Surveillance Case Definitions 151

Syphilitic Stillbirth

Clinical description

A fetal death that occurs after a 20-week gestation or in which the fetus weighs >500 g and the mother had 

untreated or inadequately treated* syphilis at delivery

Comment

For reporting purposes, syphilitic stillbirths should be reported as cases of congenital syphilis.

Syphilis, Congenital (Revised 9/96)

Clinical description

A condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, and 

only severe cases are clinically apparent at birth. An infant or child (aged <2 years) may have signs such as 

hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or 

edema (nephrotic syndrome and/or malnutrition). An older child may have stigmata (e.g., interstitial keratitis, 

nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, 

rhagades, or Clutton joints).

Laboratory criteria for diagnosis

•	 Demonstration of T. pallidum by darkfield microscopy, fluorescent antibody, or other specific stains in 

specimens from lesions, placenta, umbilical cord, or autopsy material

Case classification

Probable: a condition affecting an infant whose mother had untreated or inadequately treated* syphilis at 

delivery, regardless of signs in the infant, or an infant or child who has a reactive treponemal test for syphilis 

and any one of the following:

•	 Any evidence of congenital syphilis on physical examination

•	 Any evidence of congenital syphilis on radiographs of long bones

•	 A reactive cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL)

•	 An elevated CSF cell count or protein (without other cause)

•	 A reactive fluorescent treponemal antibody absorbed—19S-IgM antibody test or IgM enzyme-linked 

immunosorbent assay

Confirmed: a case that is laboratory confirmed

Comment

Congenital and acquired syphilis may be difficult to distinguish when a child is seropositive after infancy. Signs 

of congenital syphilis may not be obvious, and stigmata may not yet have developed. Abnormal values for 

CSF VDRL, cell count, and protein, as well as IgM antibodies, may be found in either congenital or acquired 

syphilis. Findings on radiographs of long bones may help because radiographic changes in the metaphysis 

and epiphysis are considered classic signs of congenitally acquired syphilis. The decision may ultimately be 

based on maternal history and clinical judgment. In a young child, the possibility of sexual abuse should 

be considered as a cause of acquired rather than congenital syphilis, depending on the clinical picture. For 

reporting purposes, congenital syphilis includes cases of congenitally acquired syphilis among infants and 

children as well as syphilitic stillbirths. 

* Inadequate treatment consists of any nonpenicillin therapy or penicillin administered <30 days before delivery.

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).
152 Appendix: STD Surveillance Case Definitions STD Surveillance 2009

PART 2. CASE DEFINITIONS1 FOR NON-NOTIFIABLE 

INFECTIOUS DISEASES

Genital Herpes (Herpes Simplex Virus) (Revised 9/96)

Clinical description

A condition characterized by visible, painful genital or anal lesions

Laboratory criteria for diagnosis

•	 Isolation of herpes simplex virus from cervix, urethra, or anogenital lesion, or

•	 Demonstration of virus by antigen detection technique in clinical specimens from cervix, urethra, or 

anogenital lesion, or

•	 Demonstration of multinucleated giant cells on a Tzanck smear of scrapings from an anogenital lesion

Case classification

Probable: a clinically compatible case (in which primary and secondary syphilis have been excluded by 

appropriate serologic tests and darkfield microscopy, when available) with either a diagnosis of genital herpes 

based on clinical presentation (without laboratory confirmation) or a history of one or more previous episodes 

of similar genital lesions

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Genital herpes should be reported only once per patient. The first diagnosis for a patient with no previous 

diagnosis should be reported.

Genital Warts (Revised 9/96)

Clinical description

An infection characterized by the presence of visible, exophytic (raised) growths on the internal or external 

genitalia, perineum, or perianal region

Laboratory criteria for diagnosis

•	 Histopathologic changes characteristic of human papillomavirus infection in specimens obtained by 

biopsy or exfoliative cytology or

•	 Demonstration of virus by antigen or nucleic acid detection in a lesion biopsy

Case classification

Probable: a clinically compatible case without histopathologic diagnosis and without microscopic or serologic 

evidence that the growth is the result of secondary syphilis

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Genital warts should be reported only once per patient. The first diagnosis for a patient with no previous 

diagnosis should be reported.
STD Surveillance 2009 Appendix: STD Surveillance Case Definitions 153

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
154 Appendix: STD Surveillance Case Definitions STD Surveillance 2009

Case classification

Confirmed: a clinically compatible case in a female who does not have either gonorrhea or trichomoniasis

Comment

Mucopurulent cervicitis (MPC) is a clinical diagnosis of exclusion. The syndrome may result from infection 

with any of several agents (see Chlamydia trachomatis, Genital Infections). If gonorrhea, trichomoniasis, and 

chlamydia are excluded, a clinically compatible illness should be classified as MPC. An illness in a female that 

meets the case definition of MPC and C. trachomatis infection should be classified as chlamydia.

Nongonococcal Urethritis (Revised 9/96)

Clinical description

Urethral inflammation that is not the result of infection with Neisseria gonorrhoeae. Urethral inflammation may 

be diagnosed by the presence of one of the following criteria:

•	 A visible abnormal urethral discharge, or

•	 A positive leukocyte esterase test from a male aged <60 years who does not have a history of kidney 

disease or bladder infection, prostate enlargement, urogenital anatomic anomaly, or recent urinary tract 

instrumentation, or

•	 Microscopic evidence of urethritis (≥5 white blood cells per high-power field) on a Gram stain of a 

urethral smear

Laboratory criteria for diagnosis

•	 No evidence of N. gonorrhoeae infection by culture, Gram stain, or antigen or nucleic acid detection

Case classification

Confirmed: a clinically compatible case in a male in whom gonorrhea is not found, either by culture, Gram 

stain, or antigen or nucleic acid detection

Comment

Nongonococcal urethritis (NGU) is a clinical diagnosis of exclusion. The syndrome may result from infection 

with any of several agents (see Chlamydia trachomatis, Genital Infection). If gonorrhea and chlamydia are 

excluded, a clinically compatible illness should be classified as NGU. An illness in a male that meets the case 

definition of NGU and C. trachomatis infection should be classified as chlamydia.

Pelvic Inflammatory Disease (Revised 9/96)

Clinical case definition

A clinical syndrome resulting from the ascending spread of microorganisms from the vagina and endocervix 

to the endometrium, fallopian tubes, and/or contiguous structures. In a female who has lower abdominal pain 

and who has not been diagnosed as having an established cause other than pelvic inflammatory disease (PID) 

(e.g., ectopic pregnancy, acute appendicitis, and functional pain), all the following clinical criteria must be 

present:

•	 Lower abdominal tenderness, and

•	 Tenderness with motion of the cervix, and

•	 Adnexal tenderness
STD Surveillance 2009 Appendix: STD Surveillance Case Definitions 155

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.

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).
156 Appendix: Contributors STD Surveillance 2009

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 August 9, 2010.

State/City/Outlying Area STD Project Directors STD Program Managers State Epidemiologists Laboratory Directors

Alabama Charles Woernle Anthony Merriweather Charles Woernle Sharon Massingale

Alaska Mollie Rosier Donna Cecere Joe McLaughlin Bernard Jilly

Arizona Judy Norton Roxanne Ereth Kenneth Komatsu Victor Waddell

Arkansas Kevin Detner Mark Barnes Nathaniel Smith Glen Baker

California Gail Bolan Romni Neiman Gilberto Chavez Paul Kimsey

Los Angeles Peter Kerndt Yolanda Cavalier (Acting) Gilberto Chavez Mary Beth Duke (Acting)

San Francisco Susan Philip Wendy Wolf Gilberto Chavez Sally Liska

Colorado Ralph Wilmoth Ralph Wilmoth Ken Gershman David Butcher

Connecticut Matthew Cartter Heidi Jenkins Matthew Cartter John Fontana

Delaware Catherine Mosley Catherine Mosley Paula Eggers (Acting) Jane Getchell

District of Columbia Shannon Hader Vacant John Davies-Cole Maurice Knuckles

Florida Karla Schmitt Karla Schmitt Richard Hopkins (Acting) Max Salfinger

Georgia Vacant Vacant Anilkamar Mangla Elizabeth Franko

Hawaii Peter Whiticar Venie Lee Sarah Park A. Christian Whelen

Idaho Kathy Cohen Annabeth Elliott Christine Hahn Christopher Ball

Illinois Charlie Rabins Ed Renier Craig Conover Tom Johnson

Chicago Will Wong John Paffel Craig Conover Susan Gerber

Indiana Larry Harris Clay Koher Pamela Pontones Judith Lovchik

Iowa Mary Jones Karen Thompson Patricia Quinlisk Christopher Atchison

Kansas Brenda Walker Derek Coppedge Charles Hunt Dennis Dobson

Kentucky Robert Brawley Chang Lee Kraig Humbaugh Stephanie Gibson

Louisiana Lisa Ann Longfellow Lisa Ann Longfellow Raoult Ratard Stephen Martin

Maine James Markiewicz Jennah Godo Stephen Sears Kenneth Pote

Maryland Barbara Conrad Glen Oltoff David Blythe Jack DeBoy

Baltimore Vacant Victoria Stovall David Blythe Jack DeBoy

Massachusetts Brenda Cole (Acting) Brenda Cole (Acting) Alfred DeMaria Linda Han (Acting)

Michigan Kristine Judd Kristine Judd Corrine Miller Frances Downes

Minnesota Christine Jones Peter Carr Ruth Lynfield Joanne Bartkus

Mississippi Craig Thompson Craig Thompson Paul Byers (Acting) Daphne Ware

Missouri Michael Herbert Michael Herbert Sarah Patrick Bill Whitmar

Montana Laurie Kops Lisa Underwood Steve Helgerson Anne Weber

Nebraska Phil Medina Phil Medina Thomas Safranek Steve Hinrichs

Nevada Richard Whitley Sandra Noffsinger Ishan Azzam L. Dee Brown

New Hampshire Denise Rondeau Drew Thomits Sharon Alroy-Preis Christine Bean

New Jersey Gary Ludwig Patricia Mason Christina Tan Dennis Flynn

New Mexico Daniel Burke Carmelita Garcia C. Mack Sewell David Mills

New York F. Bruce Coles Dennis Murphy Perry Smith Lawrence Sturman

New York City Susan Blank Vacant Perry Smith Sara Beatrice

North Carolina Evelyn Foust Evelyn Foust Megan Davies Leslie Wolf

North Dakota Vacant Julie Wagendorf Kirby Kruger Myra Kosse

Ohio Bill Tiedemann Jen Keagy Forrest Smith Rosemarie Gearhart

Oklahoma Jan Fox Kristen Eberly Kristy Bradley Garry McKee

Oregon Vada Latin Doug Harger Katrina Hedberg Michael Skeels

Pennsylvania Weston Ruhrig Steve Kowalewski Veronica Urdaneta S.I. Shahied

Philadelphia Caroline Johnson Melinda Salmon Veronica Urdaneta Kerry Buchs

Rhode Island Utpala Bandy Michael Gosciminski Utpala Bandy Ewa King

South Carolina Wayne Duffas Bernard Gillard (Acting) James Gibson Arthur Wozniak

South Dakota Laurie Gill David Morgan Lon Kightlinger Michael Smith

Tennessee Jeanece Seals Jane Russell Tim Jones David Smalley

Texas Ann Robbins Jim Lee Adolfo Valadez Susan Neill

Utah Emily Holmes Lynn Meinor Robert Rolfs Patrick Luedtke

Vermont Daniel Daltry Daniel Daltry Patsy Kelso Mary Celotti

Virginia Kathryn Hafford Theresa Henry Keri Hall James Pearson

Washington Mark Aubin Mark Aubin Juliet Van Eenwyk Romesh Gautom

West Virginia Caroline Williams Caroline Williams Loretta Haddy Andrea Labik

Wisconsin Sandra Breitborde Anthony Wade Jeffrey Davis Charles Brokopp

Wyoming Brownen Anderson Canyon Hardesty Tracy Murphy Richard Harris

American Samoa Laumoli Salamo Fara Utu Sharmain Edwards Utoofili Mago

Federated States of Micronesia Vita Skilling Maylean Ekiek Vita Skilling

Government of the Marshall Islands Justina Langidrik Zachraias Zachraias Paul Lalita

Northern Marianas (CNMI) Joseph Villagomz John Moreno James Hosfschneider Kevin Villagomez

Guam Josie O’Mallan Bernadette Schumann Lourdes Duguies Josie O’Mallan

Puerto Rico Greduvel Duran-Guzman Trinidad Garcia John Rullan Maritza Muniz

Republic of Palau Victor Yano Johana Ngiruchelbad Julie Erb-Alvarez Francis Permeteet

Virgin Islands Darlene Carty Gritell Martinez Eugene Tull Joseph Mark