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

Division of STD Prevention

Sexually 

Transmitted 

Disease 

Surveillance 

2010

Division of STD Prevention 

November 2011

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 2010

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 2010 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 2010. Atlanta: U.S. 

Department of Health and Human Services; 2011.

Web Site

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

Selected STD Surveillance and Prevention References and Web Sites

STD Surveillance Reports 1993–2010

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/GL-2001.htm

Recommendations for Public Health Surveillance of Syphilis in the United States

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

Behavioral Surveillance

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

National Survey of Family Growth

Chandra A, Mosher WD, Copen C, Sionean C. Sexual behavior, sexual attraction, and sexual idenity in the

United States: Data from the 2006-2008 National Survey of Family Growth. National health statistics reports;

no36. Hyattsville, MD: National Center for Health Statistics. 2011 

http://www.cdc.gov/nchs/data/nhsr/nhsr036.pdf

STD Surveillance 2010 v

Foreword

“STDs are hidden epidemics of enormous health and 

economic consequence in the United States. They are 

hidden because many Americans are reluctant to address 

sexual health issues in an open way and because of 

the biologic and social characteristics of these diseases. 

All Americans have an interest in STD prevention 

because all communities are impacted by STDs and 

all individuals directly or indirectly pay for the costs of 

these diseases. 

STDs are public health problems that lack easy 

solutions because they are rooted in human behavior 

and fundamental societal problems. Indeed, there are 

many obstacles to effective prevention efforts. The first 

hurdle will be to confront the reluctance of American 

society to openly confront issues surrounding sexuality 

and STDs. Despite the barriers, there are existing 

individual- and community-based interventions that are 

effective and can be implemented immediately. That is 

why a multifaceted approach is necessary to both the 

individual and community levels.

To successfully prevent STDs, many stakeholders 

need to redefine their mission, refocus their efforts, 

modify how they deliver services, and accept new 

responsibilities. In this process, strong leadership, 

innovative thinking, partnerships, and adequate 

resources will be required. The additional investment 

required to effectively prevent STDs may be 

considerable, but it is negligible when compared with 

the likely return on the investment. 

The process of preventing STDs must be a collaborative 

one. No one agency, organization, or sector can 

effectively do it alone; all members of the community 

must do their part. A successful national initiative to 

confront and prevent STDs requires widespread public 

awareness and participation and bold national leadership 

from the highest levels.”1

1 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 2010

Preface

Sexually Transmitted Disease Surveillance 2010 presents 

statistics and trends for sexually transmitted diseases 

(STDs) in the United States through 2010. 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. 

Prior to the publication of Sexually Transmitted Disease 

Surveillance 2010, when the percentage of unknown, 

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

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

and population data were excluded from the tables 

that presented data stratified by one or more of these 

variables. For the states for which 50% or more of their 

data were valid for age group, race/ethnicity, and sex, 

the values for unknown, missing, or invalid data were 

redistributed on the basis of the state’s distribution 

of known age group, race/ethnicity, and sex data. 

Beginning with the publication of Sexually Transmitted 

Disease Surveillance 2010, redistribution methodology is 

not applied to any of the data. The counts presented in 

this report are summations of all valid data reported in 

reporting year 2010. 

Because missing data are excluded from calculations of 

rates by age group, race/ethnicity, and sex, incidence 

rates by these characteristics, particularly by race/

ethnicity for chlamydia and gonorrhea, appear 

somewhat lower than in previous reports. 

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 STD 

Surveillance Network, and the Gonococcal Isolate 

Surveillance Project; and (3) other national surveys 

implemented by federal and private organizations.

The STD surveillance systems operated by state and 

local STD control programs, which provide the case 

report data for chlamydia, gonorrhea, syphilis, and 

chancroid, are the data sources of many of the figures 

and most of the statistical tables in this publication. 

These systems are an integral part of program 

management at all levels of STD prevention and control 

in the United States. Because of incomplete diagnosis 

and reporting, the number of STD cases reported to 

the Centers for Disease Control and Prevention is less 

than the actual number of cases occurring in the U.S. 

population. National summary data of case reports 

for other STDs are not available because they are not 

nationally notifiable diseases.

Sexually Transmitted Disease Surveillance 2010 consists 

of four sections: the National Profile, the Special 

Focus Profiles, the Tables, and the Appendix. The 

National Profile section contains figures that provide 

an overview of STD morbidity in the United States. 

The accompanying text identifies major findings and 

trends for selected STDs. The Special Focus Profiles 

section contains figures and text that describe STDs 

in selected populations that are a focus of national 

and state prevention efforts. The Tables section 

provides statistical information about STDs at county, 

metropolitan statistical area, regional, state, and national 

levels. The Appendix includes information on how to 

interpret the STD surveillance data used to produce 

this report, as well as information about Healthy People 

2020 STD objectives and progress toward meeting these 

objectives, Government Performance and Results Act 

goals and progress toward meeting these goals, and STD 

surveillance case definitions.

Any comments and suggestions that would improve 

future publications are appreciated and should be sent to

Director, Division of STD Prevention

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

and TB Prevention

Centers for Disease Control and Prevention

1600 Clifton Road, Mailstop E-02

Atlanta, Georgia 30333
STD Surveillance 2010 vii

Guide to Acronyms

CDC Centers for Disease Control and Prevention

CSF cerebrospinal fluid

DSTDP Division of STD Prevention

GISP Gonococcal Isolate Surveillance Project 

HEDIS Healthcare Effectiveness Data and Information Set

HHS U.S. Department of Health and Human Services

HMOs health maintenance organizations

HIV human immunodeficiency virus

HP2020 Healthy People 2020 

HPV human papillomavirus

HSV herpes simplex virus

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

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 2010 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), 2010.................................................................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 ....................................................................................83

Tables

National Summary ................................................................................................................................87

Chlamydia.............................................................................................................................................89

Gonorrhea ...........................................................................................................................................101

Syphilis................................................................................................................................................112

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, 2010 .............................. 142

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2010 .................. 143

Table A3. Healthy People 2020 (HP2020) Sexually Transmitted Diseases Objective Status.............. 144

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

Diseases Goals and Measures.......................................................................................... 145

STD Surveillance Case Definitions......................................................................................................146

Contributors........................................................................................................................................155
x STD Surveillance 2010

Figures in the National Profile

Chlamydia

Figure 1. Chlamydia—Rates by Sex, United States, 1990–2010...................................................... 10

Figure 2. Chlamydia—Rates by Region, United States, 2001–2010................................................ 10

Figure 3. Chlamydia—Rates by State, United States and Outlying Areas, 2010 .............................. 11

Figure 4. Chlamydia—Rates by County, United States, 2010 ......................................................... 11

Figure 5. Chlamydia—Rates by Age and Sex, United States, 2010 .................................................. 12

Figure 6. Chlamydia—Rates by Race/Ethnicity, United States, 2001–2010 .................................... 12

Figure 7. Chlamydia—Cases by Reporting Source and Sex, United States, 2001–2010................... 13

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

Sources, United States, 2010 ............................................................................................ 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, 1997–2010.................................................................. 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, 2010........................................................................... 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, 2006–2010 .................................. 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, 2006–2010 ........................................................................ 16

Gonorrhea

Figure 14. Gonorrhea—Rates, United States, 1941–2010................................................................. 22

Figure 15. Gonorrhea—Rates by Sex, United States, 1990–2010...................................................... 22

Figure 16. Gonorrhea—Rates by Region, United States, 2001–2010 ................................................ 23

Figure 17. Gonorrhea—Rates by State, United States and Outlying Areas, 2010 .............................. 23

Figure 18. Gonorrhea—Rates by County, United States, 2010 ......................................................... 24

Figure 19. Gonorrhea—Rates by Age and Sex, United States, 2010 .................................................. 24

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

United States, 2001–2010................................................................................................ 25

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

United States, 2001–2010................................................................................................ 25

Figure 22. Gonorrhea—Rates by Race/Ethnicity, United States, 2001–2010 .................................... 26

Figure 23. Gonorrhea—Cases by Reporting Source and Sex, United States, 2001–2010................... 26

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

Sources, United States, 2010 ............................................................................................ 27

Figure 25. STD Surveillance Network (SSuN) —Proportion of MSM, MSW, and 

Women Among Interviewed Gonorrhea Cases by Site, 2010............................................ 27

Figure 26. Gonorrhea—Positivity Among Women Aged 15–24 Years Tested in Family

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

Outlying Areas, 2010 ....................................................................................................... 28
STD Surveillance 2010 xi

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

Sentinel Sites and Regional Laboratories, United States, 2010.......................................... 28

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

Inhibitory Concentrations (MICs) to Ceftriaxone Among GISP 

Isolates, 2006–2010 ......................................................................................................... 29

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

Inhibitory Concentrations (MICs) to Cefixime Among GISP Isolates, 

2006 and 2009–2010....................................................................................................... 29

Figure 30. Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum 

Inhibitory Concentrations (MICs) to Azithromycin Among GISP 

Isolates, 2006–2010 ......................................................................................................... 30

Figure 31. Gonococcal Isolate Surveillance Project (GISP)—Percentage of Neisseria gonorrhoeae 

Isolates with Resistance or Intermediate Resistance to Ciprofloxacin, 1990–2010 ............ 30

Figure 32. Gonococcal Isolate Surveillance Project (GISP)—Penicillin, Tetracycline, 

and Ciprofloxacin Resistance Among GISP Isolates, 2010................................................ 31

Figure 33. Gonococcal Isolate Surveillance Project (GISP)—Drugs Used to Treat 

Gonorrhea Among GISP Participants, 1988–2010........................................................... 31

Syphilis

Figure 34. Syphilis—Reported Cases by Stage of Infection, United States, 1941–2010..................... 37

Figure 35. Primary and Secondary Syphilis—Rates by Sex and Male-to-Female Rate Ratios, 

United States, 1990–2010................................................................................................ 37

Figure 36. Primary and Secondary Syphilis—Rates by Region, United States, 2001–2010................ 38

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

Outlying Areas, 2010 ....................................................................................................... 38

Figure 38. Primary and Secondary Syphilis—Rates by County, United States, 2010 ......................... 39

Figure 39. Primary and Secondary Syphilis—Rates by Age and Sex, United States, 2010.................. 39

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

United States, 2001–2010................................................................................................ 40

Figure 41. Primary and Secondary Syphilis—Rates by Age Among Men Aged 15–44 Years, 

United States, 2001–2010................................................................................................ 40

Figure 42. Primary and Secondary Syphilis—Rates by Race/Ethnicity, 

United States, 2001–2010................................................................................................ 41

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

Sexual Behavior, United States, 2010................................................................................ 41

Figure 44. Primary and Secondary Syphilis—Reported Cases by Sex, Sexual Behavior, 

and Race/Ethnicity, United States, 2010........................................................................... 42

Figure 45. Primary and Secondary Syphilis—Reported Cases by Reporting Source and Sex, 

United States, 2001–2010................................................................................................ 42

Figure 46. Primary and Secondary Syphilis—Percentage of Reported Cases by Sex, 

Sexual Behavior, and Selected Reporting Sources, 2010.................................................... 43

Figure 47. Congenital Syphilis—Reported Cases Among Infants by Year of Birth and Rates 

of Primary and Secondary Syphilis Among Women, United States, 2001–2010............... 43
xii STD Surveillance 2010

Other Sexually Transmitted Diseases

Figure 48. Chancroid—Reported Cases, United States, 1981–2010.................................................. 47

Figure 49. Human Papillomavirus—Prevalence of High-risk and Low-risk Types Among 

Females Aged 14–59 Years, National Health and Nutrition 

Examination Survey, 2003–2006...................................................................................... 47

Figure 50. Genital Warts—Initial Visits to Physicians’ Offices, United States, 1966–2010................ 48

Figure 51. STD Surveillance Network (SSuN) —Genital Warts—Prevalence Among Sexually 

Transmitted Disease (STD) Clinic Patients by Sex, Sex of Partners, and Site, 2010 .......... 48

Figure 52. Genital Herpes—Initial Visits to Physicians’ Offices, United States, 1966–2010.............. 49

Figure 53. 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 54. Trichomoniasis and Other Vaginal Infections—Women—Initial Visits to

Physicians’ Offices, United States, 1966–2010 ................................................................. 51
STD Surveillance 2010 xiii

Figures in the Special Focus Profiles

STDs in Women and Infants

Figure A. Chlamydia—Women—Rates by State, United States and Outlying Areas, 2010.............. 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, 2010 .............. 58

Figure C. Gonorrhea—Women—Rates by State, United States and Outlying Areas, 2010 .............. 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, 2010 .............. 59

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

Outlying Areas, 2010 ....................................................................................................... 60

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

United States and Outlying Areas, 2010........................................................................... 60

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

United States, 2000–2009................................................................................................ 61

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

Aged 15–44 Years, United States, 2001–2010 .................................................................. 61

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

United States, 2000–2009................................................................................................ 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, 2006–2010 .................................. 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, 2010........................................................................... 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, 2010........................................................................... 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, 2010........................................................................... 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, 2010........................................................................... 67

STDs in Racial and Ethnic Minorities

Figure O. Chlamydia—Rates by Race/Ethnicity and Sex, United States, 2010................................. 73

Figure P. Gonorrhea—Rate Ratios by Race/Ethnicity, United States, 2001–2010........................... 73

Figure Q. Gonorrhea—Rates by Race/Ethnicity and Sex, United States, 2010 ................................. 74

Figure R. Gonorrhea—Rate Ratios by Race/Ethnicity and Region, United States, 2010.................. 74

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

United States, 2010.......................................................................................................... 75

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

Ethnicity, United States, 2001–2010................................................................................ 75

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

by Race/Ethnicity, United States, 2001–2010................................................................... 76
xiv STD Surveillance 2010

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

Race/Ethnicity, United States, 2001–2010 ....................................................................... 76

STDs in Men Who Have Sex with Men

Figure W. STD Surveillance Network (SSuN)—Gonorrhea and Chlamydia— 

Proportion of MSM Testing Positive for Gonorrhea and Chlamydia, by Site, 2010.......... 80

Figure X. STD Surveillance Network (SSuN)—Primary and Secondary Syphilis and HIV—

Proportion of MSM with Primary and Secondary Syphilis Who Are 

Co-infected with HIV, 2010 ............................................................................................ 80

Figure Y. STD Surveillance Network (SSuN)—Proportion of MSM Aattending STD 

Clinics with Primary and Secondary Syphilis, Gonorrhea or Chlamydia by 

HIV Status, 2010............................................................................................................. 81

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

Neisseria gonorrhoeae Isolates Obtained From MSM Attending 

STD Clinics, 1990–2010................................................................................................. 81

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

Neisseria gonorrhoeae Isolates Obtained from MSM Attending 

STD Clinics, by Site, 2007–2010..................................................................................... 82

STDs in Persons Entering Corrections Facilities

Figure BB. Chlamydia—Positivity by Age and Sex, Juvenile Corrections Facilities, 2010................... 85

Figure CC. Chlamydia—Positivity by Age Group and Sex, Adult Corrections Facilities, 2010 ........... 85

Figure DD. Gonorrhea—Positivity by Age and Sex, Juvenile Corrections Facilities, 2010 ................... 86

Figure EE. Gonorrhea—Positivity by Age Group and Sex, Adult Corrections Facilities, 2010 ........... 86
STD Surveillance 2010 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,1941–2010.......................................... 87

Chlamydia

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

United States, 2010.......................................................................................................... 89

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

Alphabetical Order, United States and Outlying Areas, 2006–2010 ................................. 90

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

Region in Alphabetical Order, United States and Outlying Areas, 2006–2010 ................. 91

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

in Alphabetical Order, United States and Outlying Areas, 2006–2010 ............................. 92

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

Areas (MSAs) in Alphabetical Order, United States, 2006–2010 ...................................... 93

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2006–2010 ...................... 94

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2006–2010 ...................... 95

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

Reported Cases, United States, 2010 ................................................................................ 96

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

Group and Sex, United States, 2006–2010....................................................................... 97

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

United States, 2006–2010................................................................................................ 98

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

and Sex, United States, 2006–2010.................................................................................. 99

Table 12. Chlamydia—Women 15–25 Years of Age, United States, 2006–2010............................ 100

Gonorrhea

Table 13. Gonorrhea—Reported Cases and Rates by State, Ranked by Rates, 

United States, 2010........................................................................................................ 101

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

Alphabetical Order, United States and Outlying Areas, 2006–2010 ............................... 102

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

in Alphabetical Order, United States and Outlying Areas, 2006–2010 ........................... 103

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

in Alphabetical Order, United States and Outlying Areas, 2006–2010 ........................... 104

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

Areas (MSAs) in Alphabetical Order, United States, 2006–2010 .................................... 105

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2006–2010 .................... 106

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

Statistical Areas (MSAs) in Alphabetical Order, United States, 2006–2010 .................... 107

Table 20. Gonorrhea—Counties and Independent Cities Ranked by Number of 

Reported Cases, United States, 2010 .............................................................................. 108
xvi STD Surveillance 2010

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

by Age Group and Sex, United States, 2006–2010 ......................................................... 109

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

United States, 2006–2010.............................................................................................. 110

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

and Sex, United States, 2006–2010................................................................................ 111

Syphilis

Table 23. All Stages of Syphilis—Reported Cases and Rates by State/Area and Region 

in Alphabetical Order, United States and Outlying Areas, 2006–2010 ........................... 112

Table 24. All Stages of Syphilis—Reported Cases and Rates in Selected Metropolitan 

Statistical Areas (MSAs) in Alphabetical Order, United States, 2006–2010 .................... 113

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

Ranked by Rates, United States, 2010 ............................................................................ 114

Table 26. Primary and Secondary Syphilis—Reported Cases and Rates by State/Area 

and Region in Alphabetical Order, United States and Outlying Areas, 2006–2010......... 115

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

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

Outlying Areas, 2006–2010 ........................................................................................... 116

Table 28. Primary and Secondary Syphilis—Men—Reported Cases and Rates by 

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

Outlying Areas, 2006–2010 ........................................................................................... 117

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

Metropolitan Statistical Areas (MSAs) in Alphabetical Order, United 

States, 2006–2010.......................................................................................................... 118

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

Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2006–2010.............................................................................................. 119

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

Selected Metropolitan Statistical Areas (MSAs) in Alphabetical Order, 

United States, 2006–2010.............................................................................................. 120

Table 32. Primary and Secondary Syphilis—Counties and Independent Cities Ranked 

by Number of Reported Cases, United States, 2010 ....................................................... 121

Table 33. 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 2010, United States, 2009–2010 .................... 122

Table 34. Primary and Secondary Syphilis—Reported Cases and Rates per 100,000 

Population by Age Group and Sex, United States, 2006–2010 ....................................... 123

Table 35A. Primary and Secondary Syphilis—Reported Cases by Race/Ethnicity, 

Age Group, and Sex, United States, 2006–2010............................................................. 124

Table 35B. Primary and Secondary Syphilis—Rates per 100,000 Population by 

Race/Ethnicity, Age Group, and Sex, United States, 2006–2010 .................................... 125

Table 36. Early Latent Syphilis—Reported Cases and Rates by State/Area and Region 

in Alphabetical Order, United States and Outlying Areas, 2006–2010 ........................... 126

Table 37. Early Latent Syphilis—Reported Cases and Rates in Selected Metropolitan 

Statistical Areas (MSAs) in Alphabetical Order, United States, 2006–2010 .................... 127

Table 38. Late and Late Latent Syphilis—Reported Cases and Rates by State/Area and 

Region in Alphabetical Order, United States and Outlying Areas, 2006–2010 ............... 128
STD Surveillance 2010 xvii

Table 39. Late and Late Latent Syphilis—Reported Cases and Rates in Selected Metropolitan 

Statistical Areas (MSAs) in Alphabetical Order, United States, 2006–2010 .................... 129

Table 40. Congenital Syphilis—Reported Cases and Rates in Infants by Year of Birth, by State, 

Ranked by Rates, United States, 2010 ............................................................................ 130

Table 41. 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, 2006–2010 ........................................................................................... 131

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

Ethnicity of Mother, United States, 2006–2010 ............................................................. 132

Chancroid

Table 43. Chancroid—Reported Cases and Rates by State/Area in Alphabetical Order, 

United States and Outlying Areas, 2006–2010............................................................... 133

Selected STDs

Table 44. Selected STDs and Complications—Initial Visits To Physicians’ Offices, 

National Disease and Therapeutic Index, United States, 1966–2010 .............................. 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, 2010 .............................. 142

Table A2. Reported Cases of STDs by Reporting Source and Sex: United States, 2010 .................. 143

Table A3. Healthy People 2020 (HP2020) Sexually Transmitted Diseases Objective Status.............. 144

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

Diseases Goals and Measures.......................................................................................... 145

STD Surveillance 2010 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 2010 Overview 1

National Overview of Sexually 

Transmitted Diseases (STDs), 2010

All Americans should have the opportunity to make 

choices that lead to health and wellness. Working together, 

interested, committed public and private organizations, 

communities, and individuals can take action to prevent 

sexually transmitted diseases (STDs) and their related 

health burdens. In addition to federal, state, and local 

public support for STD prevention, local community 

leaders can promote STD prevention education. Health 

providers can assess their patients’ risks and talk to them 

about testing. Parents can better educate their children 

about STDs and sexual health. Individuals can use 

condoms consistently and correctly, and openly discuss 

ways to protect their health with partners and providers. 

As noted in the Institute of Medicine report, The Hidden 

Epidemic: Confronting Sexually Transmitted Diseases,1

surveillance is a key component of all our efforts to prevent 

and control these diseases.

This overview summarizes national surveillance data 

for 2010 on the three notifiable diseases for which 

there are federally funded control programs: chlamydia, 

gonorrhea, and syphilis. Several observations for 2010 

are worthy of note.

Chlamydia

In 2010, a total of 1,307,893 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 426.0 cases per 

100,000 population, an increase of 5.1% compared with 

the rate in 2009. 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 

2010 most likely represents a continued increase in 

screening for this usually asymptomatic infection, 

expanded use of more sensitive tests, and more complete 

national reporting, but it also may reflect a true increase 

in morbidity.

In 2010, the overall rate of chlamydial infection in 

the United States among women (610.6 cases per 

100,000 females) was over two and a half times the 

rate among men (233.7 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 2006–2010, the 

chlamydia rate in men increased 36.4%, compared with 

a 19.5% increase in women during this period. Rates 

also varied among different racial and ethnic minority 

populations. For example, in 2010, the chlamydia rate 

in blacks was over eight times the rate in whites.

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 2010, the median state-specific chlamydia test 

positivity was 8.0% (range: 3.8% to 13.7%) 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 16 states, Puerto Rico, and 

the Virgin Islands, the median state-specific chlamydia 

positivity was 7.2% (range: 2.7% to 21.2%) (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 2010 in 44 states, the District of Columbia, and 

Puerto Rico. The median state-specific prevalence was 

11.4% (range: 5.2% to 21.3%) (Figure K). Among men 

entering the program in 2010 in 48 states, the District 

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

chlamydia prevalence was 7.2% (range: 1.8% to 12.7%) 

(Figure L).
2 Overview STD Surveillance 2010

Among adolescent females entering selected juvenile 

corrections facilities, the median facility-specific 

chlamydia positivity was 14.5% (range: 4.0% to 

26.5%). Among adolescent males entering selected 

juvenile corrections facilities, the median facility-specific 

chlamydia positivity was 6.5% (range: 0.5% to 13.8%).

Gonorrhea

Following a 74% decline in the rate of reported 

gonorrhea during 1975–1996, overall gonorrhea rates 

plateaued for 10 years; it decreased during 2006–2009 

to the lowest rate since national reporting began and 

then increased 2.8% between 2009 and 2010. In 2010, 

a total of 309,341 cases of gonorrhea were reported in 

the United States, which corresponds to a rate of 100.8 

cases per 100,000 population (Figure 14, Table 1). 

In 2010, as in previous years, the South had the highest 

gonorrhea rate among the four regions of the country 

(Table 14). Rates in the South and Midwest remained 

higher than rates in the Northeast and West. During 

2009–2010 rates increased in the Northeast, South, and 

West, but decreased in the Midwest (Figure 16).

During 1997–2006, gonorrhea rates in men and women 

were similar. Since 2002, the rates in women have been 

slightly higher than rates in men (Figure 15). In 2010, the 

gonorrhea rate in women was 106.5 cases per 100,000 

population compared with a rate of 94.1 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 2010, the gonorrhea rate in blacks was 18.7 times the 

rate in whites. As with chlamydia, data on gonorrhea 

prevalence in defined populations were available from 

several sources in 2010. These data showed a continuing 

high burden of disease in some adolescents and young 

adults in parts of the United States.

Antimicrobial resistance remains an important 

consideration in the treatment of gonorrhea. With 

increased resistance to the fluoroquinolones now 

endemic in the United States, the cephalosporins 

remain the only class of antibiotics recommended for 

the treatment of gonorrhea. Continued monitoring of 

susceptibility patterns to these antibiotics is critical. No 

isolates with decreased susceptibility to ceftriaxone were 

seen in 2010 in CDC’s sentinel surveillance system, 

the Gonococcal Isolate Surveillance Project (GISP). In 

2010, 9 isolates with decreased susceptibility to cefixime 

were reported, 7 from the West, and 8 in men who 

have sex with men (MSM). The percentage of isolates 

with elevated mean inhibitory concentrations (MICs) 

to cefixime increased during 2009–2010, particularly 

among isolates from the West and from MSM. 

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, then increased each year from 2001 

through 2009. In 2010, the overall rate decreased for 

the first time in 10 years. The rate decreased 21% in 

women but increased slightly, 1.3%, in men. In 2010, 

a total of 13,774 cases of P&S syphilis were reported to 

CDC. After 14 years of decline, the number of reported 

cases of congenital syphilis reached an historic low of 

339 cases in 2005. The number of cases increased from 

2006–2008 but has since decreased with 377 cases 

reported in 2010, a 15% decrease since 2008.

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 2010, 

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

rate among whites, which is substantially lower than the 

disparity observed in 1999, when the rate among blacks 

was 24 times higher than the rate among whites.

During 2006–2010, however, syphilis rates increased 

75% among black men aged 15–19 years and 134% 

among those aged 20–24 years. The 2010 rate among 

black men aged 15–19 years was 25 times the rate 

for white men of that age. Among black women aged 

15–19 years, rates increased 46% during 2006–2010 

and 59% among those aged 20–24 years. In 2010, rates 

for black women aged 15–19 years were 38 times the 

rate for white women of the same age.
STD Surveillance 2010 Overview 3

Although efforts to eliminate syphilis have focused 

on racial and ethnic minority populations, the 

syphilis rates among all MSM have increased since 

2001, especially among young MSM.3,4 While some 

decreases were observed this year, syphilis rates remain 

disproportionately high among black men and women. 

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. p 43.

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

secondary syphilis among black and Hispanic men who have 

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

2011;155 (3);145-151.

4 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 Pub Health. 2007;97(6):1076-1083.

NATIONAL PROFILE
NATIONAL PROFILE
STD Surveillance 2010 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 2010 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. Based on estimates from national surveys 

conducted from 1999–2008, chlamydia prevalence is 

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

Chlamydial infections in women, 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 2009, women aged 16–20 

years in commercial plans had a chlamydia screening 

coverage rate of 41.0%, while those in Medicaid had a 

rate of 54.4%.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 2010, a total of 1,307,893 chlamydial infections 

were reported to CDC in 50 states and the District of 

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

rate of 426.0 cases per 100,000 population, which is 

an increase of 5.1% compared with the rate of 405.3 

in 2009. During 1990–2010, the rate of reported 

chlamydial infection increased from 160.2 to 426.0 

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

Chlamydia by Region

During 2001–2010, chlamydia rates increased in all 

regions (Figure 2). In 2010, rates were highest in the 

South (468.9 per 100,000 population), followed by 

the Midwest (418.3), the Northeast (392.7), and the 

West (391.2) (Table 3). 

Chlamydia by State

In 2010, chlamydia rates by state ranged from 185.9 

cases per 100,000 population in New Hampshire to 

861.7 cases in Alaska (Figure 3, Table 2). 
8 National Profile: Chlamydia STD Surveillance 2010

Chlamydia by Metropolitan 

Statistical Area 

In 2010, the chlamydia rate per 100,000 population 

in the 50 most populous metropolitan statistical 

areas (MSAs) increased (Table 6). In 2010, 57.5% of 

chlamydia cases were reported by these MSAs. Among 

women, the 2010 rate of 638.4 cases per 100,000 was a 

3.8% increase over the 2009 rate of 614.9 cases (Table 

7). The 2010 rate among men (259.2) increased 6.8% 

from the 2009 rate (242.6) (Table 8). 

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 2010, 762 (24.3%) of 3,142 

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 2010 (Table 9). 

Chlamydia by Sex

In 2010, the overall rate of reported chlamydial 

infection among women in all 50 states and the District 

of Columbia (610.6 cases per 100,000 females) was over 

two and a half times the rate among men (233.7 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 

not receiving a diagnosis of chlamydia or being reported 

as having chlamydia. 

However, with the advent of highly sensitive nucleic 

acid amplification tests (NAATs) that can be performed 

on urine, chlamydial infection is increasingly being 

diagnosed in symptomatic and asymptomatic men. 

During 2006–2010, the reported chlamydial infection 

rate among men increased 36.4% (from 171.3 to 233.7 

cases per 100,000 males) compared with a 19.5% 

increase among women during the same period (from 

510.8 to 610.6 cases per 100,000 females).

Chlamydia by Age

Among women, the highest age-specific rates of 

reported chlamydia in 2010 were among those aged 

15–19 years (3,378.2 cases per 100,000 females) and 

20–24 years (3,407.9 cases per 100,000 females) (Figure 

5, Table 10). Within these age ranges, reported rates 

were highest among women aged 18 years (4,700.5 

cases per 100,000 females), aged 19 years (4,917.3 cases 

per 100,000 females), and aged 20 years (4,705.9 cases 

per 100,000 females) (Table 12). Age-specific rates 

among men, although substantially lower than the rates 

among women, were highest in those aged 20–24 years 

(1,187.0 cases per 100,000 males) (Figure 5, Table 10). 

Chlamydia by Race/Ethnicity

In 2010, chlamydia rates were highest among black 

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

chlamydia among blacks was more than eight times 

the rate among whites (1,167.5 and 138.7 cases per 

100,000 population, respectively). The rate among 

American Indians/Alaska Natives (592.8 cases per 

100,000) was 4.3 times the rate among whites. The rate 

among Hispanics (369.6 cases per 100,000) was 2.7 

times the rate among whites. 

During 2006–2010, rates among blacks increased 

26.9% (from 919.8 to 1,167.5 cases per 100,000). 

Among whites, rates increased 25.3% (from 110.7 to 

138.7 cases per 100,000). 

Chlamydia by Reporting Source

Most chlamydia cases reported in 2010 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 2010, 

among women, only 9.5% of chlamydia cases were 

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

among women were reported from private physicians/

health maintenance organizations (HMOs) (37.5%). In 

contrast, among men, 28.7% of chlamydia cases were 

reported from an STD clinic in 2010 and 26.0% were 

reported from private physicians/HMOs.

Chlamydia Prevalence in the 

Population

The National Health and Nutrition Examination 

Survey (NHANES) is a nationally representative survey 

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

aged 14–39 years that provides an important measure 

of chlamydia disease burden. During 1999–2002, the 

overall prevalence of chlamydial infection was 2.2% 

and was similar in males and females (2.0% and 2.5%, 

respectively).9

 Prevalence was higher among nonHispanic blacks than non-Hispanic whites in all age 

groups (Figure 9).
STD Surveillance 2010 National Profile: Chlamydia 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 2010, 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 8.0% (range: 3.8% to 13.7%) 

(Figures 10 and 11). 

Chlamydia test positivity among women aged 15–24 

years screened in family planning clinics increased in 

most HHS regions during 2006–2010 (Figure 12). 

In region IX, positivity increased through 2009 and 

then decreased in 2010, which may be attributable 

to an increase in reported tests in 2010 due to the 

implementation of an electronic data system.

The positivity trend data in Figure 10 and 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 five HHS regions (I, IV, V, 

VII, and VIII), NAATs were used nearly exclusively 

during 2006–2010. In three other regions (III, VI, 

and X), NAATs usage was 98% or higher in 2010. The 

remaining two regions (II and IX) used NAATs more 

than 93% of the time in 2010.

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 test positivity and the number of reported cases of 

C. trachomatis infections remain high among most age 

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

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

Chlamydia prevention: challenges and strategies for reducing 

disease burden and sequelae. MMWR Morb Mortal Wkly Rep. 

2011;60(12):370-3. 

2

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

Stamm WE. Prevention of pelvic inflammatory disease by screening 

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

3 Fleming DT, Wasserheit JN. From epidemiological synergy to 

public health policy and practice: the contribution of other sexually 

transmitted diseases to sexual transmission of HIV infection. Sex 

Transm Infect. 1999;75:3-17.

4 Centers for Disease Control and Prevention. Sexually transmitted 

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

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

5 National Committee for Quality Assurance. HEDIS 2010: technical 

specifications. Washington (DC): National Committee for Quality 

Assurance; 2009. p. 89-92. 

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 2010. Washington (DC): National Committee for Quality 

Assurance; 2010. p. 43-44.

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 2010

Total

Women

Men

Figure 1. Chlamydia—Rates by Sex, United States, 1990–2010

Rate (per 100,000 population)

NOTE: As of January 2000, all 50 states and the District of Columbia have regulations that require the reporting of chlamydia cases.

Year

0

125

250

375

500

625

750

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

0

125

250

375

500

625

750

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

South

Northeast

Midwest

West

Figure 2. Chlamydia—Rates by Region, United States, 2001–2010

Rate (per 100,000 population)

Year

0

100

200

300

400

500

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 
STD Surveillance 2010 National Profile: Chlamydia 11

Guam

504

Figure 3. Chlamydia—Rates by State, United States and Outlying Areas, 2010

NOTE: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 422.6 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

 202

 186

 320

 330

 360

 300

 504

 460

932

<300.0 (n = 10)

Rate per 100,000 

population

300.1–400.0 (n = 18)

>400.0 (n = 26)

320

323

407

366

316

862

Puerto Rico

150

Virgin

Islands

555

372 196

511

377

582

484

272

240

583

388

393

285

290

411

726

574

459

403

448

391

443

496

355

450

435

388

649

534

470

380

387 213

407

464

351

341

Figure 4. Chlamydia—Rates by County, United States, 2010

<300.0 (n = 1,962)

Rate per 100,000

population

300.1–400.0 (n = 418)

>400.0 (n = 762)
12 National Profile: Chlamydia STD Surveillance 2010

3,700 2,960 2,220 1,480 740 0 0 740 1,480 2,220 2,960 3,700

15–19

20–24

25–29

30–34

35–39

40–44

45–54

55–64

65+

Total

774.3

1,187.0

598.0

309.0

153.2

91.3

39.3

233.7

2.8

10.9

3,378.2

3,407.9

1,236.1

530.9

220.1

94.7

32.8

610.6

2.1

9.3

Men Rate (per 100,000 population) Women

Age

Figure 5. Chlamydia—Rates by Age and Sex, United States, 2010

Whites

Hispanics

Blacks

Asians/Pacic Islanders

American Indians/Alaska Natives

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

Rate (per 100,000 population)

Year

0

300

600

900

1200

1500

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
STD Surveillance 2010 National Profile: Chlamydia 13

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, 2001–2010

Cases (in thousands)

Year

0

100

200

300

400

500

600

700

800

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

STD Clinic

Private Physician/HMO*

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

Sources, United States, 2010

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

NOTE: These categories represent 72.5% of cases with a known reporting source. Of all cases, 11.6% 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 2010

0

2

4

6

8

10

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

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

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

States, 1997–2010

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 interval.

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 2010 National Profile: Chlamydia 15

* 2009 percent positivity for Region VI previously published in the 2009 Surveillance report has been corrected.

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, 2006–2010

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

06

4.8

07

5.2

08

5.1

09

5.8

10

5.6

06

5.9

07

6.2

08

6.5

09

7.0

10

5.4

06

5.5

07

6.3

08

6.4

09

7.4

10

9.0

06

9.6

07

9.6

08

9.4

09

9.4

10

7.6

06

7.6

07

7.6

08

7.9

09

8.9

10

7.9

06

8.8

07

10.2

08

10.6

09

11.3

10

6.5

06

6.5

07

6.8

08

7.6

09

7.7

10

7.2

06

7.3

07

7.8

08

7.6

09

8.3

10

6.8

06

7.3

07

7.5

08

8.3

09

5.5

10

5.7

06

5.8

07

6.0

08

6.0

09

6.6

10

6.8

6.4

4.9

8.5

6.3

8.3

Puerto Rico

7.6

Virgin

Islands

12.8

Guam

396

8.2 5.8

6.0

7.7

12.0

12.7

6.1

12.0

10.1

6.5

8.4

6.8

6.3

9.7

13.7

9.3

11.0

8.7

8.3

7.6

8.6

8.0

10.3

6.7

8.1

7.8

13.0

11.1

9.0

5.6

8.2 4.5

8.0

7.4

7.8

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, 2010

NOTE: Includes states and outlying areas that reported chlamydia positivity data on at least 500 women aged 15–24 years screened during 2010.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

3.8

4.6

4.8

7.6

7.2

9.2

9.3

7.2

11.8

<5.0 (n = 5)

Positivity, %

5.0–9.9 (n = 37)

>10.0 (n = 11)

8.3
16 National Profile: Chlamydia STD Surveillance 2010

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, 2006–2010

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

06 07 08 09 10 0

20

40

60

80

100

06 07 08 09 10 0

20

40

60

80

100

06 07 08 09 10 0

20

40

60

80

100

06 07 08 09 10

0

20

40

60

80

100

06 07 08 09 10 0

20

40

60

80

100

06 07 08 09 10 0

20

40

60

80

100

06 07 08 09 10 0

20

40

60

80

100

06 07 08 09 10

0

20

40

60

80

100

06 07 08 09 10 0

20

40

60

80

100

06 07 08 09 10
STD Surveillance 2010 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

Although an individual’s sexual behavior can increase 

the risk of acquiring gonorrhea, social determinants of 

health, such as poverty, may contribute to the burden of 

gonorrhea in a community.2

During 1975–1997, the national gonorrhea rate 

declined 74% after implementation of the national 

gonorrhea control program in the mid-1970s (Figure 

14). After the decline halted for several years, gonorrhea 

rates decreased further to 98.1 cases in 2009. This is the 

lowest rate since recording of gonorrhea rates began. 

The rate increased slightly in 2010 to 100.8 per 100,000 

population, with 309,341 cases reported in the United 

States (Figure 14 and Table 1). 

The increase in gonorrhea rates during 2009–2010 

was observed among men and women (Figure 15) and 

among all racial/ethnic groups (Figure 22). During 

2009–2010, rates increased in the Northeast, South, 

and West; gonorrhea rates decreased in the Midwest 

(Figure 16). 

Although gonorrhea case reporting is useful for 

monitoring disease trends, the number of gonorrhea 

cases reported to CDC is affected by many factors in 

addition to the actual occurrence of the infection within 

the population. Changes in the burden of gonorrhea 

may be masked by changes in screening practices (e.g., 

screening for chlamydia with tests that also detect N. 

gonorrhoeae infections and broader use of nucleic acid 

amplification tests [NAATs] at non-genital anatomic 

sites), the use of diagnostic tests with different test 

performance, and changes in reporting practices. As 

with other STDs, the reporting of gonorrhea cases to 

CDC is incomplete.3

 For these reasons, supplemental 

data on gonorrhea prevalence in persons screened in a 

variety of settings are useful in assessing the burden of 

disease in selected populations. 

Neisseria gonorrhoeae has progressively developed 

resistance to each of the antibiotics used for treatment 

of gonorrhea. Most recently, fluoroquinolone resistance 

emerged and resulted in the availability of only a single 

class of antibiotics that meet CDC’s efficacy standards—

the cephalosporins.4,5 The threat of cephalosporin 

resistance highlights the need for continued surveillance 

of N. gonorrhoeae antibiotic susceptibility. 

The combination of persistently high gonorrhea 

morbidity in some populations and threat of 

cephalosporin-resistant gonorrhea reinforces the need to 

better understand the epidemiology of gonorrhea. 

Gonorrhea—United States

In 2010, a total of 309,341 cases of gonorrhea were 

reported in the United States, yielding a rate of 100.8 

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

increased 2.8% since 2009; however, the rate decreased 

15.8% overall during 2006–2010.

Gonorrhea by Region

In 2010, as in previous years, the South had the highest 

gonorrhea rate (134.2 cases per 100,000 population) 

among the four regions of the United States, followed by 

the Midwest (108.5), Northeast (77.4), and West (58.7) 

(Table 14). During 2009–2010, rates increased in the 

Northeast (15.5%), West (11.4%), and South (2.1%), 

and decreased 6.5% in the Midwest (Figure 16, Table 

14). 

Gonorrhea by State

In 2010, gonorrhea rates per 100,000 population 

ranged by state from 7.3 in Wyoming to 209.9 in 

Mississippi (Figure 17, Table 13). During 2009–2010, 

59% (30/51) of states, plus the District of Columbia, 

reported an increase in gonorrhea rates (Table 14).
18 National Profile: Gonorrhea STD Surveillance 2010

Gonorrhea by Metropolitan 

Statistical Area 

The overall gonorrhea rate in the 50 most populous 

MSAs was 113.9 cases per 100,000 population in 2010 

(Table 17), representing a 4.4% rate increase from 

2009 (109.1). In 2010, 61.2% of gonorrhea cases were 

reported by these MSAs (Table 17). The total gonorrhea 

rate among women in these MSAs in 2010 (113.6) was 

similar to rates among men (113.7) (Tables 18 and 19).

Gonorrhea by County

In 2010, 50% of reported gonorrhea cases occurred 

in just 63 counties or independent cities (Table 20).

In 2010, 1,408 counties (44.8%) in the United States 

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

population (Figure 18). Rates ranged from 19.1 to 100 

per 100,000 population in 1,107 counties (35.2%) and 

more than 100 cases per 100,000 population in 627 

counties (19.9%). Most counties with more than 100 

cases per 100,000 population were located in the South. 

Ten counties in Alaska had rates greater than 100 cases 

per 100,000 population.

Gonorrhea by Sex

Before 1996, gonorrhea rates were higher among men 

than women (Figure 15). During 1997–2001, rates were 

similar among women and men. Rates have been higher 

among women since 2002. In 2010, the gonorrhea rate 

was 106.5 cases per 100,000 population among women 

and 94.1 per 100,000 population among men (Tables 

15 and 16).

Gonorrhea by Age

In 2010, gonorrhea rates were highest among 

adolescents and young adults. In 2010, the highest rates 

were observed among women aged 15–19 years (570.9) 

and 20–24 years (560.7). Among men, the rate was 

highest among those aged 20–24 years (421.0) (Figure 

19, Table 21). 

During 2009–2010, gonorrhea rates increased among 

most age groups. The largest increases were observed 

among those aged 20–24 years (4.9%) and 30–34 years 

(3.2%). Decreases were observed among those aged 

35–39 years (1.5%), 55–64 years (1.6%), and 65 years 

and greater (7.1%) (Table 21).

Among men and women, the largest increases were 

among those aged 20–24 years (6.2% for men and 

3.8% for women) (Figures 20 and 21).

Gonorrhea by Race/Ethnicity 

In 2010, gonorrhea rates remained highest among blacks 

(432.5 cases per 100,000 population) (Figure 22). The 

rate among blacks was 18.7 times the rate among whites 

(23.1 per 100,000 population). Gonorrhea rates among 

American Indians/Alaska Natives (105.7) were 4.6 times 

those of whites, and rates among Hispanics (49.9) were 

2.2 times those of whites (Figure 22, Figure P).

During 2009–2010, gonorrhea rates increased among 

American Indians/Alaska Natives (21.5%), Asian/Pacific 

Islanders (13.1%), Hispanics (11.9%), whites (9.0%), 

and blacks (0.3%) (Figure 22).

More information on gonorrhea rates among racial/

ethnicity groups can be found in the Special Focus 

Profiles.

Gonorrhea by Region and Sex

During 2009–2010, gonorrhea rates among women and 

men increased in the Northeast, South, and West, and 

decreased in the Midwest (Tables 15 and 16). In 2010, 

women (145.2) and men (121.1) in the South had the 

highest gonorrhea rates. 

Gonorrhea by Race/Ethnicity and Sex

Gonorrhea rates were higher in women than men 

among whites, Hispanics, and American Indians/Alaska 

Natives in 2010 (Figure Q). Gonorrhea rates were 

highest among black men (433.6) and black women 

(430.8) and American Indian/Alaska Native women 

(133.5) and American Indian/Alaska Native men (77.0). 

Among blacks, Hispanics, and Asians/Pacific Islanders 

aged 15–24 years, rates were higher among women 

than men (Table 22B). Among blacks, Hispanics, and 

Asian/Pacific Islanders, aged 25 years and older, rates 

were higher among men than women. Among whites 

aged 15–29 years, rates were higher among women than 

men; men had higher rates than women among those 

aged 30 years and older. Among American Indians/

Alaska Natives, aged 15–39 years, women had higher 

rates than men.
STD Surveillance 2010 National Profile: Gonorrhea 19

Gonorrhea by Reporting Source

The number of gonorrhea cases reported by STD clinics 

declined during 2001–2010 (Figure 23). In 2010, 

21.5% of gonorrhea cases were reported by STD clinics 

(Table A2). This is a decrease from 2009, when 22.6% 

of gonorrhea cases were reported by STD clinics. In 

2010, among women, private physicians or HMOs 

(29.0%) were the most common reporting source, 

followed by STD clinics (13.8%), family planning 

clinics (10.6%), other health department clinics (8.6%), 

and emergency rooms (5.6%) (Figure 24). Among men, 

STD clinics were the most common reporting source 

(30.4%) (Figure 24). Other common reporting sources 

for males were private physicians/HMOs (22.0%), other 

health department clinics (9.0%), emergency rooms 

(5.3%), and family planning clinics (4.6%) (Figure 24). 

STD Surveillance Network

The STD Surveillance Network (SSuN) is a network 

of 12 states and independently funded cities collecting 

enhanced information on a representative sample of 

gonorrhea cases reported to the state or city health 

department from all reporting sources. This project 

provides more complete estimates of case characteristics 

often missing on routine case reports—such as gender 

of sex partners—which is essential for better targeting of 

gonorrhea control efforts. In 2010, SSuN collaborators 

interviewed 3,446 gonorrhea cases representing 5% 

of total morbidity across participating jurisdictions. 

Additional information about SSuN methodology can 

be found in the STD Surveillance Network section of 

the Appendix, Interpreting STD Surveillance Data.

Based on these enhanced interviews, the burden of 

disease represented by MSM, MSW, and women varied 

substantially across collaborating sites (Figure 25). San 

Francisco County, had the highest proportion of estimated 

MSM cases (83%), while the lowest proportion of 

morbidity estimated to be attributed to MSM was found 

in Jefferson County (Birmingham), Alabama at 2.9%. 

Across all SSuN jurisdictions in 2010, 23.2% of gonorrhea 

cases were estimated to be among MSM, 28.8% among 

MSW, and 46.7% among women. 

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 2010, the median state-specific gonorrhea test 

positivity among women aged 15–24 years screened in 

selected family planning clinics in 47 states, the District 

of Columbia, Puerto Rico, and the Virgin Islands was 

0.8% (range: 0.0% to 4.1%) (Figure 26). 

Gonococcal Isolate Surveillance 

Project 

Antimicrobial resistance remains an important 

consideration in the treatment of gonorrhea.4–9 In 1986, 

the Gonococcal Isolate Surveillance Project (GISP), a 

national sentinel surveillance system, was established to 

monitor trends in antimicrobial susceptibilities of strains 

of N. gonorrhoeae in the United States.10 Data are collected 

from selected STD clinics at 25–30 GISP sentinel sites 

and from 4–5 regional laboratories (Figure 27).

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. More information 

about 2010 GISP data can be found at http://www.cdc.

gov/std/GISP.

Susceptibility to Ceftriaxone

Susceptibility testing for ceftriaxone began in 1987. 

Figure 28 displays the distribution of minimum 

inhibitory concentrations (MICs) to ceftriaxone among 

GISP isolates during 2006–2010. During 2009–2010, 

the proportion of isolates with MICs of 0.06 μg/ml and 

0.125 μg/ml did not change. The proportion of isolates 

with MICs of 0.25 μg/ml increased slightly from 0% in 

2009 to 0.05% (n = 3) in 2010.

No isolates with decreased susceptibility to ceftriaxone 

(MIC ≥ 0.5 μg/ml) were seen in 2010. GISP has 

reported four isolates with decreased susceptibility to 

ceftriaxone (MIC of 0.5 μg/ml). The locations and years 

of these isolates were San Diego, 1987; Cincinnati, 

1992 and 1993; and Philadelphia, 1997. 
20 National Profile: Gonorrhea STD Surveillance 2010

Susceptibility to Cefixime

Susceptibility testing for cefixime began in 1992, was 

discontinued in 2007, and was restarted in 2009. The 

percentage of isolates with elevated MICs (> 0.25 

μg/ml) to cefixime increased during 2006–2010, 

particularly among isolates from the West and men 

who have sex with men (MSM).8 Figure 29 displays the 

distribution of MICs to cefixime among GISP isolates 

in 2006, 2009, and 2010. During 2009–2010, increases 

were observed in the proportion of isolates with MICs 

of 0.125 μg/ml (1.4% to 1.6%), 0.25 μg/ml (0.7% to 

1.2%), and 0.5 μg/ml (0.1% to 0.2%). 

Since 2000, GISP has reported 20 isolates with 

decreased susceptibility to cefixime (MICs of 0.5 μg/

ml). Nine isolates with decreased susceptibility to 

cefixime were reported in 2010—seven were from 

the West (Honolulu, Los Angeles, Portland, and San 

Francisco) and 2 were from the Midwest (Chicago 

and Cleveland). In 2010, eight (88.9%) isolates with 

decreased susceptibility to cefixime were from MSM.

Susceptibility to Cefpodoxime

GISP began monitoring cefpodoxime susceptibility in 

2009. Of 5,693 GISP isolates tested for cefpodoxime 

susceptibility in 2010, 58.9% had MICs to cefpodoxime 

less than or equal to 0.015 μg/ml, 37.9% had MICs of 

0.03–0.125 μg/ml, and 1.9% had MICs of 0.250–0.5 

μg/ml. There were 70 (1.2%) isolates with decreased 

susceptibility to cefpodoxime (MICs of 1.0–4.0 μg/ml). 

Susceptibility to Azithromycin

GISP began monitoring azithromycin susceptibility in 

1992. Figure 30 displays the distribution of MICs to 

azithromycin among GISP isolates during 2006–2010. 

The proportion of GISP isolates with MICs of ≥ 2.0 

μg/ml to azithromycin decreased from 0.5% in 2007 

to 0.2% during 2008–2009, and increased to 0.5% 

in 2010. In 2010, 9 (0.2%) isolates had MICs to 

azithromycin of 8.0 μg/ml, and 8 (0.1%) isolates had 

MICs of 16.0 μg/ml. Of these 17 isolates, 76.5% were 

from the West and 82.4% were from MSM.

Susceptibility to Spectinomycin

All isolates were susceptible to spectinomycin in 

2010. 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 

antimicrobial) was first identified at GISP sites in 

1991. Since 1999, fluoroquinolone-resistant Neisseria 

gonorrhoeae (QRNG) prevalence steadily increased, first 

in Hawaii and the Pacific Islands, then in the Western 

states, then among MSM,11,12 and eventually among all 

populations in all regions of the United States.4 

The proportion of GISP isolates identified as QRNG 

peaked in 2007 at 14.8% (Figure 31). The proportion 

decreased to 9.6% by 2009, and increased to 12.5% in 

2010.

Quinolone-resistant Neisseria gonorrhoeae 

by Sex of Sex Partner

The prevalence of QRNG in isolates from MSM peaked 

at 38.9% in 2006 and then decreased to 20.1% by 

2009. In 2010, 23.9% of isolates from MSM and 7.9% 

of isolates from men who have sex exclusively with 

women were identified as QRNG. 

Other Antimicrobial Susceptibility Testing

Overall in 2010, 27.2% of isolates collected from 

GISP sites were resistant to penicillin, tetracycline, 

ciprofloxacin, or some combination of those antibiotics 

(Figure 32). 
STD Surveillance 2010 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 Sullivan AB, Gesink DC, Brown P, Zhou L, Kaufman JS,Fitch 

M, et al. Are neighborhood sociocultural factors influencing the 

spatial pattern of gonorrhea in North Carolina? Ann Epidemiol 

2011; 21:245-252.

3 American Social Health Association. Sexually transmitted diseases 

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

Kaiser Family Foundation; 1998.

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

sexually transmitted diseases treatment guidelines, 2006: 

fluoroquinolones no longer recommended for treatment of 

gonococcal infections. MMWR Morb Mortal Wkly Rep. 

2007;56:332-6.

5 Centers for Disease Control and Prevention. Sexually transmitted 

diseases treatment guidelines, 2010. MMWR Recomm Rep. 

2010;59(No.RR-12).

6 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.

7 Centers for Disease Control and Prevention. Neisseria 

gonorrhoeae with reduced susceptibility to azithromycin — San 

Diego County, California, 2009. MMWR Morb Mortal Wkly 

Rep. 2011;60:579-81.

8 Centers for Disease Control and Prevention. Cephalosporin 

susceptibility among Neisseria gonorrhoeae isolates — United 

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

2011;60:873-7.

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

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

204.

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

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

resistance in Neisseria gonorrhoeae. JAMA. 1990;264:1413-7.

11 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.

12 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.

Antimicrobial Treatments Given for 

Gonorrhea

The antimicrobial agents given to GISP patients 

for gonorrhea therapy are shown in Figure 33. In 

2010, 96.5% of GISP patients were treated with 

cephalosporins, similar to the proportion in 2009 

(96.2%). The proportion treated with ceftriaxone 

250 mg increased from 21.6% in 2009 to 37.4% in 

2010; the proportion treated with ceftriaxone 125 mg 

decreased from 53.9% in 2009 to 46.9% in 2010. The 

proportion treated with cefixime decreased from 13.2% 

in 2008 to 7.8% in 2010. Among patients treated 

with a cephalosporin, 75.3% were also treated with 

azithromycin, 23.6% were also treated with doxycycline, 

0.1% were also treated with another antibiotic, and 

1.1% did not receive a second antibiotic.

During 2010, 0.5% of GISP patients were treated 

with fluoroquinolones (ciprofloxacin, ofloxacin, or 

levofloxacin) and 1.7% were treated with azithromycin 

monotherapy. 

Gonorrhea Among Special Populations

More information about gonorrhea in racial/ethnic 

groups, women of reproductive age, adolescents, MSM, 

and other populations at higher risk can be found in the 

Special Focus Profiles.

Gonorrhea Summary

The national gonorrhea rate fluctuated at about 115 

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

2006, decreased during 2006–2009, and increased 

slightly in 2010. High rates persist in some geographic 

areas, among 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 azithromycin.
22 National Profile: Gonorrhea STD Surveillance 2010

0

100

200

300

400

500

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

Figure 14. Gonorrhea—Rates, United States, 1941–2010

Rate (per 100,000 population)

Year

Total

Women

Men

Figure 15. Gonorrhea—Rates by Sex, United States, 1990–2010

Rate (per 100,000 population)

Year

0

100

200

300

400

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
STD Surveillance 2010 National Profile: Gonorrhea 23

43.0

28.1

71.5

65.4

10.5

182.3

Puerto Rico

7.9

Virgin

Islands

137.5

Guam

54.4

31.5 12.3

93.7

102.2

174.7

128.3

9.5

11.1

61.2

7.3

57.6

66.1

40.2

90.0

209.9 168.5

161.3

108.8

150.4

93.9

142.9

136.7

101.1

113.1

119.6

118.5

198.4

165.0

122.2

100.7

55.5 31.8

49.3

59.9

73.9

Figure 17. Gonorrhea—Rates by State, United States and Outlying Areas, 2010

NOTE: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 99.6 per 100,000 population.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 9.3

 11.4

 37.7

 27.6

 73.0

 67.4

114.1

130.1

350.9

<19.0 (n = 8)

Rate per 100,000 

population

19.1–100.0 (n = 23)

>100.0 (n = 23)

58.6

South

Northeast

Midwest

West

Figure 16. Gonorrhea—Rates by Region, United States, 2001–2010

Rate (per 100,000 population)

Year

0

50

100

150

200

250

300

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 
24 National Profile: Gonorrhea STD Surveillance 2010

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

15–19

20–24

25–29

30–34

35–39

40–44

45–54

55–64

65+

Total

253.4

421.0

241.3

146.5

85.1

64.2

34.1

94.1

2.4

11.0

570.9

560.7

226.3

107.5

48.2

23.8

9.0

106.5

0.5

1.9

Men Rate (per 100,000 population) Women

Age

Figure 19. Gonorrhea—Rates by Age and Sex, United States, 2010

Figure 18. Gonorrhea—Rates by County, United States, 2010

<19.0 (n = 1,408)

Rate per 100,000

population

19.1–100.0 (n = 1,107)

>100.0 (n = 627)
STD Surveillance 2010 National Profile: Gonorrhea 25

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

2001–2010

Rate (per 100,000 population)

Year

35–39

40–44

30–34

25–29

20–24

15–19

Age Group

0

150

300

450

600

750

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

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, 

2001–2010

Rate (per 100,000 population)

Year

Age Group

0

200

400

600

800

1000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
26 National Profile: Gonorrhea STD Surveillance 2010

Whites

Hispanics

Blacks

Asians/Pacic Islanders

American Indians/Alaska Natives

Figure 22. Gonorrhea—Rates by Race/Ethnicity, United States, 2001–2010

Rate (per 100,000 population)

Year

0

100

200

300

400

500

600

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

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, 2001–2010

Cases (in thousands)

Year

0

40

80

120

160

200

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
STD Surveillance 2010 National Profile: Gonorrhea 27

STD Clinic

Private Physician/HMO*

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

Sources, United States, 2010

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

NOTE: These categories represent 69.5% of cases with known reporting source. Of all cases, 13.2% 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

0

20

40

60

80

100

MSW

MSM

Figure 25. STD Surveillance Network (SSuN)—Proportion of MSM,* MSW,* and Women 

Among Interviewed† Gonorrhea Cases by Site, 2010

Percentage

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

 SSuN interviews conducted from a randomly selected patient population with gonorrhea (n = 3,446). ‡

 California data excludes San Francisco.

Note: See Appendix for included jurisdictions within each state.

Women

New Connecticut

York City

Philadelphia

Baltimore

Virginia

Alabama

Louisiana

Chicago

Colorado

Washington

California‡ San 

Francisco
28 National Profile: Gonorrhea STD Surveillance 2010

Figure 27. Gonococcal Isolate Surveillance Project (GISP)—Location of Participating Sentinel 

Sites and Regional Laboratories, United States, 2010

 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

0.2

1.8

0.4

Puerto Rico

0.2

Virgin

Islands

3.1

0.2

0.7

1.3

1.9

2.2

0.1

0.2

0.3

0.0

1.0

0.3 0.4

0.5

0.3

0.2

2.8

2.2

1.4

2.1

1.3

1.4

1.1

2.3

1.3

1.6

0.7

0.8

0.9

2.2

2.1

1.5

0.5

0.6 0.3

0.6

0.9

Figure 26. Gonorrhea—Positivity Among Women Aged 15–24 Years Tested in Family 

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

Outlying Areas, 2010

* 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 2010.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

0.1

0.2

0.4

0.4

1.8

1.8

0.9

4.1

* (n = 3)

Positivity, %

<1.0 (n = 28)

1.0–1.9 (n = 13)

0.7 >2.0 (n = 9)
STD Surveillance 2010 National Profile: Gonorrhea 29

0

20

40

60

80

100

<0.015 0.03 0.06 0.125 0.25 0.5

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

Concentrations (MICs) to Cefixime Among GISP Isolates, 2006 and 2009–2010

Percentage

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

MICs (μg/ml)

2009

2006

2010

0

20

40

60

80

100

<0.008 0.015 0.03 0.06 0.125 0.25

2007

2006

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

Inhibitory Concentrations (MICs) to Ceftriaxone Among GISP Isolates, 2006–2010

Percentage

2008

2010

2009

MICs (μg/ml)
30 National Profile: Gonorrhea STD Surveillance 2010

Intermediate Resistance

Resistance

Figure 31. Gonococcal Isolate Surveillance Project (GISP)—Percentage of Neisseria 

gonorrhoeae Isolates with Resistance or Intermediate Resistance to

Ciprofloxacin, 1990–2010

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

0

5

10

15

20

201020092008200720062005200420032002200120001999199819971996199519941993199219911990

0

10

20

30

40

<0.03 0.06 0.125 0.25 0.5 1 2 4 8 16

2007

2006

Figure 30. Gonococcal Isolate Surveillance Project (GISP)—Distribution of Minimum 

Inhibitory Concentrations (MICs) to Azithromycin Among GISP Isolates, 

2006–2010

Percentage

2008

2010

2009

MICs (μg/ml)
STD Surveillance 2010 National Profile: Gonorrhea 31

0

20

40

60

80

100

1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

Figure 33. Gonococcal Isolate Surveillance Project (GISP)—Drugs Used to Treat Gonorrhea 

Among GISP Participants, 1988–2010

NOTE: For 2010, “Other” includes no therapy (1.2%), 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

2010

PenR/QRNG

PenR

TetR/QRNG

PenR/TetR

QRNG

PenR/TetR/QRNG

TetR

Susceptible

Figure 32. Gonococcal Isolate Surveillance Project (GISP)—Penicillin, Tetracycline, and 

Ciprofloxacin Resistance Among GISP Isolates, 2010

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. 

72.8%

9.4%

6.9%

2.9%

1.8%

2.0%

3.5%

0.6%

STD Surveillance 2010 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 34). 

The low rate of P&S syphilis and the concentration 

of the majority of syphilis cases in a small number 

of geographic areas in the United States led to the 

development of CDC’s National Plan to Eliminate 

Syphilis, which was announced by 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 before decreasing in 2010. 

Overall increases in rates were observed primarily among 

men (increasing from 3.0 cases per 100,000 population 

in 2001 to 7.9 cases in 2010). After persistent declines 

during 1992–2003, the rate among women increased 

from 0.8 cases (in 2004) to 1.5 cases (in 2008) per 

100,000 population, declining to 1.1 cases per 100,000 

population in 2010.

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. Of 

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

information in 2010 was available for 82%.

In 2010, 67% of P&S syphilis cases in 44 states and the 

District of Columbia that provided information about 

sex of sex partners were among MSM. 

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

Late, Late Latent, and Congenital)

During 2009–2010, the number of cases of early latent 

syphilis reported to CDC increased 4.1% (from 13,066 

to 13,604 cases), and the number of cases of late and 

late latent syphilis increased 4.3% (from 17,338 to 

18,079 cases) (Tables 1, 36, and 38). The total number 

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

and congenital) reported to CDC increased 2.2% (from 

44,830 to 45,834 cases) during 2009–2010 (Table 1).

P&S Syphilis—United States

P&S syphilis cases reported to CDC decreased from 

13,997 in 2009 to 13,774 in 2010, a decrease of 1.6%. 

The rate of P&S syphilis in the United States in 2010 

(4.5 cases per 100,000 population) was 2.2% lower than 

the rate in 2009 (4.6 cases) (Figure 34, Table 1). This is 

the first overall decrease in P&S syphilis in 10 years. 

P&S Syphilis by Region

The South accounted for 45.5% of P&S syphilis cases 

in 2010 and 53.0% in 2009. During 2009–2010, 

rates decreased 15.4% in the South (from 6.5 to 5.5 

cases per 100,000 population) and increased 5.3% in 

the Northeast (from 3.8 to 4.0 cases), 21.4% in the 

Midwest (from 2.8 to 3.4 cases), and 16.2% in the West 

(from 3.7 to 4.3 cases) (Figure 36, Table 26).

P&S Syphilis by State

In 2010, the 15 states and areas (including the District 

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

accounted for 72% of all U.S. cases of P&S syphilis. 

The rate of P&S syphilis in 14 of these 15 states and 

areas (including the District of Columbia) exceeded 

the national rate of 4.5 cases per 100,000 population; 

of these 14 states and areas (including the District of 

Columbia), 9 were in the South (Figure 37, Table 25). 
34 National Profile: Syphilis STD Surveillance 2010

P&S Syphilis by Metropolitan 

Statistical Area 

The rate of P&S syphilis in 2010 for the 50 most 

populous MSAs (6.3 cases per 100,000 population) 

(Table 29) exceeded the overall rate for the United States 

(4.5 cases) (Table 26). The rate increased in 29 of these 

50 MSAs (58%) during 2009–2010. 

P&S Syphilis by County

In 2010, 2,167 of 3,141 counties (69.0%) in the United 

States reported no cases of P&S syphilis, compared 

with 2,194 counties (69.9%) in 2009 (Figure 38). In 

2010, half of the total number of P&S syphilis cases was 

reported from 27 counties and two cities (Table 32).

P&S Syphilis by Sex

The rate of P&S syphilis increased 1.3% among men 

(from 7.8 to 7.9 cases per 100,000 men) during 2009–

2010 (Figure 35, Table 28). During this same period, 

the rate decreased 21.4% among women (from 1.4 to 

1.1 cases per 100,000 women) (Figure 35, Table 27).

P&S Syphilis by Age

In 2010, the rate of P&S syphilis was highest among 

persons aged 20–24 years and 25–29 years (13.5 and 

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

34).

During 2009–2010, rates for men increased the most in 

those aged 20–24 years and 25–29 years (Figures 39 and 

41, Table 34). Rates for men are now highest in those 

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

data indicate a major shift since 2006, when the highest 

rates were in men aged 35–39 years. Rates among 

women decreased in all age groups in 2010 (except 

for women aged 55 years and older), with the largest 

decrease in women aged 40–44 years. Rates remained 

highest among women aged 20–24 years (Figures 39 

and 40).

P&S Syphilis by Race/Ethnicity

During 2009–2010, the rate of P&S syphilis increased 

9.5% among Hispanics (from 4.2 to 4.6 cases per 

100,000 population), 8.7% among American Indians/

Alaska Natives (from 2.3 to 2.5 cases per 100,000 

population), and 5.0% among non-Hispanic whites 

(from 2.0 to 2.1 cases per 100,000 population) (Figure 

42). The rate decreased 8.7% among non-Hispanic 

blacks (from 18.4 to 16.8 cases per 100,000 population) 

and 13.3% among Asian/Pacific Islanders (from 1.5 to 

1.3 cases per 100,000 population). 

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 35). This increase 

supports analyses of case report data showing increases 

in P&S syphilis among MSM during 2005–2008.10 In 

2008, this ratio decreased to 5.0, but increased to 5.6 in 

2009, and 7.2 in 2010.

In 2005, CDC began collecting information on the sex 

partners of patients with P&S syphilis. In 2010, this 

information was available for 82% of male cases.

In 2010, among men who have sex with women only 

(MSW) with P&S syphilis, 35.8% had primary syphilis, 

and 64.2% had secondary syphilis. Among women 

with P&S syphilis, 16.0% had primary syphilis, and 

84.0% had secondary syphilis. Among MSM, 25.0% 

had primary syphilis, and 75.0% had secondary syphilis 

(Figure 43).

Among women with P&S syphilis, 16.8% were white, 

72.8% were black, 6.6% were Hispanic, and 1.6% were 

of other races/ethnicities. Among MSW, 14.8% were 

white, 67.0% were black, 13.8% were Hispanic, and 

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

38.1% were white, 37.0% were black, 19.8% were 

Hispanic, and 3.1% were of other races/ethnicities 

(Figure 44).

P&S Syphilis by Race/Ethnicity and Sex

In 2010, rates of P&S syphilis among men were 

highest among non-Hispanic black men (28.2 cases 

per 100,000 population), followed by Hispanic (8.5 

cases per 100,000 population), American Indians/

Alaska Natives (4.3 cases per 100,000 population), nonHispanic white (4.0 cases per 100,000 population), and 

Asian/Pacific Islander (2.6 per 100,000 population) men 

(Figure S).
STD Surveillance 2010 National Profile: Syphilis 35

In 2010, rates of P&S syphilis among women were 

highest among non-Hispanic black women (6.4 per 

100,000 population), followed by American Indians/

Alaska Natives (0.7 cases per 100,000 population), 

Hispanic (0.5 cases per 100,000 population), nonHispanic white (0.3 cases per 100,000 population), and 

Asian/Pacific Islander (0.1 per 100,000 population) 

women (Figure S).

P&S Syphilis by Race/Ethnicity, Age, 

and Sex 

In 2010, the rate of P&S syphilis among non-Hispanic 

blacks was highest among women aged 20–24 years 

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

20–24 years (92.5 cases per 100,000 men) and 25–29 

years (74.8 cases). For non-Hispanic whites, the rate was 

highest among women aged 20–24 years (0.9 cases) and 

among men aged 40–44 years (9.1 cases).

For Hispanics, the rate was highest among women aged 

20–24 years (1.8 cases per 100,000 women) and among 

men aged 20–24 years (19.8 cases per 100,000 men). 

For Asians/Pacific Islanders, the rate was highest among 

women aged 20–24 years (1.2 cases) and among men 

aged 20–24 years (6.5 cases). For American Indians/

Alaska Natives, the rate was highest among women aged 

30–34 years and 35–39 years (2.4 cases for both) and 

among men aged 20–24 years (15.6 cases) (Table 35B).

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 1998–2010, the 

proportion of cases reported from sources other than 

STD clinics increased from 39.2% to 68.1% (Figure 

45, Table A2). During 2001–2010, 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 45).

During 2010, 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 (33.5%) than STD clinics (30.3%) 

(Figure 46). More cases among women and MSW were 

reported from STD clinics than from private physicians.

Congenital Syphilis—United States

After an 18% increase in the rate of congenital syphilis 

during 2006–2008, the rate of congenital syphilis 

decreased during 2009–2010 (from 9.9 to 8.7 cases per 

100,000 live births) (Table 41). In 2010, a total of 377 

cases were reported, a decrease from 429 cases in 2009 

and 446 cases in 2008. This recent decrease in the rate 

of congenital syphilis is associated with the decrease 

in the rate of P&S syphilis among women that has 

occurred since 2008 (Figure 47).11

In 2010, a total of 28 states, the District of Columbia, 

and 1 outlying area had 1 or more cases of congenital 

syphilis (Tables 40 and 41).

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

more cases of congenital syphilis (Tables 41).

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, younger men and 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, 67% of P&S syphilis 

cases are among MSM. Although the majority of U.S. 

syphilis cases have occurred among MSM, syphilis 

among MSW continues to be a problem.12
36 National Profile: Syphilis STD Surveillance 2010

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

and treatment of congenital syphilis. Acta Derm Venereol. 

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

2 Centers for Disease Control and Prevention. The national plan 

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

Department of Health and Human Services; 2006.

3 Centers for Disease Control and Prevention. Resurgent bacterial 

sexually transmitted disease among men who have sex with 

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

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

4 Centers for Disease Control and Prevention. Outbreak of syphilis 

among men who have sex with men — Southern California, 

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

5 Centers for Disease Control and Prevention. Primary and secondary syphilis among men who have sex with men — New York City, 

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

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

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

transmitted diseases among men who have sex with men: San 

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

2002;92:1387-8.

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

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

2003;30:872-3.

8 Centers for Disease Control and Prevention. Primary and 

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

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

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

in primary and secondary syphilis among men who have sex with 

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

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

secondary syphilis among black and Hispanic men who have 

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

2011;155(3):145-51.

11 Centers for Disease Control and Prevention. Congenital syphilis 

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

2010;59:413-7.

12 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 2010 National Profile: Syphilis 37

Total Syphilis

Early Latent

Primary and Secondary

Figure 34. Syphilis—Reported Cases by Stage of Infection, United States, 1941–2010

Cases (in thousands)

Year

0

100

200

300

400

500

600

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

Male-to-Female Rate Ratio

Total Rate

Female Rate

Male Rate

Figure 35. Primary and Secondary Syphilis—Rates by Sex and Male-to-Female Rate Ratios, 

United States, 1990–2010

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

Year

1:1

2:1

4:1

8:1

16:1

0

5

10

15

20

25

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
38 National Profile: Syphilis STD Surveillance 2010

Guam

0.6

Figure 37. Primary and Secondary Syphilis—Rates by State, United States and Outlying 

Areas, 2010

NOTE: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 4.5 per 

100,000 population.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 0.6

 1.7

 4.3

 3.9

 2.8

 2.8

 1.0

 5.8

22.3

<0.2 (n = 2)

Rate per 100,000 

population

0.21–2.2 (n = 15)

>2.2 (n = 37)

4.0

1.9

5.6

4.9

0.3

0.4

Puerto Rico

5.7

Virgin

Islands

0.0

0.5 2.4

5.6

2.9

3.4

5.0

0.4

2.3

2.6

0.0

0.5

0.7

2.8

0.9

7.7

5.5

8.1

6.4

4.2

3.5

4.6

2.4

2.7

4.4

2.5

2.5

12.2

7.1

7.0

3.2

2.7 0.3

3.5

2.7

0.6

0.7

South

Northeast

Midwest

West

Figure 36. Primary and Secondary Syphilis—Rates by Region, United States, 2001–2010

Rate (per 100,000 population)

Year

0

2

4

6

8

10

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
STD Surveillance 2010 National Profile: Syphilis 39

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

15–19

20–24

25–29

30–34

35–39

40–44

45–54

55–64

65+

Total

5.6

21.9

19.2

15.8

12.7

13.8

8.5

7.9

0.6

2.7

4.5

3.0

3.0

2.0

1.4

1.0

0.8

1.1

0.0

0.2

Men Rate (per 100,000 population) Women

Age

Figure 39. Primary and Secondary Syphilis—Rates by Age and Sex, United States, 2010

Figure 38. Primary and Secondary Syphilis—Rates by County, United States, 2010

<0.2 (n = 2,167)

Rate per 100,000

population

0.21–2.2 (n = 383)

>2.2 (n = 592)

NOTE: In 2010, 2,167 (69.0%) of 3,141 counties in the United States reported no cases of primary and secondary syphilis.
40 National Profile: Syphilis STD Surveillance 2010

35–39

40–44

30–34

25–29

20–24

15–19

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

United States, 2001–2010

Rate (per 100,000 population)

Year

Age Group

0

1

2

3

4

5

6

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

35–39

40–44

30–34

25–29

20–24

15–19

Figure 41. Primary and Secondary Syphilis—Rates by Age Among Men Aged 15–44 Years, 

United States, 2001–2010

Rate (per 100,000 population)

Year

Age Group

0

5

10

15

20

25

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
STD Surveillance 2010 National Profile: Syphilis 41

Secondary

Primary

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

Behavior, United States, 2010

Cases

* Of the reported male cases of primary and secondary syphilis, 18.3% 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 42. Primary and Secondary Syphilis—Rates by Race/Ethnicity, United States, 

2001–2010

Rate (per 100,000 population)

Year

0

5

10

15

20

25

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
42 National Profile: Syphilis STD Surveillance 2010

Blacks

Whites

Figure 44. Primary and Secondary Syphilis—Reported Cases* by Sex, Sexual Behavior, and 

Race/Ethnicity,† United States, 2010

Cases

* Of the reported male cases of primary and secondary syphilis, 18.3% were missing sex of sex partner information; 2.0% 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‡

STD Clinic, Women

STD Clinic, Men

Non-STD Clinic, Women

Non-STD Clinic , Men

Figure 45. Primary and Secondary Syphilis—Reported Cases by Reporting Source and Sex, 

United States, 2001–2010

Cases (in thousands)

Year

0

2

4

6

8

10

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
STD Surveillance 2010 National Profile: Syphilis 43

HIV Counseling and Testing Site

Correctional Facility

Figure 46. Primary and Secondary Syphilis—Percentage of Reported Cases* by Sex, Sexual 

Behavior, and Selected Reporting Sources, 2010

Percentage

* Of the reported male cases of primary and secondary syphilis, 18.3% were missing sex of sex partner information, and 2.7% of reported male cases 

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

 HMO = health maintenance organization; MSW = men who have sex with women only; MSM = men who have sex with men.

STD Clinic

Private Physician/HMO†

MSW† Women MSM†

0

5

10

15

20

25

30

35

40

P&S Rate

CS Cases

Figure 47. Congenital Syphilis—Reported Cases Among Infants by Year of Birth and Rates of 

Primary and Secondary Syphilis Among Women, United States, 2001–2010

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

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

Year

0.0

0.2

0.4

0.6

0.8

0

1

2

3

4

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

STD Surveillance 2010 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 48, Table 1). In 2010, 

a total of 24 cases of chancroid were reported in the 

United States. Only nine states reported one or more 

cases of chancroid in 2010 (Table 43). 

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 in females aged 9–26 years; in October 

2009, this vaccine also was licensed for use in males 

aged 9–26 years. The vaccine provides protection 

against HPV types 6, 11, 16, and 18. Types 6 and 11 

are responsible for about 90% of anogenital 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 was licensed for use in females aged 10–25 years. 

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 documented 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 

women aged 14–19 years, 29% in those aged 20–29, 13% 

in those aged 30–39, 11% in those aged 40–49, and 6.3% 

in those aged 50–65.3

National population-based data were obtained from 

NHANES to examine the prevalence of both high-risk 

HPV and low-risk HPV—including types 6 and 11—in 

the civilian, non-institutionalized female population 

during 2003–2006 (Figure 49). HPV detection and 

typing were performed using the Research Use Only 

Linear Array genotyping assay (Roche Diagnostics), 

resulting in higher HPV prevalence than previously 

reported for NHANES 2003–2004 data. The overall 

HPV prevalence of high- and low-risk types was 42.5% 

(95% confidence interval [CI]: 40.3–44.7) among U.S. 

females aged 14–59 years.4

 HPV vaccine-preventable 

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

types) were detected in 8.8% of female participants: 

HPV-6 in 2.8% (95% CI: 2.2–3.6), HPV-11 in 0.3% 

(95% CI: 0.2–0.7), HPV-16 in 4.7% (95% CI: 4.0–

5.5), and HPV-18 in 1.9% (95% CI: 1.4–2.5).5

Data from the National Disease and Therapeutic Index 

(NDTI) suggest that incidence of genital warts (Figure 

50, Table 44), 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.6

For data reported in Figure 51, enhanced behavioral and 

demographic information on patients who presented 

for care in 2010 at the 41 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 2010

The prevalence of genital warts in 2010 is presented 

separately for MSM, MSW, and women by SSuN 

site. Prevalence was lowest in women for all sites and 

ranged from 1.1% to 4.0%. Prevalence was higher 

among MSM compared with MSW in Chicago, 

Birmingham, Richmond, Hartford/New Haven, 

Baltimore, Philadelphia, and New York City. Prevalence 

at these sites ranged from 2.9% to 9.2% for MSM and 

from 2.6% to 7.2% for MSW. Prevalence was higher 

in MSW compared with MSM in the remaining areas 

(San Francisco, Los Angeles, Seattle, Denver, and New 

Orleans), ranging from 4.3% to 12.7% for MSW and 

3.6% to 9.9% 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 this 

condition from the NDTI (Figure 52, Table 44).

National trend data on the seroprevalence of HSV2 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 53). 

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

Trend data for this infection are limited to estimates of 

initial physician office visits from the NDTI (Figure 54, 

Table 44). 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).7

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 Hariri S, Unger ER, Sternberg M, Dunne EF, Swan D, Patel S, et 

al. Prevalence of genital human papillomavirus among females in 

the United States, the National Health and Nutrition Examination 

Survey, 2003–2006. J Infect Dis. 2011; 204(4):566-73.

5 Dunne EF, Sternberg M, Markowitz LE, McQuillan G, Swan DC, 

Patel SS, et al. Human papillomavirus (HPV) 6, 11, 16 and 18 

prevalence among females in the United States-National Health 

and Nutrition Examination Survey, 2003–2006: opportunity to 

measure HPV vaccine impact? J Infect Dis. 2011;204(4):562-5.

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

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

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

2008;35(4):357-60.

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

Markowitz LE. The prevalence of Trichomonas vaginalis infection 

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

Clin Infect Dis. 2007;45(10):1319-26.
STD Surveillance 2010 National Profile: Other Sexually Transmitted Diseases 47

0

10

20

30

40

50

60

14–19 20–24 25–29 30–39 40–49 50–59

Low-risk HPV*

Figure 49. Human Papillomavirus—Prevalence of High-risk and Low-risk Types Among 

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

2003–2006

Prevalence, %

* HPV = human papillomavirus.

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

SOURCE: Hariri S, Unger ER, Sternberg M, Dunne EF, Swan D, Patel S, et al. Prevalence of genital HPV among females in the United States, the National Health and Nutrition 

Examination Survey, 2003–2006. J Infect Dis. 2011;204(4):566-73

High-risk HPV*

Age

Figure 48. Chancroid—Reported Cases, United States, 1981–2010

Cases (in thousands)

Year

0

1

2

3

4

5

1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009
48 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2010

Figure 50. Genital Warts—Initial Visits to Physicians’ Offices, United States, 1966–2010

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 44.

SOURCE: IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966–2010. 

Year

0

100

200

300

400

500

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

MSW*

MSM*

Figure 51. STD Surveillance Network (SSuN)—Genital Warts—Prevalence Among Sexually 

Transmitted Disease (STD) Clinic Patients by Sex, Sex of Partners, and Site, 2010

Percentage

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

Women

0

3

6

9

12

15

Hartford/

New Haven

New York

Philadelphia City

Baltimore

Richmond

Birmingham

New Orleans

Chicago

Denver

Seattle

Los Angeles

San Francisco
STD Surveillance 2010 National Profile: Other Sexually Transmitted Diseases 49

Figure 52. Genital Herpes—Initial Visits to Physicians’ Offices, United States, 1966–2010

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 44.

SOURCE: IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966–2010. 

Year

0

50

100

150

200

250

300

350

400

1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008
50 National Profile: Other Sexually Transmitted Diseases STD Surveillance 2010

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 53. 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, non-institutionalized population aged 14–49 years as the standard.

NOTE: Error bars indicate 95% condence interval.

1988–1994 1999–2004 2005–2008

Percentage

Non-Hispanic Blacks

Non-Hispanic Whites

Age

Age
STD Surveillance 2010 National Profile: Other Sexually Transmitted Diseases 51

Other Vaginitis

Trichomoniasis

Figure 54. Trichomoniasis and Other Vaginal Infections—Women—Initial Visits to

Physicians’ Offices, United States, 1966–2010

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 Surveillance Data Sources in the Appendix and Table 44.

SOURCE: IMS Health, Integrated Promotional ServicesTM, IMS Health Report, 1966–2010.

Year

0

900

1,800

2,700

3,600

4,500

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

SPECIAL FOCUS PROFILES
SPECIAL FOCUS PROFILES
STD Surveillance 2010 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 2010 Special Focus Profiles: STDs in Women and Infants 55

STDs in Women and Infants

Public Health Impact

Women and infants bear significant long-term 

consequences of STDs. In addition to biological and 

social factors such as poverty and access to quality STD 

services, a woman’s inability to negotiate safer sexual 

practices, such as condom use, can significantly affect 

her sexual health and subsequently the health of her 

unborn baby.1,2 A woman’s relationship status with her 

male partner, in particular, has been identified as an 

important predictor of her sexual health.3

 For example, 

a perceived shortage of available men in a community, 

can cause women to be more accepting of their partners’ 

concurrent sexual relationships, and partner concurrency 

is a factor associated with increased risk for STDs.4

 A 

number of studies have found significant associations 

between condom use and socio-demographic 

characteristics, including age, income, education, and 

acculturation.5 Because it is often the behavior of her 

male partner, rather than the woman’s own behavior, 

that increases a woman’s risk for STDs, even a woman 

who has only one partner may be obliged to practice 

safer sex such as using condoms.6

Women infected with C. trachomatis or N. 

gonorrhoeae can develop PID, which, in turn, can 

lead to reproductive system morbidity such as ectopic 

pregnancy and tubal factor infertility. An estimated 

10%–20% of women with chlamydia or gonorrhea may 

develop PID if they do not receive adequate treatment.7

Among women with PID, tubal scarring can cause 

infertility in 20% of women, ectopic pregnancy in 9%, 

and chronic pelvic pain in 18%.8

About 80%–90% of chlamydial infections and 50% of 

gonococcal infections in women are asymptomatic.9–11 

These infections are detected primarily through 

screening. The symptoms associated with PID are vague 

so 85% of women with PID delay seeking medical care, 

thereby increasing the risk for infertility and ectopic 

pregnancy.12 Data from 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%.13

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.14

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.15

When a woman has a syphilis infection during 

pregnancy, she can transmit the infection to the fetus 

in utero. Transmission can result in fetal death or an 

infant born with physical and mental developmental 

disabilities. Most cases of congenital syphilis are easily 

preventable if women are screened for syphilis and 

treated early during prenatal care.16

Observations

Chlamydia—United States 

During 2009–2010, the rate of reported chlamydial 

infections in women increased from 586.7 to 610.6 

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 15).
56 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2010

Prevalence Monitoring Project

Prenatal Clinics—In 2010, the median state-specific 

chlamydia test positivity among women aged 15–24 

years who were screened in selected prenatal clinics in 

16 states, Puerto Rico, and the Virgin Islands was 7.2% 

(range: 2.7% to 21.2%) (Figure B). 

Family Planning Clinics—In 2010, 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 

8.0% (range: 3.8% to 13.7%) (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 

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). After declining during 2006–2009, the 

gonorrhea rate for women (106.5 cases per 100,000 

females) increased slightly in 2010 (Figure 15, Table 15).

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 9 consecutive years (Figure 15, Tables 

15 and 16).

Prevalence Monitoring Project

Prenatal Clinics—In 2010, the median state-specific 

gonorrhea test positivity among women aged 15–24 

years who were screened in selected prenatal clinics in 

16 states, Puerto Rico, and the Virgin Islands was 0.9% 

(range: 0.0% to 4.2%) (Figure D).

Family Planning Clinics—In 2010, the median 

state-specific gonorrhea test positivity among women 

aged 15–24 years who were screened during visits to 

selected family planning clinics in 47 states, the District 

of Columbia, Puerto Rico, and the Virgin Islands was 

0.8% (range 0.0% to 4.1%) (Figure 26).

Congenital Syphilis

Trends in congenital syphilis usually follow trends in 

P&S syphilis among women, with a lag of 1–2 years 

(Figure 47). 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 34). The rate of 

congenital syphilis declined by 92.4% (from a peak 

of 107.6 cases to 8.2 cases per 100,000 live births) 

during 1991–2005 (Table 1). Rates of both female and 

congenital syphilis increased during 2005–2008, and 

have since declined. 

The rate of P&S syphilis among women was 1.1 cases 

per 100,000 women in 2010 (Table 27), and the rate of 

congenital syphilis was 8.7 cases per 100,000 live births 

in 2010 (Table 41). The highest rates of P&S syphilis 

among women and congenital syphilis were observed in 

the South (Figures E and F, Table 41).

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.17

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.18,19 However, hospitalizations for acute 

PID show modest declines in the last decade whereas 

hospitalizations for chronic PID have remained 

relatively constant (Figure G).

The estimated number of initial visits to physicians’ 

offices for PID from NDTI generally declined during 

2000–2009 (Figure H, Table 44).

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.19
STD Surveillance 2010 Special Focus Profiles: STDs in Women and Infants 57

1 Pulerwitz J, Amaro H, De Jong W, Gortmaker SL, Rudd R. 

Relationship power, condom use and HIV risk among women in 

the USA. AIDS Care. 2002;14(6):789-800.

2 McCree DH, Rompalo A. Biological and behavioral risk factors 

associated with STDs/HIV in women: implications for behavioral

interventions, In: Aral SO, Douglas JM,Lipshutz JA (editors). 

Behavioral Interventions for Prevention and Control of Sexually 

Transmitted Diseases (p. 310-324). New York, NY: Springer. 

3 El-Bassel N, Gilbert L, Krishnan S, Schilling R, Gaeta T, Purpura 

S, et al. Partner violence and sexual HIV-Risk behaviors among 

women in an inner-city emergency department. Violence Vict. 

1998;13(4):377-393.

4 Hogben M, Leichliter JS. Social determinants and sexually 

transmitted disease disparities. Sex Transm Dis. 35(12) S13-S18.

5 Manderson L, Chang T, Tye LC, Rajanayagam K. Condom use in 

heterosexual sex: a review of research, 1985–1994. In: Catalan J, 

Sherr L, Hedge B (editors). The impact of AIDS: psychological and 

social aspects of HIV Infection. p. 1-26. The Netherlands: Harwood 

Academic Publishers.

6 O’Leary A. A woman’s risk for HIV from a primary partner: 

balancing risk and intimacy. Annu Rev Sex Res. 2000; 11:191-234. 

7 Paavonen J, Westrom L, Eschenbach. Pelvic Inflammatory 

Disease. In: Holmes KK, Sparling PF, Stamm WE, Piot P, 

Wasserheit JN, Corey L, Cohen, MS, Watts DH, (editors). 

Sexually transmitted diseases. 4th ed. New York: McGraw-Hill; 

2008:1017-1050. 

8 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.

9 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; 2008:627-45.

10 Stamm WE. Chlamydia trachomatis infections in the adult. In: 

Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, 

Corey L, et al, (editors). Sexually transmitted diseases. 4th ed. 

New York: McGraw-Hill; 2008:575-93.

11 Johnson RE, Berman SM. Sexual transmission: Chlamydia 

trachomatis. In: Krämer A, Kretzschmar M, Krickeberg K, 

(editors). Modern infectious disease epidemiology. New York: 

Springer; 2009:357-80.

12 Hillis SD, Joesoef R, Marchbanks PA, Wasserheit JN, Cates 

W Jr, Westrom L. Delayed care of pelvic inflammatory disease 

as a risk factor for impaired fertility. Am J Obstet Gynecol. 

1993;168:1503-9.

13 Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes 

KK, Stamm WE. Prevention of pelvic inflammatory disease 

by screening for cervical chlamydial infection. N Engl J Med. 

1996;34(21):1362-6.

14 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.

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

Semin Perinatol. 2007;31(1):19-25.

16 Centers for Disease Control and Prevention. Guidelines for 

prevention and control of congenital syphilis. MMWR Morb 

Mortal Wkly Rep. 1988;37(No. SS-1).

17 Centers for Disease Control and Prevention. Congenital syphilis 

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

2010;59:413-17.

18 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.

19 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.

20 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.

21 Centers for Disease Control and Prevention. Ectopic pregnancy in 

the United States, 1990–1992. MMWR Morb Mortal Wkly Rep. 

1995;44:46-8.

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. Data from the National Hospital Discharge 

Survey (NHDS) suggest that hospitalizations for 

ectopic pregnancy are decreasing. Over the last decade, 

hospitalizations have decreased from 34.7 per 100,000 

in 2000 to 18.3 per 100,000 in 2009 (Figure I).20 The 

data that are available suggest that nearly half of all 

ectopic pregnancies are treated on an outpatient basis.21
58 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2010

469

444

556

532

451

1,178

Puerto Rico

236

Virgin

Islands

738

Guam

757

490 269

684

513

891

749

392

323

859

566

415

585

1,049 825

566

706

558

654

719

502

637

616

552

891

767

681

540

569 305

594

500

525

Figure A. Chlamydia—Women—Rates by State, United States and Outlying Areas, 2010

NOTE: The total chlamydial infection rate among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 605.8 per 

100,000 female population.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 288

 269

 435

 457

 512

 453

 724

 675

1,195

Rate per 100,000

population

677

<400.0 (n = 8)

400.1–600.0 (n = 24)

>600.0 (n = 22)

488

394

658

5.6

Puerto Rico

14.0

Virgin

Islands

17.0

Guam

6.7

10.4 11.9

15.1

6.0

7.7

9.3

5.5

4.7

21.2

11.7

6.6

6.7

2.7

6.5

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

by State, Infertility Prevention Project, United States and Outlying Areas, 2010

* 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 2010.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

* (n = 35)

Positivity, %

<5.0 (n = 2)

5.0–9.9 (n = 9)

>10.0 (n = 7)
STD Surveillance 2010 Special Focus Profiles: STDs in Women and Infants 59

31.3

24.7

57.1

64.0

11.5

207.6

Puerto Rico

6.8

Virgin

Islands

166.0

Guam

51.3

43.5 11.1

86.8

112.4

209.6

139.0

8.8

5.4

60.1

7.1

71.3

74.6

47.2

111.2

236.8

182.6

166.1

108.8

173.5

103.5

169.8

157.3

110.4

120.4

129.1

133.7

209.1

185.1

136.2

113.2

60.7

47.2

77.5

87.0

Figure C. Gonorrhea—Women—Rates by State, United States and Outlying Areas, 2010

NOTE: The total gonorrhea infection rate among women in the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 105.2 per 

100,000 female population.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 7.6

 8.8

 29.6

 22.3

 80.5

 70.2

136.3

137.2

338.9

Rate per 100,000

population

<19.0 (n = 8)

19.1–100.0 (n = 21)

>100.0 (n = 25)

49.0

35.1

Puerto Rico

0.2

Virgin

Islands

2.0

Guam

396

0.9

1.7

0.0

4.2

2.6

0.7

1.1

1.0

0.5

3.2

1.9

1.3

0.6

0.0 0.3 0.6

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

by State, Infertility Prevention Project, United States and Outlying Areas, 2010

* 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 2010.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

* (n = 35)

Positivity, %

<1.0 (n = 9)

1.0–1.9 (n = 5)

>2.0 (n = 4)
60 Special Focus Profiles: STDs in Women and Infants STD Surveillance 2010

1.1

0.0

6.7

12.1

0.0

0.0

Puerto Rico

4.3

Virgin

Islands

0.0

Guam

0.0

0.0 0.0

6.3

2.0

0.0

25.3

4.0

1.8

0.0

0.0

0.0

0.0

0.0

1.4

19.4

13.9

11.9

7.9

7.6

0.9

6.6

1.6

0.0

12.7

2.4

0.0

49.8

26.6

14.9

0.0

0.0 0.0

14.6

0.0

0.0

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

Outlying Areas, 2010

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 8.7 per 100,000 live births.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 0.0

 0.0

 1.3

 0.0

 4.8

 2.6

 16.4

28.2

 11.3

Rates per 100,000

live births

<1.0 (n = 25)

1.1–10.0 (n = 16)

>10.0 (n = 13)

0.0

0.1

0.1

0.4

0.5

0.0

0.0

Puerto Rico

0.9

Virgin

Islands

0.0

Guam

1.1

0.3 0.0

0.5

0.6

0.4

2.7

0.0

0.1

0.3

0.0

0.0

0.3

0.3

0.2

4.5

3.1

1.6

1.6

1.1

0.5

2.2

0.5

0.6

1.5

0.1

0.9

10.9

5.6

1.6

0.4

0.1 0.0

0.6

0.2

0.1

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

Outlying Areas, 2010

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 1.1 per 100,000 females.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

0.6

0.1

0.5

0.4

0.3

0.4

0.2

0.9

0.6

Rate per 100,000

population

<0.2 (n = 18)

0.21–4.0 (n = 33)

>4.0 (n = 3)

1.1
STD Surveillance 2010 Special Focus Profiles: STDs in Women and Infants 61

0

50

100

150

200

250

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

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

15–44 Years, United States, 2001–2010

Visits (in thousands)

NOTE: The relative standard errors for these estimates are 21.6%–30%. See Other Data Sources in the Appendix and Table 44.

SOURCE: IMS Health, Integrated Promotional ServicesTM. IMS Health Report, 1966–2010. 

Year

0

15

30

45

60

75

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Chronic

Acute, Unspecied

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

United States, 2000–2009

Hospitalizations (in thousands)

NOTE: The relative standard errors for acute and unspecied pelvic inammatory disease (PID) cases ranges from 8%–18%. The relative standard error for 

chronic PID cases ranges from 12%–28%. Data only available through 2009.

SOURCE: 2009 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 2010

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

2000–2009

Hospitalizations (in thousands)

NOTE: The relative standard errors for these estimates are 10%–23%. Data only available through 2009.

SOURCE: 2009 National Hospital Discharge Survey [Internet]. Atlanta: Centers for Disease Control and Prevention. Available from: 

http://www.cdc.gov/nchs/nhds/about/nhds.htm. 

Year

0

10

20

30

40

50

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
STD Surveillance 2010 Special Focus Profiles: STDs in Adolescents and Young Adults 63

STDs in Adolescents and Young Adults

Public Health Impact

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

 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 increased susceptibility 

to infection because of increased cervical ectopy. The 

higher prevalence of STDs among adolescents also 

may reflect multiple barriers to accessing quality STD 

prevention services, including lack of health insurance 

or ability to pay, lack of transportation, discomfort with 

facilities and services designed for adults, and concerns 

about confidentiality. Traditionally, intervention efforts 

have targeted individual-level factors associated with 

STD risk which do not address higher-level factors 

(e.g., peer norms and media influences) that may 

also influence behaviors.2

 Interventions for at-risk 

adolescents and young adults that address underlying 

aspects of the social and cultural conditions that affect 

sexual risk-taking behaviors are needed, as are strategies 

designed to improve the underlying social conditions 

themselves.3,4

Observations

Chlamydia

Rates of reported chlamydial infection among persons 

aged 15–19 years and 20–24 years continue to increase. 

During 2009–2010, rates increased 2.8% for those 

aged 15–19 years and 7.5% for those aged 20–24 years 

(Table 10).

15- to 19-Year-Old Women—In 2010, the rate among 

women aged 15–19 years was 3,378.2 cases per 100,000 

females, a 1.9% increase from the 2009 rate of 3,314.7 

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

20- to 24-Year-Old Women—In 2010, women aged 

20–24 years had the highest rate of chlamydia (3,407.9 

cases per 100,000 females) compared with any other 

age or sex group. Chlamydia rates for women in this age 

group increased 6.9% during 2009–2010.

15- to 19-Year-Old Men—Chlamydia rates for men 

aged 15–19 years increased 6.0% from 730.5 cases per 

100,000 males in 2009 to 774.3 cases per 100,000 in 

2010.

20- to 24-Year-Old Men—In 2010, as in previous 

years, men aged 20–24 years had the highest rate 

of chlamydia (1,187.0 cases per 100,000 males). 

Chlamydia rates for men in this age group increased 

8.8% during 2009–2010.

Gonorrhea

During 2009–2010, gonorrhea rates increased for persons 

aged 15–19 years (1.4%) and 20–24 years (4.9%). 

15- to 19-Year-Old Women—In 2010, as in previous 

years, women aged 15–19 years had the highest rate of 

gonorrhea (570.9 cases per 100,000 females) compared 

with any other age or sex group (Figure 19, Table 21). 

During 2009–2010, gonorrhea rates for women of this 

age group increased 0.9%. 

20- to 24-Year-Old Women—In 2010, as in previous 

years, women aged 20–24 years had the second highest 

rate of gonorrhea (560.7 cases per 100,000 females) 

compared with any other age or sex group (Figure 19, 

Table 21). During 2009–2010, gonorrhea rates for 

women in this age group increased 3.8%.

15- to 19-Year-Old Men—In 2010, as in previous years, 

men aged 15–19 years had the second highest rate of 

gonorrhea (253.4 cases per 100,000 males) (Figure 19, 

Table 21). During 2009–2010, gonorrhea rates for men in 

this age group increased 2.1% (Figure 21, Table 20).

20- to 24-Year-Old Men—In 2010, as in previous 

years, men aged 20–24 years had the highest rate of 

gonorrhea (421.0 cases per 100,000 males) (Figure 19, 

Table 21). During 2009–2010, gonorrhea rates for men 

in this age group increased 6.2%.

Primary and Secondary Syphilis 

Syphilis rates among women aged 15–19 years increased 

annually from 2004–2009 from 1.5 cases per 100,000 

females to 3.3 cases in 2009, but decreased to 3.0 in 

2010. Rates in women have been highest each year 
64 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2010

among those aged 20–24 years with 4.5 cases per 

100,000 females in 2010 (Figures 39 and 40, Table 34). 

Rates among men aged 15–19 years are much lower 

than the rates among men in older age groups (Figure 

39). However, rates in this group have increased since 

2002, from 1.3 cases per 100,000 males to 5.6 cases 

in 2010. Rates among men aged 20–24 years have 

also increased since 2002, from 5.2 cases per 100,000 

males to 21.9 cases in 2010. Not only did men aged 

20–24 years see large increases in rates, they also had 

the highest rate of syphilis among men of any age group 

since 2008 (Table 34). These changes reflect a significant 

shift in the age distribution of syphilis; rates were highest 

among men aged 35–39 years during 2002–2005. 

Prevalence Monitoring

Chlamydia test positivity among women aged 15–19 

years screened in selected family planning clinics 

increased in most of the 10 HHS regions during 

2006–2010 (Figure J). In region IX, positivity increased 

through 2009 and then decreased in 2010, which may 

be attributable to an increase in reported tests in 2010 

due to the implementation of an electronic data system. 

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 2010.

Chlamydial infection is widespread geographically 

and highly prevalent among socioeconomically 

disadvantaged young women and men entering the 

NJTP.5

 Specimens from students in each state and 

outlying area were tested by a single national contract 

laboratory.* 

Among women entering the program in 44 states, the 

District of Columbia, and Puerto Rico, the median 

state-specific chlamydia prevalence was 11.4% (range: 

5.2% to 21.3%) (Figure K). Among men entering 

the program in 48 states, the District of Columbia, 

and Puerto Rico, the median state-specific chlamydia 

prevalence was 7.2% (range: 1.8% to 12.7%) (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 43 states, the District 

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

gonorrhea prevalence in 2010 was 1.9% (range: 0.0% 

to 4.7%) (Figure M). Among men entering the program 

in 33 states, the District of Columbia, and Puerto Rico, 

the median state-specific gonorrhea prevalence was 

0.8% (range: 0.0% to 2.7%) (Figure N).

Juvenile Corrections Facilities

Among adolescent females entering selected juvenile 

corrections facilities, the median facility-specific 

chlamydia positivity was 14.5% (range: 4.0% to 

26.5%); the median gonorrhea positivity was 4.1% 

(range: 0.0% to 8.9%). Among adolescent males 

entering selected juvenile corrections facilities, the 

median facility-specific chlamydia positivity was 6.5% 

(range: 0.5 to 13.8%); the median gonorrhea positivity 

rate was 0.6% (range: 0.0% to 4.8%). 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 DiClemente RJ, Salazar LF, Crosby RA. A review of STD/HIV 

preventive interventions for adolescents: sustaining effects using an 

ecological approach. J. Pediatr. Psychol. 2007;32 (8): 888-906.

3 Sieving RE, Bernat DH, Resnick MD, Oliphant J, Pettingell S, 

Plowman S, et al. A clinic-based youth development program to 

reduce sexual risk behaviors among adolescent girls: prime time 

pilot study. Health Promot Pract (online). May 23, 2011.

4 Upchurch DM, Mason W, Kusunoki Y, Kriechbaum MJ. Social 

and behavioral determinants of self-reported STD among 

adolescents. Perspect Sex Reprod Health. 2004;36(6):276-287. 

5 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 2010 Special Focus Profiles: STDs in Adolescents and Young Adults 65

* 2009 percent positivity for Region VI previously published in the 2009 Surveillance report has been corrected.

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, 2006–2010

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

5.5

06

5.6

07

5.8

08

5.8

09

7.2

10

7.3

06

7.6

07

8.3

08

8.9

09

9.5

10

6.5

06

6.8

07

7.9

08

8.0

09

9.2

10

11.0

06

11.7

07

11.9

08

11.8

09

11.9

10

8.9

06

9.0

07

9.3

08

9.8

09

11.2

10

10.2

06

10.7

07

12.6

08

12.9

09

13.5

10

7.5

06

7.6

07

7.9

08

9.0

09

9.3

10

7.7

06

8.1

07

8.7

08

8.5

09

9.2

10

8.3

06

9.0

07

9.3

08

9.8

09

6.5

10

6.6

06

6.8

07

7.2

08

7.0

09

8.1

10

5.2

6.1

6.1

11.8

5.7

9.9

8.4

12.5

15.5

10.4

Puerto Rico

8.5

Virgin

Islands

Guam

6.2

6.0

8.6

10.8

11.1

16.5

14.6

18.3

14.9

16.4

13.9

11.9

11.1

10.8

12.8

14.4

13.0

14.0

12.3

19.6

21.3

14.6

12.4

9.8

9.2

13.1

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, 2010

* Fewer than 100 women who resided in these states/areas and entered the National Job Training Program were screened for chlamydia in 2010.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

9.6

 5.4

 11.6

11.1

15.4

9.4

10.4

12.0

* (n = 7)

Prevalence, %

<10.0 (n = 16)

10.0–14.9 (n = 23)

9.2 >15.0 (n = 7)
66 Special Focus Profiles: STDs in Adolescents and Young Adults STD Surveillance 2010

0.0

0.3

0.4

0.8

0.0

1.7

Puerto Rico

0.0

Virgin

Islands

Guam

396

0.0

0.8

1.5 0.0

0.5

0.4

3.3

2.3

1.7

3.2

1.8

3.3

2.8

2.8

2.7

3.6

3.1

2.4

2.9

2.8

1.9

4.2

4.3

3.4

1.9

1.4

0.0

2.8

0.0

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, 2010

* Fewer than 100 women who resided in these states/areas and entered the National Job Training Program were screened for gonorrhea in 2010.

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

1.8

0.5

0.0

2.1

4.7

2.9

1.9

1.9

* (n =8)

Prevalence, %

<2.0 (n = 25)

≥2.0 (n = 20)

2.3

2.7

4.6

3.3

2.7

2.7

3.3

Puerto Rico

5.4

Virgin

Islands

Guam

396

4.4 6.0

7.1

6.8

11.3

8.2

4.4

2.7

8.8

4.4

4.2

5.3

5.2

11.8

10.4

12.1

7.3

11.5

7.4

11.4

11.2

7.2

9.5

7.5

7.9

12.2

10.1

8.7

8.6

2.1 9.5

3.7

4.0

7.7

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, 2010

* Fewer than 100 men who resided in these states/areas and entered the National Job Training Program were screened for chlamydia in 2010.

VT

NH

MA

RI

CT

NJ

DE

MD

DC

 3.8

 5.6

 1.8

 5.7

 12.0

 9.8

 10.0

12.7

* (n = 3)

Prevalence, %

<10.0 (n = 38)

≥10.0 (n = 12)

6.7
STD Surveillance 2010 Special Focus Profiles: STDs in Adolescents and Young Adults 67

0.0

0.2

0.9

Puerto Rico

0.0

Virgin

Islands

Guam

396

0.1

0.6

0.8

0.5

0.6

1.5

0.0

0.4

0.5

0.8 1.1

0.6

1.5

0.6

1.8

1.1

0.8

1.5

1.1

1.4

2.7

2.0

0.5

0.0 0.4

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, 2010

* Fewer than 100 men who resided in these states/areas and entered the National Job Training Program were screened for gonorrhea in 2010.

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

0.8

0.9

0.0

0.4

0.9

1.0

* (n = 18)

Prevalence, %

<2.0 (n = 33)

≥2.0 (n = 2)

STD Surveillance 2010 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 population characteristics that 

correlate with other fundamental determinants of health 

status.1,2

Social and economic conditions, such as high rates of 

poverty, income inequality, unemployment, and low 

educational attainment, can make it more difficult 

for individuals to protect their sexual health.3

 People 

who struggle financially are often experiencing life 

circumstances that increase their risk for STDs.4

Those who cannot afford basic necessities may have 

trouble accessing and affording quality sexual health 

services.5

 As an example, in 2009, the poverty rates, 

unemployment rates, and high school drop-out rates for 

blacks, American Indians/Alaska Natives, and Hispanics 

were higher than for whites, differences commensurate 

with observed disparities in STD burden.6–8 Recent data 

show that nearly one-fifth of blacks do not have health 

insurance. Many people of Hispanic ethnicity face 

similar challenges; and for some, there are the additional 

barriers arising from immigration or undocumented 

citizenship status.9,10 Even when health care is available, 

fear and distrust of health care institutions can 

negatively affect the health care-seeking experience 

for many racial/ethnic minorities when there is social 

discrimination, provider bias, or the perception that 

these may exist.11

In communities where STD prevalence is higher, 

individuals may have a more difficult time reducing 

their risk for infection. With each sexual encounter, they 

face a greater chance of encountering an infected partner 

than those in lower prevalence settings.12 Acknowledging 

the inequity in STD rates by race or ethnicity is one of 

the first steps in empowering affected communities to 

organize and focus on this problem. 

STD Reporting Practices

Surveillance data are based on cases of STDs reported to 

state and local health departments (see Interpreting STD 

Surveillance Data in the Appendix). In many state and 

local health jurisdictions, reporting from public sources 

(e.g., STD clinics) is thought to be more complete 

than reporting from private sources. Because minority 

populations may use public clinics more than whites, 

differences in rates between minorities and whites 

may be increased by this reporting bias.13 However, 

prevalence data from population-based surveys, such 

as NHANES and the National Longitudinal Study of 

Adolescent Health, confirm the existence of marked 

STD disparities in some minority populations.14,15

Completeness of Race/Ethnicity Data

Many cases are reported with race and/or ethnicity 

missing. Rate data presented in this report are not 

adjusted for missing race or ethnicity.

Chlamydia—In 2010, 26.2% of chlamydia case reports 

were missing race or ethnicity data, ranging by state 

from 0.5% to 55.9% (Table A1).

Gonorrhea—In 2010, 20.0% of gonorrhea case reports 

were missing information on race or ethnicity data, 

ranging by state from 0.0% to 42.9% (Table A1).

Syphilis—In 2010, 2.5% of syphilis case reports were 

missing information on race or ethnicity data, ranging 

from 0.0% to 19.2% among states with 10 or more 

cases of P&S syphilis (Table A1).

Observations

Chlamydia

Chlamydia rates based on reported cases increased 

during 2009–2010 among all racial and ethnic 

groups (Figure 6). During 2006–2010, chlamydia 

rates increased by 26.9% among blacks, 4.9% among 

American Indians/Alaska Natives, 11.0% among 

Hispanics, 23.7% among Asians/Pacific Islanders, and 

25.3% among whites. 

Blacks—In 2010, the overall rate among blacks in 

the United States was 1,167.5 cases per 100,000, a 

4.0% increase from the 2009 rate of 1,122.2 cases per 

100,000. The rate of chlamydia among black women 

was over seven times the rate among white women 

(1,536.5 and 205.1 per 100,000 women, respectively) 
70 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2010

(Figure O). The chlamydia rate among black men was 

almost 11 times the rate among white men (761.8 and 

69.9 cases per 100,000 men, respectively).

Chlamydia rates were highest for blacks aged 15–19 

and 20–24 years in 2010 (Table 11B). The chlamydia 

rate among black females aged 15–19 years was 7,719.1 

cases per 100,000 women, which was 6.6 times the rate 

among white females in the same age group (1,172.1). 

The rate among black women aged 20–24 years was 

over five times the rate among white women in the same 

age group (Table 11B).

Similar racial disparities in reported chlamydia rates 

exist among men. Among males aged 15–19 years, the 

rate among blacks was 13.1 times the rate among whites 

(Table 11B). The chlamydia rate among black men 

aged 20–24 years was almost eight times the rate among 

white men of the same age group (3,292.5 and 415.4 

cases per 100,000 men, respectively).

American Indians/Alaska Natives—In 2010, the 

chlamydia rate among American Indians/Alaska Natives 

was 592.8 cases per 100,000 population, an increase of 

7.8% from the 2009 rate of 549.8 cases per 100,000. 

Overall, the rate of chlamydia among American Indians/

Alaska Natives in the United States was more than four 

times the rate among whites. 

Asians/Pacific Islanders—In 2010, the chlamydia 

rate among Asians/Pacific Islanders was 115.3 cases per 

100,000 population, an increase of 5.1% from the 2009 

rate of 109.7 cases per 100,000. The overall rate among 

Asians/Pacific Islanders was lower than the rate among 

whites.

Hispanics—In 2010, the chlamydia rate among 

Hispanics was 369.6 cases per 100,000 population, 

which is a 4.4% increase from the 2009 rate of 353.9 

cases per 100,000 and nearly three times the rate among 

whites.

Gonorrhea

During 2009–2010, gonorrhea rates increased 21.5% 

among American Indians/Alaska Natives (87.0 to 

105.7), 13.1% among Asians/Pacific Islanders (13.7 to 

15.5), 11.9% among Hispanics (44.6 to 49.9), 9.0% 

among whites (21.2 to 23.1) and 0.3% among blacks 

(431.1 to 432.5) (Figure 22).

Blacks—In 2010, 69% of all reported cases of 

gonorrhea occurred among blacks. The rate of 

gonorrhea among blacks in 2010 was 432.5 cases 

per 100,000 population (Figure 22), which was 18.7 

times the rate among whites (23.1). This disparity has 

changed little in recent years (Figure P). This disparity 

was larger for black men (22.2 times) than for black 

women (16.2 times) (Figure Q). 

As in 2009, the disparity in gonorrhea rates for blacks in 

2010 was larger in the Midwest and Northeast than in 

the West or the South (Figure R).

Considering all racial/ethnic and age categories, 

gonorrhea rates were highest for blacks aged 15–19 

and 20–24 years in 2010 (Table 22B). Black women 

aged 15–19 years had a gonorrhea rate of 2,032.4 cases 

per 100,000 women. This rate was 17.1 times the rate 

among white women in the same age group (119.0). 

Black women aged 20–24 had a gonorrhea rate of 

1,997.6 cases per 100,000 women, which was 12.7 

times the rate among white women in the same age 

group (156.7) (Table 22B). 

Black men aged 15–19 years had a gonorrhea rate of 

1,024.7 cases per 100,000 men, which was 37.4 times 

the rate among white men in the same age group (27.4). 

Black men aged 20–24 years had a gonorrhea rate of 

1,768.8 cases per 100,000 men, which was 22.6 times 

the rate among white men in the same age group (78.2) 

(Table 22B).

American Indians/Alaska Natives—In 2010, the 

gonorrhea rate among American Indians/Alaska Natives 

was 105.7 cases per 100,000 population, which was 

4.6 times the rate among whites (Figure 22, Figure P). 

The disparity between gonorrhea rates for American 

Indians/Alaska Natives and whites was larger for 

American Indian/Alaska Native women (5.0 times) than 

for American Indian/Alaska Native men (3.9 times) 

(Figure Q). In 2010, the disparity in gonorrhea rates for 

American Indians/Alaska Natives was higher in the West 

and Midwest than in the Northeast or South (Figure R).

Asians/Pacific Islanders—In 2010, the gonorrhea 

rate among Asians/Pacific Islanders was 15.5 cases per 

100,000 population, which was lower than the rate 

among whites (Figure 22, Figure P). This difference is 

larger for Asian/Pacific Islander women than for Asian/

Pacific Islander men (Figure Q). In 2010, rates among 
STD Surveillance 2010 Special Focus Profiles: STDs in Racial and Ethnic Minorities 71

Asians/Pacific Islanders were again lower than rates 

among whites in all four regions of the United States 

(Figure R).

Hispanics—In 2010, the gonorrhea rate among 

Hispanics was 49.9 cases per 100,000 population, which 

was 2.2 times the rate among whites (Figures 22 and P). 

This disparity between Hispanics and whites was similar 

to that in recent years and was higher for Hispanic men 

than for Hispanic women (Figure Q). The disparity in 

gonorrhea rates for Hispanics was highest in the Northeast 

and lowest in the West (Figure R).

Primary and Secondary Syphilis

The syphilis epidemic in the late 1980s occurred primarily 

among men who have sex with women only (MSW), 

women, and minority populations.16,17 During the 

1990s, the rate of P&S syphilis declined among all racial 

and ethnic groups (Figure 42). During 2006–2010, the 

rate increased among all racial and ethnic groups except 

American Indians/Alaska Natives (Figure 42).

Blacks—During 2009–2010, the rate of P&S syphilis 

among blacks decreased 8.7% (from 18.4 to 16.8 cases 

per 100,000 population). In 2010, 47.4% of all cases 

reported to CDC were among blacks and 31.0% of all 

cases were among whites. 

The overall 2010 rate for blacks was eight times the rate 

for whites, while the 2009 rate was 9.2 times the rate 

for whites (Figure 42). In 2010, the rate of P&S syphilis 

among black men was 7.1 times the rate among white 

men; the rate among black women was 21 times the rate 

among white women (Figure S).

In some age groups, particularly black men (including 

men who have sex with men) and women aged 15–19 

and 20–24 years, disparities have increased markedly in 

recent years as rates of disease have increased (Figures 

T and U).18 During 2006–2010, rates among men 

aged 15–19 years increased the most among black men 

(from 14.0 to 24.5 cases per 100,000 population) (Table 

35B). During the same period, rates among black men 

aged 20–24 years increased from 39.6 to 92.5 cases per 

100,000 population (134%); the magnitude of this 

increase (52.9 cases per 100,000 population) was the 

greatest reported regardless of age, sex, or race/ethnicity. 

The 2010 rate among black men aged 15–19 years was 

25 times the rate for whites. 

The largest rate increases among black women during 

2006–2010 occurred among women aged 20–24 

and 25-29 years (by 8.6 and 6.0 cases per 100,000 

population, respectively). In 2010, rates for black 

women aged 15–19 years were 38 times the rate 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.19,20

American Indians/Alaska Natives—During 2009–

2010, the rate of P&S syphilis among American 

Indians/Alaska Natives increased 8.7% (from 2.3 to 2.5 

cases per 100,000 population). In 2010, 0.5% of all 

cases reported to CDC were among American Indians/

Alaska Natives. The 2010 rate of P&S syphilis for 

American Indians/Alaska Natives was 1.2 times the rate 

for whites (Figure 42).

Asians/Pacific Islanders—During 2009–2010, the 

rate of P&S syphilis among Asians/Pacific Islanders 

decreased 13.3% (from 1.5 to 1.3 cases per 100,000 

population). In 2010, 1.5% of all cases reported to 

CDC were among Asians/Pacific Islanders. The 2010 

rate of P&S syphilis for Asians/Pacific Islanders was 0.6 

times the rate for whites (Figure 42).

Hispanics—During 2009–2010, the rate of P&S 

syphilis among Hispanics increased 9.5% (from 4.2 to 

4.6 cases per 100,000 population). In 2010, 16.2% of 

all cases reported to CDC were among Hispanics. The 

2010 rate of P&S syphilis for Hispanics was 2.2 times 

the rate for whites (Figure 42).

Congenital Syphilis

In 2010, the rate of congenital syphilis was 33.1 cases 

per 100,000 live births among blacks and 8.4 cases per 

100,000 live births among Hispanics. Race/ethnicity for 

cases of congenital syphilis is based on the mother’s race/

ethnicity. These rates were 12.3 and 3.1 times, respectively, 

the rate among whites (2.7 cases per 100,000 live births). 
72 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2010

1 Hogben M, Leichliter JS. Social determinants and sexually 

transmitted disease disparities. Sex Transm Dis. 2008;35(12 

Suppl):S13-8.

2 Cunningham PJ, Cornelius LJ. Access to ambulatory care for 

American Indians and Alaska Natives; the relative importance of 

personal and community resources. Soc Sci Med. 1995:40(3):

393-407. 

3 Gonzalez JS, Hendriksen ES, Collins EM, Duran RE, Safren SA. 

Latinos and HIV/AIDS: examining factors related to disparity and 

identifying opportunities for psychosocial intervention research. 

AIDS Behav. 2009:13:582-602.

4 Laumann EO, Youm Y. Racial/ethinic group differences in the 

prevalence of sexually transmitted diseases in the United States: a 

network explanation. Sex Transm Dis. 1999;26(5):250-61. 

5 Institute of Medicine. The Hidden Epidemic: Confronting 

Sexually Transmitted Diseases. Washington, DC: National 

Academy Press; 1997. 

6 DeNavas-Walt C, Proctor BD, Smith JC. U.S. Census Bureau, 

Current Population Reports, P60-238, Income, Poverty, and 

Health Insurance Coverage in the United States: 2009. U.S. 

Government Printing Office, Washington, DC, 2010.

7 U.S. Department of Labor U.S. Bureau of Labor Statistics. Labor 

Force Characteristics by Race and Ethnicity, 2009. August 2010.

Report 1026.

8 U.S. Department of Commerce, Census Bureau. Current 

Population Survey (CPS), October 1967-October 2009.

9 Pérez-Escamilla R. Health care access among latinos: implications 

for social and health care reform. J Hispanic High Educ. 

2010:9(1):43-60.

10 Berk ML, Schur CL. The effect of fear on access to care 

among undocumented latino immigrants. J Immigr Health. 

2001;3(3):151-156. 

11 Wiehe SE, Rosenman MB, Wang J, Katz BP, Fortenberry D. 

Chlamydia screening among young women: individual- and 

provider-level differences in testing. Pediatrics. 2011;127(2):

e336-44.

12 Hogben M, Leichliter JS. Social determinants and sexually 

transmitted disease disparities. Sex Transm Dis. 2008;35(12 

Suppl):S13-8. 

13 Miller WC. Epidemiology of chlamydial infection: are we losing 

ground? Sex Transm Infect. 2008;84:82-6. 

14 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.

15 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.

16 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.

17 Peterman TA, Heffelfinger JD, Swint EB, Groseclose SL. 

The changing epidemiology of syphilis. Sex Transm Dis. 

2005;32(Suppl 10):S4-10.

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

secondary syphilis among black and Hispanic men who have 

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

2011;155(3):145-51.

19 Centers for Disease Control and Prevention. Increase in newly 

diagnosed HIV infections among young black men who have sex 

with men--Milwaukee County, Wisconsin, 1999-2008.MMWR 

Morb Mortal Wkly Rep. 2011;60(4):99-102.

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

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

implications for human immunodeficiency virus transmission 

and public health interventions. Sex Transm Dis. 2011 

May;38(5):367-71.
STD Surveillance 2010 Special Focus Profiles: STDs in Racial and Ethnic Minorities 73

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

59.7

761.8

184.4

69.9

233.7

276.4

167.2

1,536.5

567.6

205.1

610.6

898.7

Men Rate (per 100,000 population) Women

Race/

Ethnicity

Figure O. Chlamydia—Rates by Race/Ethnicity and Sex, United States, 2010

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Hispanics

Blacks

Asians/Pacic Islanders

American Indians/Alaska Natives

Figure P. Gonorrhea—Rate Ratios* by Race/Ethnicity, United States, 2001–2010

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
74 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2010

Midwest

West

Figure R. Gonorrhea—Rate Ratios* by Race/Ethnicity and Region, United States, 2010

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

17.1

433.6

48.7

19.5

94.1

77.0

14.0

430.8

51.1

26.6

106.5

133.5

Men Rate (per 100,000 population) Women

Race/

Ethnicity

Figure Q. Gonorrhea—Rates by Race/Ethnicity and Sex, United States, 2010
STD Surveillance 2010 Special Focus Profiles: STDs in Racial and Ethnic Minorities 75

35 28 21 14 7 0 0 7 14 21 28 35

* AI/AN = American Indians/Alaska Natives; A/PI = Asians/Paci	c Islanders.

2.6

28.2

8.5

4.0

7.9

4.3

0.1

6.4

0.5

0.3

1.1

0.7

Men Rate (per 100,000 population) Women

Figure S. Primary and Secondary Syphilis—Rates by Race/Ethnicity and Sex, United States, 2010

AI/AN*

A/PI*

Blacks

Hispanics

Whites

Total

Race/

Ethnicity

0

5

10

15

20

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

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, 2001–2010

Rate (per 100,000 population)

Year
76 Special Focus Profiles: STDs in Racial and Ethnic Minorities STD Surveillance 2010

0

5

10

15

20

25

30

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

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, 2001–2010

Rate (per 100,000 population)

Year

0

10

20

30

40

50

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

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, 2001–2010

Rate (per 100,000 live births)

NOTE: Less than 1% of cases had missing maternal race/ethnicity information and were excluded.

Year
STD Surveillance 2010 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

Although a number of individual-level risk behaviors 

(e.g., higher numbers of lifetime sex partners, higher 

rates of partner change and partner acquisition rates, 

and unprotected sex) significantly contribute to the 

ongoing disparities in the sexual health of MSM, other 

interpersonal and societal-level factors have also been 

associated with higher rates of sexually transmitted 

infections, including HIV among MSM.7

 MSM who 

have lower economic status are particularly vulnerable 

to poorer health outcomes, especially if they belong to 

racial and ethnic minority populations.8

 For example, 

studies show that for black MSM, factors such as 

emotional and social support can drive sexual risk-taking 

and, in addition, broader societal factors such as power, 

privilege, and position in society also play a significant 

role.9

 Similarly, for Hispanic men, the relationship 

between individual experiences of oppression (e.g., 

social discrimination and financial hardship) and risk for 

sexually transmitted infections in the United States has 

been documented.10

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.11 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, 2010

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.12 SSuN 

currently includes 12 collaborating local and state health 

departments. In 2010, a total of 41 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.13

For data reported in this section, MSM were defined 

as men who either reported having a male sex partner 

or who self-reported as gay/homosexual or bisexual. 

MSW were defined as men who reported having sex 

with women only or who did not report the sex of 

their sex partner, but reported that they considered 

themselves straight/heterosexual. More detailed 

information about SSuN methodology can be found in 

the STD Surveillance Network section of the Appendix, 

Interpreting STD Surveillance Data.

Gonorrhea and Chlamydial Infection

In 2010, 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 Birmingham (where the proportions were 

equal), Baltimore, and Hartford/New Haven (where the 

proportion for chlamydia was higher). 

Across the participating sites, about the same number of 

MSM were tested for gonorrhea (18,462) and chlamydia 

(17,915). The median site-specific gonorrhea prevalence 

was 15.5% (range by site: 9.4%–25.8%). The median 

site-specific chlamydia prevalence was 13.0% (range by 

site: 7.5%–19.2%). For this report, a person who tested 

positive for gonorrhea or chlamydia more than one time 

was counted only once for each disease.
78 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2010

Co-infection with P&S Syphilis and HIV

In 2010, the proportion of MSM who presented to 

SSuN clinics with P&S syphilis infection who also were 

infected with HIV ranged from 25% in Hartford/New 

Haven to 54% in San Francisco (Figure X). The median 

site-specific proportion was 38.0%. P&S syphilis was 

identified by provider diagnosis and HIV was identified 

by laboratory report, self-report, or provider diagnosis.

HIV status and STDs

When comparing the prevalence of STDs by HIV status 

in MSM visiting SSuN STD clinics, the prevalence was 

lower among HIV-negative MSM or MSM of unknown 

status than among HIV-positive MSM (Figure Y). 

The prevalence of P&S syphilis was 2.6% among 

HIV-negative MSM or MSM of unknown status and 

10.5% among HIV-positive MSM. Urethral gonorrhea 

positivity was 10.3% in MSM who were HIV-negative 

or of unknown status and 15.2% in HIV-positive 

MSM. Rectal gonorrhea positivity was 8.1% in MSM 

who were HIV-negative or of unknown status and 

14.4% in HIV-positive MSM; pharyngeal gonorrhea 

positivity was 6.3% in MSM who were HIV-negative 

or of unknown status and 7.6% in HIV-positive MSM. 

Urethral chlamydia was 7.8% in MSM who were 

HIV-negative or of unknown status and 8.4% in HIVpositive MSM; rectal chlamydia positivity was 11.7% 

in MSM who were HIV-negative or of unknown HIV 

status and 19.6% in HIV-positive MSM. 

Nationally Notifiable Syphilis 

Surveillance Data

In 2008, the male-female rate ratio decreased to 5.0, 

but increased to 5.6 in 2009, increasing to 7.2 in 2010 

(Figure 35). These increases support analyses of case 

report data showing increases in P&S syphilis among 

MSM during 2005–2008, particularly among black and 

Hispanic MSM, and MSM aged 15–29 years.14

In 2010, MSM accounted for 67% of all P&S syphilis 

cases in 44 states and the District of Columbia that 

provided information about sex of sex partners. MSM 

accounted for more cases than MSW or women in all 

racial and ethnic groups (Figure 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.4,15 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 28.9% 

in 2010 (Figure Z). The proportion of isolates from 

MSM varies geographically, with the largest proportion 

reported from the West Coast (Figure AA).

More information on GISP can be found in the 

Gonorrhea section of the National Profile.
STD Surveillance 2010 Special Focus Profiles: STDs in Men Who Have Sex with Men 79

1 Fox KK, del Rio C, Holmes KK, Hook EW III, 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 Koblin BA, Husnik MJ, Marla JB, Colfax GC, Huang Y, Madison 

ME, et al. Buchbinder, SC. Risk factors for HIV infection among 

men who have sex with men. AIDS. 2006;20(5):731-739.

8 Williams DR. The health of men: structured inequalities and 

opportunities. Am J Public Health. 2003;93:724-731.

9 Mays VM, Cochran SD, Zamudio A. HIV prevention research: 

are we meeting the needs of African American men who have sex 

with men? J Black Psychol. 2004;30:78.

10 Díaz RM, Ayala G, Bein E. Sexual risk as an outcome of social 

oppression: data from a probability sample of Latino gay men 

in three U.S. cities. Cultur Divers Ethnic Minor Psychol. 

2004;10(3):255-267. 

11 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.

12 Rietmeijer K, Donnelly J, Bernstein K, Bissette J, Martins S, 

Pathela P, et al. Here comes the SSuN—early experiences with the 

STD Surveillance Network. Pub Health Rep. 2009;124(Suppl 

2):72-77.

13 Centers for Disease Control and Prevention. Sexually Transmitted 

Disease Surveillance 2008. Atlanta: U.S. Department of Health 

and Human Services; 2009.

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

secondary syphilis among black and Hispanic men who have sex 

with men: case report data from 27 States. Ann Intern Med. 2011 

Aug 2;155(3):145-51.

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

III, Thompson S, et al. National surveillance of antimicrobial 

resistance in Neisseria gonorrhoeae. JAMA. 1990;264(11):1413-7.
80 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2010

0

5

10

15

20

25

30

Hartford/

New Haven

New York

Philadelphia City

Baltimore

Richmond

New Birmingham

Orleans

Chicago

Denver

Los Seattle

Angeles

San

Francisco

Chlamydia

Gonorrhea

Figure W. STD Surveillance Network (SSuN)—Gonorrhea and Chlamydia—Proportion of 

MSM* Testing Positive for Gonorrhea and Chlamydia, by Site, 2010

Percentage

* MSM = men who have sex with men.

0

10

20

30

40

50

60

70

80

90

100

Hartford/

New Haven

New York

City

Philadelphia

Baltimore

New Richmond

Orleans

Chicago

Denver

Los Seattle

Angeles

San

Francisco

Figure X. STD Surveillance Network (SSuN)—Primary and Secondary Syphilis and 

HIV—Proportion of MSM* with Primary and Secondary Syphilis Who Are 

Co-infected with HIV, 2010

Percentage

* MSM = men who have sex with men.

NOTE: Includes sites that reported data on at least 5 MSM with P&S syphilis in 2010.
STD Surveillance 2010 Special Focus Profiles: STDs in Men Who Have Sex with Men 81

0

5

10

15

20

25

30

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

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

gonorrhoeae Isolates Obtained from MSM* Attending STD Clinics, 1990–2010

Percentage

* MSM = men who have sex with men.

Year

HIV–†

Figure Y. STD Surveillance Network (SSuN)—Proportion of MSM* Attending STD 

Clinics with Primary and Secondary Syphilis, Gonorrhea or Chlamydia 

by HIV Status, 2010

Percentage

* MSM = men who have sex with men. †

 HIV negative status includes persons of unknown status for this analysis. ‡ GC urethral and CT urethral include results from both urethral and urine specimens.

HIV+

0

4

8

12

16

20

CT CT rectal ‡ GC GC pharyngeal GC rectal urethral ‡ P&S syphilis urethral
82 Special Focus Profiles: STDs in Men Who Have Sex with Men STD Surveillance 2010

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

Neisseria gonorrhoeae Isolates Obtained from MSM* Attending STD 

Clinics, by Site, 2007–2010

* MSM = men who have sex with men.

NOTE: Participating sites include ALB = Albuquerque, NM; ATL = Atlanta, GA; BAL = Baltimore, MD; BHM = Birmingham, AL; CHI = Chicago, IL; 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

07 08 09 10

% of Isolates 

from MSM

Year

 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
STD Surveillance 2010 Special Focus Profiles: STDs in Persons Entering Corrections Facilities 83

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 2010, STD screening data from corrections 

facilities were reported in 36 states and Puerto Rico 

for chlamydia and gonorrhea. Line-listed (i.e., casespecific) data for chlamydia and gonorrhea are provided 

to CDC through the Infertility Prevention Project 

(IPP). The figures and tables presented in this section 

represent 47,489 chlamydia tests of women (25,089 

from juvenile corrections facilities and 22,400 from 

adult facilities), 112,133 chlamydia tests of men (77,027 

from juvenile facilities and 35,106 from adult facilities), 

43,319 gonorrhea tests of women (21,401 from juvenile 

facilities and 21,918 from adult facilities), and 106,371 

gonorrhea tests of men (72,446 from juvenile facilities 

and 33,925 from adult facilities). Syphilis data from 

notifiable disease surveillance are reported to CDC by 

local and state STD prevention programs.

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 128 juvenile 

corrections facilities, the overall chlamydia positivity was 

6.9% (Figure BB). Chlamydia positivity ranged from 

1.5% for adolescent males aged 12 years to 10.0% for 

those aged 18 years. 

Females in Juvenile Corrections Facilities—Among 

females aged 12–18 years entering 73 juvenile 

corrections facilities, the overall chlamydia positivity was 

15.3% (Figure BB). Positivity ranged from 7.2% for 

females aged 12 years to 17.0% for those aged 16 years. 

Men in Adult Corrections Facilities—Among men 

entering 55 adult corrections facilities in 2010, positivity 

in men aged younger than 20 years (11.7%) was higher 

than the overall prevalence observed in adolescent 

males entering juvenile facilities (6.9%) (Figure CC). 

Chlamydia positivity decreased with age, from 11.7% 

for those aged younger than 20 years to 1.9% for those 

aged older than 34 years. Overall chlamydia positivity 

among adult men entering corrections facilities in 2010 

was 6.7%. 

Women in Adult Corrections Facilities—Among 

women entering 32 adult corrections facilities in 2010, 

positivity was 6.9% (Figure CC). Chlamydia positivity 

decreased with age, from 15.3% for those aged younger 

than 20 years to 2.4% for those aged older than 34 

years. Overall chlamydia positivity in women entering 

adult corrections facilities (6.9%) was substantially 

lower than that in adolescent females entering juvenile 

corrections facilities (15.3%). However, chlamydia 

positivity among women aged younger than 20 years 

entering adult corrections facilities was similar to that 

among women entering juvenile corrections facilities.
84 Special Focus Profiles: STDs in Persons Entering Corrections Facilities STD Surveillance 2010

Gonorrhea

Overall, gonorrhea positivity in women was uniformly 

higher than in men for all age groups.

Males in Juvenile Corrections Facilities—The overall 

gonorrhea positivity for adolescent males entering 123 

juvenile corrections facilities in 2010 was 1.1% (Figure 

DD). Positivity increased with age, from 0.1% for those 

aged 12 years to 2.1% for those aged 18 years.

Females in Juvenile Corrections Facilities—The 

overall gonorrhea positivity for adolescent females 

entering 60 juvenile corrections facilities in 2010 was 

4.2% (Figure DD). Positivity generally increased with 

increasing age, from 2.8% for those aged 12 years to 

5.1% of those aged 18 years. 

Men in Adult Corrections Facilities—The overall 

gonorrhea positivity for men entering 55 adult 

corrections facilities in 2010 was 1.0% (Figure EE). 

Positivity was highest in men aged younger than 20 

years (1.6%) and declined with age to 0.4% in men 

aged older than 34 years. Men aged younger than 

20 years entering adult facilities (1.6%) had higher 

gonorrhea positivity than males entering juvenile 

corrections facilities (1.1%).

Women in Adult Corrections Facilities—Among 

women entering 32 adult corrections facilities in 2010, 

overall gonorrhea positivity was 1.9% (Figure EE). 

Positivity decreased with age, from 3.7% among those 

aged younger than 20 years to 0.9% among those aged 

older than 34 years. Women aged younger than 20 years 

entering adult facilities (3.7%) had lower gonorrhea 

positivity than females entering juvenile corrections 

facilities (4.2%).

Syphilis

In 2010, reports of P&S syphilis cases from correctional 

facilities accounted for 5% of P&S syphilis among 

MSW, 3% among women, and 1% among MSM 

(Figure 46).

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 2010 Special Focus Profiles: STDs in Persons Entering Corrections Facilities 85

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

2.4

3.8

6.1

7.8

8.8

10.0

6.9

1.5 7.2

10.1

13.3

16.2

17.0

15.0

16.3

15.3

Men Positivity Women

Age

Figure BB. Chlamydia—Positivity by Age and Sex, Juvenile Corrections Facilities, 2010

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

9.6

5.5

3.9

1.9

6.7

11.7

10.5

5.9

4.6

2.4

6.9

15.3

Men Positivity Women

Age

Figure CC. Chlamydia—Positivity by Age Group and Sex, Adult Corrections Facilities, 2010
86 Special Focus Profiles: STDs in Persons Entering Corrections Facilities STD Surveillance 2010

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

0.2

0.6

0.8

1.3

1.3

2.1

1.1

0.1 2.8

3.4

4.1

4.4

4.2

4.2

5.1

4.2

Men Positivity Women

Age

Figure DD. Gonorrhea—Positivity by Age and Sex, Juvenile Corrections Facilities, 2010

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

1.4

0.8

0.7

0.4

1.0

1.6

2.5

1.9

1.0

0.9

1.9

3.7

Men Positivity Women

Age

Figure EE. Gonorrhea—Positivity by Age Group and Sex, Adult Corrections Facilities, 2010
TABLES
TABLES
STD Surveillance 2010 National Summary Tables 87

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

per 100,000 Population, United States, 1941–2010

Syphilis

Year*

All Stages†

Primary and 

Secondary Early Latent

Late and Late 

Latent‡ Congenital Chlamydia Gonorrhea Chancroid

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

1941 485,560 368.2 68,231 51.7 109,018 82.6 202,984 153.9 17,600 651.1 NR — 193,468 146.7 3,384 2.5

1942 479,601 363.4 75,312 57.0 116,245 88.0 202,064 153.1 16,918 566.0 NR — 212,403 160.9 5,477 4.1

1943 575,593 447.0 82,204 63.8 149,390 116.0 251,958 195.7 16,164 520.7 NR — 275,070 213.6 8,354 6.4

1944 467,755 367.9 78,443 61.6 123,038 96.7 202,848 159.6 13,578 462.0 NR — 300,676 236.5 7,878 6.1

1945 359,114 282.3 77,007 60.5 101,719 79.9 142,187 111.8 12,339 431.7 NR — 287,181 225.8 5,515 4.3

1946 363,647 271.7 94,957 70.9 107,924 80.6 125,248 93.6 12,106 354.9 NR — 368,020 275.0 7,091 5.2

1947 355,592 252.3 93,545 66.4 104,124 73.9 122,089 86.6 12,200 319.6 NR — 380,666 270.0 9,515 6.7

1948 314,313 218.2 68,174 47.3 90,598 62.9 123,312 85.6 13,931 383.0 NR — 345,501 239.8 7,661 5.3

1949 256,463 175.3 41,942 28.7 75,045 51.3 116,397 79.5 13,952 382.4 NR — 317,950 217.3 6,707 4.6

1950 217,558 146.0 23,939 16.7 59,256 39.7 113,569 70.2 13,377 368.3 NR — 286,746 192.5 4,977 3.3

1951 174,924 116.1 14,485 9.6 43,316 28.7 98,311 65.2 11,094 290.4 NR — 254,470 168.9 4,233 2.8

1952 167,762 110.2 10,449 6.9 36,454 24.0 105,238 69.1 8,553 218.8 NR — 244,957 160.8 3,738 2.5

1953 148,573 95.9 8,637 5.6 28,295 18.3 98,870 63.8 7,675 193.9 NR — 238,340 153.9 3,338 2.2

1954 130,687 82.9 7,147 4.5 23,861 15.1 89,123 56.5 6,676 164.0 NR — 242,050 153.5 3,003 1.9

1955 122,392 76.2 6,454 4.0 20,054 12.5 86,526 53.8 5,354 130.7 NR — 236,197 147.0 2,649 1.7

1956 130,201 78.7 6,392 3.9 19,783 12.0 95,097 57.5 5,491 130.4 NR — 224,346 135.7 2,135 1.3

1957 123,758 73.5 6,576 3.9 17,796 10.6 91,309 54.2 5,288 123.0 NR — 214,496 127.4 1,637 1.0

1958 113,884 66.4 7,176 4.2 16,556 9.7 83,027 48.4 4,866 114.6 NR — 232,386 135.6 1,595 0.9

1959 120,824 69.2 9,799 5.6 17,025 9.8 86,740 49.7 5,130 119.7 NR — 240,254 137.6 1,537 0.9

1960 122,538 68.8 16,145 9.1 18,017 10.1 81,798 45.9 4,416 103.7 NR — 258,933 145.4 1,680 0.9

1961 124,658 68.8 19,851 11.0 19,486 10.8 79,304 43.8 4,163 97.5 NR — 264,158 145.8 1,438 0.8

1962 126,245 68.7 21,067 11.5 19,585 10.7 79,533 43.3 4,070 97.7 NR — 263,714 143.6 1,344 0.7

1963 124,137 66.5 22,251 11.9 18,235 9.8 78,076 41.8 4,031 98.4 NR — 278,289 149.0 1,220 0.7

1964 114,325 60.4 22,969 12.1 17,781 9.4 68,629 36.3 3,516 87.3 NR — 300,666 158.9 1,247 0.7

1965 112,842 58.9 23,338 12.2 17,458 9.1 67,317 35.1 3,564 94.8 NR — 324,925 169.5 982 0.5

1966 105,159 54.2 21,414 11.0 15,950 8.2 63,541 32.7 3,170 87.9 NR — 351,738 181.2 838 0.4

1967 102,581 52.2 21,053 10.7 15,554 7.9 61,975 31.5 2,894 82.2 NR — 404,836 205.9 784 0.4

1968 96,271 48.4 19,019 9.6 15,150 7.6 58,564 29.4 2,381 68.0 NR — 464,543 233.4 845 0.4

1969 92,162 45.7 19,130 9.5 15,402 7.6 54,587 27.1 2,074 57.6 NR — 534,872 265.4 1,104 0.5

1970 91,382 44.8 21,982 10.8 16,311 8.0 50,348 24.7 1,953 52.3 NR — 600,072 294.2 1,416 0.7

1971 95,997 46.4 23,783 11.5 19,417 9.4 49,993 24.2 2,052 57.7 NR — 670,268 324.1 1,320 0.6

1972 91,149 43.6 24,429 11.7 20,784 9.9 43,456 20.8 1,758 54.0 NR — 767,215 366.6 1,414 0.7

1973 87,469 41.4 24,825 11.7 23,584 11.2 37,054 17.5 1,527 48.7 NR — 842,621 398.7 1,165 0.6

1974 83,771 39.3 25,385 11.9 25,124 11.8 31,854 14.9 1,138 36.0 NR — 906,121 424.7 945 0.4

1975 80,356 37.3 25,561 11.9 26,569 12.3 27,096 12.6 916 29.1 NR — 999,937 464.1 700 0.3

1976 71,761 33.0 23,731 10.9 25,363 11.7 21,905 10.1 626 19.8 NR — 1,001,994 460.6 628 0.3

1977 64,621 29.4 20,399 9.3 21,329 9.7 22,313 10.2 463 13.9 NR — 1,002,219 456.0 455 0.2

1978 64,875 29.2 21,656 9.8 19,628 8.8 23,038 10.4 434 13.0 NR — 1,013,436 456.3 521 0.2

1979 67,049 29.9 24,874 11.1 20,459 9.1 21,301 9.5 332 9.5 NR — 1,004,058 447.1 840 0.4

1980 68,832 30.3 27,204 12.0 20,297 8.9 20,979 9.2 277 7.7 NR — 1,004,029 442.1 788 0.3

1981 72,799 31.7 31,266 13.6 21,033 9.2 20,168 8.8 287 7.9 NR — 990,864 431.8 850 0.4

1982 75,579 32.6 33,613 14.5 21,894 9.5 19,799 8.5 259 7.0 NR — 960,633 414.7 1,392 0.6

1983 74,637 31.9 32,698 14.0 23,738 10.2 17,896 7.7 239 6.6 NR — 900,435 385.1 847 0.4

1984 69,872 29.6 28,607 12.1 23,131 9.8 17,829 7.6 305 8.3 7,594 6.5 878,556 372.5 665 0.3

1985 67,563 28.4 27,131 11.4 21,689 9.1 18,414 7.7 329 8.7 25,848 17.4 911,419 383.0 2,067 0.9

1986 67,779 28.2 27,667 11.5 21,656 9.0 18,046 7.5 410 10.9 58,001 35.2 892,229 371.5 3,045 1.3

1987 87,286 36.0 35,585 14.7 28,233 11.7 22,988 9.5 480 12.6 91,913 50.8 787,532 325.0 4,986 2.1

1988 104,546 42.8 40,474 16.6 35,968 14.7 27,363 11.2 741 19.0 157,854 87.1 738,160 301.9 4,891 2.0

1989 115,089 46.6 45,826 18.6 45,394 18.4 22,032 8.9 1,837 45.5 200,904 102.5 733,294 297.1 4,697 1.9

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
88 National Summary Tables STD Surveillance 2010

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

per 100,000 Population, United States, 1941–2010 (continued)

Syphilis

Year*

All Stages†

Primary and 

Secondary Early Latent

Late and Late 

Latent‡ Congenital Chlamydia Gonorrhea Chancroid

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate§ Cases Rate Cases Rate Cases Rate

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

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 10.1 1,108,374 367.5 355,991 118.0 23 0.0

2008 46,292 15.2 13,500 4.4 12,401 4.1 19,945 6.6 446 10.3 1,210,523 398.1 336,742 110.7 25 0.0

2009 44,830 14.6 13,997 4.6 13,066 4.3 17,338 5.6 429 9.9 1,244,180 405.3 301,174 98.1 28 0.0

2010 45,834 14.9 13,774 4.5 13,604 4.4 18,079 5.9 377 8.7 1,307,893 426.0 309,341 100.8 24 0.0

* For 1941–1946, data were reported for the federal fiscal year ending June 30 of the year indicated. From 1947 to the present, data were reported for the calendar 

year ending December 31. For 1941–1958, data for Alaska and Hawaii were not included. † Includes stage of syphilis not stated.

‡ Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other than 

neurosyphilis.

§ Rates include all cases of congenitally acquired syphilis per 100,000 live births. As of 1995, cases of congenital syphilis are obtained in hardcopy and electronic 

format on the basis of case reporting form CDC 73.126.

NR = No report.

Note: Adjustments to the number of cases reported from state health departments were made for hardcopy forms and for electronic data submissions through 

June 8, 2011 (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 2010 Chlamydia Tables 89

Table 2. Chlamydia—Reported Cases and Rates by State, Ranked by Rates, United States, 2010

Rank* State Cases Rate per 100,000 Population

1 Alaska 6,019 861.7

2 Mississippi 21,417 725.5

3 Louisiana 29,151 648.9

4 New Mexico 11,706 582.5

5 South Carolina 26,525 581.5

6 Alabama 27,041 574.3

7 Arkansas 15,424 533.8

8 New York 99,920 511.3

9 Delaware 4,464 504.3

10 Michigan 49,478 496.3

11 Texas 119,872 483.7

12 Illinois 60,672 469.9

13 Hawaii 6,015 464.4

14 Maryland 26,192 459.6

15 Georgia 45,147 459.3

16 Tennessee 28,327 449.9

17 North Carolina 42,048 448.2

18 Ohio 51,150 443.1

19 Missouri 26,049 435.1

U.S. TOTAL† 1,307,893 426.0

20 Wisconsin 23,236 410.9

21 Arizona 26,861 407.2

22 California 150,443 407.0

23 Florida 74,744 403.2

24 South Dakota 3,192 392.9

25 Virginia 30,797 390.7

26 Wyoming 2,113 388.2

27 Oklahoma 14,302 387.9

28 Colorado 19,447 387.0

29 Kentucky 16,376 379.6

30 Pennsylvania 47,518 377.0

31 North Dakota 2,404 371.7

32 Nevada 9,666 365.7

33 Connecticut 12,649 359.5

34 Indiana 22,825 355.4

35 Iowa 10,542 350.5

36 Kansas 9,601 340.6

37 Rhode Island 3,480 330.4

38 Oregon 12,352 322.9

39 Washington 21,348 320.3

40 Massachusetts 21,080 319.7

41 Montana 3,082 316.1

42 New Jersey 26,142 300.2

43 Minnesota 15,294 290.4

44 Nebraska 5,114 284.6

45 Idaho 4,208 272.2

46 Utah 6,690 240.3

47 West Virginia 3,876 213.0

48 Vermont 1,257 202.2

49 Maine 2,586 196.2

50 New Hampshire 2,462 185.9

* States were ranked in descending order by rate (rounded to the nearest tenth) and by number of cases.

† Total includes cases reported by the District of Columbia with 5,589 cases and a rate of 932.0, but excludes outlying areas (Guam with 899 cases and rate of 

503.8, Puerto Rico with 5,960 cases and rate of 150.2, and Virgin Islands with 609 cases and rate of 554.6).
90 Chlamydia Tables STD Surveillance 2010

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

United States and Outlying Areas, 2006–2010

Cases Rates per 100,000 Population

State/Area 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Alabama 22,915 25,153 24,760 25,929 27,041 498.3 543.5 531.1 550.7 574.3

Alaska 4,525 4,911 4,861 5,166 6,019 675.3 718.5 708.3 739.6 861.7

Arizona 24,090 24,866 24,769 26,002 26,861 390.7 392.3 381.1 394.2 407.2

Arkansas 8,259 9,954 14,136 14,354 15,424 293.8 351.1 495.1 496.8 533.8

California 135,827 141,928 148,798 146,796 150,443 372.6 388.3 404.8 397.2 407.0

Colorado 16,313 17,186 19,180 19,998 19,447 343.2 353.5 388.3 398.0 387.0

Connecticut 10,946 11,454 12,519 12,127 12,649 312.3 327.0 357.6 344.7 359.5

Delaware 3,615 3,479 3,868 4,718 4,464 423.6 402.3 443.0 533.0 504.3

District of Columbia 3,368 6,029 6,924 6,549 5,589 579.2 1,024.8 1,169.9 1,092.1 932.0

Florida 48,955 57,575 71,017 72,931 74,744 270.6 315.5 387.5 393.4 403.2

Georgia 38,972 42,913 42,629 39,828 45,147 416.2 449.6 440.1 405.2 459.3

Hawaii 5,548 5,659 5,982 6,026 6,015 431.6 440.9 464.4 465.3 464.4

Idaho 3,345 3,722 4,194 3,842 4,208 228.1 248.2 275.2 248.5 272.2

Illinois 53,586 55,470 59,169 60,542 60,672 417.6 431.6 458.6 468.9 469.9

Indiana 19,859 20,712 22,154 21,732 22,825 314.5 326.4 347.4 338.3 355.4

Iowa 8,390 8,643 9,372 9,406 10,542 281.3 289.3 312.1 312.7 350.5

Kansas 7,829 8,180 9,208 10,510 9,601 283.2 294.7 328.6 372.9 340.6

Kentucky 8,940 8,798 12,163 13,293 16,376 212.5 207.4 284.9 308.1 379.6

Louisiana 17,885 19,362 22,659 27,628 29,151 417.1 451.0 513.7 615.0 648.9

Maine 2,306 2,541 2,608 2,431 2,586 174.5 192.9 198.1 184.4 196.2

Maryland 21,859 23,150 24,669 23,747 26,192 389.2 412.0 437.9 416.7 459.6

Massachusetts 15,394 16,145 17,503 19,315 21,080 239.1 250.3 269.4 292.9 319.7

Michigan 36,753 37,353 44,923 45,714 49,478 364.0 370.9 449.1 458.5 496.3

Minnesota 12,935 13,413 14,351 14,197 15,294 250.3 258.1 274.9 269.6 290.4

Mississippi 19,002 21,686 21,253 23,589 21,417 652.9 743.0 723.2 799.1 725.5

Missouri 22,982 23,308 24,817 25,868 26,049 393.3 396.5 419.8 432.0 435.1

Montana 2,650 2,748 3,101 2,988 3,082 280.5 286.9 320.5 306.5 316.1

Nebraska 5,428 5,132 5,573 5,443 5,114 307.0 289.2 312.5 303.0 284.6

Nevada 8,398 9,514 9,670 10,045 9,666 336.5 370.9 371.9 380.0 365.7

New Hampshire 1,997 2,055 2,109 2,102 2,462 151.9 156.2 160.3 158.7 185.9

New Jersey 20,194 21,536 22,405 23,974 26,142 231.5 247.9 258.0 275.3 300.2

New Mexico 9,829 9,460 9,262 9,493 11,706 502.9 480.2 466.8 472.4 582.5

New York 68,720 80,717 88,359 92,069 99,920 355.9 418.3 453.3 471.1 511.3

North Carolina 33,615 30,611 37,516 41,045 42,048 379.6 337.8 406.8 437.5 448.2

North Dakota 1,820 1,789 1,921 1,957 2,404 286.2 279.7 299.5 302.5 371.7

Ohio 40,106 47,434 47,117 48,239 51,150 349.4 413.7 410.2 417.9 443.1

Oklahoma 12,992 12,529 14,803 15,023 14,302 363.0 346.4 406.4 407.5 387.9

Oregon 9,577 9,849 10,744 11,497 12,352 258.8 262.8 283.5 300.5 322.9

Pennsylvania 39,487 42,469 42,233 43,068 47,518 317.4 341.6 339.3 341.7 377.0

Rhode Island 3,142 3,177 3,317 3,615 3,480 294.3 300.3 315.7 343.2 330.4

South Carolina 22,351 26,431 26,323 26,654 26,525 517.2 599.7 587.6 584.4 581.5

South Dakota 2,633 2,620 2,956 3,015 3,192 336.7 329.1 367.6 371.1 392.9

Tennessee 25,320 26,866 28,038 29,711 28,327 419.3 436.4 451.1 471.9 449.9

Texas 75,543 85,786 100,870 105,910 119,872 321.4 358.9 414.6 427.4 483.7

Utah 5,092 5,721 6,021 6,145 6,690 199.7 216.3 220.0 220.7 240.3

Vermont 1,191 1,057 1,190 1,186 1,257 190.9 170.1 191.5 190.7 202.2

Virginia 24,087 24,579 31,218 30,903 30,797 315.2 318.7 401.8 392.0 390.7

Washington 17,819 18,784 21,402 21,387 21,348 278.6 290.4 326.8 320.9 320.3

West Virginia 2,910 3,168 3,316 3,604 3,876 160.0 174.8 182.8 198.0 213.0

Wisconsin 20,190 19,555 20,996 20,906 23,236 363.4 349.1 373.1 369.7 410.9

Wyoming 1,422 1,197 1,577 1,963 2,113 276.1 228.9 296.1 360.7 388.2

U.S. TOTAL 1,030,911 1,108,374 1,210,523 1,244,180 1,307,893 344.3 367.5 398.1 405.3 426.0

Northeast 163,377 181,151 192,243 199,887 217,094 298.5 331.3 350.0 361.6 392.7

Midwest 232,511 243,609 262,557 267,529 279,557 351.1 366.9 394.5 400.3 418.3

South 390,588 428,069 486,162 505,416 531,292 358.1 387.6 435.2 446.0 468.9

West 244,435 255,545 269,561 271,348 279,950 352.4 364.6 380.4 379.1 391.2

Guam 832 822 687 620 899 486.5 473.7 390.4 347.5 503.8

Puerto Rico 5,102 7,909 6,874 7,302 5,960 129.9 200.6 173.8 184.1 150.2

Virgin Islands 203 348 587 488 609 186.9 316.9 534.4 444.4 554.6

OUTLYING AREAS 6,137 9,079 8,148 8,410 7,468 145.8 214.8 192.2 197.6 175.5

TOTAL 1,037,048 1,117,453 1,218,671 1,252,590 1,315,361 341.6 365.4 395.3 402.4 422.6
STD Surveillance 2010 Chlamydia Tables 91

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

Alphabetical Order, United States and Outlying Areas, 2006–2010

Cases Rates per 100,000 Population

State/Area 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Alabama 17,915 19,186 18,744 19,413 20,030 756.0 804.2 779.8 799.8 825.3

Alaska 3,067 3,295 3,253 3,364 3,960 947.7 1,002.6 989.7 1,000.5 1,177.7

Arizona 18,485 18,794 18,358 19,097 19,529 600.1 593.7 566.0 580.6 593.8

Arkansas 6,604 7,893 10,643 10,689 11,303 460.8 546.0 730.6 725.2 766.9

California 97,170 101,175 104,201 101,716 102,645 532.9 553.6 567.3 551.1 556.1

Colorado 12,037 12,707 13,825 14,765 14,188 510.0 527.1 564.7 592.1 569.0

Connecticut 8,205 8,577 9,239 8,937 9,223 456.2 477.7 515.0 496.3 512.2

Delaware 2,625 2,554 2,789 3,573 3,296 597.6 573.3 620.1 784.5 723.7

District of Columbia 2,510 3,970 4,438 4,153 3,782 812.7 1,279.9 1,422.7 1,311.8 1,194.6

Florida 38,536 42,173 52,206 52,747 53,318 418.6 454.3 560.0 560.3 566.4

Georgia 30,546 31,827 31,515 29,074 32,863 642.7 656.1 640.4 582.2 658.1

Hawaii 4,161 4,228 4,422 4,399 4,340 648.0 663.1 692.4 686.5 677.3

Idaho 2,435 2,660 3,048 2,768 3,014 334.4 357.1 402.5 359.5 391.5

Illinois 39,705 41,733 43,112 44,560 44,598 609.5 640.2 659.0 680.2 680.8

Indiana 14,907 15,576 16,513 16,150 16,344 465.4 483.9 510.6 495.6 501.6

Iowa 6,157 6,310 6,882 6,785 7,612 407.9 416.9 452.9 445.7 500.1

Kansas 6,286 6,629 7,401 8,209 7,449 451.4 473.6 524.8 578.5 525.0

Kentucky 6,336 6,184 8,622 9,621 11,859 295.4 285.9 395.3 438.0 539.9

Louisiana 14,290 15,334 17,260 20,719 20,564 649.0 694.6 760.4 898.1 891.4

Maine 1,672 1,831 1,847 1,705 1,814 247.6 271.5 274.0 252.7 268.9

Maryland 17,339 18,230 19,337 18,782 19,827 598.1 628.7 665.4 639.8 675.4

Massachusetts 11,175 11,671 12,646 13,786 14,753 336.6 351.2 378.1 406.8 435.4

Michigan 27,915 28,341 33,719 33,860 36,431 544.6 554.4 663.8 668.3 719.0

Minnesota 9,243 9,681 10,266 10,204 10,965 355.7 371.0 391.8 385.7 414.5

Mississippi 14,853 16,718 16,323 17,829 15,958 989.4 1,110.8 1,077.6 1,172.2 1,049.2

Missouri 16,938 17,080 18,116 18,825 18,867 566.9 567.9 599.1 614.9 616.3

Montana 1,932 2,024 2,227 2,134 2,194 409.3 423.2 461.1 438.2 450.5

Nebraska 3,956 3,755 4,123 3,884 3,561 443.7 419.5 458.5 429.2 393.5

Nevada 6,185 7,044 7,131 7,112 6,897 504.2 559.7 559.0 548.3 531.7

New Hampshire 1,484 1,533 1,548 1,542 1,808 222.7 230.0 232.2 229.6 269.2

New Jersey 16,560 17,355 18,001 18,757 20,128 371.1 391.1 406.3 422.5 453.4

New Mexico 7,456 7,044 6,986 6,987 8,718 753.3 705.7 694.4 688.3 858.9

New York 48,568 56,590 61,280 63,882 68,693 488.1 569.5 611.1 636.1 684.0

North Carolina 27,301 25,110 30,693 33,002 33,836 604.6 541.9 652.3 688.9 706.3

North Dakota 1,231 1,194 1,291 1,297 1,577 389.0 374.7 404.0 403.0 490.0

Ohio 30,483 36,143 35,021 36,724 38,636 518.4 615.1 595.4 621.5 653.8

Oklahoma 9,678 9,130 11,117 11,101 10,297 533.3 499.0 603.0 595.2 552.1

Oregon 6,585 6,890 7,433 8,136 8,565 353.8 365.5 389.7 421.9 444.1

Pennsylvania 28,503 30,511 30,509 30,335 33,175 445.8 477.9 477.6 469.1 513.1

Rhode Island 2,175 2,282 2,400 2,603 2,478 394.5 418.0 442.7 480.5 457.4

South Carolina 19,055 20,793 20,492 21,124 20,842 859.3 919.8 891.5 902.7 890.6

South Dakota 1,923 1,894 2,185 2,214 2,300 491.4 474.2 541.7 544.7 565.9

Tennessee 18,352 19,604 20,479 21,655 20,559 594.3 622.2 642.8 671.1 637.1

Texas 60,327 67,966 79,002 82,551 92,847 511.5 567.4 648.4 665.5 748.5

Utah 3,457 3,926 3,982 4,019 4,473 272.7 299.8 293.8 290.5 323.3

Vermont 897 812 896 889 910 283.1 257.4 284.0 281.6 288.2

Virginia 17,682 18,136 23,172 22,390 22,348 455.0 461.8 586.3 558.7 557.6

Washington 13,021 13,793 15,581 15,741 15,634 406.1 425.0 475.1 472.0 468.8

West Virginia 2,208 2,423 2,490 2,684 2,832 238.0 262.0 269.0 289.3 305.3

Wisconsin 14,606 14,438 15,229 15,038 16,657 522.5 512.4 538.1 528.4 585.3

Wyoming 1,051 913 1,011 1,187 1,305 413.8 354.2 385.2 444.2 488.3

U.S. TOTAL 775,788 825,660 893,004 912,718 949,802 510.8 539.8 579.4 586.7 610.6

Northeast 119,239 131,162 138,366 142,436 152,982 423.8 467.1 490.9 502.6 539.8

Midwest 173,350 182,774 193,858 197,750 204,997 515.8 542.6 574.2 583.1 604.5

South 306,157 327,231 369,322 381,107 396,361 551.6 582.3 649.8 661.6 688.1

West 177,042 184,493 191,458 191,425 195,462 511.0 527.2 541.5 536.2 547.5

Guam 692 669 574 512 664 824.7 785.4 664.1 583.9 757.2

Puerto Rico 4,091 6,781 5,834 6,336 4,878 200.3 330.8 283.7 307.0 236.3

Virgin Islands 144 267 448 435 427 253.6 462.5 775.2 752.2 738.3

OUTLYING AREAS 4,927 7,717 6,856 7,283 5,969 225.7 351.9 311.5 329.6 270.2

TOTAL 780,715 833,377 899,860 920,001 955,771 506.7 537.1 575.6 583.1 605.8

NOTE: Cases reported with unknown sex are not included in this table.
92 Chlamydia Tables STD Surveillance 2010

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

Order, United States and Outlying Areas, 2006–2010

Cases Rates per 100,000 Population

State/Area 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Alabama 4,985 5,955 6,007 6,508 6,877 223.6 265.6 266.0 285.2 301.4

Alaska 1,458 1,616 1,608 1,802 2,058 420.9 455.4 449.7 497.5 568.2

Arizona 5,588 6,055 6,401 6,904 7,331 181.1 190.8 196.5 208.8 221.7

Arkansas 1,655 2,060 3,491 3,664 4,112 120.1 148.3 249.6 258.8 290.5

California 38,003 40,213 44,060 44,592 47,239 208.5 220.0 239.6 241.0 255.3

Colorado 4,276 4,479 5,319 5,228 5,259 178.7 182.8 213.5 206.6 207.8

Connecticut 2,741 2,877 3,264 3,190 3,426 160.7 168.5 191.2 185.7 199.5

Delaware 990 925 1,079 1,145 1,168 239.0 220.6 254.9 266.5 271.8

District of Columbia 819 2,034 2,438 2,390 1,789 300.4 731.4 871.1 844.3 632.0

Florida 10,410 15,376 18,593 20,069 21,362 117.2 171.4 206.5 220.0 234.1

Georgia 8,089 10,808 10,690 10,513 11,965 175.4 230.3 224.3 217.4 247.5

Hawaii 1,384 1,431 1,560 1,626 1,675 215.1 221.6 240.2 248.5 256.0

Idaho 895 1,030 1,133 1,051 1,183 121.2 136.5 147.8 135.5 152.5

Illinois 13,881 13,736 16,052 15,964 15,957 219.7 216.9 252.4 251.0 250.9

Indiana 4,849 5,032 5,572 5,502 6,451 155.9 160.9 177.3 173.9 203.8

Iowa 2,233 2,333 2,490 2,621 2,930 151.6 158.2 167.9 176.4 197.2

Kansas 1,543 1,551 1,807 2,301 2,152 112.5 112.7 129.8 164.4 153.7

Kentucky 2,580 2,605 3,508 3,647 4,488 125.2 125.3 168.0 172.2 212.0

Louisiana 3,372 3,758 5,226 6,841 6,658 161.7 180.2 244.1 313.1 304.7

Maine 634 708 761 726 768 98.1 110.1 118.5 112.8 119.3

Maryland 4,439 4,907 5,307 4,885 6,336 163.4 180.5 194.6 176.7 229.2

Massachusetts 4,193 4,457 4,839 5,490 6,302 134.5 142.6 153.5 171.3 196.6

Michigan 8,724 8,845 11,007 11,675 12,926 175.5 178.3 223.5 238.1 263.6

Minnesota 3,692 3,732 4,085 3,993 4,329 143.7 144.2 157.1 152.4 165.2

Mississippi 4,149 4,968 4,930 5,760 5,459 294.4 351.4 346.2 402.5 381.5

Missouri 6,044 6,228 6,701 7,043 7,182 211.7 216.9 232.0 240.7 245.5

Montana 709 716 865 851 888 150.0 149.3 178.5 174.4 182.0

Nebraska 1,401 1,363 1,441 1,549 1,548 159.8 155.0 163.0 173.7 173.6

Nevada 2,211 2,460 2,539 2,931 2,768 174.2 188.3 191.7 217.7 205.6

New Hampshire 513 522 561 560 654 79.1 80.4 86.4 85.8 100.2

New Jersey 3,606 4,169 4,390 5,200 5,874 84.6 98.1 103.3 121.8 137.6

New Mexico 2,368 2,415 2,272 2,500 2,986 245.4 248.5 232.2 251.3 300.2

New York 20,148 24,045 27,056 28,171 31,224 215.4 256.9 285.9 296.6 328.7

North Carolina 6,314 5,493 6,656 7,798 8,030 145.4 124.1 147.4 169.9 174.9

North Dakota 588 594 629 654 822 184.1 185.0 195.4 201.2 252.9

Ohio 9,039 10,852 10,847 10,978 12,320 161.5 194.1 193.6 194.9 218.7

Oklahoma 3,314 3,399 3,606 3,879 3,997 187.8 190.2 200.5 212.9 219.4

Oregon 2,992 2,959 3,311 3,361 3,786 162.6 158.9 175.9 177.2 199.6

Pennsylvania 10,981 11,934 11,722 12,700 14,297 181.6 197.3 193.4 206.9 232.9

Rhode Island 962 892 915 1,012 1,002 186.4 174.3 179.9 197.9 195.9

South Carolina 3,272 5,549 5,723 5,418 5,653 155.5 258.4 262.4 243.9 254.5

South Dakota 709 725 767 788 883 181.5 182.7 191.3 194.1 217.5

Tennessee 6,968 7,262 7,559 8,055 7,748 236.1 241.6 249.5 262.4 252.4

Texas 15,178 17,687 21,812 23,302 26,966 129.6 148.3 179.6 188.3 217.9

Utah 1,635 1,795 2,039 2,126 2,215 127.5 134.4 147.6 151.8 158.1

Vermont 294 245 294 297 347 95.8 80.1 96.2 97.1 113.4

Virginia 6,384 6,433 7,985 8,442 8,397 169.9 170.0 209.2 217.9 216.7

Washington 4,798 4,991 5,767 5,645 5,711 150.4 154.9 176.4 169.6 171.6

West Virginia 698 744 825 920 1,044 78.4 83.9 92.8 103.1 117.0

Wisconsin 5,551 5,090 5,707 5,740 6,573 201.1 182.8 204.0 204.3 234.0

Wyoming 371 284 563 776 808 142.1 107.2 208.4 280.1 291.7

U.S. TOTAL 252,630 280,337 313,779 328,783 353,923 171.3 188.6 209.3 217.1 233.7

Northeast 44,072 49,849 53,802 57,346 63,894 165.6 187.4 201.2 212.8 237.1

Midwest 58,254 60,081 67,105 68,808 74,073 178.6 183.7 204.6 209.0 225.0

South 83,616 99,963 115,435 123,236 132,049 156.0 184.3 210.3 221.2 237.0

West 66,688 70,444 77,437 79,393 83,907 192.1 200.7 218.1 221.3 233.9

Guam 140 153 113 108 235 160.7 173.1 126.2 119.0 259.0

Puerto Rico 1,007 1,125 1,034 957 1,076 53.4 59.4 54.5 50.3 56.5

Virgin Islands 55 81 139 53 182 106.1 155.5 267.1 102.0 350.2

OUTLYING AREAS 1,202 1,359 1,286 1,118 1,493 59.3 66.8 63.1 54.6 73.0

TOTAL 253,832 281,696 315,065 329,901 355,416 169.7 186.9 207.3 214.9 231.5

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2010 Chlamydia Tables 93

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

(MSAs)* in Alphabetical Order, United States, 2006–2010

Cases Rates per 100,000 Population

MSAs 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Atlanta-Sandy Springs-Marietta, GA 20,979 21,609 20,722 20,292 22,144 408.3 409.3 385.4 370.6 404.4

Austin-Round Rock, TX 7,325 6,814 8,413 8,456 8,511 484.0 426.4 509.1 495.9 499.2

Baltimore-Towson, MD 11,617 13,053 13,537 12,883 13,988 437.0 489.2 507.6 478.8 519.8

Birmingham-Hoover, AL 5,338 6,913 6,690 6,120 6,126 485.3 623.8 598.6 541.1 541.6

Boston-Cambridge-Quincy, MA-NH 9,918 10,697 11,854 13,285 14,291 222.6 238.6 262.1 289.5 311.4

Buffalo-Cheektowaga-Tonawanda, NY 4,992 5,078 5,561 5,769 5,938 438.8 450.1 494.6 513.3 528.4

Charlotte-Gastonia-Concord, NC-SC 5,076 4,216 7,046 8,869 7,458 320.7 255.3 414.0 508.1 427.3

Chicago-Naperville-Joliet, IL-IN-WI 41,521 41,403 45,803 46,505 45,726 436.8 434.7 478.6 485.4 477.3

Cincinnati-Middletown, OH-KY-IN 8,616 10,080 10,016 8,872 9,805 409.5 472.4 464.8 408.5 451.4

Cleveland-Elyria-Mentor, OH 7,462 9,351 8,731 10,439 11,608 353.0 446.0 418.1 499.2 555.1

Columbus, OH 5,843 7,157 8,314 9,015 9,545 338.6 408.0 468.9 500.3 529.7

Dallas-Fort Worth-Arlington, TX 17,035 22,292 26,090 27,142 29,314 283.7 362.8 414.1 421.0 454.6

Denver-Aurora, CO 7,934 9,539 10,996 11,803 14,320 329.4 387.0 438.7 462.5 561.1

Detroit-Warren-Livonia, MI 17,201 17,934 24,987 25,347 27,751 384.9 401.4 564.7 575.6 630.2

Hartford-West Hartford-East Hartford, CT 3,799 4,300 4,781 4,467 4,616 319.6 361.6 401.6 373.5 386.0

Houston-Baytown-Sugar Land, TX 14,641 17,196 21,100 21,032 27,522 264.3 305.5 368.4 358.4 469.1

Indianapolis, IN 7,780 8,173 8,814 7,716 8,274 467.0 482.2 513.8 442.5 474.5

Jacksonville, FL 5,582 6,501 7,318 6,745 7,093 436.8 499.8 557.3 507.9 534.1

Kansas City, MO-KS 7,825 8,358 9,559 9,892 9,443 397.7 421.0 477.5 478.4 456.7

Las Vegas-Paradise, NV 6,592 7,333 7,753 8,177 7,614 370.8 399.3 415.5 429.7 400.1

Los Angeles-Long Beach-Santa Ana, CA 50,913 52,352 55,276 54,892 56,033 393.1 406.6 429.4 426.4 435.2

Louisville, KY-IN 3,319 3,493 4,953 5,294 6,344 271.6 283.1 397.9 420.6 504.1

Memphis, TN-MS-AR 10,224 11,349 11,896 13,368 12,463 802.1 886.3 925.2 1,024.4 955.1

Miami-Fort Lauderdale-Miami Beach, FL 12,142 13,761 18,128 19,101 19,095 222.2 254.2 334.8 344.3 344.2

Milwaukee-Waukesha-West Allis, WI 10,498 10,150 1,441 10,588 11,512 695.2 657.2 93.0 678.9 738.1

Minneapolis-St. Paul-Bloomington, MN-WI 9,271 9,514 10,093 9,925 10,870 292.0 296.6 312.5 303.5 332.4

Nashville-Davidson-Murfreesboro, TN 4,910 4,972 5,574 5,816 5,705 337.4 326.8 359.4 367.6 360.6

New Orleans-Metairie-Kenner, LA 3,401 4,573 5,109 6,701 6,947 331.9 443.8 450.5 563.1 583.8

New York-Newark-Edison, NY-NJ-PA 62,334 74,071 80,306 83,904 90,704 331.2 393.7 422.5 440.0 475.6

Oklahoma City, OK 4,627 4,646 5,650 5,475 4,704 394.7 389.4 468.4 446.1 383.3

Orlando, FL 6,579 6,825 8,287 9,199 9,491 331.5 335.8 403.3 441.7 455.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 27,417 28,116 28,749 30,449 33,050 470.5 482.4 492.4 510.2 553.8

Phoenix-Mesa-Scottsdale, AZ 15,278 15,245 14,314 15,615 16,519 378.2 364.8 334.3 357.8 378.5

Pittsburgh, PA 5,789 6,616 6,920 6,597 7,096 244.2 280.8 294.3 280.1 301.3

Portland-Vancouver-Beaverton, OR-WA 5,654 5,970 6,499 7,215 7,415 264.5 274.5 294.4 321.8 330.8

Providence-New Bedford-Fall River, RI-MA 4,197 4,297 4,551 4,865 4,759 260.2 268.4 285.0 303.9 297.3

Richmond, VA 5,044 5,294 6,783 6,681 7,065 422.4 436.4 553.4 539.6 570.6

Riverside-San Bernardino-Ontario, CA 12,472 14,316 13,557 16,934 12,263 309.8 350.8 329.4 408.7 296.0

Rochester, NY 4,168 4,833 5,294 5,767 6,575 402.5 469.0 511.9 556.9 634.9

Sacramento-Arden-Arcade-Roseville, CA 9,094 8,770 8,395 6,320 8,084 439.9 419.4 397.9 297.1 380.0

Salt Lake City, UT 2,910 3,395 3,562 3,424 3,717 272.5 308.6 319.3 302.9 328.9

San Antonio, TX 8,338 8,727 9,734 11,555 12,430 429.3 438.4 479.2 557.6 599.9

San Diego-Carlsbad-San Marcos, CA 11,980 12,693 14,373 14,169 15,341 407.3 426.7 478.9 464.0 502.4

San Francisco-Oakland-Fremont, CA 15,565 16,710 17,555 16,642 17,686 372.4 397.5 410.7 385.4 409.6

San Jose-Sunnyvale-Santa Clara, CA 5,898 5,892 5,796 5,537 5,691 330.0 326.7 318.6 301.0 309.3

Seattle-Tacoma-Bellevue, WA 9,778 10,397 11,532 11,533 11,510 299.6 314.2 344.8 338.4 337.7

St. Louis, MO-IL 13,509 13,710 14,092 14,546 14,691 483.1 489.0 500.3 514.2 519.3

Tampa-St. Petersburg-Clearwater, FL 7,475 9,501 11,230 11,835 12,158 277.1 348.8 410.8 430.8 442.5

Virginia Beach-Norfolk-Newport News, VA-NC 9,139 9,383 11,867 11,954 11,388 554.1 565.7 715.6 713.9 680.1

Washington-Arlington-Alexandria, DC-VA-MD-WV 15,456 18,069 20,943 20,116 19,870 292.2 340.5 390.9 367.3 362.8

U.S. MSAs TOTAL 584,455 635,637 690,544 718,843 752,263 362.3 390.6 420.4 432.5 452.6

* 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.
94 Chlamydia Tables STD Surveillance 2010

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

Areas (MSAs)* in Alphabetical Order, United States, 2006–2010

Cases Rates per 100,000 Population

MSAs 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Atlanta-Sandy Springs-Marietta, GA 16,165 15,553 14,898 14,208 15,508 622.2 582.4 547.7 512.7 559.6

Austin-Round Rock, TX 5,170 4,753 5,933 6,020 6,212 699.1 609.2 735.3 721.0 744.0

Baltimore-Towson, MD 9,344 10,416 10,774 10,187 10,744 677.9 753.5 779.9 730.8 770.7

Birmingham-Hoover, AL 4,277 5,165 4,948 4,530 4,525 751.3 900.4 855.2 774.5 773.7

Boston-Cambridge-Quincy, MA-NH 7,140 7,721 8,458 9,369 9,937 311.7 335.2 364.3 398.0 422.1

Buffalo-Cheektowaga-Tonawanda, NY 3,762 3,818 4,076 4,254 4,386 637.8 653.5 700.2 731.7 754.4

Charlotte-Gastonia-Concord, NC-SC 4,189 3,430 5,469 6,747 5,764 520.7 407.4 631.5 758.0 647.5

Chicago-Naperville-Joliet, IL-IN-WI 30,600 31,134 33,220 34,202 33,360 633.8 644.2 684.4 702.6 685.3

Cincinnati-Middletown, OH-KY-IN 6,871 8,082 8,031 7,243 7,749 638.2 740.4 728.5 652.1 697.7

Cleveland-Elyria-Mentor, OH 5,458 7,023 6,487 7,755 8,556 497.2 645.2 598.6 714.7 788.5

Columbus, OH 4,549 5,428 6,027 6,619 6,886 520.7 611.1 671.6 725.2 754.4

Dallas-Fort Worth-Arlington, TX 13,466 17,251 20,125 21,235 22,876 450.4 564.5 642.8 662.9 714.1

Denver-Aurora, CO 5,827 7,020 7,824 8,617 10,458 485.8 572.1 627.4 677.3 822.0

Detroit-Warren-Livonia, MI 13,096 13,580 18,826 18,870 20,530 572.9 594.5 831.9 836.7 910.4

Hartford-West Hartford-East Hartford, CT 2,786 3,122 3,474 3,250 3,324 456.5 511.7 569.4 530.6 542.7

Houston-Baytown-Sugar Land, TX 12,178 14,170 17,287 16,737 21,925 439.8 504.4 605.0 572.0 749.3

Indianapolis, IN 5,596 5,808 6,352 5,430 5,632 660.3 673.8 727.9 611.8 634.6

Jacksonville, FL 4,273 4,627 5,392 4,874 5,191 654.9 695.7 803.3 716.5 763.1

Kansas City, MO-KS 5,791 6,231 7,115 7,278 6,852 578.2 616.2 698.4 691.8 651.3

Las Vegas-Paradise, NV 5,014 5,620 5,842 5,874 5,537 573.3 623.0 637.5 628.5 592.4

Los Angeles-Long Beach-Santa Ana, CA 35,826 36,520 38,100 36,965 37,486 549.2 563.3 588.0 571.1 579.1

Louisville, KY-IN 2,344 2,482 3,504 3,821 4,646 374.3 392.6 548.5 593.3 721.4

Memphis, TN-MS-AR 7,935 8,846 9,199 10,170 9,529 1,202.2 1,332.7 1,377.8 1,501.5 1,406.8

Miami-Fort Lauderdale-Miami Beach, FL 9,553 9,985 13,144 13,788 13,566 340.1 359.0 472.2 485.5 477.7

Milwaukee-Waukesha-West Allis, WI 7,761 7,653 1,116 7,747 8,376 1,004.8 968.8 140.9 970.2 1,049.0

Minneapolis-St. Paul-Bloomington, MN-WI 6,462 6,727 7,037 7,028 7,710 404.3 417.2 433.7 427.0 468.5

Nashville-Davidson-Murfreesboro, TN 3,413 3,445 3,916 4,136 4,027 462.7 446.5 497.1 514.1 500.6

New Orleans-Metairie-Kenner, LA 2,673 3,503 3,722 4,875 5,065 503.2 653.5 630.1 789.5 820.3

New York-Newark-Edison, NY-NJ-PA 45,007 52,815 56,829 59,274 63,280 462.7 543.6 579.7 603.3 644.0

Oklahoma City, OK 3,394 3,262 4,119 3,912 3,292 570.1 539.5 673.4 627.6 528.1

Orlando, FL 5,326 5,203 6,160 6,740 6,777 531.7 507.6 594.1 640.8 644.3

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 19,813 20,132 20,708 21,297 22,863 658.0 668.7 686.9 690.9 741.7

Phoenix-Mesa-Scottsdale, AZ 11,859 11,675 10,725 11,405 11,892 592.7 564.2 506.4 529.1 551.7

Pittsburgh, PA 4,267 4,870 5,092 4,884 5,146 346.5 398.4 417.7 400.3 421.8

Portland-Vancouver-Beaverton, OR-WA 3,769 4,109 4,468 5,069 5,091 351.7 376.7 403.7 450.0 451.9

Providence-New Bedford-Fall River, RI-MA 2,967 3,116 3,327 3,503 3,433 355.8 376.8 403.6 425.1 416.6

Richmond, VA 3,617 3,778 4,981 4,843 5,282 590.0 605.1 790.6 760.1 829.0

Riverside-San Bernardino-Ontario, CA 9,426 10,773 10,009 12,305 8,810 468.5 528.4 486.8 595.5 426.4

Rochester, NY 2,890 3,337 3,594 3,859 4,448 544.7 632.2 679.0 728.8 840.1

Sacramento-Arden-Arcade-Roseville, CA 6,614 6,310 5,997 4,589 5,754 629.1 594.0 559.6 425.7 533.7

Salt Lake City, UT 1,941 2,299 2,254 2,173 2,434 368.8 425.3 411.0 389.2 436.0

San Antonio, TX 6,232 6,567 7,206 8,566 8,972 628.0 646.8 695.8 811.6 850.1

San Diego-Carlsbad-San Marcos, CA 8,620 9,187 10,257 10,050 10,538 590.4 620.4 688.0 660.5 692.5

San Francisco-Oakland-Fremont, CA 10,418 11,118 11,514 10,618 10,940 495.3 525.7 536.0 489.6 504.5

San Jose-Sunnyvale-Santa Clara, CA 4,128 4,232 4,218 3,989 3,951 472.4 480.4 475.3 443.2 438.9

Seattle-Tacoma-Bellevue, WA 6,915 7,412 7,975 8,062 8,000 423.6 447.2 477.1 473.1 469.5

St. Louis, MO-IL 9,952 10,012 10,166 10,481 10,489 689.2 691.6 699.4 718.4 718.9

Tampa-St. Petersburg-Clearwater, FL 5,936 6,841 8,099 8,323 8,527 428.6 489.4 577.2 590.9 605.4

Virginia Beach-Norfolk-Newport News, VA-NC 6,651 6,884 8,789 8,503 8,098 789.6 811.7 1,037.4 992.8 945.5

Washington-Arlington-Alexandria, DC-VA-MD-WV 11,722 13,194 14,967 14,429 14,146 432.7 485.5 545.7 516.1 506.0

U.S. MSAs TOTAL 432,983 466,239 501,750 518,703 538,520 528.1 564.1 601.7 614.9 638.4

* 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.

Cases reported with unknown sex are not included in this table.
STD Surveillance 2010 Chlamydia Tables 95

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

(MSAs )* in Alphabetical Order, United States, 2006–2010

Cases Rates per 100,000 Population

MSAs 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Atlanta-Sandy Springs-Marietta, GA 4,574 5,896 5,585 5,923 6,471 180.1 226.0 210.3 219.0 239.3

Austin-Round Rock, TX 2,147 2,053 2,472 2,430 2,290 277.4 251.0 292.3 279.3 263.2

Baltimore-Towson, MD 2,250 2,624 2,754 2,665 3,231 175.8 204.1 214.2 205.5 249.1

Birmingham-Hoover, AL 1,058 1,745 1,740 1,588 1,545 199.4 326.4 322.8 290.7 282.9

Boston-Cambridge-Quincy, MA-NH 2,762 2,966 3,383 3,891 4,334 127.6 136.1 153.7 174.1 193.9

Buffalo-Cheektowaga-Tonawanda, NY 1,229 1,260 1,485 1,515 1,552 224.4 231.7 273.9 279.3 286.1

Charlotte-Gastonia-Concord, NC-SC 887 786 1,549 2,102 1,684 113.9 97.1 185.3 245.7 196.9

Chicago-Naperville-Joliet, IL-IN-WI 10,905 10,259 12,578 12,273 12,250 233.1 218.7 266.7 260.4 259.9

Cincinnati-Middletown, OH-KY-IN 1,691 1,935 1,963 1,565 2,022 164.6 185.7 186.5 147.5 190.5

Cleveland-Elyria-Mentor, OH 1,953 2,285 2,216 2,579 3,016 192.2 226.7 220.6 256.3 299.8

Columbus, OH 1,272 1,706 2,275 2,319 2,627 149.3 197.0 259.8 260.8 295.5

Dallas-Fort Worth-Arlington, TX 3,558 4,987 5,962 5,903 6,432 118.0 161.5 188.1 182.0 198.3

Denver-Aurora, CO 2,107 2,519 3,161 3,184 3,862 174.2 203.5 250.9 248.8 301.7

Detroit-Warren-Livonia, MI 4,027 4,220 5,996 6,329 7,134 184.5 193.3 277.3 294.6 332.1

Hartford-West Hartford-East Hartford, CT 1,013 1,178 1,303 1,217 1,292 175.1 203.5 224.5 208.6 221.4

Houston-Baytown-Sugar Land, TX 2,449 2,963 3,776 4,259 5,560 88.4 105.1 131.5 144.8 189.0

Indianapolis, IN 2,167 2,340 2,451 2,275 2,636 264.7 280.9 290.8 265.7 307.9

Jacksonville, FL 1,309 1,873 1,912 1,868 1,893 209.3 294.6 297.8 288.3 292.2

Kansas City, MO-KS 2,034 2,127 2,444 2,614 2,591 210.6 218.3 248.5 257.4 255.1

Las Vegas-Paradise, NV 1,576 1,704 1,911 2,301 2,076 174.5 182.4 201.3 237.7 214.4

Los Angeles-Long Beach-Santa Ana, CA 14,921 15,639 16,886 17,728 18,343 232.2 244.7 264.1 276.9 286.5

Louisville, KY-IN 961 1,011 1,436 1,460 1,686 161.3 168.1 237.0 237.6 274.4

Memphis, TN-MS-AR 2,289 2,503 2,697 3,197 2,928 372.4 405.8 436.4 509.4 466.6

Miami-Fort Lauderdale-Miami Beach, FL 2,588 3,771 4,934 5,304 5,523 97.5 143.3 187.5 195.9 204.0

Milwaukee-Waukesha-West Allis, WI 2,720 2,473 321 2,767 3,134 368.8 327.8 42.4 363.5 411.7

Minneapolis-St. Paul-Bloomington, MN-WI 2,809 2,787 3,056 2,897 3,160 178.2 174.6 190.1 178.4 194.6

Nashville-Davidson-Murfreesboro, TN 1,497 1,527 1,658 1,680 1,670 208.6 203.7 217.3 216.0 214.7

New Orleans-Metairie-Kenner, LA 676 985 1,349 1,804 1,687 137.0 199.3 248.3 315.1 294.7

New York-Newark-Edison, NY-NJ-PA 17,301 21,165 23,441 24,602 27,324 190.3 232.6 254.7 266.1 295.6

Oklahoma City, OK 1,233 1,384 1,473 1,536 1,410 213.7 235.2 247.8 254.3 233.5

Orlando, FL 1,252 1,620 2,117 2,452 2,705 127.3 160.8 208.0 237.9 262.5

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 7,600 7,972 8,040 9,129 10,146 269.9 283.0 284.7 316.4 351.6

Phoenix-Mesa-Scottsdale, AZ 3,410 3,569 3,586 4,210 4,626 167.3 169.1 165.7 190.6 209.5

Pittsburgh, PA 1,522 1,745 1,828 1,712 1,947 133.6 154.0 161.4 150.8 171.6

Portland-Vancouver-Beaverton, OR-WA 1,885 1,861 2,029 2,146 2,323 176.9 171.6 184.3 192.4 208.3

Providence-New Bedford-Fall River, RI-MA 1,223 1,178 1,222 1,360 1,325 157.0 152.2 158.2 175.1 170.6

Richmond, VA 1,423 1,514 1,793 1,817 1,759 244.9 257.2 301.0 302.3 292.7

Riverside-San Bernardino-Ontario, CA 3,029 3,532 3,548 4,622 3,437 150.4 172.9 172.2 222.5 165.5

Rochester, NY 1,278 1,496 1,700 1,908 2,127 253.1 297.6 336.8 377.0 420.3

Sacramento-Arden-Arcade-Roseville, CA 2,431 2,387 2,346 1,682 2,287 239.3 232.0 226.0 160.3 218.0

Salt Lake City, UT 969 1,096 1,308 1,251 1,283 179.0 195.9 230.6 218.7 224.3

San Antonio, TX 2,104 2,160 2,527 2,986 3,458 221.5 221.5 253.8 293.7 340.1

San Diego-Carlsbad-San Marcos, CA 3,134 3,457 4,078 4,097 4,785 211.6 231.4 270.0 267.4 312.3

San Francisco-Oakland-Fremont, CA 5,058 5,465 5,968 5,909 6,645 243.6 261.6 280.7 274.9 309.2

San Jose-Sunnyvale-Santa Clara, CA 1,723 1,633 1,558 1,513 1,649 188.7 177.0 167.2 161.0 175.5

Seattle-Tacoma-Bellevue, WA 2,863 2,985 3,538 3,471 3,509 175.5 180.7 211.4 203.7 205.9

St. Louis, MO-IL 3,557 3,698 3,925 4,065 4,200 263.0 272.7 287.9 296.7 306.6

Tampa-St. Petersburg-Clearwater, FL 1,535 2,652 3,050 3,441 3,601 116.9 200.0 229.2 257.0 269.0

Virginia Beach-Norfolk-Newport News, VA-NC 2,481 2,494 3,064 3,422 3,284 307.4 307.7 377.8 418.3 401.5

Washington-Arlington-Alexandria, DC-VA-MD-WV 3,637 4,849 5,897 5,623 5,680 140.9 187.3 225.5 209.8 211.9

U.S. MSAs TOTAL 150,077 168,034 187,289 198,591 212,139 189.2 209.9 231.6 242.6 259.2

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.

NOTE: 2008 Milwaukee County STD morbidity data were misclassified, resulting in incomplete case counts for MSA-Milwaukee-Waukesha-West Allis,WI.

Cases reported with unknown sex are not included in this table.
96 Chlamydia Tables STD Surveillance 2010

Table 9. Chlamydia—Counties and Independent Cities* Ranked by Number of Reported Cases, 

United States, 2010

Rank† County/Independent City Cases Rates per 100,000 Population Cumulative Percentage

1 Los Angeles County, CA 47,544 482.8 3

2 Cook County, IL 34,664 655.6 6

3 Harris County, TX 22,322 548.3 7

4 Wayne County, MI 21,155 1,098.5 9

5 Kings County, NY 20,790 809.9 11

6 Philadelphia County, PA 19,428 1,255.6 12

7 Bronx County, NY 18,465 1,321.5 14

8 Maricopa County, AZ 15,567 386.9 15

9 Dallas County, TX 15,557 634.5 16

10 San Diego County, CA 15,341 502.4 17

11 Queens County, NY 11,667 505.8 18

12 Bexar County, TX 11,441 692.8 19

13 New York County, NY 11,328 695.4 20

14 Milwaukee County, WI 10,707 1,115.9 21

15 Denver County, CO 10,496 1,719.7 21

16 Shelby County, TN 9,978 1,084.3 22

17 Cuyahoga County, OH 9,865 773.3 23

18 Miami-Dade County, FL 8,655 346.1 24

19 San Bernardino County, CA 8,515 422.0 24

20 Orange County, CA 8,489 280.5 25

21 Baltimore (City), MD 8,247 1,293.8 26

22 Franklin County, OH 8,184 711.6 26

23 Tarrant County, TX 8,034 448.9 27

24 Clark County, NV 7,614 400.1 27

25 Marion County, IN 7,298 819.2 28

26 Hillsborough County, FL 7,020 587.3 28

27 Broward County, FL 6,956 393.8 29

28 Alameda County, CA 6,610 443.2 29

29 Sacramento County, CA 6,585 470.0 30

30 Hamilton County, OH 6,377 745.8 30

31 Fulton County, GA 6,160 595.9 31

32 Orange County, FL 6,095 561.0 31

33 King County, WA 6,053 315.8 32

34 Fresno County, CA 6,025 658.3 32

35 Suffolk County, MA 6,017 798.5 33

36 Prince George’s County, MD 5,884 705.0 33

37 Travis County, TX 5,832 568.3 34

38 Duval County, FL 5,745 670.3 34

39 Monroe County, NY 5,744 782.9 35

40 Washington, D.C. 5,589 932.0 35

41 Santa Clara County, CA 5,518 309.2 35

42 Jackson County, MO 5,507 780.4 36

43 Kern County, CA 5,457 675.9 36

44 Essex County, NJ 5,340 693.8 37

45 Jefferson County, AL 5,268 792.1 37

46 Hennepin County, MN 5,242 453.4 37

47 St. Louis County, MO 5,233 527.3 38

48 Erie County, NY 5,080 558.7 38

49 Allegheny County, PA 5,042 413.8 39

50 Honolulu County, HI 4,827 531.9 39

51 Jefferson County, KY 4,732 655.8 39

52 Mecklenburg County, NC 4,628 506.5 40

53 Orleans County, LA 4,626 1,303.6 40

54 San Francisco County, CA 4,596 563.7 40

* Accounting for 40% of reported chlamydia cases.

† Counties and independent cities were ranked in descending order by number of cases reported in 2010.
STD Surveillance 2010 Chlamydia Tables 97

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

Group and Sex, United States, 2006–2010

Age

Group

Cases Rates*

Total Male Female Unknown Sex Total Male Female Unknown Sex

10–14 13,542 1,227 12,279 36 65.7 11.6 122.0

2006

15–19 350,627 58,332 291,493 802 1,644.3 533.4 2,805.7

20–24 376,042 92,295 283,018 729 1,781.2 846.0 2,774.4

25–29 160,411 48,977 111,125 309 774.6 462.7 1,097.5

30–34 63,501 22,377 40,996 128 322.2 224.2 421.5

35–39 30,794 12,656 18,064 74 145.4 118.8 171.5

40–44 15,251 7,350 7,870 31 67.8 65.6 69.8

45–54 11,293 5,767 5,495 31 26.1 27.1 25.0

55–64 2,398 1,323 1,070 5 7.6 8.7 6.5

65+ 889 420 465 4 2.4 2.7 2.2

Unknown Age 4,789 1,444 3,009 336

10–14 13,583 1,242 12,303 38 66.9 11.9 124.1

2007

15–19 378,107 66,806 310,474 827 1,760.8 606.9 2,966.3

20–24 401,173 101,160 299,315 698 1,907.4 932.1 2,940.4

25–29 174,196 54,560 119,354 282 827.2 506.3 1,160.9

30–34 69,164 24,477 44,552 135 354.1 247.1 462.8

35–39 33,529 13,747 19,707 75 158.3 129.0 187.3

40–44 16,554 7,941 8,580 33 75.3 72.4 77.9

45–54 13,091 6,835 6,226 30 29.8 31.7 27.9

55–64 2,831 1,521 1,304 6 8.7 9.6 7.7

65+ 809 413 392 4 2.1 2.6 1.8

Unknown Age 3,920 1,168 2,510 242

10–14 14,297 1,441 12,816 40 71.3 14.0 130.9

2008

15–19 419,026 76,741 340,975 1,310 1,947.7 695.9 3,251.4

20–24 437,163 113,948 322,054 1,161 2,075.9 1,050.7 3,153.2

25–29 188,033 60,629 126,901 503 881.4 554.1 1,221.0

30–34 74,737 26,740 47,757 240 381.4 268.5 495.5

35–39 36,537 14,908 21,510 119 174.0 141.1 206.3

40–44 17,991 8,525 9,398 68 83.7 79.3 87.3

45–54 14,271 7,386 6,832 53 32.2 33.8 30.3

55–64 3,064 1,634 1,424 6 9.1 10.1 8.2

65+ 887 427 453 7 2.3 2.6 2.0

Unknown Age 3,168 939 2,003 226

10–14 13,899 1,405 12,447 47 69.6 13.7 127.6

2009

15–19 429,173 80,725 347,597 851 1,992.6 730.5 3,314.7

20–24 454,760 120,975 332,946 839 2,111.3 1,090.5 3,187.3

25–29 190,481 62,437 127,708 336 878.7 561.7 1,209.1

30–34 77,606 28,344 49,103 159 390.2 280.4 502.0

35–39 36,286 14,859 21,354 73 176.7 143.5 209.7

40–44 18,263 8,750 9,467 46 87.0 83.3 90.3

45–54 15,033 7,818 7,183 32 33.7 35.6 31.8

55–64 3,365 1,787 1,573 5 9.7 10.6 8.7

65+ 946 472 471 3 2.4 2.8 2.1

Unknown Age 3,159 839 2,039 281

10–14 14,531 1,590 12,860 81 72.8 15.6 131.9

2010

15–19 441,342 85,570 354,252 1,520 2,049.1 774.3 3,378.2

20–24 488,996 131,686 355,994 1,316 2,270.2 1,187.0 3,407.9

25–29 197,525 66,470 130,561 494 911.2 598.0 1,236.1

30–34 83,408 31,230 51,925 253 419.4 309.0 530.9

35–39 38,384 15,861 22,421 102 186.9 153.2 220.1

40–44 19,614 9,594 9,931 89 93.4 91.3 94.7

45–54 16,106 8,635 7,423 48 36.1 39.3 32.8

55–64 3,523 1,834 1,674 15 10.1 10.9 9.3

65+ 954 464 481 9 2.4 2.8 2.1

Unknown Age 2,358 636 1,503 219

* No population data are available for unknown sex and age; therefore, rates are not calculated. The 0- to 9-year age group is not 

shown because some of these cases may not be due to sexual transmission. 

NOTE: This table should be used only for age comparisons.
98 Chlamydia Tables STD Surveillance 2010

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

2006–2010

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

2006

10–14 1,948 60 1,888 5,784 633 5,151 1,514 168 1,346 76 2 74 221 13 208

15–19 71,844 7,924 63,920 132,857 27,806 105,051 43,701 7,337 36,364 2,717 337 2,380 4,599 769 3,830

20–24 90,730 20,735 69,995 122,504 35,497 87,007 54,538 13,246 41,292 4,722 955 3,767 4,960 1,022 3,938

25–29 34,057 10,332 23,725 49,106 17,506 31,600 26,866 7,711 19,155 2,525 666 1,859 2,230 534 1,696

30–34 11,509 4,064 7,445 18,487 8,088 10,399 11,495 3,397 8,098 1,392 405 987 985 240 745

35–39 5,524 2,352 3,172 8,644 4,542 4,102 5,115 1,658 3,457 724 228 496 468 121 347

40–44 2,840 1,486 1,354 4,281 2,519 1,762 2,125 812 1,313 426 140 286 267 73 194

45–54 2,207 1,268 939 3,318 1,994 1,324 1,258 483 775 336 139 197 175 58 117

55–64 482 306 176 561 370 191 226 98 128 77 30 47 36 10 26

65+ 135 77 58 156 90 66 78 28 50 12 7 5 12 3 9

TOTAL 221,276 48,604 172,672 345,698 99,045 246,653 146,916 34,938 111,978 13,007 2,909 10,098 13,953 2,843 11,110

2007

10–14 1,860 75 1,785 5,935 682 5,253 1,554 167 1,387 93 6 87 184 13 171

15–19 76,230 9,047 67,183 147,660 32,378 115,282 45,799 7,979 37,820 3,045 430 2,615 4,313 700 3,613

20–24 96,161 22,184 73,977 136,611 40,976 95,635 55,604 13,591 42,013 4,830 1,015 3,815 4,671 1,014 3,657

25–29 37,190 11,492 25,698 55,155 20,271 34,884 27,786 7,991 19,795 2,818 746 2,072 2,160 493 1,667

30–34 12,585 4,441 8,144 21,181 9,228 11,953 11,897 3,576 8,321 1,446 440 1,006 917 241 676

35–39 6,278 2,563 3,715 9,737 5,030 4,707 5,275 1,763 3,512 823 272 551 431 110 321

40–44 3,148 1,597 1,551 4,845 2,793 2,052 2,248 858 1,390 452 189 263 245 75 170

45–54 2,621 1,578 1,043 3,942 2,415 1,527 1,414 564 850 349 141 208 159 51 108

55–64 566 381 185 716 449 267 244 90 154 109 51 58 16 5 11

65+ 149 99 50 163 88 75 75 33 42 16 8 8 6 3 3

TOTAL 236,788 53,457 183,331 385,945 114,310 271,635 151,896 36,612 115,284 13,981 3,298 10,683 13,102 2,705 10,397

2008

10–14 1,902 102 1,800 6,142 721 5,421 1,698 171 1,527 79 9 70 152 10 142

15–19 80,792 10,062 70,730 162,945 36,861 126,084 50,849 9,166 41,683 3,513 460 3,053 4,682 758 3,924

20–24 101,469 24,144 77,325 148,914 45,631 103,283 60,850 15,577 45,273 5,768 1,276 4,492 5,149 1,127 4,022

25–29 39,575 12,593 26,982 59,263 22,118 37,145 29,819 8,969 20,850 3,246 890 2,356 2,474 597 1,877

30–34 13,839 4,954 8,885 22,436 9,749 12,687 12,897 3,995 8,902 1,671 517 1,154 1,009 253 756

35–39 6,652 2,752 3,900 10,252 5,279 4,973 6,037 1,987 4,050 933 316 617 473 121 352

40–44 3,408 1,774 1,634 5,144 2,921 2,223 2,619 1,010 1,609 453 177 276 263 89 174

45–54 2,799 1,653 1,146 4,173 2,525 1,648 1,553 630 923 420 181 239 208 60 148

55–64 645 411 234 800 495 305 278 117 161 132 48 84 30 7 23

65+ 163 107 56 173 92 81 82 32 50 28 14 14 10 5 5

TOTAL 251,244 58,552 192,692 420,242 126,392 293,850 166,682 41,654 125,028 16,243 3,888 12,355 14,450 3,027 11,423

2009

10–14 1,728 90 1,638 5,957 731 5,226 1,647 179 1,468 75 6 69 166 15 151

15–19 82,536 11,007 71,529 167,131 39,037 128,094 52,022 9,420 42,602 3,462 470 2,992 4,469 735 3,734

20–24 106,086 25,653 80,433 156,996 49,312 107,684 62,384 16,222 46,162 5,862 1,323 4,539 5,289 1,204 4,085

25–29 41,177 13,399 27,778 60,479 23,007 37,472 30,627 9,342 21,285 3,290 891 2,399 2,422 571 1,851

30–34 14,917 5,501 9,416 23,433 10,302 13,131 13,194 4,229 8,965 1,606 457 1,149 1,016 279 737

35–39 6,593 2,797 3,796 10,380 5,326 5,054 6,096 2,012 4,084 920 320 600 475 113 362

40–44 3,377 1,697 1,680 5,100 2,965 2,135 2,714 1,062 1,652 526 197 329 238 71 167

45–54 3,084 1,890 1,194 4,156 2,455 1,701 1,727 714 1,013 447 186 261 181 62 119

55–64 720 481 239 861 514 347 313 125 188 117 46 71 36 13 23

65+ 165 106 59 184 96 88 78 34 44 32 19 13 8 4 4

TOTAL 260,383 62,621 197,762 434,677 133,745 300,932 170,802 43,339 127,463 16,337 3,915 12,422 14,300 3,067 11,233

2010

10–14 1,913 116 1,797 6,044 783 5,261 1,593 198 1,395 87 4 83 171 12 159

15–19 85,578 11,855 73,723 170,734 40,666 130,068 53,075 9,773 43,302 3,498 486 3,012 4,483 793 3,690

20–24 115,757 28,197 87,560 168,099 53,317 114,782 66,532 17,220 49,312 6,252 1,386 4,866 5,847 1,402 4,445

25–29 44,460 14,886 29,574 61,748 23,694 38,054 31,261 9,873 21,388 3,501 1,004 2,497 2,777 720 2,057

30–34 16,770 6,237 10,533 24,916 11,025 13,891 14,205 4,641 9,564 1,688 587 1,101 1,146 320 826

35–39 7,213 3,148 4,065 10,627 5,500 5,127 6,514 2,169 4,345 1,017 368 649 522 157 365

40–44 3,804 2,022 1,782 5,287 3,075 2,212 2,967 1,198 1,769 546 225 321 234 74 160

45–54 3,427 2,153 1,274 4,229 2,504 1,725 1,900 840 1,060 462 198 264 203 48 155

55–64 717 492 225 814 461 353 325 140 185 106 37 69 43 12 31

65+ 179 126 53 165 85 80 78 34 44 31 17 14 4 2 2

TOTAL 279,818 69,232 210,586 452,663 141,110 311,553 178,450 46,086 132,364 17,188 4,312 12,876 15,430 3,540 11,890

NOTE: These tables should be used only for race/ethnicity comparisons. The 0- to 9-year age group is not shown because some of these cases may not be due to 

sexual transmission, and they are not included in the totals. In 2010, race/ethnicity was unknown (i.e., unknown, missing, or invalid data values) for 26.2% of reported 

chlamydia cases, age was unknown for 0.2% of cases, and sex was unknown for 0.3% of cases. See Table 10 for age-specific cases and rates and Tables 3-5 for 

total and sex-specific cases and rates.
STD Surveillance 2010 Chlamydia Tables 99

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

United States, 2006–2010

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 15.8 0.9 31.4 179.3 38.6 324.4 38.4 8.3 69.9 8.5 0.4 16.9 105.4 12.2 200.9

2006

15–19 542.2 116.5 991.5 4,003.9 1,653.8 6,417.8 1,206.3 392.9 2,071.7 301.7 72.6 545.4 1,987.7 655.1 3,360.1

20–24 691.8 308.5 1,094.9 4,031.9 2,310.2 5,793.2 1,453.6 650.1 2,408.5 479.2 190.4 778.8 2,246.3 909.8 3,630.2

25–29 275.2 166.0 385.7 1,747.6 1,282.3 2,187.1 645.4 332.2 1,040.3 215.0 115.2 311.8 1,193.4 565.9 1,833.7

30–34 98.1 68.8 127.7 730.0 672.8 781.7 292.6 159.1 451.3 103.2 61.5 143.1 603.1 293.7 913.1

35–39 40.7 34.5 47.0 326.4 364.1 292.8 144.8 87.9 209.9 56.7 36.6 75.8 281.0 146.7 413.0

40–44 18.6 19.5 17.8 153.2 192.6 118.5 67.9 49.5 88.3 37.1 25.1 48.5 147.5 82.6 209.3

45–54 7.0 8.1 5.9 66.2 86.2 49.1 27.8 21.1 34.7 17.3 15.2 19.2 51.8 36.1 66.1

55–64 2.0 2.6 1.4 18.0 26.6 11.0 8.9 8.0 9.7 6.0 5.1 6.8 16.3 9.5 22.5

65+ 0.4 0.6 0.3 5.0 7.5 3.4 3.3 2.7 3.6 1.0 1.3 0.7 6.3 3.6 8.4

TOTAL 124.4 56.0 189.6 1,093.3 665.6 1,473.5 413.6 189.6 655.0 106.7 49.5 160.1 661.8 275.5 1,032.2

10–14 15.4 1.2 30.3 188.9 42.7 339.8 39.2 8.2 71.6 10.3 1.3 19.6 91.2 12.7 171.9

2007

15–19 576.9 133.4 1,044.6 4,376.7 1,893.9 6,927.5 1,222.6 413.6 2,081.5 335.2 91.8 594.2 1,863.6 598.0 3,159.0

20–24 733.5 329.8 1,158.8 4,471.8 2,650.4 6,338.0 1,506.9 686.3 2,457.4 506.2 208.6 816.0 2,097.0 894.0 3,345.3

25–29 294.1 180.4 409.4 1,911.0 1,435.5 2,366.5 665.4 343.6 1,070.2 243.8 130.6 354.3 1,115.4 503.8 1,740.0

30–34 109.1 76.5 142.0 841.1 770.8 904.9 298.0 164.2 458.4 109.6 68.3 149.0 558.6 293.0 825.4

35–39 46.9 38.1 55.8 366.4 401.4 335.1 144.8 90.6 207.1 61.9 42.0 80.9 258.1 132.5 382.2

40–44 21.4 21.7 21.1 176.5 217.5 140.5 70.3 51.0 91.6 38.9 33.4 44.0 139.0 87.1 188.5

45–54 8.3 10.0 6.5 77.1 102.3 55.5 29.8 23.4 36.4 17.5 15.0 19.8 46.2 31.1 59.9

55–64 2.2 3.1 1.4 21.9 30.9 14.8 9.1 7.0 11.0 8.1 8.2 8.0 6.9 4.5 9.0

65+ 0.5 0.8 0.3 5.1 7.2 3.8 3.0 3.1 2.9 1.2 1.4 1.1 3.0 3.4 2.7

TOTAL 132.8 61.4 200.9 1,208.5 760.2 1,607.4 417.7 194.2 658.2 113.0 55.3 166.8 614.0 259.1 954.0

10–14 16.0 1.7 31.1 200.4 46.3 359.4 42.6 8.4 78.4 8.8 2.0 15.7 77.0 10.0 146.0

2008

15–19 616.0 149.4 1,108.1 4,781.5 2,132.7 7,507.3 1,320.7 462.7 2,229.8 385.7 98.0 691.3 2,042.4 654.9 3,457.4

20–24 772.6 358.3 1,209.2 4,809.6 2,915.4 6,746.1 1,661.2 800.5 2,636.4 612.0 264.9 974.9 2,296.8 987.9 3,653.2

25–29 306.8 193.2 422.9 2,003.9 1,515.4 2,480.0 720.2 390.5 1,130.9 285.9 157.8 412.4 1,219.4 581.5 1,873.0

30–34 119.6 85.1 154.5 884.8 806.0 956.6 319.1 180.2 487.9 130.6 82.7 176.3 606.4 303.3 911.0

35–39 50.8 41.8 59.9 386.9 422.3 355.4 161.8 99.5 233.7 68.8 47.7 88.9 283.3 145.6 419.7

40–44 24.0 25.0 23.0 190.9 231.5 155.2 79.9 58.3 104.0 38.5 31.0 45.7 153.4 106.2 198.6

45–54 8.8 10.5 7.2 80.1 105.0 58.8 31.2 24.8 37.8 20.5 18.6 22.2 59.5 36.0 81.0

55–64 2.5 3.3 1.8 23.5 32.6 16.2 9.7 8.5 10.9 9.3 7.3 11.0 12.4 6.1 18.1

65+ 0.5 0.8 0.3 5.3 7.3 4.0 3.1 2.8 3.3 2.1 2.4 1.8 4.7 5.4 4.2

TOTAL 140.5 67.0 210.6 1,301.8 831.0 1,721.2 448.2 216.1 697.7 129.7 64.4 190.5 668.6 286.2 1,035.1

10–14 14.7 1.5 28.6 196.8 47.5 350.8 40.6 8.6 74.1 8.1 1.3 15.1 85.3 15.2 157.6

2009

15–19 638.5 165.9 1,137.3 4,887.9 2,250.9 7,602.0 1,290.2 451.4 2,190.4 369.9 97.8 656.9 1,985.2 646.6 3,350.5

20–24 801.5 377.9 1,247.4 4,906.5 3,045.2 6,813.7 1,606.2 784.7 2,541.0 590.2 262.5 927.7 2,330.6 1,043.1 3,663.2

25–29 314.6 202.0 430.2 2,000.7 1,528.7 2,468.5 738.1 409.1 1,140.5 273.1 151.4 389.3 1,150.8 537.2 1,776.9

30–34 126.8 93.0 160.9 893.6 819.7 961.5 327.4 190.4 495.7 123.8 73.0 171.2 593.4 324.0 866.1

35–39 52.1 44.0 60.3 394.6 428.7 364.0 162.2 99.4 235.7 68.7 49.0 87.3 286.1 136.9 433.8

40–44 24.6 24.7 24.5 194.0 240.6 153.0 82.1 60.4 106.6 44.8 34.8 54.1 142.7 86.5 197.2

45–54 9.7 12.0 7.5 78.7 100.8 59.8 33.4 27.0 40.2 21.7 19.0 24.1 51.0 36.6 64.3

55–64 2.7 3.7 1.8 24.1 32.4 17.5 10.5 8.6 12.2 7.9 6.8 8.9 14.2 10.8 17.2

65+ 0.5 0.8 0.3 5.5 7.5 4.3 2.8 2.9 2.8 2.3 3.1 1.6 3.7 4.2 3.3

TOTAL 145.3 71.5 215.8 1,328.0 866.3 1,740.2 447.8 218.8 695.2 127.5 63.6 186.4 653.6 286.5 1,005.4

10–14 16.3 1.9 31.4 199.7 50.9 353.2 39.2 9.5 70.5 9.4 0.9 18.1 87.9 12.1 166.0

2010

15–19 662.1 178.6 1,172.1 4,993.3 2,344.9 7,719.1 1,316.3 468.3 2,226.4 373.7 101.2 661.3 1,991.5 697.7 3,311.1

20–24 874.6 415.4 1,357.9 5,253.5 3,292.5 7,262.8 1,713.0 833.0 2,714.4 629.5 275.0 994.6 2,576.5 1,214.7 3,986.0

25–29 339.6 224.4 458.0 2,042.6 1,574.4 2,506.9 753.3 432.4 1,146.0 290.6 170.6 405.2 1,319.5 677.4 1,974.7

30–34 142.5 105.4 180.0 950.1 877.3 1,017.2 352.5 208.9 528.9 130.1 93.7 164.0 669.4 371.6 970.7

35–39 57.0 49.6 64.6 404.0 442.8 369.3 173.4 107.1 250.8 75.9 56.4 94.4 314.4 190.1 437.4

40–44 27.7 29.4 26.0 201.2 249.5 158.5 89.7 68.2 114.2 46.5 39.7 52.8 140.3 90.2 188.9

45–54 10.8 13.7 8.0 80.1 102.8 60.7 36.8 31.7 42.1 22.4 20.2 24.4 57.2 28.3 83.7

55–64 2.7 3.8 1.7 22.8 29.0 17.8 10.9 9.6 12.0 7.2 5.5 8.6 16.9 10.0 23.2

65+ 0.6 0.9 0.3 4.9 6.6 3.9 2.8 2.9 2.8 2.2 2.8 1.8 1.8 2.1 1.6

TOTAL 156.1 79.1 229.7 1,383.0 914.0 1,801.6 467.9 232.7 721.9 134.1 70.1 193.2 705.2 330.6 1,064.2

NOTE: These tables should be used only for race/ethnicity comparisons. The 0- to 9-year age group is not shown because some of these cases may not 

be due to sexual transmission, and they are not included in the totals. In 2010, race/ethnicity was unknown (i.e., unknown, missing, or invalid data values) 

for 26.2% of reported chlamydia cases, age was unknown for 0.2% of cases, and sex was unknown for 0.3% of cases. See Table 10 for age-specific cases 

and rates and Tables 3-5 for total and sex-specific cases and rates.
100 Chlamydia Tables STD Surveillance 2010

Table 12. Chlamydia—Women 15–25 Years of Age, United States, 2006–2010

Age Cases Rates per 100,000 Population

2006

15 23,893 1,131.6

16 43,568 2,029.6

17 62,260 3,008.2

18 80,157 3,929.2

19 81,615 4,037.4

20 75,752 3,724.9

21 65,778 3,215.7

22 55,275 2,752.2

23 46,624 2,283.2

24 39,589 1,911.1

25 32,390 1,532.0

2007

15 23,729 1,139.3

16 45,131 2,134.5

17 67,160 3,123.3

18 86,461 4,168.5

19 87,993 4,302.3

20 79,823 3,937.3

21 70,060 3,434.3

22 59,132 2,882.7

23 49,066 2,436.5

24 41,234 2,014.3

25 34,339 1,653.9

2008

15 25,468 1,244.1

16 47,865 2,294.3

17 73,080 3,449.3

18 96,581 4,481.6

19 97,981 4,710.6

20 87,892 4,283.4

21 74,816 3,677.0

22 63,397 3,096.3

23 52,641 2,557.1

24 43,308 2,143.1

25 35,773 1,741.9

2009

15 25,118 1,246.0

16 47,662 2,316.9

17 72,782 3,466.4

18 98,822 4,626.6

19 103,213 4,738.9

20 92,398 4,384.4

21 78,650 3,775.1

22 64,631 3,122.6

23 53,362 2,558.1

24 43,905 2,091.4

25 35,465 1,720.0

2010

15 25,432 1,261.6

16 48,233 2,344.7

17 73,089 3,481.0

18 100,399 4,700.5

19 107,099 4,917.3

20 99,175 4,705.9

21 84,674 4,064.3

22 69,755 3,370.1

23 56,264 2,697.2

24 46,126 2,197.2

25 37,155 1,801.9

NOTE: This table should be used only for age comparisons. Cases with unknown sex are not included in this table.
STD Surveillance 2010 Gonorrhea Tables 101

Table 13. Gonorrhea—Reported Cases and Rates by State, Ranked by Rates, United States, 2010

Rank* State Cases Rates per 100,000 Population

1 Mississippi 6,195 209.9

2 Louisiana 8,912 198.4

3 Alaska 1,273 182.3

4 South Carolina 7,970 174.7

5 Alabama 7,933 168.5

6 Arkansas 4,769 165.0

7 Georgia 15,852 161.3

8 North Carolina 14,111 150.4

9 Ohio 16,496 142.9

10 Michigan 13,627 136.7

11 Maryland 7,413 130.1

12 Texas 31,788 128.3

13 Illinois 15,777 122.2

14 Missouri 7,159 119.6

15 Oklahoma 4,369 118.5

16 Delaware 1,010 114.1

17 Tennessee 7,121 113.1

18 Florida 20,163 108.8

19 Pennsylvania 12,883 102.2

20 Indiana 6,496 101.1

U.S. TOTAL† 309,341 100.8

21 Kentucky 4,345 100.7

22 Virginia 7,402 93.9

23 New York 18,320 93.7

24 Wisconsin 5,091 90.0

25 Kansas 2,084 73.9

26 Connecticut 2,569 73.0

27 California 26,441 71.5

28 New Jersey 5,872 67.4

29 Nebraska 1,187 66.1

30 Nevada 1,728 65.4

31 New Mexico 1,229 61.2

32 Iowa 1,803 59.9

33 Hawaii 759 58.6

34 South Dakota 468 57.6

35 Colorado 2,787 55.5

36 Arizona 3,249 49.3

37 Washington 2,864 43.0

38 Minnesota 2,119 40.2

39 Massachusetts 2,483 37.7

40 West Virginia 579 31.8

41 North Dakota 204 31.5

42 Oregon 1,076 28.1

43 Rhode Island 291 27.6

44 Maine 162 12.3

45 New Hampshire 151 11.4

46 Utah 310 11.1

47 Montana 102 10.5

48 Idaho 147 9.5

49 Vermont 58 9.3

50 Wyoming 40 7.3

* States were ranked in descending order by rate (rounded to the nearest tenth) and by number of cases.

† Total includes cases reported by the District of Columbia with 2,104 cases and a rate of 350.9, but excludes outlying areas (Guam with 97 cases and a rate of 54.4, 

Puerto Rico with 312 cases and a rate of 7.9, and Virgin Islands with 151 cases and a rate of 137.5).
102 Gonorrhea Tables STD Surveillance 2010

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

United States and Outlying Areas, 2006–2010

Cases Rates per 100,000 Population

State/Area 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Alabama 10,665 10,885 9,740 7,498 7,933 231.9 235.2 208.9 159.2 168.5

Alaska 630 579 578 990 1,273 94.0 84.7 84.2 141.7 182.3

Arizona 5,949 5,062 3,449 3,250 3,249 96.5 79.9 53.1 49.3 49.3

Arkansas 4,306 4,168 4,514 4,460 4,769 153.2 147.0 158.1 154.4 165.0

California 33,740 31,294 25,787 23,228 26,441 92.5 85.6 70.2 62.8 71.5

Colorado 3,695 3,376 3,757 2,823 2,787 77.7 69.4 76.1 56.2 55.5

Connecticut 2,610 2,327 2,801 2,558 2,569 74.5 66.4 80.0 72.7 73.0

Delaware 1,485 1,293 1,045 971 1,010 174.0 149.5 119.7 109.7 114.1

District of Columbia 1,887 2,373 2,656 2,561 2,104 324.5 403.4 448.8 427.1 350.9

Florida 23,976 23,327 23,326 20,878 20,163 132.5 127.8 127.3 112.6 108.8

Georgia 19,669 17,835 16,272 13,687 15,852 210.1 186.9 168.0 139.2 161.3

Hawaii 885 659 610 631 759 68.8 51.3 47.4 48.7 58.6

Idaho 206 269 187 110 147 14.0 17.9 12.3 7.1 9.5

Illinois 20,186 20,813 20,674 19,962 15,777 157.3 161.9 160.2 154.6 122.2

Indiana 8,732 8,790 8,769 6,835 6,496 138.3 138.5 137.5 106.4 101.1

Iowa 1,966 1,928 1,700 1,658 1,803 65.9 64.5 56.6 55.1 59.9

Kansas 2,210 2,282 2,274 2,505 2,084 80.0 82.2 81.2 88.9 73.9

Kentucky 3,277 3,449 4,548 3,827 4,345 77.9 81.3 106.5 88.7 100.7

Louisiana 10,883 11,137 9,455 8,996 8,912 253.8 259.4 214.4 200.3 198.4

Maine 137 118 96 143 162 10.4 9.0 7.3 10.8 12.3

Maryland 7,328 6,768 6,666 6,395 7,413 130.5 120.5 118.3 112.2 130.1

Massachusetts 2,429 2,695 2,129 1,976 2,483 37.7 41.8 32.8 30.0 37.7

Michigan 15,677 15,482 17,064 14,704 13,627 155.3 153.7 170.6 147.5 136.7

Minnesota 3,303 3,459 3,037 2,303 2,119 63.9 66.5 58.2 43.7 40.2

Mississippi 7,511 8,314 7,494 7,241 6,195 258.1 284.8 255.0 245.3 209.9

Missouri 10,204 9,876 8,014 6,488 7,159 174.6 168.0 135.6 108.4 119.6

Montana 194 122 122 80 102 20.5 12.7 12.6 8.2 10.5

Nebraska 1,433 1,434 1,460 1,376 1,187 81.0 80.8 81.9 76.6 66.1

Nevada 2,791 2,357 2,172 1,726 1,728 111.8 91.9 83.5 65.3 65.4

New Hampshire 180 138 100 113 151 13.7 10.5 7.6 8.5 11.4

New Jersey 5,492 6,076 5,298 4,762 5,872 62.9 70.0 61.0 54.7 67.4

New Mexico 1,733 1,796 1,403 1,082 1,229 88.7 91.2 70.7 53.8 61.2

New York 17,459 17,697 17,108 17,004 18,320 90.4 91.7 87.8 87.0 93.7

North Carolina 17,312 16,666 15,972 13,870 14,111 195.5 183.9 173.2 147.9 150.4

North Dakota 153 116 143 151 204 24.1 18.1 22.3 23.3 31.5

Ohio 19,190 21,066 16,803 15,988 16,496 167.2 183.7 146.3 138.5 142.9

Oklahoma 4,951 4,827 5,185 4,673 4,369 138.3 133.4 142.4 126.7 118.5

Oregon 1,461 1,236 1,225 1,113 1,076 39.5 33.0 32.3 29.1 28.1

Pennsylvania 11,466 12,706 11,071 10,138 12,883 92.2 102.2 88.9 80.4 102.2

Rhode Island 508 402 307 322 291 47.6 38.0 29.2 30.6 27.6

South Carolina 10,320 10,326 9,442 8,318 7,970 238.8 234.3 210.8 182.4 174.7

South Dakota 367 261 375 344 468 46.9 32.8 46.6 42.3 57.6

Tennessee 9,694 9,564 8,780 7,926 7,121 160.5 155.3 141.3 125.9 113.1

Texas 30,449 32,073 32,199 29,295 31,788 129.5 134.2 132.4 118.2 128.3

Utah 888 821 477 341 310 34.8 31.0 17.4 12.2 11.1

Vermont 72 64 37 50 58 11.5 10.3 6.0 8.0 9.3

Virginia 6,476 6,269 10,337 7,789 7,402 84.7 81.3 133.1 98.8 93.9

Washington 4,231 3,653 3,127 2,285 2,864 66.2 56.5 47.7 34.3 43.0

West Virginia 953 930 746 475 579 52.4 51.3 41.1 26.1 31.8

Wisconsin 6,927 6,752 6,087 5,201 5,091 124.7 120.5 108.2 92.0 90.0

Wyoming 120 81 124 74 40 23.3 15.5 23.3 13.6 7.3

U.S. TOTAL 358,366 355,991 336,742 301,174 309,341 119.7 118.0 110.7 98.1 100.8

Northeast 40,353 42,223 38,947 37,066 42,789 73.7 77.2 70.9 67.0 77.4

Midwest 90,348 92,259 86,400 77,515 72,511 136.4 139.0 129.8 116.0 108.5

South 171,142 170,204 168,377 148,860 152,036 156.9 154.1 150.7 131.4 134.2

West 56,523 51,305 43,018 37,733 42,005 81.5 73.2 60.7 52.7 58.7

Guam 98 141 109 59 97 57.3 81.2 61.9 33.1 54.4

Puerto Rico 302 323 273 230 312 7.7 8.2 6.9 5.8 7.9

Virgin Islands 34 69 120 115 151 31.3 62.8 109.2 104.7 137.5

OUTLYING AREAS 434 533 502 404 560 10.3 12.6 11.8 9.5 13.2

TOTAL 358,800 356,524 337,244 301,578 309,901 118.2 116.6 109.4 96.9 99.6
STD Surveillance 2010 Gonorrhea Tables 103

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

Alphabetical Order, United States and Outlying Areas, 2006–2010

Cases Rates per 100,000 Population

State/Area 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Alabama 5,983 6,095 5,582 4,240 4,432 252.5 255.5 232.2 174.7 182.6

Alaska 356 326 321 516 698 110.0 99.2 97.7 153.5 207.6

Arizona 2,847 2,342 1,577 1,475 1,553 92.4 74.0 48.6 44.8 47.2

Arkansas 2,182 2,275 2,520 2,562 2,729 152.3 157.4 173.0 173.8 185.1

California 15,688 14,533 11,625 9,430 10,546 86.0 79.5 63.3 51.1 57.1

Colorado 1,879 1,807 1,978 1,502 1,514 79.6 75.0 80.8 60.2 60.7

Connecticut 1,478 1,372 1,686 1,491 1,449 82.2 76.4 94.0 82.8 80.5

Delaware 829 699 606 564 621 188.7 156.9 134.7 123.8 136.3

District of Columbia 808 1,077 1,259 1,233 1,073 261.6 347.2 403.6 389.5 338.9

Florida 12,427 11,793 12,279 10,745 10,240 135.0 127.0 131.7 114.1 108.8

Georgia 10,002 9,334 8,687 7,253 8,297 210.4 192.4 176.5 145.2 166.1

Hawaii 476 295 298 264 314 74.1 46.3 46.7 41.2 49.0

Idaho 113 152 90 51 68 15.5 20.4 11.9 6.6 8.8

Illinois 10,926 11,312 11,342 11,248 8,924 167.7 173.5 173.4 171.7 136.2

Indiana 4,806 4,884 5,056 3,985 3,598 150.0 151.7 156.3 122.3 110.4

Iowa 1,179 1,121 1,024 1,049 1,179 78.1 74.1 67.4 68.9 77.5

Kansas 1,327 1,401 1,459 1,541 1,235 95.3 100.1 103.5 108.6 87.0

Kentucky 1,709 1,887 2,511 2,132 2,487 79.7 87.2 115.1 97.1 113.2

Louisiana 5,605 5,822 5,177 5,125 4,824 254.5 263.7 228.1 222.2 209.1

Maine 54 45 43 62 75 8.0 6.7 6.4 9.2 11.1

Maryland 3,850 3,529 3,604 3,457 4,028 132.8 121.7 124.0 117.8 137.2

Massachusetts 1,214 1,282 1,100 976 1,004 36.6 38.6 32.9 28.8 29.6

Michigan 8,900 8,984 10,047 8,536 7,971 173.6 175.7 197.8 168.5 157.3

Minnesota 1,814 1,930 1,657 1,270 1,248 69.8 74.0 63.2 48.0 47.2

Mississippi 4,400 4,901 4,357 4,335 3,602 293.1 325.6 287.6 285.0 236.8

Missouri 5,752 5,481 4,542 3,585 3,951 192.5 182.3 150.2 117.1 129.1

Montana 123 75 92 46 56 26.1 15.7 19.0 9.4 11.5

Nebraska 865 847 891 821 675 97.0 94.6 99.1 90.7 74.6

Nevada 1,257 1,066 1,012 826 830 102.5 84.7 79.3 63.7 64.0

New Hampshire 97 63 49 54 59 14.6 9.5 7.3 8.0 8.8

New Jersey 2,829 3,059 2,813 2,435 3,115 63.4 68.9 63.5 54.8 70.2

New Mexico 1,003 974 783 570 610 101.3 97.6 77.8 56.2 60.1

New York 8,479 8,324 8,349 7,927 8,718 85.2 83.8 83.3 78.9 86.8

North Carolina 8,718 8,941 8,876 7,868 8,314 193.1 193.0 188.6 164.2 173.5

North Dakota 86 66 93 88 140 27.2 20.7 29.1 27.3 43.5

Ohio 10,508 11,771 9,784 9,766 10,034 178.7 200.3 166.3 165.3 169.8

Oklahoma 2,780 2,606 2,964 2,809 2,493 153.2 142.4 160.8 150.6 133.7

Oregon 609 564 553 505 477 32.7 29.9 29.0 26.2 24.7

Pennsylvania 6,219 6,945 6,210 5,650 7,268 97.3 108.8 97.2 87.4 112.4

Rhode Island 273 169 135 146 121 49.5 31.0 24.9 27.0 22.3

South Carolina 5,406 5,640 5,704 5,004 4,905 243.8 249.5 248.2 213.8 209.6

South Dakota 215 153 247 190 290 54.9 38.3 61.2 46.7 71.3

Tennessee 5,104 5,247 4,801 4,365 3,884 165.3 166.5 150.7 135.3 120.4

Texas 15,619 16,192 17,029 16,071 17,246 132.4 135.2 139.8 129.6 139.0

Utah 369 345 137 70 75 29.1 26.3 10.1 5.1 5.4

Vermont 39 30 19 29 24 12.3 9.5 6.0 9.2 7.6

Virginia 3,287 3,369 5,847 4,314 4,146 84.6 85.8 147.9 107.6 103.5

Washington 1,938 1,858 1,522 949 1,044 60.4 57.2 46.4 28.5 31.3

West Virginia 488 504 425 281 326 52.6 54.5 45.9 30.3 35.1

Wisconsin 4,047 4,066 3,744 3,113 3,164 144.8 144.3 132.3 109.4 111.2

Wyoming 71 41 71 44 19 28.0 15.9 27.0 16.5 7.1

U.S. TOTAL 187,033 187,594 182,577 162,568 165,693 123.1 122.6 118.5 104.5 106.5

Northeast 20,682 21,289 20,404 18,770 21,833 73.5 75.8 72.4 66.2 77.0

Midwest 50,425 52,016 49,886 45,192 42,409 150.0 154.4 147.7 133.3 125.1

South 89,197 89,911 92,228 82,358 83,647 160.7 160.0 162.3 143.0 145.2

West 26,729 24,378 20,059 16,248 17,804 77.2 69.7 56.7 45.5 49.9

Guam 49 66 58 32 45 58.4 77.5 67.1 36.5 51.3

Puerto Rico 152 165 128 126 141 7.4 8.0 6.2 6.1 6.8

Virgin Islands 23 51 86 90 96 40.5 88.3 148.8 155.6 166.0

OUTLYING AREAS 224 282 272 248 282 10.3 12.9 12.4 11.2 12.8

TOTAL 187,257 187,876 182,849 162,816 165,975 121.5 121.1 117.0 103.2 105.2

NOTE: Cases reported with unknown sex are not included in this table.
104 Gonorrhea Tables STD Surveillance 2010

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

Order, United States and Outlying Areas, 2006–2010

Cases Rates per 100,000 Population

State/Area 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Alabama 4,678 4,786 4,151 3,250 3,430 209.8 213.5 183.8 142.4 150.3

Alaska 274 253 257 474 575 79.1 71.3 71.9 130.9 158.7

Arizona 3,097 2,718 1,869 1,775 1,696 100.4 85.7 57.4 53.7 51.3

Arkansas 2,122 1,890 1,993 1,898 2,038 154.0 136.0 142.5 134.1 144.0

California 17,856 16,632 14,025 13,705 15,773 98.0 91.0 76.3 74.1 85.2

Colorado 1,816 1,569 1,777 1,319 1,273 75.9 64.0 71.3 52.1 50.3

Connecticut 1,132 955 1,113 1,067 1,120 66.3 55.9 65.2 62.1 65.2

Delaware 656 594 439 407 389 158.4 141.7 103.7 94.7 90.5

District of Columbia 1,072 1,284 1,383 1,328 1,028 393.2 461.7 494.1 469.2 363.2

Florida 11,546 11,527 10,995 10,099 9,906 130.0 128.5 122.1 110.7 108.6

Georgia 9,510 8,401 7,465 6,368 7,421 206.2 179.0 156.7 131.7 153.5

Hawaii 409 364 312 367 445 63.6 56.4 48.0 56.1 68.0

Idaho 92 112 97 58 78 12.5 14.8 12.7 7.5 10.1

Illinois 9,260 9,501 9,331 8,710 6,824 146.6 150.0 146.7 137.0 107.3

Indiana 3,895 3,880 3,693 2,831 2,884 125.2 124.1 117.5 89.5 91.1

Iowa 787 807 676 609 624 53.4 54.7 45.6 41.0 42.0

Kansas 883 881 815 964 849 64.4 64.0 58.6 68.9 60.7

Kentucky 1,561 1,559 2,030 1,690 1,854 75.7 75.0 97.2 79.8 87.6

Louisiana 5,186 5,201 4,233 3,849 3,540 248.6 249.4 197.7 176.1 162.0

Maine 83 73 53 81 86 12.8 11.4 8.3 12.6 13.4

Maryland 3,461 3,238 3,054 2,922 3,377 127.4 119.1 112.0 105.7 122.2

Massachusetts 1,212 1,412 1,026 996 1,479 38.9 45.2 32.5 31.1 46.1

Michigan 6,738 6,447 6,876 6,004 5,634 135.6 130.0 139.6 122.5 114.9

Minnesota 1,489 1,529 1,380 1,033 871 58.0 59.1 53.1 39.4 33.2

Mississippi 3,111 3,413 3,135 2,906 2,593 220.7 241.4 220.2 203.1 181.2

Missouri 4,452 4,395 3,472 2,903 3,208 156.0 153.1 120.2 99.2 109.6

Montana 71 47 29 34 46 15.0 9.8 6.0 7.0 9.4

Nebraska 552 583 568 553 512 63.0 66.3 64.2 62.0 57.4

Nevada 1,533 1,291 1,160 900 898 120.8 98.8 87.6 66.9 66.7

New Hampshire 83 75 51 59 92 12.8 11.6 7.9 9.0 14.1

New Jersey 2,657 3,014 2,483 2,326 2,727 62.3 70.9 58.4 54.5 63.9

New Mexico 730 822 619 512 619 75.7 84.6 63.3 51.5 62.2

New York 8,976 9,363 8,751 9,072 9,601 95.9 100.0 92.5 95.5 101.1

North Carolina 8,594 7,725 7,023 5,902 5,712 198.0 174.5 155.5 128.6 124.4

North Dakota 67 50 50 62 64 21.0 15.6 15.5 19.1 19.7

Ohio 8,493 9,164 6,693 6,068 6,421 151.7 163.9 119.4 107.7 114.0

Oklahoma 2,171 2,221 2,212 1,857 1,873 123.0 124.3 123.0 101.9 102.8

Oregon 852 672 672 608 599 46.3 36.1 35.7 32.0 31.6

Pennsylvania 5,247 5,758 4,860 4,484 5,615 86.8 95.2 80.2 73.0 91.5

Rhode Island 235 232 172 176 170 45.5 45.3 33.8 34.4 33.2

South Carolina 4,899 4,665 3,712 3,289 3,056 232.9 217.3 170.2 148.1 137.6

South Dakota 152 107 128 153 177 38.9 27.0 31.9 37.7 43.6

Tennessee 4,590 4,317 3,979 3,560 3,235 155.5 143.6 131.4 116.0 105.4

Texas 14,812 15,819 15,150 13,215 14,524 126.4 132.6 124.8 106.8 117.3

Utah 519 476 340 271 235 40.5 35.6 24.6 19.3 16.8

Vermont 33 34 18 21 33 10.7 11.1 5.9 6.9 10.8

Virginia 3,187 2,895 4,477 3,465 3,248 84.8 76.5 117.3 89.4 83.8

Washington 2,293 1,795 1,600 1,334 1,818 71.9 55.7 48.9 40.1 54.6

West Virginia 465 426 321 194 253 52.2 48.0 36.1 21.7 28.4

Wisconsin 2,870 2,673 2,332 2,061 1,926 104.0 96.0 83.4 73.4 68.6

Wyoming 49 40 53 30 21 18.8 15.1 19.6 10.8 7.6

U.S. TOTAL 170,508 167,685 153,103 137,819 142,470 115.6 112.8 102.1 91.0 94.1

Northeast 19,658 20,916 18,527 18,282 20,923 73.9 78.6 69.3 67.9 77.7

Midwest 39,638 40,017 36,014 31,951 29,994 121.5 122.4 109.8 97.0 91.1

South 81,621 79,961 75,752 66,199 67,477 152.3 147.4 138.0 118.8 121.1

West 29,591 26,791 22,810 21,387 24,076 85.3 76.3 64.3 59.6 67.1

Guam 49 75 51 27 52 56.2 84.9 56.9 29.8 57.3

Puerto Rico 150 158 145 104 171 8.0 8.3 7.6 5.5 9.0

Virgin Islands 11 18 34 25 55 21.2 34.6 65.3 48.1 105.8

OUTLYING AREAS 210 251 230 156 278 10.4 12.3 11.3 7.6 13.6

TOTAL 170,718 167,936 153,333 137,975 142,748 114.2 111.4 100.9 89.9 93.0

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2010 Gonorrhea Tables 105

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

(MSAs)* in Alphabetical Order, United States, 2006–2010

MSAs

Cases Rates per 100,000 Population

2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Atlanta-Sandy Springs-Marietta, GA 10,223 9,060 8,084 7,466 8,337 199.0 171.6 150.4 136.4 152.3

Austin-Round Rock, TX 2,446 2,075 2,388 1,973 1,932 161.6 129.8 144.5 115.7 113.3

Baltimore-Towson, MD 4,653 4,156 4,146 3,869 4,369 175.0 155.8 155.4 143.8 162.4

Birmingham-Hoover, AL 2,444 3,129 2,891 1,970 2,363 222.2 282.3 258.7 174.2 208.9

Boston-Cambridge-Quincy, MA-NH 1,542 1,770 1,464 1,352 1,881 34.6 39.5 32.4 29.5 41.0

Buffalo-Cheektowaga-Tonawanda, NY 2,068 2,289 1,898 1,574 1,227 181.8 202.9 168.8 140.1 109.2

Charlotte-Gastonia-Concord, NC-SC 3,388 2,388 3,249 3,165 2,424 214.0 144.6 190.9 181.3 138.9

Chicago-Naperville-Joliet, IL-IN-WI 15,127 14,979 16,181 15,864 12,380 159.1 157.3 169.1 165.6 129.2

Cincinnati-Middletown, OH-KY-IN 3,862 4,583 3,926 3,219 3,379 183.5 214.8 182.2 148.2 155.6

Cleveland-Elyria-Mentor, OH 4,663 4,286 2,770 3,089 3,608 220.6 204.4 132.6 147.7 172.5

Columbus, OH 3,303 4,136 3,853 3,192 3,351 191.4 235.8 217.3 177.2 186.0

Dallas-Fort Worth-Arlington, TX 8,365 10,064 9,197 7,930 8,766 139.3 163.8 146.0 123.0 136.0

Denver-Aurora, CO 2,253 2,238 2,625 1,995 2,344 93.5 90.8 104.7 78.2 91.8

Detroit-Warren-Livonia, MI 8,535 8,554 10,850 9,366 9,160 191.0 191.5 245.2 212.7 208.0

Hartford-West Hartford-East Hartford, CT 988 920 1,029 961 1,126 83.1 77.4 86.4 80.4 94.1

Houston-Baytown-Sugar Land, TX 7,318 7,757 7,290 6,232 7,652 132.1 137.8 127.3 106.2 130.4

Indianapolis, IN 4,410 4,543 4,194 2,975 2,969 264.7 268.0 244.5 170.6 170.3

Jacksonville, FL 2,954 3,113 2,979 2,015 2,128 231.1 239.3 226.8 151.7 160.2

Kansas City, MO-KS 3,822 3,683 3,268 3,192 3,213 194.3 185.5 163.2 154.4 155.4

Las Vegas-Paradise, NV 2,478 2,112 1,918 1,553 1,604 139.4 115.0 102.8 81.6 84.3

Los Angeles-Long Beach-Santa Ana, CA 12,210 11,059 9,832 9,774 11,156 94.3 85.9 76.4 75.9 86.6

Louisville, KY-IN 1,749 1,908 2,300 2,125 2,272 143.1 154.7 184.8 168.8 180.5

Memphis, TN-MS-AR 4,665 4,756 4,475 4,536 4,086 366.0 371.4 348.1 347.6 313.1

Miami-Fort Lauderdale-Miami Beach, FL 5,356 5,152 5,471 5,239 5,506 98.0 95.2 101.0 94.4 99.3

Milwaukee-Waukesha-West Allis, WI 5,006 4,960 446 3,588 3,425 331.5 321.2 28.8 230.0 219.6

Minneapolis-St. Paul-Bloomington, MN-WI 2,780 2,834 2,345 1,800 1,665 87.6 88.3 72.6 55.0 50.9

Nashville-Davidson-Murfreesboro, TN 1,734 1,692 1,541 1,225 1,292 119.2 111.2 99.4 77.4 81.7

New Orleans-Metairie-Kenner, LA 1,962 2,713 2,045 2,082 1,991 191.5 263.3 180.3 175.0 167.3

New York-Newark-Edison, NY-NJ-PA 14,949 15,396 15,116 15,254 17,507 79.4 81.8 79.5 80.0 91.8

Oklahoma City, OK 2,315 2,373 2,403 2,066 1,700 197.5 198.9 199.2 168.3 138.5

Orlando, FL 3,393 2,743 2,704 2,663 2,495 170.9 135.0 131.6 127.9 119.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 8,163 8,669 7,724 7,407 9,694 140.1 148.7 132.3 124.1 162.4

Phoenix-Mesa-Scottsdale, AZ 4,260 3,333 2,211 2,317 2,335 105.5 79.7 51.6 53.1 53.5

Pittsburgh, PA 2,057 2,599 2,569 1,866 2,069 86.8 110.3 109.3 79.2 87.9

Portland-Vancouver-Beaverton, OR-WA 1,128 1,053 1,033 826 926 52.8 48.4 46.8 36.8 41.3

Providence-New Bedford-Fall River, RI-MA 693 621 455 427 382 43.0 38.8 28.5 26.7 23.9

Richmond, VA 1,778 2,199 2,698 1,900 1,742 148.9 181.3 220.1 153.5 140.7

Riverside-San Bernardino-Ontario, CA 2,994 3,166 2,199 1,921 1,924 74.4 77.6 53.4 46.4 46.4

Rochester, NY 1,457 1,207 1,345 1,465 1,319 140.7 117.1 130.1 141.5 127.4

Sacramento-Arden-Arcade-Roseville, CA 2,235 2,315 1,771 1,124 1,676 108.1 110.7 83.9 52.8 78.8

Salt Lake City, UT 623 573 346 244 204 58.3 52.1 31.0 21.6 18.0

San Antonio, TX 2,701 2,601 3,113 3,697 3,729 139.1 130.7 153.2 178.4 180.0

San Diego-Carlsbad-San Marcos, CA 2,767 2,385 2,066 1,829 2,021 94.1 80.2 68.8 59.9 66.2

San Francisco-Oakland-Fremont, CA 6,029 5,695 5,065 4,375 4,867 144.2 135.5 118.5 101.3 112.7

San Jose-Sunnyvale-Santa Clara, CA 1,065 893 712 563 586 59.6 49.5 39.1 30.6 31.9

Seattle-Tacoma-Bellevue, WA 3,079 2,572 2,182 1,700 2,189 94.3 77.7 65.2 49.9 64.2

St. Louis, MO-IL 6,547 6,483 5,003 3,620 4,137 234.1 231.2 177.6 128.0 146.2

Tampa-St. Petersburg-Clearwater, FL 3,667 3,819 3,852 3,818 3,516 135.9 140.2 140.9 139.0 128.0

Virginia Beach-Norfolk-Newport News, VA-NC 2,544 2,504 4,935 3,647 3,429 154.2 151.0 297.6 217.8 204.8

Washington-Arlington-Alexandria, DC-VA-MD-WV 4,358 4,665 5,557 5,321 5,234 82.4 87.9 103.7 97.2 95.6

U.S. MSAs TOTAL 209,106 208,773 197,714 181,371 189,287 129.6 128.3 120.4 109.1 113.9

* 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.
106 Gonorrhea Tables STD Surveillance 2010

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

Areas (MSAs)* in Alphabetical Order, United States, 2006–2010

Cases Rates per 100,000 Population

MSAs 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Atlanta-Sandy Springs-Marietta, GA 5,026 4,515 3,967 3,633 3,954 193.5 169.1 145.8 131.1 142.7

Austin-Round Rock, TX 1,134 992 1,177 980 910 153.3 127.1 145.9 117.4 109.0

Baltimore-Towson, MD 2,470 2,179 2,302 2,181 2,397 179.2 157.6 166.6 156.5 171.9

Birmingham-Hoover, AL 1,511 1,761 1,655 1,056 1,323 265.4 307.0 286.0 180.6 226.2

Boston-Cambridge-Quincy, MA-NH 728 773 720 624 708 31.8 33.6 31.0 26.5 30.1

Buffalo-Cheektowaga-Tonawanda, NY 1,153 1,258 1,059 878 669 195.5 215.3 181.9 151.0 115.1

Charlotte-Gastonia-Concord, NC-SC 1,584 1,188 1,697 1,750 1,334 196.9 141.1 196.0 196.6 149.9

Chicago-Naperville-Joliet, IL-IN-WI 7,853 7,813 8,594 8,712 6,741 162.7 161.7 177.1 179.0 138.5

Cincinnati-Middletown, OH-KY-IN 2,465 2,884 2,696 2,181 2,330 229.0 264.2 244.5 196.4 209.8

Cleveland-Elyria-Mentor, OH 2,277 2,180 1,469 1,808 2,082 207.4 200.3 135.5 166.6 191.9

Columbus, OH 1,758 2,142 2,062 1,873 1,917 201.2 241.1 229.8 205.2 210.0

Dallas-Fort Worth-Arlington, TX 4,129 4,905 4,953 4,556 4,788 138.1 160.5 158.2 142.2 149.5

Denver-Aurora, CO 1,044 1,128 1,345 1,035 1,261 87.0 91.9 107.9 81.4 99.1

Detroit-Warren-Livonia, MI 4,613 4,721 6,226 5,204 5,217 201.8 206.7 275.1 230.8 231.3

Hartford-West Hartford-East Hartford, CT 521 522 609 551 633 85.4 85.6 99.8 90.0 103.3

Houston-Baytown-Sugar Land, TX 3,806 3,805 3,749 3,302 4,174 137.5 135.5 131.2 112.8 142.6

Indianapolis, IN 2,297 2,385 2,290 1,603 1,545 271.1 276.7 262.4 180.6 174.1

Jacksonville, FL 1,506 1,532 1,587 1,048 1,152 230.8 230.4 236.4 154.1 169.3

Kansas City, MO-KS 2,099 2,040 1,888 1,821 1,810 209.6 201.8 185.3 173.1 172.1

Las Vegas-Paradise, NV 1,123 954 880 746 779 128.4 105.8 96.0 79.8 83.3

Los Angeles-Long Beach-Santa Ana, CA 5,657 5,001 4,214 3,641 3,947 86.7 77.1 65.0 56.2 61.0

Louisville, KY-IN 887 1,026 1,228 1,133 1,263 141.6 162.3 192.2 175.9 196.1

Memphis, TN-MS-AR 2,548 2,789 2,472 2,537 2,285 386.0 420.2 370.2 374.6 337.3

Miami-Fort Lauderdale-Miami Beach, FL 2,708 2,444 2,661 2,439 2,480 96.4 87.9 95.6 85.9 87.3

Milwaukee-Waukesha-West Allis, WI 2,923 2,972 300 2,098 2,070 378.4 376.2 37.9 262.8 259.2

Minneapolis-St. Paul-Bloomington, MN-WI 1,486 1,500 1,210 928 950 93.0 93.0 74.6 56.4 57.7

Nashville-Davidson-Murfreesboro, TN 794 800 783 625 597 107.6 103.7 99.4 77.7 74.2

New Orleans-Metairie-Kenner, LA 965 1,322 984 1,098 1,014 181.7 246.6 166.6 177.8 164.2

New York-Newark-Edison, NY-NJ-PA 7,015 6,979 7,089 6,886 8,124 72.1 71.8 72.3 70.1 82.7

Oklahoma City, OK 1,275 1,202 1,294 1,188 962 214.2 198.8 211.5 190.6 154.3

Orlando, FL 1,688 1,377 1,424 1,364 1,171 168.5 134.3 137.3 129.7 111.3

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 4,257 4,416 4,098 3,811 5,125 141.4 146.7 135.9 123.6 166.3

Phoenix-Mesa-Scottsdale, AZ 2,014 1,497 988 1,022 1,071 100.7 72.3 46.7 47.4 49.7

Pittsburgh, PA 1,174 1,530 1,524 1,161 1,274 95.3 125.2 125.0 95.2 104.4

Portland-Vancouver-Beaverton, OR-WA 436 446 420 322 371 40.7 40.9 38.0 28.6 32.9

Providence-New Bedford-Fall River, RI-MA 374 282 209 196 159 44.9 34.1 25.4 23.8 19.3

Richmond, VA 824 1,122 1,436 1,010 994 134.4 179.7 227.9 158.5 156.0

Riverside-San Bernardino-Ontario, CA 1,602 1,705 1,237 1,024 976 79.6 83.6 60.2 49.6 47.2

Rochester, NY 748 608 744 744 714 141.0 115.2 140.6 140.5 134.9

Sacramento-Arden-Arcade-Roseville, CA 1,164 1,190 917 557 907 110.7 112.0 85.6 51.7 84.1

Salt Lake City, UT 246 229 88 37 41 46.7 42.4 16.0 6.6 7.3

San Antonio, TX 1,412 1,279 1,557 1,921 1,886 142.3 126.0 150.3 182.0 178.7

San Diego-Carlsbad-San Marcos, CA 1,158 961 803 620 535 79.3 64.9 53.9 40.7 35.2

San Francisco-Oakland-Fremont, CA 2,122 2,174 1,863 1,421 1,710 100.9 102.8 86.7 65.5 78.9

San Jose-Sunnyvale-Santa Clara, CA 488 385 312 248 249 55.8 43.7 35.2 27.6 27.7

Seattle-Tacoma-Bellevue, WA 1,300 1,205 965 604 686 79.6 72.7 57.7 35.4 40.3

St. Louis, MO-IL 3,718 3,539 2,756 1,908 2,188 257.5 244.5 189.6 130.8 150.0

Tampa-St. Petersburg-Clearwater, FL 2,064 1,973 2,006 1,907 1,834 149.0 141.1 143.0 135.4 130.2

Virginia Beach-Norfolk-Newport News, VA-NC 1,305 1,355 2,875 2,008 1,858 154.9 159.8 339.3 234.4 216.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,048 2,268 2,711 2,637 2,673 75.6 83.5 98.8 94.3 95.6

U.S. MSAs TOTAL 105,497 105,253 102,093 92,637 95,838 128.7 127.3 122.4 109.8 113.6

* 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.

Cases reported with unknown sex are not included in this table.
STD Surveillance 2010 Gonorrhea Tables 107

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

(MSAs)* in Alphabetical Order, United States, 2006–2010

 Cases Rates per 100,000 Population

MSAs 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Atlanta-Sandy Springs-Marietta, GA 5,083 4,484 4,054 3,786 4,306 200.1 171.9 152.6 140.0 159.2

Austin-Round Rock, TX 1,310 1,081 1,208 991 1,022 169.2 132.2 142.8 113.9 117.5

Baltimore-Towson, MD 2,180 1,976 1,841 1,675 1,968 170.3 153.7 143.2 129.2 151.7

Birmingham-Hoover, AL 932 1,367 1,235 913 1,024 175.6 255.7 229.1 167.2 187.5

Boston-Cambridge-Quincy, MA-NH 812 996 742 726 1,173 37.5 45.7 33.7 32.5 52.5

Buffalo-Cheektowaga-Tonawanda, NY 913 1,031 839 696 558 166.7 189.6 154.7 128.3 102.9

Charlotte-Gastonia-Concord, NC-SC 1,804 1,199 1,542 1,405 1,083 231.7 148.1 184.5 164.3 126.6

Chicago-Naperville-Joliet, IL-IN-WI 7,267 7,161 7,586 7,141 5,610 155.4 152.6 160.9 151.5 119.0

Cincinnati-Middletown, OH-KY-IN 1,373 1,674 1,224 1,019 1,043 133.6 160.6 116.3 96.0 98.3

Cleveland-Elyria-Mentor, OH 2,366 2,091 1,295 1,254 1,517 232.8 207.4 128.9 124.6 150.8

Columbus, OH 1,537 1,985 1,788 1,289 1,431 180.4 229.2 204.2 145.0 161.0

Dallas-Fort Worth-Arlington, TX 4,230 5,123 4,243 3,374 3,975 140.3 165.9 133.9 104.0 122.5

Denver-Aurora, CO 1,209 1,110 1,278 958 1,083 100.0 89.7 101.5 74.8 84.6

Detroit-Warren-Livonia, MI 3,890 3,786 4,502 4,005 3,924 178.2 173.4 208.2 186.4 182.7

Hartford-West Hartford-East Hartford, CT 467 398 418 410 493 80.7 68.7 72.0 70.3 84.5

Houston-Baytown-Sugar Land, TX 3,504 3,930 3,525 2,926 3,465 126.4 139.4 122.8 99.5 117.8

Indianapolis, IN 2,106 2,150 1,902 1,369 1,421 257.3 258.1 225.7 159.9 166.0

Jacksonville, FL 1,448 1,581 1,392 966 973 231.5 248.7 216.8 149.1 150.2

Kansas City, MO-KS 1,723 1,643 1,380 1,371 1,403 178.4 168.6 140.3 135.0 138.1

Las Vegas-Paradise, NV 1,354 1,158 1,038 807 825 149.9 123.9 109.3 83.3 85.2

Los Angeles-Long Beach-Santa Ana, CA 6,505 6,023 5,543 6,081 7,156 101.2 94.2 86.7 95.0 111.8

Louisville, KY-IN 858 881 1,070 990 1,007 144.0 146.5 176.6 161.1 163.9

Memphis, TN-MS-AR 2,117 1,967 2,003 1,998 1,800 344.4 318.9 324.1 318.4 286.8

Miami-Fort Lauderdale-Miami Beach, FL 2,648 2,706 2,801 2,799 3,024 99.7 102.8 106.4 103.4 111.7

Milwaukee-Waukesha-West Allis, WI 2,080 1,975 145 1,470 1,354 282.0 261.8 19.1 193.1 177.9

Minneapolis-St. Paul-Bloomington, MN-WI 1,294 1,334 1,135 872 715 82.1 83.6 70.6 53.7 44.0

Nashville-Davidson-Murfreesboro, TN 940 892 758 600 694 131.0 119.0 99.4 77.1 89.2

New Orleans-Metairie-Kenner, LA 981 1,352 1,050 976 919 198.8 273.5 193.2 170.5 160.5

New York-Newark-Edison, NY-NJ-PA 7,929 8,406 8,017 8,363 9,358 87.2 92.4 87.1 90.5 101.2

Oklahoma City, OK 1,040 1,171 1,103 876 736 180.2 199.0 185.5 145.0 121.9

Orlando, FL 1,704 1,366 1,277 1,297 1,320 173.3 135.6 125.5 125.8 128.1

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 3,904 4,250 3,626 3,593 4,565 138.6 150.9 128.4 124.5 158.2

Phoenix-Mesa-Scottsdale, AZ 2,242 1,834 1,222 1,295 1,264 110.0 86.9 56.5 58.6 57.2

Pittsburgh, PA 883 1,069 1,045 704 795 77.5 94.3 92.3 62.0 70.0

Portland-Vancouver-Beaverton, OR-WA 692 607 611 504 555 64.9 56.0 55.5 45.2 49.8

Providence-New Bedford-Fall River, RI-MA 318 338 246 231 223 40.8 43.7 31.9 29.7 28.7

Richmond, VA 954 1,074 1,261 886 745 164.2 182.4 211.7 147.4 123.9

Riverside-San Bernardino-Ontario, CA 1,390 1,450 961 895 944 69.0 71.0 46.7 43.1 45.5

Rochester, NY 709 599 601 721 605 140.4 119.2 119.1 142.5 119.5

Sacramento-Arden-Arcade-Roseville, CA 1,046 1,098 835 558 756 103.0 106.7 80.4 53.2 72.0

Salt Lake City, UT 377 344 258 207 163 69.6 61.5 45.5 36.2 28.5

San Antonio, TX 1,289 1,322 1,556 1,775 1,843 135.7 135.5 156.3 174.6 181.3

San Diego-Carlsbad-San Marcos, CA 1,531 1,415 1,254 1,206 1,482 103.4 94.7 83.0 78.7 96.7

San Francisco-Oakland-Fremont, CA 3,882 3,493 3,179 2,933 3,127 186.9 167.2 149.5 136.5 145.5

San Jose-Sunnyvale-Santa Clara, CA 570 506 398 314 333 62.4 54.8 42.7 33.4 35.4

Seattle-Tacoma-Bellevue, WA 1,779 1,367 1,216 1,094 1,501 109.1 82.7 72.7 64.2 88.1

St. Louis, MO-IL 2,829 2,944 2,247 1,712 1,949 209.2 217.1 164.8 125.0 142.3

Tampa-St. Petersburg-Clearwater, FL 1,602 1,842 1,822 1,887 1,678 122.0 138.9 136.9 141.0 125.3

Virginia Beach-Norfolk-Newport News, VA-NC 1,237 1,148 2,058 1,633 1,569 153.3 141.6 253.7 199.6 191.8

Washington-Arlington-Alexandria, DC-VA-MD-WV 2,291 2,385 2,823 2,681 2,554 88.8 92.1 107.9 100.0 95.3

U.S. MSAs TOTAL 103,129 103,082 95,153 88,232 93,031 130 128.8 117.7 107.8 113.7

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.

NOTE: 2008 Milwaukee County STD morbidity data were misclassified, resulting in incomplete case counts for MSA-Milwaukee-Waukesha-West Allis, WI.

Cases reported with unknown sex are not included in this table.
108 Gonorrhea Tables STD Surveillance 2010

Table 20. Gonorrhea—Counties and Independent Cities* Ranked by Number of Reported Cases, 

United States, 2010

Rank† County/Independent City Cases Rates per 100,000 Population Cumulative Percentage

1 Cook County, IL 10,123 191.5 3

2 Los Angeles County, CA 9,993 101.5 6

3 Wayne County, MI 7,495 389.2 8

4 Philadelphia County, PA 6,533 422.2 11

5 Harris County, TX 6,529 160.4 13

6 Dallas County, TX 5,033 205.3 14

7 Kings County, NY 3,957 154.1 16

8 Bexar County, TX 3,544 214.6 17

9 Shelby County, TN 3,479 378.1 18

10 Milwaukee County, WI 3,309 344.9 19

11 Bronx County, NY 3,301 236.2 20

12 Cuyahoga County, OH 3,170 248.5 21

13 Baltimore (City), MD 3,163 496.2 22

14 Franklin County, OH 3,149 273.8 23

15 Fulton County, GA 3,093 299.2 24

16 New York County, NY 2,877 176.6 25

17 Marion County, IN 2,838 318.6 26

18 Tarrant County, TX 2,566 143.4 27

19 Hamilton County, OH 2,511 293.7 28

20 Miami-Dade County, FL 2,444 97.7 28

21 Maricopa County, AZ 2,281 56.7 29

22 Jefferson County, AL 2,257 339.4 30

23 Jackson County, MO 2,188 310.0 30

24 Broward County, FL 2,146 121.5 31

25 Washington, D.C. 2,104 350.9 32

26 Queens County, NY 2,027 87.9 33

27 San Diego County, CA 2,021 66.2 33

28 Jefferson County, KY 1,992 276.1 34

29 Hillsborough County, FL 1,951 163.2 34

30 San Francisco County, CA 1,936 237.4 35

31 Duval County, FL 1,895 221.1 36

32 DeKalb County, GA 1,862 249.2 36

33 Alameda County, CA 1,824 122.3 37

34 Denver County, CO 1,732 283.8 37

35 Prince George’s County, MD 1,727 206.9 38

36 Essex County, NJ 1,711 222.3 39

37 St. Louis (City), MO 1,694 475.1 39

38 Orange County, FL 1,674 154.1 40

39 Allegheny County, PA 1,648 135.2 40

40 King County, WA 1,611 84.1 41

41 Clark County, NV 1,604 84.3 41

42 Sacramento County, CA 1,536 109.6 42

43 Orleans County, LA 1,516 427.2 42

44 Mecklenburg County, NC 1,516 165.9 43

45 Caddo County, LA 1,495 589.5 43

46 Oklahoma County, OK 1,460 203.7 44

47 Travis County, TX 1,445 140.8 44

48 St. Louis County, MO 1,437 144.8 45

49 Pulaski County, AR 1,368 358.2 45

50 Tulsa County, OK 1,329 220.8 45

51 Pinellas County, FL 1,329 146.2 46

52 Montgomery County, OH 1,327 249.2 46

53 Monroe County, NY 1,263 172.1 47

54 Wake County, NC 1,251 139.4 47

55 Bell County, TX 1,178 412.2 47

56 Orange County, CA 1,163 38.4 48

57 San Bernardino County, CA 1,146 56.8 48

58 Mobile County, AL 1,138 276.4 49

59 Richland County, SC 1,126 302.7 49

60 Erie County, NY 1,109 122.0 49

61 Hinds County, MS 1,102 445.0 50

62 Lucas County, OH 1,099 237.1 50

63 Hennepin County, MN 1,073 92.8 50

* Accounting for 50% of reported gonorrhea cases.

† Counties and independent cities were ranked in descending order by number of cases reported in 2010.
STD Surveillance 2010 Gonorrhea Tables 109

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

and Sex, United States, 2006–2010

Age

Group

Cases Rates*

Total Male Female Unknown Sex Total Male Female Unknown Sex

10–14 4,232 671 3,556 5 20.5 6.4 35.3

2006

15–19 96,104 29,899 66,015 190 450.7 273.4 635.4

20–24 110,465 48,951 61,313 201 523.3 448.7 601.0

25–29 61,554 32,717 28,738 99 297.2 309.1 283.8

30–34 31,164 18,721 12,383 60 158.1 187.6 127.3

35–39 20,573 13,712 6,821 40 97.1 128.8 64.7

40–44 14,462 10,558 3,875 29 64.3 94.3 34.4

45–54 13,777 10,983 2,766 28 31.8 51.6 12.6

55–64 3,121 2,668 449 4 9.9 17.5 2.7

65+ 796 639 150 7 2.1 4.1 0.7

Unknown Age 1,644 838 648 158

10–14 3,946 619 3,313 14 19.4 6.0 33.4

2007

15–19 98,260 31,090 66,961 209 457.6 282.5 639.7

20–24 111,418 48,848 62,401 169 529.7 450.1 613.0

25–29 61,157 32,135 28,941 81 290.4 298.2 281.5

30–34 30,191 18,019 12,123 49 154.6 181.9 125.9

35–39 19,028 12,648 6,336 44 89.9 118.7 60.2

40–44 13,138 9,651 3,463 24 59.8 88.0 31.4

45–54 13,299 10,640 2,645 14 30.3 49.3 11.9

55–64 3,168 2,675 484 9 9.7 17.0 2.9

65+ 707 617 89 1 1.9 3.9 0.4

Unknown Age 1,186 568 522 96

10–14 3,660 596 3,059 5 18.3 5.8 31.2

2008

15–19 97,069 30,468 66,326 275 451.2 276.3 632.5

20–24 108,747 46,796 61,647 304 516.4 431.5 603.6

25–29 56,654 28,928 27,563 163 265.6 264.4 265.2

30–34 27,561 16,077 11,387 97 140.6 161.4 118.1

35–39 16,378 10,552 5,773 53 78.0 99.8 55.4

40–44 11,020 7,809 3,170 41 51.2 72.7 29.5

45–54 11,123 8,612 2,481 30 25.1 39.4 11.0

55–64 2,622 2,186 423 13 7.8 13.5 2.4

65+ 655 545 103 7 1.7 3.3 0.5

Unknown Age 801 379 350 72

10–14 2,983 507 2,471 5 14.9 5.0 25.3

2009

15–19 86,996 27,444 59,353 199 403.9 248.3 566.0

20–24 100,645 43,986 56,436 223 467.3 396.5 540.3

25–29 49,855 26,016 23,719 120 230.0 234.1 224.6

30–34 24,607 14,364 10,178 65 123.7 142.1 104.1

35–39 13,971 8,997 4,928 46 68.0 86.9 48.4

40–44 8,975 6,504 2,446 25 42.8 61.9 23.3

45–54 9,294 7,311 1,954 29 20.8 33.3 8.6

55–64 2,212 1,848 363 1 6.4 11.0 2.0

65+ 554 446 108 0 1.4 2.7 0.5

Unknown Age 766 300 394 72

10–14 3,016 486 2,498 32 15.1 4.8 25.6

2010

15–19 88,250 28,002 59,867 381 409.7 253.4 570.9

20–24 105,619 46,708 58,574 337 490.3 421.0 560.7

25–29 50,890 26,818 23,907 165 234.8 241.3 226.3

30–34 25,401 14,809 10,510 82 127.7 146.5 107.5

35–39 13,769 8,812 4,907 50 67.0 85.1 48.2

40–44 9,262 6,745 2,495 22 44.1 64.2 23.8

45–54 9,555 7,490 2,043 22 21.4 34.1 9.0

55–64 2,194 1,852 338 4 6.3 11.0 1.9

65+ 520 411 105 4 1.3 2.4 0.5

Unknown Age 554 257 229 68

* No population data are available for unknown sex and age; therefore, rates are not calculated. The 0- to 9-year age group is not shown because some of 

these cases may not be due to sexual transmission.

NOTE: This table should be used only for age comparisons.
110 Gonorrhea Tables STD Surveillance 2010

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

2006–2010

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

2006

10–14 442 37 405 2,386 385 2,001 271 49 222 17 1 16 26 1 25

15–19 12,196 2,015 10,181 54,194 19,050 35,144 6,137 1,889 4,248 423 97 326 667 193 474

20–24 17,022 5,413 11,609 61,318 30,149 31,169 8,197 3,835 4,362 640 272 368 825 288 537

25–29 9,998 4,119 5,879 32,364 19,114 13,250 5,003 2,740 2,263 434 223 211 490 190 300

30–34 5,239 2,588 2,651 15,531 10,446 5,085 2,531 1,453 1,078 276 162 114 243 89 154

35–39 4,112 2,498 1,614 9,382 6,878 2,504 1,551 967 584 182 117 65 141 68 73

40–44 3,108 2,108 1,000 6,521 5,147 1,374 913 635 278 106 77 29 85 44 41

45–54 2,938 2,206 732 6,605 5,709 896 662 474 188 91 53 38 93 56 37

55–64 721 609 112 1,356 1,241 115 119 85 34 21 10 11 19 14 5

65+ 171 152 19 284 249 35 38 29 9 4 2 2 5 4 1

TOTAL 55,947 21,745 34,202 189,941 98,368 91,573 25,422 12,156 13,266 2,194 1,014 1,180 2,594 947 1,647

2007

10–14 353 15 338 2,265 395 1,870 269 47 222 16 0 16 22 2 20

15–19 12,049 2,101 9,948 57,387 20,121 37,266 5,818 1,896 3,922 384 95 289 515 114 401

20–24 16,642 5,173 11,469 63,917 30,729 33,188 7,832 3,703 4,129 614 242 372 707 209 498

25–29 9,829 4,037 5,792 33,322 19,108 14,214 4,657 2,574 2,083 411 230 181 381 150 231

30–34 4,999 2,382 2,617 15,591 10,306 5,285 2,410 1,443 967 273 164 109 173 67 106

35–39 3,757 2,141 1,616 9,056 6,611 2,445 1,395 902 493 141 92 49 123 60 63

40–44 2,757 1,864 893 6,207 4,894 1,313 785 539 246 89 62 27 72 21 51

45–54 2,866 2,156 710 6,503 5,513 990 623 456 167 85 49 36 61 37 24

55–64 712 611 101 1,361 1,231 130 133 97 36 33 24 9 10 9 1

65+ 187 167 20 250 219 31 34 30 4 9 7 2 3 3 0

TOTAL 54,151 20,647 33,504 195,859 99,127 96,732 23,956 11,687 12,269 2,055 965 1,090 2,067 672 1,395

2008

10–14 330 26 304 2,086 355 1,731 229 31 198 20 3 17 24 4 20

15–19 10,862 1,917 8,945 57,157 19,657 37,500 5,883 1,861 4,022 406 100 306 522 122 400

20–24 15,635 4,715 10,920 62,799 29,555 33,244 7,754 3,640 4,114 675 284 391 726 245 481

25–29 8,921 3,494 5,427 30,939 17,151 13,788 4,644 2,494 2,150 440 225 215 405 145 260

30–34 4,390 2,043 2,347 14,295 9,221 5,074 2,343 1,370 973 247 133 114 187 71 116

35–39 2,988 1,672 1,316 7,789 5,478 2,311 1,387 887 500 160 111 49 111 50 61

40–44 2,234 1,478 756 5,054 3,813 1,241 820 570 250 101 76 25 78 34 44

45–54 2,366 1,753 613 5,231 4,322 909 594 430 164 121 85 36 76 42 34

55–64 586 503 83 1,162 1,028 134 119 84 35 33 22 11 16 14 2

65+ 172 147 25 204 185 19 28 21 7 8 4 4 7 6 1

TOTAL 48,484 17,748 30,736 186,716 90,765 95,951 23,801 11,388 12,413 2,211 1,043 1,168 2,152 733 1,419

2009

10–14 253 22 231 1,728 300 1,428 171 31 140 12 1 11 18 3 15

15–19 9,423 1,802 7,621 51,156 17,688 33,468 5,361 1,728 3,633 412 92 320 556 128 428

20–24 13,889 4,456 9,433 58,645 27,754 30,891 7,174 3,434 3,740 601 265 336 725 228 497

25–29 7,845 3,415 4,430 27,229 15,186 12,043 4,081 2,288 1,793 398 214 184 408 160 248

30–34 4,025 2,045 1,980 12,624 7,998 4,626 2,128 1,282 846 228 132 96 229 97 132

35–39 2,597 1,496 1,101 6,579 4,641 1,938 1,170 737 433 149 109 40 137 62 75

40–44 1,866 1,307 559 3,861 2,945 916 730 524 206 100 75 25 78 38 40

45–54 2,125 1,669 456 3,982 3,284 698 562 421 141 103 73 30 81 48 33

55–64 532 450 82 896 800 96 110 78 32 30 17 13 25 19 6

65+ 157 138 19 176 145 31 29 19 10 7 6 1 4 3 1

TOTAL 42,712 16,800 25,912 166,876 80,741 86,135 21,516 10,542 10,974 2,040 984 1,056 2,261 786 1,475

2010

10–14 268 22 246 1,691 300 1,391 181 26 155 6 1 5 15 3 12

15–19 9,307 1,821 7,486 52,017 17,771 34,246 5,669 1,928 3,741 406 126 280 660 168 492

20–24 15,415 5,308 10,107 60,213 28,643 31,570 8,266 3,957 4,309 724 337 387 900 290 610

25–29 8,768 3,939 4,829 26,618 14,860 11,758 4,593 2,666 1,927 467 286 181 546 215 331

30–34 4,637 2,407 2,230 12,480 7,702 4,778 2,414 1,547 867 271 172 99 278 121 157

35–39 2,785 1,693 1,092 6,105 4,175 1,930 1,336 853 483 197 141 56 151 72 79

40–44 2,231 1,565 666 3,731 2,883 848 851 611 240 114 78 36 100 52 48

45–54 2,508 1,968 540 3,817 3,121 696 629 478 151 100 77 23 79 48 31

55–64 582 489 93 847 766 81 117 90 27 25 16 9 18 15 3

65+ 133 117 16 136 118 18 37 29 8 4 4 0 4 2 2

TOTAL 46,634 19,329 27,305 167,655 80,339 87,316 24,093 12,185 11,908 2,314 1,238 1,076 2,751 986 1,765

NOTE: These tables should be used only for race/ethnicity comparisons. The 0- to 9-year age group is not shown because some of these cases may not be due 

to sexual transmission, and they are not included in the totals. In 2010, race/ethnicity was unknown (i.e., unknown, missing, or invalid data values) for 20.0% of 

reported gonorrhea cases, age was unknown for 0.2% of cases, and sex was unknown for 0.4% of cases. See Table 21 for age-specific cases and rates and Tables 

14-16 for total and sex-specific cases and rates.
STD Surveillance 2010 Gonorrhea Tables 111

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

United States, 2006–2010

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 3.6 0.6 6.7 73.9 23.5 126.0 6.9 2.4 11.5 1.9 0.2 3.6 12.4 0.9 24.1

2006

15–19 92.0 29.6 157.9 1,633.2 1,133.0 2,147.0 169.4 101.2 242.0 47.0 20.9 74.7 288.3 164.4 415.8

20–24 129.8 80.5 181.6 2,018.1 1,962.2 2,075.3 218.5 188.2 254.4 65.0 54.2 76.1 373.6 256.4 495.0

25–29 80.8 66.2 95.6 1,151.7 1,400.1 917.1 120.2 118.0 122.9 37.0 38.6 35.4 262.2 201.3 324.4

30–34 44.6 43.8 45.5 613.3 869.0 382.3 64.4 68.1 60.1 20.5 24.6 16.5 148.8 108.9 188.7

35–39 30.3 36.7 23.9 354.3 551.3 178.8 43.9 51.3 35.5 14.2 18.8 9.9 84.7 82.4 86.9

40–44 20.4 27.7 13.1 233.3 393.6 92.4 29.2 38.7 18.7 9.2 13.8 4.9 47.0 49.8 44.2

45–54 9.3 14.1 4.6 131.9 246.9 33.2 14.7 20.7 8.4 4.7 5.8 3.7 27.6 34.9 20.9

55–64 3.0 5.1 0.9 43.4 89.2 6.6 4.7 7.0 2.6 1.6 1.7 1.6 8.6 13.3 4.3

65+ 0.6 1.2 0.1 9.1 20.8 1.8 1.6 2.8 0.7 0.3 0.4 0.3 2.6 4.8 0.9

TOTAL 31.5 25.1 37.6 600.7 661.0 547.1 71.6 66.0 77.6 18.0 17.2 18.7 123.0 91.8 153.0

10–14 2.9 0.2 5.7 72.1 24.7 121.0 6.8 2.3 11.5 1.8 0.0 3.6 10.9 2.0 20.1

2007

15–19 91.2 31.0 154.7 1,701.0 1,176.9 2,239.4 155.3 98.3 215.9 42.3 20.3 65.7 222.5 97.4 350.6

20–24 126.9 76.9 179.7 2,092.3 1,987.6 2,199.5 212.2 187.0 241.5 64.4 49.7 79.6 317.4 184.3 455.5

25–29 77.7 63.4 92.3 1,154.5 1,353.2 964.3 111.5 110.7 112.6 35.6 40.3 31.0 196.7 153.3 241.1

30–34 43.3 41.0 45.6 619.1 860.8 400.1 60.4 66.3 53.3 20.7 25.5 16.1 105.4 81.4 129.4

35–39 28.1 31.8 24.3 340.7 527.6 174.1 38.3 46.3 29.1 10.6 14.2 7.2 73.6 72.3 75.0

40–44 18.8 25.4 12.1 226.2 381.1 89.9 24.5 32.0 16.2 7.7 11.0 4.5 40.8 24.4 56.5

45–54 9.0 13.7 4.4 127.2 233.5 36.0 13.1 18.9 7.1 4.3 5.2 3.4 17.7 22.6 13.3

55–64 2.8 5.0 0.8 41.7 84.7 7.2 4.9 7.5 2.6 2.4 3.8 1.2 4.3 8.2 0.8

65+ 0.6 1.3 0.1 7.9 17.9 1.6 1.4 2.8 0.3 0.7 1.3 0.3 1.5 3.4 0.0

TOTAL 30.4 23.7 36.7 613.3 659.3 572.4 65.9 62.0 70.1 16.6 16.2 17.0 96.9 64.4 128.0

10–14 2.8 0.4 5.2 68.0 22.8 114.8 5.7 1.5 10.2 2.2 0.7 3.8 12.2 4.0 20.6

2008

15–19 82.8 28.5 140.1 1,677.2 1,137.3 2,232.8 152.8 93.9 215.2 44.6 21.3 69.3 227.7 105.4 352.4

20–24 119.0 70.0 170.8 2,028.3 1,888.3 2,171.4 211.7 187.1 239.6 71.6 59.0 84.9 323.9 214.8 436.9

25–29 69.2 53.6 85.1 1,046.2 1,175.1 920.6 112.2 108.6 116.6 38.8 39.9 37.6 199.6 141.2 259.4

30–34 37.9 35.1 40.8 563.7 762.3 382.6 58.0 61.8 53.3 19.3 21.3 17.4 112.4 85.1 139.8

35–39 22.8 25.4 20.2 294.0 438.2 165.1 37.2 44.4 28.8 11.8 16.8 7.1 66.5 60.2 72.7

40–44 15.7 20.8 10.7 187.6 302.2 86.6 25.0 32.9 16.2 8.6 13.3 4.1 45.5 40.6 50.2

45–54 7.4 11.1 3.8 100.4 179.7 32.4 11.9 16.9 6.7 5.9 8.8 3.4 21.7 25.2 18.6

55–64 2.3 4.0 0.6 34.1 67.8 7.1 4.2 6.1 2.4 2.3 3.3 1.4 6.6 12.2 1.6

65+ 0.5 1.1 0.1 6.3 14.7 0.9 1.1 1.8 0.5 0.6 0.7 0.5 3.3 6.4 0.8

TOTAL 27.1 20.3 33.6 578.4 596.8 562.0 64.0 59.1 69.3 17.6 17.3 18.0 99.6 69.3 128.6

10–14 2.2 0.4 4.0 57.1 19.5 95.9 4.2 1.5 7.1 1.3 0.2 2.4 9.2 3.0 15.7

2009

15–19 72.9 27.2 121.2 1,496.1 1,019.9 1,986.2 133.0 82.8 186.8 44.0 19.1 70.3 247.0 112.6 384.0

20–24 104.9 65.6 146.3 1,832.8 1,713.9 1,954.6 184.7 166.1 205.9 60.5 52.6 68.7 319.5 197.5 445.7

25–29 59.9 51.5 68.6 900.7 1,009.1 793.3 98.3 100.2 96.1 33.0 36.4 29.9 193.9 150.5 238.1

30–34 34.2 34.6 33.8 481.4 636.4 338.7 52.8 57.7 46.8 17.6 21.1 14.3 133.8 112.6 155.1

35–39 20.5 23.6 17.5 250.1 373.6 139.6 31.1 36.4 25.0 11.1 16.7 5.8 82.5 75.1 89.9

40–44 13.6 19.0 8.2 146.9 238.9 65.6 22.1 29.8 13.3 8.5 13.2 4.1 46.8 46.3 47.2

45–54 6.7 10.6 2.9 75.4 134.8 24.6 10.9 15.9 5.6 5.0 7.4 2.8 22.8 28.3 17.8

55–64 2.0 3.5 0.6 25.1 50.4 4.9 3.7 5.4 2.1 2.0 2.5 1.6 9.8 15.8 4.5

65+ 0.5 1.0 0.1 5.3 11.3 1.5 1.1 1.6 0.6 0.5 1.0 0.1 1.8 3.1 0.8

TOTAL 23.8 19.2 28.3 509.8 523.0 498.1 56.4 53.2 59.9 15.9 16.0 15.8 103.3 73.4 132.0

10–14 2.3 0.4 4.3 55.9 19.5 93.4 4.5 1.3 7.8 0.6 0.2 1.1 7.7 3.0 12.5

2010

15–19 72.0 27.4 119.0 1,521.3 1,024.7 2,032.4 140.6 92.4 192.3 43.4 26.2 61.5 293.2 147.8 441.5

20–24 116.5 78.2 156.7 1,881.8 1,768.8 1,997.6 212.8 191.4 237.2 72.9 66.9 79.1 396.6 251.3 547.0

25–29 67.0 59.4 74.8 880.5 987.4 774.6 110.7 116.8 103.3 38.8 48.6 29.4 259.4 202.3 317.8

30–34 39.4 40.7 38.1 475.9 612.9 349.9 59.9 69.6 47.9 20.9 27.5 14.8 162.4 140.5 184.5

35–39 22.0 26.7 17.4 232.1 336.1 139.0 35.6 42.1 27.9 14.7 21.6 8.1 91.0 87.2 94.7

40–44 16.3 22.8 9.7 142.0 233.9 60.8 25.7 34.8 15.5 9.7 13.8 5.9 60.0 63.4 56.7

45–54 7.9 12.5 3.4 72.3 128.1 24.5 12.2 18.0 6.0 4.8 7.9 2.1 22.3 28.3 16.7

55–64 2.2 3.8 0.7 23.8 48.2 4.1 3.9 6.2 1.8 1.7 2.4 1.1 7.1 12.4 2.2

65+ 0.4 0.9 0.1 4.1 9.2 0.9 1.3 2.4 0.5 0.3 0.7 0.0 1.8 2.1 1.6

TOTAL 26.0 22.1 29.8 512.2 520.4 504.9 63.2 61.5 64.9 18.1 20.1 16.1 125.7 92.1 158.0

NOTE: These tables should be used only for race/ethnicity comparisons. The 0- to 9-year age group is not shown because some of these cases may not be due 

to sexual transmission, and they are not included in the totals. In 2010, race/ethnicity was unknown (i.e., unknown, missing, or invalid data values) for 20.0% of 

reported gonorrhea cases, age was unknown for 0.2% of cases, and sex was unknown for 0.4% of cases. See Table 21 for age-specific cases and rates and Tables 

14-16 for total and sex-specific cases and rates.
112 Syphilis Tables STD Surveillance 2010

Table 23. All Stages of Syphilis*—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2006–2010

Cases Rates per 100,000 Population

State/Area 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Alabama 931 1,006 1,187 1,138 781 20.2 21.7 25.5 24.2 16.6

Alaska 25 16 9 4 15 3.7 2.3 1.3 0.6 2.1

Arizona 926 1,245 1,394 1,084 904 15.0 19.6 21.4 16.4 13.7

Arkansas 246 371 508 552 534 8.8 13.1 17.8 19.1 18.5

California 6,046 6,323 6,911 6,033 6,114 16.6 17.3 18.8 16.3 16.5

Colorado 182 157 352 269 342 3.8 3.2 7.1 5.4 6.8

Connecticut 197 148 173 179 234 5.6 4.2 4.9 5.1 6.7

Delaware 74 63 60 87 44 8.7 7.3 6.9 9.8 5.0

District of Columbia 314 416 370 431 495 54.0 70.7 62.5 71.9 82.5

Florida 2,945 3,918 4,585 3,860 4,069 16.3 21.5 25.0 20.8 21.9

Georgia 1,933 2,254 2,833 2,717 2,347 20.6 23.6 29.2 27.6 23.9

Hawaii 66 58 68 88 73 5.1 4.5 5.3 6.8 5.6

Idaho 12 14 26 31 20 0.8 0.9 1.7 2.0 1.3

Illinois 1,473 1,220 1,565 1,915 2,236 11.5 9.5 12.1 14.8 17.3

Indiana 250 216 351 324 412 4.0 3.4 5.5 5.0 6.4

Iowa 68 65 75 65 68 2.3 2.2 2.5 2.2 2.3

Kansas 87 97 125 151 110 3.1 3.5 4.5 5.4 3.9

Kentucky 188 153 218 239 311 4.5 3.6 5.1 5.5 7.2

Louisiana 1,390 1,808 2,024 1,964 2,484 32.4 42.1 45.9 43.7 55.3

Maine 22 21 27 15 41 1.7 1.6 2.1 1.1 3.1

Maryland 1,038 1,171 1,088 993 1,015 18.5 20.8 19.3 17.4 17.8

Massachusetts 378 399 479 473 639 5.9 6.2 7.4 7.2 9.7

Michigan 384 473 546 635 680 3.8 4.7 5.5 6.4 6.8

Minnesota 189 186 266 217 350 3.7 3.6 5.1 4.1 6.6

Mississippi 520 708 745 745 823 17.9 24.3 25.4 25.2 27.9

Missouri 430 484 542 514 512 7.4 8.2 9.2 8.6 8.6

Montana 2 8 10 5 5 0.2 0.8 1.0 0.5 0.5

Nebraska 34 30 36 45 33 1.9 1.7 2.0 2.5 1.8

Nevada 389 396 325 306 412 15.6 15.4 12.5 11.6 15.6

New Hampshire 35 52 41 37 43 2.7 4.0 3.1 2.8 3.2

New Jersey 799 926 1,009 890 947 9.2 10.7 11.6 10.2 10.9

New Mexico 237 180 189 208 151 12.1 9.1 9.5 10.3 7.5

New York 4,586 5,001 5,515 4,623 4,859 23.8 25.9 28.3 23.7 24.9

North Carolina 962 1,093 999 1,524 1,233 10.9 12.1 10.8 16.2 13.1

North Dakota 3 2 4 8 6 0.5 0.3 0.6 1.2 0.9

Ohio 491 549 763 795 1,076 4.3 4.8 6.6 6.9 9.3

Oklahoma 251 216 257 296 272 7.0 6.0 7.1 8.0 7.4

Oregon 99 59 97 132 173 2.7 1.6 2.6 3.5 4.5

Pennsylvania 888 844 902 1,027 1,007 7.1 6.8 7.2 8.1 8.0

Rhode Island 71 76 55 64 79 6.7 7.2 5.2 6.1 7.5

South Carolina 397 411 412 507 579 9.2 9.3 9.2 11.1 12.7

South Dakota 29 12 6 10 12 3.7 1.5 0.7 1.2 1.5

Tennessee 1,015 1,212 1,284 1,317 1,193 16.8 19.7 20.7 20.9 18.9

Texas 4,956 5,506 6,336 6,975 6,411 21.1 23.0 26.0 28.1 25.9

Utah 68 45 40 55 133 2.7 1.7 1.5 2.0 4.8

Vermont 7 11 18 1 4 1.1 1.8 2.9 0.2 0.6

Virginia 701 736 789 755 800 9.2 9.5 10.2 9.6 10.1

Washington 423 367 438 322 535 6.6 5.7 6.7 4.8 8.0

West Virginia 30 27 44 32 26 1.6 1.5 2.4 1.8 1.4

Wisconsin 170 170 187 166 186 3.1 3.0 3.3 2.9 3.3

Wyoming 1 6 9 7 6 0.2 1.1 1.7 1.3 1.1

U.S. TOTAL 36,958 40,925 46,292 44,830 45,834 12.3 13.6 15.2 14.6 14.9

Northeast 6,983 7,478 8,219 7,309 7,853 12.8 13.7 15.0 13.2 14.2

Midwest 3,608 3,504 4,466 4,845 5,681 5.4 5.3 6.7 7.2 8.5

South 17,891 21,069 23,739 24,132 23,417 16.4 19.1 21.2 21.3 20.7

West 8,476 8,874 9,868 8,544 8,883 12.2 12.7 13.9 11.9 12.4

Guam 13 37 45 12 11 7.6 21.3 25.6 6.7 6.2

Puerto Rico 1,068 1,269 797 725 723 27.2 32.2 20.2 18.3 18.2

Virgin Islands 5 5 1 2 4 4.6 4.6 0.9 1.8 3.6

OUTLYING AREAS 1,086 1,311 843 739 738 25.8 31.0 19.9 17.4 17.3

TOTAL 38,044 42,236 47,135 45,569 46,572 12.5 13.8 15.3 14.6 15.0

* See Syphilis Morbidity Reporting in the Appendix for definition.
STD Surveillance 2010 Syphilis Tables 113

Table 24. All Stages of Syphilis*—Reported Cases and Rates in Selected Metropolitan Statistical 

Areas (MSAs)†

 in Alphabetical Order, United States, 2006–2010

MSAs

Cases Rates per 100,000 Population

2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Atlanta-Sandy Springs-Marietta, GA 1,641 1,904 2,243 2,187 1,916 31.9 36.1 41.7 39.9 35.0

Austin-Round Rock, TX 212 234 344 352 362 14.0 14.6 20.8 20.6 21.2

Baltimore-Towson, MD 642 650 685 567 531 24.1 24.4 25.7 21.1 19.7

Birmingham-Hoover, AL 561 483 504 412 234 51.0 43.6 45.1 36.4 20.7

Boston-Cambridge-Quincy, MA-NH 329 324 383 411 544 7.4 7.2 8.5 9.0 11.9

Buffalo-Cheektowaga-Tonawanda, NY 42 28 20 40 43 3.7 2.5 1.8 3.6 3.8

Charlotte-Gastonia-Concord, NC-SC 303 301 224 345 287 19.1 18.2 13.2 19.8 16.4

Chicago-Naperville-Joliet, IL-IN-WI 1,386 1,116 1,452 1,797 2,085 14.6 11.7 15.2 18.8 21.8

Cincinnati-Middletown, OH-KY-IN 58 77 105 227 484 2.8 3.6 4.9 10.5 22.3

Cleveland-Elyria-Mentor, OH 53 83 127 170 182 2.5 4.0 6.1 8.1 8.7

Columbus, OH 229 222 311 252 245 13.3 12.7 17.5 14.0 13.6

Dallas-Fort Worth-Arlington, TX 1,678 1,643 1,780 2,148 1,955 27.9 26.7 28.3 33.3 30.3

Denver-Aurora, CO 141 120 269 223 293 5.9 4.9 10.7 8.7 11.5

Detroit-Warren-Livonia, MI 284 339 304 411 456 6.4 7.6 6.9 9.3 10.4

Hartford-West Hartford-East Hartford, CT 65 51 71 67 85 5.5 4.3 6.0 5.6 7.1

Houston-Baytown-Sugar Land, TX 1,570 2,048 2,088 2,038 1,891 28.3 36.4 36.5 34.7 32.2

Indianapolis, IN 121 95 189 156 233 7.3 5.6 11.0 8.9 13.4

Jacksonville, FL 165 198 308 235 228 12.9 15.2 23.5 17.7 17.2

Kansas City, MO-KS 228 268 237 220 145 11.6 13.5 11.8 10.6 7.0

Las Vegas-Paradise, NV 355 364 299 273 389 20.0 19.8 16.0 14.3 20.4

Los Angeles-Long Beach-Santa Ana, CA 3,594 3,581 3,572 3,278 3,003 27.8 27.8 27.7 25.5 23.3

Louisville, KY-IN 101 77 91 123 197 8.3 6.2 7.3 9.8 15.7

Memphis, TN-MS-AR 612 761 748 777 758 48.0 59.4 58.2 59.5 58.1

Miami-Fort Lauderdale-Miami Beach, FL 1,455 1,863 2,408 1,969 2,259 26.6 34.4 44.5 35.5 40.7

Milwaukee-Waukesha-West Allis, WI 100 127 138 117 121 6.6 8.2 8.9 7.5 7.8

Minneapolis-St. Paul-Bloomington, MN-WI 161 170 223 182 309 5.1 5.3 6.9 5.6 9.5

Nashville-Davidson-Murfreesboro, TN 194 240 277 302 258 13.3 15.8 17.9 19.1 16.3

New Orleans-Metairie-Kenner, LA 352 560 491 462 684 34.4 54.3 43.3 38.8 57.5

New York-Newark-Edison, NY-NJ-PA 4,924 5,503 6,097 5,087 5,334 26.2 29.2 32.1 26.7 28.0

Oklahoma City, OK 116 114 161 210 148 9.9 9.6 13.3 17.1 12.1

Orlando, FL 403 583 460 408 391 20.3 28.7 22.4 19.6 18.8

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 773 778 812 959 930 13.3 13.3 13.9 16.1 15.6

Phoenix-Mesa-Scottsdale, AZ 757 866 857 682 644 18.7 20.7 20.0 15.6 14.8

Pittsburgh, PA 152 122 98 70 72 6.4 5.2 4.2 3.0 3.1

Portland-Vancouver-Beaverton, OR-WA 74 51 64 114 153 3.5 2.3 2.9 5.1 6.8

Providence-New Bedford-Fall River, RI-MA 92 100 71 76 95 5.7 6.2 4.4 4.7 5.9

Richmond, VA 106 129 226 207 213 8.9 10.6 18.4 16.7 17.2

Riverside-San Bernardino-Ontario, CA 376 340 452 416 428 9.3 8.3 11.0 10.0 10.3

Rochester, NY 90 76 51 52 66 8.7 7.4 4.9 5.0 6.4

Sacramento-Arden-Arcade-Roseville, CA 136 117 243 212 183 6.6 5.6 11.5 10.0 8.6

Salt Lake City, UT 41 35 35 40 95 3.8 3.2 3.1 3.5 8.4

San Antonio, TX 473 420 598 739 730 24.4 21.1 29.4 35.7 35.2

San Diego-Carlsbad-San Marcos, CA 572 788 828 495 607 19.4 26.5 27.6 16.2 19.9

San Francisco-Oakland-Fremont, CA 741 783 1,044 932 1,150 17.7 18.6 24.4 21.6 26.6

San Jose-Sunnyvale-Santa Clara, CA 94 159 156 141 183 5.3 8.8 8.6 7.7 9.9

Seattle-Tacoma-Bellevue, WA 356 309 359 256 439 10.9 9.3 10.7 7.5 12.9

St. Louis, MO-IL 186 252 322 294 403 6.7 9.0 11.4 10.4 14.2

Tampa-St. Petersburg-Clearwater, FL 428 612 680 631 502 15.9 22.5 24.9 23.0 18.3

Virginia Beach-Norfolk-Newport News, VA-NC 245 232 248 236 236 14.9 14.0 15.0 14.1 14.1

Washington-Arlington-Alexandria, DC-VA-MD-WV 928 1,163 956 1,004 1,191 17.5 21.9 17.8 18.3 21.7

U.S. MSAs TOTAL 28,695 31,459 34,709 33,002 34,370 17.8 19.3 21.1 19.9 20.7

* 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.
114 Syphilis Tables STD Surveillance 2010

Table 25. Primary and Secondary Syphilis—Reported Cases and Rates by State, Ranked by Rates, 

United States, 2010

Rank* State Cases Rate per 100,000 Population

1 Louisiana 546 12.2

2 Georgia 795 8.1

3 Mississippi 228 7.7

4 Arkansas 205 7.1

5 Illinois 908 7.0

6 Florida 1,184 6.4

7 Maryland 328 5.8

8 New York 1,098 5.6

9 California 2,065 5.6

10 Alabama 260 5.5

11 Texas 1,230 5.0

12 Nevada 130 4.9

13 Ohio 528 4.6

U.S. TOTAL† 13,774 4.5

14 Tennessee 277 4.4

15 Massachusetts 285 4.3

16 North Carolina 396 4.2

17 Washington 266 4.0

18 Rhode Island 41 3.9

19 Virginia 279 3.5

20 Arizona 230 3.5

21 South Carolina 155 3.4

22 Kentucky 139 3.2

23 Pennsylvania 369 2.9

24 Minnesota 149 2.8

25 New Jersey 244 2.8

26 Connecticut 98 2.8

27 Colorado 138 2.7

28 Indiana 175 2.7

29 Hawaii 35 2.7

30 New Mexico 53 2.6

31 Missouri 152 2.5

32 Oklahoma 92 2.5

33 Maine 32 2.4

34 Michigan 235 2.4

35 Utah 65 2.3

36 Oregon 71 1.9

37 New Hampshire 22 1.7

38 Delaware 9 1.0

39 Wisconsin 49 0.9

40 Kansas 19 0.7

41 Nebraska 12 0.7

42 Vermont 4 0.6

43 Iowa 19 0.6

44 South Dakota 4 0.5

45 North Dakota 3 0.5

46 Alaska 3 0.4

47 Idaho 6 0.4

48 West Virginia 6 0.3

49 Montana 3 0.3

Wyoming 0 0.0

* States were ranked in descending order by rate (rounded to the nearest tenth) and by number of cases.

† Total includes cases reported by the District of Columbia with 134 cases and a rate of 22.3, but excludes outlying areas (Guam with 1 case and rate of 0.6, Puerto 

Rico with 228 cases and rate of 5.7, and Virgin Islands with 0 cases and rate of 0.0).
STD Surveillance 2010 Syphilis Tables 115

Table 26. Primary and Secondary Syphilis—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2006–2010

State/Area

Cases Rates per 100,000 Population

2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Alabama 319 380 449 417 260 6.9 8.2 9.6 8.9 5.5

Alaska 11 7 1 0 3 1.6 1.0 0.1 0.0 0.4

Arizona 203 296 317 231 230 3.3 4.7 4.9 3.5 3.5

Arkansas 77 122 206 275 205 2.7 4.3 7.2 9.5 7.1

California 1,835 2,038 2,204 1,900 2,065 5.0 5.6 6.0 5.1 5.6

Colorado 69 57 128 105 138 1.5 1.2 2.6 2.1 2.7

Connecticut 64 39 34 65 98 1.8 1.1 1.0 1.8 2.8

Delaware 20 18 16 27 9 2.3 2.1 1.8 3.1 1.0

District of Columbia 116 178 146 163 134 19.9 30.3 24.7 27.2 22.3

Florida 719 913 1,044 1,041 1,184 4.0 5.0 5.7 5.6 6.4

Georgia 581 680 914 953 795 6.2 7.1 9.4 9.7 8.1

Hawaii 18 9 29 33 35 1.4 0.7 2.3 2.5 2.7

Idaho 3 1 7 3 6 0.2 0.1 0.5 0.2 0.4

Illinois 431 464 554 750 908 3.4 3.6 4.3 5.8 7.0

Indiana 93 54 140 158 175 1.5 0.9 2.2 2.5 2.7

Iowa 19 21 16 23 19 0.6 0.7 0.5 0.8 0.6

Kansas 27 28 30 32 19 1.0 1.0 1.1 1.1 0.7

Kentucky 73 56 93 92 139 1.7 1.3 2.2 2.1 3.2

Louisiana 342 533 707 741 546 8.0 12.4 16.0 16.5 12.2

Maine 9 9 10 4 32 0.7 0.7 0.8 0.3 2.4

Maryland 300 345 378 314 328 5.3 6.1 6.7 5.5 5.8

Massachusetts 124 155 216 238 285 1.9 2.4 3.3 3.6 4.3

Michigan 118 123 210 230 235 1.2 1.2 2.1 2.3 2.4

Minnesota 47 59 116 71 149 0.9 1.1 2.2 1.3 2.8

Mississippi 86 133 184 237 228 3.0 4.6 6.3 8.0 7.7

Missouri 168 239 224 173 152 2.9 4.1 3.8 2.9 2.5

Montana 1 8 7 4 3 0.1 0.8 0.7 0.4 0.3

Nebraska 7 4 15 5 12 0.4 0.2 0.8 0.3 0.7

Nevada 137 111 77 91 130 5.5 4.3 3.0 3.4 4.9

New Hampshire 13 30 20 14 22 1.0 2.3 1.5 1.1 1.7

New Jersey 173 227 226 212 244 2.0 2.6 2.6 2.4 2.8

New Mexico 79 46 44 61 53 4.0 2.3 2.2 3.0 2.6

New York 736 1,068 1,217 1,182 1,098 3.8 5.5 6.2 6.0 5.6

North Carolina 309 323 287 579 396 3.5 3.6 3.1 6.2 4.2

North Dakota 1 1 0 4 3 0.2 0.2 0.0 0.6 0.5

Ohio 184 194 351 360 528 1.6 1.7 3.1 3.1 4.6

Oklahoma 70 65 86 97 92 2.0 1.8 2.4 2.6 2.5

Oregon 29 18 26 57 71 0.8 0.5 0.7 1.5 1.9

Pennsylvania 264 263 272 341 369 2.1 2.1 2.2 2.7 2.9

Rhode Island 14 36 18 20 41 1.3 3.4 1.7 1.9 3.9

South Carolina 66 91 98 123 155 1.5 2.1 2.2 2.7 3.4

South Dakota 13 7 1 0 4 1.7 0.9 0.1 0.0 0.5

Tennessee 249 367 413 403 277 4.1 6.0 6.6 6.4 4.4

Texas 1,064 1,160 1,405 1,644 1,230 4.5 4.9 5.8 6.6 5.0

Utah 21 20 25 31 65 0.8 0.8 0.9 1.1 2.3

Vermont 3 10 11 0 4 0.5 1.6 1.8 0.0 0.6

Virginia 190 230 266 299 279 2.5 3.0 3.4 3.8 3.5

Washington 182 154 181 139 266 2.8 2.4 2.8 2.1 4.0

West Virginia 11 6 13 8 6 0.6 0.3 0.7 0.4 0.3

Wisconsin 68 66 65 44 49 1.2 1.2 1.2 0.8 0.9

Wyoming 0 4 3 3 0 0.0 0.8 0.6 0.6 0.0

U.S. TOTAL 9,756 11,466 13,500 13,997 13,774 3.3 3.8 4.4 4.6 4.5

Northeast 1,400 1,837 2,024 2,076 2,193 2.6 3.4 3.7 3.8 4.0

Midwest 1,176 1,260 1,722 1,850 2,253 1.8 1.9 2.6 2.8 3.4

South 4,592 5,600 6,705 7,413 6,263 4.2 5.1 6.0 6.5 5.5

West 2,588 2,769 3,049 2,658 3,065 3.7 4.0 4.3 3.7 4.3

Guam 3 8 6 2 1 1.8 4.6 3.4 1.1 0.6

Puerto Rico 150 169 167 227 228 3.8 4.3 4.2 5.7 5.7

Virgin Islands 1 0 0 0 0 0.9 0.0 0.0 0.0 0.0

OUTLYING AREAS 154 177 173 229 229 3.7 4.2 4.1 5.4 5.4

TOTAL 9,910 11,643 13,673 14,226 14,003 3.3 3.8 4.4 4.6 4.5
116 Syphilis Tables STD Surveillance 2010

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

Region in Alphabetical Order, United States and Outlying Areas, 2006–2010

Cases Rates per 100,000 Population

State/Area 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Alabama 116 143 171 137 75 4.9 6.0 7.1 5.6 3.1

Alaska 2 1 0 0 0 0.6 0.3 0.0 0.0 0.0

Arizona 33 64 56 22 20 1.1 2.0 1.7 0.7 0.6

Arkansas 35 50 81 104 82 2.4 3.5 5.6 7.1 5.6

California 128 115 110 79 74 0.7 0.6 0.6 0.4 0.4

Colorado 5 2 3 6 2 0.2 0.1 0.1 0.2 0.1

Connecticut 2 2 0 1 5 0.1 0.1 0.0 0.1 0.3

Delaware 4 1 6 11 1 0.9 0.2 1.3 2.4 0.2

District of Columbia 6 5 7 10 2 1.9 1.6 2.2 3.2 0.6

Florida 98 153 193 147 147 1.1 1.6 2.1 1.6 1.6

Georgia 41 53 96 101 82 0.9 1.1 2.0 2.0 1.6

Hawaii 1 1 7 6 7 0.2 0.2 1.1 0.9 1.1

Idaho 2 1 1 0 0 0.3 0.1 0.1 0.0 0.0

Illinois 37 39 38 55 108 0.6 0.6 0.6 0.8 1.6

Indiana 10 8 16 13 20 0.3 0.2 0.5 0.4 0.6

Iowa 6 3 3 6 3 0.4 0.2 0.2 0.4 0.2

Kansas 2 6 5 9 1 0.1 0.4 0.4 0.6 0.1

Kentucky 7 9 14 4 8 0.3 0.4 0.6 0.2 0.4

Louisiana 123 209 307 349 251 5.6 9.5 13.5 15.1 10.9

Maine 2 0 0 0 0 0.3 0.0 0.0 0.0 0.0

Maryland 61 47 77 42 26 2.1 1.6 2.6 1.4 0.9

Massachusetts 7 10 6 5 16 0.2 0.3 0.2 0.1 0.5

Michigan 26 27 60 40 23 0.5 0.5 1.2 0.8 0.5

Minnesota 4 1 5 0 9 0.2 0.0 0.2 0.0 0.3

Mississippi 36 35 66 73 69 2.4 2.3 4.4 4.8 4.5

Missouri 19 27 29 15 3 0.6 0.9 1.0 0.5 0.1

Montana 0 2 1 0 0 0.0 0.4 0.2 0.0 0.0

Nebraska 1 0 3 0 3 0.1 0.0 0.3 0.0 0.3

Nevada 34 12 14 7 7 2.8 1.0 1.1 0.5 0.5

New Hampshire 0 0 0 0 1 0.0 0.0 0.0 0.0 0.1

New Jersey 12 16 21 26 16 0.3 0.4 0.5 0.6 0.4

New Mexico 22 15 6 6 3 2.2 1.5 0.6 0.6 0.3

New York 29 32 52 55 47 0.3 0.3 0.5 0.5 0.5

North Carolina 67 60 44 108 55 1.5 1.3 0.9 2.3 1.1

North Dakota 0 0 0 1 1 0.0 0.0 0.0 0.3 0.3

Ohio 43 28 63 63 132 0.7 0.5 1.1 1.1 2.2

Oklahoma 19 24 25 24 16 1.0 1.3 1.4 1.3 0.9

Oregon 0 2 2 1 1 0.0 0.1 0.1 0.1 0.1

Pennsylvania 34 34 21 42 36 0.5 0.5 0.3 0.6 0.6

Rhode Island 0 2 0 1 2 0.0 0.4 0.0 0.2 0.4

South Carolina 11 10 12 10 9 0.5 0.4 0.5 0.4 0.4

South Dakota 5 2 1 0 0 1.3 0.5 0.2 0.0 0.0

Tennessee 73 113 119 122 49 2.4 3.6 3.7 3.8 1.5

Texas 261 297 450 490 333 2.2 2.5 3.7 4.0 2.7

Utah 3 0 1 0 2 0.2 0.0 0.1 0.0 0.1

Vermont 0 0 0 0 2 0.0 0.0 0.0 0.0 0.6

Virginia 23 16 25 22 20 0.6 0.4 0.6 0.5 0.5

Washington 4 6 5 6 5 0.1 0.2 0.2 0.2 0.1

West Virginia 1 2 4 2 0 0.1 0.2 0.4 0.2 0.0

Wisconsin 3 6 14 10 6 0.1 0.2 0.5 0.4 0.2

Wyoming 0 1 2 1 0 0.0 0.4 0.8 0.4 0.0

U.S. TOTAL 1,458 1,692 2,242 2,232 1,780 1.0 1.1 1.5 1.4 1.1

Northeast 86 96 100 130 125 0.3 0.3 0.4 0.5 0.4

Midwest 156 147 237 212 309 0.5 0.4 0.7 0.6 0.9

South 982 1,227 1,697 1,756 1,225 1.8 2.2 3.0 3.0 2.1

West 234 222 208 134 121 0.7 0.6 0.6 0.4 0.3

Guam 1 4 1 1 1 1.2 4.7 1.2 1.1 1.1

Puerto Rico 46 56 29 23 18 2.3 2.7 1.4 1.1 0.9

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 47 60 30 24 19 2.2 2.7 1.4 1.1 0.9

TOTAL 1,505 1,752 2,272 2,256 1,799 1.0 1.1 1.5 1.4 1.1

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2010 Syphilis Tables 117

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

Region in Alphabetical Order, United States and Outlying Areas, 2006–2010

Cases Rates per 100,000 Population

State/Area 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Alabama 203 237 278 280 185 9.1 10.6 12.3 12.3 8.1

Alaska 9 6 1 0 3 2.6 1.7 0.3 0.0 0.8

Arizona 166 230 261 208 210 5.4 7.2 8.0 6.3 6.4

Arkansas 42 72 125 171 123 3.0 5.2 8.9 12.1 8.7

California 1,706 1,921 2,092 1,821 1,990 9.4 10.5 11.4 9.8 10.8

Colorado 64 55 125 99 136 2.7 2.2 5.0 3.9 5.4

Connecticut 62 37 34 64 93 3.6 2.2 2.0 3.7 5.4

Delaware 16 17 10 16 8 3.9 4.1 2.4 3.7 1.9

District of Columbia 110 173 139 153 132 40.3 62.2 49.7 54.1 46.6

Florida 621 760 850 894 1,037 7.0 8.5 9.4 9.8 11.4

Georgia 540 626 818 852 713 11.7 13.3 17.2 17.6 14.7

Hawaii 17 8 22 27 28 2.6 1.2 3.4 4.1 4.3

Idaho 1 0 6 3 6 0.1 0.0 0.8 0.4 0.8

Illinois 394 425 516 695 800 6.2 6.7 8.1 10.9 12.6

Indiana 83 46 124 145 155 2.7 1.5 3.9 4.6 4.9

Iowa 13 18 13 17 16 0.9 1.2 0.9 1.1 1.1

Kansas 25 22 25 23 18 1.8 1.6 1.8 1.6 1.3

Kentucky 66 47 79 88 131 3.2 2.3 3.8 4.2 6.2

Louisiana 219 324 400 392 284 10.5 15.5 18.7 17.9 13.0

Maine 7 9 10 4 32 1.1 1.4 1.6 0.6 5.0

Maryland 239 298 301 272 302 8.8 11.0 11.0 9.8 10.9

Massachusetts 117 145 210 233 269 3.8 4.6 6.7 7.3 8.4

Michigan 92 96 150 190 212 1.9 1.9 3.0 3.9 4.3

Minnesota 43 58 111 71 140 1.7 2.2 4.3 2.7 5.3

Mississippi 50 98 118 164 159 3.5 6.9 8.3 11.5 11.1

Missouri 149 212 195 158 149 5.2 7.4 6.8 5.4 5.1

Montana 1 6 6 4 3 0.2 1.3 1.2 0.8 0.6

Nebraska 6 4 12 5 9 0.7 0.5 1.4 0.6 1.0

Nevada 103 99 63 84 123 8.1 7.6 4.8 6.2 9.1

New Hampshire 13 30 20 14 21 2.0 4.6 3.1 2.1 3.2

New Jersey 161 211 205 186 228 3.8 5.0 4.8 4.4 5.3

New Mexico 57 31 38 55 50 5.9 3.2 3.9 5.5 5.0

New York 707 1,036 1,165 1,127 1,051 7.6 11.1 12.3 11.9 11.1

North Carolina 242 263 243 471 341 5.6 5.9 5.4 10.3 7.4

North Dakota 1 1 0 3 2 0.3 0.3 0.0 0.9 0.6

Ohio 141 166 288 297 396 2.5 3.0 5.1 5.3 7.0

Oklahoma 51 41 61 73 76 2.9 2.3 3.4 4.0 4.2

Oregon 29 16 24 56 70 1.6 0.9 1.3 3.0 3.7

Pennsylvania 230 229 251 299 333 3.8 3.8 4.1 4.9 5.4

Rhode Island 14 34 18 19 39 2.7 6.6 3.5 3.7 7.6

South Carolina 55 81 86 113 146 2.6 3.8 3.9 5.1 6.6

South Dakota 8 5 0 0 4 2.0 1.3 0.0 0.0 1.0

Tennessee 176 254 294 281 228 6.0 8.4 9.7 9.2 7.4

Texas 803 863 955 1,154 896 6.9 7.2 7.9 9.3 7.2

Utah 18 20 24 31 63 1.4 1.5 1.7 2.2 4.5

Vermont 3 10 11 0 2 1.0 3.3 3.6 0.0 0.7

Virginia 167 214 241 277 259 4.4 5.7 6.3 7.1 6.7

Washington 178 148 176 133 261 5.6 4.6 5.4 4.0 7.8

West Virginia 10 4 9 6 6 1.1 0.5 1.0 0.7 0.7

Wisconsin 65 60 51 34 43 2.4 2.2 1.8 1.2 1.5

Wyoming 0 3 1 2 0 0.0 1.1 0.4 0.7 0.0

U.S. TOTAL 8,293 9,769 11,255 11,764 11,981 5.6 6.6 7.5 7.8 7.9

Northeast 1,314 1,741 1,924 1,946 2,068 4.9 6.5 7.2 7.2 7.7

Midwest 1,020 1,113 1,485 1,638 1,944 3.1 3.4 4.5 5.0 5.9

South 3,610 4,372 5,007 5,657 5,026 6.7 8.1 9.1 10.2 9.0

West 2,349 2,543 2,839 2,523 2,943 6.8 7.2 8.0 7.0 8.2

Guam 2 4 5 1 0 2.3 4.5 5.6 1.1 0.0

Puerto Rico 104 113 138 204 210 5.5 6.0 7.3 10.7 11.0

Virgin Islands 1 0 0 0 0 1.9 0.0 0.0 0.0 0.0

OUTLYING AREAS 107 117 143 205 210 5.3 5.8 7.0 10.0 10.3

TOTAL 8,400 9,886 11,398 11,969 12,191 5.6 6.6 7.5 7.8 7.9

NOTE: Cases reported with unknown sex are not included in this table.
118 Syphilis Tables STD Surveillance 2010

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

Statistical Areas (MSAs)* in Alphabetical Order, United States, 2006–2010

Cases Rates per 100,000 Population

MSAs 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Atlanta-Sandy Springs-Marietta, GA 529 608 765 809 651 10.3 11.5 14.2 14.8 11.9

Austin-Round Rock, TX 84 74 107 99 107 5.5 4.6 6.5 5.8 6.3

Baltimore-Towson, MD 213 211 270 204 212 8.0 7.9 10.1 7.6 7.9

Birmingham-Hoover, AL 244 189 188 145 82 22.2 17.1 16.8 12.8 7.2

Boston-Cambridge-Quincy, MA-NH 117 131 173 203 240 2.6 2.9 3.8 4.4 5.2

Buffalo-Cheektowaga-Tonawanda, NY 18 11 3 10 11 1.6 1.0 0.3 0.9 1.0

Charlotte-Gastonia-Concord, NC-SC 121 103 58 138 106 7.6 6.2 3.4 7.9 6.1

Chicago-Naperville-Joliet, IL-IN-WI 416 427 535 732 881 4.4 4.5 5.6 7.6 9.2

Cincinnati-Middletown, OH-KY-IN 13 34 62 124 272 0.6 1.6 2.9 5.7 12.5

Cleveland-Elyria-Mentor, OH 18 29 64 71 82 0.9 1.4 3.1 3.4 3.9

Columbus, OH 107 76 135 115 120 6.2 4.3 7.6 6.4 6.7

Dallas-Fort Worth-Arlington, TX 320 265 328 502 342 5.3 4.3 5.2 7.8 5.3

Denver-Aurora, CO 56 46 103 92 120 2.3 1.9 4.1 3.6 4.7

Detroit-Warren-Livonia, MI 82 91 100 151 146 1.8 2.0 2.3 3.4 3.3

Hartford-West Hartford-East Hartford, CT 23 15 8 25 32 1.9 1.3 0.7 2.1 2.7

Houston-Baytown-Sugar Land, TX 396 501 456 432 330 7.1 8.9 8.0 7.4 5.6

Indianapolis, IN 47 26 80 81 108 2.8 1.5 4.7 4.6 6.2

Jacksonville, FL 41 44 67 57 49 3.2 3.4 5.1 4.3 3.7

Kansas City, MO-KS 112 149 102 80 43 5.7 7.5 5.1 3.9 2.1

Las Vegas-Paradise, NV 132 102 72 86 125 7.4 5.6 3.9 4.5 6.6

Los Angeles-Long Beach-Santa Ana, CA 945 1,061 920 858 766 7.3 8.2 7.1 6.7 5.9

Louisville, KY-IN 41 32 36 57 105 3.4 2.6 2.9 4.5 8.3

Memphis, TN-MS-AR 145 208 234 189 165 11.4 16.2 18.2 14.5 12.6

Miami-Fort Lauderdale-Miami Beach, FL 369 414 509 518 652 6.8 7.6 9.4 9.3 11.8

Milwaukee-Waukesha-West Allis, WI 38 53 45 28 29 2.5 3.4 2.9 1.8 1.9

Minneapolis-St. Paul-Bloomington, MN-WI 43 57 105 67 140 1.4 1.8 3.3 2.0 4.3

Nashville-Davidson-Murfreesboro, TN 40 84 85 92 73 2.7 5.5 5.5 5.8 4.6

New Orleans-Metairie-Kenner, LA 90 168 170 138 92 8.8 16.3 15.0 11.6 7.7

New York-Newark-Edison, NY-NJ-PA 811 1,208 1,353 1,301 1,219 4.3 6.4 7.1 6.8 6.4

Oklahoma City, OK 24 36 61 70 55 2.0 3.0 5.1 5.7 4.5

Orlando, FL 94 145 126 109 103 4.7 7.1 6.1 5.2 4.9

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 173 205 214 289 307 3.0 3.5 3.7 4.8 5.1

Phoenix-Mesa-Scottsdale, AZ 157 193 211 169 161 3.9 4.6 4.9 3.9 3.7

Pittsburgh, PA 91 60 38 29 36 3.8 2.5 1.6 1.2 1.5

Portland-Vancouver-Beaverton, OR-WA 25 11 21 53 66 1.2 0.5 1.0 2.4 2.9

Providence-New Bedford-Fall River, RI-MA 18 44 25 28 47 1.1 2.7 1.6 1.7 2.9

Richmond, VA 28 38 92 97 89 2.3 3.1 7.5 7.8 7.2

Riverside-San Bernardino-Ontario, CA 108 95 157 115 157 2.7 2.3 3.8 2.8 3.8

Rochester, NY 14 16 9 11 16 1.4 1.6 0.9 1.1 1.5

Sacramento-Arden-Arcade-Roseville, CA 32 59 102 73 57 1.5 2.8 4.8 3.4 2.7

Salt Lake City, UT 15 19 23 28 54 1.4 1.7 2.1 2.5 4.8

San Antonio, TX 136 157 195 216 183 7.0 7.9 9.6 10.4 8.8

San Diego-Carlsbad-San Marcos, CA 235 347 345 190 274 8.0 11.7 11.5 6.2 9.0

San Francisco-Oakland-Fremont, CA 363 308 478 438 543 8.7 7.3 11.2 10.1 12.6

San Jose-Sunnyvale-Santa Clara, CA 52 56 42 59 91 2.9 3.1 2.3 3.2 4.9

Seattle-Tacoma-Bellevue, WA 160 138 153 115 236 4.9 4.2 4.6 3.4 6.9

St. Louis, MO-IL 65 112 121 83 118 2.3 4.0 4.3 2.9 4.2

Tampa-St. Petersburg-Clearwater, FL 110 195 191 180 183 4.1 7.2 7.0 6.6 6.7

Virginia Beach-Norfolk-Newport News, VA-NC 84 88 98 102 92 5.1 5.3 5.9 6.1 5.5

Washington-Arlington-Alexandria, DC-VA-MD-WV 250 377 297 324 311 4.7 7.1 5.5 5.9 5.7

U.S. MSAs TOTAL 7,845 9,116 10,132 10,182 10,479 4.9 5.6 6.2 6.1 6.3

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.
STD Surveillance 2010 Syphilis Tables 119

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

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2006–2010

MSAs

Cases Rates per 100,000 Population

2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Atlanta-Sandy Springs-Marietta, GA 33 40 51 59 44 1.3 1.5 1.9 2.1 1.6

Austin-Round Rock, TX 11 12 16 14 18 1.5 1.5 2.0 1.7 2.2

Baltimore-Towson, MD 53 40 70 33 19 3.8 2.9 5.1 2.4 1.4

Birmingham-Hoover, AL 94 80 77 44 21 16.5 13.9 13.3 7.5 3.6

Boston-Cambridge-Quincy, MA-NH 7 10 4 3 12 0.3 0.4 0.2 0.1 0.5

Buffalo-Cheektowaga-Tonawanda, NY 2 0 0 0 0 0.3 0.0 0.0 0.0 0.0

Charlotte-Gastonia-Concord, NC-SC 28 20 9 14 6 3.5 2.4 1.0 1.6 0.7

Chicago-Naperville-Joliet, IL-IN-WI 43 31 40 46 107 0.9 0.6 0.8 0.9 2.2

Cincinnati-Middletown, OH-KY-IN 5 6 14 26 107 0.5 0.5 1.3 2.3 9.6

Cleveland-Elyria-Mentor, OH 2 5 13 14 6 0.2 0.5 1.2 1.3 0.6

Columbus, OH 30 11 19 15 11 3.4 1.2 2.1 1.6 1.2

Dallas-Fort Worth-Arlington, TX 112 93 116 153 103 3.7 3.0 3.7 4.8 3.2

Denver-Aurora, CO 3 1 1 3 0 0.3 0.1 0.1 0.2 0.0

Detroit-Warren-Livonia, MI 20 22 27 26 9 0.9 1.0 1.2 1.2 0.4

Hartford-West Hartford-East Hartford, CT 1 1 0 0 3 0.2 0.2 0.0 0.0 0.5

Houston-Baytown-Sugar Land, TX 65 108 114 113 77 2.3 3.8 4.0 3.9 2.6

Indianapolis, IN 1 3 8 6 12 0.1 0.3 0.9 0.7 1.4

Jacksonville, FL 11 11 16 11 11 1.7 1.7 2.4 1.6 1.6

Kansas City, MO-KS 17 25 20 8 1 1.7 2.5 2.0 0.8 0.1

Las Vegas-Paradise, NV 32 11 11 7 6 3.7 1.2 1.2 0.7 0.6

Los Angeles-Long Beach-Santa Ana, CA 72 58 31 22 17 1.1 0.9 0.5 0.3 0.3

Louisville, KY-IN 3 2 3 1 4 0.5 0.3 0.5 0.2 0.6

Memphis, TN-MS-AR 52 87 71 67 33 7.9 13.1 10.6 9.9 4.9

Miami-Fort Lauderdale-Miami Beach, FL 40 60 74 54 55 1.4 2.2 2.7 1.9 1.9

Milwaukee-Waukesha-West Allis, WI 2 5 11 9 5 0.3 0.6 1.4 1.1 0.6

Minneapolis-St. Paul-Bloomington, MN-WI 3 1 5 0 5 0.2 0.1 0.3 0.0 0.3

Nashville-Davidson-Murfreesboro, TN 2 13 14 23 10 0.3 1.7 1.8 2.9 1.2

New Orleans-Metairie-Kenner, LA 25 51 53 36 30 4.7 9.5 9.0 5.8 4.9

New York-Newark-Edison, NY-NJ-PA 31 42 60 69 52 0.3 0.4 0.6 0.7 0.5

Oklahoma City, OK 6 13 16 16 12 1.0 2.2 2.6 2.6 1.9

Orlando, FL 14 13 21 19 7 1.4 1.3 2.0 1.8 0.7

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 6 14 17 37 33 0.2 0.5 0.6 1.2 1.1

Phoenix-Mesa-Scottsdale, AZ 18 29 24 8 12 0.9 1.4 1.1 0.4 0.6

Pittsburgh, PA 28 25 6 4 2 2.3 2.0 0.5 0.3 0.2

Portland-Vancouver-Beaverton, OR-WA 0 1 0 0 2 0.0 0.1 0.0 0.0 0.2

Providence-New Bedford-Fall River, RI-MA 0 2 0 1 3 0.0 0.2 0.0 0.1 0.4

Richmond, VA 1 3 6 3 6 0.2 0.5 1.0 0.5 0.9

Riverside-San Bernardino-Ontario, CA 10 4 5 5 1 0.5 0.2 0.2 0.2 0.0

Rochester, NY 0 1 0 1 3 0.0 0.2 0.0 0.2 0.6

Sacramento-Arden-Arcade-Roseville, CA 3 2 18 16 12 0.3 0.2 1.7 1.5 1.1

Salt Lake City, UT 1 0 1 0 0 0.2 0.0 0.2 0.0 0.0

San Antonio, TX 32 35 58 42 28 3.2 3.4 5.6 4.0 2.7

San Diego-Carlsbad-San Marcos, CA 12 12 12 6 3 0.8 0.8 0.8 0.4 0.2

San Francisco-Oakland-Fremont, CA 7 12 12 9 20 0.3 0.6 0.6 0.4 0.9

San Jose-Sunnyvale-Santa Clara, CA 7 4 3 5 3 0.8 0.5 0.3 0.6 0.3

Seattle-Tacoma-Bellevue, WA 2 4 2 4 2 0.1 0.2 0.1 0.2 0.1

St. Louis, MO-IL 3 9 16 9 3 0.2 0.6 1.1 0.6 0.2

Tampa-St. Petersburg-Clearwater, FL 15 52 54 29 33 1.1 3.7 3.8 2.1 2.3

Virginia Beach-Norfolk-Newport News, VA-NC 18 10 12 11 3 2.1 1.2 1.4 1.3 0.4

Washington-Arlington-Alexandria, DC-VA-MD-WV 11 12 15 19 13 0.4 0.4 0.5 0.7 0.5

U.S. MSAs TOTAL 994 1,106 1,246 1,120 985 1.2 1.3 1.5 1.3 1.2

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.

NOTE: Cases reported with unknown sex are not included in this table.
120 Syphilis Tables STD Surveillance 2010

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

Metropolitan Statistical Areas (MSAs)* in Alphabetical Order, United States, 2006–2010

MSAs

Cases Rates per 100,000 Population

2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Atlanta-Sandy Springs-Marietta, GA 496 567 714 750 607 19.5 21.7 26.9 27.7 22.4

Austin-Round Rock, TX 73 62 91 85 89 9.4 7.6 10.8 9.8 10.2

Baltimore-Towson, MD 160 171 200 171 193 12.5 13.3 15.6 13.2 14.9

Birmingham-Hoover, AL 150 109 111 101 61 28.3 20.4 20.6 18.5 11.2

Boston-Cambridge-Quincy, MA-NH 110 121 169 200 228 5.1 5.6 7.7 8.9 10.2

Buffalo-Cheektowaga-Tonawanda, NY 16 11 3 10 11 2.9 2.0 0.6 1.8 2.0

Charlotte-Gastonia-Concord, NC-SC 93 83 49 124 100 11.9 10.3 5.9 14.5 11.7

Chicago-Naperville-Joliet, IL-IN-WI 373 396 495 686 774 8.0 8.4 10.5 14.6 16.4

Cincinnati-Middletown, OH-KY-IN 8 28 48 98 165 0.8 2.7 4.6 9.2 15.5

Cleveland-Elyria-Mentor, OH 16 24 51 57 76 1.6 2.4 5.1 5.7 7.6

Columbus, OH 77 65 116 100 109 9.0 7.5 13.2 11.2 12.3

Dallas-Fort Worth-Arlington, TX 208 172 212 349 239 6.9 5.6 6.7 10.8 7.4

Denver-Aurora, CO 53 45 102 89 120 4.4 3.6 8.1 7.0 9.4

Detroit-Warren-Livonia, MI 62 69 73 125 137 2.8 3.2 3.4 5.8 6.4

Hartford-West Hartford-East Hartford, CT 22 14 8 25 29 3.8 2.4 1.4 4.3 5.0

Houston-Baytown-Sugar Land, TX 331 393 342 319 253 11.9 13.9 11.9 10.8 8.6

Indianapolis, IN 46 23 72 75 96 5.6 2.8 8.5 8.8 11.2

Jacksonville, FL 30 33 51 46 38 4.8 5.2 7.9 7.1 5.9

Kansas City, MO-KS 95 124 82 72 42 9.8 12.7 8.3 7.1 4.1

Las Vegas-Paradise, NV 100 91 61 79 119 11.1 9.7 6.4 8.2 12.3

Los Angeles-Long Beach-Santa Ana, CA 873 1,002 889 836 749 13.6 15.7 13.9 13.1 11.7

Louisville, KY-IN 38 30 33 56 101 6.4 5.0 5.4 9.1 16.4

Memphis, TN-MS-AR 93 121 163 122 132 15.1 19.6 26.4 19.4 21.0

Miami-Fort Lauderdale-Miami Beach, FL 329 354 435 464 597 12.4 13.5 16.5 17.1 22.1

Milwaukee-Waukesha-West Allis, WI 36 48 34 19 24 4.9 6.4 4.5 2.5 3.2

Minneapolis-St. Paul-Bloomington, MN-WI 40 56 100 67 135 2.5 3.5 6.2 4.1 8.3

Nashville-Davidson-Murfreesboro, TN 38 71 71 69 63 5.3 9.5 9.3 8.9 8.1

New Orleans-Metairie-Kenner, LA 65 117 117 102 55 13.2 23.7 21.5 17.8 9.6

New York-Newark-Edison, NY-NJ-PA 780 1,166 1,293 1,232 1,167 8.6 12.8 14.0 13.3 12.6

Oklahoma City, OK 18 23 45 54 43 3.1 3.9 7.6 8.9 7.1

Orlando, FL 80 132 105 90 96 8.1 13.1 10.3 8.7 9.3

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 167 191 197 252 274 5.9 6.8 7.0 8.7 9.5

Phoenix-Mesa-Scottsdale, AZ 136 162 187 161 149 6.7 7.7 8.6 7.3 6.7

Pittsburgh, PA 63 35 32 25 34 5.5 3.1 2.8 2.2 3.0

Portland-Vancouver-Beaverton, OR-WA 25 10 21 53 64 2.3 0.9 1.9 4.8 5.7

Providence-New Bedford-Fall River, RI-MA 18 42 25 27 44 2.3 5.4 3.2 3.5 5.7

Richmond, VA 27 35 86 94 83 4.6 5.9 14.4 15.6 13.8

Riverside-San Bernardino-Ontario, CA 98 90 150 110 156 4.9 4.4 7.3 5.3 7.5

Rochester, NY 14 15 9 10 13 2.8 3.0 1.8 2.0 2.6

Sacramento-Arden-Arcade-Roseville, CA 29 57 84 57 45 2.9 5.5 8.1 5.4 4.3

Salt Lake City, UT 14 19 22 28 54 2.6 3.4 3.9 4.9 9.4

San Antonio, TX 104 122 137 174 155 10.9 12.5 13.8 17.1 15.2

San Diego-Carlsbad-San Marcos, CA 223 335 333 184 271 15.1 22.4 22.1 12.0 17.7

San Francisco-Oakland-Fremont, CA 355 296 466 429 523 17.1 14.2 21.9 20.0 24.3

San Jose-Sunnyvale-Santa Clara, CA 45 52 39 54 88 4.9 5.6 4.2 5.7 9.4

Seattle-Tacoma-Bellevue, WA 158 134 151 111 234 9.7 8.1 9.0 6.5 13.7

St. Louis, MO-IL 62 103 105 74 115 4.6 7.6 7.7 5.4 8.4

Tampa-St. Petersburg-Clearwater, FL 95 143 137 151 150 7.2 10.8 10.3 11.3 11.2

Virginia Beach-Norfolk-Newport News, VA-NC 66 78 86 91 89 8.2 9.6 10.6 11.1 10.9

Washington-Arlington-Alexandria, DC-VA-MD-WV 239 365 282 305 298 9.3 14.1 10.8 11.4 11.1

U.S. MSAs TOTAL 6,847 8,005 8,884 9,062 9,487 8.6 10.0 11.0 11.1 11.6

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.

NOTE: Cases reported with unknown sex are not included in this table.
STD Surveillance 2010 Syphilis Tables 121

Table 32. Primary and Secondary Syphilis—Counties and Independent Cities* Ranked by 

Number of Reported Cases, United States, 2010

Rank† County/Independent City Cases Rates per 100,000 Population Cumulative Percentage

1 Cook County, IL 799 15.1 5

2 Los Angeles County, CA 689 7.0 10

3 New York County, NY 415 25.5 13

4 San Francisco County, CA 375 46.0 16

5 Miami-Dade County, FL 373 14.9 19

6 Fulton County, GA 320 31.0 21

7 San Diego County, CA 274 9.0 23

8 Harris County, TX 272 6.7 25

9 Hamilton County, OH 245 28.7 27

10 Philadelphia County, PA 238 15.4 29

11 Kings County, NY 235 9.2 30

12 Broward County, FL 220 12.5 32

13 King County, WA 216 11.3 33

14 Caddo County, LA 180 71.0 35

15 Bexar County, TX 180 10.9 36

16 Dallas County, TX 176 7.2 37

17 Bronx County, NY 163 11.7 38

18 Baltimore (City), MD 162 25.4 40

19 DeKalb County, GA 160 21.4 41

20 Maricopa County, AZ 155 3.9 42

21 Tarrant County, TX 151 8.4 43

22 Shelby County, TN 141 15.3 44

23 Washington, D.C. 134 22.3 45

24 Queens County, NY 133 5.8 46

25 Suffolk County, MA 132 17.5 47

26 Clark County, NV 125 6.6 48

27 Hillsborough County, FL 118 9.9 49

28 Riverside County, CA 116 5.5 50

29 Alameda County, CA 112 7.5 50

30 Franklin County, OH 110 9.6 51

31 Denver County, CO 99 16.2 52

32 Hennepin County, MN 99 8.6 53

33 Marion County, IN 97 10.9 53

34 Wayne County, MI 97 5.0 54

35 Mecklenburg County, NC 93 10.2 55

36 Jefferson County, KY 90 12.5 55

37 Santa Clara County, CA 89 5.0 56

38 Orange County, FL 87 8.0 57

39 Travis County, TX 83 8.1 57

40 Prince George’s County, MD 82 9.8 58

41 Orange County, CA 77 2.5 58

42 Orleans County, LA 71 20.0 59

43 Cuyahoga County, OH 70 5.5 59

44 Forsyth County, NC 68 18.9 60

45 Jefferson County, AL 65 9.8 60

46 Davidson County, TN 59 9.3 61

47 Palm Beach County, FL 59 4.6 61

48 Hinds County, MS 58 23.4 62

49 St. Louis (City), MO 57 16.0 62

50 Pinellas County, FL 57 6.3 62

51 Clayton County, GA 56 20.3 63

52 Salt Lake County, UT 54 5.2 63

53 Cobb County, GA 53 7.4 64

54 Middlesex County, MA 53 3.5 64

55 Richmond (City), VA 52 25.4 64

56 Jefferson County, TX 52 21.4 65

57 Hudson County, NJ 52 8.7 65

58 Lafayette County, LA 51 24.2 66

59 Pima County, AZ 51 5.0 66

60 Sacramento County, CA 50 3.6 66

61 Oklahoma County, OK 47 6.6 67

62 Essex County, NJ 47 6.1 67

63 Duval County, FL 46 5.4 67

64 Polk County, FL 45 7.7 68

65 Harrison County, MS 44 24.3 68

66 Multnomah County, OR 44 6.1 68

67 East Baton Rouge County, LA 42 9.7 69

68 Wake County, NC 41 4.6 69

69 San Bernardino County, CA 41 2.0 69

70 St. Louis County, MO 40 4.0 69

71 Miller County, AR 39 89.6 70

72 Escambia County, FL 39 12.9 70

73 Guilford County, NC 39 8.1 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 2010.
122 Syphilis Tables STD Surveillance 2010

Table 33. 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 2010, United States, 2009–2010

Male Female Male-to-Female

2009 2010 2009 2010 Rate Ratio

County/Independent City† Cases Rates Cases Rates Cases Rates Cases Rates 2009 2010

Maricopa County, AZ 157 7.7 146 7.2 8 0.4 9 0.5 19.3 14.4

Alameda County, CA 65 8.8 104 14.1 4 0.5 8 1.1 17.6 12.8

Los Angeles County, CA 747 15.3 676 13.8 21 0.4 13 0.3 38.3 46.0

Riverside County, CA 87 8.2 116 10.9 4 0.4 0 0.0 20.5 22.8

San Diego County, CA 184 12.0 271 17.7 6 0.4 3 0.2 30.0 88.5

San Francisco County, CA 310 74.9 369 89.1 4 1.0 6 1.5 74.9 59.4

Washington, D.C. 153 54.1 132 46.6 10 3.2 2 0.6 16.9 77.7

Broward County, FL 154 17.9 208 24.2 18 2.0 12 1.3 9.0 18.6

Hillsborough County, FL 87 14.8 98 16.6 14 2.3 20 3.3 6.4 5.0

Miami-Dade County, FL 280 22.9 339 27.8 33 2.6 34 2.7 8.8 10.3

DeKalb County, GA 187 51.5 149 41.1 20 5.2 11 2.9 9.9 14.2

Fulton County, GA 368 72.3 302 59.3 28 5.3 18 3.4 13.6 17.4

Cook County, IL 594 23.1 705 27.4 40 1.5 94 3.5 15.4 7.8

Caddo County, LA 66 54.8 85 70.5 75 56.3 94 70.6 1.0 1.0

Baltimore (City), MD 118 39.7 148 49.8 23 6.8 14 4.1 5.8 12.1

Suffolk County, MA 112 30.7 125 34.3 1 0.3 7 1.8 102.0 19.1

Clark County, NV 79 8.2 119 12.3 7 0.7 6 0.6 11.7 20.5

Bronx County, NY 164 25.0 150 22.8 11 1.5 13 1.8 16.7 12.7

Kings County, NY 282 23.2 226 18.6 26 1.9 9 0.7 12.2 26.6

New York County, NY 430 55.4 406 52.3 9 1.1 9 1.1 50.4 47.5

Queens County, NY 118 10.5 130 11.6 1 0.1 3 0.3 105.0 38.7

Franklin County, OH 92 16.4 101 18.0 15 2.6 9 1.5 6.3 12.0

Hamilton County, OH 79 19.3 146 35.6 26 5.8 99 22.2 3.3 1.6

Philadelphia County, PA 191 26.4 212 29.3 27 3.3 26 3.2 8.0 9.2

Shelby County, TN 113 25.8 113 25.8 62 12.9 28 5.8 2.0 4.4

Bexar County, TX 172 21.3 153 18.9 40 4.7 27 3.2 4.5 5.9

Dallas County, TX 206 16.6 122 9.8 88 7.3 54 4.5 2.3 2.2

Harris County, TX 256 12.5 217 10.6 71 3.5 55 2.7 3.6 3.9

Tarrant County, TX 122 13.7 105 11.7 60 6.7 46 5.1 2.0 2.3

King County, WA 96 10.0 214 22.3 3 0.3 2 0.2 33.3 112.0

* Cases per 100,000 population.

† Counties and independent cities are in alphabetical order by state.
STD Surveillance 2010 Syphilis Tables 123

Table 34. Primary and Secondary Syphilis—Reported Cases and Rates per 100,000 

Population by Age Group and Sex, United States, 2006–2010

Age

Group

Cases Rates*

Total Male Female Unknown Sex Total Male Female Unknown Sex

10–14 13 2 11 0 0.1 0.0 0.1

2006

15–19 565 332 233 0 2.6 3.0 2.2

20–24 1,381 1,080 299 2 6.5 9.9 2.9

25–29 1,573 1,330 241 2 7.6 12.6 2.4

30–34 1,220 1,056 163 1 6.2 10.6 1.7

35–39 1,580 1,426 154 0 7.5 13.4 1.5

40–44 1,515 1,362 153 0 6.7 12.2 1.4

45–54 1,442 1,277 165 0 3.3 6.0 0.8

55–64 375 340 35 0 1.2 2.2 0.2

65+ 81 79 2 0 0.2 0.5 0.0

Unknown Age 8 8 0 0

10–14 13 5 8 0 0.1 0.0 0.1

2007

15–19 664 416 248 0 3.1 3.8 2.4

20–24 1,817 1,461 356 0 8.6 13.5 3.5

25–29 1,840 1,574 265 1 8.7 14.6 2.6

30–34 1,499 1,303 193 3 7.7 13.2 2.0

35–39 1,720 1,529 191 0 8.1 14.4 1.8

40–44 1,744 1,551 192 1 7.9 14.1 1.7

45–54 1,663 1,463 200 0 3.8 6.8 0.9

55–64 409 379 30 0 1.3 2.4 0.2

65+ 91 82 9 0 0.2 0.5 0.0

Unknown Age 4 4 0 0

10–14 27 8 19 0 0.1 0.1 0.2

2008

15–19 903 585 318 0 4.2 5.3 3.0

20–24 2,397 1,877 520 0 11.4 17.3 5.1

25–29 2,256 1,851 404 1 10.6 16.9 3.9

30–34 1,733 1,489 244 0 8.8 15.0 2.5

35–39 1,809 1,568 241 0 8.6 14.8 2.3

40–44 1,776 1,573 202 1 8.3 14.6 1.9

45–54 2,027 1,790 236 1 4.6 8.2 1.0

55–64 458 412 46 0 1.4 2.5 0.3

65+ 105 97 8 0 0.3 0.6 0.0

Unknown Age 6 5 1 0

10–14 19 4 15 0 0.1 0.0 0.2

2009

15–19 1,005 661 344 0 4.7 6.0 3.3

20–24 2,812 2,242 570 0 13.1 20.2 5.5

25–29 2,405 2,027 377 1 11.1 18.2 3.6

30–34 1,857 1,571 286 0 9.3 15.5 2.9

35–39 1,612 1,409 203 0 7.8 13.6 2.0

40–44 1,643 1,476 167 0 7.8 14.1 1.6

45–54 2,033 1,815 218 0 4.6 8.3 1.0

55–64 517 475 42 0 1.5 2.8 0.2

65+ 90 83 7 0 0.2 0.5 0.0

Unknown Age 2 1 1 0

10–14 18 7 11 0 0.1 0.1 0.1

2010

15–19 932 617 313 2 4.3 5.6 3.0

20–24 2,907 2,429 474 4 13.5 21.9 4.5

25–29 2,455 2,131 322 2 11.3 19.2 3.0

30–34 1,794 1,597 197 0 9.0 15.8 2.0

35–39 1,454 1,313 140 1 7.1 12.7 1.4

40–44 1,553 1,448 104 1 7.4 13.8 1.0

45–54 2,056 1,877 176 3 4.6 8.5 0.8

55–64 493 457 36 0 1.4 2.7 0.2

65+ 107 102 5 0 0.3 0.6 0.0

Unknown Age 4 3 1 0

* No population data are available for unknown sex and age; therefore, rates are not calculated. The 0- to 9-year age group is not 

shown because some of these cases may not be due to sexual transmission.

NOTE: This table should be used only for age comparisons.
124 Syphilis Tables STD Surveillance 2010

Table 35A. Primary and Secondary Syphilis—Reported Cases by Race/Ethnicity, Age Group, and Sex, 

United States, 2006–2010

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

2006

10–14 1 0 1 11 2 9 0 0 0 0 0 0 1 0 1

15–19 69 37 32 404 235 169 71 44 27 1 1 0 0 0 0

20–24 282 239 43 827 608 219 210 180 30 12 11 1 7 6 1

25–29 412 363 49 761 610 151 289 256 33 35 33 2 7 6 1

30–34 409 372 37 471 374 97 230 210 20 32 29 3 13 10 3

35–39 670 627 43 497 414 83 262 244 18 31 30 1 13 8 5

40–44 756 711 45 420 335 85 214 200 14 28 27 1 14 9 5

45–54 728 691 37 477 373 104 136 122 14 23 21 2 9 5 4

55–64 182 174 8 131 108 23 33 31 2 2 2 0 5 4 1

65+ 33 33 0 24 22 2 16 16 0 0 0 0 5 5 0

TOTAL 3,542 3,247 295 4,023 3,081 942 1,461 1,303 158 164 154 10 74 53 20

2007

10–14 0 0 0 12 4 8 0 0 0 0 0 0 0 0 0

15–19 92 47 45 453 287 166 88 63 25 0 0 0 7 2 5

20–24 326 260 66 1,085 848 237 316 277 39 14 12 2 13 6 7

25–29 463 410 53 909 744 165 335 303 32 33 32 1 14 7 7

30–34 479 430 49 583 478 105 308 282 26 36 33 3 18 14 4

35–39 657 610 47 644 524 120 275 263 12 29 29 0 14 9 5

40–44 787 731 56 570 454 116 248 237 11 25 24 1 6 4 2

45–54 772 723 49 584 457 127 175 160 15 22 22 0 9 7 2

55–64 204 201 3 148 124 24 39 36 3 2 2 0 0 0 0

65+ 44 42 2 36 29 7 5 5 0 1 1 0 0 0 0

TOTAL 3,824 3,454 370 5,024 3,949 1,075 1,789 1,626 163 162 155 7 81 49 32

2008

10–14 2 1 1 22 7 15 2 0 2 0 0 0 0 0 0

15–19 120 71 49 632 404 228 124 96 28 7 5 2 2 0 2

20–24 440 354 86 1,499 1,123 376 346 298 48 33 33 0 11 8 3

25–29 560 479 81 1,157 888 269 395 359 36 43 39 4 14 11 3

30–34 525 473 52 736 585 151 332 300 32 46 46 0 11 8 3

35–39 653 582 71 705 575 130 327 300 27 28 26 2 5 2 3

40–44 740 677 63 652 531 121 267 252 15 23 22 1 5 4 1

45–54 946 887 59 742 593 149 214 196 18 21 21 0 5 4 1

55–64 218 209 9 176 144 32 34 32 2 7 7 0 2 1 1

65+ 58 55 3 28 23 5 10 10 0 2 2 0 0 0 0

TOTAL 4,262 3,788 474 6,349 4,873 1,476 2,051 1,843 208 210 201 9 55 38 17

2009

10–14 1 0 1 16 3 13 2 1 1 0 0 0 0 0 0

15–19 106 69 37 762 479 283 109 90 19 9 8 1 3 2 1

20–24 431 352 79 1,885 1,439 446 392 358 34 36 34 2 12 10 2

25–29 502 438 64 1,400 1,120 280 392 370 22 34 31 3 13 10 3

30–34 508 452 56 896 697 199 333 315 18 43 41 2 9 7 2

35–39 571 511 60 646 535 111 279 258 21 45 41 4 11 9 2

40–44 707 665 42 586 478 108 257 245 12 22 21 1 5 5 0

45–54 973 903 70 734 606 128 235 223 12 27 25 2 5 3 2

55–64 276 267 9 178 151 27 42 37 5 2 2 0 1 1 0

65+ 45 45 0 34 27 7 6 6 0 0 0 0 0 0 0

TOTAL 4,120 3,702 418 7,137 5,535 1,602 2,047 1,903 144 218 203 15 59 47 12

2010

10–14 0 0 0 15 5 10 2 2 0 0 0 0 0 0 0

15–19 94 66 28 678 425 253 119 100 19 7 5 2 7 7 0

20–24 476 420 56 1,865 1,498 367 441 409 32 39 33 6 19 18 1

25–29 555 509 46 1,375 1,125 250 415 396 19 28 28 0 14 13 1

30–34 530 496 34 833 693 140 319 304 15 42 40 2 7 5 2

35–39 554 514 40 513 431 82 298 284 14 29 29 0 5 3 2

40–44 649 625 24 491 426 65 314 303 11 25 25 0 4 4 0

45–54 1,062 1,007 55 599 495 104 271 264 7 23 22 1 8 5 3

55–64 286 274 12 139 117 22 42 41 1 7 7 0 0 0 0

65+ 64 62 2 22 19 3 15 15 0 1 1 0 0 0 0

TOTAL 4,270 3,973 297 6,530 5,234 1,296 2,236 2,118 118 201 190 11 64 55 9

NOTE: These tables should be used only for race/ethnicity comparisons. The 0- to 9-year age group is not shown because some of these cases may not be due to 

sexual transmission, and they are not included in the totals. In 2010, race/ethnicity was unknown (i.e., unknown, missing, or invalid data values) for 2.5% of reported 

primary and secondary syphilis cases, age was unknown for 0.0% of cases, and sex was unknown for 0.1% of cases. See Table 34 for age-specific cases and rates 

and Tables 26-28 for total and sex-specific cases and rates.
STD Surveillance 2010 Syphilis Tables 125

Table 35B. Primary and Secondary Syphilis—Rates per 100,000 Population by Race/Ethnicity, Age 

Group, and Sex, United States, 2006–2010

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 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.5 0.0 1.0

2006

15–19 0.5 0.5 0.5 12.2 14.0 10.3 2.0 2.4 1.5 0.1 0.2 0.0 0.0 0.0 0.0

20–24 2.2 3.6 0.7 27.2 39.6 14.6 5.6 8.8 1.7 1.2 2.2 0.2 3.2 5.3 0.9

25–29 3.3 5.8 0.8 27.1 44.7 10.5 6.9 11.0 1.8 3.0 5.7 0.3 3.7 6.4 1.1

30–34 3.5 6.3 0.6 18.6 31.1 7.3 5.9 9.8 1.1 2.4 4.4 0.4 8.0 12.2 3.7

35–39 4.9 9.2 0.6 18.8 33.2 5.9 7.4 12.9 1.1 2.4 4.8 0.2 7.8 9.7 6.0

40–44 5.0 9.3 0.6 15.0 25.6 5.7 6.8 12.2 0.9 2.4 4.8 0.2 7.7 10.2 5.4

45–54 2.3 4.4 0.2 9.5 16.1 3.9 3.0 5.3 0.6 1.2 2.3 0.2 2.7 3.1 2.3

55–64 0.7 1.5 0.1 4.2 7.8 1.3 1.3 2.5 0.2 0.2 0.3 0.0 2.3 3.8 0.9

65+ 0.1 0.3 0.0 0.8 1.8 0.1 0.7 1.6 0.0 0.0 0.0 0.0 2.6 6.0 0.0

TOTAL 2.0 3.7 0.3 12.7 20.7 5.6 4.1 7.1 0.9 1.3 2.6 0.2 3.5 5.1 2.0

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 13.4 16.8 10.0 2.3 3.3 1.4 0.0 0.0 0.0 3.0 1.7 4.4

20–24 2.5 3.9 1.0 35.5 54.9 15.7 8.6 14.0 2.3 1.5 2.5 0.4 5.8 5.3 6.4

25–29 3.7 6.4 0.8 31.5 52.7 11.2 8.0 13.0 1.7 2.9 5.6 0.2 7.2 7.2 7.3

30–34 4.2 7.4 0.9 23.2 39.9 7.9 7.7 13.0 1.4 2.7 5.1 0.4 11.0 17.0 4.9

35–39 4.9 9.1 0.7 24.2 41.8 8.5 7.5 13.5 0.7 2.2 4.5 0.0 8.4 10.8 6.0

40–44 5.4 10.0 0.8 20.8 35.4 7.9 7.8 14.1 0.7 2.1 4.2 0.2 3.4 4.6 2.2

45–54 2.4 4.6 0.3 11.4 19.4 4.6 3.7 6.6 0.6 1.1 2.3 0.0 2.6 4.3 1.1

55–64 0.8 1.6 0.0 4.5 8.5 1.3 1.4 2.8 0.2 0.1 0.3 0.0 0.0 0.0 0.0

65+ 0.1 0.3 0.0 1.1 2.4 0.4 0.2 0.5 0.0 0.1 0.2 0.0 0.0 0.0 0.0

TOTAL 2.1 4.0 0.4 15.7 26.3 6.4 4.9 8.6 0.9 1.3 2.6 0.1 3.8 4.7 2.9

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 18.5 23.4 13.6 3.2 4.8 1.5 0.8 1.1 0.5 0.9 0.0 1.8

20–24 3.4 5.3 1.3 48.4 71.7 24.6 9.4 15.3 2.8 3.5 6.9 0.0 4.9 7.0 2.7

25–29 4.3 7.3 1.3 39.1 60.8 18.0 9.5 15.6 2.0 3.8 6.9 0.7 6.9 10.7 3.0

30–34 4.5 8.1 0.9 29.0 48.4 11.4 8.2 13.5 1.8 3.6 7.4 0.0 6.6 9.6 3.6

35–39 5.0 8.8 1.1 26.6 46.0 9.3 8.8 15.0 1.6 2.1 3.9 0.3 3.0 2.4 3.6

40–44 5.2 9.5 0.9 24.2 42.1 8.4 8.1 14.5 1.0 2.0 3.9 0.2 2.9 4.8 1.1

45–54 3.0 5.6 0.4 14.2 24.7 5.3 4.3 7.7 0.7 1.0 2.2 0.0 1.4 2.4 0.5

55–64 0.8 1.7 0.1 5.2 9.5 1.7 1.2 2.3 0.1 0.5 1.1 0.0 0.8 0.9 0.8

65+ 0.2 0.4 0.0 0.9 1.8 0.2 0.4 0.9 0.0 0.1 0.3 0.0 0.0 0.0 0.0

TOTAL 2.4 4.3 0.5 19.7 32.0 8.6 5.5 9.6 1.2 1.7 3.3 0.1 2.5 3.6 1.5

10–14 0.0 0.0 0.0 0.5 0.2 0.9 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0

2009

15–19 0.8 1.0 0.6 22.3 27.6 16.8 2.7 4.3 1.0 1.0 1.7 0.2 1.3 1.8 0.9

20–24 3.3 5.2 1.2 58.9 88.9 28.2 10.1 17.3 1.9 3.6 6.7 0.4 5.3 8.7 1.8

25–29 3.8 6.6 1.0 46.3 74.4 18.4 9.4 16.2 1.2 2.8 5.3 0.5 6.2 9.4 2.9

30–34 4.3 7.6 1.0 34.2 55.5 14.6 8.3 14.2 1.0 3.3 6.5 0.3 5.3 8.1 2.4

35–39 4.5 8.0 1.0 24.6 43.1 8.0 7.4 12.7 1.2 3.4 6.3 0.6 6.6 10.9 2.4

40–44 5.2 9.7 0.6 22.3 38.8 7.7 7.8 13.9 0.8 1.9 3.7 0.2 3.0 6.1 0.0

45–54 3.1 5.7 0.4 13.9 24.9 4.5 4.5 8.4 0.5 1.3 2.5 0.2 1.4 1.8 1.1

55–64 1.0 2.1 0.1 5.0 9.5 1.4 1.4 2.5 0.3 0.1 0.3 0.0 0.4 0.8 0.0

65+ 0.1 0.3 0.0 1.0 2.1 0.3 0.2 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0

TOTAL 2.3 4.2 0.5 21.8 35.9 9.3 5.4 9.6 0.8 1.7 3.3 0.2 2.7 4.4 1.1

10–14 0.0 0.0 0.0 0.5 0.3 0.7 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0

2010

15–19 0.7 1.0 0.4 19.8 24.5 15.0 3.0 4.8 1.0 0.7 1.0 0.4 3.1 6.2 0.0

20–24 3.6 6.2 0.9 58.3 92.5 23.2 11.4 19.8 1.8 3.9 6.5 1.2 8.4 15.6 0.9

25–29 4.2 7.7 0.7 45.5 74.8 16.5 10.0 17.3 1.0 2.3 4.8 0.0 6.7 12.2 1.0

30–34 4.5 8.4 0.6 31.8 55.1 10.3 7.9 13.7 0.8 3.2 6.4 0.3 4.1 5.8 2.4

35–39 4.4 8.1 0.6 19.5 34.7 5.9 7.9 14.0 0.8 2.2 4.4 0.0 3.0 3.6 2.4

40–44 4.7 9.1 0.4 18.7 34.6 4.7 9.5 17.2 0.7 2.1 4.4 0.0 2.4 4.9 0.0

45–54 3.3 6.4 0.3 11.3 20.3 3.7 5.2 10.0 0.3 1.1 2.2 0.1 2.3 2.9 1.6

55–64 1.1 2.1 0.1 3.9 7.4 1.1 1.4 2.8 0.1 0.5 1.0 0.0 0.0 0.0 0.0

65+ 0.2 0.5 0.0 0.7 1.5 0.1 0.5 1.3 0.0 0.1 0.2 0.0 0.0 0.0 0.0

TOTAL 2.4 4.5 0.3 20.0 33.9 7.5 5.9 10.7 0.6 1.6 3.1 0.2 2.9 5.1 0.8

NOTE: These tables should be used only for race/ethnicity comparisons. The 0- to 9-year age group is not shown because some of these cases may not be due to 

sexual transmission, and they are not included in the totals. In 2010, race/ethnicity was unknown (i.e., unknown, missing, or invalid data values) for 2.5% of reported 

primary and secondary syphilis cases, age was unknown for 0.0% of cases, and sex was unknown for 0.1% of cases. See Table 34 for age-specific cases and rates 

and Tables 26-28 for total and sex-specific cases and rates.
126 Syphilis Tables STD Surveillance 2010

Table 36. Early Latent Syphilis—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2006–2010

Cases Rates per 100,000 Population

State/Area 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Alabama 341 363 440 419 277 7.4 7.8 9.4 8.9 5.9

Alaska 6 3 2 0 5 0.9 0.4 0.3 0.0 0.7

Arizona 186 269 258 196 166 3.0 4.2 4.0 3.0 2.5

Arkansas 67 115 144 172 202 2.4 4.1 5.0 6.0 7.0

California 1,369 1,421 1,648 1,621 1,788 3.8 3.9 4.5 4.4 4.8

Colorado 38 35 91 63 129 0.8 0.7 1.8 1.3 2.6

Connecticut 27 20 28 40 51 0.8 0.6 0.8 1.1 1.4

Delaware 16 14 23 23 14 1.9 1.6 2.6 2.6 1.6

District of Columbia 77 84 77 158 239 13.2 14.3 13.0 26.3 39.9

Florida 760 1,155 1,252 1,254 1,294 4.2 6.3 6.8 6.8 7.0

Georgia 366 423 563 768 636 3.9 4.4 5.8 7.8 6.5

Hawaii 2 11 9 15 15 0.2 0.9 0.7 1.2 1.2

Idaho 3 3 6 3 4 0.2 0.2 0.4 0.2 0.3

Illinois 267 224 271 344 502 2.1 1.7 2.1 2.7 3.9

Indiana 46 39 83 55 103 0.7 0.6 1.3 0.9 1.6

Iowa 6 6 11 9 4 0.2 0.2 0.4 0.3 0.1

Kansas 18 25 54 58 63 0.7 0.9 1.9 2.1 2.2

Kentucky 36 34 47 64 88 0.9 0.8 1.1 1.5 2.0

Louisiana 481 722 809 799 742 11.2 16.8 18.3 17.8 16.5

Maine 7 5 10 10 6 0.5 0.4 0.8 0.8 0.5

Maryland 193 320 313 261 279 3.4 5.7 5.6 4.6 4.9

Massachusetts 82 116 149 135 195 1.3 1.8 2.3 2.0 3.0

Michigan 43 73 99 155 121 0.4 0.7 1.0 1.6 1.2

Minnesota 58 55 47 46 73 1.1 1.1 0.9 0.9 1.4

Mississippi 197 269 232 312 386 6.8 9.2 7.9 10.6 13.1

Missouri 93 120 145 146 133 1.6 2.0 2.5 2.4 2.2

Montana 0 0 1 0 2 0.0 0.0 0.1 0.0 0.2

Nebraska 1 3 0 6 1 0.1 0.2 0.0 0.3 0.1

Nevada 119 174 168 137 178 4.8 6.8 6.5 5.2 6.7

New Hampshire 2 13 4 6 5 0.2 1.0 0.3 0.5 0.4

New Jersey 314 343 415 401 386 3.6 3.9 4.8 4.6 4.4

New Mexico 85 66 45 40 41 4.3 3.4 2.3 2.0 2.0

New York 993 1,149 1,372 1,266 1,358 5.1 6.0 7.0 6.5 6.9

North Carolina 294 247 221 357 328 3.3 2.7 2.4 3.8 3.5

North Dakota 0 0 2 0 0 0.0 0.0 0.3 0.0 0.0

Ohio 115 135 224 221 189 1.0 1.2 2.0 1.9 1.6

Oklahoma 121 115 117 172 149 3.4 3.2 3.2 4.7 4.0

Oregon 19 6 18 29 33 0.5 0.2 0.5 0.8 0.9

Pennsylvania 286 309 309 361 355 2.3 2.5 2.5 2.9 2.8

Rhode Island 6 10 7 14 20 0.6 0.9 0.7 1.3 1.9

South Carolina 174 143 192 284 344 4.0 3.2 4.3 6.2 7.5

South Dakota 6 4 3 2 0 0.8 0.5 0.4 0.2 0.0

Tennessee 233 304 312 333 363 3.9 4.9 5.0 5.3 5.8

Texas 1,312 1,467 1,733 1,932 1,874 5.6 6.1 7.1 7.8 7.6

Utah 7 2 10 7 20 0.3 0.1 0.4 0.3 0.7

Vermont 2 1 6 1 0 0.3 0.2 1.0 0.2 0.0

Virginia 165 177 238 233 275 2.2 2.3 3.1 3.0 3.5

Washington 81 76 98 64 109 1.3 1.2 1.5 1.0 1.6

West Virginia 6 9 16 8 4 0.3 0.5 0.9 0.4 0.2

Wisconsin 60 91 78 66 52 1.1 1.6 1.4 1.2 0.9

Wyoming 0 0 1 0 3 0.0 0.0 0.2 0.0 0.6

U.S. TOTAL 9,186 10,768 12,401 13,066 13,604 3.1 3.6 4.1 4.3 4.4

Northeast 1,719 1,966 2,300 2,234 2,376 3.1 3.6 4.2 4.0 4.3

Midwest 713 775 1,017 1,108 1,241 1.1 1.2 1.5 1.7 1.9

South 4,839 5,961 6,729 7,549 7,494 4.4 5.4 6.0 6.7 6.6

West 1,915 2,066 2,355 2,175 2,493 2.8 2.9 3.3 3.0 3.5

Guam 3 3 2 1 0 1.8 1.7 1.1 0.6 0.0

Puerto Rico 368 408 241 164 191 9.4 10.3 6.1 4.1 4.8

Virgin Islands 0 1 0 0 3 0.0 0.9 0.0 0.0 2.7

OUTLYING AREAS 371 412 243 165 194 8.8 9.7 5.7 3.9 4.6

TOTAL 9,557 11,180 12,644 13,231 13,798 3.1 3.7 4.1 4.3 4.4
STD Surveillance 2010 Syphilis Tables 127

Table 37. Early Latent Syphilis—Reported Cases and Rates in Selected Metropolitan Statistical 

Areas (MSAs)* in Alphabetical Order, United States, 2006–2010

Cases Rates per 100,000 Population

MSAs 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Atlanta-Sandy Springs-Marietta, GA 293 363 402 613 529 5.7 6.9 7.5 11.2 9.7

Austin-Round Rock, TX 51 66 109 135 137 3.4 4.1 6.6 7.9 8.0

Baltimore-Towson, MD 136 185 214 153 148 5.1 6.9 8.0 5.7 5.5

Birmingham-Hoover, AL 220 196 199 150 67 20.0 17.7 17.8 13.3 5.9

Boston-Cambridge-Quincy, MA-NH 65 95 124 116 161 1.5 2.1 2.7 2.5 3.5

Buffalo-Cheektowaga-Tonawanda, NY 14 6 10 3 0 1.2 0.5 0.9 0.3 0.0

Charlotte-Gastonia-Concord, NC-SC 98 63 62 78 90 6.2 3.8 3.6 4.5 5.2

Chicago-Naperville-Joliet, IL-IN-WI 269 209 251 324 476 2.8 2.2 2.6 3.4 5.0

Cincinnati-Middletown, OH-KY-IN 7 12 23 42 88 0.3 0.6 1.1 1.9 4.1

Cleveland-Elyria-Mentor, OH 11 21 48 70 20 0.5 1.0 2.3 3.3 1.0

Columbus, OH 55 47 89 64 42 3.2 2.7 5.0 3.6 2.3

Dallas-Fort Worth-Arlington, TX 532 468 496 592 647 8.9 7.6 7.9 9.2 10.0

Denver-Aurora, CO 32 30 68 57 109 1.3 1.2 2.7 2.2 4.3

Detroit-Warren-Livonia, MI 34 47 45 88 76 0.8 1.1 1.0 2.0 1.7

Hartford-West Hartford-East Hartford, CT 10 8 10 13 18 0.8 0.7 0.8 1.1 1.5

Houston-Baytown-Sugar Land, TX 291 468 555 421 370 5.3 8.3 9.7 7.2 6.3

Indianapolis, IN 18 20 56 27 70 1.1 1.2 3.3 1.5 4.0

Jacksonville, FL 56 51 86 82 91 4.4 3.9 6.5 6.2 6.9

Kansas City, MO-KS 41 70 79 64 59 2.1 3.5 3.9 3.1 2.9

Las Vegas-Paradise, NV 112 170 166 135 174 6.3 9.3 8.9 7.1 9.1

Los Angeles-Long Beach-Santa Ana, CA 851 893 910 1,070 991 6.6 6.9 7.1 8.3 7.7

Louisville, KY-IN 18 12 20 17 46 1.5 1.0 1.6 1.4 3.7

Memphis, TN-MS-AR 174 222 199 259 256 13.7 17.3 15.5 19.8 19.6

Miami-Fort Lauderdale-Miami Beach, FL 304 440 563 644 749 5.6 8.1 10.4 11.6 13.5

Milwaukee-Waukesha-West Allis, WI 46 65 60 46 35 3.0 4.2 3.9 2.9 2.2

Minneapolis-St. Paul-Bloomington, MN-WI 52 54 43 45 68 1.6 1.7 1.3 1.4 2.1

Nashville-Davidson-Murfreesboro, TN 42 56 54 64 70 2.9 3.7 3.5 4.0 4.4

New Orleans-Metairie-Kenner, LA 127 222 239 243 193 12.4 21.5 21.1 20.4 16.2

New York-Newark-Edison, NY-NJ-PA 1,178 1,360 1,628 1,530 1,595 6.3 7.2 8.6 8.0 8.4

Oklahoma City, OK 74 65 72 123 76 6.3 5.4 6.0 10.0 6.2

Orlando, FL 91 160 148 132 138 4.6 7.9 7.2 6.3 6.6

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 280 310 305 362 348 4.8 5.3 5.2 6.1 5.8

Phoenix-Mesa-Scottsdale, AZ 166 165 160 131 126 4.1 3.9 3.7 3.0 2.9

Pittsburgh, PA 43 45 43 25 27 1.8 1.9 1.8 1.1 1.1

Portland-Vancouver-Beaverton, OR-WA 9 5 11 22 33 0.4 0.2 0.5 1.0 1.5

Providence-New Bedford-Fall River, RI-MA 9 12 13 16 26 0.6 0.7 0.8 1.0 1.6

Richmond, VA 29 45 81 59 77 2.4 3.7 6.6 4.8 6.2

Riverside-San Bernardino-Ontario, CA 64 49 89 88 86 1.6 1.2 2.2 2.1 2.1

Rochester, NY 8 5 5 6 7 0.8 0.5 0.5 0.6 0.7

Sacramento-Arden-Arcade-Roseville, CA 23 16 39 38 43 1.1 0.8 1.8 1.8 2.0

Salt Lake City, UT 5 2 10 4 12 0.5 0.2 0.9 0.4 1.1

San Antonio, TX 172 115 203 290 305 8.9 5.8 10.0 14.0 14.7

San Diego-Carlsbad-San Marcos, CA 123 156 179 80 177 4.2 5.2 6.0 2.6 5.8

San Francisco-Oakland-Fremont, CA 220 200 281 253 373 5.3 4.8 6.6 5.9 8.6

San Jose-Sunnyvale-Santa Clara, CA 18 25 25 22 29 1.0 1.4 1.4 1.2 1.6

Seattle-Tacoma-Bellevue, WA 74 70 91 56 91 2.3 2.1 2.7 1.6 2.7

St. Louis, MO-IL 30 57 70 90 106 1.1 2.0 2.5 3.2 3.7

Tampa-St. Petersburg-Clearwater, FL 177 294 275 225 117 6.6 10.8 10.1 8.2 4.3

Virginia Beach-Norfolk-Newport News, VA-NC 74 54 69 78 84 4.5 3.3 4.2 4.7 5.0

Washington-Arlington-Alexandria, DC-VA-MD-WV 171 265 224 306 441 3.2 5.0 4.2 5.6 8.1

U.S. MSAs TOTAL 6,997 8,034 9,201 9,551 10,097 4.3 4.9 5.6 5.7 6.1

* MSAs were selected on the basis of the largest population in the 2000 U.S. Census.
128 Syphilis Tables STD Surveillance 2010

Table 38. Late and Late Latent Syphilis*—Reported Cases and Rates by State/Area and Region in 

Alphabetical Order, United States and Outlying Areas, 2006–2010

Cases Rates per 100,000 Population

State/Area 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Alabama 262 254 286 289 235 5.7 5.5 6.1 6.1 5.0

Alaska 8 6 6 4 7 1.2 0.9 0.9 0.6 1.0

Arizona 521 650 789 629 493 8.4 10.3 12.1 9.5 7.5

Arkansas 92 122 149 95 116 3.3 4.3 5.2 3.3 4.0

California 2,773 2,777 2,995 2,449 2,223 7.6 7.6 8.1 6.6 6.0

Colorado 73 63 133 101 75 1.5 1.3 2.7 2.0 1.5

Connecticut 106 87 109 72 83 3.0 2.5 3.1 2.0 2.4

Delaware 38 31 20 36 19 4.5 3.6 2.3 4.1 2.1

District of Columbia 120 153 147 110 121 20.6 26.0 24.8 18.3 20.2

Florida 1,445 1,830 2,272 1,547 1,572 8.0 10.0 12.4 8.3 8.5

Georgia 977 1,142 1,345 982 898 10.4 12.0 13.9 10.0 9.1

Hawaii 46 38 30 39 23 3.6 3.0 2.3 3.0 1.8

Idaho 6 10 13 24 9 0.4 0.7 0.9 1.6 0.6

Illinois 760 522 720 805 799 5.9 4.1 5.6 6.2 6.2

Indiana 111 121 128 110 134 1.8 1.9 2.0 1.7 2.1

Iowa 43 37 48 33 45 1.4 1.2 1.6 1.1 1.5

Kansas 41 44 41 58 28 1.5 1.6 1.5 2.1 1.0

Kentucky 78 63 77 81 84 1.9 1.5 1.8 1.9 1.9

Louisiana 551 516 485 413 1,163 12.9 12.0 11.0 9.2 25.9

Maine 6 7 7 1 3 0.5 0.5 0.5 0.1 0.2

Maryland 526 482 374 387 386 9.4 8.6 6.6 6.8 6.8

Massachusetts 172 128 114 100 158 2.7 2.0 1.8 1.5 2.4

Michigan 210 262 227 246 322 2.1 2.6 2.3 2.5 3.2

Minnesota 83 72 102 99 128 1.6 1.4 2.0 1.9 2.4

Mississippi 237 305 320 188 200 8.1 10.4 10.9 6.4 6.8

Missouri 166 124 171 189 225 2.8 2.1 2.9 3.2 3.8

Montana 1 0 2 1 0 0.1 0.0 0.2 0.1 0.0

Nebraska 26 23 21 34 20 1.5 1.3 1.2 1.9 1.1

Nevada 117 104 71 75 99 4.7 4.1 2.7 2.8 3.7

New Hampshire 20 9 17 17 16 1.5 0.7 1.3 1.3 1.2

New Jersey 297 345 364 270 314 3.4 4.0 4.2 3.1 3.6

New Mexico 66 62 96 107 57 3.4 3.1 4.8 5.3 2.8

New York 2,833 2,766 2,903 2,160 2,387 14.7 14.3 14.9 11.1 12.2

North Carolina 352 516 480 578 499 4.0 5.7 5.2 6.2 5.3

North Dakota 2 1 2 3 3 0.3 0.2 0.3 0.5 0.5

Ohio 192 219 185 206 349 1.7 1.9 1.6 1.8 3.0

Oklahoma 58 33 51 25 31 1.6 0.9 1.4 0.7 0.8

Oregon 51 33 53 46 69 1.4 0.9 1.4 1.2 1.8

Pennsylvania 335 264 313 321 280 2.7 2.1 2.5 2.5 2.2

Rhode Island 51 30 30 29 18 4.8 2.8 2.9 2.8 1.7

South Carolina 155 176 120 100 80 3.6 4.0 2.7 2.2 1.8

South Dakota 10 1 2 8 8 1.3 0.1 0.2 1.0 1.0

Tennessee 527 537 548 568 542 8.7 8.7 8.8 9.0 8.6

Texas 2,501 2,780 3,071 3,271 3,204 10.6 11.6 12.6 13.2 12.9

Utah 38 23 5 17 47 1.5 0.9 0.2 0.6 1.7

Vermont 2 0 1 0 0 0.3 0.0 0.2 0.0 0.0

Virginia 343 328 281 221 245 4.5 4.3 3.6 2.8 3.1

Washington 160 135 159 118 159 2.5 2.1 2.4 1.8 2.4

West Virginia 13 11 14 16 16 0.7 0.6 0.8 0.9 0.9

Wisconsin 42 12 43 56 84 0.8 0.2 0.8 1.0 1.5

Wyoming 1 2 5 4 3 0.2 0.4 0.9 0.7 0.6

U.S. TOTAL 17,644 18,256 19,945 17,338 18,079 5.9 6.1 6.6 5.6 5.9

Northeast 3,822 3,636 3,858 2,970 3,259 7.0 6.6 7.0 5.4 5.9

Midwest 1,686 1,438 1,690 1,847 2,145 2.5 2.2 2.5 2.8 3.2

South 8,275 9,279 10,040 8,907 9,411 7.6 8.4 9.0 7.9 8.3

West 3,861 3,903 4,357 3,614 3,264 5.6 5.6 6.1 5.0 4.6

Guam 7 24 37 9 10 4.1 13.8 21.0 5.0 5.6

Puerto Rico 535 682 381 328 302 13.6 17.3 9.6 8.3 7.6

Virgin Islands 4 4 1 2 1 3.7 3.6 0.9 1.8 0.9

OUTLYING AREAS 546 710 419 339 313 13.0 16.8 9.9 8.0 7.4

TOTAL 18,190 18,966 20,364 17,677 18,392 6.0 6.2 6.6 5.7 5.9

* Late and late latent syphilis includes late latent syphilis, latent syphilis of unknown duration, neurosyphilis, and late syphilis with clinical manifestations other than 

neurosyphilis.
STD Surveillance 2010 Syphilis Tables 129

Table 39. Late and Late Latent Syphilis*—Reported Cases and Rates in Selected Metropolitan 

Statistical Areas (MSAs)†

 in Alphabetical Order, United States, 2006–2010

Cases Rates per 100,000 Population

MSAs 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Atlanta-Sandy Springs-Marietta, GA 814 929 1,068 756 723 15.8 17.6 19.9 13.8 13.2

Austin-Round Rock, TX 74 94 127 116 118 4.9 5.9 7.7 6.8 6.9

Baltimore-Towson, MD 283 236 186 193 162 10.6 8.8 7.0 7.2 6.0

Birmingham-Hoover, AL 94 93 110 112 84 8.5 8.4 9.8 9.9 7.4

Boston-Cambridge-Quincy, MA-NH 147 98 86 92 142 3.3 2.2 1.9 2.0 3.1

Buffalo-Cheektowaga-Tonawanda, NY 7 9 7 27 32 0.6 0.8 0.6 2.4 2.8

Charlotte-Gastonia-Concord, NC-SC 83 133 100 127 91 5.2 8.1 5.9 7.3 5.2

Chicago-Naperville-Joliet, IL-IN-WI 687 469 650 727 703 7.2 4.9 6.8 7.6 7.3

Cincinnati-Middletown, OH-KY-IN 37 31 20 58 117 1.8 1.5 0.9 2.7 5.4

Cleveland-Elyria-Mentor, OH 24 33 15 29 79 1.1 1.6 0.7 1.4 3.8

Columbus, OH 67 99 84 71 82 3.9 5.6 4.7 3.9 4.6

Dallas-Fort Worth-Arlington, TX 809 881 934 1,020 941 13.5 14.3 14.8 15.8 14.6

Denver-Aurora, CO 51 43 98 74 64 2.1 1.7 3.9 2.9 2.5

Detroit-Warren-Livonia, MI 155 187 154 171 232 3.5 4.2 3.5 3.9 5.3

Hartford-West Hartford-East Hartford, CT 32 27 51 29 34 2.7 2.3 4.3 2.4 2.8

Houston-Baytown-Sugar Land, TX 856 1,032 1,024 1,139 1,149 15.5 18.3 17.9 19.4 19.6

Indianapolis, IN 56 49 53 48 55 3.4 2.9 3.1 2.8 3.2

Jacksonville, FL 63 102 153 95 87 4.9 7.8 11.7 7.2 6.6

Kansas City, MO-KS 75 49 55 70 43 3.8 2.5 2.7 3.4 2.1

Las Vegas-Paradise, NV 95 85 52 49 85 5.3 4.6 2.8 2.6 4.5

Los Angeles-Long Beach-Santa Ana, CA 1,759 1,588 1,722 1,332 1,238 13.6 12.3 13.4 10.3 9.6

Louisville, KY-IN 42 33 34 48 46 3.4 2.7 2.7 3.8 3.7

Memphis, TN-MS-AR 287 326 306 316 326 22.5 25.5 23.8 24.2 25.0

Miami-Fort Lauderdale-Miami Beach, FL 773 997 1,326 797 853 14.1 18.4 24.5 14.4 15.4

Milwaukee-Waukesha-West Allis, WI 16 9 32 43 57 1.1 0.6 2.1 2.8 3.7

Minneapolis-St. Paul-Bloomington, MN-WI 65 59 75 70 101 2.0 1.8 2.3 2.1 3.1

Nashville-Davidson-Murfreesboro, TN 112 100 138 145 115 7.7 6.6 8.9 9.2 7.3

New Orleans-Metairie-Kenner, LA 133 157 75 78 391 13.0 15.2 6.6 6.6 32.9

New York-Newark-Edison, NY-NJ-PA 2,905 2,913 3,089 2,237 2,502 15.4 15.5 16.3 11.7 13.1

Oklahoma City, OK 18 12 26 16 17 1.5 1.0 2.2 1.3 1.4

Orlando, FL 217 277 184 165 149 10.9 13.6 9.0 7.9 7.2

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 315 253 287 304 271 5.4 4.3 4.9 5.1 4.5

Phoenix-Mesa-Scottsdale, AZ 424 486 468 368 345 10.5 11.6 10.9 8.4 7.9

Pittsburgh, PA 18 17 17 16 9 0.8 0.7 0.7 0.7 0.4

Portland-Vancouver-Beaverton, OR-WA 40 34 32 39 54 1.9 1.6 1.4 1.7 2.4

Providence-New Bedford-Fall River, RI-MA 65 44 33 31 22 4.0 2.7 2.1 1.9 1.4

Richmond, VA 49 46 53 50 47 4.1 3.8 4.3 4.0 3.8

Riverside-San Bernardino-Ontario, CA 203 194 202 210 185 5.0 4.8 4.9 5.1 4.5

Rochester, NY 68 55 37 34 43 6.6 5.3 3.6 3.3 4.2

Sacramento-Arden-Arcade-Roseville, CA 78 40 100 94 81 3.8 1.9 4.7 4.4 3.8

Salt Lake City, UT 21 14 2 8 29 2.0 1.3 0.2 0.7 2.6

San Antonio, TX 156 142 190 221 232 8.0 7.1 9.4 10.7 11.2

San Diego-Carlsbad-San Marcos, CA 202 273 292 211 148 6.9 9.2 9.7 6.9 4.8

San Francisco-Oakland-Fremont, CA 156 263 277 239 230 3.7 6.3 6.5 5.5 5.3

San Jose-Sunnyvale-Santa Clara, CA 22 76 84 58 62 1.2 4.2 4.6 3.2 3.4

Seattle-Tacoma-Bellevue, WA 122 99 115 84 112 3.7 3.0 3.4 2.5 3.3

St. Louis, MO-IL 89 82 129 120 177 3.2 2.9 4.6 4.2 6.3

Tampa-St. Petersburg-Clearwater, FL 140 119 212 223 195 5.2 4.4 7.8 8.1 7.1

Virginia Beach-Norfolk-Newport News, VA-NC 85 89 80 55 59 5.2 5.4 4.8 3.3 3.5

Washington-Arlington-Alexandria, DC-VA-MD-WV 496 514 425 362 425 9.4 9.7 7.9 6.6 7.8

U.S. MSAs TOTAL 13,585 13,990 15,069 12,977 13,544 8.4 8.6 9.2 7.8 8.1

* 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 2010

Table 40. Congenital Syphilis—Reported Cases and Rates in Infants by Year of Birth, by 

State, Ranked by Rates, United States, 2010

Rank* State† Cases Rates per 100,000 Live Births

1 Louisiana 33 49.8

2 Maryland 22 28.2

3 Arkansas 11 26.6

4 Texas 103 25.3

5 Mississippi 9 19.4

6 Delaware 2 16.4

7 Illinois 27 14.9

8 Arizona 15 14.6

9 Alabama 9 13.9

10 Tennessee 11 12.7

11 Nevada 5 12.1

12 Georgia 18 11.9

YEAR 2020 TARGET 9.1

U.S. TOTAL‡ 377 8.7

13 Florida 19 7.9

14 North Carolina 10 7.6

15 California 38 6.7

16 Ohio 10 6.6

17 New York 16 6.3

18 Connecticut 2 4.8

19 Idaho 1 4.0

20 New Jersey 3 2.6

21 Missouri 2 2.4

22 Pennsylvania 3 2.0

23 Utah 1 1.8

24 Michigan 2 1.6

25 Wisconsin 1 1.4

26 Massachusetts 1 1.3

27 Washington 1 1.1

28 Virginia 1 0.9

Alaska 0 0.0

Colorado 0 0.0

Hawaii 0 0.0

Indiana 0 0.0

Iowa 0 0.0

Kansas 0 0.0

Kentucky 0 0.0

Maine 0 0.0

Minnesota 0 0.0

Montana 0 0.0

Nebraska 0 0.0

New Hampshire 0 0.0

New Mexico 0 0.0

North Dakota 0 0.0

Oklahoma 0 0.0

Oregon 0 0.0

Rhode Island 0 0.0

South Carolina 0 0.0

South Dakota 0 0.0

Vermont 0 0.0

West Virginia 0 0.0

Wyoming 0 0.0

* States were ranked in descending order by rate (rounded to the nearest tenth) and by number of cases. 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 1 case and a rate of 11.3, but excludes outlying areas (Guam with 0 cases and rate of 

0.0, Puerto Rico with 2 cases and rate of 4.3, and Virgin Islands with 0 cases and rate of 0.0).
STD Surveillance 2010 Syphilis Tables 131

Table 41. 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, 2006–2010

Cases Rates per 100,000 Live Births

State/Area* 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Alabama 9 9 12 13 9 14.2 13.9 18.5 20.1 13.9

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 16 30 30 28 15 15.6 29.1 29.1 27.2 14.6

Arkansas 10 12 9 10 11 24.4 29.0 21.8 24.2 26.6

California 69 87 64 63 38 12.3 15.4 11.3 11.1 6.7

Colorado 2 2 0 0 0 2.8 2.8 0.0 0.0 0.0

Connecticut 0 2 2 2 2 0.0 4.8 4.8 4.8 4.8

Delaware 0 0 1 1 2 0.0 0.0 8.2 8.2 16.4

District of Columbia 1 1 0 0 1 11.7 11.3 0.0 0.0 11.3

Florida 21 20 17 18 19 8.9 8.4 7.1 7.5 7.9

Georgia 9 9 11 14 18 6.1 6.0 7.3 9.3 11.9

Hawaii 0 0 0 1 0 0.0 0.0 0.0 5.2 0.0

Idaho 0 0 0 1 1 0.0 0.0 0.0 4.0 4.0

Illinois 15 10 20 16 27 8.3 5.5 11.1 8.8 14.9

Indiana 0 2 0 1 0 0.0 2.2 0.0 1.1 0.0

Iowa 0 1 0 0 0 0.0 2.4 0.0 0.0 0.0

Kansas 1 0 0 3 0 2.4 0.0 0.0 7.1 0.0

Kentucky 1 0 1 2 0 1.7 0.0 1.7 3.4 0.0

Louisiana 16 37 23 11 33 25.2 55.8 34.7 16.6 49.8

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 19 24 23 31 22 24.5 30.7 29.5 39.7 28.2

Massachusetts 0 0 0 0 1 0.0 0.0 0.0 0.0 1.3

Michigan 13 15 10 4 2 10.2 12.0 8.0 3.2 1.6

Minnesota 1 0 1 1 0 1.4 0.0 1.4 1.4 0.0

Mississippi 0 1 9 8 9 0.0 2.2 19.4 17.2 19.4

Missouri 3 1 2 6 2 3.7 1.2 2.4 7.3 2.4

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 16 7 9 3 5 40.0 17.0 21.9 7.3 12.1

New Hampshire 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

New Jersey 15 11 4 7 3 13.0 9.5 3.4 6.0 2.6

New Mexico 7 6 4 0 0 23.4 19.6 13.1 0.0 0.0

New York 24 18 23 15 16 9.6 7.1 9.1 5.9 6.3

North Carolina 7 7 11 10 10 5.5 5.3 8.4 7.6 7.6

North Dakota 0 0 0 1 0 0.0 0.0 0.0 11.3 0.0

Ohio 0 1 3 8 10 0.0 0.7 2.0 5.3 6.6

Oklahoma 2 3 3 2 0 3.7 5.4 5.4 3.6 0.0

Oregon 0 2 0 0 0 0.0 4.1 0.0 0.0 0.0

Pennsylvania 3 8 8 4 3 2.0 5.3 5.3 2.7 2.0

Rhode Island 0 0 0 1 0 0.0 0.0 0.0 8.1 0.0

South Carolina 2 1 2 0 0 3.2 1.6 3.2 0.0 0.0

South Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Tennessee 6 4 11 13 11 7.1 4.6 12.7 15.0 12.7

Texas 79 99 127 128 103 19.8 24.3 31.2 31.4 25.3

Utah 2 0 0 0 1 3.7 0.0 0.0 0.0 1.8

Vermont 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virginia 3 1 4 2 1 2.8 0.9 3.7 1.8 0.9

Washington 0 2 0 1 1 0.0 2.2 0.0 1.1 1.1

West Virginia 0 1 1 0 0 0.0 4.5 4.5 0.0 0.0

Wisconsin 0 1 1 0 1 0.0 1.4 1.4 0.0 1.4

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 372 435 446 429 377 8.7 10.1 10.3 9.9 8.7

Northeast 42 39 37 29 25 6.2 5.7 5.4 4.2 3.6

Midwest 33 31 37 40 42 3.7 3.4 4.1 4.4 4.6

South 185 229 265 263 249 11.5 13.9 16.1 16.0 15.2

West 112 136 107 97 61 10.5 12.6 9.9 9.0 5.6

Guam 0 2 0 0 0 0.0 57.5 0.0 0.0 0.0

Puerto Rico 15 10 8 6 2 30.9 21.4 17.2 12.9 4.3

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 15 12 8 6 2 27.9 23.2 15.4 11.6 3.9

TOTAL 387 447 454 435 379 9.0 10.2 10.4 10.0 8.7

* Mother’s state of residence was used to assign case.
132 Syphilis Tables STD Surveillance 2010

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

Race/Ethnicity of Mother, United States, 2006–2010

Year of 

Birth Race/Ethnicity Cases Rates per 100,000 Live Births 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 30.4

Hispanics 144 13.5

Asians/Pacific Islanders 20 8.2

American Indians/Alaska Natives 8 18.3

Other 4 NA

Unknown 14 NA

Total 435 10.1

2008

Whites, Non-Hispanic 67 2.9

Blacks, Non-Hispanic 226 35.8

Hispanics 135 12.7

Asians/Pacific Islanders 7 2.9

American Indians/Alaska Natives 6 13.8

Other 1 NA

Unknown 4 NA

Total 446 10.3

2009

Whites, Non-Hispanic 65 2.8

Blacks, Non-Hispanic 215 34.0

Hispanics 128 12.0

Asians/Pacific Islanders 11 4.5

American Indians/Alaska Natives 5 11.5

Other 2 NA

Unknown 3 NA

Total 429 9.9

2010

Whites, Non-Hispanic 62 2.7

Blacks, Non-Hispanic 209 33.1

Hispanics 89 8.4

Asians/Pacific Islanders 9 3.7

American Indians/Alaska Natives 1 2.3

Other 3 NA

Unknown 4 NA

Total 377 8.7

NA = Not applicable.
STD Surveillance 2010 Chancroid Tables 133

Table 43. Chancroid—Reported Cases and Rates by State/Area in Alphabetical Order, United 

States and Outlying Areas, 2006-2010

Cases Rates per 100,000 Population

State/Area 2006 2007 2008 2009 2010 2006 2007 2008 2009 2010

Alabama 0 0 0 0 1 0.0 0.0 0.0 0.0 0.0

Alaska 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arizona 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Arkansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

California 0 1 2 1 5 0.0 0.0 0.0 0.0 0.0

Colorado 0 0 2 0 0 0.0 0.0 0.0 0.0 0.0

Connecticut 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Delaware 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

District of Columbia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Florida 1 3 0 1 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 1 0 0.0 0.0 0.0 0.0 0.0

Iowa 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kansas 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Kentucky 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Louisiana 1 4 0 0 0 0.0 0.1 0.0 0.0 0.0

Maine 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Maryland 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Massachusetts 0 1 4 3 1 0.0 0.0 0.1 0.0 0.0

Michigan 1 0 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 5 5 2 0 0 0.0 0.0 0.0 0.0 0.0

North Carolina 5 2 4 6 1 0.1 0.0 0.0 0.1 0.0

North Dakota 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Ohio 0 0 1 0 0 0.0 0.0 0.0 0.0 0.0

Oklahoma 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Oregon 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 1 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 1 0.0 0.0 0.0 0.0 0.0

Texas 5 5 8 8 12 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 1 0 0 1 0 0.0 0.0 0.0 0.0 0.0

Washington 0 0 1 0 1 0.0 0.0 0.0 0.0 0.0

West Virginia 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Wisconsin 0 2 0 6 0 0.0 0.0 0.0 0.1 0.0

Wyoming 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

U.S. TOTAL 19 23 25 28 24 0.0 0.0 0.0 0.0 0.0

Guam 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Puerto Rico 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

Virgin Islands 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

OUTLYING AREAS 0 0 0 0 0 0.0 0.0 0.0 0.0 0.0

TOTAL 19 23 25 28 24 0.0 0.0 0.0 0.0 0.0
134 Selected STDs STD Surveillance 2010

Table 44. Selected STDs and Complications—Initial Visits to Physicians’ Offices, National 

Disease and Therapeutic Index, United States, 1966-2010

Year Genital Herpes Genital Warts

Vaginal 

Trichomoniasis* Other Vaginitis*

Pelvic Inflammatory 

Disease†

1966 19,000 56,000 579,000 1,155,000 NA

1967 15,000 72,000 515,000 1,277,000 NA

1968 16,000 87,000 463,000 1,460,000 NA

1969 15,000 61,000 421,000 1,390,000 NA

1970 17,000 119,000 529,000 1,500,000 NA

1971 49,000 128,000 484,000 1,281,000 NA

1972 26,000 165,000 574,000 1,810,000 NA

1973 51,000 198,000 466,000 1,858,000 NA

1974 75,000 202,000 427,000 1,907,000 NA

1975 36,000 181,000 500,000 1,919,000 NA

1976 57,000 217,000 473,000 1,690,000 NA

1977 116,000 221,000 324,000 1,713,000 NA

1978 76,000 269,000 329,000 2,149,000 NA

1979 83,000 200,000 363,000 1,662,000 NA

1980 57,000 218,000 358,000 1,670,000 423,000

1981 133,000 191,000 369,000 1,742,000 283,000

1982 134,000 256,000 268,000 1,859,000 374,000

1983 106,000 203,000 424,000 1,932,000 424,000

1984 157,000 224,000 381,000 2,450,000 381,000

1985 124,000 263,000 291,000 2,728,000 425,000

1986 136,000 275,000 338,000 3,118,000 457,000

1987 102,000 351,000 293,000 3,087,000 403,000

1988 163,000 290,000 191,000 3,583,000 431,000

1989 148,000 220,000 165,000 3,374,000 413,000

1990 172,000 275,000 213,000 4,474,000 358,000

1991 235,000 282,000 198,000 3,822,000 377,000

1992 139,000 218,000 182,000 3,428,000 335,000

1993 172,000 167,000 207,000 3,755,000 407,000

1994 142,000 239,000 199,000 4,123,000 332,000

1995 160,000 253,000 141,000 3,927,000 262,000

1996 208,000 191,000 245,000 3,472,000 286,000

1997 176,000 145,000 176,000 3,100,000 260,000

1998 188,000 211,000 164,000 3,200,000 233,000

1999 224,000 240,000 171,000 3,077,000 250,000

2000 179,000 220,000 222,000 3,470,000 254,000

2001 157,000 233,000 210,000 3,365,000 244,000

2002 216,000 266,000 150,000 3,315,000 197,000

2003 203,000 264,000 179,000 3,516,000 123,000

2004 269,000 316,000 221,000 3,602,000 132,000

2005 266,000 357,000 165,000 4,071,000 176,000

2006 371,000 422,000 200,000 3,891,000 106,000

2007 317,000 312,000 205,000 3,723,000 146,000

2008 292,000 385,000 204,000 3,571,000 104,000

2009 306,000 357,000 216,000 3,063,000 100,000

2010 232,000 376,000 149,000 3,192,000 113,000

* Women only.

† Women aged 15-44 years only.

NA = Not available.

NOTE: Standard errors for estimates under 100,000 are not available. The relative standard errors for estimates 100,000-300,000 are from 20% to 30%; 

300,000-600,000 are from 16% to 20%; 600,000-1,000,000 are from 13% to 16%; and 1,000,000-5,000,000 are from 9% to 13%.

SOURCE: National Disease and Therapeutic Index (IMS Health). See Other Data Sources in the Appendix for more information.
APPENDIX
APPENDIX
STD Surveillance 2010 Appendix: Interpreting STD Surveillance Data 135

Interpreting STD Surveillance Data

Sexually Transmitted Disease Surveillance 2010 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 2010

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 8, 2011, 

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

2000–2010 Rates and Population

CDC’s National Center for Health Statistics (NCHS) 

released bridged-race population counts for the 2000–

2009 U.S. resident populations that are based on counts 

from the 2000 U.S. Census. These estimates resulted 

from bridging the 31 race categories used in the 2000 

census, as specified in the 1997 Office of Management 

and Budget (OMB) standards, to the five race/ethnicity 

groups specified in the 1977 OMB standards. This 

report uses the first published population estimate for 

a given year. The latest available year for bridged-race 

population estimates at the time this report was written 

was 2009, thus 2009 population estimates were used 

to calculate 2010 rates. Once published, the 2010 

population estimates will be used to calculate rates in 

the upcoming 2011 STD Surveillance Report. 

Population estimates for Guam, Puerto Rico, and the 

Virgin Islands were obtained from the U.S. Census 

Bureau Web site at http://www.census.gov/ipc/www/

idb/tables.html. The 2009–2010 rates for outlying areas 

were calculated by using the 2009 population estimates.

Because of the use of the updated population data, rates 

for 2001–2009 may be different from those presented in 

previous STD surveillance reports.

1990–1999 Rates and Population

The population counts for 1990 through 1999 

incorporated the bridged single-race estimates of the 

April 1, 2000, U.S. resident population. These files were 

prepared by the U.S. Census Bureau with support from 

the National Cancer Institute.

1981–1989 Rates and Population

Rates were calculated by using U.S. Census Bureau 

population estimates for 1981 through 1989.1,2

1941–1980 Rates and Population

Rates for 1941 through 1980 were based on population 

estimates from the U.S. Census Bureau and are currently 

maintained by CDC’s Division of STD Prevention.

1941–2010 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 1941–2010. 

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 2010, live births now are used as 

the denominator for congenital syphilis, and case counts 
STD Surveillance 2010 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 2010 

were calculated by using live birth data for 2007.

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 2010 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 cityspecific 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).

Prior to the publication of Sexually Transmitted Disease 

Surveillance 2010, when the percentage of unknown, 

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

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

and population data were excluded from the tables 

that presented data stratified by one or more of these 

variables. For the states for which 50% or more of their 

data were valid for age group, race/ethnicity, and sex, 

the values for unknown, missing, or invalid data were 

redistributed on the basis of the state’s distribution 
138 Appendix: Interpreting STD Surveillance Data STD Surveillance 2010

of known age group, race/ethnicity, and sex data. 

Beginning with the publication of Sexually Transmitted 

Disease Surveillance 2010, redistribution methodology is 

not applied to any of the data. The counts presented in 

this report are summations of all valid data reported in 

reporting year 2010.

As a result, rate data that are stratified by one or more of 

these variables reflect rates based on reported data only.

Classification of STD Morbidity 

Reporting Sources

Before 1996, states classified the source of case reports 

as either private source (including private physicians, 

hospitals, and institutions) or public source (primarily 

STD clinics). As states began reporting morbidity data 

electronically in 1996, the classification categories for 

source of case reports expanded to include the following 

data sources: STD clinics, HIV counseling and testing 

sites, drug treatment clinics, family planning clinics, 

prenatal/obstetrics clinics, tuberculosis clinics, private 

physicians/health maintenance organizations, hospitals 

(inpatient), emergency rooms, correctional facilities, 

laboratories, blood banks, the National Job Training 

Program (NJTP), school-based clinics, mental health 

providers, the military, the Indian Health Service, and 

other unspecified sources.

Analysis of the data reported electronically after 1996 

confirmed that the new STD clinic source of report 

data corresponded to the earlier public source category. 

Therefore, source of case report data during 1984–2010 

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). 

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 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.
STD Surveillance 2010 Appendix: Interpreting STD Surveillance Data 139

In addition to changing the case definition for 

congenital syphilis, CDC introduced a new data 

collection form (CDC 73.126) in 1990 (revised April 

2010). Since 1995, the data collected on this form have 

been used for reporting congenital syphilis cases and 

associated rates. This form is used to collect individual 

case information, which allows more thorough analysis 

of case characteristics. For the purpose of analyzing race/

ethnicity, cases are classified by the race/ethnicity of the 

mother. Congenital syphilis cases were reported by state 

and city of residence of the mother during 1995–2010.

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. 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 (SSuN)

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.

The SSuN data contained in this report include 

demographic, behavioral, clinical, and laboratory 

information collected from all patients at 41 STD 

clinics within the jurisdictions of SSuN health 

departments. These clinics are located in San Francisco, 

CA (San Francisco City Clinic); Los Angeles, CA (12 

STD clinics in Los Angeles County); Seattle, WA 

(Seattle-King County Clinic); Denver, CO (Denver 

Metro Health Clinic); Chicago, IL (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 (9 public STD clinics in 5 

boroughs); Hartford, CT (Hartford STD Clinic); and 

New Haven, CT (New Haven STD Clinic).
140 Appendix: Interpreting STD Surveillance Data STD Surveillance 2010

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 9 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 9 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 2010, the antimicrobial agents tested by GISP 

were ceftriaxone, cefixime, cefpodoxime, azithromycin, 

spectinomycin, ciprofloxacin, penicillin, and tetracycline. 

The antimicrobial susceptibility criteria used in GISP for 

2010 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

* 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. 

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, non-institutionalized 

population. For more information, see: http://www.cdc.

gov/nchs/nhanes.htm.

National Disease and Therapeutic Index

The information on the number of initial visits 

to private physicians’ offices for STDs was based 

on analysis of data from the National Disease and 

Therapeutic Index (NDTI) (machine-readable files or 

summary statistics for 1966 through 2010). NDTI is a 

probability sample survey of private physicians’ clinical 

management practices. For more information on this 

database, contact IMS Health, e-mail: ServiceCenter@

us.imshealth.com; Telephone: (800) 523-5334.

National Hospital Discharge Survey

The information on patients hospitalized for pelvic 

inflammatory disease (PID) or ectopic pregnancy was 

based on analysis of data from the National Hospital 

Discharge Survey (NHDS) (machine-readable files for 

1980 through 2009. NHDS, which is conducted by 

NCHS, is an ongoing, nationwide sample survey of 

medical records of patients discharged from acute care 

hospitals in the United States. For more information, 

see: http://www.cdc.gov/nchs/nhds.htm. The estimates 

generated by using NHDS data are based on statistical 

surveys and therefore have sampling variability 

associated with the estimates.
STD Surveillance 2010 Appendix: Interpreting STD Surveillance Data 141

Healthy People 2020 Objectives

For three decades, Healthy People has provided a 

comprehensive set of national 10-year health promotion 

and disease prevention objectives aimed at improving 

the health of all Americans.7

 It is grounded in the 

principle that establishing objectives and providing 

benchmarks to track and monitor progress over time can 

motivate, guide, and focus action.

Healthy People 2020 (HP2020) continues in the 

tradition of its ambitious, yet achievable, 10-year agenda 

for improving the Nation’s health. HP2020 is the result 

of a multiyear process that reflects input from a diverse 

group of individuals and organizations. HP2020 is 

organized into 42 topic areas, with more than 1,200 

measures designed drive action that will support its four 

overarching goals:

1. Attain high-quality, longer lives free of preventable 

disease, disability, injury, and premature death.

2. Achieve health equity, eliminate disparities, and 

improve the health of all groups.

3. Create social and physical environments that 

promote good health for all.

4. Promote quality of life, healthy development, and 

healthy behaviors across all life stages.

The topic area, Sexually Transmitted Diseases, contains 

objectives and measures related to STDs. Baselines, 

HP2020 targets, and annual progress toward the targets 

are reported in Table A3. The year 2020 targets for the 

diseases addressed in this report are as follows: P&S 

syphilis (males), 8.8 cases per 100,000 population; P&S 

syphilis (females), 1.4 cases per 100,000 population 

congenital syphilis, 9.1 cases per 100,000 live births; 

gonorrhea (females aged 15–44 years), 257.0 cases per 

100,000 population and gonorrhea (males aged 15–44 

years), 198.0 cases per 100,000 population. 

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.

The majority of the STD-related HP2020 targets were 

set using a standard percentage improvement with a 

standard default of a “10 percent improvement over the 

baseline.”

Government Performance and Results 

Act of 1993

The Government Performance and Results Act (GPRA) 

of 1993 was enacted by Congress to increase confidence 

in the capability of the federal government to increase 

the effectiveness and accountability of federal programs, 

to improve service delivery, to provide federal agencies 

a uniform tool for internal management, and to help 

Congress make decisions. 

GPRA requires each agency to have a performance 

plan with long-term outcomes and annual, measurable 

performance goals and to report on these plans annually, 

comparing results with annual goals. There are two 

GPRA goals for STD: reducing PID and eliminating 

syphilis. Each of these goals has specific measures of 

progress, which are outlined in Table A4.

1 U.S. Census Bureau. United States population estimates by age, 

sex and race: 1980–1988. In: Current population reports [Series 

P-25, No. 1045]. Washington, DC: U.S. Government Printing 

Office; 1990. 

2 U.S. Census Bureau. United States population estimates by age, 

sex and race: 1989. In: Current population reports [Series P-25, 

No. 1057]. Washington, DC: U.S. Government Printing Office; 

1990.

3 Centers for Disease Control and Prevention. Vital statistics of 

the United States 1988. vol.1 - natality. Hyattsville (MD): U.S. 

Department of Health and Human Services; 1990.

4 Office of Management and Budget. Standards for defining 

metropolitan and micropolitan statistical areas. Federal Register. 

2000;65(249):82228-38.

5 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 

2020 Web site. http://healthypeople.gov/2020/default.aspx.
142 Appendix: Percentage Unknown STD Surveillance 2010

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

Variables by State and by Nationally Notifiable STD, 2010

State

Primary and Secondary Syphilis Gonorrhea Chlamydia

Percentage 

Unknown 

Race/

Ethnicity

Percentage 

Unknown 

Age

Percentage 

Unknown 

Sex

Percentage 

Unknown 

Sex Partner

Percentage 

Unknown 

Race/

Ethnicity

Percentage 

Unknown 

Age

Percentage 

Unknown 

Sex

Percentage 

Unknown 

Race/

Ethnicity

Percentage 

Unknown 

Age

Percentage 

Unknown 

Sex

Alabama 0.0 0.0 0.0 28.1 26.3 0.2 0.9 30.9 0.2 0.5

Alaska* 0.0 0.0 0.0 100.0 0.1 0.1 0.0 0.5 0.0 0.0

Arizona 3.0 0.0 0.0 40.0 14.2 0.0 0.0 19.2 0.0 0.0

Arkansas 0.0 0.0 0.0 8.8 8.8 0.0 0.0 9.2 0.0 0.1

California 2.3 0.1 0.0 8.9 28.6 0.3 0.5 35.5 0.3 0.4

Colorado 0.0 0.0 0.0 8.7 37.8 0.0 0.0 55.9 0.1 0.0

Connecticut 0.0 0.0 0.0 5.1 23.6 0.2 0.0 34.6 0.4 0.0

Delaware* 0.0 0.0 0.0 100.0 1.8 0.0 0.0 3.6 0.0 0.0

District of Columbia 1.5 0.0 0.0 23.1 22.3 0.1 0.1 28.4 0.1 0.3

Florida 3.1 0.0 0.0 4.6 6.9 0.0 0.1 9.2 0.0 0.1

Georgia 1.5 0.0 0.0 21.6 32.6 0.2 0.8 41.6 0.2 0.7

Hawaii 0.0 0.0 0.0 2.9 32.7 0.0 0.0 51.5 0.1 0.0

Idaho* 16.7 0.0 0.0 0.0 42.9 0.0 0.7 34.6 0.0 0.3

Illinois 1.5 0.0 0.0 26.2 17.4 0.0 0.2 18.8 0.0 0.2

Indiana 0.6 0.0 0.0 2.9 14.6 0.2 0.2 18.7 0.1 0.1

Iowa 0.0 0.0 0.0 5.3 11.1 0.0 0.0 12.7 0.0 0.0

Kansas 0.0 0.0 0.0 10.5 19.7 0.0 0.0 37.4 0.0 0.0

Kentucky 0.7 0.0 0.0 7.9 22.9 0.3 0.1 29.4 0.6 0.2

Louisiana 7.9 0.2 2.0 19.4 25.1 0.4 6.1 31.0 0.6 6.6

Maine 6.3 0.0 0.0 15.6 17.9 0.0 0.6 26.7 0.4 0.2

Maryland 2.7 0.0 0.0 7.3 24.1 0.4 0.1 32.2 0.2 0.1

Massachusetts 0.7 0.0 0.0 17.9 22.6 0.3 0.0 35.9 0.3 0.1

Michigan 0.9 0.0 0.0 1.7 36.9 0.1 0.2 39.5 0.2 0.2

Minnesota 0.0 0.0 0.0 12.1 10.9 0.0 0.0 15.2 0.0 0.0

Mississippi 0.4 0.0 0.0 4.8 16.6 0.1 0.0 20.3 0.1 0.0

Missouri 2.6 0.0 0.0 3.3 13.1 0.0 0.0 23.3 0.0 0.0

Montana* 0.0 0.0 0.0 66.7 15.7 2.9 0.0 12.0 0.5 0.0

Nebraska 16.7 0.0 0.0 58.3 21.4 0.1 0.0 32.4 0.0 0.1

Nevada 10.0 0.0 0.0 1.5 30.4 0.0 0.0 35.9 0.1 0.0

New Hampshire 0.0 0.0 0.0 9.1 18.5 0.0 0.0 28.7 0.0 0.0

New Jersey 0.0 0.0 0.0 11.1 33.1 0.6 0.5 46.3 0.5 0.5

New Mexico 18.9 0.0 0.0 47.2 20.9 0.2 0.0 33.0 0.1 0.0

New York 4.9 0.0 0.0 18.9 35.7 0.3 0.0 44.8 0.4 0.0

North Carolina 0.3 0.0 0.0 100.0 9.3 0.2 0.6 13.6 0.1 0.4

North Dakota* 33.3 0.0 0.0 100.0 21.6 0.0 0.0 41.6 0.0 0.2

Ohio 0.0 0.2 0.0 12.9 22.6 0.6 0.2 30.7 0.4 0.4

Oklahoma 0.0 0.0 0.0 4.3 4.2 0.0 0.1 6.2 0.0 0.1

Oregon 4.2 0.0 0.0 60.6 10.9 0.0 0.0 19.5 0.0 0.0

Pennsylvania 2.2 0.0 0.0 13.8 24.2 0.0 0.0 27.8 0.0 0.1

Rhode Island 2.4 0.0 0.0 2.4 21.6 0.0 0.0 21.2 0.0 0.0

South Carolina 0.6 0.0 0.0 4.5 28.4 0.0 0.1 32.3 0.0 0.1

South Dakota* 0.0 0.0 0.0 0.0 3.8 0.0 0.2 28.6 0.0 0.3

Tennessee 1.8 0.0 0.0 3.2 2.0 0.1 0.0 3.4 0.1 0.1

Texas 0.3 0.0 0.1 1.6 5.1 0.1 0.1 6.2 0.1 0.0

Utah 0.0 0.0 0.0 100.0 1.9 0.0 0.0 1.3 0.0 0.0

Vermont* 0.0 0.0 0.0 0.0 0.0 0.0 1.7 17.7 0.1 0.0

Virginia 0.0 0.0 0.0 3.9 17.0 0.1 0.1 30.0 0.1 0.2

Washington 19.2 0.0 0.0 5.6 19.7 0.0 0.1 24.2 0.0 0.0

West Virginia* 33.3 0.0 0.0 0.0 13.5 0.0 0.0 17.5 0.0 0.0

Wisconsin 0.0 0.0 0.0 40.8 18.2 0.2 0.0 17.2 0.4 0.0

Wyoming* 0.0 0.0 0.0 0.0 27.5 0.0 0.0 22.4 0.0 0.0

U.S. TOTAL 2.5 0.0 0.1 15.4 20.0 0.2 0.4 26.2 0.2 0.3

* Percentages for primary and secondary syphilis are based on less than 10 cases.

NOTE: Unknown includes unknown, missing, or invalid data values.
STD Surveillance 2010 Appendix: STD Reporting Source 143

Table A2. Reported Cases of STDs by Reporting Source and Sex, United States, 2010

Disease

Non-STD Clinic STD Clinic Total

Male Female Total* Male Female Total* Male† Female† Total‡

Chlamydia 222,899 759,728 985,034 89,902 80,091 170,149 353,923 949,802 1,307,893

Gonorrhea 86,808 123,302 210,732 37,832 19,681 57,568 142,470 165,693 309,341

Primary syphilis 2,029 190 2,221 1,100 73 1,173 3,250 284 3,537

Secondary syphilis 6,095 1,055 7,155 2,330 359 2,689 8,731 1,496 10,237

Early latent syphilis 7,359 2,058 9,431 2,762 785 3,550 10,561 3,007 13,604

Late and late latent syphilis§ 9,166 4,598 13,827 2,169 885 3,062 12,096 5,861 18,079

Chancroid 8 11 19 2 2 4 10 13 24

* 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.
144 Appendix: Healthy People 2020 STD Surveillance 2010

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

HP2020 Objectives Baseline 

Year Baseline 2010 HP 2020 

Target

1 Reduce the proportion of adolescents and young adults with Chlamydia 

trachomatis infections

a. Among females aged 15 to 24 years attending family planning clinics 2008 7.4% 8.0% 6.7%

b. Among females aged 24 years and under enrolled in a National Job Training 

Program

2008 12.8% 11.4% 11.5%

c. Among males aged 24 years and under enrolled in a National Job Training 

Program

2008 7.0% 7.2% 6.3%

2 Reduce Chlamydia rates among females aged 15 to 44 years 

(DEVELOPMENTAL)

N/A 1,493.3 N/A

3 Increase the proportion of sexually active females aged 24 years and 

under enrolled in Medicaid plans who are screened for genital Chlamydia 

infections during the measurement year

a. Females aged 16 to 20 years 2008 52.7% 54.6% 74.4%

b. Females aged 21 to 24 years 2008 59.4% 62.3% 80.0%

4 Increase the proportion of sexually active females aged 24 years and 

under enrolled in commercial health insurance plans who are screened for 

genital Chlamydia infections during the measurement year

a. Females aged 16 to 20 years 2008 40.1% 40.8% 65.9%

b. Females aged 21 to 24 years 2008 43.5% 45.7% 78.3%

5 Reduce the proportion of females aged 15 to 44 who have ever required 

treatment for pelvic inflammatory disease (PID)

2006-2008 3.99% N/A 3.59%

6 Reduce gonorrhea rates

a. Females aged 15 to 44 years 2008 284.0 258.7 257.0

b. Males aged 15 to 44 years 2008 219.4 205.4 198.0

7 Reduce sustained domestic transmission of primary and secondary 

syphilis 

a. Among females 2008 1.5 1.1 1.4

b. Among males 2008 7.6 7.9 6.8

8 Reduce congenital syphilis 2008 10.1 8.7 9.1

9 Reduce the proportion of females with human papillomavirus (HPV) 

infection (DEVELOPMENTAL)

a. Females with types 6 and 11 N/A N/A N/A

b. Females with types 16 and 18 N/A N/A N/A

c. Females with other types N/A N/A N/A

10 Reduce the proportion of young adults with genital herpes infection due 

to herpes simplex type 2

2005-2008 10.5% N/A 9.5%

HP2020 

Objective Data Source

1 a STD Surveillance System (STDSS), NCHHSTP, CDC

1 b., c National Job Training Program, STD Surveillance System (STDSS), NCHHSTP, CDC

2 STD Surveillance System (STDSS), NCHHSTP, CDC

3 a., b Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)

4 a., b Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA)

5 National Survey of Family Growth (NSFG), NCHS, CDC

6 a., b STD Surveillance System (STDSS), NCHHSTP, CDC

7 a., b STD Surveillance System (STDSS), NCHHSTP, CDC

8 STD Surveillance System (STDSS), NCHHSTP, CDC

9 a., b NHANES, CDC, NCHS and the National Health Interview Survey (NHIS), CDC

9 c NHANES, CDC, NCHS

10 NHANES, CDC, NCHS
STD Surveillance 2010 Appendix: GPRA Goals 145

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

Goals and Measures

GPRA Goals

Actual Performance Long-term Goal

2008 2009 2010 2011

Goal 1: Reduction in PID (as measured by initial visits to 

physicians in women 15–44-years of age) 104,000 100,000 113,000 89,000

a. Prevalence of chlamydia in women <25 years at high-risk* 12.8% 11.3% 11.4% 11.7%

b. Incidence of gonorrhea/100, 000 population in women 15–44 

years of age 285 255 259 288

Goal 2: Elimination of Syphilis (as measured by incidence of 

P&S Syphilis/100,000 population) 4.5 4.6 4.5 6.0

a. Incidence of P&S syphilis/100, 000 population, men 7.6 7.8 7.9 10.2

b. Incidence of P&S syphilis/100, 000 population, women 1.5 1.4 1.1 2.1

c. Incidence of congenital syphilis/100, 000 live births 10.4 10.0 8.7 17.7

d. Black:white rate ratio of P&S syphilis 8.1:1 9.0:1 8.0:1 9.5:1

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

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.

GPRA= Government Performance and Results Act; PID= pelvic inflammatory disease; P&S= primary and secondary.
146 Appendix: STD Surveillance Case Definitions STD Surveillance 2010

STD Surveillance Case Definitions

PART 1. CASE DEFINITIONS1 FOR NATIONALLY NOTIFIABLE 

INFECTIOUS DISEASES

Chancroid (Revised 9/96)

Clinical description

A sexually transmitted disease characterized by painful genital ulceration and inflammatory inguinal 

adenopathy. The disease is caused by infection with Haemophilus ducreyi.

Laboratory criteria for diagnosis

•	 Isolation of H. ducreyi from a clinical specimen

Case classification

Probable: a clinically compatible case with both a) no evidence of Treponema pallidum infection by darkfield 

microscopic examination of ulcer exudate or by a serologic test for syphilis performed ≥7 days after onset of 

ulcers and b) either a clinical presentation of the ulcer(s) not typical of disease caused by herpes simplex virus 

(HSV) or a culture negative for HSV.

Confirmed: a clinically compatible case that is laboratory confirmed

Chlamydia trachomatis, Infection (Revised 6/09)

Clinical description

Infection with Chlamydia trachomatis may result in urethritis, epididymitis, cervicitis, acute salpingitis, or 

other syndromes when sexually transmitted; however, the infection is often asymptomatic in women. Perinatal 

infections may result in inclusion conjunctivitis and pneumonia in newborns. Other syndromes caused by C. 

trachomatis include lymphogranuloma venereum (see Lymphogranuloma Venereum) and trachoma.

Laboratory criteria for diagnosis

•	 Isolation of C. trachomatis by culture or

•	 Demonstration of C. trachomatis in a clinical specimen by detection of antigen or nucleic acid

Case classification

Confirmed: a case that is laboratory confirmed

Gonorrhea (Revised 9/96)

Clinical description

A sexually transmitted infection commonly manifested by urethritis, cervicitis, or salpingitis. Infection may be 

asymptomatic.

1 Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance, 1997. MMWR 

Morb Mortal Wkly Rep. 1997;46(No. RR-10).
STD Surveillance 2010 Appendix: STD Surveillance Case Definitions 147

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
148 Appendix: STD Surveillance Case Definitions STD Surveillance 2010

Syphilis, latent

Clinical description

A stage of infection caused by T. pallidum in which organisms persist in the body of the infected person 

without causing symptoms or signs. Latent syphilis is subdivided into early, late, and unknown categories 

based on the duration of infection.

Case classification

Probable: no clinical signs or symptoms of syphilis and the presence of one of the following:

•	 No past diagnosis of syphilis, a reactive nontreponemal test (i.e., VDRL or RPR), and a reactive 

treponemal test (i.e., FTA-ABS or MHA-TP)

•	 A past history of syphilis therapy and a current nontreponemal test titer demonstrating fourfold or greater 

increase from the last nontreponemal test titer

Syphilis, early latent

Clinical description

A subcategory of latent syphilis. When initial infection has occurred within the previous 12 months, latent 

syphilis is classified as early latent.

Case classification

Probable: latent syphilis (see Syphilis, latent) in a person who has evidence of having acquired the infection 

within the previous 12 months based on one or more of the following criteria:

•	 Documented seroconversion or fourfold or greater increase in titer of a nontreponemal test during the 

previous 12 months

•	 A history of symptoms consistent with primary or secondary syphilis during the previous 12 months

•	 A history of sexual exposure to a partner who had confirmed or probable primary or secondary syphilis or 

probable early latent syphilis (documented independently as duration <1 year)

•	 Reactive nontreponemal and treponemal tests from a person whose only possible exposure occurred 

within the preceding 12 months

Syphilis, late latent

Clinical description

A subcategory of latent syphilis. When initial infection has occurred >1 year previously, latent syphilis is 

classified as late latent.

Case classification

Probable: latent syphilis (see Syphilis, latent) in a patient who has no evidence of having acquired the disease 

within the preceding 12 months (see Syphilis, early latent) and whose age and titer do not meet the criteria 

specified for latent syphilis of unknown duration.

Syphilis, latent, of unknown duration

Clinical description

A subcategory of latent syphilis. When the date of initial infection cannot be established as having occurred 

within the previous year and the patient’s age and titer meet criteria described below, latent syphilis is classified 

as latent syphilis of unknown duration.

Case classification

Probable: latent syphilis (see Syphilis, latent) that does not meet the criteria for early latent syphilis, and the 

patient is aged 13–35 years and has a nontreponemal titer ≥32
STD Surveillance 2010 Appendix: STD Surveillance Case Definitions 149

Neurosyphilis

Note

Since neurosyphilis can occur at almost any stage of syphilis, between 1996 and 2005, it was classified and 

reported as one of several mutually exclusive stages of syphilis. In 2005, the Division of STD Prevention 

requested that STD control programs discontinue classifying and reporting neurosyphilis as a distinct stage of 

syphilis. Since 2005, if the patient has confirmed or probable neurosyphilis, the case should be reported as the 

appropriate state of syphilis and neurological manifestations should be noted.

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.
150 Appendix: STD Surveillance Case Definitions STD Surveillance 2010

Syphilitic Stillbirth

Clinical description

A fetal death that occurs after a 20-week gestation or in which the fetus weighs >500 g and the mother had 

untreated or inadequately treated* syphilis at delivery

Comment

For reporting purposes, syphilitic stillbirths should be reported as cases of congenital syphilis.

Syphilis, Congenital (Revised 9/96)

Clinical description

A condition caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists, and 

only severe cases are clinically apparent at birth. An infant or child (aged <2 years) may have signs such as 

hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice (nonviral hepatitis), pseudoparalysis, anemia, or 

edema (nephrotic syndrome and/or malnutrition). An older child may have stigmata (e.g., interstitial keratitis, 

nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, 

rhagades, or Clutton joints).

Laboratory criteria for diagnosis

•	 Demonstration of T. pallidum by darkfield microscopy, fluorescent antibody, or other specific stains in 

specimens from lesions, placenta, umbilical cord, or autopsy material

Case classification

Probable: a condition affecting an infant whose mother had untreated or inadequately treated* syphilis at 

delivery, regardless of signs in the infant, or an infant or child who has a reactive treponemal test for syphilis 

and any one of the following:

•	 Any evidence of congenital syphilis on physical examination

•	 Any evidence of congenital syphilis on radiographs of long bones

•	 A reactive cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL)

•	 An elevated CSF cell count or protein (without other cause)

•	 A reactive fluorescent treponemal antibody absorbed—19S-IgM antibody test or IgM enzyme-linked 

immunosorbent assay

Confirmed: a case that is laboratory confirmed

Comment

Congenital and acquired syphilis may be difficult to distinguish when a child is seropositive after infancy. Signs 

of congenital syphilis may not be obvious, and stigmata may not yet have developed. Abnormal values for 

CSF VDRL, cell count, and protein, as well as IgM antibodies, may be found in either congenital or acquired 

syphilis. Findings on radiographs of long bones may help because radiographic changes in the metaphysis 

and epiphysis are considered classic signs of congenitally acquired syphilis. The decision may ultimately be 

based on maternal history and clinical judgment. In a young child, the possibility of sexual abuse should 

be considered as a cause of acquired rather than congenital syphilis, depending on the clinical picture. For 

reporting purposes, congenital syphilis includes cases of congenitally acquired syphilis among infants and 

children as well as syphilitic stillbirths. 

* Inadequate treatment consists of any nonpenicillin therapy or penicillin administered <30 days before delivery.
STD Surveillance 2010 Appendix: STD Surveillance Case Definitions 151

PART 2. CASE DEFINITIONS1 FOR NON-NOTIFIABLE 

INFECTIOUS DISEASES

Genital Herpes (Herpes Simplex Virus) (Revised 9/96)

Clinical description

A condition characterized by visible, painful genital or anal lesions

Laboratory criteria for diagnosis

•	 Isolation of herpes simplex virus from cervix, urethra, or anogenital lesion, or

•	 Demonstration of virus by antigen detection technique in clinical specimens from cervix, urethra, or 

anogenital lesion, or

•	 Demonstration of multinucleated giant cells on a Tzanck smear of scrapings from an anogenital lesion

Case classification

Probable: a clinically compatible case (in which primary and secondary syphilis have been excluded by 

appropriate serologic tests and darkfield microscopy, when available) with either a diagnosis of genital herpes 

based on clinical presentation (without laboratory confirmation) or a history of one or more previous episodes 

of similar genital lesions

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Genital herpes should be reported only once per patient. The first diagnosis for a patient with no previous 

diagnosis should be reported.

Genital Warts (Revised 9/96)

Clinical description

An infection characterized by the presence of visible, exophytic (raised) growths on the internal or external 

genitalia, perineum, or perianal region

Laboratory criteria for diagnosis

•	 Histopathologic changes characteristic of human papillomavirus infection in specimens obtained by 

biopsy or exfoliative cytology or

•	 Demonstration of virus by antigen or nucleic acid detection in a lesion biopsy

Case classification

Probable: a clinically compatible case without histopathologic diagnosis and without microscopic or serologic 

evidence that the growth is the result of secondary syphilis

Confirmed: a clinically compatible case that is laboratory confirmed

Comment

Genital warts should be reported only once per patient. The first diagnosis for a patient with no previous 

diagnosis should be reported.

1 Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance, 1997. MMWR 

Morb Mortal Wkly Rep. 1997;46(No. RR-10).
152 Appendix: STD Surveillance Case Definitions STD Surveillance 2010

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
STD Surveillance 2010 Appendix: STD Surveillance Case Definitions 153

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
154 Appendix: STD Surveillance Case Definitions STD Surveillance 2010

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.
STD Surveillance 2010 Appendix: Contributors 155

Contributors

We gratefully acknowledge the contributions of state STD project directors, STD program managers, state and territorial 

epidemiologists, and laboratory directors. The persons listed were in the positions shown as of September 8, 2011.

State/City/Outlying Area STD Project Directors STD Program Managers State Epidemiologists Laboratory Directors

Alabama Vacant Jane Cheeks Kelly Stevens Sharon Massingale

Alaska Susan Jones Donna Cecere Joe McLaughlin Bernard Jilly

Arizona Judy Norton Roxanne Ereth Kenneth Komatsu Victor Waddell

Arkansas Tina Long Mark Morehead Nathaniel Smith Glen Baker

California Jacqueline Mincks Romni Neiman Gilberto Chavez Paul Kimsey

Los Angeles Peter Kerndt Yolanda Cavalier Gilberto Chavez Mary Beth Duke (Acting)

San Francisco Susan Philip Wendy Wolf Gilberto Chavez Sally Liska

Colorado Ralph Wilmoth Rebecca Jordan Ken Gershman David Butcher

Connecticut Matthew Cartter Heidi Jenkins Matthew Cartter John Fontana

Delaware Catherine Mosley Catherine Mosley Marjorie Shannon Christina Pleasanton

District of Columbia Gregory Pappas Kim Seechuk John Davies-Cole Maurice Knuckles

Florida Stacy Shiver Daniel George Richard Hopkins Max Salfinger

Georgia Anil Mangla Michelle Allen Cherie Drenzek Elizabeth Franko

Hawaii Peter Whiticar Venie Lee Sarah Park A. Christian Whelen

Idaho Kathy Cohen Annabeth Elliott Christine Hahn Christopher Ball

Illinois Richard Zimmerman Richard Zimmerman Craig Conover Tom Johnson

Chicago Chris Brown John Paffel Craig Conover Susan Gerber

Indiana Larry Harris Andrea Allen Pamela Pontones Judith Lovchik

Iowa Randy Mayer Randy Mayer Patricia Quinlisk Christopher Atchison

Kansas Brenda Walker Derek Coppedge Charles Hunt Leo Henning

Kentucky Robert Brawley Chang Lee Kraig Humbaugh Stephanie Gibson

Louisiana DeAnn Gruber Dee Cordova Raoult Ratard Stephen Martin

Maine James Markiewicz James Markiewicz Stephen Sears Kenneth Pote

Maryland Barbara Conrad Glen Oltoff David Blythe Robert Myers

Baltimore Vacant Victoria Stovall David Blythe Jack DeBoy

Massachusetts Brenda Cole Brenda Cole Alfred DeMaria Linda Han)

Michigan Kristine Judd Kristine Judd Corrine Miller Frances Downes

Minnesota Christine Jones Peter Carr Ruth Lynfield Joanne Bartkus

Mississippi Nicholas Mosca Vacant Paul Byers Daphne Ware

Missouri Michael Herbert Michael Herbert George Turabelidze Bill Whitmar

Montana Laurie Kops Vacant Carol Ballew Susanne Zanto

Nebraska Sandy Klocke Jeri Weberg-Bryce Thomas Safranek Steve Hinrichs

Nevada Richard Whitley Sandra Noffsinger Ishan Azzam L. Dee Brown

New Hampshire Christine Adamski Lindsay Pierce 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 Bob Reed Vacant Millicent Eidson (Acting) Lawrence Sturman

New York City Susan Blank Vacant Perry Smith Sara Beatrice

North Carolina Pete Moore Jacqueline Clymore Megan Davies Leslie Wolf

North Dakota Vacant Julie Wagendorf Kirby Kruger Myra Kosse

Ohio Bill Tiedemann Jen Keagy Mary DiOrio (Acting) Rosemarie Gearhart

Oklahoma Jan Fox Kristen Eberly Kristy Bradley Robin Botchlet

Oregon Vada Latin Doug Harger Katrina Hedberg Michael Skeels

Pennsylvania Beth Butler Steve Kowalewski Maria Moll (Acting) S.I. Shahied

Philadelphia Caroline Johnson Melinda Salmon Maria Moll (Acting) Kerry Buchs

Rhode Island Utpala Bandy Michael Gosciminski Utpala Bandy Ewa King

South Carolina Dennis Murphy Janice Tapp James Gibson Arthur Wozniak

South Dakota Vacant Amanda Gill Lon Kightlinger Michael Smith

Tennessee Jeanece Seals Lauarie Anderson Tim Jones David Smalley

Texas Ann Robbins Jim Lee Thomas Erlinger Grace Kubin

Utah Emily Holmes Lynn Meinor Robert Rolfs Barbara Jepson

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 Loretta Haddy Loretta Haddy Loretta Haddy Andrea Labik

Wisconsin Diane Christen Anthony Wade Jeffrey Davis Charles Brokopp

Wyoming Brownen Anderson Canyon Hardesty Tracy Murphy Richard Harris

American Samoa Elizabeth Ponausuia Fara Utu Sharmain Mageo Utoofili Mago

Federated States of Micronesia Vita Skilling Mayleen Ekiek Vita Skilling

Government of the Marshall Islands Richard Trinidad Justina Langidrik Paul Lalita

Northern Marianas (CNMI) Joseph Villagomz John Dax Moreno James Hosfschneider Kevin Villagomez

Guam Josie O’Mallan Bernadette Schumann Josephine O’Mallan 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

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